Appendix C_Partner Survey_CLEAN

APPENDIX C

Partner survey

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average 25 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.

OMB Approval number: 0970-0527, Expiration Date: XX/XX/XXX.

OMB No.: 0970-0527

Expiration Date: XX/XX/XXX

Partner Survey

Regional Partnership Grants National
Cross-Site Evaluation

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average 25 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. OMB Approval number: 0970-0527, Expiration Date: XX/XX/XXX.

The Regional Partnership Grants (RPG) program supports interagency collaborations and program integration designed to increase the well-being, improve the permanency, and enhance the safety of children who are in, or at risk of, out-of-home placements as a result of a parent or caretaker’s substance abuse. The Children’s Bureau within the U.S. Department of Health and Human Services, Administration for Children and Families (ACF) has contracted with Mathematica Policy Research to complete the national cross-site evaluation of the program. The evaluation will describe the interventions that were implemented, the nature of the partnerships, the types of services provided, and their impacts.

You are being asked to complete this survey because you were identified as a representative of a partner organization working with the RPG grantee, [RPG GRANTEE]. Representatives from partner organizations are asked to complete this survey to provide information about their own organizations, relationships with the grantee and other collaborating organizations, and program implementation. The length of this survey is different for different people, but on average it should take about 25 minutes.

Your participation in this survey is important and will help us understand more about the partnerships implementing RPG-funded programs. Please provide responses for your organization, [ORGANIZATION]. If you represent a specific branch or program within your organization that is engaged with the RPG partnership, rather than the organization as a whole, please provide information about that branch or program rather than the organization as a whole. If you are unsure of how to answer a question, please give the best answer you can rather than leaving it blank.

Your responses will be kept private and used only for research purposes. They will be combined with the responses of other staff and reported in the aggregate; and no individual names will be reported. Participation in the survey is completely voluntary and you may choose to skip any question.

If you have any questions about the survey, please contact the team at Mathematica by emailing RPGSurveys @mathematica-mpr.com or calling 866-627-9538 (toll-free).

Please read and answer the statement below and then click the “Next” button in the lower right-hand corner to begin the survey.

i1. I have read the introduction and understand that the information I provide will be kept private and used only for research purposes. My responses will be combined with the responses of other staff and no individual names will be reported.

1 □ I agree with the above statement and will complete the survey

0 □ I do not agree with the above statement and will not complete the survey GO TO END

The first questions are about your organization, [ORGANIZATION].

1. Which of the following best describes your organization?

MARK ONE ONLY

1 □ Child welfare services provider

2 □ Substance abuse treatment provider

3 □ Mental health services provider

4 □ School district, school, or early childhood education or services provider

5 □ Housing/homeless services provider

6 □ Medical or dental services provider

7 □ University

8 □ Court/judicial agency

9 □ Corrections or law enforcement agency

10 □ Home visiting services provider

11 □ Department in state or tribal government

12 □ Department in local government

13 □ Foundation

14 □ Research/evaluation organization

15 □ Other (Describe)

2. What are the main activities your organization conducts in general?

MARK ALL THAT APPLY

1 □ Regulation and oversight

2 □ Child welfare services

3 □ Substance abuse treatment

4 □ Family therapy

5 □ Medical or dental services

6 □ Education or early childhood intervention

7 □ Legal processes

8 □ Law enforcement

9 □ Home visiting

10 □ Funding

11 □ Evaluation

12 □ Program planning and policy development

13 □ Advocacy

14 □ Other (Describe)

3. Does your organization currently provide program or other services or plan to serve RPG program clients?

MARK ONE ONLY

1 □ Currently provides services to RPG clients

2 □ Plans to provide services to RPG clients

3 □ No GO TO Q.6

4. Approximately how many RPG program clients does your organization currently serve or plan to serve each year?

Your best estimate is fine.

| | | , | | | | CLIENTS

5. Which of the following programs does your organization provide or plan to provide to RPG program clients?

MARK ALL THAT APPLY

1 □ 24/7 Dad

2 □ Alternatives for Families-Cognitive Behavioral

3 □ Attachment, Self-Regulation, and Competence (ARC)

4 □ Celebrating Families!

5 □ Centering Pregnancy

6 □ Child-Parent Psychotherapy (CPP)

7 □ Cognitive Behavior Therapy (CBT)

8 □ Dialectical Behavior Therapy (DBT)

9 □ Family Behavior Therapy (FBT)

10 □ Family Group Conferencing

11 □ Family Treatment Drug Court (FTDC)

12 □ Guiding Good Choices (GGC)

13 □ Hazelden Co-Occurring Disorders Program

14 □ Hazelden Living Balance Programs

15 □ Helping Men Recover

16 □ Head Start

17 □ Healthy Families

18 □ Homebuilders Intensive Family Preservation Services

19 □ Incredible Years Parenting Class

20 □ Kelly Bear

21 □ Keys for Interactive Parenting (KIPS)

22 □ Lifespan Integration

23 □ Matrix Model Program

24 □ MindUP

25 □ Modified Therapeutic Community (MTC)

26 □ Moral Reconation Therapy

27 □ Motivational Enhancement Therapy

28 □ Motivational Interviewing

29 □ Multisystemic Family Therapy (MST)

MARK ALL THAT APPLY

30 □ My Baby and Me (Ages 0-3)

31 □ Nurse-Family Partnership (NFP)

32 □ Nurturing Parenting Programs

33 □ Parent and Child Interactive Therapy

34 □ Parent Child Assistance Program (PCAP)

35 □ Parents and Children Together (PACT)

36 □ Parents as Teachers Curriculum

37 □ Partners in Parenting

38 □ Prolonged Exposure

39 □ Recovery Coach

40 □ Relapse Prevention Therapy (RPT)

41 □ Resource Mothers

42 □ SafeCare

43 □ Sanctuary Model

44 □ Screening, Brief Intervention, and Referral to Treatment (SBIRT)

45 □ Seeking Safety

46 □ Solution Focused Brief Therapy (SFBT)

47 □ Staying Connected with Your Teen

48 □ Strengthening Families

49 □ Strong Kids

50 □ Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS)

51 □ Supportive Education for Children of Addicted Parents

52 □ Trauma Focused Cognitive Behavioral Therapy (TF-CBT)

53 □ Untangling Relationships

54 □ Other (Describe)

55 □ None of these

6. Approximately how much funding from the Regional Partnership Grants program did your organization receive this fiscal year, if any? If your organization did not receive RPG funding this fiscal year, please answer $0.00.

$ | | | | , | | | |.00 AMOUNT OF FUNDING RECEIVED FROM RPG PROGRAM

d □ Don’t know

7. Which of the following in-kind resources is your organization is contributing to the RPG program this fiscal year?

MARK ALL THAT APPLY

1 □ Staff time

2 □ Office space

3 □ Volunteers

4 □ Office supplies

5 □ RPG program materials

6 □ Computer/Internet, telephone, or fax service

7 □ Other (Describe)

8 □ None of these

Partner Goals

8. In your own words, what are the main goals of the RPG partnership?

Relationships/Communication Systems

9. Do you currently serve on a steering, implementation, governance, or some other committee for the RPG grant?

1 □ Yes

0 □ No

10. Other than formal RPG partnership meetings, how frequently does your organization communicate about RPG with the organizations listed below?

First, please indicate if you were previously working with a member of the RPG partnership prior to the beginning the RPG grant in 2012. Next, please indicate if you do not communicate at all, if you communicate infrequently (a few times each month), or if you communicate regularly (every day or nearly every day) with that partner. Please choose the answer that best represents the frequency of communication. Please ignore the row that contains your organization.

Organization	Were you previously working with this partner prior to receiving the RPG grant funds? (MARK IF YES)		We do not communicate at all outside of RPG partnership meetings	We communicate infrequently (a few times each month) outside of RPG partnership meetings	We communicate regularly (every day or nearly every day) outside of RPG partnership meetings
	Yes	No
[ROSTER OF ORGANIZATIONS]	1 □	0 □	1 □	2 □	3 □
______________________________	1 □	0 □	1 □	2 □	3 □
______________________________	1 □	0 □	1 □	2 □	3 □
______________________________	1 □	0 □	1 □	2 □	3 □
______________________________	1 □	0 □	1 □	2 □	3 □
______________________________	1 □	0 □	1 □	2 □	3 □
______________________________	1 □	0 □	1 □	2 □	3 □

11. To what extent do you disagree or agree with each of the following statements about the current status of the collaboration among RPG partner organizations?

	Strongly Disagree	Disagree	Agree	Strongly Agree
a. Our collaborative effort was started because we wanted to do something about an important problem	1 □	2 □	3 □	4 □
b. Our RPG program’s top priority was having a concrete impact on the real problem	1 □	2 □	3 □	4 □
c. The organizations involved in our RPG program included those organizations affected by the issue	1 □	2 □	3 □	4 □
d. Participation was not dominated by any one group or sector	1 □	2 □	3 □	4 □
e. Our partner organizations have access to credible information that supports problem solving and decision making	1 □	2 □	3 □	4 □
f. RPG partner organizations agree on what decisions will be made by the group	1 □	2 □	3 □	4 □
g. Partner organizations agree to work together on this issue	1 □	2 □	3 □	4 □
h. Organizations involved in our RPG program have set ground rules and norms about how we will work	1 □	2 □	3 □	4 □
i. We have a method for communicating the activities and decisions of the group to all partner organizations	1 □	2 □	3 □	4 □
j. There are clearly defined roles for RPG partner organizations	1 □	2 □	3 □	4 □
k. Partner organizations are more interested in getting a good decision for the RPG program than improving the position of their own organization	1 □	2 □	3 □	4 □
l. Staff who participate in RPG program meetings are effective liaisons between their home organizations and the group	1 □	2 □	3 □	4 □
m. Partner organizations trust each other sufficiently to honestly and accurately share information, perceptions, and feedback	1 □	2 □	3 □	4 □
n. Partner organizations are willing to let go of an idea for one that appears to have more merit	1 □	2 □	3 □	4 □
o. Partner organizations are willing to devote whatever effort is necessary to achieve the goals	1 □	2 □	3 □	4 □
p. Divergent opinions are expressed and listened to	1 □	2 □	3 □	4 □
q. The openness and credibility of the process helps partner organizations set aside doubts and skepticism	1 □	2 □	3 □	4 □
r. Our group sets aside vested interests to achieve our common goal	1 □	2 □	3 □	4 □
s. Our group has an effective decision making process	1 □	2 □	3 □	4 □
t. Our group is effective in obtaining the resources it needs to accomplish its objectives	1 □	2 □	3 □	4 □
u. The time and effort of the collaboration is directed at achieving our goals rather than keeping the collaboration in business	1 □	2 □	3 □	4 □

12. Using the two columns below, please indicate the organizational levels at which collaboration most often occurs among all of the organizations in the partnership to fill in the following statement: Generally speaking, collaboration among organizations in the partnership typically occurs at the following levels: (column A) to (column B).

MARK ONE ONLY IN COLUMN A MARK ONE ONLY IN COLUMN B

1 □ Administrators/organization leaders 1 □ Administrators/organization leaders

2 □ Front-line staff/mid-level supervisors 2 □ Front-line staff/mid-level supervisors

13. Indicate the degree to which you disagree or agree with each of the following statements about RPG programming:

	Strongly Disagree	Disagree	Agree	Strongly Agree	Does not apply/ Don’t know
a. We developed strategies to recruit community participation	1 □	2 □	3 □	4 □	d □
b. Community members are included in program planning and development	1 □	2 □	3 □	4 □	d □
c. We developed formal mechanisms to solicit support and input from community members and consumers	1 □	2 □	3 □	4 □	d □
d. Front-line staff have up-to-date resource directories for family support centers and resources	1 □	2 □	3 □	4 □	d □
e. Community-wide accountability systems are used to monitor substance abuse and child welfare issues	1 □	2 □	3 □	4 □	d □
f. Consumers, patients in recovery, and program graduates have active roles in planning, developing, implementing, and monitoring services	1 □	2 □	3 □	4 □	d □

14. Indicate the degree to which you disagree or agree with each of the following statements about clients receiving RPG programming:

	Strongly Disagree	Disagree	Agree	Strongly Agree	Does not apply/ Don’t know
a. Services provided to families are coordinated across multiple partners	1 □	2 □	3 □	4 □	d □
b. Case management is coordinated across both substance abuse treatment providers and child welfare agencies	1 □	2 □	3 □	4 □	d □
c. Families receiving joint case management receive regular cross-agency assessments	1 □	2 □	3 □	4 □	d □
d. Staff from both substance abuse treatment providers and child welfare agencies participate in joint case management activities such as family team conferences, case plan reviews, or intake or permanency staffings	1 □	2 □	3 □	4 □	d □
e. Judicial officers and attorneys are viewed as partners in developing new approaches to serve families with substance use disorders in the child welfare system	1 □	2 □	3 □	4 □	d □
f. Substance abuse and child welfare agencies and the courts have negotiated shared principles or goal statements	1 □	2 □	3 □	4 □	d □
g. Region/partnership developed responses to conflicting time frames associated with child welfare services, substance abuse treatment, Temporary Assistance for Needy Families, and child development	1 □	2 □	3 □	4 □	d □
h. Substance abuse treatment and child protective service case plans are coordinated	1 □	2 □	3 □	4 □	d □
i. Formal working agreements have been developed on how courts, child welfare, and treatment agencies will share client information	1 □	2 □	3 □	4 □	d □
j. Data tracking child welfare and substance abuse clients across systems is used to monitor outcomes	1 □	2 □	3 □	4 □	d □
k. Substance abuse agencies, child welfare agencies, and court systems have developed shared outcomes for families and agree on how to use information on outcomes with families	1 □	2 □	3 □	4 □	d □
l. Joint training programs for the three main systems staff have been developed to help staff and providers work together effectively	1 □	2 □	3 □	4 □	d □

15. Below is a list of organizations identified as part of your RPG partnership. Which RPG-related services does your organization coordinate with or collaborate on with each organization? If you do not coordinate or collaborate with the organization on any of the listed activities, leave the row blank. Please ignore the row that contains your organization.

Organization	Screening and/or Assessment	RPG Program Referrals	Case Management or Coordination	Substance Abuse Treatment	Mental Health / Trauma Services	Other Social or Family Services
[ROSTER OF ORGANIZATIONS]	1 □	2 □	3 □	4 □	5 □	6 □
_____________________	1 □	2 □	3 □	4 □	5 □	6 □
_____________________	1 □	2 □	3 □	4 □	5 □	6 □
_____________________	1 □	2 □	3 □	4 □	5 □	6 □
_____________________	1 □	2 □	3 □	4 □	5 □	6 □
_____________________	1 □	2 □	3 □	4 □	5 □	6 □
_____________________	1 □	2 □	3 □	4 □	5 □	6 □
_____________________	1 □	2 □	3 □	4 □	5 □	6 □
_____________________	1 □	2 □	3 □	4 □	5 □	6 □

16. Thank you for your participation in this survey. If there is anything else that you would like to tell us about your work on the RPG program or about the partnership as a whole, please share it here.

(End of survey for those who opt out in the first screen)

Thank you for considering participation in this survey. Please click the “Submit survey” button in the lower right hand corner so that we have a record of your desire NOT to participate. This will result in your removal from our contact list.

(End of survey for respondents)

Thank you for completing the Regional Partnership Grant Partner Survey!

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