Instructions: Module 3 - TheMeasurementGroup.com

Citation: Huba, G. J., Melchior, L. A., Staff of The Measurement Group, and HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1995). Module 3: Presentation-Training Form. Available: www.TheMeasurementGroup.com. Culver City, California: The Measurement Group.

Answer questions by either filling in a circle, or writing a number or letter in a square box. If the answer goes in a square box, you must use a CAPITAL LETTER or number that does not touch the side of the box. Print only one letter or number in each box. If the letters or numbers that you print touch the sides of the boxes, or if you do not clearly print the information, the computer will "kick out" the form and we will need to return it to you to be completed correctly. If the question asks the answer to be filled in a circle, make sure that the circle is completely darkened. Only darken one circle for each question unless the instructions specifically tell you to darken as many as apply for that question.

Site. This is a code to identify your project in the cross-cutting evaluation. It should be pre-printed on the form. If it has not been already entered on the form, check with your project to find out your site code and enter it in the boxes. Site codes are 3 letters.

Sub-Provider. If appropriate, enter the code for the service provider agency doing the activity. The provider codes are determined by your local project. Provider codes can be up to 3 letters.

Training #. Enter the three-digit code for the training session. For example, if this is the third training or presentation that your project has held, you would enter "003" in these boxes.

Training Date. Enter the numbers representing the date of the training or presentation in these boxes. Enter the month as a number from 01 to 12 for January through December. Enter the day as a two-digit number (01 to 31). Enter the last two digits of the current year (for example, "95" for 1995). Make sure that if a month or day is less than 10, you place a "0" before the number.

Hour. Enter the starting time of the presentation as a two-digit number. Round to the nearest hour. For example, if the start time is between 10:31am and 11:30 am you would enter "11" in the boxes and darken the circle labeled "am."

Length Minutes. Enter the length of time of the training as a three-digit number. For example, if the length of time of the training is 90 minutes, you would enter "090."

Staff Providing Services. Enter the staff member code or codes for each of the staff providing services. The staff codes are determined by your local project. Staff codes are 3 numbers. If the staff code is less than 3 digits, place "0"s before the number. For example, 3 is "003."

Areas of Planned Impact. Indicate the areas of planned impact by darkening one or more of the circles. For example, if the purpose of the training was to increase participant knowledge about the HIV virus, then you would darken the circle labeled "Knowledge Change."

Areas of Planned Impact	Working Definition
Attitude Change	Change in values or beliefs regarding HIV or AIDS
Skills / Behavior Change	Change in type, level, or extent of skills or behaviors regarding HIV or AIDS
Knowledge Change	Change in type, level, or extent of knowledge regarding HIV or AIDS

Language Used. Indicate the language used for the training by darkening the appropriate circle. For example, if both English and Spanish were spoken during the training, you would darken the circle labeled "Both E & S."

It is best to fill out the rest of this form in the order of: Part I (A to H), Part II, Part III, Part IV (A and B), Part V (A and B), Part VI.

I. DISCUSSION-EDUCATION-TRAINING TOPICS. Indicate which topics were presented during the training by darkening the appropriate circle(s). You may darken more than one. Use the boxes labeled "Other" (in part H) to indicate topics not listed on the form. You can write in up to three "Other" topics.

*A. Medical Intervention and Management-Diagnosis Treatment*
Training Topics	Working definition
076 Protocol	Includes issues related to the administration of ZDV to pregnant women and their newborn infants following a specific clinical protocol.
AIDS 101/Update	Includes basic information about HIV disease and AIDS, updates on statistics, recent research, and the latest developments in the field.
Clinical manifestations of HIV disease	Includes bio-psycho-social symptoms associated with HIV disease and AIDS.
Clinical trials	Includes training on the function and use of clinical trials related to HIV.
Early intervention and management of HIV infection	Includes issues related to the early stages of HIV disease, focused on bio-psycho-social interventions that can be made in this stage.
Epidemiology	Includes training focused on trends in HIV disease among populations.
Health promotion	Includes topics focused on prevention, wellness, and delaying the course of HIV symptoms.
Immunology/virology	Specific medical training on the effects of HIV on the immune system
Long-term care	Includes issues related to long-term bio-psycho-social interventions for HIV disease.
Neuropsychiatric manifestations	Includes topics related to the diagnosis and treatment of neuropsychological and neuropsychiatric symptoms of HIV disease.
Oral manifestations of HIV	Includes training on symptoms of HIV that occur orally.
Pre- and post-test HIV counseling	Includes training on issues related to providing individual counseling before and after individuals receive an HIV antibody test.
Pregnancy	Includes discussion of prenatal and postnatal care for pregnant women, general health issues for women, medical complications associated with pregnancy, and HIV-related pregnancy risks such as transmission of HIV to the fetus.
Treatment (drug intervention, opportunistic infections, etc.)	Includes topics related to drug intervention, opportunistic infections/tumors, and alternative therapies. Considers "treatment" as broadly defined.
Tuberculosis	Includes training on issues related to tuberculosis risk and manifestations among HIV-infected individuals.

*B. Psychosocial Issues-Case Management*
Training Topics	Working definition
Care for caregivers	Includes topics related to helping caregivers; focus may include issues of burn-out, grief, loss, etc.
Case management	A range of client-centered services that links clients and other family members with health care, psychosocial and other services to insure timely, coordinated access to medically appropriate levels of health and support services and ongoing assessment of the client’s and other family members’ needs and personal support systems. Key activities include: (1) initial comprehensive, individualized service plan, (2) development of continuity of care, (3) coordination of services required to implement the plan and client monitoring to assess the efficacy of the plan, and (4) periodic re-evaluation and adaptation of the plan as necessary over the life of the client. May include client-specific advocacy and/or review of utilization of services.
Coordination of care/advocacy issues	Includes active oversight of client services and personally advocating for client rights to receive services.
Crisis intervention	Includes topics related to providing bio-psycho-social interventions for short-term crisis situations (as opposed to more long-term therapy or counseling).
Early intervention and management	Includes issues related to the early stages of HIV disease, focused on bio-psycho-social interventions that can be made in this stage.
Psychosocial issues	Includes topics related to the individual and his or her relationships with others. May include issues of coping, relationships with family and friends, etc.
Risk assessment and sexual history taking	Includes training on conducting assessment of individual risk for HIV infection and how to obtain information about an individual’s sexual behaviors.
Social/psychological services	Includes discussion of counseling and social services for individuals with HIV and their families.
Substance abuse	Includes topics related to active and/or recovering substance abuse (including alcohol, other drug, and injection drug use).
Violence and victimization	Includes topics related to violence and abuse (physical, emotional, sexual) as they relate to HIV disease.
*C. Special Populations*
Training Topics	Working definition
Adolescent/youth	Includes topics related to HIV among youth aged 12-24 years.
Gay/lesbian issues	Includes topics related to HIV among gay and lesbian individuals.
HIV sensitivity	Includes topics related to helping individuals, groups, families, communities, etc. become more sensitive in dealing with issues related to HIV.
Immigrants/refugees	Includes topics related to HIV among recent immigrants and refugees.
Incarcerated	Includes topics related to those who are in jail, in prison, or otherwise incarcerated.
Pediatric	Includes topics related to HIV among children aged 0-11 years.
Racial and ethnic minority issues/cultural factors	Includes topics related to HIV among members of racial and ethnic minority groups.
Substance abusers	Includes topics related to HIV among active and recovering substance abusers (including alcohol, other drug, and injection drug users).
Women	Includes topics related to HIV among women (with and without children).
Women and reproductive health	Includes topics related specifically to women’s health, including OB/GYN care and family planning.

*D. Prevention of HIV Transmission*
Training Topics	Working definition
Pediatric risk issues	Includes topics related to HIV transmission to children, including pre- and peri-natally.
Reproductive health issues	Includes topics related to reproductive health for women and men.
Sexual activity issues	Includes topics related to HIV risk via sexual transmission; includes issues of "safer sex," multiple partners, etc.
Substance abuse issues	Includes topics related to HIV risk via substance abuse; includes injection drug use, needle sharing, risky behaviors performed while under the influence of alcohol or other drugs, etc.
*E. Workplace Issues*
Training Topics	Working definition
Dealing with co-workers’ fears	Includes topics related to misinformation in the workplace (e.g., casual contact), dealing with the fears of co-workers of HIV infected individuals.
Dealing with health workers’ fears	Includes topics related to the fears of health care workers who worry about exposure to HIV in their work.
Employer policy development	Includes discussions of how to help employers to develop policies for the workplace regarding HIV.
Health insurance issues	Includes topics related to health insurance for individuals with HIV disease.
Infection control	Includes issues of how to reduce the spread of HIV infection or to avoid inadvertent infection.
Technical assistance to employers/org. issues	Indicates that technical assistance was provided in this session to employers about organizational issues concerning HIV.
*F. Legal Advocacy-Ethical Issues-Community-Empowerment*
Training Topics	Working definition
Community AIDS response	Includes topics related to helping communities become more active in the fight against HIV disease.
Confidentiality	Includes topics related to confidentiality of information about HIV at the client-patient and agency level.
Consent	Includes topics related to consent; may affect release of information, services, evaluation, data collection, etc.
Empowerment	Includes topics related to empowerment of individuals, groups, families, communities, etc. as it relates to HIV.
Ethical/legal issues	Includes discussion of ethical and legal issues concerning HIV; may include issues of discrimination, client rights, etc.
*G. Personal-Interpersonal Issues*
Training Topics	Working definition
Barriers to education	Includes topics related to the barriers to education experienced by individuals who are seeking training in HIV related issues.
Family/caregiver issues	Includes discussion of issues faced by families and caregivers of HIV infected individuals.
Grief and loss	Includes topics related to coping with the grief and loss associated with disease, illness, and/or death.

H. Other. If you provided training on a topic or topics not listed above, write these topics in the boxes.

II. Settings. Indicate the type of setting(s) by darkening one or more of the circles. Use the boxes labeled "Other" to indicate a setting not listed here.

Settings	Working Definition
Community (hotel, conference site)	Settings that are in the community, such as conference sites or hotels where trainings take place.
Community Based Organization	Settings that are decentralized and community-based that usually provide client-centered services.
Criminal Justice	Settings that are related to or are part of the criminal justice system, such as jails, prisons, offices of probation or parole officers, or courts.
Health Care	Settings that are related to or are part of the health care system, such as clinics or hospitals. Note that physician office is coded elsewhere.
Physician Office	Office of a physician in private practice that is not within a clinic or hospital.
Religious	Settings of worship or other religious activities, such as churches, congregations, synagogues, or temples.
School / Educational	Settings for teaching and learning, such as a schools, colleges, or universities.
Social Service Agency	An agency that provides social services such as case management or public assistance.
Workplace	Settings in which people work.
Other	Other settings not coded elsewhere.

III. Purpose of Activity. Indicate the purpose of the training by darkening one or more of the appropriate circle(s). Use the boxes labeled "Other" to write in a purpose not listed on the form.

Purpose of Activity	Working Definition
Agency Outreach	To increase agencies’ awareness of services and to reach agencies that may desire or need knowledge, training, or services. To expand service network and establish referral linkages.
Client Advocacy	To advocate on behalf of the client or assistance to the client to gain medical or social services, benefits, entitlements, etc. Target of advocacy is likely to include service providers.
Community Outreach	To increase awareness within communities of services and to identify and reach persons who may desire or need knowledge, training, or services.
Education Update	To provide the latest, up-to-date information or knowledge on a topic.
Family Education / Support	To provide education, information, or support to family members of clients.
Fund-Raising	To procure or elicit monetary support, resources, or other funds, or to engage in activities that lead to increasing the resource base.
Group Prevention	To prevent health or psychosocial problems and to promote wellness within groups of people rather than at the individual level.
Health Fair	To increase knowledge and access to health care in an open, public forum.
Policy Advocacy	To advocate for specific policy impacting a group of people or constituents. Target of advocacy may include administrators, elected officials, planning councils, and advisory boards.
Recruit Volunteers	To increase the pool of volunteers for an agency or program.
Teaching Methods and Skills	To increase knowledge and provide information on specific methods and skills; to ‘"train the trainers".
Other	Other purposes of activity not coded elsewhere

IV. Participants. Indicate the types of participants by darkening one or more of the circles provided. There are two sections: "A. Primary Caregivers" on the left and "B. Other Participant Groups" on the right. Use the boxes labeled "Other" to indicate a type of participant not listed on the form.

A. Primary Caregivers	Working Definitions
Mental Health Providers	Providers of mental health care, treatment, or services, such as psychiatrists, psychologists, counselors, and clinical social workers.
Primary Health Care Providers (Medical/Dental)	Providers of medical or dental services focusing on the prevention of illness and the ongoing management of chronic conditions and acute health problems.
Social Service Providers	Providers of social services, such as health educators, case managers, caseworkers, health education trainers, vocational training providers, and housing specialists.
Substance Abuse Treatment Providers	Providers of substance abuse treatment, care, or services.
Support Health Care Personnel	Providers of support health care, such as nurses, nurse practitioners, physician assistants, dental hygienists, and health technicians.
Other	Other primary caregivers not coded elsewhere.

B. Other Participant Groups	Working Definition
Advocates (including attorneys)	Providers that advocate on behalf of the client or give assistance to the client to gain medical or social services, benefits, entitlements, etc.
Case Managers / Case Coordinates	Providers of a range of client-centered services that link clients and other family members with health care, psychosocial services, and other services to ensure timely, coordinated access to appropriate services.
CJS Workers	Persons that work in the criminal justice system, such as probation and parole officers.
Community Services Providers	Providers of social services in the community, such as administrators of recreational and outreach programs.
Counselors	Providers of mental health or psychosocial care or services.
Employers	Persons who provide employment or jobs for client or client groups.
Family Members	Family members or relatives of client or client groups.
Grass Roots Organizations	Community organizations composed of persons interested in effecting social change, such as ACT-UP.
Peer Advocates	Non-professional activists that advocate on behalf of their peers.
Planning / Policy Makers	Persons who are involved with policy or planning, such as city planners, politicians or representatives of politicians, and other policy making groups.
Religious leaders	Persons who are in leadership positions in churches or other religious organizations, such as priests, pastors, and rabbis.
Service Recipients / Consumers / PWAs	Clients or recipients of services, such as persons with AIDS.
Teacher / Educational Leaders / Academics	Teachers of any level of students, or administrators of schools, school systems, or educational programs.
Young Adults: 19-25 years old	Persons who are 19 to 25 years old.
Youth: 12-18 years old	Persons who are 12 to 18 years old.
Other	Other participant groups not coded elsewhere.

V. INDIVIDUALS SERVED, CONTACTED, OR REACHED

A. Number of Males. Write the number of males participating in this activity. If you do not have an actual count, provide an estimate. If the number is less than 100, place "0"s to the left of the number. For example, if 78 men attended the training, you would enter "078."

% aged 12 & under. Enter the percentage of males aged 12 years and younger. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% aged 13-19. Enter the percentage of males aged 13-19 years. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% aged 20+. Enter the percentage of males aged 20 years and older. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

The total of the three age categories should add to 100%.

% African Am-Black. Enter the percentage of African American males. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Caucasian-White. Enter the percentage of Caucasian males. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Native Am-Am Indian. Enter the percentage of Native American males. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Asian Am-Pac Island. Enter the percentage of Asian American males. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Hispanic-Latino. Enter the percentage of Hispanic or Latino males. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Other-Multiracial. Enter the percentage of males with other ethnic/racial backgrounds. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

The total of the six race/ethnicity categories should add to 100%.

B. Number of Females. Write the number of females participating in this activity. If you do not have an actual count, provide an estimate. If the number is less than 100, place "0"s to the left of the number. For example, if 78 women attended the training, you would enter "078."

% aged 12 & under. Enter the percentage of females aged 12 years or younger. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% aged 13-19. Enter the percentage of females aged 13-19 years. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% aged 20+. Enter the percentage of females aged 20 years and older. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

The total of the three age categories should add to 100%.

% African Am-Black. Enter the percentage of African American females. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Caucasian-White. Enter the percentage of Caucasian females. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Native Am-Am Indian. Enter the percentage of Native American females. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Asian Am-Pac Island. Enter the percentage of Asian American females. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Hispanic-Latino. Enter the percentage of Hispanic or Latino females. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Other-Multiracial. Enter the percentage of females with other ethnic/racial backgrounds. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

The total of the six race/ethnicity categories should add to 100%.

Actual %s and Counts Used. Darken this circle if the numbers you provided were actual percentages and counts. If this is not marked, it will be assumed that they are estimates.

VI. Methods. Indicate which training methods were used by darkening the appropriate circle(s). Use the boxes labeled "Other" to write in a method not listed on the form.

Methods	Working Definitions
Interactive Training	A method of providing information or instruction that involves interaction between the trainer and the trainee(s). Includes "hands-on", non-didactic presentations.
Lecture	A method of providing information or instruction characterized by one-way communication from the lecturer to the recipients. Usually considered formal and didactic.
Preceptorship / Mentoring	A method of training by a mentor or preceptor that involves intense, hands-on, one-to-one instruction or demonstration that usually takes place over a number of days or weeks.
Self-Study	A method of learning characterized by an individual taking the initiative to teach him/herself.
Telecommunications	Training achieved via voice (telephone), video, or other electronic means where trainers and trainees are not in the same location.
Other	Other methods not coded elsewhere.