Sustainability Survey—Affiliate Centers
SUSTAINABILITY SURVEY—FOR AFFILIATE CENTERS
Demographic Questions—Affiliate Centers
1. In what year did you receive your NCTSN grant from SAMHSA?
2001
2002
2003
2005
2. Did your center receive a no-cost extension from SAMHSA?
Yes
No
3. If yes, how long was your no-cost extension?
1 month
3 months
6 months
Other:__________
4. What was the length of your initial grant?
3 years
4 years
5. Was your center refunded by SAMHSA?
Yes
No
6. If yes, was there a lapse of time between the two grants?
Yes
No
7. If your center was refunded, were the grant activities a continuation of the previous grant?
Yes
No
8. If you were refunded, in what year were you refunded?
2001
2002
2003
Funding Questions—Affiliate Centers
1. What are the current funding sources of your center? (Check all that apply)
Federal funding
Private foundations
State funding
Local funding
Private foundation
Medicaid
Corporate/benefactor
Philanthropic funding
Clinical fees
Non-clinical producing programs (e.g., selling training materials)
Other:
2. For all funding sources checked in question 1, please specify the type of funding received or type of fees generated to sustain your program from the following sources:
Federal funding, please specify:
Private foundations, please specify:
State funding, please specify:
Local funding, please specify: _
Private foundation, please specify:
Medicaid
Corporate/benefactor, please specify:
Philanthropic funding, please specify:
Clinical fees, please specify:
Non-clinical producing programs (e.g., selling training materials), please specify:
Other (please specify):
3. What are the percentages for each type of funding source your center receives/generates? (This question will be open-ended, a box asking for the percentages for each and will be generated for each of the options in question 1)
Federal funding
Private foundations
State funding
Local funding
Private foundation
Medicaid
Corporate/benefactor
Philanthropic funding
Clinical fees
Non-clinical producing programs (e.g., selling training materials)
Other:
4. In the past 4 years, what were the funding sources of your center? (Check all that apply)
Federal funding
Private foundations
State funding
Local funding
Private foundation
Medicaid
Corporate/benefactor
Philanthropic funding
Clinical fees
Non-clinical producing programs (e.g., selling training materials)
Other:
5. What are the percentages for each type of funding source in the past 4 years? (This question will be open-ended, a box asking for the percentages for each and will be generated for each of the options in question 4)
Federal funding
Private foundations
State funding
Local funding
Private Foundation
Medicaid
Corporate/benefactor
Philanthropic funding
Clinical fees
Non-clinical producing programs (e.g., selling training materials)
Other:
6. In the past 4 years what were the funding sources in which your center had applied, but were not awarded? (Check all that apply)
Federal funding
Private foundations
State funding
Local funding
Philanthropic funding
Other:
7. For all funding in which your center has applied, but not awarded in the past 4 years (question 5), please specify the type of funding applied for from the following sources:
Federal funding, please specify:
Private foundations, please specify:
State funding, please specify:
Local funding, please specify:
Philanthropic funding, please specify:
Other (please specify):
8. What financial strategies has your center used to facilitate the sustainability of your program? (Check all that apply)
Identifying local financial resources
Identifying state financial resources
Identifying federal financial resources
Identifying philanthropic funding sources
Identifying other funding sources
Collaborating with stakeholders in identifying financial resources
Collaborating with stakeholders in applying for financial resources
Applying for financial resources
Partnering with other non-NCTSN agencies in applying for financial resources
Partnering with NCTSN agencies in applying for financial resources
Establishing a center workforce to apply for financial resources
Developing agency services to generate financial resources
Reporting agency/program effectiveness to gain financial resources
Other:
9. What factors contribute to the fiscal sustainability of your center? (Check all that apply)
Workforce expertise
Community presence
Agency services
Client outcomes
Trainings offered
Community collaborations
NCTSN collaborations
Stakeholder involvement
Agency financial support
Agency non-financial resources
Other:
10. What financial constraints/barriers hindered your ability to sustain services at your center? (Check all that apply)
Limited availability of financial resources
Agency competitiveness for similar financial resources
Limited agency budget to hire a workforce with expertise in obtaining funding
Limited agency reporting on cost effectiveness
Other:
11. Has your organization received Technical Assistance (TA) from the National Center during your NCTSN grant around the topic of sustaining organizational services through funding resources?
Yes
No
12. If yes, what kind of TA around the topic of sustaining organizational services through funding has your organization received from the National Center? (Check all that apply)
Locating funding resources
Writing grants
Managing fiscal resources
Fiscal planning
Creating financial collaborations
Prioritizing for cost effective services
Other:
13. Has your center adhered to its fiscal sustainability plan after funding at your center ended?
Yes
No
14. What financial factors contributed to adhering to this plan? (Check all that apply)
No cost extension
TA Technical Assistance on financial information from the National Center
NCTSN collaborations on funding resources
Staff contributing to grant writing
Other funding
Other:
15. What financial factors hindered your center’s ability to adhere to this plan? (Check all that apply)
Lack of a no cost extension
Lack of TA on financial resources from the National Center
Lack of NCTSN collaborations on funding resources
Lack of staffing to obtain funding
Lack of other funding
Other:
Center Mission—Affiliate Centers
1. Has your agency’s mission changed as a result of your NCTSN grant activities?
Yes
No
Don’t know
2. If yes, how has the program’s mission changed? (Check all that apply)
Agency provides more comprehensive services to focus population
Agency provides more specific evidence-based treatments to their focus population
Agency provides more trauma-informed screening and assessments to clients
Agency provides supervision to staff on evidence-based practices and assessments
Agency provides more trauma-informed training to outside agencies
Agency facilitates trauma-informed trainings to outside agencies
Agency provides more information on client outcomes
Agency provides more information to their Board of Directors or Governing body on services provided
Other:
3. What specific NCTSN factors contributed to your changed mission? (Check all that apply)
Trauma-informed training
Supervision
Evidence-based outcome measures
Evidence-based screening assessments
Evidence-based practices
Other:
Infrastructure of the Organization—Affiliate Centers
Center activities
1. What activities has your center used to involve stakeholders in your sustainability plan? (Check all that apply)
Participation in agency outreach activities
Participation in agency collaborations
Participation in planning agency services
Participation in agency staff meetings
Participation in agency board meetings
Participation in NCTSN activities
Participation in community activities
Other:
To what extent have center stakeholders been involved in the following center activities? |
Not at all
(1)
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To a small extent (2) |
To some extent
(3) |
To a great extent (4) |
To a very great extent (5) |
Don’t know/ Not applicable (6)
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Agency outreach activities |
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Agency collaborations |
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Planning agency services |
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Agency staff meetings |
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Agency board meetings |
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NCTSN activities |
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Community activities |
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Other: ___________ |
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2. What organizational factors facilitated the decision to sustain certain activities at your center? (Check all that apply)
Services provided
Client needs
Staff expertise
Staff training
Staff supervision
Outreach activities
Community relationships
Collaborative relationships
Partnerships with other agencies
Partnerships with other NCTSN centers
Other:
To what extent have the following organizational factors facilitated the decision to sustain certain activities at your organization? |
Not at all
(1) |
To a small extent
(2) |
To some extent
(3) |
To a great extent
(4) |
To a very great extent (5) |
Don’t know/ Not applicable (6) |
Services provided |
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Client needs |
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Staff expertise |
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Staff training |
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Staff supervision |
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Outreach activities |
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Community relationships |
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Collaborative relationships |
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Partnerships with other agencies |
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Partnerships with other NCTSN centers |
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Other: ___________ |
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3. What factors hindered sustainability efforts at your center? (Check all that apply)
Lack of an agency workforce
Lack of staff training
Lack of staff supervision
Limited agency involvement in the community through outreach activities
Lack of community relationships
Lack of collaboration
Lack of agency partnerships
Lack of partnerships with other NCTSN centers
Agency policies/regulations
Other:
To what extent have the following factors hindered the sustainability efforts at your center? |
Not at all
(1) |
To a small extent
(2) |
To some extent
(3) |
To a great extent
(4) |
To a very great extent (5) |
Don’t know/ Not applicable (6) |
Lack of an agency workforce |
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Lack of staff training |
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Lack of supervision |
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Limited agency involvement in the community through outreach activities |
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Lack of community relationships |
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Lack of collaboration |
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Lack of agency partnerships |
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Lack of partnerships with other NCTSN centers |
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Agency policies/regulations |
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Other: ___________ |
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4. What activities has your organization sustained after the NCTSN grant ended? (Check all that apply)
Facilitating trauma-informed trainings
Delivering trauma-informed trainings
Trauma-informed trainer training
Clinical supervision of trauma-informed evidence-based practices
NCTSN trauma-informed product/ intervention development
NCTSN trauma-informed product dissemination
Trauma-informed administration of CDS
Trauma-informed outcome data collection and evaluation
Trauma-informed screening
Trauma-informed service delivery of evidence-based practices
NCTSN meeting involvement
NCTSN workgroup meetings
NCTSN collaborations
Trauma-informed staff development
Trauma-informed system change reform
Other:
5. What activities have not been sustained at your organization after grant funding ended? (Check all that apply)
Facilitating trauma-informed trainings
Delivering trauma-informed trainings
Trauma-informed trainer training
Clinical supervision of trauma-informed evidence-based practices
NCTSN trauma-informed product/ intervention development
NCTSN trauma-informed product dissemination
Trauma-informed administration of CDS
Trauma-informed outcome data collection and evaluation
Trauma-informed screening
Trauma-informed service delivery of evidence-based practices
NCTSN meeting involvement
NCTSN workgroup meetings
NCTSN collaborations
Trauma-informed staff development
Trauma-informed system change reform
Other:
6. What strategies have you used to facilitate the sustainability of certain center activities? (Check all that apply)
Hiring a workforce
Training a workforce
Supervising a workforce
Developing training resources
Maintaining an agency presence in the community through outreach activities
Establishing community relationships
Establishing collaborative relationships
Partnering with other agencies
Partnering with other NCTSN centers
Other:
7. How has your center collaborated with other NCTSN centers in your sustainability planning? (Check all that apply)
NCTSN workshops
National meetings/conferences
Regional meetings/conferences
Learning collaborative trainings
Trauma-informed trainings
Service delivery
Community outreach
NCTSN product development
Dissemination efforts
Other:
8. How has your center collaborated with other centers outside the NCTSN in your sustainability planning? (Check all that apply)
Workshops
Meetings
Facilitating trainings
Delivering trainings
Providing supervision
Developing a workforce
Service delivery
Service coordination
Clinical practice
Community outreach
Dissemination efforts
Other:
9. What kind of collaborative relationships does your center have with the National Center? (Check all that apply)
Training
Workgroups
Product development
Other:
10. How has your center identified opportunities for policy change? (Check all that apply)
Congressional reporting
Government representatives
Committee involvement
Advocacy groups on policy change
Other:
11. Has your organization received technical assistance from the National Center around the topic of sustainability?
Yes
No
12. If your organization has received technical assistance, please indicate the type of technical assistance received? (Check all that apply)
Information on training staff in evidence-based practices
Information on providing supervision for staff
Information on measuring clinical outcomes in clients
Defining service delivery after the grant
NCTSN affiliation after the grant
Information on collaboration within the NCTSN after the grant
Information on collaboration in the community outside the NCTSN after the grant
Other:
Service Delivery and the Continuation of Practices and Programs—Affiliate Centers
Center Activities
1. What products has your center developed in collaboration with other members of the NCTSN over the course of your grant? (Check all that apply)
Assessment tools
Clinical treatments
Training or technical assistance resources
Information resources
Other:
2. What products has your center sustained after NCTSN funding? (Check all that apply)
Assessment tools
Clinical treatments
Training or technical assistance resources
Information resources
Other:
3. What factors (other than monetary) facilitated sustaining the abovementioned products in question 2? (Check all that apply)
Workforce
Training
Supervision
NCTSN collaborations
Organizational affiliations
Other:
4. What products has your center not been able to sustain after NCTSN funding? (Check all that apply)
Assessment tools
Clinical treatments
Training or technical assistance resources
Information resources
Other:
5. What factors (other than monetary) hindered your center’s ability to sustain these products (question 4)? (Check all that apply)
Lack of workforce
Lack of training
Lack of supervision
Lack of NCTSN collaborations
Lack of organizational affiliations
Other:
6. Of the products that your center sustained in question 2, describe the stage of development for each product by marking an X in the appropriate box. If there is more than one product of the same category or stage of development, please note this with a number.
Stage of Development |
Assessment Tools |
Clinical Treatments |
Training or TA Resources |
Information Resources |
Other |
Conceptualization Stage |
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Development and Standardization Stage |
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Standardization Stage |
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Pilot Testing Stage |
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Dissemination Stage |
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Evaluation Stage |
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Creation of a Record in the Knowledge Bank |
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Other:___________ |
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7. If your center is involved in developing more than one product in the following categories, please specify the number of products in which your center has developed as a part of the NCTSN? (Open ended question for each choice)
Assessment tools _____
Clinical treatments_____
Training or technical assistance resources_____
Information resources _____
Other: _____
8. For each product mentioned in number 7, does your center plan to advance the product to another NCTSN development stage? (Yes/No to each response in question 7)
Yes
No
9. What factors (other than monetary) will facilitate advancing the development of these products? (Check all that apply for each item endorsed in number 7)
Workforce
Clientele
Agency services
NCTSN collaborations
Organizational affiliations
Other:
10. What factors (other than monetary) will hinder advancing the development of these products? (Check all that apply for each item endorsed in number 7)
Lack of workforce
Lack of clientele
Lack of agency services
Lack of NCTSN collaborations
Lack of organizational affiliations
Other:
11. What types of trauma-informed trainings has your center delivered throughout the course of the NCTSN grant? (Check all that apply)
Train-the-trainer model type trainings (i.e., training participants to be trainers)
Psychoeducational programs on the impact of trauma
Screening trainings related to trauma exposure
Trainings on referrals/triaging of trauma-exposed children to appropriate levels of clinical intervention
Clinical intervention trainings for trauma-exposed children
Non-clinical intervention trainings during/after a traumatic event
Support service trainings during/after a traumatic event
Trainings to improving provider responses to child victims of trauma
Trainings on increasing ability of providers to reduce potential for traumatic stress
Prevention trainings on child traumatic exposure
Trainings on secondary trauma among front line human service providers
Other:
12. What types of trauma-informed trainings has your center facilitated throughout the course of the NCTSN grant? (Check all that apply)
Train-the-trainer model type trainings (i.e., training participants to be trainers)
Psychoeducational programs on the impact of trauma
Screening trainings related to trauma exposure
Trainings on referrals/triaging of trauma-exposed children to appropriate levels of clinical intervention
Clinical intervention trainings for trauma-exposed children
Non-clinical intervention trainings during/after a traumatic event
Support service trainings during/after a traumatic event
Trainings to improving provider responses to child victims of trauma
Trainings on increasing ability of providers to reduce potential for traumatic stress
Prevention trainings on child traumatic exposure
Trainings on secondary trauma among front line human service providers
Other:
13. What types of trauma-informed trainings has your center sustained (both facilitated and delivered trainings) after the grant? (Check all that apply)
Train-the-trainer model type trainings (i.e., training participants to be trainers)
Psychoeducational programs on the impact of trauma
Screening trainings related to trauma exposure
Trainings on referrals/triaging of trauma-exposed children to appropriate levels of clinical intervention
Clinical intervention trainings for trauma-exposed children
Non-clinical intervention trainings during/after a traumatic event
Support service trainings during/after a traumatic event
Trainings to improving provider responses to child victims of trauma
Trainings on increasing ability of providers to reduce potential for traumatic stress
Prevention trainings on child traumatic exposure
Trainings on secondary trauma among front line human service providers
Other:
14. What types of trauma-informed trainings (both facilitated and delivered trainings) has your center not been able to sustain after the grant? (Check all that apply)
Train-the-trainer model type trainings (i.e., training participants to be trainers)
Psychoeducational programs on the impact of trauma
Screening trainings related to trauma exposure
Trainings on referrals/triaging of trauma-exposed children to appropriate levels of clinical intervention
Clinical intervention trainings for trauma-exposed children
Non-clinical intervention trainings during/after a traumatic event
Support service trainings during/after a traumatic event
Trainings to improving provider responses to child victims of trauma
Trainings on increasing ability of providers to reduce potential for traumatic stress
Prevention trainings on child traumatic exposure
Trainings on secondary trauma among front line human service providers
Other:
15. What factors (other than monetary) contributed to sustaining the types of trainings mentioned in question 3? (Check all that apply)
Workforce
NCTSN collaborations
Organizational affiliations
Other:
16. What factors (other than monetary) hindered your center’s ability to sustain the types of trainings mentioned in question 4? (Check all that apply)
Lack of workforce
Lack of NCTSN collaborations
Lack of organizational affiliations
Other:
Which of the Core Data Set measures have you continued to use with your target population after NCSTN funding ended? (Check all that apply)
Core Clinical Characteristics Baseline Form
Core Clinical Characteristics Follow-Up Form
Core Clinical Characteristics General Trauma Form
Core Clinical Characteristics Trauma Detail Form
Child Behavior Checklist (CBCL 1.5-5)
Child Behavior Checklist (CBCL 6-18)
UCLA PTSD Reaction Index
Trauma Symptom Checklist for Children–Abbreviated version (TSCC-A)
What other trauma-informed screening and assessment measures do you use with your clients? (Open–ended question)
What factors (other than monetary) have contributed to your continued use of the Core Data Set measures with your target population? (Check all that apply)
Workforce
Clinical practice
Agency services
NCTSN involvement
NCTSN collaborations
Organizational affiliations
Agency/board decisions
NICON
Other:
What factors (other than monetary) have hindered your use of the Core Data Set measures with your target population? (Check all that apply)
Lack of workforce
Changing agency services
Lack of NCTSN involvement
Decreased NCTSN collaborations
Lack of organizational affiliations
Agency/board decisions
Other:
What factors (other than monetary) have contributed to your use of other assessment measures with your target population? (Check all that apply)
Workforce
Clinical practice
Agency services
Training
Supervision
NCTSN involvement
NCTSN collaborations
Organizational affiliations
Agency/board decisions
Other:
What factors (other than monetary) hinder your use of other assessment measures with your target population? (Check all that apply)
Lack of workforce
Lack of training
Lack of supervision
Changing agency services
Lack of NCTSN involvement
Decreased NCTSN collaborations
Lack of organizational affiliations
Agency/board decisions
Other:
Trauma-informed Evidence Based Practices
What trauma-informed evidence-based practice(s) has your center used during the course of your grant? (Check all that apply)
Dialectical Behavior Therapy
Attachment, Self-Regulation, and Competence Alternatives for Families - A Cognitive Behavioral Therapy
Trauma Assessment Pathway
Child Adult Relationship Enhancement
Child Development Community Policing Program
Child and Family Traumatic Stress Intervention
Combined Parent Child Cognitive-Behavioral Approach for Children and Families At-Risk for Child Physical Abuse
Cognitive Behavioral Intervention for Trauma in Schools
Child-Parent Psychotherapy
Culturally Modified Trauma Focused Treatment
Parent-Child Interaction Therapy
Structured Psychotherapy for Adolescents Responding to Chronic Stress
Trauma-Focused Cognitive Behavioral Therapy
Trauma Systems Therapy
Other:
What trauma-informed evidence-based practice(s) has your center continued to use after funding? (Check all that apply)
Dialectical Behavior Therapy
Attachment, Self-Regulation, and Competence Alternatives for Families - A Cognitive Behavioral Therapy
Trauma Assessment Pathway
Child Adult Relationship Enhancement
Child Development Community Policing Program
Child and Family Traumatic Stress Intervention
Combined Parent Child Cognitive-Behavioral Approach for Children and Families At-Risk for Child Physical Abuse
Cognitive Behavioral Intervention for Trauma in Schools
Child-Parent Psychotherapy
Culturally Modified Trauma Focused Treatment
Parent-Child Interaction Therapy
Structured Psychotherapy for Adolescents Responding to Chronic Stress
Trauma-Focused Cognitive Behavioral Therapy
Trauma Systems Therapy
Other:
What factors (other than monetary) have contributed to your continued use of the trauma-informed evidence-based practices mentioned in question 2 with your target population? (For each practice, check all that apply)
Workforce
Clinical practice
Agency services
Training
Supervision
NCTSN involvement
NCTSN collaborations
Organizational affiliations
Agency/board decisions
Other:
What factors (other than monetary) have hindered your use trauma-informed evidence-based practices with your target population? (Check all that apply)
Lack of workforce
Lack of training
Lack of supervision
Changing agency services
Lack of NCTSN involvement
Decreased NCTSN collaborations
Lack of organizational affiliations
Agency/board decisions
Other:
What factors (other than monetary) have contributed to your use of other trauma-informed evidence-based practices with your target population? (Check all that apply)
Workforce
Clinical practice
Agency services
Training
Supervision
NCTSN involvement
NCTSN collaborations
Organizational affiliations
Agency/board decisions
Other:
What factors (other than monetary) have hindered your use of other trauma-informed evidence-based practices with your target population? (Check all that apply)
Lack of workforce
Lack of training
Lack of supervision
Changing agency services
Lack of NCTSN involvement
Decreased NCTSN collaborations
Lack of organizational affiliations
Agency/board decisions
Other:
What factors (other than monetary) contribute to your continued center’s involvement with NCTSN? (Check all that apply)
Agency services
Workforce participation
Involvement in delivering trauma-informed training
Involvement in facilitating trauma-informed training
Involvement in learning collaboratives
Involvement in product development
Involvement in workgroups
Involvement in supervision
Involvement in Core Data Set administration
Other:
What factors (other than monetary) have hindered your center’s involvement with NCTSN? (Check all that apply)
Changing agency services
Decreased workforce
Lack of delivery of trauma-informed training
Lack of facilitating trauma-informed training
Lack of involvement in product development
Lack of involvement in NCTSN workgroups
Lack of ongoing NCTSN collaborations
Lack of continued administration of Core Data Set
Other:
Non-NCTSN Involvement
What factors have contributed to your involvement with non-NCTSN centers after funding ended? (Check all that apply)
Community collaborations
Agency services
Client needs
Involvement in delivering trauma-informed training
Involvement in facilitating trauma-informed training
Providing supervision
Involvement in Core Data Set administration
Other:
What factors have hindered your center’s involvement with non-NCTSN centers after funding ended? (Check all that apply)
Lack of community collaborations
Changing agency services
Changing client needs
Lack of involvement in delivering trauma-informed training
Lack of involvement in facilitating trauma-informed training
Lack of participation in providing supervision
Other:
Thank you for your participation!
Page
| File Type | application/msword |
| File Title | SUSTAINABILITY SURVEY—FOR AFFILIATE CENTERS |
| Author | Angela Momtagno |
| Last Modified By | DHHS |
| File Modified | 2011-04-11 |
| File Created | 2011-04-11 |