Social and Community Service Managers/survey

An Assessment of the Sustainability and Impact of Community Coalitions Once Federal Funding Has Expired

HCAPQuestionnaire_vOMB

Social and Community Service Managers/survey

OMB: 0990-0368

Document [pdf]

Download: pdf | pdf

Form Approved
OMB No. 0990Exp. Date XX/XX/20XX

SUID

Survey of CAP/HCAP Coalitions
Post-Federal Funding
If you have any questions about the study, please contact the NORC Project Director, Caitlin Oppenheimer, at (301) 634-9322.

Introduction
This survey is being conducted by the Assistant Secretary for Planning and Evaluation
at the U.S. Department of Health and Human Services and the National Opinion
Research Center (NORC) as part of a study to assess the status of community
coalitions that received Community Access Program (CAP) or Healthy Communities
Access Program (HCAP) funding. The survey should take 40 – 50 minutes to complete
and is an important part of the overall study.
This survey asks questions about the current structure, activities, and impacts of
coalitions that received CAP/HCAP funding and asks for some comparisons to the
coalition during the CAP/HCAP grant period. NORC has identified you as the most
knowledgeable person about the coalition and its CAP/HCAP history. However, we do
not expect you to be able to answer all the questions yourself. We encourage you to
ask other people involved with the coalition for help completing the survey. If you think
that there is someone else that would be better suited to answer these questions,
please send an email to HCAP@norc.org and tell us who we should contact.
If you have any questions about the study, please contact the NORC Project Director,
Caitlin Oppenheimer, at (301) 634-9322.
Your cooperation is very much appreciated.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information
collection is 0990- . The time required to complete this information collection is estimated to average 40 minutes
per response, including the time to review instructions, search existing data resources, gather the data needed,
and complete and review the information collection. If you have comments concerning the accuracy of the time
estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services,
OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201,
Attention: PRA Reports
Clearance Officer

Section I:
Background Information
1.

Does your CAP/HCAP coalition still exist? By this
we mean that there is currently an alliance of at least
three member organizations. We expect that the
coalition has evolved since the CAP/HCAP grant; it
may even have changed names, size, members, or
goals. But what we are asking here is simply
whether it’s currently in existence.
1.
2.

Section II:
Characteristics of Your Coalition
This section asks about some of the features of your
coalition, including your coalition’s: size,
composition of membership, vision, mission, goals,
funding, structure, evaluation efforts, and
community served.
Remember, we do not expect you to be able to
answer all the questions yourself. We encourage
you to ask other people involved with the coalition
for help completing the survey. If you think that
there is someone else that would be better suited to
answer these questions, please send an email to
HCAP@norc.org and tell us who we should contact.

Yes
No  (SKIP TO SECTION VI ON PAGE 14)

What is the current name of the coalition
previously funded by the CAP/HCAP grant?

COMMUNITY SERVED BY THE COALITION
3.

1.
2.

Does the coalition have a webpage?

What is the approximate size of the population in
the area where your coalition works?

Yes
No  (SKIP TO QUESTION 5)

What is the coalition’s web address?

www.

What are the characteristics of the population
receiving services from your coalition? (Check all
that apply.)
1.

What is your role in the coalition? Please select
the appropriate statement.

I am the day-to-day manager/ administrator
of the coalition.

I am a leader of the coalition, but I do not
mange the day-to-day operations and
activities.
Other (specify):

7.
8.
9.
10.
11.

Were you involved in any way with the coalition
when it was funded by the CAP/HCAP grant?
1.
2.

Yes
No  (SKIP TO SECTION II ON THIS PAGE)

12
13.

14.

Briefly describe your role with the coalition when it
was funded by the CAP/HCAP grant.

15.

Urban
Rural
Suburban
Uninsured
Underinsured/underserved
White
African American
Hispanic/Latino
Asian American/Pacific Islander
Native American
Mixed race or other racial or ethnic group
(specify):

Low-income
Middle-income
High-income
Other characteristics (specify):

COALITION MEMBERSHIP
10.

How many organizations are members of your
coalition?

11.

Of these, how many members do you consider to
be active members?

12.

About how often do new organizations join the
coalition?
1.
2.
3.
4.
5.
6.

13.

2.
3.
4.
5.
6.

Never
Less than once every two years
About once a year
About once every six months
About once every three months
More than once every three months

What is the most common reason for membership
turnover (losing or adding member organizations)?
1.
2.
3.

What sectors and types of organizations do
coalition members represent?
(Check all that apply.)
Health-Sector Members
1.
Federally Qualified Health Centers
2.
Academic medical centers
3.
Free clinics/other community health centers
4.
Migrant health centers
5.
Public housing primary care programs
6.
Public or private health care providers/
practices
7.
Hospitals with a low-income utilization rate
greater than 25%
8.
Other hospitals
9.
Area health education centers
10.
Primary care associations
11.
Managed care organizations
12.
Medical/dental societies
13.
Specialty care providers
14.
Oral health providers
15.
Long-term care providers
16.
Home health providers
17.
Laboratories
18.
Pharmacies
19.
Private insurance providers
20.
Medicaid programs
21.
Rural health clinics
22.
Other health care coverage programs
23.
Mental health programs/providers
24.
Substance abuse programs
25.
Community-based organizations
26.
School-based health centers
Non-Health Sector Members
27.
Government (e.g., local health department or
elected officials)
28.
Social services (e.g., juvenile justice
programs or temporary housing assistance)
29.
Education (e.g., elementary schools or
university public health programs)
30.
Faith (e.g., churches or faith-based
organizations)
31.
Business (e.g., chambers of commerce or
local non profits)
32.
Foundations (e.g., philanthropic
organizations)
33.
Other (specify):

About how often does the coalition lose member
organizations?
1.

14.

15.

Changes in coalition funding
Shifts in coalition projects and activities
Reassessment of the coalition’s membership
needs and priorities
Changes within the member organization
(e.g., new leadership, shift in priorities)
Other (specify):

18.

COALITION MISSION & GOALS
16.

Is your coalition working to achieve some or all of
the same goals it addressed under the CAP/HCAP
grant?
1.
2.
3.

17.

20.

Please list all of your new goals.

No, none of the same goals
Yes, at least one of the same goals
Yes, all of the same goals

19.

Yes

No  (SKIP TO Q20)

To attract new members
To qualify for new funding sources
To address new or additional needs of the
community
Other (specify):

1.
2.

Has your coalition added one or more new goals
since the end of your CAP/HCAP grant?
1.

Why did your coalition add one or more new
goals? (Check all that apply.)

Please indicate how much you disagree or agree with the following statements:
Strongly
Disagree

Your coalition’s:

Disagree

Agree

Strongly
Agree

No Opinion/
Not Applicable

a. vision, mission, and goals are documented.

b. vision, mission, and goals take into account what is
happening in the community.

c. member organizations agree on the coalition’s vision,
mission, and goals.

d. member organizations are committed to pursuing
activities to achieve the coalition’s vision, mission, and
goals.

e. vision, mission, and goals are understood by residents
and institutions in your community

f. vision, mission, and goals are periodically
re-evaluated or updated.

g. activities are evaluated in relation to its vision, mission,
and goals.

COALITION STRUCTURE
21.

Does your coalition currently have a lead
organization?
1.
2.

22.

25.

Yes
No  (SKIP TO Q24)

What type of organization currently leads the
coalition?

26.
23.

Has the lead organization changed since the end
of the CAP/HCAP grant?
1.

24.

Yes  WHAT WAS THE FORMER LEAD
ORGANIZATION?

3.
4.

How many paid staff, in terms of full-time
equivalents (FTEs), are employed by the coalition?

28.

Has the size of the coalition’s FTE staff changed
since the end of the CAP/HCAP grant?
1.

Yes, with all of our members
Yes, with most of our members
Yes, with some of our members
No, not with any of our members

27.
No

Steering Committee (a committee made up of
representatives from member organizations
who work with the consortia leadership)
Board of Directors (a group of individuals
external to the consortia who provide input
and/or oversight to the consortia leadership)
Executive Committee (a small group of
consortia leadership responsible for consortia
operations)
Community Advisory Board (a group of laypersons from the community who provide
input on consortia activities and direction)

Formal, such as legally incorporated or
Memoranda of Understanding
Informal, such as letters of support or verbal
agreements  (SKIP TO Q27)
Other (specify):

Does your coalition have Memoranda of
Understanding or inter-agency agreements with any
coalition members?
1.

Does your coalition have any of the following
boards or committees?
(Check all that apply.)
1.

What is the structure of your coalition
membership?

Yes, we have more staff now than we did
during the CAP/HCAP grant.
Yes, we have fewer staff now than we did
during the CAP/HCAP grant.
No, we have the same size staff now as we
did during the CAP/HCAP grant.

29.

Please indicate how much you disagree or agree with the following statements:
Strongly
Disagree

Your coalition:
a. has a regular, reliable meeting cycle.
b. has active committees.
c. members have copies of the coalition bylaws.
d. has an executive board/leadership team that meets
regularly and with good attendance.
e. has an executive board/ leadership team that communicates
with committees and members on a regular basis.
Coalition members:
f. are involved in project design.
g. are involved in project implementation.
h. share responsibility for providing project resources.
i. share credit for project successes.
j. have clearly defined roles and responsibilities.
Your coalition’s leadership:
k. had a strong connection to the community prior to assuming
leadership of the coalition.
l. fosters active involvement of other key stakeholders (e.g.,
board members, leaders of membership organizations,
community organizers, etc.).
m. is good at negotiating, facilitating groups, networking, and
other skills that help foster relationships with community
stakeholders.
n. communicates a clear mission and vision for the coalition
with all its members.
o. has expertise in the health and social issues the coalition is
addressing.

30.

31.

About how often do all coalition members
convene for formal meetings?
1.
2.
3.
4.
5.

Every month or more
Every one to three months
Every four to six months
Once a year or less
Never

Strongly
Agree

No Opinion/
Not Applicable

Yes
No

Does your coalition have a formal process for
managing conflicts among members and/or between
members and coalition leadership?
Yes
No

1.
2.

33.

Agree

Does your coalition have formal decision making
processes (e.g., consensus or majority policies)?
1.

32.

Disagree

Please provide some information about your coalition’s leader or director.
Check the appropriate box for each of the questions below.
1 year or
less

How long has the coalition leader or director:

Between 1
year and 3
years

3-5 years

5-10 years

More than 10
years

No Opinion/
Not
Applicable

directed or managed the coalition?

worked in the field of health care delivery or health
care administration?

lived or worked in the community served by the
coalition?

COALITION FUNDING RESOURCES
34.

Does your coalition currently receive financial resources from any of the following sources?
Yes/No

a. U.S. Department of Health and
Human Services

b. Other Federal Agency/Department
(specify): _______________________

c. State Health Department

2
1
2

d. Other State Agency/Department
(specify): _______________________

e. Local (county or community)
Health Department
f. Other Local (county or community)
Agency/Department (specify):
_______________________

g. United Way

35.

2
1
2
1
2

Yes/No

h. Foundations
(specify): _______________________
i. Health Insurers/Managed Care
Organizations
(specify): _______________________
j. Businesses
(specify): _______________________

k. Universities/Academic Institutions
(specify): _______________________

Community Based Organizations
(specify): _______________________

Yes
No

m. Faith Based Organizations
(specify): _______________________

Yes
No

n. Other (specify):
_______________________

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

2
1
2
1
2

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

Does your coalition currently receive in-kind contributions from its members?
Yes/No

a. Facilities (e.g., office space, exam
rooms)

b. Equipment and Supplies (e.g.,
computers, brochures, test kits)

c. Salary Sharing/Time Coverage for Key
Coalition Personnel

d. Volunteers
e. Administrative Staff or Services

2
1
2
1
2

Yes
No

g. Grant Writing Staff or Services

Yes
No

h. Fundraising/Development Staff or Services

Yes
No

Evaluation Staff or Services

Other
(specify): _________________________

Yes
No

Provider Staff or Services

1
2
1
2
1
2
1
2
1
2

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

36.

Please estimate the percentage of your funding
sources that must be used for coalition operations
(e.g., office space, core staff), programmatic
activities (e.g., service delivery, interventions), or
both.

COALITION EVALUATION ACTIVITIES
39.

Please indicate how much you disagree or agree
with the following statements:

% Coalition operations only

Strongly
Disagree

b. Evaluations of your
coalition’s core
operations (e.g.,
community
communications)
are conducted on a
regular basis.

increases from year to year
is the same from year to year
decreases from year to year
changes significantly in either direction from
year to year

c. Evaluations of your
coalition’s
programs, services,
and activities are
conducted on a
regular basis.

How would you describe your current funding
situation compared to your funding situation during
your time as a CAP/HCAP grantee?

d. Project
effectiveness is
demonstrated
through evaluation.

% Both

How stable is the funding stream for your
coalition? In general, would you say that funding:
1.
2.
3.
4.

38.

No Opinion/
Not
Applicable

a. Your coalition
develops evaluation
plans prior to
implementing
programs, services,
and activities.

% Programmatic activities only

37.

Strongly
Disagree Agree Agree

Less than
during
CAP/HCAP
grant

a. Diversity of funding
sources

Same as during
CAP/HCAP
grant
2

More than
during
CAP/HCAP
grant
3

What, if any, types of evaluation methodologies
and tools has your coalition used to assess the
effectiveness of your operations or programs,
services, and activities? (Check all that apply.)

Process evaluation
Program monitoring
Outcomes evaluation
Empowerment evaluation
Evaluation capacity building (e.g., building
capacity among member organizations to
conduct evaluative activities)
Quantitative methods (e.g., secondary
analysis of data sets, survey analysis)
Qualitative methods (e.g., focus groups,
interviews)
Experimental or quasi-experimental designs
(e.g., control and intervention populations)
Other (specify):

10.

None

b. Funding earmarked
for programs,
services, or
activities

c. Funding for
coalition operations

d. Flexibility to allocate
funds wherever
they
are needed or can
be most effective

e. Certainty about
sources of future
funding

40.

2.
2

3.
4.
5.

8.
1

41.

43.

How important are your evaluation activities for
each of the following purposes?
No Opinion/
Very
Somewhat Somewhat Very
Not
Unimportant Unimportant Important Important Applicable

Activity #1:

a. Demonstrating
results to your
community

b. Demonstrating
results to your
funders

c. Competing for
funding more
successfully

Activity #2:
Activity #3:

44.
1

e. Modifying coalition
programs,
services, and
activities

Activity #2:
Activity #3:

45.

46.

This section is about the types of activities your
coalition has been conducting since receiving the
CAP/HCAP grant. By activities, we mean the
projects, programs, products, and services your
coalition works on to serve the community.

Programs and services (e.g., enrollment
assistance for entitlement programs or
patient navigation)
Systems change (e.g., integrating data
systems or pro bono provider systems)
Health behavior change (e.g., wellness
programs or training peer educators)
Capacity building (e.g., providing technical
assistance to other organizations or
community leader development programs)
Policy advocacy and change (e.g., informing
local leaders and elected officials or
collaborating with local institutions like school
systems)
Dissemination of information and products
(e.g., health fairs or community newsletters)

47.

The priorities of our funders changed.
We added new activities in order to qualify for
(or as a result of) receiving new funding.
The demographics and/or needs of the
population we serve changed.
We expanded our reach to a new population
that required different activities to achieve our
goals.
Our evaluation results suggested that we
alter or change our activities.
Other (specify):

Are the activities you currently conduct consistent
with at least one of your coalition’s goals during the
CAP/HCAP funding period?
1.
2.

No, none of the same activities
Yes, at least one of the same activities
Yes, all of the same activities  (SKIP TO
SECTION IV PAGE 10)
Yes, all of the same activities in addition to
new activities.

Please select the reason(s) why your coalition has
changed the activities it conducts or added new
activities. (Check all that apply.)
1.

Please check all the activities your coalition has
conducted since you first received your
CAP/HCAP grant.
1.

Is your coalition conducting some or all of the
same activities it did under the CAP/HCAP grant?
1.

Section III: Coalition Activities

42.

Out of the activities selected in Q42, please select
the three activities that make up the largest portion
of the coalition’s current work.
Activity #1:

d. Modifying coalition
operations (e.g.,
staff, convening
membership
meetings)

f. Longterm/sustainability
planning

Out of the activities selected in Q42, please select
the three activities that made up the largest portion
of the coalition’s work during the CAP/HCAP grant
period.

Yes
No

50.

Section IV: Planning for
Sustainability

What actions, if any, has your coalition ever taken
to prepare for sustainability?
(Check all that apply.)

12.

Reassessed the coalition’s goals, activities,
or priorities
Identified the most effective goals and
activities to continue
Developed a strategic plan for attaining
resources
Reduced the membership
Reorganized the membership
Restructured coalition operations/processes
(e.g., fewer meetings, smaller leadership
team)
Established a committee to strategically
address sustainability issues
Hired an external consultant to advise the
coalition on issues of sustainability
Located partners and institutions to take over
programs and services developed by the
coalition
Developed an infrastructure in the community
to support systems-level activities
Ensured appropriate mechanisms for
implementation and enforcement of policy
activities in the community
Other (specify):

13.

None

This section asks about the plans, strategies, and
actions your coalition has used since receiving the
CAP/HCAP grant to ensure the long-term viability of
your coalition and its activities.

48.

According to your coalition’s definition,
sustainability of your coalition means:
1.

5.
6.

our coalition has the resources it needs to
continue operating with our membership and
structures in-tact for the long-term.
our coalition’s programs, services, and
activities will continue in the long-term even if
our coalition is no longer in operation.
both our coalition and its activities will
continue in the long-term.
our coalition has made a lasting impact on
our community that will continue regardless
of whether our coalition or its activities
continue operating.

10.

11.

49.

Has your coalition ever developed a sustainability
plan?
1.
2.

4.
5.

Yes, prior to receiving our CAP/HCAP grant.
Yes, within the first year of our CAP/HCAP
grant.
Yes, after the first year but still prior to the
end of our CAP/HCAP grant.
Yes, after our CAP/HCAP grant ended.
No, but we have plans to develop a
sustainability plan.
No, and we don’t have any plans to develop a
sustainability plan.

51.

Who is involved in sustainability planning at your
coalition? (Check all that apply.)
1.

5.
6.
7.

52.

When are sustainability issues addressed by the
coalition?
1.

3.
4.

53.

In the course of regular meetings and
planning activities
As we near the end of major grants and other
funding cycles
Only when sustainability becomes a problem
Rarely or never

Strongly
Disagree

Strongly
Disagree Agree Agree

55.

No Opinion/
Not
Applicable

a. has leaders who
are continually
planning for
sustainability.

b. identifies alternative
strategies for
project survival.

c. has sufficient
funding for current
project activities
and operations.

d. has sufficient
funding for the next
year.

e. has sufficient
funding for the longterm
(2 or more years).

has sufficient
funding for hiring
and retaining quality
staff.

54.

This section focuses on the types of impacts your
coalition has had on the community you serve. By
impacts, we mean the intermediate and long-term
outcomes of your coalition’s activities on individual
health and behavior, the health care system, and
policies that affect your community.

Please indicate how much you disagree or agree
with the following statements about your coalition:

Currently, your
coalition:

Section V: Coalition Impacts

Since the end of your CAP/HCAP grant period,
how successful has your coalition been at changing
individual health and behavior outcomes such as
immunization or primary care utilization?
1.
2.

4.
5.

56.

Very unsuccessful
Unsuccessful
Successful
Very successful
Not applicable  (SKIP TO Q58)

To what particular individual health and
behavior outcomes has your coalition contributed?
If relevant, please direct us to documents or
websites where these outcomes are described in
greater detail.
Outcome #1:

Outcome #2:

Outcome #3:

Outcome #4:
1

Outcome #5:
Documents and websites where these
outcomes are described in greater detail:

In your estimation, how likely is it that your
coalition will continue to exist 2 years, 5 years, and
10 years from now?
Very
Likely

Somewhat
Likely

Somewhat
Unlikely

Very
Unlikely

a. 2 years from now

b. 5 years from now

c. 10 years from now

57.

About how many of your coalition’s individual
health and behavior outcomes will continue to
benefit the community without any additional support
from the coalition?
1.
2.
3.
4.
5.

All
Most
Some
A Few
None

58.

1.
2.
3.
4.
5.

59.

62.

Since the end of your CAP/HCAP grant period,
how successful has your coalition been at changing
systems-level outcomes such as integrated data
systems or cultural competency training?
Very unsuccessful
Unsuccessful
Successful
Very successful
Not applicable  (SKIP TO Q61)

To what particular policy outcomes has your
coalition contributed? If relevant, please direct us to
documents or websites where these outcomes are
described in greater detail.
Outcome #1:
Outcome #2:
Outcome #3:

To what particular systems-level outcomes has
your coalition contributed? If relevant, please direct
us to documents or websites where these outcomes
are described in greater detail.

Outcome #4:
Outcome #5:

Outcome #1:
Documents and websites where these
outcomes are described in greater detail:

Outcome #2:
Outcome #3:
Outcome #4:

63.

Outcome #5:

About how many of your coalition’s policy
outcomes will continue to benefit the community
without any additional support from the coalition?
1.

Documents and websites where these
outcomes are described in greater detail:

2
3.
4.
5.

60.

64.

About how many of your coalition’s systems-level
outcomes will continue to benefit the community
without any additional support from the coalition?
1.
2.
3.
4.
5.

All
Most
Some
A Few
None

Thinking through the history of your coalition,
which of the following statements most accurately
describes your coalition’s impacts? Most of our
greatest impacts occurred:
1.

2.
3.

61.

Since the end of your CAP/HCAP grant period,
how successful has your coalition been at changing
policies such as reimbursement rates, implementing
smoking ordinances, or instituting new insurance
plans to cover the uninsured?
1.
2.
3.
4.
5.

Very unsuccessful
Unsuccessful
Successful
Very successful
Not applicable  (SKIP TO Q64)

All
Most
Some
A Few
None

early on, before we received CAP/HCAP
funding.
during our CAP/HCAP funding period.
within 1 to 2 years after our CAP/HCAP
funding period.
2 or more years after our CAP/HCAP funding
period.
Our impacts have occurred at a steady pace
throughout the history of our coalition.

CONCLUDING THOUGHTS
65.

66.

If you could start your coalition over again, what
would you do differently?

Is there anything else you think we should know
about your coalition?

END
Thank you for completing this survey.
Your responses are valuable.
Please return your questionnaire in the postage-paid envelope to:
Coalition Sustainability Project # 6681
C/O NORC
1 North State Street, Suite 1600
Chicago, Illinois 60602

70.

Section VI: Coalitions that Disbanded
67.

In what year did your coalition disband?

What were some of the characteristics of the
population that received services from your
coalition? (Check all that apply.)
1.
2.
3.

68.

Why did the coalition disband? Please select the
answer that best describes the situation.

5.
6.

1.
2.

3.
4.

The coalition achieved all its goals.
The coalition was no longer needed in the
community.
The coalition ran out of resources.
The coalition had organizational problems or
conflicts that could not be solved.
Other (specify):

7.
8.
9.
10.
11.

12
13.
14.
15.

Urban
Rural
Suburban
Uninsured
Underinsured/underserved
White
African American
Hispanic/Latino
Asian American/Pacific Islander
Native American
Mixed race or other racial or ethnic group
(specify):

Low-income
Middle-income
High-income
Other characteristics (specify):

Coalition Membership
71.

How many organizations were members of your
coalition?

72.

Of these, how many organizations did you
consider to be active members?

73.

About how often did new organizations join the
coalition?

CHARACTERISTICS OF YOUR COALITION
This section asks about some of the features of your
coalition, including: the community your coalition
served; the size and composition of your coalition’s
member organizations; the type of funding your
coalition received; the structure of your coalition;
and your coalition’s evaluation efforts.

Community Served by the Coalition
69.

1.
2.

What was the approximate size of the population
in the area where your coalition worked?

3.
4.

5.
6.

Never
Less than once every two years
About once a year
About once every six months
About once every three months
More than once every three months

74.

1.
2.
3.
4.
5.
6.

75.

76.

About how often did the coalition lose member
organizations?
Never
Less than once every two years
About once a year
About once every six months
About once every three months
More than once every three months

Health-Sector Members
1.
Federally Qualified Health Centers
2.
Academic medical centers
3.
Free clinics/other community health centers
4.
Migrant health centers
5.
Public housing primary care programs
6.
Public or private health care providers/
practices
7.
Hospitals with a low-income utilization rate
greater than 25%
8.
Other hospitals
9.
Area health education centers
10.
Primary care associations
11.
Managed care organizations
12.
Medical/dental societies
13.
Specialty care providers
14.
Oral health providers
15.
Long-term care providers
16.
Home health providers
17.
Laboratories
18.
Pharmacies
19.
Private insurance providers
20.
Medicaid programs
21.
Rural health clinics
22.
Other health care coverage programs
23.
Mental health programs/providers
24.
Substance abuse programs
25.
Community-based organizations
26.
School-based health centers
Non-Health Sector Members
27.
Government (e.g., local health department or
elected officials)
28.
Social services (e.g., juvenile justice
programs or temporary housing assistance)
29.
Education (e.g., elementary schools or
university public health programs)
30.
Faith (e.g., churches or faith-based
organizations)
31.
Business (e.g., chambers of commerce or
local non profits)
32.
Foundations (e.g., philanthropic
organizations)
33.
Other (specify):

What was the most common reason for
membership turnover (losing or adding member
organizations)?
1.
2.
3.

What sectors and types of organizations did
coalition members represent?
(Check all that apply.)

80.

Coalition Structure
77.

Did your coalition have a lead organization?
1.
2.

78.

Yes
No  (SKIP TO Q79)

What type of organization led the coalition?

81.

79.

What was the structure of your coalition
membership?

Did your coalition have written Memoranda of
Understanding or inter-agency agreements with any
coalition members?

Did your coalition have any of the following boards
or committees? (Check all that apply.)

82.

Formal, such as legally incorporated or
Memoranda of Understanding
Informal, such as letters of support or verbal
agreements  (SKIP TO Q82)
Other (specify):

Yes, with all of our members
Yes, with most of our members
Yes, with some of our members
No, not with any of our members

How many paid staff, in terms of full-time
equivalents (FTEs), were employed by the coalition?

83.

Please indicate how much you disagree or agree with the following statements:
Strongly
Disagree

Your coalition:
a. had a regular, reliable meeting cycle.
b. had active committees.
c. members had copies of the coalition bylaws.
d. had an executive board/leadership team that met
regularly and with good attendance.
e. had an executive board/leadership team that
communicated with committees and members on a
regular basis.
Coalition members:
f. were involved in project design.
g. were involved in project implementation.
h. shared responsibility for providing project resources.
i. shared credit for project successes.
j. had clearly defined roles and responsibilities.
Your coalition’s leadership:
k. had a strong connection to the community prior to
assuming leadership of the coalition.
l. fostered active involvement of other key stakeholders
(e.g., board members, leaders of membership
organizations, community organizers, etc.).
m. was good at negotiating, facilitating groups, networking,
and other skills that help foster relationships with
community stakeholders.
n. communicated a clear mission and vision for the coalition
with all its members.
o. had expertise in the health and social issues the coalition
is addressing.

84.

About how often did all coalition members
convene for formal meetings?
1.
2.
3.
4.
5.

85.

Every month or more
Every one to three months
Every four to six months
Once a year or less
Never

Strongly
Agree

No Opinion/ Not
Applicable

Did your coalition have formal decision making
processes (e.g., consensus or majority policies)?
2.

Yes
No

Did your coalition have a formal process for
managing conflicts among members and/or between
members and coalition leadership?
1.
2.

87.

Agree

86.

Disagree

Yes
No

Please provide some information about your coalition’s leader or director. Check the appropriate box for each of
the questions below.
How long had the coalition leader or director:
a. directed or managed the coalition?
b. worked in the field of health care delivery or
health care administration?
c. lived or worked in the community served by
the coalition?

1 year or less

Between 1 year
and 3 years

3-5 years

5-10 years

More than 10
years

No Opinion/ Not
Applicable

Coalition Funding Resources
88.

Did your coalition receive financial resources from any of the following sources?
Yes/No

a. U.S. Department of Health and
Human Services

b. Other Federal Agency/Department
(specify): _______________________

2
1

c. State Health Department

d. Other State Agency/Department
(specify): _______________________

e. Local (county or community)
Health Department
f. Other Local (county or community)
Agency/Department (specify):
_______________________

1
2
1
2
1

g. United Way

89.

Yes/No

h. Foundations
(specify): _______________________
i. Health Insurers/Managed Care
Organizations
(specify): _______________________
j. Businesses
(specify): _______________________

k. Universities/Academic Institutions
(specify): _______________________

Community Based Organizations
(specify): _______________________

Yes
No

m. Faith Based Organizations
(specify): _______________________

Yes
No

n. Other (specify):
_______________________

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

2
1
2
1
2

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

Did your coalition receive in-kind contributions from its members?
Yes/No

a. Facilities (e.g., office space, exam
rooms)

b. Equipment and Supplies (e.g.,
computers, brochures, test kits)

c. Salary Sharing/Time Coverage for Key
Coalition Personnel

d. Volunteers
e. Administrative Staff or Services

90.

2
1
2
1
2

Yes
No

g. Grant Writing Staff or Services

Yes
No

h. Fundraising/Development Staff or Services

Yes
No

Evaluation Staff or Services

Other
(specify): _________________________

Yes
No

Provider Staff or Services

1
2
1
2
1
2
1
2
1
2

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

How stable was the funding stream for your coalition? In general, would you say that funding:
1.
2.
3.
4.

91.

increased from year to year.
was the same from year to year.
decreased from year to year.
changed significantly in either direction from year to year.

Please estimate the percentage of your funding sources that had to be used for coalition operations (e.g., office
space, core staff), programmatic activities (e.g., service delivery, interventions), or both.
% Coalition operations only

% Programmatic activities only

% Both

94.

Coalition Evaluation Activities
92.

Please indicate how much you disagree or agree
with the following statements:
Strongly
Disagree

a. Your coalition
developed
evaluation plans
prior to
implementing
programs, services,
and activities.
b. Evaluations of your
coalition’s core
operations (e.g.,
community
communications)
were conducted on
a regular basis.

c. Evaluations of your
coalition’s
programs, services,
and activities were
conducted on a
regular basis.

d. Project
effectiveness was
demonstrated
through evaluation.

93.

How important were your evaluation activities for
each of the following purposes?

Strongly
Disagree Agree Agree

No Opinion/
Very
Somewhat Somewhat Very
Not
Unimportant Unimportant Important Important Applicable

No Opinion/
Not
Applicable

10.

None

2.
3.
4.
5.

b. Demonstrating
results to your
funders

c. Competing for
funding more
successfully

d. Modifying coalition
operations (e.g.,
staff, convening
membership
meetings)

e. Modifying coalition
programs,
services, and
activities

f. Longterm/sustainability
planning

Continue to next page

What, if any, types of evaluation methodologies
and tools did your coalition use to assess the
effectiveness of your operations or programs,
services, and activities?
(Check all that apply.)
1.

a. Demonstrating
results to your
community

COALITION ACTIVITIES

PLANNING FOR SUSTAINABILITY

This section is about the types of activities your
coalition conducted after receiving the CAP/HCAP
grant. By activities, we mean the projects,
programs, products, and services your coalition
worked on to serve the community.

This section asks about the actions your coalition
undertook after receiving the CAP/HCAP grant to
plan for long-term viability of your coalition and its
activities.

98.
95.

Please check all the activities your coalition
conducted from the time you received your
CAP/HCAP grant until the coalition disbanded.
1.

96.

According to your coalition’s definition,
sustainability of the coalition meant:
1.

99.

Did your coalition ever develop a sustainability
plan?
1.
2.

Out of the activities selected in Q95, please select
the three activities that made up the largest portion
of the coalition’s work during the CAP/HCAP grant
period.

4.
5.

Activity #1:

Activity #2:
Activity #3:

97.

Are any of the original activities that your coalition
conducted during the CAP/HCAP grant still being
conducted today (either by your
organization/coalition or another
organization/coalition)?
1.

No, none of the original activities are being
conducted today
Yes, at least one of the original activities are
being conducted today
Yes, all of the original activities are being
conducted today

our coalition had the resources it needed to
continue operating with our membership and
structures in-tact for the long-term.
our coalition’s programs, services, and
activities would continue in the long-term
even if our coalition was no longer in
operation.
both our coalition and its activities would
continue in the long-term.
our coalition made a lasting impact on our
community that would continue regardless of
whether our coalition or its activities
continued operating.

Yes, prior to receiving our CAP/HCAP grant.
Yes, within the first year of our CAP/HCAP
grant.
Yes, after the first year but still prior to the
end of our CAP/HCAP grant.
Yes, after our CAP/HCAP grant ended.
No, but we had plans to develop a
sustainability plan.
No, we didn’t have any plans to develop a
sustainability plan.

100. What actions, if any, did your coalition take to

102. When were sustainability issues addressed by the

prepare for sustainability?
(Check all that apply.)
1.

4.
5.
6.

10.

11.

12.

13.

coalition?
1.

3.
4.

In the course of regular meetings and
planning activities
As we neared the end of major grants and
other funding cycles
Only when sustainability became a problem
Rarely or never

103. Please indicate how much you disagree or agree
with the following statements:
Your coalition’s:

Strongly
Disagree

Disagree

Agree

Strongly
Agree

No Opinion/
Not
Applicable

a. had leaders who
were continually
planning for
sustainability.

b. identified
alternative
strategies for
project survival.

COALITION IMPACTS
This section is about the types of impacts your
coalition had on the community you served. By
impacts, we mean the intermediate and long-term
outcomes of your coalition’s activities on individual
health and behavior, the health care system, and
policies that affect your community.

None

101. Who was involved in sustainability planning at
your coalition? (Check all that apply.)
1.

5.
6.
7.

104. Since the end of your CAP/HCAP grant period,
how successful was your coalition at changing
individual health and behavior outcomes such as
immunization or primary care utilization?
1.
2.
3.
4.
5.

Very unsuccessful
Unsuccessful
Successful
Very successful
Not applicable  (SKIP TO Q107)

105. Please tell us about particular individual health

108. Please tell us about particular systems-level

and behavior outcomes that your coalition
contributed to. If relevant, please direct us to
documents or websites where these outcomes are
described in greater detail.

outcomes that your coalition contributed to. If
relevant, please direct us to documents or websites
where these outcomes are described in greater
detail.

Outcome #1:

Outcome #2:

Outcome #3:

Outcome #4:

Outcome #5:

Documents and websites where these
outcomes are described in greater detail:

106. About how many of your coalition’s individual

109. About how many of your coalition’s systems-level

health and behavior outcomes continued to benefit
the community after the coalition disbanded?
1.
2.
3.
4.
5.

outcomes continued to benefit the community after
the coalition disbanded?

All
Most
Some
A Few
None

1.
2.
3.
4.
5.

107. Since the end of your CAP/HCAP grant period,

110. Since the end of your CAP/HCAP grant period,

how successful was your coalition at changing
systems-level outcomes such as integrated data
systems or cultural competency training?
1.
2.
3.
4.
5.

All
Most
Some
A Few
None

how successful was your coalition at changing
policies such as reimbursement rates, implementing
smoking ordinances, or instituting new insurance
plans to cover the uninsured?

Very unsuccessful
Unsuccessful
Successful
Very successful
Not applicable  (SKIP TO Q110)

1.
2.
3.
4.
5.

Very unsuccessful
Unsuccessful
Successful
Very successful
Not applicable  (SKIP TO Q113)

111. Please tell us about particular policy outcomes
that your coalition contributed to. If relevant, please
direct us to documents or websites where these
outcomes are described in greater detail.

Background Information
114. What was your role in the coalition? Please select

Outcome #1:

the appropriate statement.
1.

Outcome #2:
2.

Outcome #3:
3.

I was the day-to-day manager/administrator
of the coalition.
I was a leader of the coalition but I did not
mange the day-to-day operations and
activities.
Other (specify):

Outcome #4:
Outcome #5:

115. Were you involved in any way with the coalition

Documents and websites where these
outcomes are described in greater detail:

when it was funded by the CAP/HCAP grant?
1.
2.

Yes
No  (SKIP TO Q117)

116. Briefly describe your role with the coalition when it
112. About how many of your coalition’s policy

was funded by the CAP/HCAP grant.

outcomes continued to benefit the community after
the coalition disbanded?
1.
2
3.
4.
5.

All
Most
Some
A Few
None

113. Thinking through the history of your coalition,
which of the following statements most accurately
describes your coalition’s impacts? Most of our
greatest impacts occurred:
1.

2.
3.

CONCLUDING THOUGHTS
118. Is there anything else you think we should know

117. If you could start your coalition over again, what

about your coalition?

would you do differently?

File Type	application/pdf
File Title	Survey of CAP/HCAP Coalitions Post-Federal Funding
Author	Benz-Jennifer
File Modified	2010-10-08
File Created	2010-10-08