GLS Youth Suicide Prevention Evaluation Tools Guide

Who is responsible for what forms?
QPR or AMSR TRAINERS:
GLS Youth Suicide Prevention Evaluation Tools Guide
• Pre-Post Question, Persuade, Refer (QPR) Training Survey (QPR Trainers only)
• Training Exit Survey (TES) and TES cover page (QPR and AMSR Trainers)
• Early Identification, Referral and Follow-up (EIRF) Individual (QPR Trainers only – instruct Trainees in how to
complete the EIRF)
SEED GRANTEE COALITIONS:
• Prevention Strategies Inventory (PSI) and PSI Budget
• Early Identification, Referral and Follow-up (EIRF) Individual (if the project includes QPR or screening for
suicide)
• Training Exit Survey (if the project includes any type of training)
• Pre-Post Question, Persuade, Refer (QPR) Training Survey (if the project includes QPR Training)
• Community Outreach Form
Pre-Post Question, Persuade, Refer (QPR) Training Survey --
What is it: Pre and post survey created to assess knowledge/beliefs gained from QPR training.
Who fills it out: Gatekeepers taking QPR training (QPR Trainers will administer/instruct gatekeepers on how to do
this). This survey is specific to QPR.
Where do I access it: Hard copies: print from http://youthsuicideprevention.nebraska.edu/ (on left navigation bar
under Evaluation Tools) or you can get hard copies mailed to you by contacting Kate Speck at the Public Policy
Center (kspeck@nebraska.edu or 402 472-0501). We encourage online registration for QPR training, which includes
the Pre Training survey. Contact Kate Speck before the training date to set up an electronic pre survey for your
training.
When is it due: Electronic survey data is recorded when the gatekeepers complete the surveys. Hard copies of the
pre and post surveys including a copy of the sign in sheet should be mailed to Kate Speck within one week of the
training date (include with TES material, below).
Training Exit Survey (TES) --
What is it: Instruments created to assess the content of the training, the participants’ intended use of the skills and
knowledge learned, and satisfaction with their training experience. Four types: Gatekeeper, Clinician, Core, and
Campus Connect.
Who fills it out:
TES Survey: Training participants.
TES Cover Page: Trainers need to fill out a TES Cover Page for every training.
Where do I access it: TES Survey only comes in paper format. Trainers should request hard copies by contacting Kate
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Speck at the Public Policy Center (kspeck@nebraska.edu or 402 472-0501).
When is it due: The TES surveys, pre- and post-surveys, and cover page from each training should be grouped
together and mailed to Kate Speck at 215 Centennial Mall South, Suite 401, Lincoln NE, 68588 within one
week of the training date.
Early Identification, Referral and Follow-up (EIRF) – Individual --
What is it: Survey used to track early identification activities, referrals for service, and services received.
Who fills it out: Gatekeepers fill this out every time a new referral is made (QPR Trainers will administer/instruct
gatekeepers on how to do this). One survey is completed for each youth identified as at risk for suicide and referred
to services (mental health or otherwise). Report on the identification and referral immediately after it has occurred,
even if the follow-up on the referral has not been done yet. Reporting on the referral Follow-up can be done at the
same time as the identification/referral or at any time up to 3 months after the referral is made, depending on how
soon the follow-up is completed.
Where do I access it: http://youthsuicideprevention.nebraska.edu/ (on left navigation bar under Evaluation Tools).
Start with the “EIRF – Individual” survey to report on the identification and referral of youth at risk for suicide. If you
have done the referral Follow-up then you can complete this section in the same survey. If you have not done the
referral Follow-up then you can complete this section at another time in a different survey: the “EIRF - Referral
Follow-up” survey.
When is it due: Complete EIRF surveys continuously as youth are identified and referred.
Prevention Strategies Inventory (PSI) and PSI Budget --
What is it: Inventory that captures all suicide prevention strategies purchased, developed, or utilized by
your suicide prevention program. The PSI Budget portion captures information on prevention strategy
expenditures to date.
Who fills out the Inventory and Budget: One representative from each Coalition who receives funding from GLS
Youth Suicide Prevention grant.
Where do I access the Inventory and Budget: Contact Teri Perkins (tperkins@nebraska.edu).
When are the Inventory and Budget due: By the 15th of the month following the end of each quarter (quarter
end dates: Dec 30, March 30, June 30, and Sept 30).
Community Outreach Form –
What is it: Form completed by seed grantees with information on outreach programs/activities.
Who fills it out: Seed grantees.
Where do I access it: Contact Danielle Sodergren (mdsodergren@hotmail.com).
When is it due: By the 15th of the month following the end of each quarter (quarter end dates: Dec 30, March
30, June 30, and Sept 30).
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