Prevention: PEAK

Play Kit I: "No Bullying Allowed!"

Outcomes Assessment: Post-Kit Use Survey

Recently, you agreed to participate in our survey research about bullying in your school and your use of the No Bullying Allowed! Play Kit. Complete this survey after you have implemented the program with your students.

The Second Mile is conducting this assessment solely to determine the effectiveness of this program. The following identifying information will be used to match your responses with those you gave prior to using the kit. No individual or school names or identifying information will be used by The Second Mile in reporting the results.

All boxes denoted with an asterisk (*) must be filled out. Thank you.

Date:
Name:*
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The Second Mile Bullying Questionnaire
Please consider the current state of bullying in your classroom or school and respond to the following items:

	Not At All 0	1	To a Moderate Degree 2	3	To an Extremely High Degree 4
1. Teachers and administrators perceive bullying as a problem in this school.
2. Students perceive bullying as a problem in this school.
3. Parents perceive bullying as a problem in this school.
4. All parties are willing to discuss the problem of bullying.
5. Most bullying incidents are reported to adults.
6. Teachers actively intervene in bullying incidents.
7. Administrators actively intervene in bullying incidents.
8. Parents actively intervene in bullying incidents.
9. The number of bullying incidents has decreased over the past six months.
10. The severity of bullying incidents has decreased over the past six months.
11. Students can define bullying and provide examples of bullying behavior.
12. Students can identify appropriate strategies to use in bullying situations.
13. Students utilize anti-bullying strategies in school and non-school settings.


14. How many days or weeks have passed since you concluded presenting No Bullying Allowed! to your students? Weeks Days
15. To date, with how many students have you used No Bullying Allowed?
16. What is the total number of students with whom you anticipate using the program?
17. Check the grade(s) with which you have used or will use the program. 3rd 4th 5th 6th 7th Other
18. Check the setting(s) in which the No Bullying Allowed! play has been used. Small Group Single Classroom Several Classrooms Whole School Other
19. Check the setting(s) in which the No Bullying Allowed! program has been implemented. Small Group Single Classroom Several Classrooms Whole School Other

No Bullying Allowed! Play Kit Evaluation
Please respond to items #18-40 if you used one or more portions of the Play Kit. Please rate the effectiveness of each component of No Bullying Allowed! (If you did not use a given component, please mark "Not Used.")

	Not Used N/A	Poor 1	Fair 2	Average 3	Very Good 4	Excellent 5
20. Overall Assessment of No Bullying Allowed! Play Kit
Program Guide N/A 1 2 3 4 5
21. Introduction and Background Information
22. Information Sheet: Bullies and Victims
23. Information Sheet: How Can Parents Support School Anti-Bullying Efforts?
24. Information Sheet: What Can One Teacher or Counselor Do?
25. Information Sheet: What Can Schools Do?
26. Information Sheet: Changing the Culture
27. Suggested Lesson Outline and Activity Sequence
28. Guidelines for Discussions
29. Possible Responses for Discussion Questions
30. Selected References
Suggestions for Staging N/A 1 2 3 4 5
31. Staging Options
32. Suggestions for Involving Additional Students
33. Properties for Full Staging
Student Materials N/A 1 2 3 4 5
34. No Bullying Allowed! Script
35. Discussion Questions
36. Bullying Questionnaire
37. Definition of Bullying
38. Strategies to Stop the Bullying
39. Witness Cards
40. Individual and Class Commitment Forms


Indicate the extent to which this program was successful in meeting the student objectives listed in the Program Guide. The student will:

	Not Effective 1	2	Moderately Effective 3	4	Highly Effective 5
41. Define bullying and provide examples of bullying behavior
42. Identify appropriate strategies to use in bullying situations
43. Utilize anti-bullying strategies in school and non-school settings


Final Comments
What improvements would you suggest for this program?
What topic(s) would you like to see covered in our next PEAK Program?
Please share any reactions from or comments made by students.


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Copyright 2007 The Second Mile All rights reserved

Prevention: PEAK

Play Kit I: "No Bullying Allowed!"

Outcomes Assessment: Post-Kit Use Survey

The Second Mile Bullying Questionnaire

No Bullying Allowed! Play Kit Evaluation

Final Comments