Sage Stream Evaluation V2
1.
Name of Organization / Individual Subscriber / Caregiver
2.
If In a Community - Name of Activity Person Present
3.
What type of activity was it?
Group
Individual
Combination
4.
What was the name of the artist?
5.
Activities Design - Met your goals and objectives
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Do not agree
1 - Strongly Disagree
6.
Activities Design - Duration of activity was appropriate
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Do not agree
1 - Strongly Disagree
7.
Activities Design - Technology functioned properly on viewer’s side
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Do not agree
1 - Strongly Disagree
8.
Activities Design - Technology functioned properly on presenter's side
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Do not agree
1 - Strongly Disagree
9.
Educator / Entertainer - Related well with participants
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Do not agree
1 - Strongly Disagree
10.
Educator / Entertainer - Communicated clearly
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Do not agree
1 - Strongly Disagree
11.
Educator / Entertainer - Maintained participants' interest
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Do not agree
1 - Strongly Disagree
12.
Educator / Entertainer - Knew their material and/or their craft
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Do not agree
1 - Strongly Disagree
13.
Response and Participation - In Community, Residents actively participated in session. Individual Subscriber / Home Care Client - actively participated.
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Do not agree
1 - Strongly Disagree
14.
Resident or Individual Response and Participation - Verbally participated (asking & answering questions/singing along). We list detailed therapy goals at the end, which are optional to answer but will help us improve.
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Do not agree
1 - Strongly Disagree
15.
Resident or Individual Response and Participation - Verbal and Non-Verbal residents participated by smiling/nodding, blinking, opening eyes, moving mouth, positive expressions
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Do not agree
1 - Strongly Disagree
16.
Resident or Individual Response and Participation - Body movement - hand, finger, any - indicated participation
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Do not agree
1 - Strongly Disagree
17.
Did you observe changes in emotional levels prior to and after that indicating successful participation? i.e. relaxed behavior, increased alertness, breathing patterns, mood in room elevated.
Yes, a lot of positive change.
Yes positive.
Yes, somewhat positive.
Not observable.
Somewhat negative changes.
Negative changes.
Yes, a lot of negative change.
18.
Were family members present for activity?
Yes
No
19.
Ask participants if they experienced program in a way meaningful to them.
Yes
No
20.
Do they want more programs like this?
Yes
No
21.
Do they want that artist/educator to live stream again?
Yes
No
22.
Therapy Goals - Did program achieve any of these? Check all boxes that apply.
Increased energy level of the individual or in the room
Improve hand-eye coordination
Maintain or improve range of motion
Increased relaxation
Eased pain
Improved attention
Improve awareness of person, place, time
Improve ability to follow simple and complex directions
Increase participation
Reduce behaviors that interfere with care
Improve speech and verbal communication
Experience exceptional moments of human interaction
Increase social interaction
Decrease isolationImprove interpersonal skills
Build relationships or bond with group
Improve self expression
Strengthen sense of identity
Improve coping strategies
Decrease anxiety
Learn or retrieve a skill
23.
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