11 - CBCS - Event Follow Up Survey

OMB #: 0970-0XXXX

Expiration Date: XX/XX/XXXX

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to gather feedback on capacity building products and services to better meet the needs of child welfare professionals. Public reporting burden for this collection of information is estimated to average 5 minutes per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The control number for this project is 0970-XXXX. The control number expires on XX/XX/XXXX. If you have any comments on this collection of information, please contact Beth Claxon, ACF, Administration on Children, Youth and Families by e-mail at Beth.Claxon@acf.hhs.gov.

Event Follow Up Survey

PURPOSE: Participants of events evaluated with the Brief Event Survey will be recruited to participate in the Event Follow-Up Survey to assess outcomes achieved after the event. The event follow-up survey will be administered approximately 3 months after the event.

Instructions for On-line Survey Development

Participants of events evaluated with the Brief Event Survey will be recruited to participate in the Event Follow-Up Survey to assess outcomes achieved after the event. The event follow-up survey will be administered approximately 3 months after the event.

Because brief event surveys are tailored to each event’s unique information needs and context, event follow-up surveys are also tailored to align with the brief event survey. When creating each on-line follow-up survey, content specialists will use the required questions listed below and choose up to 4 optional questions related to products that can be added to the survey, as needed to align with the brief survey. It is expected that each tailored survey will have no more than 20 questions, including 14 required questions and a maximum of 6 optional product questions, with a burden of no more than 5 minutes.

Required Questions

(4 required questions + 4 outcome questions + 6 demographic questions = 14 total required questions)

	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree or Disagree	Somewhat Agree	Agree	Strongly Agree	NA	Don’t Know
The [Name of Peer Learning Activity or Event] has been helpful in my work.	SD	2	3	4	5	6	SA	NA	DK
As a result of the information I learned through the [Name of Event], I am more effective in my work.	SD	2	3	4	5	6	SA	NA	DK
What aspects of the [Name of Event] have been most useful to your work?
What additional assistance do you or your organization need with this topic?
Required Outcome Questions (Select 4 max)
The [Peer Learning Activity or Event] increased my knowledge about [Topic].	SD	2	3	4	5	6	SA	NA	DK
SKIP PATTERN: If 4, 5 or 6 is selected to the above question, ask: How often are you applying what was learned? Frequently Occasionally Not at all
Please provide a specific example of the topics in which the [Peer Learning Activity or Event] has increased your knowledge: __________
The [Peer Learning Activity or Event] increased my practical skills regarding [Topic].	SD	2	3	4	5	6	SA	NA	DK
Please provide a specific example of how your skills have increased: __________
I discovered new tools, ideas, & ways of thinking from the relationships developed during the Peer Learning Event.	SD	2	3	4	5	6	SA	NA	DK
I improved my connections with peers/colleagues as a result of the Peer Learning Event.	SD	2	3	4	5	6	SA	NA	DK
Provide a specific example of how the Peer Learning Event improved your relationship with peers: __________
As a result of this [Peer Learning Event], how often over the past 3 months have you engaged with other attendees outside of official activities? Never Once Every Few Months Monthly A Few Times a Month Weekly Two to Three Times a Week
Please select the various ways you have already applied the information from the [Peer Networking Activity or Event] in your work. (Select all that apply) Supported program improvement Supported policy development Provided information to clients/families Shared information with my peers SKIP PATTERN: If ‘provided information to clients/families’ or ‘shared information with my peers’ is selected: Please provide the number of people that you shared with? _____ Supported public awareness/advocacy efforts Grant writing/Fundraising Trained staff/colleagues SKIP PATTERN: If ‘trained staff/colleagues’ is selected then: In what setting will this information be used? Formal Training with Co-Workers Informal Training with Co-Workers Distribute Materials to Co-Workers Classroom/University Train the Trainer Other Conducted research & evaluation My own professional development I have not yet applied this to my work Other (Please describe): __________ Please provide a specific example of how you have applied the information to your work: _____

In which State/Territory/Tribe do you work? ________ (pull down list)

Which best describes your organization?

• State Child Welfare Agency

• County Child Welfare Agency

• Territorial Child Welfare Agency

• Tribal Child Welfare Agency

• State or County Court/Legal System

• Tribal Court/Legal System

• Private or Community-based Child Welfare Agency

• Local Government/Tribal Council

• Law Enforcement Organization

• Primary Care/Health Care Services Provider

• Behavioral/Mental Health Services Provider

• Substance Abuse Services Provider

• Domestic Violence Services Provider

• Juvenile Justice Organization

• Primary/Secondary Education

• College/University

• Technical Assistance Provider

• Federal Government

• Other (please describe): __________

What is your primary role?

CW professional response options

• Agency Director/Deputy Director

• Program/Middle Manager

• Supervisor

• Caseworker/Direct Practice Worker/Frontline Staff

• Parent Partner

• Other (please describe): __________

Court professional response options

• CIP or TCIP Director/Coordinator

• CIP or TCIP Staff

• Judge

• Attorney for CW agency

• Attorney for Parent

• Attorney for Child

• Attorney Guardian Ad Litem

• Court Administrative Officer

• Court/Attorney Data Manager/IT Staff

• Court Appointed Special Advocate/Non-attorney GAL/Advocate

• Court Case Worker/Social Worker

• Other (please describe): __________

Education professional response options

• Dean/Director/Administrator

• Teaching Faculty

• Training Academy Leadership/Staff

• Research Faculty/Staff (non-teaching role)

• Student

• Other (please describe): __________

Which of the following best describes your primary work responsibilities? (Select 3)

• Administration

• Workforce Development/Training

• Continuous Quality Improvement/Evaluation

• Information Technology/SACWIS/Data Systems

• Indian Child Welfare Act

• Primary or Secondary Prevention

• Child Protective Services

• In-home Services/Promoting Safe and Stable Families

• Foster Care/Placement/Licensing/Reunification

• Adoption/Guardianship

• Youth in Transition/Chafee/Independent Living Programs

• Other (please describe): __________

What best describes you?

• Child Welfare Professional

• Other HHS Professional

• Legal Professional

• Education Professional

• Student/Intern

• Current or Former Youth in Foster Care

• Biological Parent/Relative Caregiver/Family Member

• Non-Relative Foster or Adoptive Family Member

• Community Member/Community Leader/Tribal Elder

• Other (please describe): __________

How many years of service do you have in your current profession?

• Less than 1 year

• 1–5 years of service

• 6–10 years of service

• 11–15 years of service

• 16+ years of service

Optional Questions

Product Optional Questions

(Select no more than 6 optional questions related to Center Products)

	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree or Disagree	Somewhat Agree	Agree	Strongly Agree	NA	Don’t Know
I shared what I learned from this Center product with others.	SD	2	3	4	5	6	SA	NA	DK
SKIP PATTERN: If 4, 5, or 6 is selected for item above ask: How many people did you share with? _____
I recommended this Center product to others.	SD	2	3	4	5	6	SA	NA	DK
I have used Center products or learning experiences to inform practice, programs, or policy in my agency.	SD	2	3	4	5	6	SA	NA	DK
Please select the various ways you have applied the information from the Center product in your work. (Select all that apply) Supported program improvement Supported policy development Provided information to clients/families Shared with peers Supported public awareness/advocacy Grant writing/Fundraising Trained staff/colleagues Conducted research & evaluation My own professional development (e.g., increased knowledge) I have not yet applied this to my work Other (please describe): __________ Please provide a specific example: __________
What aspects of the Center product were most useful to your work? __________
In what ways would you like to be able to use Center publications, tools, and products in the future? __________
What suggestions do you have for improving Center publications and products? __________
What topics would you like to see the Center develop resources on? __________

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