Thank you for your interest in the FACTS training! To help improve the training as well as inform future trainings, please complete the survey below.
Today M-D-Y
What is your participant ID? First letter of your first name: Last letter of your last name: Day you were born ( must be 2 digits): Example: Emily Smit h DOB 12/ 08/1985 Code: EH08
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Did you complete the FACTS training?
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Yes
No
Please describe how easy/accessible it was for you to complete this training.
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Please describe factors that stopped you from completing the FACTS training.
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What was most valuable to you from the FACTS program?
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How did you view the FACTS training?
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Phone
Tablet
Computer (Desktop or Laptop)
Other- please describe
Describe how you viewed the training
The next set of questions ask you to evaluate your experience with the Communication Skills training.
The online, self-paced format was easy to navigate.
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Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
The online, self-paced content was engaging.
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Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
The online, self-paced content was an effective way to learn communication strategies.
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Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
The example scenarios helped me understand the different communication strategies.
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Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
I would recommend this training to others.
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Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Please provide any other feedback about the FACTS program here.
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We would like to know about your knowledge and experience with the Center for Behavioral Health and Learning and inpatient psychiatric services in general.
I am currently involved in my loved one's mental health care.
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Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
I am aware of strategies to help me support my loved one's mental health care.
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Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
I use strategies to help support my loved one's mental health care.
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Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
The next set of questions ask you to rate your confidence on approaches to difficult conversations with a family member or loved one:
I am confident in my ability to create a positive 
environment for having a difficult conversation
with my family member or loved one.
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Strongly Agree
Agree
Neither agree nor disagree
Disagree
Strongly Disagree
I am confident in my ability to ask open-ended questions to communicate with my family member or loved one.
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Strongly Agree
Agree
Neither agree nor disagree
Disagree
Strongly Disagree
I am confident in my ability to use active listening 
in my conversation with my family member or loved one.
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Strongly Agree
Agree
Neither agree nor disagree
Disagree
Strongly Disagree
I am confident in my ability to effectively make requests 
and share concerns with my family member or loved one.
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Strongly Agree
Agree
Neither agree nor disagree
Disagree
Strongly Disagree
The next set of questions asks you to think about how you would approach a difficult conversation with a loved one.
You are about to have a difficult conversation with a loved one. Which of the following actions are most likely to create a positive environment for successful communication?
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Turn on the TV to provide background noise.
Start the conversation as you are getting ready to leave for work.
Start the communication when you are already upset.
Take some deep breaths to focus on goals for conversation.
You are talking to your loved one about how their current depression symptoms are impacting the rest of the family. You plan to ask open-ended questions to understand more about their perspective on current mood symptoms. Which of the following statements best represents an open-ended question?
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Is it the dark thoughts again?
Can you tell me more about how you are feeling?
Is it depression again?
Are you willing to make changes in your participation in the family?
You are working hard to engage in active listening in a conversation with your loved one about psychotic symptoms they are experiencing. Reflections are one part of active listening. Which of the following statements best represents a reflection?
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It sounds like you are trying really hard not to listen to the scary voices.
You seem to be feeling scared when you hear the voices.
I noticed your voice sounds shaky when you talk about hearing scary voices.
All of the above.
You need your loved one to help more with chores around the house. You are trying to be more effective in making requests for help. Which of the following statements would be most likely to be successful in supporting this goal?
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Can you please do more laundry, dishes and vacuuming?
Can you please take the garbage out each night?
I'm tired of doing everything around here!
Can you please do more to help with the house?
The questions below reflect how people sometimes feel when they are taking care of a loved one. After each statement, choose the response that best describes how often you feel that way. There are no right or wrong answers.
DO YOU FEEL that because of the time you spend with your relative that you don't have enough time for yourself?
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Never
Rarely
Sometimes
Quite frequently
Nearly always
DO YOU FEEL stressed caring for your loved one and trying to meet other responsibilities such as your job or caring for other family member(s)?
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Never
Rarely
Sometimes
Quite frequently
Nearly always
DO YOU FEEL strained when you are around your loved one?
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Never
Rarely
Sometimes
Quite frequently
Nearly always
DO YOU FEEL uncertain about what to do about your loved one and their care needs?
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Never
Rarely
Sometimes
Quite frequently
Nearly always
Which of the following are barriers to you being involved in your loved one's mental health care? (Select all that apply).
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We are hoping to interview some family/caregivers about their experience with the Communication Skills training. Are you willing to be contacted to be invited for an interview?
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Yes
No
What is the best way to reach you to set up an interview?
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Email
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Phone
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(555)-555-5555
Other (please describe below)
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