Data Collection Is a Critical Component of Our Work and We Greatly Appreciate Your Cooperation!

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/ Stepping On Leader Step-by-Step Questionnaire Instructions /

Thank you so much for becoming a Stepping On Workshop Leader with the Faith Community Nurse Network. We know that in Leader Training you have learned a great deal about falls and group facilitation, as well as how to get your workshop organized and filled.

Data Collection is a critical component of our work and we greatly appreciate your cooperation!

The materials given to you (also available on the website), are what you’ll need for data collection and evaluation for all 2017 - 2018 Stepping On Workshops.

Review materials (If additional copies are needed please make them)

 1 gold Letter to Workshop Leaders with Script

 2 light blue Attendance Logs (used at each session)

 2 pre-labeled envelopes to return materials to FCNN

 24 white Stepping On “Participant Information” Questionnaires (administer 1st Session)

 24 mint green “Post Program” surveys (administer at 7th Session)

 24 grey “Participant Evaluation” surveys (administer at 7th Session)

 24 tan Rapid Screen Surveys to use during the home visit (or telephone call)

Prepare for initial “Participant Information” Questionnaire

 Read through the Letter with Script (gold)

 Inform participants when they register and when you confirm their attendance, that the first session may be a few minutes longer, but after that, the rest of the sessions will just be 2 hours

 Ensure that the workshop room is available for the extra time the first session

 Ensure the space has chairs and a firm surface such as a desk or table for writing

 Gather enough pens

Session 1: Distribute the “Participant Information” Questionnaires and Pens

 Introduce yourself and the white “Participant Information” Questionnaire, using the gold Script

 Pass out the white Questionnaires and pens

 Answer questions

 Ask participants to complete the Questionnaire

 Individuals who miss the first session, may complete the “Participant Information” Questionnaire BEFORE the second session, but no later

 As participants complete the survey, collect them from participants and put them in the pre-labeled envelope for safekeeping for now

Data Security

 Keep the completed Questionnaires inside the pre-labeled envelope in a secure location until after you have competed the home visits (i.e., between the 7th session and the Booster session)

Sessions 1-7: Attendance Log Collection

 List all participants on the blue Attendance Log

 Document attendance for each session on the blue Attendance Log

Session 7: Distribute the “Post Program Survey” and “Participant Evaluation”

 As you end the 7th session, pass out the mint green “Post Program Survey” and the grey “Participant Evaluation”

 Ask participants to complete the forms handed out and collect them as they are completed in the pre-labeled envelope

 Continue to keep all completed forms in the pre-labeled envelope for safekeeping

Home Visit or Call: Distribute “Rapid Screen”

 Discuss that the Department of Human Services has a “Rapid Screen” Process. Say/paraphrase:

“There are two main goals for the home visit/personal phone call portion of our program. 1) Perform a Rapid Screen to identify and to discuss general risks for you to remain independent. 2) Perform a one on one touch base about the Stepping On you recently participated in.

Pertaining to the Rapid Screen, 7 risk factors are most likely to cause older adults across America to move from home permanently to an assisted living or nursing home setting. These are risk factors that you can address.

Offering this screen is a requirement of our funding agency, the Department of Human Services. Saying that, the purpose of it is to empower you to know your risks so that you may remain within the community.

Pertaining to the home visit/phone call for Stepping On, the purpose is to see how program has gone for you, to answer your questions, and to discuss your home hazards in more detail. Do I have your permission to proceed?”

 After obtaining consent, ask the participant to complete the tan “Rapid Screen” form during the home visit. If you are performing the home visit over the phone, you may ask the participant the questions and complete the screen over the phone. If the person declines, write “participant declines” on the form.

 If the participant proceeds and scores, high or moderate risk on the screen, document what resources/follow-up you performed on the back of the form. If you performed any active coordination for the participant, use your current documentation process to also keep a record of your work.

 Follow the manual for the home visit portion of the one on one visit

 Collect the tan “Rapid Screen” forms as they are completed within the pre-labeled envelope with all other documentation saved

After Home Visits and Calls are completed

 Make copies of the light blue Attendance Log (send in original – keep copy for your records)

 Use the pre-labeled envelope to return to Faith Community Nurse Network office or bring to the next Symposium:

1. All of the completed white “Participant Information” forms

2. All of the completed mint green “Post Program” surveys and grey “Participant Evaluations” from session 7

3. The completed blue Attendance Log

5. All the tan “Rapid Screens” you completed as well as any referrals you have made due to the rapid screen.

Booster Session

 N/A. Documentation should be complete prior to the Booster Session.

THANK YOU!

Questions? Contact

Jessica Drecktrah, MHA, MN, RN, FCN

Program Director

Faith Community Nurse Network of the Greater Twin Cities

612-237-4639

This program is supported, in part, by a Live Well at Home grant from Minnesota Department of Human Services.