1

Appendix F: MTSS-B Staff and Teacher Survey

Thank you for your participation in the MTSS-B research study. We would like you to answer 

some questions about your experience in the school in which you are working. This information 

is crucial in helping us understand the impacts of MTSS-B on students. As a token of our 

appreciation you will receive $25 for completing the survey.

When answering the questions, please keep in mind the following:

o Participation is voluntary – You can choose not to answer any question. If you skip a 

question on the web-based survey a screen will appear asking if you intended to skip the 

question and giving you the option to select “Not Sure” or “Decline to Answer.”

o Participation is private - All your responses will be kept private and will be used only 

for this study and related research. Your name will never appear in any public document, 

be linked to your responses, or revealed to people outside of the MDRC research team.

MDRC, a non-profit, non-partisan social policy research agency based in New York, is 

conducting this research. (Please see www.mdrc.org for more information.) The U.S.

Department of Education is providing the funding. 

o Participation is very easy – This should take approximately 30 minutes to complete. 

You can answer the questions all at once, or over several sittings. 

(Please select “Next” to continue.)

o If you have any questions or concerns about the MTSS-B research study, please contact 

Fred Doolittle at MDRC (fred.doolittle@mdrc.org or 212-340-8638). 

1. Yes - I consent to participate in the survey GO TO NAME

2. No - I choose not to participate in the survey GO TO END INTERVIEW

END INTERVIEW 

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Thank you for your time. We are sorry that you do not want to complete the MTSS-B Staff 

Survey. If you change your mind or have any questions, please contact Fred Doolittle at MDRC 

(fred.doolittle@mdrc.org or 212-340-8638). 

(Please select “Next” to exit survey)

A1. What is your age?

(Please select only one response)

1. 18-30

2. 31-40

3. 41-50

4. 51-60

5. 61+

6. Not Sure

9. Decline to answer

A2. Are you male or female?

(Please select only one response)

1. Male

2. Female

3. Not Sure

 9. Decline to Answer

A3. Please select your position at this school.

(Please select only one response)

1. Self-contained classroom teacher (e.g. you teach only one group of students who spend 

most of the day with you)

2. Subject-specific classroom teacher (e.g. art, science, PE)

3. Administrator (e.g. principal, dean, or assistant principal)

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4. Administrative assistant

5. Special education teacher

6. Other instructional staff (counselor, librarian, specialist, etc.)

7. Student support staff (e.g. School counselor; school psychologist; nurse)

8. Custodial or food service staff (e.g. cafeteria or maintenance staff)

9. Other (SPECIFY): ____________________________

 99. Decline to Answer

Teachers (“Self-contained classroom teacher” or “Subject-specific classroom teacher” in 

A3) go to A4.

Staff (all other responses in A3) go to A6. 

(Subsequent skip instructions will use these same definitions for Teachers and Staff.)

A4. How many years in total have you worked as a teacher?

(Range = 0 to 50)

Enter number of years ___ ___

52 Decline to Answer

A5. How many years in total have you worked as a teacher in this school?

(Range = 0 to 50)

Enter number of years ___ ___

52 Decline to Answer

A6. Please indicate the highest degrees you have completed.

(Please select all that apply)

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1. High school Degree

2. Associate’s Degree

3. Bachelor’s Degree

4. Master’s Degree

5. Post-Master’s Certificate

6. Doctorate

7. None of the above

8. Other (Specify): ____________________________

9. Not Sure

99. Decline to Answer

A7. Please check all certifications earned.

(Please select all that apply)

1. General elementary grade teacher

2. Reading teacher

3. Special educator

4. English as a Second Language

5. Bilingual education

6. Gifted and talented

7. Guidance

8. Administrator

9. Supervisor

10. Regular or standard state certificate or advanced professional teaching certificate

11. Provisional teaching certificate

12. I have no certifications at this time

13. Other (please specify): _________________________________

14. Not sure

99. Decline to answer

Teachers only; Staff go to B1. 

A8. What grade do you teach this year?

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(Please select all that apply)

1. Kindergarten

2. 1

st grade

3. 2

nd grade

4. 3

rd grade

5. 4

th grade

6. 5

th grade

7. 6

th grade

8. Other: (SPECIFY): ___________________

9. Not Sure

99. Decline to Answer

If Kindergarten through 6th grade or Other in A8, go to A9. 

If Not sure or Decline to answer in A8, go to B1.

A9. How many years have you taught this grade?

(Range = 0 to 50)

Enter number of years ___ ___

51 Not Sure

52 Decline to Answer

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B1. The following are statements are about the school at which you currently work. Please 

indicate the extent to which each statement characterizes your school this school year by

choosing the appropriate response.

(Please select one response per row)

Never

Occurs

Rarely

Occurs

Sometimes

Occurs

Often

occurs

Very 

often

occurs

Almost 

always 

occurs

Not 

Sure

Decline 

to 

Answer

a. The principal 

explores all sides 

of topics and 

admits that other 

opinions exist

1 2 3 4 5 6 7 9

b. The principal gets 

what he or she 

asks for from 

superiors

1 2 3 4 5 6 7 9

c. The principal 

discusses 

classroom issues 

with teachers

1 2 3 4 5 6 7 9

d. The principal 

accepts questions 

without appearing 

to brush off or put 

down the staff

1 2 3 4 5 6 7 9

e. Extra materials are 

available if 

requested

1 2 3 4 5 6 7 9

f. Students neglect to 

complete 

homework

1 2 3 4 5 6 7 9

g. Students are 

cooperative during 

classroom 

instruction

1 2 3 4 5 6 7 9

h. The school is 

vulnerable to 

outside pressures

1 2 3 4 5 6 7 9

i. The principal is 

able to influence 

the actions of his 

or her superiors

1 2 3 4 5 6 7 9

j. The principal 1 2 3 4 5 6 7 9

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treats all faculty 

members as his or 

her equal

k. The principal goes 

out of his or her 

way to show 

appreciation to 

teachers

12345679

l. Teachers are 

provided with 

adequate materials 

for their 

classrooms

12345679

m. Teachers in this 

school like each 

other

12345679

n. Community 

demands are 

accepted even 

when they are not 

consistent with the 

educational 

program

12345679

o. The principal lets 

faculty know what 

is expected of 

them

12345679

p. Teachers receive 

the necessary 

classroom supplies

12345679

q. The 

principal/assistant 

principal conducts 

meaningful 

evaluations

12345679

r. Students respects 

others who get 

good grades

12345679

s. Teachers feel 

pressure from the 

community

12345679

t. The principal’s 

recommendations 

are given serious 

consideration by 

his or her 

superiors

12345679

u. The principal 

maintains definite 

standards of 

12345679
8

performance

v. Supplementary 

materials are 

available for 

classroom use

12345679

w. Teachers exhibit 

friendliness to 

each other

12345679

x. Students seek 

extra work so they 

can get good 

grades

12345679

y. Select citizen 

groups are 

influential with the 

board

12345679

z. The principal 

looks out for the 

personal welfare 

of faculty 

members

12345679

aa. Teachers express 

pride in their 

school

12345679

bb. Teachers identify 

with the school

12345679

cc. The school is open 

to the whims of 

the public

12345679

dd. A few vocal 

parents can change 

school policy

12345679

ee. Students try hard 

to improve on 

previous work

12345679

ff. Teachers 

accomplish their 

jobs with 

enthusiasm

12345679

gg. The learning 

environment is 

orderly and serious

12345679

hh. The principal is 

friendly and 

approachable

12345679

ii. There is a feeling 

of trust and 

confidence among 

the staff

12345679

jj. Teachers show 12345679
9

commitment to 

their jobs

kk. Teachers are 

indifferent to each 

other

1 2 3 4 5 6 7 9

B2. This set of questions asks about feelings school staff sometimes experience. Please rate how 

frequently you experience each of the following in the school at which you currently teach.

(Please select one response per row)

Never

A few 

times a 

year

Month

-ly

A few 

times 

per 

month

Every 

week

A few 

times 

per 

week

Every

day

Not 

Sure

Declin

e to 

Answe

r

a. I feel 

emotionally 

drained from 

my work

1 2 3 4 5 6 7 8 9

b. I feel used up 

at the end of 

the workday

1 2 3 4 5 6 7 8 9

c. I feel fatigued 

when I get up 

in the morning 

and have to 

face another 

day on the job

1 2 3 4 5 6 7 8 9

d. I can easily 

understand how 

my students 

feel about 

things

1 2 3 4 5 6 7 8 9

e. I feel I treat 

most students 

as respected 

individuals

1 2 3 4 5 6 7 8 9

f. Working with 

students all day 

really is a strain 

for me

1 2 3 4 5 6 7 8 9

g. I deal very 

effectively with 

the problems of

my students

1 2 3 4 5 6 7 8 9

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h. I feel burned 

out from my 

work

123456789

i. I feel I’m 

positively 

influencing my 

students’ lives 

through my 

work

123456789

j. I’ve become 

more callous 

towards people 

since I took this 

job

123456789

k. I worry that 

this job is 

hardening me 

emotionally

123456789

l. I feel very 

energetic

123456789

m. I feel frustrated 

by my job

123456789

n. I feel I’m 

working too 

hard on my job

123456789

o. I really care 

what happens 

to most 

students

123456789

p. Working 

directly with 

students puts 

too much stress 

on me

123456789

q. I can easily 

create a relaxed 

atmosphere 

with my 

students

123456789

r. I feel 

exhilarated 

after working 

closely with 

my students

123456789

s. I have 

accomplished 

many 

worthwhile 

things in this 

123456789
11

job

t. I feel like I’m 

at the end of 

my rope

1 2 3 4 5 6 7 8 9

u. In my work, I 

deal with 

emotional 

problems very 

calmly

1 2 3 4 5 6 7 8 9

v. I feel students 

blame me for 

some of their 

problems

1 2 3 4 5 6 7 8 9

B3. Please mark the extent to which each of the following school-wide systems are in place in 

the school in which you teach. School-wide is defined as involving all students, all staff, and all 

settings.

(Please select one response per row)

In place Partially in 

place

Not in 

place Not Sure Decline to answer

a. A small number (e.g. 3-5) of 

positively and clearly stated 

student expectations or rules 

are defined

1 2 3 4 9

b. Expected student behaviors 

are taught directly 1 2 3 4 9

c. Expected student behaviors 

are rewarded regularly 1 2 3 4 9

d. Problem behaviors (failure to 

meet expected student 

behaviors) are defined clearly

1 2 3 4 9

e. Consequences for problem 

behaviors are clearly defined 1 2 3 4 9

f. Distinctions between officeversus classroom-managed 

problem behaviors are clear

1 2 3 4 9

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g. Options exist to allow 

classroom instruction to 

continue when problem 

behavior occurs

1 2 3 4 9

h. Procedures are in place to 

address emergency/dangerous 

situations

1 2 3 4 9

i. A team exists for behavior 

support planning and problem 

solving

1 2 3 4 9

j. School administrator is an 

active participant on the 

behavior support team

1 2 3 4 9

k. Data on problem behavior are 

collected and summarized 

within an on-going system

1 2 3 4 9

B4. Please mark the extent to which each of the following non-classroom setting systems is in 

place in the school in which you teach. Non-classroom settings are defined as particular times or 

places where supervision is emphasized (e.g. hallways, cafeteria, playground, bus).

(Please select one response per row)

In place Partially in 

place Not in place Not Sure Decline to answer

a. School-wide expected 

student behaviors apply to 

non-classroom settings

1 2 3 7 9

b. School-wide expected 

student behaviors are taught 

in non-classroom settings

1 2 3 7 9

c. Supervisors actively

supervise (move, scan, and 

interact with) students in 

non-classroom settings

1 2 3 7 9

d. Rewards exist for meeting 

expected student behaviors 

in non-classroom settings

1 2 3 7 9

e. Status of student behavior 

and management practices 

are evaluated quarterly from 

data

1 2 3 7 9

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f. All staff are involved 

directly or indirectly in 

management of nonclassroom settings

1 2 3 7 9

B5. Please mark the extent to which each of the following classroom setting systems is in place 

in the school in which you teach. Classroom settings are defined as instructional settings in 

which teacher(s) supervise and teach groups of students.

(Please select one response per row)

In place Partially in 

place

Not in 

place Not Sure Decline to answer

a. Expected student behavior 

and routines in classrooms are 

stated positively and defined 

clearly

1 2 3 7 9

b. Problem behaviors are 

defined clearly 1 2 3 7 9

c. Expected student behavior 

and routines in classrooms are 

taught directly

1 2 3 7 9

d. Expected student behaviors 

are acknowledged regularly 

(positively reinforced) (˃ 4 

positives to 1 negative) 

1 2 3 7 9

e. Problem behaviors receive 

consistent consequences 1 2 3 7 9

B6. Please mark the extent to which each of the following individual student systems is in place 

in the school in which you teach. Individual student systems are defined as specific supports for 

students who engage in chronic problem behaviors (1% - 7% of enrollment).

(Please select one response per row)

In place Partially in 

place

Not in 

place Not Sure Decline to answer

a. Assessments are conducted 

regularly to identify students 1 2 3 4 9

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with chronic behavior 

problems

b. A simple process exists for 

teachers to request assistance 1 2 3 4 9

c. Behavior is monitored and 

feedback provided regularly 

to the behavior support team 

and relevant staff

1 2 3 4 9

C1. Does a program/curriculum addressing each of the following areas exist at your school this 

school year? 

Programming instruction: For each item in C1, if “Yes” ask C2 and C3 for that item. 

Otherwise, ask C1 for the next item on the list.

Paper survey note: C1 – C3 will be displayed different on the paper version of the survey so 

that C1 – C3 can asked administered consequently for each item before moving on to the 

next item.

(Please select one response per row)

Yes No Not Sure Decline to 

answer

a. Violence prevention/peace 

promotion 1 2 3 9

b. Social and emotional 

development 1 2 3 9

c. Character evaluation 1 2 3 9

d. Tolerance and diversity 1 2 3 9

e. Risk prevention/health 

promotion 1 2 3 9

f. Civic responsibility and 

community service 1 2 3 9

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FOR C2 and C3, ONLY DISPLAY ITEMS FOR WHICH YES RESPONSES WERE 

GIVEN IN C1.

C2. Does this program or activity include all students or some students?

(Please one response per row)

All students Some students Not Sure Decline to 

answer

a. Violence prevention/peace 

promotion 1 2 3 9

b. Social and emotional 

development 1 2 3 9

c. Character evaluation 1 2 3 9

d. Tolerance and diversity 1 2 3 9

e. Risk prevention/health 

promotion 1 2 3 9

f. Civic responsibility and 

community service 1 2 3 9

C3. How often does this program or activity occur?

(Please select one response per row)

Daily Weekly Monthly One 

time

As 

needed

Not 

Sure

Decline 

to 

Answer

a. Violence 

prevention/peace 

promotion

1 2 3 4 5 6 9

b. Social and emotional 

development 1 2 3 4 5 6 9

c. Character evaluation 1 2 3 4 5 6 9

d. Tolerance and diversity 1 2 3 4 5 6 9

e. Risk prevention/health 

promotion 1 2 3 4 5 6 9

f. Civic responsibility and 

community service 1 2 3 4 5 6 9

C4. What types of materials, if any, do you use in conjunction with the programs or activities 

listed in this section?
16

(Please select all that apply)

1. Teacher/instructor guides

2. Materials for student completion

3. Instructional aids

4. Giveaways

5. Specific children’s literature

6. Other (please specify)_________

7. Not sure

99. Decline to answer

Teachers go to C5. 

Staff go to D2a.

C5. Please think about behavior management programs or activities that you have used with 

your class since the beginning of the school year to address social and character development. By

behavior management we mean strategies or techniques designed to maximize positive behaviors 

and minimize negative behaviors. Typical examples are sticker or star charts, points or token 

program, time out for disruptive behavior, and daily and weekly reward programs.

Do you have any behavior management programs or activities going on in your classroom? 

(Please select only one response)

1. Yes GO TO C6

2. No GO TO D1a

3. Not Sure GO TO D1a

99. Decline to Answer GO TO D1a

C6. Please indicate the name of the classroom management program you have used this year? 

1. Lion’s Quest Skills for Adolescence

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2. Positive Action

3. Too Good for Drugs

4. Too Good for Violence

5. Incredible Years

6. Second Step Violence Prevention Program

7. Skillstreaming

8. Stop and Think Social Skills Program

9. Olweus Bullying Prevention Program

10. CHAMPS

11. Other (SPECIFY): ___________________________

12. Not Sure

99. Decline to answer

C7. Do you use these behavior and management strategies with all of your students or some of 

your students this year?

(Please select only one response)

1. With all students

2. With some students

3. Not Sure

9. Decline to answer

C8. How often do you use the behavior and management strategies above this year?

1. Daily

2. Weekly

3. Monthly

4. One-time

5. As needed

6. Not Sure

7. Other (SPECIFY BY INDICATING NUMBER OF HOURS AND WEEKS)

 9. Decline to answer
18

Teachers go to D1a. 

Staff go to D2a.

D1a. During the 2015-2016 school year, have you ever used a classroom strategy to teach and 

reinforce school-wide expectations (e.g. Good Behavior Game or Positive Behavior Game)?

1. Yes GO TO D2

2. No GO TO D3a

3. Not Sure GO TO D3a

9. Decline to Answer GO TO D3a

D1b. In the past month, how many times have you used this strategy in your classroom?

1. At least once a day

2. A few times per week

3. Once per week

4. Less than once per week

5. I have not used this strategy in the past month

6. Not Sure

9. Decline to Answer

D2a. During the 2015-16 school year, does your school use any specific programs designed for 

students who struggle with behavior and who do not respond to universal or school-wide 

approach?

1. Yes GO TO D2b

2. No GO TO D3a

3. Not Sure GO TO D3a

 9. Decline to Answer GO TO D3a

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D2b. What is the most commonly used program called?

Specify by writing in the name of the program below:

 

98. Not Sure

99. Decline to Answer

Teachers go to D2c. Staff go to D3a.

D2c. Did you implement this program with any students in your classroom?

1. Yes GO TO D2d

2. No GO TO D3a

3. Not Sure GO TO D3a

 9. Decline to Answer GO TO D3a

D2d. On average how often do you implement the program’s strategies with students in your 

classroom during the 2015-2016 school year?

1. Daily

2. Several times per week

3. Monthly

4. Not Sure

9. Decline to Answer

D2e. What proportion of your students do you implement this with during the 2015-2016 school 

year?

1. 1-10 percent

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2. 11-20 percent

3. 21-40 percent

4. Over 40 percent

5. Not Sure

9. Decline to answer

D3a. Did you participate in any professional development (e.g., workshops, trainings, webinars, 

individual meetings, coaching) related to student behavior during the summer of 2015 or during 

the 2015-2016 school year?

1. Yes

2. No

3. Not Sure

 9. Decline to Answer

Staff: skip D3b. If yes to D3A go to D4. 

All others End Survey.

D3b. Did you participate in any professional development (e.g., workshops, trainings, webinars, 

individual meetings, coaching) related to classroom management during the summer of 2015 or 

during the 2015-2016 school year?

1. Yes

2. No

3. Not sure

 9. Decline to Answer

Teachers: If yes in D3a or D3b, go to D4. 

All others go to D5. 

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D4. During the summer of 2015 and the 2015-2016 school year, what is your estimate of the 

total number of hours you spent in the following professional activities?

(Write down the total number of hours you spent in each of these activities. Mark “0” if you did 

not participate in an activity.)

Range = 0 - 97

Number 

of Hours Not Sure

Decline 

to 

Answer

a. Attended short, stand-alone training or workshop about schoolwide 

systems for student behavior or classroom management (half-day or 

less, webinars, etc.)

98 99

b. Attended longer institute or workshop about schoolwide systems 

for student behavior or classroom management (more than half-day) 98 99

c. Participated in work embedded PD about schoolwide systems for 

student behavior or classroom management (e.g., trainings taking 

place during grade level meetings, faculty assemblies)

98 99

d. Attended short, stand-alone training or workshop about specific 

interventions for students with behavioral challenges (half-day or 

less, webinars, etc.)

98 99

e. Attended longer institute or workshop about specific interventions 

for students with behavioral challenges (more than half-day) 98 99

f. Participated in work embedded PD about specific interventions for 

students with behavioral challenges (e.g., trainings taking place 

during grade level meetings, faculty assemblies)

98 99

g. Received coaching or mentoring related to student behavior and/or 

classroom management 98 99

h. Acted as a coach or mentor related to student behavior and/or 

classroom management 98 99

i. Other (e.g., participate in teacher study group, network or 

collaboration supporting PD in student behavior or classroom 

management, participate in committee or task force related to 

student behavior or classroom management)

98 99

Teachers: Go to D5. 

Staff: Go to END INTERVIEW 2.

D5.This series of questions asks you about coaching activities about student behavior or 

classroom management that you may have engaged in during the 2015-2016 school year. By

coaching we mean one-on-one or small group activities that you engaged in with a colleague 

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designated to be your mentor or coach. Coaching is different from training because it is 

individualized to meet your specific needs.

How often did you experience the following coaching activities during the 2015-2016 school 

year?

(Please select one response per row)

Did not 

happen

Less 

than 

once a 

month

Once or 

twice a 

month

More 

than 

twice a 

month

Once a 

week or 

more 

often

Not 

Sure

Decline 

to 

Answer

a. I observed while the 

coach 

modeled/demonstrated a 

student behavior or 

classroom management 

strategy

1 2 3 4 5 6 9

b. I worked with the coach 

to develop a plan to create 

behavior expectations for 

my classroom

1 2 3 4 5 6 9

c. I worked with the coach 

to develop a plan to teach 

behavior expectations in

my classroom

1 2 3 4 5 6 9

d. I worked with the coach 

to develop a plan to 

reinforce behavior 

expectations in my 

classroom

1 2 3 4 5 6 9

e. I worked with the coach 

to interpret data about 

student behavior in my 

classroom

1 2 3 4 5 6 9

f. I worked with the coach 

to establish a new office 

referral system.

1 2 3 4 5 6 9

END INTERVIEW 2

Thank you for your participation in the MTSS-B research study. You should receive your 

incentive for participating approximately two weeks after completing the survey. 

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If you have any questions or concerns about the MTSS-B research study, please contact Fred 

Doolittle at MDRC (fred.doolittle @mdrc.org or 212-340-8638). 

(Please select “Next” to exit survey)