Dementia Module 2 Survey

Question Title

* 1. What is your role in working with persons with dementia?

Family caregiver

Certified Family Home Provider

Case manager, care coordinator

Direct care worker

Health care provider

First responder

Community business

Other (please specify)

Question Title

* 2. What was your level of awareness of the triggers of a Flight, Fight and Freeze (3F) response before and after completing Dementia Module 2?

	Strongly Disagree	Disagree	Neither	Agree	Strongly Agree
Before taking the Providing Safe and Comfortable Care dementia skills training, I was aware that when a person with dementia feels unsafe their body triggers a Flight, Fight and Freeze (3F) response.	Before taking the Providing Safe and Comfortable Care dementia skills training, I was aware that when a person with dementia feels unsafe their body triggers a Flight, Fight and Freeze (3F) response. Strongly Disagree	Before taking the Providing Safe and Comfortable Care dementia skills training, I was aware that when a person with dementia feels unsafe their body triggers a Flight, Fight and Freeze (3F) response. Disagree	Before taking the Providing Safe and Comfortable Care dementia skills training, I was aware that when a person with dementia feels unsafe their body triggers a Flight, Fight and Freeze (3F) response. Neither	Before taking the Providing Safe and Comfortable Care dementia skills training, I was aware that when a person with dementia feels unsafe their body triggers a Flight, Fight and Freeze (3F) response. Agree	Before taking the Providing Safe and Comfortable Care dementia skills training, I was aware that when a person with dementia feels unsafe their body triggers a Flight, Fight and Freeze (3F) response. Strongly Agree
After taking the Providing Safe and Comfortable Care dementia skills training, I am aware that when a person with dementia feels unsafe their body triggers a Flight, Fight and Freeze (3F) response.	After taking the Providing Safe and Comfortable Care dementia skills training, I am aware that when a person with dementia feels unsafe their body triggers a Flight, Fight and Freeze (3F) response. Strongly Disagree	After taking the Providing Safe and Comfortable Care dementia skills training, I am aware that when a person with dementia feels unsafe their body triggers a Flight, Fight and Freeze (3F) response. Disagree	After taking the Providing Safe and Comfortable Care dementia skills training, I am aware that when a person with dementia feels unsafe their body triggers a Flight, Fight and Freeze (3F) response. Neither	After taking the Providing Safe and Comfortable Care dementia skills training, I am aware that when a person with dementia feels unsafe their body triggers a Flight, Fight and Freeze (3F) response. Agree	After taking the Providing Safe and Comfortable Care dementia skills training, I am aware that when a person with dementia feels unsafe their body triggers a Flight, Fight and Freeze (3F) response. Strongly Agree

Question Title

* 3. Please rate your confidence in abilities to control avoidable stressors Before and After taking Module 2.

	Strongly disagree	Disagree	Neither	Agree	Strongly agree
Before taking the Providing Safe and Comfortable Care dementia skills training, I have confidence in my ability to control avoidable stressors while providing care to a person with dementia.	Before taking the Providing Safe and Comfortable Care dementia skills training, I have confidence in my ability to control avoidable stressors while providing care to a person with dementia. Strongly disagree	Before taking the Providing Safe and Comfortable Care dementia skills training, I have confidence in my ability to control avoidable stressors while providing care to a person with dementia. Disagree	Before taking the Providing Safe and Comfortable Care dementia skills training, I have confidence in my ability to control avoidable stressors while providing care to a person with dementia. Neither	Before taking the Providing Safe and Comfortable Care dementia skills training, I have confidence in my ability to control avoidable stressors while providing care to a person with dementia. Agree	Before taking the Providing Safe and Comfortable Care dementia skills training, I have confidence in my ability to control avoidable stressors while providing care to a person with dementia. Strongly agree
After taking the Providing Safe and Comfortable Care dementia skills training, I had confidence in my ability to control avoidable stressors while providing care to a person with dementia.	After taking the Providing Safe and Comfortable Care dementia skills training, I had confidence in my ability to control avoidable stressors while providing care to a person with dementia. Strongly disagree	After taking the Providing Safe and Comfortable Care dementia skills training, I had confidence in my ability to control avoidable stressors while providing care to a person with dementia. Disagree	After taking the Providing Safe and Comfortable Care dementia skills training, I had confidence in my ability to control avoidable stressors while providing care to a person with dementia. Neither	After taking the Providing Safe and Comfortable Care dementia skills training, I had confidence in my ability to control avoidable stressors while providing care to a person with dementia. Agree	After taking the Providing Safe and Comfortable Care dementia skills training, I had confidence in my ability to control avoidable stressors while providing care to a person with dementia. Strongly agree

Other (please specify)

Question Title

* 4. How likely are you to use the information presented in this module?

Not likely

Somewhat likely

Likely

Very likely

Not likely

Somewhat likely

Likely

Very likely

Comments?

Question Title

* 5. How likely are you to recommend this module to others?

Not likely

Somewhat likely

Likely

Very likely

Not likely

Somewhat likely

Likely

Very likely

Comments?