SIS Collaborative Final Survey Store It Safe (SIS) Collaborative Participant Final Survey Participant Information Expect this survey to take approximately 15 minutes to complete. The information you provide will be used to improve future Ohio AAP programs. You may denote "N/A" if you do not have an answer for any question, and use estimates or your best knowledge if needed. An * indicates a required field. Please provide your practice name: * Please provide your first and last name: Please provide your email (to receive ABP attestation link): Are you seeking Maintenance of Certification credit for your participation? Yes No Please rate the frequency with which you currently address the following at WCVs with families 2 - 5 years of age. (Select a number from the scale below.) 0 = Does not apply / do not wish to answer; 1 = Never; 2 = Rarely (at least once a month); 3 = Sometimes (at least once a week); 4 = Most of the time (almost every well visit) Firearm safety (in general) 0 1 2 3 4 Barrier methods to prevent injuries 0 1 2 3 4 Recommendation of use of a locked storage device for firearms and potentially dangerous items 0 1 2 3 4 Store It Safe Program (specifically) 0 1 2 3 4 Firearm safety in the homes of friends or relatives 0 1 2 3 4 Providing a lock box for a family in need of safe storage 0 1 2 3 4 Please rate your degree of confidence in your ability to do the following items. Select a number from the scale below. 0 = Does not apply/Do not wish to answer; 1 = Not at all confident; 2 = Somewhat Confident; 3 = Moderately Confident; 4 = Confident; 5 = Very Confident Discuss firearm safety 0 1 2 3 4 5 Discuss barrier methods for injury prevention 0 1 2 3 4 5 Discuss firearm safety in the homes of friends or relatives 0 1 2 3 4 5 Provide firearm safety resources 0 1 2 3 4 5 Develop a PDSA Cycle for Quality Improvement 0 1 2 3 4 5 Using and interpreting data 0 1 2 3 4 5 Reporting on improvement outcomes and efforts to others 0 1 2 3 4 5 What was most helpful part of this project for improving your practice? Resources for Families (Gun boxes) Data Collection/Run Charts Increased Knowledge/Education Networking OtherOther What are your sustainability plans (select all that apply)? Continue using the changes made during this project WITHOUT modification Continue using the changes made during this project WITH modifications Add portions of the project into EMR No plans to use ANY portion of the project in the future OtherOther In regards to the amount of resources needed by your practice in this project (gun boxes), was the number of resources: Lower than expected Higher than expected As expected OtherOther How did this project change the way you address firearm safety in practice? What, if any, feedback did families provide on their experiences with this project? If you encountered barriers or challenges while implementing this project, what were they? How did you overcome them? Are there additional educational materials or resources you feel would improve this project for future waves? What are they? Please share if you have any additional feedback or comments. Submit If you are human, leave this field blank.
