CCOE Community Partner Survey

NATIONAL COMMUNITY CENTERS OF EXCELLENCE

(CCOE) IN WOMEN’S HEALTH

NATIONAL EVALUATION: ROUND II

CCOE Community Partner Survey

You were selected to participate in Round II of the National Evaluation of the National Community Centers of Excellence in Women’s Health (CCOE) program, based on your partnership with your local CCOE or CCOE—Ambassadors for Change program. The Department of Health and Human Services (DHHS) Office on Women’s Health (OWH) is sponsoring this evaluation. Community partners for the CCOEs were randomly selected to provide input on what community resources the CCOE programs are leveraging and how. Additionally, your responses will help OWH learn how services are integrated between each CCOE and its community partners.

Data gathered from this effort will be aggregated at the national level and individual CCOE level. CCOE-level information will be used for program improvement purposes. At a national level, your feedback will influence future decisions about the CCOE program.

The following topic areas will be covered in the survey. However, please only complete the sections that are applicable to the services and support you provide for the CCOE program.

IMPORTANT: Please read the descriptions listed below for each service:

• Health Service Delivery: Includes a full range of care (including but not limited to: acute, chronic, and preventive care), and incorporates both primary and specialty services (including mental and dental health services, patient education, health promotion, enabling services, and ancillary services).

• Training Health Care Providers: Includes activities such as in-service training, continuing education, workshops and demonstrations, courses, and internship opportunities; and targets a broad spectrum of providers including health care professionals, students, residents, and lay health care workers.

• Community Research: Includes original patient-oriented research, population-based research to facilitate women’s entry into clinical trial(s)/patient-oriented research, linkages with other organizations conducting community-based research, other creative research projects that utilize community resources, and participation in the national CCOE evaluation.

• Public Education and Outreach: Includes patient educational materials, activities, and outreach such as: distance learning; working with the media; health fairs; outreach workers; resource centers; partnerships with libraries, pharmacies, stores/businesses, schools, faith-based, and other organizations.

• Leadership Development: Leadership development for women in the health professions supports strategies to encourage women to join and remain in the health professions and to become leaders in their communities. Activities may include: mentoring, leadership training, skills development, shadowing, providing employment opportunities, and internships for students.

• Technical Assistance (TA): Focused on sharing and promoting the CCOE model of care to other organizations and communities.

It is estimated that the survey will take approximately 20-30 minutes to complete once data is gathered.

Please complete a working draft of this survey on paper prior to completing the actual online survey. This draft will assist you in filling out the Internet survey. (Note: You must complete the entire Internet survey at one time. Any data entered but not submitted will not be saved. Partially completed surveys cannot be accepted.)

The information you provide will be kept confidential, and will not be disclosed to anyone but the Department of Health and Human Services (DHHS) Office on Women’s Health (OWH) in aggregate form only, except as otherwise required by law. If you have any questions on how to complete this survey please contact Fatima Riaz at (240) 314-5675 or at 1101 Wootton Parkway, Suite 9246, Rockville, MD 20852.

Thank you in advance for your participation!

CP_GI_01_2006. What is the name of your organization? ________________________

CP_GI_02_2006. Please select the CCOE you have a partnership with.

• Christiana Care Health System

• Great Plains of Greeley County

• Griffin Health Services Corporation

• Hennepin County Department of Primary Care / North Point Health and Wellness Center

• Jefferson Health System

• Kokua Kalihi Valley Comprehensive Family Services

• Mariposa Community Health Center

• Morton Plant Hospital / Turley Family Health Center

• Northeastern Vermont Area Health Education Center

• Northeast Missouri Health Council, Inc.

• NorthEast Ohio Neighborhood Health Services, Inc.

• Oakhurst Medical Centers

• St. Barnabas Hospital and Healthcare System

• Women’s Health Services

CP_GI_03_2006. Please select the type of service(s) your organization offers to CCOE participants only and list each service offered:

Example: Health care delivery services: physical exams, lab tests

• A. Health care delivery services: _________________________________________

• B Training lay, allied health, and/or professional health care providers: _____________________

• C Community-based research: __________________________________________

• D. Public education and outreach: ________________________________________

• E Leadership development: _____________________________________________

• F Technical assistance: ________________________________________________

• G Enabling services, such as child care, transportation: ______________________

• H Other, please specify: _______________________________________________

CP_GI_03.1_2006. How would you rate your relationship with the CCOE?

• Excellent

• Good

• Fair

• Poor

CP_GI_03.2_2006. How would you rate your relationship with other CCOE partners?

• Excellent

• Good

• Fair

• Poor

CP_GI_03.3_2006. What has contributed to the success of your partnerships? Select all that apply:

• Contract

• Length of relationship

• Physical location of the partner

• Interpersonal relationship between coordinators

• CCOE board membership and involvement

• Mutual benefit to both organizations

• CP_GI_03.4_2006. Other, please specify ________________________

CP_GI_03.5_2006. Please describe how your partnership with the CCOE has impacted your organization and its ability to provide services to women.

CP_GI_03.6_2006. How has your partnership with the CCOE improved access to health care services?

CP_GI_03.7_2006. What steps have been taken to remove service barriers?

CP_GI_04_2006. Does your organization have procedures for tracking women served by the CCOE program?

• Yes

• No

CP_GI_04B_2006. If yes, how do you track these women?

• Electronic medical record system

• Paper record

• CP_GI_04C_2006Other: ______________________________

CP_GI_04D_2006. If yes, what types of information do you track?

• Cost of Services

• Services rendered by CCOE

• Services rendered by Partner Organizations

• Non-health care services rendered by CCOE

• Non-health care services rendered by Partner Organizations

• CCOE patient referrals

• CCOE patient referral compliance

• Wellness check compliance

• Number of women receiving health care services

• CP_GI_04E_2006Other: ______________________________

CP_GI_04F_2006. Do you share your patients’ clinical data with the CCOE (within the confines and in compliance of HIPAA and any other statute or regulation governing privacy)?

• Yes

• No

CP_GI_05_2006. What is the average wait time for a CCOE referred patient to get an appointment (consider only the health professional’s availability and exclude conflicts in the patient’s schedule)?

• 1 – 3 days

• 4 – 7 days

• 2 – 3 weeks

• One month

• Over one month

CP_HSD_01_2006. For each health professional listed, please indicate how many current full-time equivalents (FTEs) provide care to CCOE participants (e.g., part time nurse practitioner = .5 FTE). Decimals are acceptable. For each health professional, estimate the number of female staff and the number of multilingual staff. Also, please indicate the languages spoken by the health professionals.

health professional	# of FTE’s providing Service	# of female staff	# of MULTILINGUAL staff (languages spoken)
Example: Community Health Worker/ Outreach Worker	5	4	1 (Spanish)
Endocrinologist	01.	01A.	01B.
Family Physician or General Practitioner	02	02A	02B
Health or Peer Educator	03	03A	03B
Internist or Internal Medicine Physician	04	04A	04B
Mental Health Professional (e.g., Licensed Counselor, Psychiatrist, Psychologist, Social Worker)	05	05A	05B
Nurse Midwife	06	06A	06B
Nurse Practitioner (NP)	07	07A	07B
Nutritionist	08	08A	08B
Obstetrician or Gynecologist	09	09A	09B
Pediatrician	10	10A	10B
Physician’s Assistant (PA)	11	11A	11B
Registered Nurse (RN)	12	12A	12B
Substance Abuse Counselor	13	13A	13B
Other: __________________	14	14A	14B

CP_HD_06_2006. Please describe how your organization’s health care service delivery is integrated with the CCOE program and other partner organizations.

CP_HD_07A_2006. What are the best practices related to health service delivery and coordination with the CCOE? CP_GI_04B_2006. What are your lessons learned?

CP_HD_07C_2006. What are the biggest issues or concerns related to health service delivery and coordination with the CCOE?

Training Health Care Providers and Community Health Care Workers

CP_TR_08_2006. Please describe how your organization’s training is integrated with the CCOE program and other partner organizations.

CP_TR_09A_2006. What are the best practices related to implementation of training activities and coordination with the CCOE? CP_TR_09B_2006. What are your lessons learned?

CP_TR_09c_2006. What are the biggest issues or concerns related to implementation of training activities and coordination with the CCOE?

CP_CR_10_2006. How are research results communicated to the public? Please select all that apply.

• Internet

• Newspaper

• Internal newsletter

• Journal or magazine advertisements

• Published in a journal or magazine

• Television/radio

• Lectures

• Educational materials/brochures

• During an office visit (staff or doctor communicate results)

• CP_CR_10A_2006. Other, please specify: _______________________________________________

CP_CR_11_2006. Please describe how your organization’s community research results are integrated into the CCOE program and/or the local community.

CP_CR_12A_2006. What are the best practices related to implementation of community research and coordination with the CCOE? CP_CR_12B_2006. What are your lessons learned?

CP_CR_12c_2006. What are the biggest issues or concerns related to implementation of community research and coordination with the CCOE?

Please rate the extent to which you agree with each of the following statements.

Educational materials distributed by my organization…	Strongly Agree	Agree	Neither agree nor disagree	Disagree	Strongly Disagree
• CP_EO_13_2006…are available in large font	○	○	○	○	○
• CP_EO_14_2006…are available in language(s) other than English	○	○	○	○	○
• CP_EO_15_2006…are appropriate to the reading level of the targeted audience	○	○	○	○	○
• CP_EO_16_2006 …address important issues in the community	○	○	○	○	○
• CP_EO_17_2006…are geared toward prevention (i.e., smoking cessation, drug avoidance, nutrition guidance, etc.,)	○	○	○	○	○
• CP_EO_17A_2006…help patients improve their health literacy	○	○	○	○	○
• CP_EO_17B_2006…are aimed at empowering patients to manage their own health	○	○	○	○	○

CP_EO_18_2006. Please describe how your organization’s education and outreach programs and activities are integrated with the CCOE program and other partner organizations.

CP_EO_18A_2006. How does the CCOE partner measure the success of one method of outreach versus another?

CP_EO_18B_2006. What are the top three most successful methods?

1.

2.

3.

CP_EO_19A_2006. What are the best practices related to education and outreach activities and coordination with the CCOE? CP_EO_19B_2006. What are your lessons learned?

CP_EO_19C_2006. What are the biggest issues or concerns related to education and outreach activities and coordination with the CCOE?

CP_LD_20_2006. Please describe how your organization’s leadership and skills development activities are integrated with the CCOE program and other partner organizations.

CP_LD_21_2006. Do other organizations, besides the CCOE and your organization, provide free or low cost leadership training and skills development opportunities to women in the community?

• Yes

• No

CP_LD_21A_2006. If yes, please describe what the opportunities are and the community organizations that provide them.

CP_LD_22A_2006. What are the best practices related to implementation of leadership development activities and coordination with the CCOE? CP_LD_22B_2006. What are your lessons learned?

CP_LD_22C_2006. What are the biggest issues or concerns related to implementation of leadership development activities and coordination with the CCOE?

CP_TA_23_2006. During the last year, have you provided or assisted the CCOE in providing other communities and/or organizations with information on how to replicate the CCOE model?

• Yes

• No

CP_TA_23A_2006. If yes, please describe the type of assistance or information your organization provided.

CP_TA_24A_2006. What are the best practices related to implementation of technical assistance activities and coordination with the CCOE? CP_TA_24B_2006. What are your lessons learned?

CP_TA_24C_2006. What are the biggest issues or concerns related to implementation of technical assistance activities and coordination with the CCOE?

Other Services

CP_OTH_01_2006. Please list any additional services your organization provides to the CCOE program (that were not mentioned in this survey). For each service, provide a brief description of the services provided.

service 1-2	description 1A-2A

1