1 Start 2 Complete

Section One: My Role as a Site Champion

I understand my role as a site champion. *

Yes

No

I understand how to complete medication audits and 6-month snap shot reports and distribute client surveys. *

Yes

No

I am comfortable accessing Parkinson’s Foundation resources. *

Yes

No

I understand and use the Member Portal to support my role as site champion. *

Yes

No

This program has improved the care I provide to people with Parkinson’s. *

Yes

No

Program outcomes are shared regularly with senior management and teammates at my site. *

Yes

No

Our site uses TULIPS visual reminders designed for this program. *

Yes

No

Section 2: Improvements In Parkinson’s Care At My Site

Please rate the following changes your site has made as a result of training using The TULIPS Approach ™ received in the Community Partners in Parkinson’s Care program. *

	Always	Usually	Sometimes	Never
Staff are more patient and provide time when working with clients with Parkinson’s.	Staff are more patient and provide time when working with clients with Parkinson’s. - Always	Staff are more patient and provide time when working with clients with Parkinson’s. - Usually	Staff are more patient and provide time when working with clients with Parkinson’s. - Sometimes	Staff are more patient and provide time when working with clients with Parkinson’s. - Never
Staff understand that people with Parkinson’s may move differently at different times of the day.	Staff understand that people with Parkinson’s may move differently at different times of the day. - Always	Staff understand that people with Parkinson’s may move differently at different times of the day. - Usually	Staff understand that people with Parkinson’s may move differently at different times of the day. - Sometimes	Staff understand that people with Parkinson’s may move differently at different times of the day. - Never
Exercise is incorporated into the care plan for clients with Parkinson’s.	Exercise is incorporated into the care plan for clients with Parkinson’s. - Always	Exercise is incorporated into the care plan for clients with Parkinson’s. - Usually	Exercise is incorporated into the care plan for clients with Parkinson’s. - Sometimes	Exercise is incorporated into the care plan for clients with Parkinson’s. - Never
Care plans address both motor and non-motor problems seen in clients with Parkinson’s.	Care plans address both motor and non-motor problems seen in clients with Parkinson’s. - Always	Care plans address both motor and non-motor problems seen in clients with Parkinson’s. - Usually	Care plans address both motor and non-motor problems seen in clients with Parkinson’s. - Sometimes	Care plans address both motor and non-motor problems seen in clients with Parkinson’s. - Never
Changes have been made to improve Parkinson’s medication accuracy and timeliness.	Changes have been made to improve Parkinson’s medication accuracy and timeliness. - Always	Changes have been made to improve Parkinson’s medication accuracy and timeliness. - Usually	Changes have been made to improve Parkinson’s medication accuracy and timeliness. - Sometimes	Changes have been made to improve Parkinson’s medication accuracy and timeliness. - Never
Staff demonstrate awareness of effective communication strategies for clients with Parkinson’s.	Staff demonstrate awareness of effective communication strategies for clients with Parkinson’s. - Always	Staff demonstrate awareness of effective communication strategies for clients with Parkinson’s. - Usually	Staff demonstrate awareness of effective communication strategies for clients with Parkinson’s. - Sometimes	Staff demonstrate awareness of effective communication strategies for clients with Parkinson’s. - Never

I have observed staff using cueing strategies they learned in this training program. *

Yes

No

I feel there are more appropriate referrals to the interprofessional team as a result of this training. *

Yes

No

Section 3: Ongoing Success

What Challenge Most Affects Ongoing Success of the Community Partners program at your site? *

Select One

Lack of time for site champion responsibilities

Limited staffing capacity/time for training

Interprofessional healthcare relationships

Organization/institution policy

Other...

What Challenge Most Affects Ongoing Success of the Community Partners program at your site? Other...

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