OMB Control #: 0970-XXXX
Expiration Date: XX/XX/XXXX
INSTRUMENT 2: LIA SURVEY
[Online Survey to be programmed in Qualtrics]
SC1. Does your home visiting program receive MIECHV (Maternal, Infant and Early Childhood Home Visiting) funding?
Yes
No
If SC1=1 (YES):
SC2. What source of MIECHV funding does your home visiting program receive?
State or territory MIECHV funding
Tribal MIECHV funding
Don’t know
GO TO SURVEY INTRODUCTION AND CONSENT
If SC1=2 (NO): Thank you for your time. We will not be able to include your agency in the study since we are seeking home visiting programs that receive MIECHV funding.
We invite you to participate in this voluntary data collection. There are no foreseeable risks involved in participating in this research beyond those experienced in everyday life. There are no direct benefits to you from participation; however, the information you provide about your home visiting program may provide valuable information to help reach and serve eligible families through home visiting and assist the federal government with future planning for the home visiting field.
Your responses will be kept strictly private to the extent permitted by law. Only the project team will have access to this information. If you participate in a follow up interview, some responses you share in the survey may be discussed during the interview. Your answers will not be shared with any other agencies. Your responses will be combined with responses from other home visiting program staff and conveyed in a report prepared for the Administration for Children and Families, Office of Planning, Research, and Evaluation. In our research report, the information you provide will not be attributed by name to you or your individual program.
If you are unsure how to answer a question, please give the best answer you can rather than leaving it blank. You have the right to refuse a question and stop participation at any time, but we appreciate complete responses when possible so our study findings can reflect your experiences and perspectives.
The survey will take approximately 30 minutes to complete. The survey is designed to understand recruitment and enrollment processes in home visiting programs by examining challenges to reaching caseload capacity and opportunities to overcome those challenges. We are asking that the survey is completed by a staff member at your home visiting program who has responsibility for outreach, recruitment, or enrollment of families. If you feel you are not the best person to complete the survey, please stop here and share the survey link with someone at your home visiting program who has responsibility for outreach, recruitment and enrollment of families.
Although we are seeking MIECHV-funded home visiting programs to participate in the survey, we are interested in hearing about the experience of your program as a whole (not only about the MIECHV-funded case slots).
Please note that you may start/restart the survey as needed but once you click “submit” your answers are final and you cannot go back into the survey to make changes.
By clicking next, you consent to participate in this survey. Please click next to begin.
A1. What is your current position or role within your agency? [Select all that apply.]
Program manager
Supervisor
Home visitor
Outreach/Recruitment/Enrollment specialist
Other (PLEASE SPECIFY): _____________________
A2. What is the name of your home visiting program’s agency?
________________________________________[WRITE-IN RESPONSE]
A3. What is the address of your home visiting program agency’s office?
Street number and street name _______________________________________
City _____________________________________________________________
State ____________________________________________________________
Zip code __________________________________________________________
A4. What type of organization is your implementing agency? [Select all that apply]
Government health department/agency
Government education department/agency
Health care organization
Community-based nonprofit
Tribal organization
Other (PLEASE SPECIFY): _____________________
A5. In addition to home visiting, does your agency offer any of these other types of services or operate other programs that provide services to families? [Select all that apply.]
Early childhood education
Child care/day care
Parenting groups
Health care services
Mental health services
Substance use/dependency- related services
Adult education or employment services
Transportation services
Food assistance-related services
Other (PLEASE SPECIFY): _____________________
A6. Which home visiting model(s) does your agency implement with MIECHV funding? [Select all that apply.]
Attachment and Biobehavioral Catch-Up (ABC) Intervention
Child FIRST
Early Head Start – Home-Based Option
Early Intervention Program for Adolescent Mothers
Early Start (New Zealand)
Family Check-Up for Children
Family Connects/Durham Connects
Family Spirit
Health Access Nurturing Development Services (HANDS) Program
Healthy Beginnings
Healthy Families America (HFA)
(11) Home Instruction for Parents of Preschool Youngsters (HIPPY)
(12) Maternal Early Childhood Sustained Home-Visiting Program (MECSH)
(13) Maternal Infant Health Program (MIHP)
(13) Minding the Baby
(14) Nurse-Family Partnership (NFP)
(15) Parents as Teachers (PAT)
(16) Play and Learning Strategies – Infant (PALS Infant)
(17) SafeCare Augmented
(18) Other (PLEASE SPECIFY): _____________________
IF MORE THAN ONE MODEL IS SELECTED IN A6: GO TO A7
IF ONLY ONE MODEL IS SELECTED IN A6: GO TO A8
A7. Of the MIECHV-funded models your agency implements, which home visiting program currently serves the largest number of families? [Please select one option only.]
[ONLY SHOW THE RESPONSE OPTIONS THAT THE RESPONDENT SELECTED IN QUESTION A6]
[FIRST MODEL SELECTED IN A6]
[SECOND MODEL SELECTED IN A6]
[THIRD MODEL SELECTED IN A6]
[FOURTH MODEL SELECTED IN A6]
[FIFTH MODEL SELECTED IN A6]
AFTER A7 RESPONSE: For the remainder of the survey, we’d like you to answer questions as they relate to operating the [INSERT MODEL NAME FROM RESPONSE SELECTED IN A7, HEREAFTER REFERRED TO AS “MODEL NAME”] home visiting program. For example, when questions are asked about program capacity or home visitor caseloads, please respond based only on your knowledge or experience with the [INSERT MODEL NAME] program, and not the other program models.
As a reminder, if your [INSERT MODEL NAME] home visiting program includes MIECHV and non-MIECHV funded case slots, we are interested in hearing about the experience of your program as a whole (not only about the MIECVHV-funded case slots within the [INSERT MODEL NAME] home visiting program).
If SC2=2, display: If you are implementing [INSERT MODEL NAME] program in more than one site, please select the largest of those sites and respond to the remaining questions as they relate to that site only.
A8. How long has your agency been serving families using the [INSERT MODEL NAME] program?
Less than 1 year
1 to up to 2 years
2 years to up to 5 years
5 years or longer
A9. Does your [INSERT MODEL NAME] program have an outreach worker or other key staff member whose primary responsibility is outreach, recruitment or enrollment of families?
Yes
No
Not currently, but we have in the past
A10. Does your [INSERT MODEL NAME] program have any other staff members that are tasked with outreach, recruitment or enrollment? This could include home visitors who are responsible for recruiting families into the program.
Yes
No
Not currently, but we have in the past
A11. Do you use centralized intake, or contract with another agency to conduct outreach, recruitment, and enrollment activities at your [INSERT MODEL NAME] program? SELECT ALL THAT APPLY.
Yes, use centralized intake
Yes, contract with another agency
We have contracted with another agency in the past but do not currently
We have used centralized intake in the past but do not currently
No
B1. How many families are currently enrolled at your [INSERT MODEL NAME] program?
If your program includes MIECHV and non-MIECHV funding, we are interested in the total number of families enrolled.
______ [ALLOW VALUES RANGING FROM 1-999]
B2. What is the total number of families that your [INSERT MODEL NAME] program is able to serve when operating at capacity? This is the number you have agreed to serve with your program model and/or funder.
We are interested in the total number of families your [INSERT MODEL NAME] program is able to serve, regardless of how many program slots are funded by MIECHV.
______ [ALLOW VALUES RANGING FROM 1-999]
B2a. In practice, have you found the target for capacity to be a reasonable goal?
Yes
No
Don’t know
IF B2a=2 (NO): GO TO B2bIF B2a=1 (YES) or 3 (DON’T KNOW): GO TO B3
B2b. What has made the target for capacity an unreasonable goal?
___________________________________________________
First, we’d like you to think back to what program operations were like in the year before the COVID-19 pandemic outbreak in the U.S. (approximately February 2019 to February 2020).
B3. To the best of your ability, please think back to what program operations were like in the year before the COVID-19 pandemic outbreak in the U.S. (February 2019 to February 2020). In the year prior to March 2020, was your [INSERT MODEL NAME] program typically under capacity in terms of the number of families it served during that time?
For the purposes of this study, “typically under capacity” is defined as a program providing home visiting services to less than 85 percent of the number of families that program is able to serve when operating at capacity for at least half of the time (6 or more months) over the year.
Yes
No
Don’t know
B4. Thinking back to what program operations were like for your [INSERT MODEL NAME] program in the year before the COVID-19 pandemic outbreak in the U.S. (February 2019 to February 2020), were the following factors challenges in your ability to maintain capacity (that is, to serve the number of families that your program has agreed to serve)? [CHECK ALL THAT APPLY]
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B5. For each of the following statements, please reflect on your [INSERT MODEL NAME] program’s experience of community need and program capacity in the year before the COVID-19 pandemic outbreak in the U.S. (February 2019 to February 2020), and indicate if you agree or disagree.
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Agree |
Disagree |
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Now we’d like to ask about the period since March 2020 (the approximate beginning of the COVID-19 pandemic outbreak in the U.S. until now).
B6. Since March 2020 (the approximate beginning of the COVID-19 pandemic outbreak in the U.S. until now), how many months in total has your [INSERT MODEL NAME] program been under capacity?
For the purposes of this study, “under capacity” is defined as a program providing home visiting services to less than 85 percent of the number of families that program is able to serve when operating at capacity.
0 months/ Never
1 months
2 months
3 months
4 months
5 months
6 months
7 months
[8 months]
[9 months]
[10 months]
[11 months]
[Longer than 11 months]
Don’t know
B7. Since March 2020 (the approximate beginning of the COVID-19 pandemic outbreak in the U.S. until now), have the following factors been challenges in your ability to maintain capacity (that is, to serve the number of families that your program has agreed to serve)? [CHECK ALL THAT APPLY]
We’d like to know about all challenges your program has experienced during the period since March 2020, whether or not they are directly related to the COVID-19 pandemic.
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B8. For each of the following statements, please reflect on your [INSERT MODEL NAME] program’s experience of community need and program capacity since March 2020 (the approximate beginning of the COVID-19 pandemic outbreak in the U.S. until now) and indicate if you agree or disagree.
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Agree |
Disagree |
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Now we’d like to learn about your general perspectives on recruitment and enrollment of families.
C1. Based on your experiences, which of these factors are important in getting families initially interested in participating in home visiting? [CHECK ALL THAT APPLY]
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C2. Based on your experiences, which of these factors are important to emphasize in your initial messaging to families to get them interested in home visiting? [CHECK ALL THAT APPLY]
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Not important |
Important |
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C3. Based on your experiences, how important are each of the following reasons for explaining why families choose not to enroll in home visiting services?
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Not important |
Somewhat important |
Moderately important |
Very important |
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D1. Has your [INSERT MODEL NAME] program engaged in any of the following activities to identify potentially eligible families in your community over the past two years? For this question, we are interested in the activities your program conducts related to initially just finding where families may be, not the outreach and recruitment strategies you might then use after you find families. [Select all that apply.]
Find and connect with other community services that serve similar types of families
Use existing data sources to identify neighborhoods where potentially eligible families reside
Using program graduates to identify families
Other (PLEASE SPECIFY): ______________________________
D2. Has your [INSERT MODEL NAME] program engaged in any of the following strategies for reaching families in the community and getting them interested in participating in home visiting services over the past two years? [Select all that apply.]
Conduct direct outreach to potentially eligible families (for example, directly talking to families, handing fliers to families or putting fliers in their mailboxes, or directly calling families)
Distributing resources to parents (for example, food distribution, diaper distribution, lending library)
Host or participate in program outreach and recruitment events like special events, fairs or parent nights
Attend other community events, like health fairs, for community awareness or because you think potential eligible families may be present
Reach out to other programs or community service organizations where you know potential eligible families may be present (for example, WIC offices, doctor’s offices, community health centers, hospitals, child care centers)
Physically visit other programs or community service organizations where you know potential eligible families may be present (e.g., WIC offices, doctor’s offices, community health centers, hospitals, child care centers)
Use social media
Have memorandum of understanding (MOU) or formal agreement in place with referral partners
Other (PLEASE SPECIFY): ______________________________
D3. For each of the strategies you use, please rate the success of this method for reaching out to families on a scale of 1 to 4.
[PREFILL WITH ONLY THE RESPONSE OPTIONS SELECTED IN D2] |
Not successful (1) |
Somewhat Successful (2) |
Very Successful (3) |
Extremely successful (4) |
STRATEGY 1 (FROM D2) |
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STRATEGY 2 (FROM D2) |
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STRATEGY 3 (FROM D2) |
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STRATEGY 4 (FROM D2) |
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STRATEGY 5 (FROM D2) |
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STRATEGY 6 (FROM D2) |
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STRATEGY 7 (FROM D2) |
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STRATEGY 8 (FROM D2) |
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STRATEGY 9 (FROM D2) |
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D4. Does your [INSERT MODEL NAME] program tailor outreach materials or strategies to different types of potentially eligible families?
Yes
No
Don’t know
If D4=1 (YES): GO TO QUESTION D5
If D4=2 (NO): GO TO QUESTION D6
D5. Please briefly describe:
________________________________________[WRITE-IN RESPONSE]
D6. Does your [INSERT MODEL NAME] program use any of the following outreach and recruitment materials? [Select all that apply]
Program flyer, brochure or pamphlet
Community newspapers
Program website
Visual program advertisement (for example, billboard, posters)
Commercials
Other social media site (PLEASE SPECIFY)________
Other (PLEASE SPECIFY): ______________________________
Don’t know
D7. Do you track or monitor how referral partners or families hear about your [INSERT MODEL NAME] program?
Yes
No
Don’t know
D8. Thinking about all the families enrolled in your [INSERT MODEL NAME] program over the past two years, approximately what percentage came from referral partners or another agency? Your best guess is fine.
_________% [ALLOW VALUES RANGING FROM 0-100]
D9. Thinking about all the families enrolled in your program over the past two years, approximately what percentage came from direct outreach efforts? Your best guess is fine.
_________% [ALLOW VALUES RANGING FROM 0-100]
D10. Thinking about all the families enrolled in your program over the past two years, approximately what percentage came seeking services on their own (including through referrals from friends or family)? Your best guess is fine.
_________% [ALLOW VALUES RANGING FROM 0-100]
E1. In the year before the COVID-19 pandemic outbreak in the U.S. (February 2019 to February 2020), what types of organizations referred families to your [INSERT MODEL NAME] program? [CHECK ALL THAT APPLY]
Government health department/agency
Government education department/agency
Health care organization/clinic
WIC office
Child welfare agency
Child care resource agency
Centralized intake
Tribal organization
Other community-based nonprofit
Don’t know
E2. Since March 2020 (the approximate beginning of the COVID-19 pandemic outbreak in the U.S. until now), what types of organizations have referred families to your [INSERT MODEL NAME] program? [CHECK ALL THAT APPLY]
Government health department/agency
Government education department/agency
Health care organization/clinic
WIC office
Child welfare agency
Child care resource agency
Centralized intake
Tribal organization
Other community-based nonprofit
Don’t know
E3. For the following set of questions, we’d like you to think of the organization that currently provides the most referrals into your [INSERT MODEL NAME] program. Please fill in the name of this community organization.*
*We are asking for the names of these organizations so we can ask you some questions about them. These names will not be used or shared outside the study team.
Name 1: _____________________________________[WRITE-IN RESPONSE]
For the organization that provides the most referrals into your program, please answer the following questions:
E4. What is the organizational type of [NAME FROM E3]?
Government health department/agency
Government education department/agency
Health care organization/clinic
WIC office
Child welfare agency
Child care resource agency
Centralized intake
Tribal organization
Other community-based nonprofit. If (9), please specify: _______
Other (PLEASE SPECIFY) _____________________
Don’t know
E5. What factors do you think contribute to the number of referrals your [INSERT MODEL NAME] program receives from [NAME FROM E1]? [CHECK ALL THAT APPLY]
We have a memorandum of understanding (MOU) with [NAME FROM E1]
We have frequent communication with [NAME FROM E1]
We have a clear point of contact at [NAME FROM E1]
Many of the families served by [NAME FROM E1] are part of the target population we serve
[NAME FROM E1] has a clear understanding of the referral process
Other, specify:___________________________________
E6. Out of the referrals you received from [NAME FROM E3] in the past year, approximately what percentage of referred families were deemed eligible for services by your [INSERT MODEL NAME] program? Your best guess is fine.
_________% [ALLOW VALUES RANGING FROM 1-100]
E7. Out of those families that were referred by [NAME FROM E3] in the past year, what percentage enrolled in your [INSERT MODEL NAME] program (received a first home visit)? Your best guess is fine.
_________% [ALLOW VALUES RANGING FROM 1-100]
E8. Do you think that the number of families referred from [NAME FROM E3] is less than it could be?
Yes
No
Don’t know
E9. For the following set of questions, we’d like you to think of one organization that currently provides fewer referrals into your [INSERT MODEL NAME] program than it potentially could. Please choose an organization other than the one that currently provides the most referrals for your program. Please fill in the name of this community organization.*
*We are asking for the name of this organization so we can ask you some questions. This name will not be used or shared outside the study team.
Name: _____________________________________[WRITE-IN RESPONSE]
E10. What is the organizational type of [NAME FROM E9]?
Government health department/agency
Government education department/agency
Health care organization/clinic
WIC office
Child welfare agency
Child care resource agency
Centralized intake
Tribal organization
Other community-based nonprofit. If (9), please specify: _____
Other (PLEASE SPECIFY) _____________________
Don’t know
E11. What factors do you think contribute to [NAME FROM E9] providing fewer referrals into your [INSERT MODEL NAME] program than it potentially could? [CHECK ALL THAT APPLY]
We do not have a memorandum of understanding (MOU) with [NAME FROM E9]
We do not have frequent communication with [NAME FROM E9]
We do not have a clear point of contact at [NAME FROM E9]
Few of the families served by [NAME FROM E9] are part of the target population we serve
[NAME FROM E9] does not have a clear understanding of the referral process
Other, specify:____________________
E12. Out of the referrals you received from [NAME FROM E9] in the past year, approximately what percentage of referred families were deemed eligible for services by your [INSERT MODEL NAME] program? Your best guess is fine.
_________% [ALLOW VALUES RANGING FROM 0-100
E13. Out of those referrals you received from [NAME FROM E13] in the past year, what percentage enrolled in your [INSERT MODEL NAME] program (received a first home visit)? Your best guess is fine.
_________% [ALLOW VALUES RANGING FROM 0-100]
F1. Would you be open to participating in a follow-up conversation with members of the study team? These follow-up interviews would be under 1 hour long, would take place over the phone or video-conference, and would be open-ended in nature. These interviews would allow the team to learn more about issues related to your program’s particular experiences, including challenges and opportunities, with maintaining caseloads and would help us understand your program’s broader community context and dynamics.
Yes
No
F2. What is the best email address to reach you at?
________________________________________ [WRITE-IN RESPONSE]
F3. What is the best phone number to reach you at?
(XXX) XXX-XXXX
F4. What is your preferred method of contact?
Phone call
Text (IF DIFFERENT FROM F3, PLEASE SPECIFY): ______________
F5. Please share any additional information about your [INSERT MODEL NAME] program’s outreach, recruitment, and enrollment in the space below. For example, we’d like to hear about challenges and successes you haven’t already mentioned, as well as innovations you’ve tried:
This
collection of information is voluntary and will be used to
understand the challenges that programs may face in reaching
caseload capacity and promising strategies they use to address
these challenges. Information collected will be kept private.
Public reporting burden for the described collection of information
is estimated to average 31 minutes per response, including the time
for reviewing instructions, gathering and maintaining the data
needed, and reviewing the collection of information. An agency may
not conduct or sponsor, and a person is not required to respond to,
a collection of information unless it displays a currently valid
OMB control number. The OMB number and expiration date for this
collection are OMB #: 0970-XXXX, Exp: XX/XX/XXXX. Send
comments regarding the burden estimate or any other aspect of this
collection of information, including suggestions for reducing this
burden to Susan Zaid; szaid@jbassoc.com.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Helen Lee |
File Modified | 0000-00-00 |
File Created | 2021-11-24 |