Attachment 3_HCAPQuestionnaire

Attachment 3_HCAPQuestionnaire.doc

An Assessment of the Sustainability and Impact of Community Coalitions Once Federal Funding Has Expired

Attachment 3_HCAPQuestionnaire

OMB: 0990-0368

Document [doc]
Download: doc | pdf






Survey of CAP/HCAP Coalitions Post-Federal Funding







Introduction


This survey is being conducted by the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services and NORC, a national organization for research at the University of Chicago, as part of a study to assess the status of community coalitions that received Community Access Program (CAP) or Healthy Communities Access Program (HCAP) funding. The survey should take 40 – 50 minutes to complete and is an important part of the overall study.


This survey asks questions about the current structure, activities, and impacts of coalitions that received CAP/HCAP funding and asks for some comparisons to the coalition during the CAP/HCAP grant period. NORC has identified you as the most knowledgeable person about the coalition and its CAP/HCAP history. However, we do not expect you to be able to answer all the questions yourself. We encourage you to ask other people involved with the coalition for help completing the survey. If you think that there is someone else that would be better suited to answer these questions, please send an email to HCAP@norc.org and tell us who we should contact.


If you have any questions about the study, please contact the NORC Project Director, Caitlin Oppenheimer, at (301) 634-9322.


Your cooperation is very much appreciated.


Section I: Background Information

  1. Does your CAP/HCAP coalition still exist? By this we mean that there is currently an alliance of at least three member organizations. We expect that the coalition has evolved since the CAP/HCAP grant; it may even have changed names, size, members, or goals. But what we are asking here is simply whether it’s currently in existence.

a. Yes

b. No (skip to Section VI)

  1. What is the current name of the coalition previously funded by the CAP/HCAP grant?


  2. Does the coalition have a webpage?

www.

a. Yes What is the web address?

b. No

  1. What is your role in the coalition? Please select the appropriate statement.

a. I am the day-to-day manager/administrator of the coalition.

b. I am a leader of the coalition, but I do not mange the day-to-day operations and activities.

c. Other (specify):




  1. Were you involved in any way with the coalition when it was funded by the CAP/HCAP grant?


a. Yes Briefly describe your role:

b. No


Section II: Characteristics of Your Coalition

This section asks about some of the features of your coalition, including your coalition’s: size, composition of membership, vision, mission, goals, funding, structure, evaluation efforts, and community served.

Remember, we do not expect you to be able to answer all the questions yourself. We encourage you to ask other people involved with the coalition for help completing the survey. If you think that there is someone else that would be better suited to answer these questions, please send an email to HCAP@norc.org and tell us who we should contact.

Community Served by the Coalition

  1. What is the approximate size of the population in the area where your coalition works?




    ,




    ,




  2. What are some of the characteristics of the population receiving services from your coalition? (Check all that apply.)

a. Urban

b. Rural

c. Suburban

d. Uninsured

e. Underinsured/underserved

f. White

g. African American

h. Hispanic/Latino

i. Asian American/Pacific Islander

j. Native American

k. Other racial or ethnic group (specify):


l. Low-income

m. Middle-income

n. High-income

o. Other (specify):




Coalition Membership

  1. How many organizations are members of your coalition?




  2. Of these, how many organizations would you consider to be active members?




  3. About how often do new organizations join the coalition?

a. Never

b. Less than once every two years

c. About once a year

d. About once every six months

e. About once every three months

f. More than once every three months

  1. About how often does the coalition lose member organizations?

a. Never

b. Less than once every two years

c. About once a year

d. About once every six months

e. About once every three months

f. More than once every three months

  1. What is the most common reason for membership turnover?

a. Changes in coalition funding

b. Shifts in coalition projects and activities

c. Reassessment of the coalition’s membership needs and priorities

d. Changes within the member organization (e.g., new leadership, shift in priorities)

e. Other (specify):


  1. What sectors and types of organizations do coalition members represent?
    (Check all that apply.)

Health

Social Services

Federally Qualified Health Centers

Academic medical centers

Free clinics/other community health centers

Migrant health centers

Public housing primary care programs

Public or private health care providers/ practices

Hospitals with a low-income utilization rate greater than 25%

Other hospitals

Area health education centers

Primary care associations

Managed care organizations

Medical/dental societies

Specialty care providers

Oral health providers

Long-term care providers

Home health providers

Laboratories

Pharmacies

Private insurance providers

Medicaid programs

Rural health clinics

Other health care coverage programs

Community-based organizations

School-based health centers

Other

Schools

Child care providers

Low-income housing providers

Employment programs

Temporary housing and shelter providers

Food aid programs

Violence prevention programs

Juvenile justice programs

Adult justice and prisoner reentry programs

Community-based organizations

Other

Education

Universities/colleges

Academic public health programs and departments

Medical schools

Dental schools

Policy centers

Evaluation centers

Undergraduate and graduate internship programs

Student organizations

Student health clinics

Other

Government

Other

State public health departments

Local public health departments

Veterans Administration

Local governments

State governments

Tribal governments

Elected officials

Local or state political staff
(e.g., advisor to the mayor)

Other

Consumer advocacy groups

Philanthropic organizations

Foundations, businesses (for profit)

Businesses (non profit)

Chambers of commerce/ small business organizations

Large employers

Small employers

Employee unions

Transit authorities

Tribal (non-government)

Other

Substance Abuse & Mental Health

Faith

Mental health programs/providers

Substance abuse programs

Community-based organizations

Other

Churches

Synagogues

Mosques

Other houses of worship

Parochial schools

Faith-based organizations

Other

Coalition Mission & Goals

  1. Is your coalition working to achieve some or all of the same goals it addressed under the CAP/HCAP grant?

a. No, none of the same goals

b. Yes, at least one of the same goals

c. Yes, all of the same goals

  1. Has your coalition added one or more new goals since the end of your CAP/HCAP grant?

a. Yes Please list all of your new goals:


b. No (SKIP TO Q17)

  1. Why did your coalition add one or more new goals?

a. To attract new members

b. To qualify for new funding sources

c. To address new or additional needs of the community

d. Other (specify):




  1. Please indicate how much you disagree or agree with the following statements:

Your coalition’s:

Strongly Disagree

Disagree

Agree

Strongly Agree

No Opinion/
Not Applicable

a.

vision, mission, and goals are documented.

1

2

3

4

5

b.

vision, mission, and goals take into account what is happening in the community.

1

2

3

4

5

c.

member organizations agree on the coalition’s vision, mission, and goals.

1

2

3

4

5

d.

member organizations are committed to pursuing activities to achieve the coalition’s vision, mission, and goals.

1

2

3

4

5

e.

vision, mission, and goals are understood by residents and institutions in your community

1

2

3

4

5

f.

vision, mission, and goals are periodically
re-evaluated or updated.

1

2

3

4

5

g.

activities are evaluated in relation to its vision, mission, and goals.

1

2

3

4

5

Coalition Structure

  1. Does your coalition currently have a lead organization?

a. Yes

b. No (SKIP TO Q21)

  1. What type of organization currently leads the coalition? Please choose from the types of organizations you listed as members in Q13.


  2. Has the lead organization changed since the end of the CAP/HCAP grant?

a. Yes What was the former lead organization?


b. No

  1. Does your coalition have any of the following boards or committees? (Check all that apply.)

a. Steering Committee (a committee made up of representatives from member organizations who work with the consortia leadership)

b. Board of Directors (a group of individuals external to the consortia who provide input and/or oversight to the consortia leadership)

c. Executive Committee (a small group of consortia leadership responsible for consortia operations)

d. Community Advisory Board (a group of lay-persons from the community who provide input on consortia activities and direction)

  1. What is the structure of your coalition membership?

a. Formal, such as legally incorporated or Memoranda of Understanding

b. Informal, such as letters of support or verbal agreements (SKIP TO Q24)

c. Other (specify):


  1. Does your coalition have Memoranda of Understanding or inter-agency agreements with any coalition members?

a. Yes, with all of our members

b. Yes, with most of our members

c. Yes, with some of our members

d. No, not with any of our members

  1. How many paid staff, in terms of full-time equivalents (FTEs), are employed by the coalition?




  2. Has the size of the coalition’s FTE staff changed since the end of the CAP/HCAP grant?

a. Yes, we have more staff now than we did during the CAP/HCAP grant.

b. Yes, we have fewer staff now than we did during the CAP/HCAP grant.

c. No, we have the same size staff now as we did during the CAP/HCAP grant.

  1. Please indicate how much you disagree or agree with the following statements:


    Strongly Disagree

    Disagree

    Agree

    Strongly Agree

    No Opinion/ Not Applicable

    a.

    Your coalition has a regular, reliable meeting cycle.

    1

    2

    3

    4

    5

    b.

    Your coalition has active committees.

    1

    2

    3

    4

    5

    c.

    All of your members have copies of the coalition bylaws.

    1

    2

    3

    4

    5

    d.

    Your coalition’s executive board/leadership team meets regularly and with good attendance.

    1

    2

    3

    4

    5

    e.

    Your coalition’s executive board/ leadership team communicates with committees and members on a regular basis.

    1

    2

    3

    4

    5

  2. About how often do all coalition members convene for formal meetings?

a. Every month or more

b. Every one to three months

c. Every four to six months

d. Once a year or less

e. Never

  1. Does your coalition have formal decision making processes (e.g., consensus or majority policies)?

a. Yes

b. No

  1. Does your coalition have a formal process for managing conflicts among members and/or between members and coalition leadership?

a. Yes

b. No

  1. Please indicate how much you disagree or agree with the following statements:

Coalition members:

Strongly Disagree

Disagree

Agree

Strongly Agree

No Opinion/ Not Applicable

a.

are involved in project design.

1

2

3

4

5

b.

are involved in project implementation.

1

2

3

4

5

c.

share responsibility for providing project resources.

1

2

3

4

5

d.

share credit for project successes.

1

2

3

4

5

e.

have clearly defined roles and responsibilities.

1

2

3

4

5


  1. Please provide some information about your coalition’s leader or director.
    Check the appropriate box for each of the questions below.

How long has the coalition leader or director:

1 year or less

Between 1 year and 3 years

3-5 years

5-10 years

More than 10 years

No Opinion/
Not Applicable

a.

directed or managed the coalition?

1

2

3

4

5

6

b.

worked in the field of health care delivery or health care administration?

1

2

3

4

5

6

c.

lived or worked in the community served by the coalition?

1

2

3

4

5

6


  1. Please indicate how much you disagree or agree with the following statements:

Your coalition’s leadership:

Strongly Disagree

Disagree

Agree

Strongly Agree

No Opinion/ Not Applicable

a.

had a strong connection to the community prior to assuming leadership of the coalition.

1

2

3

4

5

b.

fosters active involvement of other key stakeholders (e.g., board members, leaders of membership organizations, community organizers, etc.).

1

2

3

4

5

c.

is good at negotiating, facilitating groups, networking, and other skills that help foster relationships with community stakeholders.

1

2

3

4

5

d.

communicates a clear mission and vision for the coalition with all its members.

1

2

3

4

5

e.

has expertise in the health and social issues the coalition is addressing.

1

2

3

4

5

Coalition Funding Resources

  1. Does your coalition currently receive financial resources from any of the following sources? If so, please estimate the percentage of your budget from each source and check whether those funds are used for coalition operations (e.g., office space, core staff), programmatic activities (e.g., service delivery, interventions), or both. Finally, please tell us if you feel that you can count on that source of funding from year to year.


    Yes/
    No

    %
    Overall Budget

    Operations,
    Programmatic
    Activities, or Both

    Is this a source of funding that our coalition can count on from year to year?

    a. U.S. Department of Health and
    Human Services

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    b. Other Federal Agency/Department
    (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    c. State Health Department

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    d. Other State Agency/Department
    (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    e. Local (county or community)
    Health Department

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    f. Other Local (county or community) Agency/Department (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    g. United Way

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    h. Foundations
    (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    i. Businesses
    (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    j. Universities/Academic Institutions
    (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    k. Community Based Organizations
    (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    l. Faith Based Organizations
    (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    m. Other (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

  2. Does your coalition currently receive in-kind contributions from its members? If so, please check the types of in-kind contributions the coalition receives and check whether those contributions are used for coalition operations, programmatic activities, or both.


Yes/No

Operations, Programmatic Activities, or Both

a. Facilities (e.g., office space, exam rooms)

1 Yes

2 No

1 Operations

2 Programmatic Activities

3 Both

b. Equipment and Supplies (e.g., computers, brochures, test kits)

1 Yes

2 No

1 Operations

2 Programmatic Activities

3 Both

c. Salary Sharing/Time Coverage for Key Coalition Personnel

1 Yes

2 No

1 Operations

2 Programmatic Activities

3 Both

d. Volunteers

1 Yes

2 No

1 Operations

2 Programmatic Activities

3 Both

e. Administrative Staff or Services

1 Yes

2 No

1 Operations

2 Programmatic Activities

3 Both

f. Provider Staff or Services

1 Yes

2 No

1 Operations

2 Programmatic Activities

3 Both

g. Grant Writing Staff or Services

1 Yes

2 No

1 Operations

2 Programmatic Activities

3 Both

h. Evaluation Staff or Services

1 Yes

2 No

1 Operations

2 Programmatic Activities

3 Both

i. Other Staff or Services
(specify): _________________________

1 Yes

2 No

1 Operations

2 Programmatic Activities

3 Both

j. Other
(specify): _________________________

1 Yes

2 No

1 Operations

2 Programmatic Activities

3 Both


  1. How stable is the funding stream for your coalition? In general, would you say that funding:

a. increases from year to year

b. is the same from year to year

c. decreases from year to year

d. changes significantly in either direction from year to year

  1. How would you describe your current funding situation compared to your funding situation during your time as a CAP/HCAP grantee?


Less than during CAP/HCAP grant

Same as during CAP/HCAP grant

More than during CAP/HCAP grant

a. Diversity of funding sources

1

2

3

b. Funding earmarked for programs, services, or activities

1

2

3

c. Funding for coalition operations

1

2

3

d. Flexibility to allocate funds wherever they
are needed or can be most effective

1

2

3

e. Certainty about sources of future funding

1

2

3

Coalition Evaluation Activities

  1. Please indicate how much you disagree or agree with the following statements:


    Strongly Disagree

    Disagree

    Agree

    Strongly Agree

    No Opinion/ Not Applicable

    a. Your coalition develops evaluation plans prior to implementing programs, services, and activities.

    b. Evaluations of your coalition’s core operations (e.g., community communications) are conducted on a regular basis.

    c. Evaluations of your coalition’s programs, services, and activities are conducted on a regular basis.

    d. Project effectiveness is demonstrated through evaluation.

  2. What, if any, types of evaluation methodologies and tools has your coalition used to assess the effectiveness of your operations or programs, services, and activities?
    (Check all that apply.)

a. Process evaluation

b. Program monitoring

c. Outcomes evaluation

d. Empowerment evaluation

e. Evaluation capacity building (e.g., building capacity among member organizations to conduct evaluative activities)

f. Quantitative methods (e.g., secondary analysis of data sets, survey analysis)

g. Qualitative methods (e.g., focus groups, interviews)

h. Experimental or quasi-experimental designs (e.g., control and intervention populations)

i. Other (specify):


j. I don’t know

  1. How important are your evaluation activities for each of the following purposes?


Very Important

Somewhat Important

Unimportant

Very Unimportant

No Opinion/ Not Applicable

a. Demonstrating results to your community

1

2

3

4

5

b. Demonstrating results to your funders

1

2

3

4

5

c. Competing for funding more successfully

1

2

3

4

5

d. Modifying coalition operations (e.g., staff, convening membership meetings)

1

2

3

4

5

e. Modifying coalition programs, services, and activities

1

2

3

4

5

f. Long-term/sustainability planning

1

2

3

4

5



Section III: Coalition Activities

This section is about the types of activities your coalition has been conducting since receiving the CAP/HCAP grant. By activities, we mean the projects, programs, products, and services your coalition works on to serve the community.

Remember, we do not expect you to be able to answer all the questions yourself. We encourage you to ask other people involved with the coalition for help completing the survey. If you think that there is someone else that would be better suited to answer these questions, please send an email to HCAP@norc.org and tell us who we should contact.

  1. Please check all the activities your coalition has conducted since you first received your CAP/HCAP grant.

    Programs & Services

    Capacity Building

    Enrollment assistance for entitlement programs

    Pharmacy assistance

    Coordination of social services

    Translation services

    Patient navigation

    New insurance plans

    Care coordination

    New provider sites and access points

    Testing sites

    Establishing medical homes

    Expanding access to specialty services

    Direct health services

    Other

    Providing technical assistance and training to other organizations (e.g., how to conduct needs assessments, evaluation training)

    Establishing networks of organizations

    Community leader development programs

    Developing community resource guides

    Other

    Systems Change

    Policy Advocacy and Change

    Integrating data systems

    Data sharing

    Coordinated EMRs

    Coordinated financial management information systems

    Registries

    Coordinated screening and enrollment systems

    Disease management systems

    Cultural competency training

    Pro bono provider systems

    Other

    Informing local leaders and elected officials

    Informing state leaders and elected officials

    Collaborating with local institutions (e.g., school systems to change school lunch policy)

    Participating in local state or regional summits

    Other

    Health Behavior Change

    Dissemination of Information and Products

    Health counseling

    Training peer educators

    Wellness programs

    Screening programs

    Other

    Community newsletters

    Hotlines

    Websites

    Marketing brochures

    Health fairs

    Special events (e.g., bike to work days)

    Outreach materials

    Program materials

    Other

  2. Out of these activities, please select the three activities that made up the largest portion of the coalition’s work during the CAP/HCAP grant period.

Activity #1:



Activity #2:



Activity #3:


  1. Out of these activities, please select the three activities that make up the largest portion of the coalition’s current work.

Activity #1:



Activity #2:



Activity #3:


  1. Is your coalition conducting some or all of the same activities it did under the CAP/HCAP grant?

a. No, none of the same activities

b. Yes, at least one of the same activities

c. Yes, all of the same activities (Skip To Section IV)

d. Yes, all of the same activities in addition to new activities.

  1. Please select the reason(s) why your coalition has changed the activities it conducts or added new activities. (Check all that apply.)

a. The priorities of our funders changed.

b. We added new activities in order to qualify for (or as a result of) receiving new funding.

c. The demographics and/or needs of the population we serve changed.

d. We expanded our reach to a new population that required different activities to achieve our goals.

e. Our evaluation results suggested that we alter or change our activities.

f. Other (specify):


  1. Are the activities you currently conduct consistent with at least one of your coalition’s goals during the CAP/HCAP funding period?

a. Yes

b. No

Section IV: Planning for Sustainability

This section asks about the plans, strategies, and actions your coalition has used since receiving the CAP/HCAP grant to ensure the long-term viability of your coalition and its activities.

Remember, we do not expect you to be able to answer all the questions yourself. We encourage you to ask other people involved with the coalition for help completing the survey. If you think that there is someone else that would be better suited to answer these questions, please send an email to HCAP@norc.org and tell us who we should contact.

  1. According to your coalition’s definition, sustainability of your coalition means:

a. our coalition has the resources it needs to continue operating with our membership and structures in-tact for the long-term.

b. our coalition’s programs, services, and activities will continue in the long-term even if our coalition is no longer in operation.

c. both our coalition and its activities will continue in the long-term.

d. our coalition has made a lasting impact on our community that will continue regardless of whether our coalition or its activities continue operating.

  1. Has your coalition ever developed a sustainability plan?

a. Yes, prior to receiving our CAP/HCAP grant.

b. Yes, within the first year of our CAP/HCAP grant.

c. Yes, after the first year but still prior to the end of our CAP/HCAP grant.

d. Yes, after our CAP/HCAP grant ended.

e. No, but we have plans to develop a sustainability plan.

f. No, and we don’t have any plans to develop a sustainability plan.

  1. What actions, if any, has your coalition ever taken to prepare for sustainability?
    (Check all that apply.)

a. Reassessed the coalition’s goals, activities, or priorities

b. Identified the most effective goals and activities to continue

c. Developed a strategic plan for attaining resources

d. Reduced the membership

e. Reorganized the membership

f. Restructured coalition operations/processes (e.g., fewer meetings, smaller leadership team)

g. Established a committee to strategically address sustainability issues

h. Hired an external consultant to advise the coalition on issues of sustainability

i. Located partners and institutions to take over programs and services developed by the coalition

j. Developed an infrastructure in the community to support systems-level activities

k Ensured appropriate mechanisms for implementation and enforcement of policy activities in the community

l. Other (specify):


  1. Who is involved in sustainability planning at your coalition? (Check all that apply.)

a. Steering Committee (a committee made up of representatives from member organizations who work with the consortia leadership)

b. Board of Directors (a group of individuals external to the consortia who provide input and/or oversight to the consortia leadership)

c Executive Committee (a small group of consortia leadership responsible for consortia operations)

d. Community Advisory Board (a group of lay-persons from the community who provide input on consortia activities and direction)

e. Individual member organizations

f. Coalition staff

g. Other (specify):


  1. When are sustainability issues addressed by the coalition?

a. In the course of regular meetings and planning activities

b. As we near the end of major grants and other funding cycles

c. Only when sustainability becomes a problem

d. Rarely or never

  1. Please indicate how much you disagree or agree with the following statements about your coalition:

    Currently, your coalition:

    Strongly Disagree

    Disagree

    Agree

    Strongly Agree

    No Opinion/ Not Applicable

    a. has leaders who are continually planning for sustainability.

    1

    2

    3

    4

    5

    b. identifies alternative strategies for project survival.

    1

    2

    3

    4

    5

    c. has sufficient funding for current project activities and operations.

    1

    2

    3

    4

    5

    d. has sufficient funding for the next year.

    1

    2

    3

    4

    5

    e. has sufficient funding for the long-term
    (2 or more years).

    1

    2

    3

    4

    5

    f. has sufficient funding for hiring and retaining quality staff.

    1

    2

    3

    4

    5

  2. In your estimation, how likely is it that your coalition will continue to exist 2 years, 5 years, and 10 years from now?


Very
Likely

Somewhat Likely

Somewhat Unlikely

Very
Unlikely

2 years from now

1

2

3

4

5 years from now

1

2

3

4

10 years from now

1

2

3

4

Section V: Coalition Impacts

This section focuses on the types of impacts your coalition has had on the community you serve. By impacts, we mean the intermediate and long-term outcomes of your coalition’s activities on individual health and behavior, the health care system, and policies that affect your community.

Remember, we do not expect you to be able to answer all the questions yourself. We encourage you to ask other people involved with the coalition for help completing the survey. If you think that there is someone else that would be better suited to answer these questions, please send an email to HCAP@norc.org and tell us who we should contact.

  1. Since the end of your CAP/HCAP grant period, how successful has your coalition been at contributing to the following types of impacts?


    Very Unsuccessful

    Unsuccessful

    Successful

    Very Successful

    No Opinion/
    Not Applicable

    a. Changing individual health and behavior outcomes such as immunization or primary care utilization.

    1

    2

    3

    4

    5

    b. Changing systems-level outcomes such as integrated data systems or cultural competency training.

    1

    2

    3

    4

    5

    c. Changing policies such as reimbursement rates, implementing smoking ordinances, or instituting new insurance plans to cover the uninsured.

    1

    2

    3

    4

    5

  2. To what particular individual health and behavior outcomes has your coalition contributed? If relevant, please direct us to documents or websites where these outcomes are described in greater detail.

Outcome #1:



Outcome #2:



Outcome #3:



Outcome #4:



Outcome #5:



Documents and websites where these outcomes are described in greater detail:


  1. About how many of your coalition’s individual health and behavior outcomes will continue to benefit the community without any additional support from the coalition?

a. All

b. Most

c. Some

d. A Few

e. None

f. Did not contribute to any individual health and behavior outcomes

  1. To what particular systems-level outcomes has your coalition contributed? If relevant, please direct us to documents or websites where these outcomes are described in greater detail.

Outcome #1:



Outcome #2:



Outcome #3:



Outcome #4:



Outcome #5:



Documents and websites where these outcomes are described in greater detail:



  1. About how many of your coalition’s systems-level outcomes will continue to benefit the community without any additional support from the coalition?

a. All

b. Most

c. Some

d. A Few

e. None

f. Did not contribute to any system-level outcomes

  1. To what particular policy outcomes has your coalition contributed? If relevant, please direct us to documents or websites where these outcomes are described in greater detail.

Outcome #1:



Outcome #2:



Outcome #3:



Outcome #4:



Outcome #5:



Documents and websites where these outcomes are described in greater detail:


  1. About how many of your coalition’s policy outcomes will continue to benefit the community without any additional support from the coalition?

a. All

b Most

c. Some

d. A Few

e. None

f Did not contribute to any policy outcomes

  1. Thinking through the history of your coalition, which of the following statements most accurately describes your coalition’s impacts? Most of our greatest impacts occurred:

a. early on, before we received CAP/HCAP funding.

b. during our CAP/HCAP funding period.

c. within 1 to 2 years after our CAP/HCAP funding period.

d. 2 or more years after our CAP/HCAP funding period.

e. Our impacts have occurred at a steady pace throughout the history of our coalition.

  1. Many factors outside a coalition’s control have the potential to influence coalition operations, activities, impacts, and the coalition’s chances for sustainability. For each of the following factors, please indicate if it has ever influenced your coalition. If so, please indicate if it was a positive or negative influence.


Has this factor ever had an influence on the coalition’s operations, activities, impacts, or sustainability?

Did the factor have a positive or negative influence on the coalition?

a. A new organization entered the community.

1 Yes

2 No

1 Positive

2 Negative

b. An existing organization closed or left the community.

1 Yes

2 No

1 Positive

2 Negative

c. Local political culture changed (e.g., new administrations, elected officials).

1 Yes

2 No

1 Positive

2 Negative

d. The size and/or demographics of the community changed.

1 Yes

2 No

1 Positive

2 Negative

e. Local policy changed (e.g., size of the public health nursing staff).

1 Yes

2 No

1 Positive

2 Negative

f. State policy changed (e.g., Medicaid reimbursement rates).

1 Yes

2 No

1 Positive

2 Negative

g. Federal policy changed (e.g., Medicare Part D)

1 Yes

2 No

1 Positive

2 Negative

h. The mission or priorities of a funder changed.

1 Yes

2 No

1 Positive

2 Negative

i. Local economic conditions changed.

1 Yes

2 No

1 Positive

2 Negative

j. State or federal economic conditions changed.

1 Yes

2 No

1 Positive

2 Negative

k. A major event changed awareness or attitudes in the community (e.g., the death of an uninsured person is attributed to lack of access to preventive services).

1 Yes

2 No

1 Positive

2 Negative

l. Other factors: _________________________

1 Yes

2 No

1 Positive

2 Negative

Concluding Thoughts

  1. If you could start your coalition over again, what would you do differently?


  2. Is there anything else you think we should know about your coalition?





END

Thank you for completing this survey.

Your responses are valuable.


Please return your questionnaire in the postage-paid envelope to:


Coalition Sustainability Project # 6681

C/O NORC

1 North State Street, Suite 1600

Chicago, Illinois 60602



Section VI: Coalitions that Disbanded

Remember, we do not expect you to be able to answer all the questions yourself. We encourage you to ask other people who were involved with the coalition for help completing the survey. If you think that there is someone else that would be better suited to answer these questions, please send an email to HCAP@norc.org and tell us who we should contact.

  1. In what year did your coalition disband?





  2. Why did the coalition disband? Please select the answer that best describes the situation.

a. The coalition achieved all its goals.

b. The coalition was no longer needed in the community.

c. The coalition ran out of resources.

d. The coalition had organizational problems or conflicts that could not be solved.

e. Other (specify):




Characteristics of Your Coalition

This section asks about some of the features of your coalition, including: the community your coalition served; the size and composition of your coalition’s member organizations; the type of funding your coalition received; the structure of your coalition; and your coalition’s evaluation efforts.

Community Served by the Coalition

  1. What was the approximate size of the population in the area where your coalition worked?




    ,




    ,




  2. What were some of the characteristics of the population that received services from your coalition? (Check all that apply.)

a. Urban

b. Rural

c. Suburban

d. Uninsured

e. Underinsured/underserved

f. White

g. African American

h. Hispanic/Latino

i. Asian American/Pacific Islander

j. Native American

k. Other racial or ethnic group (specify):


l. Low-income

m . Middle-income

n. High-income

o. Other (specify):


Coalition Membership

  1. How many organizations were members of your coalition?




  2. Of these, how many organizations did you consider to be active members?




  3. About how often did new organizations join the coalition?

a. Never

b. Less than once every two years

c. About once a year

d. About once every six months

e. About once every three months

f. More than once every three months

  1. About how often did the coalition lose member organizations?

a. Never

b. Less than once every two years

c. About once a year

d. About once every six months

e. About once every three months

f. More than once every three months

  1. What was the most common reason for membership turnover?

a. Changes in coalition funding

b. Shifts in coalition projects and activities

c. Reassessment of the coalition’s membership needs and priorities

d. Changes within the member organization (e.g., new leadership, shift in priorities)

e. Other (specify):


  1. What sectors and types of organizations did coalition members represent?
    (Check all that apply.)

Health

Social Services

Federally Qualified Health Centers

Academic medical centers

Free clinics/other community health centers

Migrant health centers

Public housing primary care programs

Public or private health care providers/ practices

Hospitals with a low-income utilization rate greater than 25%

Other hospitals

Area health education centers

Primary care associations

Managed care organizations

Medical/dental societies

Specialty care providers

Oral health providers

Long-term care providers

Home health providers

Laboratories

Pharmacies

Private insurance providers

Medicaid programs

Rural health clinics

Other health care coverage programs

Community-based organizations

School-based health centers

Other

Schools

Child care providers

Low-income housing providers

Employment programs

Temporary housing and shelter providers

Food aid programs

Violence prevention programs

Juvenile justice programs

Adult justice and prisoner reentry programs

Community-based organizations

Other

Education

Universities/colleges

Academic public health programs and departments

Medical schools

Dental schools

Policy centers

Evaluation centers

Undergraduate and graduate internship programs

Student organizations

Student health clinics

Other

Government

Other

State public health departments

Local public health departments

Veterans Administration

Local governments

State governments

Tribal governments

Elected officials

Local or state political staff (e.g., advisor to the mayor)

Other

Consumer advocacy groups

Philanthropic organizations

Foundations, businesses (for profit)

Businesses (non profit)

Chambers of commerce/ small business organizations

Large employers

Small employers

Employee unions

Transit authorities

Tribal (non-government)

Other

Substance Abuse & Mental Health

Faith

Mental health programs/providers

Substance abuse programs

Community-based organizations

Other

Churches

Synagogues

Mosques

Other houses of worship

Parochial schools

Faith-based organizations

Other

Coalition Structure

  1. Did your coalition have a lead organization?

a. Yes

b. No (SKIP TO Q76)

  1. What type of organization led the coalition? Please choose from the types of organizations you listed as members in Q73.


  2. Did your coalition have any of the following boards or committees? (Check all that apply.)

a. Steering Committee (a committee made up of representatives from member organizations who work with the consortia leadership)

b. Board of Directors (a group of individuals external to the consortia who provide input and/or oversight to the consortia leadership)

c. Executive Committee (a small group of consortia leadership responsible for consortia operations)

d. Community Advisory Board (a group of lay-persons from the community who provide input on consortia activities and direction)

  1. What was the structure of your coalition membership?

a. Formal, such as legally incorporated or Memoranda of Understanding

b. Informal, such as letters of support or verbal agreements (SKIP TO Q79)

c. Other (specify):


  1. Did your coalition have written Memoranda of Understanding or inter-agency agreements with any coalition members?

a. Yes, with all of our members

b. Yes, with most of our members

c Yes, with some of our members

d. No, not with any of our members

  1. How many paid staff, in terms of full-time equivalents (FTEs), were employed by the coalition?






  1. Please indicate how much you disagree or agree with the following statements:


    Strongly Disagree

    Disagree

    Agree

    Strongly Agree

    No Opinion/ Not Applicable

    a. Your coalition had a regular, reliable meeting cycle.

    1

    2

    3

    4

    5

    b. Your coalition had active committees.

    1

    2

    3

    4

    5

    c. All of your members had copies of the coalition bylaws.

    1

    2

    3

    4

    5

    d. Your coalition’s executive board/leadership team met regularly and with good attendance.

    1

    2

    3

    4

    5

    e. Your coalition’s executive board/leadership team communicated with committees and members on a regular basis.

    1

    2

    3

    4

    5

  2. About how often did all coalition members convene for formal meetings?

a. Every month or more

b. Every one to three months

c. Every four to six months

d. Once a year or less

a. Never

  1. Did your coalition have formal decision making processes (e.g., consensus or majority policies)?

a. Yes

b. No

  1. Did your coalition have a formal process for managing conflicts among members and/or between members and coalition leadership?

a. Yes

b. No

  1. Please indicate how much you disagree or agree with the following statements:

    Coalition members:

    Strongly Disagree

    Disagree

    Agree

    Strongly Agree

    No Opinion/ Not Applicable

    a. were involved in project design.

    1

    2

    3

    4

    5

    b. were involved in project implementation.

    1

    2

    3

    4

    5

    c. shared responsibility for providing project resources.

    1

    2

    3

    4

    5

    d. shared credit for project successes.

    1

    2

    3

    4

    5

    e. had clearly defined roles and responsibilities.

    1

    2

    3

    4

    5

  2. Please provide some information about your coalition’s leader or director. Check the appropriate box for each of the questions below.

    How long had the coalition leader or director:

    1 year or less

    Between 1 year and 3 years

    3-5 years

    5-10 years

    More than 10 years

    No Opinion/ Not Applicable

    a. directed or managed the coalition?

    1

    2

    3

    4

    5

    1

    b. worked in the field of health care delivery or health care administration?

    1

    2

    3

    4

    5

    1

    c. lived or worked in the community served by the coalition?

    1

    2

    3

    4

    5

    1

  3. Please indicate how much you disagree or agree with the following statements:

Your coalition’s leadership:

Strongly Disagree

Disagree

Agree

Strongly Agree

No Opinion/ Not Applicable

a. had a strong connection to the community prior to assuming leadership of the coalition.

1

2

3

4

5

b. fostered active involvement of other key stakeholders (e.g., board members, leaders of membership organizations, community organizers, etc.).

1

2

3

4

5

c. was good at negotiating, facilitating groups, networking, and other skills that help foster relationships with community stakeholders.

1

2

3

4

5

d. communicated a clear mission and vision for the coalition with all its members.

1

2

3

4

5

e. had expertise in the health and social issues the coalition is addressing.

1

2

3

4

5

Coalition Funding Resources

  1. Did your coalition receive financial resources from any of the following sources? If so, please estimate the percentage of your budget from each source and check whether those funds were used for coalition operations (e.g., office space, core staff), programmatic activities (e.g., service delivery, interventions), or both.


    Yes/
    No

    %
    Overall Budget

    Operations,
    Programmatic
    Activities, or Both

    Is this a source of funding that our coalition can count on from year to year?

    a. U.S. Department of Health and
    Human Services

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    b. Other Federal Agency/Department
    (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    c. State Health Department

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    d. Other State Agency/Department
    (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    e. Local (county or community)
    Health Department

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    f. Other Local (county or community) Agency/Department (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    g. United Way

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    h. Foundations
    (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    i. Businesses
    (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    j. Universities/Academic Institutions
    (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    k. Community Based Organizations
    (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    l. Faith Based Organizations
    (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

    m. Other (specify): _______________________

    1 Yes

    2 No


    1 Operations

    2 Programmatic Activities

    3 Both

    1 Yes

    2 No

  2. Did your coalition receive in-kind contributions from its members? If so, please check the types of in-kind contributions the coalition received and check whether those contributions were used for coalition operations, programmatic activities, or both.


    Yes/No

    Operations, Programmatic Activities, or Both

    a. Facilities (e.g., office space, exam rooms)

    1 Yes

    2 No

    1 Operations

    2 Programmatic Activities

    3 Both

    b. Equipment and Supplies (e.g., computers, brochures, test kits)

    1 Yes

    2 No

    1 Operations

    2 Programmatic Activities

    3 Both

    c. Salary Sharing/Time Coverage for Key Coalition Personnel

    1 Yes

    2 No

    1 Operations

    2 Programmatic Activities

    3 Both

    d. Volunteers

    1 Yes

    2 No

    1 Operations

    2 Programmatic Activities

    3 Both

    e. Administrative Staff or Services

    1 Yes

    2 No

    1 Operations

    2 Programmatic Activities

    3 Both

    f. Provider Staff or Services

    1 Yes

    2 No

    1 Operations

    2 Programmatic Activities

    3 Both

    g. Grant Writing Staff or Services

    1 Yes

    2 No

    1 Operations

    2 Programmatic Activities

    3 Both

    h. Evaluation Staff or Services

    1 Yes

    2 No

    1 Operations

    2 Programmatic Activities

    3 Both

    i. Other Staff or Services
    (specify): _________________________

    1 Yes

    2 No

    1 Operations

    2 Programmatic Activities

    3 Both

    j. Other
    (specify): _________________________

    1 Yes

    2 No

    1 Operations

    2 Programmatic Activities

    3 Both

  3. How stable was the funding stream for your coalition? In general, would you say that funding:

a. increased from year to year.

b. was the same from year to year.

c. decreased from year to year.

d. changed significantly in either direction from year to year.

Coalition Evaluation Activities

  1. Please indicate how much you disagree or agree with the following statements:


    Strongly Disagree

    Disagree

    Agree

    Strongly Agree

    No Opinion/ Not Applicable

    a. Your coalition developed evaluation plans prior to implementing programs, services, and activities.

    1

    2

    3

    4

    5

    b. Evaluations of your coalition’s core operations (e.g., community communications) were conducted on a regular basis.

    1

    2

    3

    4

    5

    c. Evaluations of your coalition’s programs, services, and activities were conducted on a regular basis.

    1

    2

    3

    4

    5

    d. Project effectiveness was demonstrated through evaluation.

    1

    2

    3

    4

    5

  2. What, if any, types of evaluation methodologies and tools did your coalition use to assess the effectiveness of your operations or programs, services, and activities?
    (Check all that apply.)

a. Process evaluation

b. Program monitoring

c. Outcomes evaluation

d. Empowerment evaluation

e. Evaluation capacity building (e.g., building capacity among member organizations to conduct evaluative activities)

f. Quantitative methods (e.g., secondary analysis of data sets, survey analysis)

g. Qualitative methods (e.g., focus groups, interviews)

h. Experimental or quasi-experimental designs (e.g., control and intervention populations)

i. Other (specify):


j. I don’t know

  1. How important were your evaluation activities for each of the following purposes?


Very Important

Somewhat Important

Unimportant

Very Unimportant

No Opinion/
Not Applicable

a. Demonstrating results to your community

1

2

3

4

5

b. Demonstrating results to your funders

1

2

3

4

5

c. Competing for funding more successfully

1

2

3

4

5

d. Modifying coalition operations (e.g., staff, convening membership meetings)

1

2

3

4

5

e. Modifying coalition programs, services, and activities

1

2

3

4

5

f. Long-term/sustainability planning

1

2

3

4

5

Coalition Activities

This section is about the types of activities your coalition conducted after receiving the CAP/HCAP grant. By activities, we mean the projects, programs, products, and services your coalition worked on to serve the community.

  1. Please check all the activities your coalition conducted from the time you received your CAP/HCAP grant until the coalition disbanded.

Programs & Services

Capacity Building

Enrollment assistance for entitlement programs

Pharmacy assistance

Coordination of social services

Translation services

Patient navigation

New insurance plans

Care coordination

New provider sites and access points

Testing sites

Establishing medical homes

Expanding access to specialty services

Direct health services

Other

Providing technical assistance and training to other organizations (e.g., how to conduct needs assessments, evaluation training)

Establishing networks of organizations

Community leader development programs

Developing community resource guides

Other

Systems Change

Policy Advocacy and Change

Integrating data systems

Data sharing

Coordinated EMRs

Coordinated financial management information systems

Registries

Coordinated screening and enrollment systems

Disease management systems

Cultural competency training

Pro bono provider systems

Other

Informing local leaders and elected officials

Informing state leaders and elected officials

Collaborating with local institutions (e.g., school systems to change school lunch policy)

Participating in local state or regional summits

Other

Health Behavior Change

Dissemination of Information and Products

Health counseling

Training peer educators

Wellness programs

Screening programs

Other

Community newsletters

Hotlines

Websites

Marketing brochures

Health fairs

Special events (e.g., bike to work days)

Outreach materials

Program materials

Other


  1. Out of these activities, please select the three activities that made up the largest portion of the coalition’s work during the CAP/HCAP grant period.

Activity #1:



Activity #2:



Activity #3:


  1. Are any of the original activities that your coalition conducted during the CAP/HCAP grant still being conducted today (either by your organization/coalition or another organization/coalition)?

a. No, none of the original activities are being conducted today

b. Yes, at least one of the original activities are being conducted today

c. Yes, all of the original activities are being conducted today


Planning for Sustainability

This section asks about the actions your coalition undertook after receiving the CAP/HCAP grant to plan for long-term viability of your coalition and its activities.

  1. According to your coalition’s definition, sustainability of the coalition meant:

a. our coalition had the resources it needed to continue operating with our membership and structures in-tact for the long-term.

b. our coalition’s programs, services, and activities would continue in the long-term even if our coalition was no longer in operation.

c. both our coalition and its activities would continue in the long-term.

d. our coalition made a lasting impact on our community that would continue regardless of whether our coalition or its activities continued operating.

  1. Did your coalition ever develop a sustainability plan?

a. Yes, prior to receiving our CAP/HCAP grant.

b. Yes, within the first year of our CAP/HCAP grant.

c. Yes, after the first year but still prior to the end of our CAP/HCAP grant.

d. Yes, after our CAP/HCAP grant ended.

e. No, but we had plans to develop a sustainability plan.

f. No, we didn’t have any plans to develop a sustainability plan.

  1. What actions, if any, did your coalition take to prepare for sustainability?
    (Check all that apply.)

a. Reassessed the coalition’s goals, activities, or priorities

b. Identified the most effective goals and activities to continue

c. Developed a strategic plan for attaining resources

d. Reduced the membership

e. Reorganized the membership

f. Restructured coalition operations/processes (e.g., fewer meetings, smaller leadership team)

g. Established a committee to strategically address sustainability issues

h. Hired an external consultant to advise the coalition on issues of sustainability

i. Located partners and institutions to take over programs and services developed by the coalition

j. Developed an infrastructure in the community to support systems-level activities

k. Ensured appropriate mechanisms for implementation and enforcement of policy activities in the community

l. Other (specify):




  1. Who was involved in sustainability planning at your coalition? (Check all that apply.)

a. Steering Committee (a committee made up of representatives from member organizations who work with the consortia leadership)

b. Board of Directors (a group of individuals external to the consortia who provide input and/or oversight to the consortia leadership)

c. Executive Committee (a small group of consortia leadership responsible for consortia operations)

d. Community Advisory Board (a group of lay-persons from the community who provide input on consortia activities and direction)

e. Individual member organizations

f. Coalition staff

g. Other (specify):


  1. When were sustainability issues addressed by the coalition?

a. In the course of regular meetings and planning activities

b. As we neared the end of major grants and other funding cycles

c. Only when sustainability became a problem

d. Rarely or never

  1. Please indicate how much you disagree or agree with the following statements:

Your coalition:

Strongly Disagree

Disagree

Agree

Strongly Agree

No Opinion/ Not Applicable

a. had leaders who were continually planning for sustainability.

1

2

3

4

5

b. identified alternative strategies for project survival.

1

2

3

4

5



Coalition Impacts

This section is about the types of impacts your coalition had on the community you served. By impacts, we mean the intermediate and long-term outcomes of your coalition’s activities on individual health and behavior, the health care system, and policies that affect your community.

  1. Since the end of your CAP/HCAP grant period, how successful was the coalition at contributing to the following types of impacts?


    Very Unsuccessful

    Unsuccessful

    Successful

    Very Successful

    No Opinion/ Not Applicable

    a. Changing individual health and behavior outcomes such as immunization or primary care utilization.

    1

    2

    3

    4

    5

    b. Changing systems-level outcomes such as integrated data systems or cultural competency training.

    1

    2

    3

    4

    5

    c. Changing policies such as reimbursement structures or smoking ordinances.

    1

    2

    3

    4

    5

  2. Please tell us about particular individual health and behavior outcomes that your coalition contributed to. If relevant, please direct us to documents or websites where these outcomes are described in greater detail.

Outcome #1:



Outcome #2:



Outcome #3:



Outcome #4:



Outcome #5:



Citations and websites:


  1. About how many of your coalition’s individual health and behavior outcomes continue to benefit the community even without support from the coalition?

a. All

b. Most

c. Some

d. A Few

e. None

f. Did not contribute to any individual health and behavior outcomes

  1. Please tell us about particular systems-level outcomes that your coalition contributed to. If relevant, please direct us to documents or websites where these outcomes are described in greater detail.

Outcome #1:



Outcome #2:



Outcome #3:



Outcome #4:



Outcome #5:



Citations and websites:


  1. About how many of your coalition’s systems-level outcomes continue to benefit the community even without support from the coalition?

a. All

b. Most

c. Some

d. A Few

e. None

f. Did not contribute to any systems-level outcomes

  1. Please tell us about particular policy outcomes that your coalition contributed to. If relevant, please direct us to documents or websites where these outcomes are described in greater detail.

Outcome #1:



Outcome #2:



Outcome #3:



Outcome #4:



Outcome #5:



Citations and websites:


  1. About how many of your coalition’s policy outcomes continue to benefit the community even without support from the coalition?

a. All

b. Most

c. Some

d. A Few

e. None

f. Did not contribute to any policy outcomes

  1. Thinking through the history of your coalition, which of the following statements most accurately describes your coalition’s impacts? Most of our greatest impacts occurred:

a. early on, before we received CAP/HCAP funding.

b. during our CAP/HCAP funding period.

c. within 1 to 2 years after our CAP/HCAP funding period.

d. 2 or more years after our CAP/HCAP funding period.

e. Our impacts have occurred at a steady pace throughout the history of our coalition.

  1. Many factors outside a coalition’s control have the potential to influence coalition operations, activities, impacts, and the coalition’s chances for sustainability. For each of the following factors, please indicate if it ever influenced your coalition. If so, please indicate if it was a positive or negative influence.


Has this factor ever had an influence on the coalition’s operations, activities, impacts, or sustainability?

Did the factor have a positive or negative influence on the coalition?

a. A new organization entered the community.

1 Yes

2 No

1 Positive

2 Negative

b. An existing organization closed or left the community.

1 Yes

2 No

1 Positive

2 Negative

c. Changes to the local political culture (e.g., new administrations, elected officials).

1 Yes

2 No

1 Positive

2 Negative

d. The size and/or demographics of the community changed.

1 Yes

2 No

1 Positive

2 Negative

e. Local policy changes (e.g., size of the public health nursing staff).

1 Yes

2 No

1 Positive

2 Negative

f. State policy changes (e.g., Medicaid reimbursement rates).

1 Yes

2 No

1 Positive

2 Negative

g. Federal policy changes (e.g., Medicare Part D)

1 Yes

2 No

1 Positive

2 Negative

h. The mission or priorities of a funder changed.

1 Yes

2 No

1 Positive

2 Negative

I. Changes in local economic conditions.

1 Yes

2 No

1 Positive

2 Negative

j. Changes in state or federal economic conditions.

1 Yes

2 No

1 Positive

2 Negative

k. A major event changes awareness or attitudes in the community (e.g., the death of an uninsured person is attributed to lack of access to preventive services).

1 Yes

2 No

1 Positive

2 Negative

l. Other factors: _________________________

1 Yes

2 No

1 Positive

2 Negative

Background Information

  1. What was your role in the coalition? Please select the appropriate statement.

a. I was the day-to-day manager/administrator of the coalition.

b. I was a leader of the coalition but I did not mange the day-to-day operations and activities.

c. Other (specify):


  1. Were you involved in any way with the coalition when it was funded by the CAP/HCAP grant?

a


. Yes Briefly describe your role:

b. No

Concluding Thoughts

  1. If you could start your coalition over again, what would you do differently?


  2. Is there anything else you think we should know about your coalition?



END

Thank you for completing this survey.

Your responses are valuable.


Please return your questionnaire in the postage-paid envelope to:


Coalition Sustainability Project # 6681

C/O NORC

1 North State Street, Suite 1600

Chicago, Illinois 60602

File Typeapplication/msword
File TitleSurvey of CAP/HCAP Coalitions Post-Federal Funding
AuthorBenz-Jennifer
Last Modified Bydemus-imelda
File Modified2010-04-16
File Created2010-04-16

© 2024 OMB.report | Privacy Policy