Form 0920-24GZ Sheriffs’ Advice-Seeking Survey

ATTACHMENT A: SHERIFFS’ ADVICE-SEEKING SURVEY INSTRUMENT

Form Approved

OMB No. 0920-1154

Exp. Date 3/31/2026

CDC estimates the average public reporting burden for this collection of information as 7 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333; ATTN: PRA (0920-1154).

Sheriffs’ Advice-Seeking Survey

State sheriffs’ associations and the U.S. Centers for Disease Control and Prevention are conducting a brief survey about advice-seeking among sheriffs concerning the adoption of evidence-based public health strategies to help people prior to and upon release from jail. This survey is being sent to all sheriff members in your state. We ask that only sheriffs complete the survey. We hope that you will follow the link below to answer this brief set of questions.

Rights Regarding Participation: Your input is important; however, your participation in this survey is completely voluntary. There are no penalties or consequences to you or your organization for not participating. You can choose to stop the survey at any time, or not answer a question, for whatever reason. If you stop the survey, at your request, we will destroy the survey. You may ask any questions that you have before, during, or after you complete the survey. The survey will take approximately 7 minutes.

Benefits: Your participation will not result in any direct benefit to you. Your input will help to provide a better understanding of the advice networks of sheriffs so that health improvement efforts can better be disseminated.

Risks: This survey poses no known risks to you and/or your jail. Please know that in the survey we ask you to name other sheriffs and other jails. All identifying information of sheriffs and jails will be kept strictly confidential with names of sheriffs and jails known only to the members of the study team and the participating sheriffs’ associations.

Contact information: If you have any concerns about completing this survey or have any questions about the study, please contact Tessa Swigart at Tessa.Swigart@icfnext.com.

By clicking on the following survey link you indicate your consent to participate in the survey.

1. Your name: _______________________________________

2. Your jail: _______________________________________

1. Demographics

3. What is your age?_____________

4. How long have you been a sheriff?

• Less than 1 year

• 1-5 yrs.

• 6-10 yrs.

• 11-15 yrs.

• 16-20 yrs.

• 20+ yrs.

5. How long have you been in the justice-related field?

• Less than 1 year

• 1-5 yrs.

• 6-10 yrs.

• 11-15 yrs.

• 16-20 yrs.

• 20+ yrs.

2. Advice Seeking

6. Please list up to three other sheriffs in your state whose advice you seek or actions you monitor regarding new ways to improve the health of incarcerated persons prior to and upon release from jail. If you do not have three names to list, select the names you know and leave the remaining answer boxes blank.

Name of Sheriff	County
[Select from drop down]	[Select from drop down]
[Select from drop down]	[Select from drop down]
[Select from drop down]	[Select from drop down]

7. Now please list three jails in your state other than your own that you look to for good ideas for improving the health of incarcerated persons prior to and upon release from jail. If you do not have three names to list, select the names you know and leave the remaining answer boxes blank.

Name of Jail	County
[Select from drop down]	[Select from drop down]
[Select from drop down]	[Select from drop down]
[Select from drop down]	[Select from drop down]

3. Jail services

8. Does your jail system provide services during incarceration or upon release to prevent overdose post-release? These include services like peer support,¹ overdose education, naloxone² kits or prescriptions for naloxone, fentanyl test strips,³ medications for opioid use disorder,⁴ and linkage to care (e.g., medications for opioid use disorder or harm reduction services⁵) in the community.

• Yes (skip to Q9)

• No (skip to Q10)

• I don’t know (skip to Q11)

9. What type of services does your jail system provide during incarceration or upon release to prevent overdose post-release?

• Peer support

• Overdose education

• Naloxone kits

• Prescriptions for naloxone

• Fentanyl test strips

• Medications for opioid use disorder

• Linkage to medications for opioid use disorder in the community

• Linkage to harm reduction services in the community

• Other (e.g., Therapeutic Community, Narcotics Anonymous). If other, please specify ____________________________________________

10. [If yes to Q8, skip to Q11] Why do you think your jail does not provide overdose prevention services?

Overdose Prevention Services	Please select up to three top reasons why you think your jail system does not provide each of these prevention services listed below.
Peer support Services	Not the jail’s responsibility Not the jail’s priority Lack of support among the community/constituents Not aligned with jail's mission or approach to health services I don’t think this service is beneficial enough It is too logistically complex Short duration of stays in the jail Lack of options for peer support services in the community Lack of funding or other resources Other, if other please specify___________________
Naloxone Distribution	Not the jail’s responsibility Not the jail’s priority Lack of support among the community/constituents Not aligned with jail's mission or approach to health services I don’t think this service is beneficial enough It is too logistically complex The jail takes an abstinence-only approach Short duration of stays in the jail I am unclear if there are legal considerations Lack of funding or other resources Other, if other please specify___________________
Fentanyl Test Strips	Not the jail’s responsibility Not the jail’s priority Lack of support among the community/constituents Not aligned with jail's mission or approach to health services I don’t think this service is beneficial enough It is too logistically complex The jail takes an abstinence-only approach. Short duration of stays in the jail I am unclear if there are legal considerations Lack of funding or other resources Other, if other please specify___________________

11. Do you believe your jail should provide overdose prevention services?

• Yes

• No

• I don’t know

12. Thank you so much for participating in the survey. Would you be willing to be contacted in the future to provide more information about your perspective on re-entry services?

• Yes

• No

1 Peer support services include connecting an individual to a peer mentor, navigator, or recovery coach.

2 Naloxone is a medication that is used to reverse an opioid overdose.

3 Fentanyl test strips are drug-checking equipment that allow people who use drugs to self-check their drug supply for the presence of fentanyl and fentanyl analogs.

4 Medications for opioid use disorder refer to the three FDA-approved medications (i.e., buprenorphine, methadone, and naltrexone) used to treat opioid use disorder.

5 Syringe service programs and harm reduction vending machines are examples of harm reduction services.

Sheriffs’ Advice-Seeking Survey 3/4/2023 Page 5