R-TEP & G-TEP EVALUATION FORM

Please fill out the sections relevant to the training you took.

12 CE for both trainings or 6 CE for a single training

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Did you attend an R-TEP or G-TEP Training?*
- R-TEP (Recent Traumatic Episode Protocol)
- G-TEP (Group Traumatic Episode Protocol)
- Both
Recent Traumatic Episode Protocol (R-TEP) Date Attended:
MM slash DD slash YYYY
Group Traumatic Episode Protocol (G-TEP) Date Attended:
MM slash DD slash YYYY
OVERALL LEARNING EXPERIENCE
Course Content was current
- 1 (YES)
- 2
- 3 (SOMEWHAT)
- 4
- 5 (NO)
Learning Objectives: R-TEP
R-TEP participants will be able to:
1.) Name 2 reasons for a different protocol for recent trauma.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
2.) Identify 1 issue encountered with early EMDR intervention
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
3.) Describe one challenge for the therapist with EEI.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
4.) Define episode narrative & how and when this is obtained.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
5.) Explain how to obtain your targets for processing.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
6.) Describe how targets are identified for the google search.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
7.) Define focused processing.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
8.) Demonstrate the use of EMDr and EMD.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
9.) Describe how to deal with stuck points.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
10.) Define how the search for Points of Disturbance end.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
11.) State how to close a session & begin the next one.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
12.) Name a published research study utilizing RTEP.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
13.) Cite one goal of EEI (Early EMDR Intervention).
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
14.) Name 1 assessment tool useful with traumatized clients
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
Learning Objectives: G-TEP
G-TEP participants will be able to:
1.) List one challenge faced adapting R-TEP for groups
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
2.) Identify materials are necessary for a G-TEP session.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
3.) Describe the important staffing considerations.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
4.) State the 6 + 2 steps.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
5.) Explain two uses for the Step 1 exercise.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
6.) Recite the steps that encourage group sharing.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
7.) Describe how you determine the length of sets.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
8.) Explain how to determine when to check in.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
9.) Give an example of an introduction to begin the exercise.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
10.) Describe what to do if SUDs are not reducing or dissociation occurs.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
11.) Explain the options for Follow-Up have in G-TEP.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
12.) Name 1 published G-TEP study.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
13.) Tell 1advantage of G-TEP.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
14.) Discuss the adaptations for children and non-readers.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
OVERALL
1.) The course was appropriate to my level of training.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
2.) Accuracy and utility of content were discussed.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
3.) Teaching methods were effective.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
4.) Visual aids, handouts, and oral presentations clarified content.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
5.) Program flyer was informative and accurate.
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
If Done On-Line
1.) Platform was reliable
- Not At All
- Poor
- Adequate/Ok
- Good
- Best
2.) Technology was conducive to learning
- Not At All
- Poor
- Adequate/Ok
- Good
- Best
PRESENTER
Maria G Masciandaro, PsyD
1.) Knew the subject matter
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
2.) Presented content effectively (e.g., promoted deep reasoning and learning; included a consideration of obstacles or anomalies)
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
3.) Elaborated upon the stated objectives
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
4.) Maintained my interest
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
5.) Answered questions effectively
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
6.) Was responsive to questions, comments, and opinions
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
7.) Provided a variety of applied examples (e.g., case presentations)
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
Professional & Ethical Issues
Presenter made clearly evident, prior to registration, the following:
a. Requirements for successful completion of activity*
- Yes
- No
b. Commercial support for CE program, sponsor, or instructor (or any other relationship that could reasonably be construed as a conflict of interest)*
- Yes
- No
c. Commercial support for content of instruction (e.g., research grants funding research findings etc.) that could be construed as a conflict of interest*
- Yes
- No
d. Commercial support or benefit for endorsement of products (e.g., books, training, drugs, etc.)*
- Yes
- No
e. Accuracy and utility of the materials presented, the basis of such statements, the limitations of the content being taught and the severe and most common risks*
- Yes
- No
If An In-Person Training
1.) Facility was adequate for my needs*
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
2.) Special needs were met*
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
3.) Facility was comfortable and accessible*
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
4.) Food and beverage were adequate (if applicable)*
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
5.) Program brochure was informative and accurate*
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
Learning
1.) Information could be applied to my practice or other work context*
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
2.) Information contributes to achieving personal or professional goals*
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
3.) Issues of diversity were addressed*
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
4.) How much did you learn as a result of this CE program?*
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
5.) How useful was the content of this CE program for your practice or other professional development?*
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
6.) This program enhanced my professional expertise*
- Yes
- No
7.) I would recommend this program to others*
- Yes
- No
8.) Teaching methods and tools focused on how to apply program content to my practice/work environment*
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
9.) Learning was enhanced through a variety of formats.*
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
10.) The presentation facilitated the integration and synthesis of information.*
- 1 (Strongly Disagree)
- 2 (Disagree)
- 3 (Neither Agree nor Disagree)
- 4 (Agree)
- 5 (Strongly Agree)
Participant information
1.) Please note your profession and status (Check all that apply)
- Social Worker
- University Faculty
- Masters Level Licensed Therapist
- Psychologist
- Other
2.) Please note years in your profession
- Student
- 1 - 5
- 6 - 10
- 11 - 20
- 20+

R-TEP & G-TEP EVALUATION FORM

OVERALL LEARNING EXPERIENCE

Learning Objectives: R-TEP

Learning Objectives: G-TEP

OVERALL

If Done On-Line

PRESENTER

Professional & Ethical Issues

If An In-Person Training

Learning

Participant information