TelAbility Conference Log

It is the responsibility of the Host Site (the site that coordinated the event and makes the call) to complete the Data Collection Log.
Data Collection Logs should be completed immediately following the videoconference.
Please record the date and time the video conference started and ended.
Please define the purpose of the video conference:
- A Video clinic includes a session where a physician or licensed therapist is involved and providing medical advice or consultation.
- A Consultation includes a session where professionals and/or parents are talking together regarding a specific issue or child. For example: if a classroom teacher and parent want to talk with a Speech Language Pathologist at the CDSA regarding the child’s IFSP or progress the child is making.
- Networking is any type of collaborative event or way to build or expand the WATCH Community.
- Education includes any type of professional development opportunity.
- Administrative includes any type of meeting between directors, teachers, or CDSA staff for administrative, advocacy, or collaboration purposes.
Please account for all people present at all locations by title and by Site.
The Host Site should end the video conference by asking other sites involved about their satisfaction and comfort level of the session. Also ask for any concerns or benefits of the session. These comments should be included in Satisfaction Area of the Data Log.

Thank you!

	Video Conference Data Collection Log

Your use of this page will help us accurately track the conferences that occur via the WATCH Program and the TelAbility network. Accurate data will enable us to plan for the future and improve and expand our services. Therefore, we appreciate you taking the time to complete and submit the following brief form after every videoconference. After completing and submitting the form, please close this browser window to return to TelAbility. How to complete the Data Collection Log >> It is the responsibility of the Host Site (the site that coordinated the event and makes the call) to complete the Data Collection Log. Data Collection Logs should be completed immediately following the videoconference. Please record the date and time the video conference started and ended. Please define the purpose of the video conference: A Video clinic includes a session where a physician or licensed therapist is involved and providing medical advice or consultation. A Consultation includes a session where professionals and/or parents are talking together regarding a specific issue or child. For example: if a classroom teacher and parent want to talk with a Speech Language Pathologist at the CDSA regarding the child’s IFSP or progress the child is making. Networking is any type of collaborative event or way to build or expand the WATCH Community. Education includes any type of professional development opportunity. Administrative includes any type of meeting between directors, teachers, or CDSA staff for administrative, advocacy, or collaboration purposes. Please account for all people present at all locations by title and by Site. The Host Site should end the video conference by asking other sites involved about their satisfaction and comfort level of the session. Also ask for any concerns or benefits of the session. These comments should be included in Satisfaction Area of the Data Log. Thank you!
Name: EMail: On what date and at what time did your conference take place? , from: : to: : Please account for all people present at all locations by their title: Administrator Child Developmental Therapist Early Childhood Educator Early Intervention Service Coordinator Early Interventionist Educational Diagnostician Infant-Family Specialist Licensed Counselor/Mental Health Provider Nurse Nutritionist Occupational Therapist Parent Parent Educator Physical Therapist Physician Psychologist Social Worker Speech Language Pathologist Technician Translator Other Sites Participating: (Enter number of participants for each site) Abilitation's Children Therapy and Wellness Center Dr. Alexander's Office UNC Hospitals WATCH Tech Support TelAbility at Timberlyne Carolina Pediatric Dysphagia Charlie Gaddy/UCP Child Development Center Community Partnerships, Inc Developmental Therapy Associates Easter Seals-UCP Child Therapy Services Hilltop Home Jordan Child and Family Enrichment Center Learning Together Lucy Daniels Center Pediatric Therapy Associates Project Enlightenment Tammy Lynn Center Wake County Preschool Services White Plains Children's Center CDSA - Raleigh CDSA - Rocky Mount Other Allied Health Center for Human Movement Science CDSA - Asheville CDSA - Boone CDSA - Chapel Hill CDSA - Charlotte CDSA - Concord CDSA - Cullowhee CDSA - Durham CDSA - Elizabeth City CDSA - Fayetteville CDSA - Greensboro CDSA - Greenville CDSA - Hickory CDSA - Morganton CDSA - New Bern CDSA - Sandhills CDSA - Shelby CDSA - Wilmington CDSA - Winston-Salem Early Intervention Branch What was the purpose of the conference? (Check all that apply) Video Clinic (w/child present) Networking Consultation Administration Education/Professional Development Other: This session provide me with new and useful knowledge? (5 is Strongly Agree; 1 is Strongly DisAgree) 5 4 3 2 1 How satisfied were you with your experience overall? (5 is very satisfied; 1 is not at all satisfied) 5 4 3 2 1 How comfortable were the participants during the videoconference? (5 is very comfortable; 1 is not at all comfortable) 5 4 3 2 1 How satisfied were you with the communication and coordination efforts provided to you about this video conference (ie: knew what the conference was about, logistics, registration, etc.)? (5 is very satisfied; 1 is not at all satisfied) 5 4 3 2 1 What were the concerns or technical difficulties present during this video conference?(Check all that apply) audio delay poor audio quality lost connection could not connect to other site poor visual connection Other: What were the notable benefits of this video conference session?(Check all that apply) increased care coordination for child/family reduced travel time and costs increased opportunity for communication and collaboration increased number of participants able to participate increased knowledge of participants exposure to new technology exposure to new resources Other: *What was the total number of round trip miles of driving saved for all participants at your location?*