Public reporting burden for this collection of information is estimated to be 0.5 hours to complete this questionnaire. 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 control number for this project is 0970-0288. The control number expires on X/X/XXXX.
National Technical Assistance and Evaluation Center
Improving Child Welfare Outcomes Through Systems of Care Program
System of Care (SOC) Collaborative/Steering Committee Survey
INFORMED CONSENT
This survey is designed to help us learn more about the Systems of Care initiative in your community, specifically around issues related to continued planning and implementation, the resources available to the community, the level of collaboration among systems in your community, and changes you are seeing as a result of the initiative. You were selected to complete this survey by your local project director based on your level of activity in the Systems of Care initiative. To determine the extent to which change has occurred over time, this survey will be administered a total of three times: once in 2005, once in 2006, and now (2008).
Before you get started, there are a few other issues of which you need to be aware. First, it is important that you know that your participation in this survey is completely voluntary and that no one associated with your Systems of Care initiative will know whether or not you complete it. Also, you may skip any questions you do not wish to answer, without consequence. However, because your input is invaluable in helping the evaluation team understand the types of changes that occur as a result of the Systems of Care initiative, we would like to ask that you consider answering each question. Finally, if you do not wish to participate in this survey, please simply return the blank survey to the project coordinator/evaluator.
The survey should take about 30 minutes to complete. To protect your confidentiality, surveys will be collected by the local project coordinator/evaluator and placed in sealed envelope and mailed to Caliber, an ICF International Company. No one in your community will see your responses, including the project coordinator/evaluator or other collaborative members. All analyses and reports will only present data in aggregate form – either by County, State, or cross-site, that is by all nine grantee communities. Please do not put your name on the survey so your answers can remain completely anonymous.
As part of our agreement with the local evaluation team, Caliber, an ICF International Company, will be providing the raw data from this survey to them. However, since the survey is anonymous, there is not way to track individual respondents. Your local team, is also bound by the same confidentiality regulations as the national evaluation team (i.e., the team conducting this survey). Therefore, they are required to keep confidential the information they receive from the national team, and to report findings in summary form only. To ensure compliance to these regulations, the national evaluation team has a signed agreement with the local evaluation team.
Thank you in advance for completing this survey. You input will be integral in helping the national evaluation team understand how the Systems of Care initiative is working in communities nationwide.
SOC Collaborative/Steering Committee Survey
STATE: _____________________________________________________(PRE_FILL)
COUNTY/TRIBE: ______________________________________(PRE_FILL) DATE: _____________
BACKGROUND
When did you first begin to actively participate in the Systems of Care Initiative?
____(Mo.)/____(Yr.)
What type of organization do you represent? Check ONE response category that most closely fits your organization.
Job in legal services: __________________
|
____________________________________ |
|
|
How long have you worked in the field you identified in question 2?
____ Years ___ Months
4. If you represent an organization/agency, please select ONE of the following that BEST describes your position within your agency:
A. Agency Director
B. Administrative
C. Supervisor/Manager
D. Direct Services (primarily work directly with clients)
E. Not applicable (do not represent an agency/organization)
F. Other
____ a) 1 - 5 ___d) 21 - 50 ___g) Not Applicable
____ b) 6 - 10 ___e) 51 - 100
____ c) 11 - 20 ___f) More than 100
6. Are you male or female? (circle one)
A. Male B. Female
7. Are you Hispanic/Spanish/Latino?
A. No, not Hispanic/Spanish/Latino
B. Yes, Hispanic/Spanish/Latino
8. Select one of more of the following categories to best describe your race:
White
B. Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
9. How many times have you taken this survey?
A. This is my first time
Two times
Three times
Not Sure/Don’t Know
10. How long have you participated on the System of Care (SOC) collaborative?
___ Years ___ Months
____ a) 1 - 5 ___d) 16 - 20 ___g) 31 - 35
____ b) 6 - 10 ___e) 21 - 25 ___g) 36 - 40
____ c) 11 - 15 ___f) 26 - 30 ___g) 41 >
13. Have you participated in a collaborative initiative prior to the Systems of Care Initiative?
____a) Yes ___b) No
14a. Please indicate the role(s) you play (if any) in SOC interagency collaborative activities.
(For each item, circle Yes (Y) or No (N))
Roles |
Yes |
No |
Attend meetings regularly |
Y |
N |
Serve as member of workgroup (subcommittee) |
Y |
N |
Work on activities outside of meetings |
Y |
N |
Help organize activities (other than meetings) |
Y |
N |
Direct the implementation of a particular program |
Y |
N |
Chair/lead a workgroup |
Y |
N |
Serveas an officer other than chair |
Y |
N |
Chair/co-chair the entire group |
Y |
N |
|
Yes |
No |
Has regularly scheduled meetings |
Y |
N |
Has workgroups or subcommittees |
Y |
N |
Conducts work on activities outside of meetings |
Y |
N |
Has bylaws |
Y |
N |
Has an agenda for each meeting |
Y |
N |
Distributes minutes from meetings |
Y |
N |
Has a vision statement |
Y |
N |
Has a mission statement |
Y |
N |
Has a written strategic plan |
Y |
N |
Tracks progress on strategic plan (goals, objectives) |
Y |
N |
Revisits strategic plan (at least once annually) |
Y |
N |
Has formalized rules and procedures |
Y |
N |
15. The following statements refer to your community and agency readiness for
this systems of care effort over the past year. For each statement, please indicate the extent to which you agree with the statement, using the following scale: “1” means you strongly disagree, “2” means you disagree, “3” means you are neutral (neither disagree nor agree), “4” means you agree, and “5” means you strongly agree. If you do not know, please circle the X in the right hand column (Don’t Know).
|
Strongly Disagree |
Disagree |
Neutral |
Agree |
Strongly Agree |
Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
X |
|
1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
16. Please rate the extent to which each of the following served as challenges to your local Systems of Care initiative over the past year. Please use the following scale where “1” means not at all an obstacle and “5” means very much an obstacle. If you do not know, please circle the X in the right hand column (Don’t Know).
|
Not at all |
A little |
Somewhat |
Moderately |
Very Much |
Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
X |
|
1 |
2 |
3 |
4 |
5 |
X |
|
1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
____________________________
|
1 |
2 |
3 |
4 |
5 |
X |
____________________________ |
1 |
2 |
3 |
4 |
5 |
X |
____________________________
|
1 |
2 |
3 |
4 |
5 |
X |
17. Please rate the extent to which each of the following factors has contributed to the success of the Systems of Care initiative in your community over the past year. Please use the scale below where “1” means not at all a success factor and “5” means very much a success factor. If you do not know, please circle the X in the right hand column.
|
Not at all |
A little |
Somewhat |
Moderately |
Very Much |
Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
X |
|
1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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3 |
4 |
5 |
X |
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3 |
4 |
5 |
X |
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5 |
X |
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5 |
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5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
____________________________ |
1 |
2 |
3 |
4 |
5 |
X |
18. The following statements refer to the Systems of Care planning and implementation process in your community over the past year. Please indicate the extent to which you agree with each statement with “1”indicating Strongly Disagree and “5” means Strongly Agree. If you do not know, please circle the X in the far right hand column (Don’t Know).
|
Strongly Disagree |
Disagree |
Neutral |
Agree |
Strongly Agree |
Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
X |
|
1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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3 |
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5 |
X |
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3 |
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X |
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3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
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5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
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5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
19. The following statements refer to the effectiveness of your Systems of Care (SOC)
activities and efforts. For each statement, please indicate the extent to which you agree with the statement, using the following scale: “1” means you strongly disagree, “2” means you disagree, “3” means you are neutral (neither disagree nor agree), “4” means you agree, and “5” means you strongly agree. If you do not know, please circle the X in the far right hand column (Don’t Know).
|
Strongly Disagree |
Disagree |
Neutral |
Agree |
Strongly Agree |
Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
X |
|
1 |
2 |
3 |
4 |
5 |
X |
|
1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
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1 |
2 |
3 |
4 |
5 |
X |
|
1 |
2 |
3 |
4 |
5 |
X |
|
1 |
2 |
3 |
4 |
5 |
X |
|
1 |
2 |
3 |
4 |
5 |
X |
The final set of questions refer to your collaborative’s sustainability plans. that is, strategies to continue and/or expand the SOC initiative BEYOND FEDERAL grant funding.
20. When did your collaborative start planning for sustainability? (circle one)
A. From the beginning of the grant (2003)
B. 2004
C. 2005
D. 2006
E. In the past year (2007/8)
21. The following statements refer to your collaborative’s sustainability planning efforts. For each statement, please indicate the extent to which you agree with the statement, using the following scale: “1” means you strongly disagree, “2” means you disagree, “3” means you are neutral (neither disagree nor agree), “4” means you agree, and “5” means you strongly agree. If you do not know, please circle the X in the far right hand column (Don’t Know).
Each of the statements REFERS to continuing efforts beyond federal grant funding. Please select Not Applicable if your community has not yet implemented the activity in question.
|
Strongly Disagree |
Disagree |
Neutral |
Agree |
Strongly Agree |
Don’t Know |
Not Applicable |
A. The collaborative has specific plans to provide ongoing training on SOC principles to staff of child serving agencies. |
1 |
2 |
3 |
4 |
5 |
X |
X |
B. The collaborative has plans for continuing to hold SOC steering committee/collaborative meetings. |
1 |
2 |
3 |
4 |
5 |
X |
X |
C. The collaborative has plans for continuing family involvement on the SOC steering committee/collaborative. |
1 |
2 |
3 |
4 |
5 |
X |
X |
D. The collaborative has plans to continue compensating family members for their participation on SOC collaborative groups. |
1 |
2 |
3 |
4 |
5 |
X |
X |
E. The collaborative has plans for compensating family members who train staff of child serving agencies. |
1 |
2 |
3 |
4 |
5 |
X |
X |
F. The collaborative has plans for continuing the family navigator/parent partner program in the child welfare system. |
1 |
2 |
3 |
4 |
5 |
X |
X |
G. The collaborative has specific plans for increasing family centered practices in child serving agencies. |
1 |
2 |
3 |
4 |
5 |
X |
X |
H. The collaborative has specific plans for increasing an individualized, strengths-based approach in child serving agencies. |
1 |
2 |
3 |
4 |
5 |
X |
X |
I. The collaborative has plans for continuing to provide training on cultural competence to child serving agencies. |
1 |
2 |
3 |
4 |
5 |
X |
X |
J. The collaborative has specific plans to increase the ethnic and racial diversity of staff of child serving agencies. |
1 |
2 |
3 |
4 |
5 |
X |
X |
K. The collaborative has specific plans to continue to increase the safety, well-being, and permanency of children in the target population. |
1 |
2 |
3 |
4 |
5 |
X |
X |
L. The collaborative has specific plans to continue to increase the availability of community-based services. |
1 |
2 |
3 |
4 |
5 |
X |
X |
M. The collaborative has plans to continue to assess the effectiveness of services for children and families in the child welfare system. |
1 |
2 |
3 |
4 |
5 |
X |
X |
N. Key child serving agencies will continue to have access to each other’s data systems. |
1 |
2 |
3 |
4 |
5 |
X |
X |
O. Key child serving agencies have signed MOU’s agreeing to continue to collaborate in serving children and families. |
1 |
2 |
3 |
4 |
5 |
X |
X |
P. Procedures for continuing to share case information across agencies have been established. |
1 |
2 |
3 |
4 |
5 |
X |
X |
Q. The collaborative has developed strategies to continue to combine agency resources to better serve children and families (e.g., blended funding, identification of alternative funding, etc.). |
1 |
2 |
3 |
4 |
5 |
X |
X |
Thank You For Your Help With This Important Study
Please return the Survey to your Project Coordinator/Evaluator |
File Type | application/msword |
File Title | Community Assessment Survey Items |
Author | brooksj |
Last Modified By | ICF |
File Modified | 2008-06-20 |
File Created | 2008-04-24 |