Community Partners Site Champion Training Evaluation

Please indicate if the following learning objectives for this training were met. *

	Objective was not met	Objective was met
Describe and disseminate the TULIPS Curriculum℠ to your staff	Describe and disseminate the TULIPS Curriculum℠ to your staff - Objective was not met	Describe and disseminate the TULIPS Curriculum℠ to your staff - Objective was met
Identify motor and non-motor symptoms of Parkinson’s disease (PD) and their impact on mobility, mood, cognition and quality of life.	Identify motor and non-motor symptoms of Parkinson’s disease (PD) and their impact on mobility, mood, cognition and quality of life. - Objective was not met	Identify motor and non-motor symptoms of Parkinson’s disease (PD) and their impact on mobility, mood, cognition and quality of life. - Objective was met
Recognize the importance of medications on time for individuals living with Parkinson’s disease and incorporate timely medication administration into daily practice.	Recognize the importance of medications on time for individuals living with Parkinson’s disease and incorporate timely medication administration into daily practice. - Objective was not met	Recognize the importance of medications on time for individuals living with Parkinson’s disease and incorporate timely medication administration into daily practice. - Objective was met
Integrate skills to develop comprehensive care plans for clients/residents with Parkinson’s utilizing an interprofessional team approach that includes appropriate treatment/management strategies for care.	Integrate skills to develop comprehensive care plans for clients/residents with Parkinson’s utilizing an interprofessional team approach that includes appropriate treatment/management strategies for care. - Objective was not met	Integrate skills to develop comprehensive care plans for clients/residents with Parkinson’s utilizing an interprofessional team approach that includes appropriate treatment/management strategies for care. - Objective was met
Identify site champion roles and responsibilities including PD staff education, data outcome collection, partner portal usage and ongoing communication with Community Partners (CP) staff.	Identify site champion roles and responsibilities including PD staff education, data outcome collection, partner portal usage and ongoing communication with Community Partners (CP) staff. - Objective was not met	Identify site champion roles and responsibilities including PD staff education, data outcome collection, partner portal usage and ongoing communication with Community Partners (CP) staff. - Objective was met

Please rate the extent that you agree/disagree with the following: *

	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree
The content was applicable to my work	The content was applicable to my work - Strongly Disagree	The content was applicable to my work - Disagree	The content was applicable to my work - Somewhat Disagree	The content was applicable to my work - Neither Agree nor Disagree	The content was applicable to my work - Somewhat Agree	The content was applicable to my work - Agree	The content was applicable to my work - Strongly Agree
The educational design and format of this activity facilitated my learning	The educational design and format of this activity facilitated my learning - Strongly Disagree	The educational design and format of this activity facilitated my learning - Disagree	The educational design and format of this activity facilitated my learning - Somewhat Disagree	The educational design and format of this activity facilitated my learning - Neither Agree nor Disagree	The educational design and format of this activity facilitated my learning - Somewhat Agree	The educational design and format of this activity facilitated my learning - Agree	The educational design and format of this activity facilitated my learning - Strongly Agree
I have a better understanding of my role as a Site Champion	I have a better understanding of my role as a Site Champion - Strongly Disagree	I have a better understanding of my role as a Site Champion - Disagree	I have a better understanding of my role as a Site Champion - Somewhat Disagree	I have a better understanding of my role as a Site Champion - Neither Agree nor Disagree	I have a better understanding of my role as a Site Champion - Somewhat Agree	I have a better understanding of my role as a Site Champion - Agree	I have a better understanding of my role as a Site Champion - Strongly Agree
I understand how to complete Medication Audits and Snapshot Reports, and distribute Client Surveys	I understand how to complete Medication Audits and Snapshot Reports, and distribute Client Surveys - Strongly Disagree	I understand how to complete Medication Audits and Snapshot Reports, and distribute Client Surveys - Disagree	I understand how to complete Medication Audits and Snapshot Reports, and distribute Client Surveys - Somewhat Disagree	I understand how to complete Medication Audits and Snapshot Reports, and distribute Client Surveys - Neither Agree nor Disagree	I understand how to complete Medication Audits and Snapshot Reports, and distribute Client Surveys - Somewhat Agree	I understand how to complete Medication Audits and Snapshot Reports, and distribute Client Surveys - Agree	I understand how to complete Medication Audits and Snapshot Reports, and distribute Client Surveys - Strongly Agree
I am comfortable in accessing Parkinson's Foundation resources and other educational materials	I am comfortable in accessing Parkinson's Foundation resources and other educational materials - Strongly Disagree	I am comfortable in accessing Parkinson's Foundation resources and other educational materials - Disagree	I am comfortable in accessing Parkinson's Foundation resources and other educational materials - Somewhat Disagree	I am comfortable in accessing Parkinson's Foundation resources and other educational materials - Neither Agree nor Disagree	I am comfortable in accessing Parkinson's Foundation resources and other educational materials - Somewhat Agree	I am comfortable in accessing Parkinson's Foundation resources and other educational materials - Agree	I am comfortable in accessing Parkinson's Foundation resources and other educational materials - Strongly Agree
I understand how the Partner Portal will support my role as a Site Champion	I understand how the Partner Portal will support my role as a Site Champion - Strongly Disagree	I understand how the Partner Portal will support my role as a Site Champion - Disagree	I understand how the Partner Portal will support my role as a Site Champion - Somewhat Disagree	I understand how the Partner Portal will support my role as a Site Champion - Neither Agree nor Disagree	I understand how the Partner Portal will support my role as a Site Champion - Somewhat Agree	I understand how the Partner Portal will support my role as a Site Champion - Agree	I understand how the Partner Portal will support my role as a Site Champion - Strongly Agree
I will improve care I provide to people with Parkinson's because of my participation in this activity	I will improve care I provide to people with Parkinson's because of my participation in this activity - Strongly Disagree	I will improve care I provide to people with Parkinson's because of my participation in this activity - Disagree	I will improve care I provide to people with Parkinson's because of my participation in this activity - Somewhat Disagree	I will improve care I provide to people with Parkinson's because of my participation in this activity - Neither Agree nor Disagree	I will improve care I provide to people with Parkinson's because of my participation in this activity - Somewhat Agree	I will improve care I provide to people with Parkinson's because of my participation in this activity - Agree	I will improve care I provide to people with Parkinson's because of my participation in this activity - Strongly Agree
I feel comfortable sharing outcome measures with senior management at my workplace	I feel comfortable sharing outcome measures with senior management at my workplace - Strongly Disagree	I feel comfortable sharing outcome measures with senior management at my workplace - Disagree	I feel comfortable sharing outcome measures with senior management at my workplace - Somewhat Disagree	I feel comfortable sharing outcome measures with senior management at my workplace - Neither Agree nor Disagree	I feel comfortable sharing outcome measures with senior management at my workplace - Somewhat Agree	I feel comfortable sharing outcome measures with senior management at my workplace - Agree	I feel comfortable sharing outcome measures with senior management at my workplace - Strongly Agree
I will adjust the way I interact with the Interprofessional team to optimize initial and follow-up sessions with my residents or clients	I will adjust the way I interact with the Interprofessional team to optimize initial and follow-up sessions with my residents or clients - Strongly Disagree	I will adjust the way I interact with the Interprofessional team to optimize initial and follow-up sessions with my residents or clients - Disagree	I will adjust the way I interact with the Interprofessional team to optimize initial and follow-up sessions with my residents or clients - Somewhat Disagree	I will adjust the way I interact with the Interprofessional team to optimize initial and follow-up sessions with my residents or clients - Neither Agree nor Disagree	I will adjust the way I interact with the Interprofessional team to optimize initial and follow-up sessions with my residents or clients - Somewhat Agree	I will adjust the way I interact with the Interprofessional team to optimize initial and follow-up sessions with my residents or clients - Agree	I will adjust the way I interact with the Interprofessional team to optimize initial and follow-up sessions with my residents or clients - Strongly Agree

What new team-based care strategies will you employ as a result of this activity? *

Share relevant information with care team members

Improved verbal communication with my care team members

Improved hand off information to those outside my care team

Improved referral process to those outside my care team

Improved communication with my clients or residents that is consistent with messaging from other care team members.

Other

What new team-based care strategies will you employ as a result of this activity? Other

What new care strategies will you consider employing because of the site champion training? *

Involve more team members to create the care plan for residents and clients

Document and share successful cueing and care strategies with other team members

Improve communication with family caregivers

Share relevant information for medical providers regarding observed PD changes and prior to appointments

Utilize visual reminders (TULIPS images) within care plan, medication records, client rooms, etc.

Share medication audit/client survey/snapshot report outcomes with team members

Other (other strategies you will employ)

What new care strategies will you consider employing because of the site champion training? Other (other strategies you will employ)

Was the content presented during the activity fair, balanced, and free of commercial bias? Commercial bias is defined as information presented in an activity that attempts to sway participant opinion of favor of commercial product/device or to further a commercial entity's business initiatives: *

Yes (Training was free from bias)

No (Training contained commercial bias)

If no, please clarify

What future educational topics would you like the Parkinson's Foundation to cover? *

Because my workplace is a Community Partner of the Parkinson's Foundation, I believe it will: *

Positively impact the care my staff team and I provide for people with Parkinson's

Increase the number of residents or clients at my workplace

Actively engage and empower staff team to provide better Parkinson's care

Other...

Because my workplace is a Community Partner of the Parkinson's Foundation, I believe it will: Other...

Do you have any concerns regarding your role and responsibilities as a Site Champion? *

Yes

No

If so, what are they? *

If you have anything else you would like to share about your experience participating in Site Champion training, please comment here: *

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