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Program Evaluation Rubric

Nichole Thilges

AET/570

April 24, 2017

Dr. Gregory Dlabach

Table of Contents
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Level One Evaluation Page 3

Level Two Evaluations Page 4

Level Three Evaluations Page 8

Level Four Evaluations Page 10

References Page 11

Nonviolent Crisis Intervention Certification

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Participant Evaluation Date:_________________

1. What is your overall reaction to the course?

Very Good Good Average Poor Very Poor

2. The instructor demonstrated an elevated level of knowledge of the topic.

Strongly agree Agree Neutral Disagree Strongly

disagree

3. The instructor was aware and responsive to the environment and participants.

Strongly agree Agree Neutral Disagree Strongly

disagree

4. Were the materials, hand-outs and/or activities useful?

Strongly agree Agree Neutral Disagree Strongly

disagree

5. Were the objectives clearly defined and appropriate?

Strongly agree Agree Neutral Disagree Strongly

disagree

6. Would you recommend this training to others?

Strongly agree Agree Neutral Disagree Strongly

disagree

7. The training facilities had adequate seating and lighting?

Strongly agree Agree Neutral Disagree Strongly

disagree

8. Which part(s) of this training will you share with others?

__________________________________________________________________________________________

__________________________________________________________________________________________

_________________________________________________________________________________________

_-

__________________________________________________________________________________________

Do you anticipate experiencing any barriers to implementing these new skills at your location? Please explain.
What assistance may you need?
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__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Nonviolent Crisis Intervention Certification

Pre-Test Name:________________________ Date:_____________________

1. Complete the Crisis Development Model.

Member (Patient) Behavior Staff Actions

1. 1.

2. 2.

3. 3.

4. 4.
2. Complete the Verbal Escalation Continuum.

3. Explain the three reasons for using the supportive stance.

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4. Explain how the Decision-Making Matrix is used to assess situational risks.

Pre Test Name:_________________ Date:_________________

5. List and explain each step in the COPING Model.

Member (Patient) Staff Actions

C C

O O

P P

I I

N N

G G

6. List the core values of the Nonviolent Crisis Intervention theory.

Nonviolent Crisis Intervention Certification

Post-Test Name:_________________ Date:_________________
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7. Complete the Crisis Development Model.

Member (Patient) Behavior Staff Actions

1. 1.

2. 2.

3. 3.

4. 4.
8. Complete the Verbal Escalation Continuum.

9. Explain the three reasons for using the supportive stance.

10.Explain how the Decision-Making Matrix is used to assess situational risks.

________________________________________________________________________
________________________________________________________________________

Post Test Name:_________________ Date:_________________

11.List and explain each step in the COPING Model.

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Member (Patient) Staff Actions

C C

O O

P P

I I

N N

G G

12.List the core values of the Nonviolent Crisis Intervention theory.

Nonviolent Crisis Intervention Certification

Survey Date:_________________

1. Have you had an opportunity to use skills learned during Nonviolent Crisis Intervention training?

Yes No Not Sure

2. Since the training, do you feel more confident when dealing with a member (patient) during an escalated
event?

Yes No Not Sure

3. If you had an escalated member (patient) in your office, what would you do?
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Handle the situation as usual Call my supervisor Use my new skills of

Nonviolent
Crisis Intervention

4. If you have not used the new skills, what assistance do you need to start using the new skills?

Additional training Additional practice Using the skills will not

help with
my position

Nonviolent Crisis Intervention Certification

Record Review Name:_______________ Job:_______ Date:_________________
Member ID # Yes No Not Applicable
Does the employee have
more than a years
experience?
Does the employee have
a bachelors degree?
Has the employee
attended the NCI
training?
Was this meeting the first
for the employee and
member?
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Was the member

escalated prior to the
meeting?
Did the member become
escalated during the
encounter?
Did the escalated event
end without police
involvement?
Is there evidence of the
use of NCI skills within
the record? Please add
notes below.
If there is evidence of
effective NCI use? Please
add notes below.
NOTES: (Please continue on back of page if necessary.)

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Nonviolent Crisis Intervention Certification
Group Interview Name:___________________ Date:_________________
This is the script and questions to be used during a group interview that will be recorded and then transcribed.
Hello everyone and welcome to the group interview. Thanking you for taking the time out of your busy

schedules to speak with me. Also, Marta is here. She will be taking notes throughout the interview. We will be

using only first names during the session. The final report will be presented to the CEO. That final report will

not contain any names. Today we will be discussing the Nonviolent Crisis Intervention training that you

completed. Do not feel that we are looking for the right answers. We need your honest opinions, thoughts, and
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statements. As you can see, we will be recording the session. We need to ensure that everyones statements are

heard and that we miss nothing. To do that, the session will be recorded and transcribed. Now let us begin.

1. Thinking back to the Nonviolent Crisis Intervention (NCI) training, what do you think about the

training?
2. What aspects of the training were the best?
3. What aspects of the training were the worst?
4. Think back to before the training, did you feel comfortable working with members that were either

escalated at the beginning of the session or became escalated during the session with you?
5. How has the NCI training helped you while working with escalated members?
6. Please share an example of how NCI training has helped you while working with an escalated member?
7. How could the training be improved to help you in the field?
8. Of everything that we have discussed today, what is the most important item?

A summary of the discussion will be presented to the group at which time I will ask the group if I need to add

anything to the discussion.

References

Brinkerhoff, R. O., & Mooney, T. P. (2008). Section VI: Measuring and evaluating impact - chapter 30: Level 3

evaluation. Alexandria: Association for Talent Development. Retrieved from

https://search.proquest.com/docview/896136536?accountid=35812

Coscarelli, W., & Shrock, S. (2008). Section VI: Measuring and evaluating impact - chapter 29: Level 2:

Learning-five essential steps for creating your tests and two cautionary tales. Alexandria: Association

for Talent Development. Retrieved from

https://search.proquest.com/docview/896137857?accountid=35812

Kristiansen, N. (2008). Section VI: Measuring and evaluating impact - chapter 28: Level 1: Reaction

evaluation. Alexandria: Association for Talent Development. Retrieved from

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https://search.proquest.com/docview/896136538?accountid=35812

McCain, D. V. (2008). Section VI: Measuring and evaluating impact - chapter 31: Level 4: Results. Alexandria:

Association for Talent Development. Retrieved from

https://search.proquest.com/docview/896136428?accountid=35812