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# 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 qu estion. 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 onl y 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 rese arch 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 particip ate in the survey GO TO NAME 2. No - I choose not to participate in the survey GO TO END IN TERVIEW

END INTERVIEW New Screen New Screen

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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) New Screen

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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 ye ars in total have you worked as a teacher? ( 

### Range = 0 to 50) Enter number of ye ars ___ ___ 52 Decline to Answer A5. How many ye ars in total have you worked as a teacher in this school? ( 

### Range = 0 to 50) Enter number of ye ars ___ ___ 52 Decline to Answer

A6. Please indicate the highest degrees you have completed. ( Please select all that apply) New Screen New Screen

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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 te acher 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.** A 8 . What grade do you teach this year? New Screen

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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 6 th**  

### grade or Other in A**8 , go to A** **9 .**  **If Not sure or Decline to answer in A 8**  **, go to B1**  **.** A9 . How many ye ars have you taught this grade? ( 

### Range = 0 to 50) Enter number of ye ars ___ ___ 51 Not Sure 52 Decline to Answer New Screen

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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 ye ar by choosing the appropriate response. ( Please select one response per row) Never Occurs Rarely

Occurs Some times 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 me mbers as his or her equal k. The principal goes out of his or her way to show appreciation to teachers 1 2 3 4 5 6 7 9 l. Teachers are provided with adequate materials for their classrooms 1 2 3 4 5 6 7 9

m. Teachers in this school like each other 1 2 3 4 5 6 7 9 n. Community demands are accepted even when they are not consistent with the educational program 1 2 3 4 5 6 7 9

o. The principal lets faculty know what is expected of them 1 2 3 4 5 6 7 9 p. Teachers receive the necessary classroom supplies 1 2 3 4 5 6 7 9 q. The principal/assistant principal conducts meaningful evaluations 1 2 3 4 5 6 7 9

r. Students respects others who get good grades 1 2 3 4 5 6 7 9 s. Teachers feel pressure from the community 1 2 3 4 5 6 7 9 t. The principal’s recommendations are given serious consideration by his or her superiors 1 2 3 4 5 6 7 9

u. The principal maintains definite standards of 1 2 3 4 5 6 7 9

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performance v. Supplementary materials are available for classroom use 1 2 3 4 5 6 7 9
w. Teachers exhibit friendliness to each other 1 2 3 4 5 6 7 9 x. Students seek extra work so they can get good grades 1 2 3 4 5 6 7 9 y. Select citizen groups are influential with the board 1 2 3 4 5 6 7 9
z. The principal looks out for the personal welfare of faculty me mbers 1 2 3 4 5 6 7 9

aa. Teachers express pride in their school 1 2 3 4 5 6 7 9 bb. Teachers identify with the school 1 2 3 4 5 6 7 9 cc. The school is open to the whims of the public 1 2 3 4 5 6 7 9 dd. A few vocal parents can change school policy 1 2 3 4 5 6 7 9 ee. Students try hard to improve on previous work 1 2 3 4 5 6 7 9 ff. Teachers accomplish their jobs with enthusiasm 1 2 3 4 5 6 7 9 gg. The learning environment is orderly and serious 1 2 3 4 5 6 7 9 hh. The principal is friendly and approachable 1 2 3 4 5 6 7 9 ii. There is a feeling of trust and confidence among the staff 1 2 3 4 5 6 7 9 jj. Teachers show 1 2 3 4 5 6 7 9

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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 frequentl y you experience each of the following in the school at which you currentl y 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 1 2 3 4 5 6 7 8 9 i. I feel I’m positively influencing my students’ lives through my work 1 2 3 4 5 6 7 8 9 j. I’ ve become more callous towards people since I took this job 1 2 3 4 5 6 7 8 9 k. I worry that this job is hardening me emotionally 1 2 3 4 5 6 7 8 9 l. I feel very energetic 1 2 3 4 5 6 7 8 9
m. I feel frustrated by my job 1 2 3 4 5 6 7 8 9 n. I feel I’m working too hard on my job 1 2 3 4 5 6 7 8 9 o. I really care what happens to most students 1 2 3 4 5 6 7 8 9 p. Working directly with students puts too much stress on me 1 2 3 4 5 6 7 8 9 q. I can easily create a relaxed atmosphere with my students 1 2 3 4 5 6 7 8 9

r. I feel exhilarated after working closely with my students 1 2 3 4 5 6 7 8 9

s. I have accomplished many worthwhile things in this 1 2 3 4 5 6 7 8 9

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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 s ystems are in place in the school in which you teach. School
- wide is defined as involving all student s, 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 office
versus 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 s ystems 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, pl ayground, 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 non
classroom settings 1 2 3 7 9



### B5. Please mark the extent to which each of the following classroom setting s ystems 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



### B 6 . 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 conse**  **quently 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 ty

pes of materials, if any, do you use in conjunction with the programs or activities listed in this section?

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(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. Ty pical examples are sticker or star charts, points or token program, time out for disruptive behavior, and daily and weekl y 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 D1 a 3. Not Sure GO TO D1 a 99
. Decline to Answer GO TO D1 a

C6. Please indicate the name of the classroom management program you have used this year? 1. Lion’s Quest Skill s for Adolescence New Screen

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2. Positive Action 3. Too Good for Drugs 4. Too Good for Violence 5. In credible Years 6. Second Step Violence Prevention Program 7. Skillstreaming 8. Stop and Think Social Skills Program 9. Olweus B ull ying 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

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**Teachers go to D1 a**  **. Staff go to D2**  **a.** D1 a . During the 2015
- 20 16 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

D 1b
. 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

D 2 a. 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 D 2b 2. No GO TO D 3 a 3. Not Sure GO TO D 3 a 9
. Decline to Answer GO TO D 3 a New Screen

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D 2b. 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 D 2**  **c. Staff go to**  **D 3**  **a .** 
D 2 c. Did you implement this program with any students in your classroom? 1. Yes GO TO D 2 d 2. No GO TO D 3 a 3. Not Sure GO TO D 3 a 9
. Decline to Answer GO TO D 3 a

D 2 d
. 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 D 2 e. What proportion of your students do you implement this with during the 2015
- 2016 school ye ar? 1. 1 - 10 percent New Screen

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2. 11 - 20 percent 3. 21 - 40 percent 4. Over 40 percent 5. Not Sure 9
. Decline to answer

D 3 a . 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 ye ar? 1. Yes 2. No 3. 

### Not Sure 9
. Decline to Answer **Staff: skip D 3**  **b. If yes to D**  **3 A go to D**  **4 .**  **All others End Survey.**
D 3 b . 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 D 3**  **a or D 3**  **b, go to D 4**  **. All others go to D5**  **.** New Screen

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D 4 . 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 9 9 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 ass emblies) 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.**  D 5 . 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 co lleague New Screen

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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 ye ar? ( Please select on e 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)