Form 1 State of the States Survey in PDF format

1. INTRODUCTION

Thank you for completing STIPDA's 2009 State of the States questionnaire. The questionnaire is administered to each 
U.S. state health department's injury and/or violence prevention program to develop a comprehensive picture of the status 
of these programs over time. 

We know your time is valuable. In designing and testing this questionnaire, STIPDA has made every effort to limit the 
questions to those most essential in developing a profile of state injury and/or violence prevention programs. Depending 
on the size and breadth of your program, it will take approximately 2­8 hours to gather the needed information and 
complete this questionnaire. Based on results from the pilot, it seems the most efficient way to finish the survey is to 
complete the hard copy first and then enter the data online. You may also complete the hard copy and then fax or email 
the survey to STIPDA to enter the data online. 

Please complete the survey by COB on Friday, March 26, 2010. 

The information collected through this questionnaire will:  
• Provide an annual description of each state's injury and/or violence prevention program;  
• Be used to generate an annual report on the state of injury and violence prevention programs in the U.S.;  
• Provide the third year of data for measuring changes in these injury and violence prevention programs over time;  
• Inform partners at the federal, national, state and local levels about the activities in the states or nation;  
• Be used by STIPDA to conduct in­depth analyses and create special reports; and  
• Help STIPDA develop future programs and services. 
The information collected through this questionnaire will be included in the next State of the States Highlights Report and 
shared as needed to strengthen and draw awareness to state injury and violence prevention programs. Most data 
collected will be presented in aggregate. If you have any questions about the questionnaire, please contact Amber 
Williams at 770­690­9000 or amber.williams@stipda.org.  
Other 

To express our appreciation for your participation, STIPDA will prepare a special report for your state including national 
comparison data.  

THANK YOU again for your contribution to this important and exciting project. 

2. INSTRUCTIONS AND DEADLINE (Monday, December 7, 2009)

The 2009 State of the States questionnaire asks for information about several aspects of your state's injury and/or 
violence prevention program, including program infrastructure, funding, partnerships, projects/interventions, data, strategic 
plans, and staff roles and FTEs. While the survey is being implemented in 2010, please answer the questions based on 
the status of your program in the 2009 calendar year.  

You may find it helpful to first review the hard copy of the questionnaire (emailed to your State Representative) in order to 
gather all necessary information before completing the questionnaire. You also may find it helpful to coordinate 
completion of the questionnaire among your staff by distributing hard copies of the staffing section and other portions of 
the questionnaire to appropriate staff members who are most knowledgeable about topics addressed in the questionnaire. 

There are several ways to complete the questionnaire: 
l Complete the entire questionnaire online through survey monkey.  
l Complete the questionnaire in hard copy first, then enter all responses online through survey monkey.  
l Complete the entire questionnaire in hard copy and FAX or email it to STIPDA for data entry (770­690­8996 FAX or 
geri.stahl@stipda.org EMAIL). 

If you cannot use one of these methods to complete the survey, please contact Amber Williams at STIPDA (770­690­
9000) to identify an alternative arrangement. WHICHEVER METHOD YOU CHOOSE, PLEASE COMPLETE THE
QUESTIONNAIRE BY Friday, March 26, 2010.  

If you complete the survey online, you can complete the questionnaire over several days or weeks. Your responses are 
saved by page when you click on the "next" button at the bottom of each page in the questionnaire. You can re­access 
the questionnaire to edit or complete it by using the same computer each time. If you try to complete the remainder of 
the survey on a different computer, you will not see any of your previous data. HOWEVER, UPON RE­ACCESSING THE
QUESTIONNAIRE ON THE SAME COMPUTER, YOU CAN ONLY GO TO THE LAST COMPLETED PAGE, NOT THE
BEGINNING OF THE QUESTIONNAIRE.  

Funding Source Questions In previous State of the States Surveys, STIPDA has asked questions about the funding 
sources of the state's injury and violence prevention program. STIPDA plans to do this again in the 2009 survey; however, 
the questions will be asked in a different format. We will be conducting a 30 minute to one hour telephone survey with 
each state representative to obtain this information. In advance of the call, the state representative will be given a copy of 
the questions to answer. A STIPDA staff member will then go over these questions with the representative during the call 
to ensure that STIPDA accurately captures the information. Look for more information about this portion of the survey 
coming later this year.  

Please note that throughout the questionnaire, the acronym IVPP is used to indicate "injury and/or violence
prevention program."  
Other 

3. QUESTIONNAIRE FOCUS AND TERMINOLOGY

Finally, a word about questionnaire focus and terminology. The intent of this survey is to assess the program within the 
state health department that is considered the PRIMARY or CENTRAL FOCUS of injury and/or violence prevention 
activities. Some state injury prevention programs may address only unintentional injury, as violence (intentional injury) is 
addressed by another organizational unit(s) within the state health department. In other states, the primary program may 
address both unintentional injury and violence (intentional injury). In completing the questionnaire, please focus your 
responses (especially those about staff and FTEs) on the one program that is considered the PRIMARY or CENTRAL 
injury and/or violence prevention program. Information about injury or violence prevention activities in other areas of the 
state health department will be captured in questions about partnerships and collaboration. In some states, however, 
there simply is no central injury and/or violence prevention program. Perhaps there is no funding or personnel, or 
prevention activities may be spread among programs and units with no coordinating program or staff. Regardless of how 
your program is defined, the individual or program charged with program planning, strategic planning and/or policy 
development for injury and/or violence prevention should answer the questions to the best of their ability based on what is 
considered to be the PRIMARY or CENTRAL FOCUS of your state’s injury and/or violence prevention activities.  

If you have any questions or concerns about how to define the boundaries of your state's program, please contact Amber 
Williams (Amber.Williams@stipda.org, 770­690­9000) at STIPDA to discuss. Clarification before completing the 
questionnaire will help ensure that the data collected for the State of the States report are comparable among states.  

Please note that throughout the questionnaire, the acronym IVPP is used to indicate "injury and/or violence
prevention program."  

4. CONTACT INFORMATION

REMINDER ­­ While the survey is being implemented in 2010, all questions should be answered based on the
status of your program in the 2009 calendar year.  

First, please provide the following contact information in case there are any questions when STIPDA analyzes the 
information and data you provided. Contact information will not be included in the analysis or reporting of questionnaire 
data. 

Questions marked with an asterisk (*) require an answer. 

* 1. In which state is the injury and/or violence prevention program (IVPP) located?
State:

6

* 2. Please provide the first and last name, title/position, email address, and
telephone number for the contact person for this survey.
First Name:
Other 
Last
Name:
Title/Position:
Email Address:
Phone Number:

* 3. Are you the STIPDA State Representative?

j Yes
k
l
m
n
j No
k
l
m
n

5. DESCRIPTION OF STATE PROGRAM

The next set of questions focuses on the infrastructure of the state's injury and/or violence prevention program (IVPP).  

Questions marked with an asterisk (*) require an answer. 

* 1. Does the state IVPP have a full­time director?

j Yes
k
l
m
n
j No
k
l
m
n

* 2. Is the state IVPP located within the state health department?

j Yes
k
l
m
n
j No
k
l
m
n

* 3. Who is responsible for the IVPP activities conducted at the state health department?
j There is an identified injury/violence prevention program that is solely/primarily responsible for IVPP activities.
k
l
m
n

j There is no single identified IVPP program. IVPP activities are decentralized throughout the health department with multiple 
k
l
m
n
programs responsible for different aspects of injury and/or violence prevention. 

j Other (please specify)
k
l
m
n

5
6  

In what division/organizational unit is the IVPP
* 4.Other 
located?

j Health promotion/disease 
k
l
m
n

j EMS
k
l
m
n

prevention/community health 

j
k
l
m
n

j Environmental health
k
l
m
n

Epidemiology

j Maternal child health/family health
k
l
m
n
j Other (please specify)
k
l
m
n

* 5. Where are the following programs located in your state? (Please indicate the health

department division/organizational unit, or if the program is located outside of the health
department, please indicate the agency/office and division.)
Child Maltreatment
Intimate Partner Violence/Sexual Assault
Poisoning
Motor Vehicle Safety/Child Passenger 
Safety
Senior Falls
Suicide
Teen Dating Violence

* 6. Does the IVPP address/include:
j Unintentional injuries only
k
l
m
n
j Intentional injuries only
k
l
m
n

j Both unintentional and intentional injuries
k
l
m
n

7. In what year was the IVPP established?
Year

* 8. Is there a state mandate (legislative or budgetary) for a comprehensive injury and/or
violence prevention program (IVPP)(i.e., not a specific silo of injury and violence
prevention such as child passenger safety)?

j Yes
k
l
m
n
j No
k
l
m
n

j Don't know
k
l
m
n

6. STATE MANDATE

Questions marked with an asterisk (*) require an answer. 

* 1. You indicated in the previous question that your state has a mandate (legislative or
budgetary) for a comprehensive injury and/or violence prevention program (IVPP)?
Is this mandate funded?

j Yes
k
l
m
n
j No
k
l
m
n

7. STATE MANDATE (CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. You indicated in the previous question that your state does not have a mandate
(legislative or budgetary) for a comprehensive injury and/or violence prevention
program (IVPP)?

Would the development of a state mandate significantly benefit your program? If yes,
how? Select all that apply.
c No
d
e
f
g

c Yes, by increasing resources (e.g., personnel, etc.)
d
e
f
g

c Yes, by increasing expertise (e.g., surveillance, data analysis, etc.)
d
e
f
g
c Yes, by improving leadership
d
e
f
g
c Yes, by policy development
d
e
f
g

c Yes, for other reasons (please specify)
d
e
f
g

8. STATE PLANS

The next set of questions addresses the existence and use of strategic plans to prevent injury and violence in the state 
during 2009. By strategic plans, we mean any document used to guide injury and/or violence prevention efforts. 

Questions marked with an asterisk (*) require an answer. 

* 1. In 2009, in your state, which types of plans included activities to prevent injuries and
violence. Please check ALL that apply.

c State­wide health plan, which includes injury and violence prevention and other health issues (multiple agencies)
d
e
f
g
c State­wide injury and violence prevention plan (multiple agencies) 
d
e
f
g

c Health department's plan, which includes injury and violence prevention and other health issues
d
e
f
g
c Health department's injury and violence prevention plan
d
e
f
g

c A plan(s) has/have been developed for specific injury/violence problems such as suicide, child occupant safety, falls, etc.
d
e
f
g
c We do not have a plan
d
e
f
g

c In 2009 we were developing a plan
d
e
f
g
c Other (please specify)
d
e
f
g

9. STATE PLANS (CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. Did the IVPP use this plan(s) to monitor/evaluate progress in 2009?

j Yes
k
l
m
n
j No
k
l
m
n

j Don't know
k
l
m
n

* 2. In a previous question, you indicated that there was a state­wide injury and violence
prevention plan or a health department injury and violence prevention plan in 2009.

When was this plan created? (If you have both plans, consider the one which is the most 
recent.)
j less than 1 year ago
k
l
m
n
j 1­2 years ago
k
l
m
n
j 3­4 years ago
k
l
m
n

j more than 5 years ago
k
l
m
n

10. STATE PLANS (CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. You indicated in the previous question that there was a state­wide health plan and/or
a health department plan that includes injury and violence prevention.

Please selected the option that best describes how injury and violence are included
within the plan. (If you have both types of plans, consider the one which is most recent.)
j Injury and/or violence prevention was included generally within the plan
k
l
m
n

j Specific injury and/or violence prevention topics were included within the plan
k
l
m
n
j Don't Know
k
l
m
n

j Other (please specify)
k
l
m
n

* 2. Did the IVPP use this plan(s) to monitor/evaluate progress in 2009?

j Yes
k
l
m
n
j No
k
l
m
n

j Don't know
k
l
m
n

* 3. In a previous question, you indicated that there was a state­wide health plan and/or a
health department plan that includes injury and violence prevention.

When was this plan created? (If you have both plans, consider the one which is the most 
recent.)
j less than 1 year ago
k
l
m
n
j 1­2 years ago
k
l
m
n
j 3­4 years ago
k
l
m
n

j more than 5 years ago
k
l
m
n

11. STATE PLANS (CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. You indicated in a previous question that there is a state­wide health plan and/or a

health department plan that includes injury and violence prevention that was over 5
years old. Does your state/health department have any plans to revise or update that
plan?
j Currently revising
k
l
m
n

j Revising within 1­2 years
k
l
m
n

j Revising within 3­4 years
k
l
m
n

j No plans to revise at this time
k
l
m
n
j Other (please specify)
k
l
m
n

12. STATE PLANS (CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. In 2009 in your state, did you have a plan which focused on activities to prevent
violence?

j Yes, one plan
k
l
m
n

j Yes, multiple plans
k
l
m
n
j No
k
l
m
n

j In 2009 we were developing a plan
k
l
m
n

13. STATE PLANS (CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. In the previous question you indicated that there
was a plan(s) for violence prevention in 2009. What
topics are included in that plan(s)? CHOOSE ALL
THAT APPLY
c Bullying
d
e
f
g

c Sexual Violence
d
e
f
g

c Child Maltreatment
d
e
f
g

c School Violence
d
e
f
g

c Community Violence
d
e
f
g
c Elder Abuse
d
e
f
g

c Suicide
d
e
f
g

c Teen Dating Violence
d
e
f
g

c Gang Violence
d
e
f
g
c Gun Violence
d
e
f
g

c Youth Violence
d
e
f
g

c Violence in the Workplace
d
e
f
g

c Intimate Partner Violence
d
e
f
g
c Other (please specify)
d
e
f
g

* 2. Did the IVPP use this plan(s) to monitor/evaluate progress in 2009?

j Yes
k
l
m
n
j No
k
l
m
n

j Don't know
k
l
m
n

* 3. In a previous question, you indicated you had a violence prevention plan(s) for your
state.

When was this plan created? (If there is more than one plan, please consider the one
which is the most recent.)
j less than 1 year ago
k
l
m
n
j 1­2 years ago
k
l
m
n
j 3­4 years ago
k
l
m
n

j more than 5 years ago
k
l
m
n

14. STATE PLANS (CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. You indicated in a previous question that you have a violence prevention plan that
was over 5 years old. Do you have any plans to revise or update that plan?
j Currently revising
k
l
m
n

j Revising within 1­2 years
k
l
m
n

j Revising within 3­4 years
k
l
m
n

j No plans to revise at this time
k
l
m
n
j Other (please specify)
k
l
m
n

15. PARTNERSHIPS/COLLABORATION WITHIN THE STATE HEALTH
DEPARTMENT

This next section focuses on collaboration within the state health department.  

Questions marked with an asterisk (*) require an answer. 

1. Please indicate how the IVPP worked with other offices WITHIN the
state health department in 2009 to address injuries and violence.
A broad name of each office is listed below because each state
names their offices differently. Please select the name that most
accurately reflects the group you are working with. For example, if
your state office is called "mental health and substance abuse," but
you are working with your substance abuse colleagues ­­ please
select substance abuse and not both substance abuse and mental
health. If there is overlap in offices (i.e. disease
prevention/preventative medicine is considered to be the same as
health promotion/education/community health), answer the questions
for only one of the offices and choose "N/A" for the other office.
For ease of data entry, this question continues with additional state
health department offices in Question #2.
INSTRUCTIONS:
1. Indicate the strength of partnership with the office (New and 
Developing, Strong, Needs Improvement, None or N/A) from the 
drop down menu.  
2. If a partnership exists, please indicate the manner in which you 
partner/collaborate with that agency by selecting "Yes" or "No" in 
the drop down menu under each type of collaboration (shared 
data, actively involved in IVPP planning, programs, etc.)  
3. If a partner/office does NOT exist, choose "N/A" and then 
disregard the remaining questions.  
4. If a relationship does NOT exist with the partner/office, choose 
"None" and then disregard the remaining questions.  
Part 1
Actively involved 
Strength of
Partnership

Shared Data

IVPP 

in IVPP 

IVPP Provided 

IVPP Received 

Collaborated for  Provided/Received 

planning, 

Funding TO

Funding FROM

Policy/Advocacy

Training/Technical 

programs, etc.

Assistance

Aging

6

6

6

6

6

6

Alcohol/Drug 

6

6

6

6

6

6

Chronic Disease

6

6

6

6

6

6

Disease Prevention/ 

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

Environmental Health

6

6

6

6

6

6

Epidemiology

6

6

6

6

6

6

Health Promotion/ 

6

6

6

6

6

6

Addiction/Substance 
Abuse

Preventative 
Medicine
Emergency Medical 
Services or EMSC
Emergency 
Preparedness

Education/Community 
Health

2. CONTINUED FROM QUESTION 1:
Please indicate how the IVPP worked with other offices WITHIN the
state health department in 2009 to address injuries and violence.
A broad name of each office is listed below because each state
names their offices differently. Please select the name that most
accurately reflects the group you are working with. For example, if
your state office is called "mental health and substance abuse," but
you are working with your substance abuse colleagues ­­ please
select substance abuse and not both substance abuse and mental
health. If there is overlap in offices (i.e. disease
prevention/preventative medicine is considered to be the same as
health promotion/education/community health), answer the questions
for only one of the offices and choose "N/A" for the other office.
INSTRUCTIONS:
1. Indicate the strength of partnership with the office (New and 
Developing, Strong, Needs Improvement, None or N/A) from the 
drop down menu.  
2. If a partnership exists, please indicate the manner in which you 
partner/collaborate with that agency by selecting "Yes" or "No" in 
the drop down menu under each type of collaboration (shared 
data, actively involved in IVPP planning, programs, etc.)  
3. If a partner/office does NOT exist, choose "N/A" and then 
disregard the remaining questions.  
4. If a relationship does NOT exist with the partner/office, choose 
"None" and then disregard the remaining questions.  

Part 2
Actively involved 
Strength of
Partnership

Shared Data

IVPP 

in IVPP 

IVPP Provided 

IVPP Received 

Collaborated for  Provided/Received 

planning, 

Funding TO

Funding FROM

Policy/Advocacy

programs, etc.
Maternal & 

Training/Technical 
Assistance

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

Child Health
Mental 
Health
Nursing 
Services

Occupational 

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

Other #1

6

6

6

6

6

6

6

Other #2

6

6

6

6

6

6

6

Other #3

6

6

6

6

6

6

6

Other #4

6

6

6

6

6

6

6

Other #5

6

6

6

6

6

6

6

Health
School 
Health
Sexual 
Health
Vital 
Statistics

3. If you selected other in the previous question, please list the office/unit in the space
provided.
Other #1
Other #2
Other #3
Other #4
Other #5

16. PARTNERSHIPS/COLLABORATION WITH OTHER STATE AGENCIES

This next section focuses on collaboration with other state agencies.  

Questions marked with an asterisk (*) require an answer. 

1. Please indicate how the IVPP worked with OTHER STATE
AGENCIES in 2009 to address injuries and violence.
A broad name of each agency is listed below because each state
names their agencies differently. Please select the name that most
accurately reflects the group you are working with.
For ease of data entry, this question continues with additional state
health department offices in Question #2.
INSTRUCTIONS:
1. Indicate the strength of partnership with the agency (New and 
Developing, Strong, Needs Improvement, or N/A) from the drop 
down menu.  
2. If a partnership exists, please indicate the manner in which you 
partner/collaborate with that agency by selecting "Yes" or "No" in 
the drop down menu under each type of collaboration (shared 
data, actively involved in IVPP planning, programs, etc.)  
3. If a partner/office does NOT exist, choose "N/A" for strength of 
partnership and disregard the remaining questions.  
4. If a relationship does NOT exist with the partner/office, choose 
"None" for strength of partnership and disregard the remaining 
questions 
Part 1
Actively involved 
Strength of
Partnership

Shared Data

IVPP 

in IVPP 

IVPP Provided 

IVPP Received 

Collaborated for  Provided/Received 

planning, 

Funding TO

Funding FROM

Policy/Advocacy

programs, etc.
Attorney 

Training/Technical 
Assistance

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

General’s 
Office
Child 
Welfare 
Agencies
Criminal 
Justice/ Law 
Enforcement

Education

6

6

6

6

6

6

6

Elder Affairs/ 

6

6

6

6

6

6

6

6

6

6

6

6

6

6

Aging
Fire 
Department/ 
Fire 
Marshall

2. CONTINUED FROM QUESTION 1:
Please indicate how the IVPP worked with OTHER STATE AGENCIES
in 2009 to address injuries and violence.
A broad name of each agency is listed below because each state
names their agencies differently. Please select the name that most
accurately reflects the group you are working with.
INSTRUCTIONS:
1. Indicate the strength of partnership with the agency (New and 
Developing, Strong, Needs Improvement, or N/A) from the drop 
down menu.  
2. If a partnership exists, please indicate the manner in which you 
partner/collaborate with that agency by selecting "Yes" or "No" in 
the drop down menu under each type of collaboration (shared 
data, actively involved in IVPP planning, programs, etc.)  
3. If a partner/office does NOT exist, choose "N/A" for strength of 
partnership and disregard the remaining questions.  
4. If a relationship does NOT exist with the partner/office, choose 
"None" for strength of partnership and disregard the remaining 
questions 
If selecting "other," you will be given an opportunity to specify the 
agency in the subsequent question below.  

Part 2
Actively involved 
Strength of
Partnership

Shared Data

IVPP 

in IVPP 

IVPP Provided 

IVPP Received 

Collaborated for  Provided/Received 

planning, 

Funding TO

Funding FROM

Policy/Advocacy

programs, etc.
Highway 

Training/Technical 
Assistance

6

6

6

6

6

6

6

Labor

6

6

6

6

6

6

6

Mental Health

6

6

6

6

6

6

6

Safety

State 

6

6

6

6

6

6

6

6

6

6

6

6

6

6

Other #1

6

6

6

6

6

6

6

Other #2

6

6

6

6

6

6

6

Other #3

6

6

6

6

6

6

6

Other #4

6

6

6

6

6

6

6

Other #5

6

6

6

6

6

6

6

Universities
Department of 
Transportation

3. If you selected other in the previous question, please list the agency(ies) in the space
provided.
Other #1
Other #2
Other #3
Other #4
Other #5

17. PARTNERSHIPS/COLLABORATION WITH NON­GOVERNMENTAL
ORGANIZATIONS

This next section focuses on collaboration with non­governmental organizations.  

Questions marked with an asterisk (*) require an answer. 

1. Please indicate how the IVPP worked with NON­GOVERNMENTAL
ORGANIZATIONS in 2009 to address injuries and violence. For ease of
data entry, this question continues with additional state health
department offices in Question #2.
INSTRUCTIONS:
1. Indicate the strength of partnership with the organization (New 
and Developing, Strong, Needs Improvement, or N/A) from the 
drop down menu.  
2. If a partnership exists, please indicate the manner in which you 
partner/collaborate with that agency by selecting "Yes" or "No" in 
the drop down menu under each type of collaboration (shared 
data, actively involved in IVPP planning, programs, etc.)  
3. If a partner/office does NOT exist, select "N/A" for strength of 
partnership and disregard the remaining questions.  
4. If a relationship does NOT exist with the partner/office, choose 
"None" for strength of partnership and disregard the remaining 
questions. 
Part 1
Actively involved 
Strength of
Partnership

Shared Data

IVPP 

in IVPP 

IVPP Provided 

IVPP Received 

Collaborated for  Provided/Received 

planning, 

Funding TO

Funding FROM

Policy/Advocacy

programs, etc.
Academic 

Training/Technical 
Assistance

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

Businesses

6

6

6

6

6

6

6

Children's 

6

6

6

6

6

6

6

Institutions 
(other than 
state 
universities)
American 
Red Cross 
chapters
Brain Injury 
Association

Safety 
Network

Consumer 

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

groups
Healthcare 
associations
Injury 
Prevention 
Research 
Centers
Metropolitan 
Planning 
Organizations 
(MPOs)
Mothers 
Against Drunk 
Drivers 
(MADD)

2. CONTINUED FROM QUESTION 1:
Please indicate how the IVPP worked with NON­GOVERNMENTAL
ORGANIZATIONS in 2009 to address injuries and violence.
INSTRUCTIONS:
1. Indicate the strength of partnership with the organization (New 
and Developing, Strong, Needs Improvement, or N/A) from the 
drop down menu.  
2. If a partnership exists, please indicate the manner in which you 
partner/collaborate with that agency by selecting "Yes" or "No" in 
the drop down menu under each type of collaboration (shared 
data, actively involved in IVPP planning, programs, etc.)  
3. If a partner/office does NOT exist, select "N/A" for strength of 
partnership and disregard the remaining questions.  
4. If a relationship does NOT exist with the partner/office, choose 
"None" for strength of partnership and disregard the remaining 
questions. 
If selecting "other," you will be given an opportunity to specify the 
organization in the subsequent question below.  

Part 2
Actively involved 
Strength of
Partnership

Shared Data

IVPP 

in IVPP 

IVPP Provided 

IVPP Received 

Collaborated for  Provided/Received 

planning, 

Funding TO

Funding FROM

Policy/Advocacy

programs, etc.
Students 

Training/Technical 
Assistance

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

PTA’s

6

6

6

6

6

6

6

Religious 

6

6

6

6

6

6

6

Against 
Destructive 
Decisions 
(SADD)
Safe Kids 
Coalitions 
(state and/or 
local)
Safety 
Council
Safe 
Communities 
Coalitions
Sports 
associations

organizations
Youth­

6

6

6

6

6

6

6

Other #1

6

6

6

6

6

6

6

Other #2

6

6

6

6

6

6

6

Other #3

6

6

6

6

6

6

6

Other #4

6

6

6

6

6

6

6

Other #5

6

6

6

6

6

6

6

serving 
organizations 
(YMCA, etc.)

3. If you selected other in the previous question, please list the non­governmental
department/agency/organization in the space provided.
Other #1
Other #2
Other #3
Other #4
Other #5

18. PARTNERSHIPS/COLLABORATION WITH NON­STATE GOVERNMENTAL
ORGANIZATIONS

This next section focuses on collaboration with non­state governmental organizations.  

Questions marked with an asterisk (*) require an answer. 

1. Please indicate how the IVPP worked with NON­STATE
GOVERNMENTAL ORGANIZATIONS in 2009 to address injuries and
violence.
INSTRUCTIONS:
1. Indicate the strength of partnership with the organization (New 
and Developing, Strong, Needs Improvement, or N/A) from the 
drop down menu.  
2. If a partnership exists, please indicate the manner in which you 
partner/collaborate with that agency by selecting "Yes" or "No" in 
the drop down menu under each type of collaboration (shared 
data, actively involved in IVPP planning, programs, etc.)  
3. If a partner/office does NOT exist, select "N/A" for strength of 
partnership and disregard the remaining questions.  
4. If a relationship does NOT exist with the partner/office, choose 
"None" for strength of partnership and disregard the remaining 
questions. 
If selecting "other," you will be given an opportunity to specify the 
organization in the subsequent question below. 
Actively involved 
Strength of
Partnership

Shared Data

IVPP 

in IVPP 

IVPP Provided 

IVPP Received 

Collaborated for  Provided/Received 

planning, 

Funding TO

Funding FROM

Policy/Advocacy

programs, etc.
Administration 

Training/Technical 
Assistance

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

on Aging
Centers for 
Disease 
Control and 
Prevention 
(CDC)
Federal 
Highway 
Administration 
(FHA)
Health 
Resources and 
Services 

Administration 
(HRSA)
Indian Health 

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

Other #1

6

6

6

6

6

6

6

Other #2

6

6

6

6

6

6

6

Other #3

6

6

6

6

6

6

6

Other #4

6

6

6

6

6

6

6

Other #5

6

6

6

6

6

6

6

Service (IHS)
Local Health 
Departments
National 
Highway 
Traffic 
Administration 
(NHTSA)
Substance 
Abuse and 
Mental Health 
Services 
Administration 
(SAMHSA)

2. If you selected other in the previous question, please list the non­state governmental
department/agency/organization in the space provided.
Other #1
Other #2
Other #3
Other #4
Other #5

19. DATA

The next four questions focus on the availability and use of data sets useful to injury and violence prevention.  

Questions marked with an asterisk (*) require an answer. 

1. Please specify the availability, access, and use of the
following datasets in the state in 2009. We are interested in
learning about the availability of the data sources in your
state IN 2009, not the availability OF 2009 data. We want to
know if the data source was available (any year's data) in
2009.
INSTRUCTIONS:
1. Indicate the whether or not the data source is available 
in your state (Available, Available but Incomplete, Not 
Available, Don't Know) from the drop down menu.  
2. If data source is available in your state, please indicate 
whether or not you had access to Raw, Summary or No 
data in 2009 and if you used the data in 2009 by 
selecting "Yes" or "No" in the drop down menus 
(Access to Data, Use of Data). Please also indicate if the 
data is available for specific age and racial/ethnic 
categories by selecting "Yes" or "No" in the drop down 
menus.  
3. If the data source is NOT available in your state select 
"Not Available" and disregard the remaining questions 
about that data source.  
4. If you do not know if data source is available in your 
state select "Do Not Know" and disregard the remaining 
questions about that data source.  

Yes 
Behavioral 

Is the data 

Is the data 

Data Availability

Access to the 

Use of Data in 

available for 

available by 

in Your State

Data in 2009

2009

specific age 

racial/ethnic 

categories?

categories?

6

6

6

6

6

6

6

6

6

6

Risk Factor 
Surveillance 
System 
(BRFSS)
Child Death 
Review 
(CDR)

Emergency 
Yes 
Department 

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

(ED)
Emergency 
Medical 
Services 
(EMS)
Fatality 
Analysis 
Reporting 
System 
(FARS)
Hospital 
Discharge 
Data (HDD)
Medical 
Examiner
Other 
National 
Occupant 
Protection 
Use Survey 
(NOPUS)
Uniform 
Crime 
Reporting 
System 
(UCR)
National 
Violent 
Death 
Reporting 
System 
(NVDRS)
Vital 
Records
Youth Risk 
Behavior 
Surveillance 
System 
(YRBSS)
State 
Surveys

2. Please specify the availability, access, and use of the
following data in the state in 2009. We are interested in
learning about the availability of the data in your state IN
2009, not the availability OF 2009 data. We want to know if
the data source was available (any year's data) in 2009.
Other 

INSTRUCTIONS:
1. Indicate the whether or not the data source is available 
in your state (Available, Available but Incomplete, Not 
Available, Don't Know) from the drop down menu.  
2. If data source is available in your state, please indicate 
whether or not you had access to Raw, Summary or No 
data in 2009 and if you used the data in 2009 by 
selecting "Yes" or "No" in the drop down menus 
(Access to Data, Use of Data). Please also indicate if the 
data is available for specific age and racial/ethnic 
categories by selecting "Yes" or "No" in the drop down 
menus.  
3. If the data source is NOT available in your state select 
"Not Available" and disregard the remaining questions 
about that data source.  
4. If you do not know if data source is available in your 
state select "Do Not Know" and disregard the remaining 
questions about that data source.  

For ease of data entry, this question continues in Question 
#3 below.  

Alcohol involvement 

Is the data 

Is the data 

Data Availability

Access to the 

Use of Data in 

available for 

available by 

in Your State

Data in 2009

2009

specific age 

ethnic/racial 

categories?

categories?

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

data
All Terrain Vehicle 
(ATV) injury data
Child abuse/neglect 
data
Child safety seat use 
data
Childhood injury 
data

Domestic/intimate 

6

6

6

6

6

Fall injuries data

6

6

6

6

6

Fire and burns injury 

6

6

6

6

6

Firearm injury data

6

6

6

6

6

Homicide data

6

6

6

6

6

Mass trauma/disaster­

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

partner violence data

data

related data
Motor vehicle injury 
data
Motorcycle/motorized 
scooter injury data
Occupational injury 
data

3. Please specify the availability, access, and use of the
following data in the state in 2009. We are interested in
learning about the availability of the data in your state IN
2009, not the availability OF 2009 data. We want to know if
the data source was available (any year's data) in 2009.
INSTRUCTIONS:
1. Indicate the whether or not the data source is available 
in your state (Available, Available but Incomplete, Not 
Available, Don't Know) from the drop down menu.  
2. If data source is available in your state, please indicate 
whether or not you had access to Raw, Summary or No 
data in 2009 and if you used the data in 2009 by 
selecting "Yes" or "No" in the drop down menus 
(Access to Data, Use of Data). Please also indicate if the 
data is available for specific age and racial/ethnic 
categories by selecting "Yes" or "No" in the drop down 
menus.  
3. If the data source is NOT available in your state select 
"Not Available" and disregard the remaining questions 
about that data source.  
4. If you do not know if data source is available in your 
state select "Do Not Know" and disregard the remaining 
questions about that data source.  

Pedestrian injury 

Is the data 

Is the data 

Data Availability

Access to the 

Use of Data in 

available for 

available by 

in Your State

Data in 2009

2009

specific age 

racial/ethnic 

categories?

categories?

6

6

6

6

6

Poisoning data

6

6

6

6

6

Rural/agricultural 

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

data

injury data
Safety belt use 
data
School­based 
injury data
Sexual 
assault/rape data
Smoke alarm 
data

Spinal cord 

6

6

6

6

6

6

6

6

6

6

Suicide data

6

6

6

6

6

Suicide attempts 

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

injury (SCI) data
Submersion 
injuries/drowning 
data

data
Teen Dating 
Violence
Trauma 
System/Registry 
data
Traumatic brain 
injury (TBI) data

4. Are there other data sets you used or had access to in 2009 in addition to those that
were listed in the previous questions?
Other #1
Other #2
Other #3
Other #4
Other #5

* 5. Does your state IVPP have sufficient access to epidemiologists, statisticians, or other
data professionals to analyze data for the IVP program?

j Yes
k
l
m
n
j No
k
l
m
n

Other 

* 6. What percent time does your program have access to an epidemiologist to conduct
injury and violence data analyses?
j 0%
k
l
m
n

j 1­25%
k
l
m
n

j 26­50%
k
l
m
n
j 51­75%
k
l
m
n
j 76­99%
k
l
m
n

j 100% (i.e., equivalent to one FTE)
k
l
m
n

j More than 100% (i.e., equivalent to more than one FTE)
k
l
m
n

* 7. Have you or another representative of the IVPP received a copy of
the following Injury Surveillance Workgroup (ISW) Reports published
by STIPDA?
Received a Copy of the ISW Report
Consensus Recommendations for Injury Surveillance in State 

6

Health Departments (1999)
Consensus Recommendations for Using Hospital Discharge Data 

6

for Injury Surveillance (2003)
Consensus Recommendations for Surveillance of Falls and Fall­

6

Related Injuries (2006)
Consensus Recommendations for Injury Surveillance in State 

6

Health Departments (2007)
Assessing an Expanded Definition for Injuries in Hospital Discharge 

6

Data Systems (2008)

8. In the coming year, STIPDA plans to commission an external evaluation to examine
the dissemination, use, and potential effects of the ISW reports released to date. The
evaluator might like to follow up with the individual in your state who is most likely to
have a need for the ISW reports (e.g. epidemiologist who works with injury data). Please
provide the contact information for the individual our evaluator should contact in the
space below.
Name:
Email Address:
Phone Number:

20. DATA REPORTS

The next two questions focus on reports the injury and/or violence prevention program (IVPP) released in 2009.  

Questions marked with an asterisk (*) require an answer. 

* 1. In 2009, did the IVPP publish any publications in peer­reviewed journals?

j Yes
k
l
m
n
j No
k
l
m
n

j In process
k
l
m
n

Other 

* 2. In 2009, did the IVPP present data at a national or state meeting? Check all that apply.

c Abstracts
d
e
f
g

c Oral Presentations
d
e
f
g

c Poster Presentations
d
e
f
g
c Did Not Present
d
e
f
g

* 3. In 2009, did the IVPP release a report, paper, or other document specific to falls or fall­
related injuries?
j No
k
l
m
n

j Yes (please provide the title of the report)
k
l
m
n

* 4. In 2009, did the IVPP release a report, paper, or other document that specifically
focused on examining injuries documented in hospital discharge data?
j No
k
l
m
n

j Yes (please provide the title of the report)
k
l
m
n

* 5. Which of the following reports, if any, did the IVPP release in 2009 on the status of
injury and/or violence in your state? Please check ALL that apply.
c Comprehensive report on unintentional injuries
d
e
f
g
c Comprehensive report on intentional injuries
d
e
f
g

c Comprehensive report on both unintentional and intentional injuries
d
e
f
g
c Report on childhood injuries
d
e
f
g

c Issue/topic specific report(s), papers or other documents
d
e
f
g
c None
d
e
f
g

c Other (please specify)
d
e
f
g

21. DATA REPORTS (CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. In the previous question you indicated that you had released at least one report in

2009. For the types of reports listed below, please provide the citation of the most recent
report developed. Skip any categories in which you did not release a report.
Comprehensive report on unintentional injuries
Comprehensive report on intentional injuries:
Comprehensive report on both intentional and 
unintentional injuries
Report on childhood injuries
Issue or topic specific reports, papers or documents 
(beyond fall or fall­related, or hospital discharge)

* 2. In a previous question you indicated the state
IVPP released at least one report in 2009. How does
your state use these reports? Choose all that apply.
c Evaluation
d
e
f
g

c Policy Development
d
e
f
g

c Funding Justification
d
e
f
g
c Grant Requirements
d
e
f
g
c Information Sharing
d
e
f
g

c Program Design/Planning
d
e
f
g

c Strategic Planning
d
e
f
g

c Other (please specify)
d
e
f
g

22. PREVENTION PROGRAMS

This section primarily focuses on the areas of injury/violence addressed by IVPP programs in 2009.  

Questions marked with an asterisk (*) require an answer. 

* 1. This question attempts to
assess the level of effort the state
IVPP
Other  gives to each
injury/violence area, whether or
not it is lead by or located within
the state IVPP.
Please select from the drop down 
menu to indicate the level of 
program focus during 2009 in 
each injury/violence area that the 
state IVPP addresses through its 
programs and activities.  
  Other 
Choices include primary focus, 
secondary focus, minimal focus, 
or did not focus on in 2009. You 
can choose multiple areas of 
primary or secondary focus.
For ease of data entry, this
question continues with
additional Prevention Programs
in Question #2 below.
Part 1
Program Focus
All Terrain Vehicle 

6

(ATV) injury
Child abuse/neglect

6

Child passenger 

6

safety
Domestic/intimate 

6

partner violence
Elder Abuse

6

Fall injuries

6

Fire and burns injury

6

Firearm injury

6

Homicide

6

Mass trauma/ 

6

disaster­related
Motor vehicle injury

6

Motorcycle/motorized 

6

scooter injury
Occupational injury

6

* 2. CONTINED FROM QUESTION
#1: This question attempts to
assess the level of effort the state
IVPP gives to each
injury/violence area, whether or
not it is lead by or located within
the state IVPP.
Other 
Please select from the drop down 
menu to indicate the level of 
program focus during 2009 in 
each injury/violence area that the 
state IVPP addresses through its 
programs and activities. 

Choices include primary focus, 
secondary focus, minimal focus, 
or did not focus on in 2009.You 

can choose multiple areas of 
primary or secondary focus.
Part
Other  2
Program Focus
Pedestrian injury

6

Poisoning

6

Rural/agricultural 

6

injury
School­based injury

6

Sexual assault/rape

6

Spinal cord injury 

6

(SCI)

6

Submersion 
injuries/drowning
Suicide/self­inflicted

6

Suicide attempts

6

Teen Dating 

6

Violence

6

Traumatic brain 
injury (TBI)
Injuries to children

6

Injuries to 

6

adolescents
Injuries to elderly

6

Injuries to a 

6

racial/ethnic group

6

Injuries to gender­
specific group
Other #1

6

Other #2

6

Barriers 
Other #3

6

Other #4

6

Other #5

6

* 3. For the primary areas of focus you indicated in the previous questions above (#1 and
#2), please select how the IVPP determined that those areas of focus were primary.
Choose all that apply.
c Data
d
e
f
g

c Funding directives
d
e
f
g

c Needs assessment
d
e
f
g

c Political influence
d
e
f
g
c State mandates
d
e
f
g

c Other (please specify)
d
e
f
g

* 4. In questions #1 and #2 above, you indicated the areas of primary focus for your state

IVPP in 2009. Please tell us more about how you evaluated activities in these primary
focus areas. For the areas indicated as primary focus in 2009, for how many of them did 
you complete the following types of evaluation? The total number entered for each type 
of evaluation should not exceed the total number of primary focus areas. For example, if
you had four (4) areas of primary focus in 2009, the total number of formative
evaluations completed should not be more than four (4).
Definitions are provided below for each type of evaluation:
Formative Evaluation – testing program plans, messages, materials, strategies, or
modifications for weaknesses and strengths before they are put into effect
Other 
l Process Evaluation – testing whether the program’s procedures for reaching the
l

target population are working as planned
l Impact Evaluation – assessing the program’s progress toward its goals (i.e.,
measuring the immediate changes brought about by the program in the target
population such as changes in knowledge, attitudes and beliefs that may lead to
changes in health behavior)
l Outcome Evaluation – measuring whether your program met its ultimate goal of
reducing morbidity and mortality due to injury
Citation: Thompson NJ, McClintock HO. Demonstrating Your Program’s Worth: A Primer 
on Evaluation for Programs To Prevent Unintentional Injury. Atlanta: Centers for 
Disease Control and Prevention, National Center for Injury Prevention and Control, 
1998.
Other 
Formative
Process
Impact
Outcome

* 5. Did your state IVPP use the CDC "Framework for Program Evaluation in Public
Health" to plan and implement program evaluations in 2009?

j Yes
k
l
m
n
j No
k
l
m
n

* 6. Does your IVPP have access to a program evaluator?
j Yes, within IVPP program
k
l
m
n

j Yes, within state health department
k
l
m
n
j Yes, by consultant
k
l
m
n
j No
k
l
m
n

j Other (please specify)
k
l
m
n

23. INJURY TOPIC AREAS ­ INTEGRATION

The next set of questions focuses on the integration of injury and violence prevention programs/activities into other health 
department programs.  

Questions marked with an asterisk (*) require an answer.
The following definition was agreed upon at a CDC forum with the Evaluation Standards Work Group / Program 
Integration & Sub­Group: 

Integration: Process whereby formal units jointly pursue a shared objective in order to improve the health of the 
population (1). They do this through joint (2,3): 
Decision­making, priority­setting, planning  
Responsibility for program development, co­investment, resource sharing & development, implementation, 
evaluation, program improvement  
lOther 
Mutual accountability for results & stewardship  
l Sharing of risks and rewards 
l
l

Citation:  
(1) Mark, Henry, and Julnes (2000). Evaluation: An integrated framework for understanding, guiding, and improving 
policies and programs. Jossey­Bass: San Francisco, CA. [Social betterment] 
(2) Himmelman, AT. Collaboration for a Change: Definitions, Decision­making models, Roles, and Collaboration Process 
Guide. http://depts.washington.edu/ccph/pdf_files/4achange.pdf. [Continuum from networking through collaboration] 
(3) Slonim AB, et al. Recommendations for integration of chronic disease programs; are your programs linked? Prev 
Chronic Dis [serial online] 2007 Apr [date cited]. Available from http//www.cdc.gov/pcd/issues/2007/apr/06_0163.htm.  

* 1. In 2009, what injury/violence prevention efforts were integrated with other areas of the
health department, state agencies, and/or outside agencies/organizations?
5
6  

What priority does
* 2.Other 
your state IVPP place
on integrating injury
and/or violence
prevention activities
into these state
offices/programs?
Priority for 
Integrating
Chronic Disease

6

Environmental 

6

Health
Maternal and Child 

6

Health

24. INJURY TOPIC AREAS ­ PREVENTING FALLS AMONG OLDER ADULTS

The next set of questions focuses on the injury topic of Preventing Falls Among Older Adults. We are interested in 
programs located within the IVPP (including those that are done in collaboration with partners.) 

Questions marked with an asterisk (*) require an answer. 

* 1. Did your state IVPP have programs or activities for Preventing Falls Among Older
Adults in 2009?

j Yes
k
l
m
n
j No
k
l
m
n

j Not Applicable (not a priority area for the state)
k
l
m
n

25. INJURY TOPIC AREAS ­ PREVENTING FALLS AMONG OLDER ADULTS
(CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. What programs or activities for Preventing Falls Among Older Adults did your state
IVPP in 2009? Check all that apply.

c Multi­factorial (must include at least two of the following: exercise, medication adjustment, vision correction, home modification)
d
e
f
g
c Exercise Program
d
e
f
g

c Home Modification
d
e
f
g

c Education and Awareness
d
e
f
g

Other 
c Other (please specify)
d
e
f
g

* 2. How were these programs or activities evaluated in 2009?
Check all that apply.
c Number of participants enrolled
d
e
f
g
c Participants' reports of falls
d
e
f
g

c Media reports
d
e
f
g

c Pre­ and post­surveys of participants
d
e
f
g

c Policy changes
d
e
f
g

c Program costs
d
e
f
g

c Emergency department or hospital 
d
e
f
g
admissions for falls 
Other 

c Other (please specify)
d
e
f
g

26. INJURY TOPIC AREAS ­ PREVENTING FALLS AMONG OLDER ADULTS
(CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. Did your IVPP provide funding to local health departments or other organizations in
your state for Preventing Falls Among Older Adults programs in 2009?
j Yes (Funding given to the local health department or other organization)
k
l
m
n

j No (Funding available, but not given to the local health department or other organization)
k
l
m
n

j Not applicable (No funding available to give to local health department or other organization)
k
l
m
n

27. INJURY TOPIC AREAS ­ PREVENTING CHILD MALTREATMENT

The next set of questions focuses on the injury topic of Preventing Child Maltreatment. We are interested in programs 
located within the IVPP (including those that are done in collaboration with partners.) 

Questions marked with an asterisk (*) require an answer. 

* 1. Did your state IVPP have programs or activities for Preventing Child Maltreatment in
2009?

j Yes
k
l
m
n
j No
k
l
m
n

Other 

j Not Applicable (not a priority area for the state)
k
l
m
n

28. INJURY TOPIC AREAS ­ PREVENTING CHILD MALTREATMENT (CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. What types of interventions and program activities did your IVPP
have that focused on Preventing Child Maltreatment in 2009? Please
check all that apply.
c Parenting training/parent skill building
d
e
f
g

c Concrete assistance/support for families 
d
e
f
g
(financial or transportation assistance, child care, 

c Home visitation (Nurse or other trained 
d
e
f
g

respite care) 

professional deliverer) 

c Home visitation (Paraprofessional deliverer)
d
e
f
g
c Home visitation (Other deliverer)
d
e
f
g

c Social support/network building for families
d
e
f
g

c Parent literacy/career/employment skills
d
e
f
g

c Parental mental health/substance abuse 
d
e
f
g
services 
Other 

c Other (please specify)
d
e
f
g

* 2. What outcomes did you measure to evaluate these programs and
activities in 2009? Please check all that apply.
c Process indicators (e.g. number of participants, 
d
e
f
g

c Knowledge gain/retention/refresh
d
e
f
g

number of materials distributed, etc.) 

c Behavior change/maintenance
d
e
f
g

c Anecdotes/informal measures (e.g., word of 
d
e
f
g

c Media reports/presence
d
e
f
g

maltreatment, children in foster placement, 

emergency department data, child fatalities due child 
maltreatment, child well­being/developmental status) 

c Likeability/acceptability
d
e
f
g

c Environment change
d
e
f
g

c None
d
e
f
g
c Other (please specify)
d
e
f
g

c Long term outcomes (e.g., CPS reports of child 
d
e
f
g

mouth; newspaper stories) 

c Institutional/policy change
d
e
f
g

Other 

29. INJURY TOPIC AREAS ­ PREVENTING CHILD MALTREATMENT (CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. You indicated in a previous question that programs or activities for Preventing Child
Maltreatment are not a priority in your state. What needs to happen to make this injury
and violence prevention area a priority in your state?
5
6  

30. INJURY TOPIC AREAS ­ PREVENTING CHILD MALTREATMENT (CONTINUED)
Questions marked with an asterisk (*) require an answer. 

* 1. Did your IVPP provide funding to local health departments or other organizations in
your state for Preventing Child Maltreatment programs in 2009?
j Yes (Funding given to the local health department or other organization)
k
l
m
n

j No (Funding available, but not given to the local health department or other organization)
k
l
m
n

j Not applicable (No funding available to give to local health department or other organization)
k
l
m
n

* 2. What are the barriers to using child maltreatment data in your state? Check all that
apply.

c Not Applicable ­ child maltreatment data are not available in my state
d
e
f
g
c Barriers to using data (please specify)
d
e
f
g

5
6  

* 3. What are the types and extent of barriers you face in pursuing policy changes or
other advocacy efforts related to child maltreatment?

5
6  

* 4. Do you and/or your staff have the capacity to participate in distance learning
opportunities?

j Yes
k
l
m
n
j No
k
l
m
n

31. INJURY TOPIC AREAS ­­ PREVENTING CHILD MALTREATMENT
(CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. What child maltreatment prevention topics would
be most beneficial for your program in a distance
learning opportunity?
c Data analysis
d
e
f
g

c Data collection
d
e
f
g

c Report writing
d
e
f
g

c Review of evidence base for child 
d
e
f
g

c Partnership development
d
e
f
g
c
d
e
f
g

maltreatment (What works?) 

c Evaluation
d
e
f
g

Policy

c Other (please specify)
d
e
f
g

32. INJURY TOPIC AREAS ­­ PREVENTING CHILD MALTREATMENT
(CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. You indicated in a previous question that you and/or your staff did not have the
capacity to participate in distance learning opportunities.

What would you need to develop this capacity? Check all that apply.
c Information technology network capacity
d
e
f
g
c Training
d
e
f
g

c Other (please specify)
d
e
f
g

33. INJURY TOPIC AREAS ­ PREVENTING TEEN DATING VIOLENCE

The next set of questions focuses on the injury topic of Preventing Teen Dating Violence. We are interested in programs 
located within the IVPP (including those that are done in collaboration with partners.) 

Questions marked with an asterisk (*) require an answer. 

* 1. Did your state IVPP have programs or activities for Preventing Teen Dating Violence
in 2009?

j Yes
k
l
m
n
j No
k
l
m
n

j Not Applicable (not a priority area for the state)
k
l
m
n

34. INJURY TOPIC AREAS ­ PREVENTING TEEN DATING VIOLENCE
(CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. What types of interventions and program
activities did your IVPP have that focused on
Preventing Teen Dating Violence in 2009? Please
check all that apply.
c Strategic planning
d
e
f
g

c Educational sessions
d
e
f
g

c Surveillance
d
e
f
g

c Evaluation
d
e
f
g

c Training for professionals
d
e
f
g

materials 

c Partnership/coalition building
d
e
f
g
c Capacity building
d
e
f
g

c Other (please specify)
d
e
f
g

c Policy
d
e
f
g

c Information and awareness raising 
d
e
f
g

c Media campaigns
d
e
f
g

* 2. What outcomes did you measure to evaluate these programs and
activities in 2009? Please check all that apply.
c Process indicators (e.g. number of participants, 
d
e
f
g

c Knowledge gain/retention/refresh
d
e
f
g

number of materials distributed, etc.) 

c Behavior change/maintenance
d
e
f
g

c Anecdotes/informal measures (e.g., word of 
d
e
f
g

c Media reports/presence
d
e
f
g

c Other (please specify)
d
e
f
g

incidence of TDV) 

c Environment change
d
e
f
g

c Likeability/acceptability
d
e
f
g

c Long term outcomes (e.g., such as the reduced 
d
e
f
g

mouth; newspaper stories) 

c Institutional/policy change
d
e
f
g

c None
d
e
f
g

35. INJURY TOPIC AREAS ­ PREVENTING TEEN DATING VIOLENCE
(CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. Did your IVPP provide funding to local health departments or other organizations in
your state for Preventing Teen Dating Violence programs in 2009?
j Yes (Funding given to the local health department or other organization)
k
l
m
n

j No (Funding available, but not given to the local health department or other organization)
k
l
m
n

j Not applicable (No funding available to give to local health department or other organization)
k
l
m
n

36. SUPPORT FOR LOCAL PREVENTION EFFORTS

The next set of questions focuses on how the state IVPP provides support for local injury and violence prevention efforts. 
This includes both funding and in­kind support to local health departments, community based organizations, etc.  

Questions marked with an asterisk (*) require an answer. 

* 1. In 2009, did the IVPP provide any funding or in­kind support for local injury/violence
prevention activities?

j Yes
k
l
m
n
j No
k
l
m
n
Other 

37. SUPPORT FOR LOCAL PREVENTION EFFORTS (CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. Please check all methods used by the IVPP in
2009 to provide funding and/or in­kind support for
local prevention efforts. Check all that apply.
c Mini­grants
d
e
f
g

c In­kind support for epi/data
d
e
f
g

c Supplies/equipment (i.e. car seats, 
d
e
f
g

c In­kind support for program development
d
e
f
g

smoke alarms) 

c In­kind support for technical assistance
d
e
f
g
c In­kind support for training
d
e
f
g
c Other (please specify)
d
e
f
g

c In­kind support for evaluation
d
e
f
g

5
5
6
6  

* 2. What sources of funding did the IVPP use to provide resources to local injury and
violence prevention efforts in 2009? Please check all that apply.
c Pass­through funds (i.e. RPE, etc)
d
e
f
g

c Preventive Health & Human Services Block Grant funds
d
e
f
g

c Other federal funds (i.e. smoke detector grant funds, etc)
d
e
f
g
c State funds
d
e
f
g

c Other (please specify)
d
e
f
g

5
5
6
6  

38. TRAINING AND TECHNICAL ASSISTANCE

This section focuses on communication, technical assistance and training efforts by the state injury and/or violence 
prevention program (IVPP) in 2009.  

Questions marked with an asterisk (*) require an answer. 

* 1. In 2009, how did the IVPP communicate injury
and/or violence­related information to target
populations, program partners, local groups, etc.?
Please check ALL that apply.
c Website
d
e
f
g

c Listserv
d
e
f
g

c Newsletter
d
e
f
g

c Regular mailings
d
e
f
g

c TV/radio/newspaper
d
e
f
g

c Participated in steering committees, community meetings, professional association 
d
e
f
g
meetings 

c None of the above
d
e
f
g

c Other (please specify)
d
e
f
g

39. TRAINING AND TECHNICAL ASSISTANCE (CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. In 2009, what was the PRIMARY way in which
your IVPP communicated injury and/or violence­
related information to target populations, program
partners, local groups, etc.? Please select only one.
j Website
k
l
m
n

j TV/radio/newspaper
k
l
m
n

j Listserv
k
l
m
n

j Newsletter
k
l
m
n

j Participated in steering committees, 
k
l
m
n
community meetings, professional association 

j Regular mailings
k
l
m
n

meetings 

j Other (please specify)
k
l
m
n

j None of the above
k
l
m
n

40. TRAINING AND TECHNICAL ASSISTANCE (CONTINUED)

Questions marked with an asterisk (*) require an answer. 

* 1. What methods did the IVPP use in 2009 to provide technical
assistance and training to partners, grantees, and others engaged in
injury and violence prevention? Please check ALL that apply.
c Offered practical experience for students
d
e
f
g

c Conducted distance learning via satellite, video 
d
e
f
g

c Responded to requests for technical assistance
d
e
f
g
c Offered courses for academic credit or CEUs
d
e
f
g

conference, or video tape 

c Conducted distance learning via computer 
d
e
f
g

(Internet based, Webcast, or CD­ROM) 

c Conducted in­person training (workshops, 
d
e
f
g

c None
d
e
f
g

conference sessions, presentations, etc) 

c Other (please specify)
d
e
f
g

5
5
6
6  

* 2. What are the technical assistance resources your program uses?
Check all that apply.

c Businesses
d
e
f
g

c SAVIR
d
e
f
g

c Federal Agencies (such as CDC, HRSA, NHTSA, 
d
e
f
g

c Self Assessment
d
e
f
g

SAMHSA) 

c Injury Prevention Research Centers
d
e
f
g
c Internet
d
e
f
g

c
d
e
f
g

c STAT Report (for your own state)
d
e
f
g

c STIPDA
d
e
f
g

c Peer to Peer
d
e
f
g

c University/Academic Institutions (other than 
d
e
f
g

IPRCs) 

c Resource Centers (such as CSN, SPRC or CDR)
d
e
f
g
Other (please specify) 

c Other National Organizations
d
e
f
g

Regional Networks

* 3. Is your IVPP aware of the National Training Initiative for Injury and Violence
Prevention's Core Competencies? (See list below)

1. Ability to describe and explain injury and/or violence as a major social and health 
problem. 
2. Ability to access, interpret, use and present injury and/or violence data.  
3. Ability to design and implement injury and/or violence prevention activities.  
4. Ability to evaluate injury and/or violence prevention activities.  
5. Ability to build and manage an injury and/or violence prevention program.  
6. Ability to disseminate information related to injury and/or violence prevention to the 
community, other professionals, key policy makers and leaders through diverse 
communication networks.  
7. Ability to stimulate change related to injury and/or violence prevention through 
policy, enforcement, advocacy and education.  
8. Ability to maintain and further develop competency as an injury and/or violence 
prevention professional.  
9. Demonstrate the knowledge, skills and best practices necessary to address at least 
one specific injury and/or violence topic (e.g. motor vehicle occupant injury, intimate 
partner violence, fire and burns, suicide, drowning, child injury, etc.) and be able to 
serve as a resource regarding that area.  

j Yes
k
l
m
n
j No
k
l
m
n

* 4. Do you create staff performance plans that explicitly include the above listed National
Training Initiative for Injury and Violence Prevention's Core Competencies?

j Yes
k
l
m
n
j No
k
l
m
n

j Don't know
k
l
m
n

* 5. How many trainings or other professional development
sessions did you offer to the local health department or
other partners in your state in 2009?
# of Sessions

* 6. Do any of these trainings explicitly incorporate the National Training Initiative for
Injury and Violence Prevention's Core Competencies?

j Yes
k
l
m
n
j No
k
l
m
n

j No trainings/professional development offered in 2009
k
l
m
n
j Don't know
k
l
m
n

41. POLICY

This section of the questionnaire addresses how the IVPP worked to influence public policy during the most recently 
completed legislative session (i.e. completed prior to 12/31/2009).  

Policy is a general term which includes laws, regulations, and rules – both informal and formal. There are different 
subtypes of policies, and settings in which they may exist:  

Public policies: Laws or ordinances enacted at the federal, state, or local levels of government through a legislative 
process or another formal process of approval. Example: laws which mandate the use of motorcycle helmets  

Regulatory policies: Rules and regulations created, approved, and enforced by governmental agencies, generally at the 
federal­ or state­level. Example: The establishment by the Centers for Medicare and Medicaid of a diagnostic 
reimbursement group and a reimbursement schedule for payment of child safety seats for children with special 
healthcare needs.  

Organizational policies: Rules and procedures created, adopted, and enforced within organizations, public or private, 
affecting employees or members of the organization or individuals served by the organization. Organizations include (but 
are not limited to) private companies, health care providers, health insurance companies, national non­profit 
organizations, schools or entire school districts, or community groups. Example: Data sharing policies with emergency 
departments and medical examiners offices.  

Questions marked with an asterisk (*) require an answer. 

* 1. During the most recently completed legislative session (i.e. completed prior to

12/31/2009), did the IVPP have mechanisms or protocols for communicating with policy­
makers around issues related to injury and violence prevention?

j Yes
k
l
m
n
j No
k
l
m
n

j Don't know
k
l
m
n

* 2. Please describe the methods the IVPP program used in 2009 to
influence public policy either directly or through collaboration with
partners. Please check all that apply.
Method used by  Method used through 
IVPP

collaboration/partners

State IVPP not 
Method not used

permitted to use 
this method

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

Met with policy­makers

6

6

6

6

Participated in boards and/or 

6

6

6

6

6

6

6

6

6

6

6

6

Sent materials to policy­makers

6

6

6

6

Testified at state and local 

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

6

Assessed/monitored impact of 
laws
Conducted cost­benefit 
analyses of IVP policies
Drafted and submitted potential 
policies to policy­makers
Invited Congressional delegates 
to meetings/events
Invited state or local legislators 
to meetings/events

commissions
Recommended health 
department positions on bills
Requested opportunity to 
review bills

hearings
Worked to increase public 
awareness of laws
Worked to develop/enforce 
regulations for injury/violence 
prevention
Worked to create/encourage 
adoption of organizational 
policies for injury/violence 
prevention

* 3. What injury and violence prevention topic areas does your state's
IVPP address through policy efforts?
c None
d
e
f
g

c Mass trauma/ disaster­related
d
e
f
g

c All Terrain Vehicle (ATV) 
d
e
f
g
injury 

c Child abuse/neglect
d
e
f
g
c Childhood injury
d
e
f
g

c Occupational injury
d
e
f
g

c Domestic/intimate partner 
d
e
f
g

c Homicide
d
e
f
g

c Injuries to children
d
e
f
g

c Sexual assault/rape
d
e
f
g

c Injuries to adolescents
d
e
f
g
c Injuries to elderly
d
e
f
g

c Injuries to a racial/ethnic 
d
e
f
g

group 

c Injuries to gender­specific 
d
e
f
g

environment 

group 

c Spinal cord injury (SCI)
d
e
f
g

c Other (please specify)
d
e
f
g

c Smart growth/built 
d
e
f
g

c Traumatic brain injury (TBI
d
e
f
g

c School­based injury
d
e
f
g

c Fire and burns injury
d
e
f
g
c
d
e
f
g

c Poisoning
d
e
f
g

c Suicide attempts
d
e
f
g

c Teen Dating Violence
d
e
f
g

c Rural/agricultural injury
d
e
f
g

Firearm injury

c Pedestrian injury
d
e
f
g

c Submersion injuries/drowning
d
e
f
g
c Suicide/self­inflicted
d
e
f
g

injury 

violence 

c Fall injuries
d
e
f
g

c Motorcycle/motorized scooter 
d
e
f
g

c Child passenger safety
d
e
f
g

c Elder Abuse
d
e
f
g

c Motor vehicle injury
d
e
f
g

* 4. In 2009, did the IVPP maintain a record of existing state policies (laws, regulations,
etc) related to injury and violence prevention?

j Yes
k
l
m
n
j No
k
l
m
n

j Don't know
k
l
m
n

* 5. What role does your IVPP play in helping to implement or increase awareness of new
laws? (seat belt laws, child passenger safety laws, bullying prevention, graduated
driving license, etc.)
5

6  

* 6. What are the types and extent of barriers you face in pursuing policy changes or
other advocacy efforts related to injury and violence prevention efforts?
5
6  

42. CHANGES IN YOUR PROGRAM SINCE 2007

In this section we would like to give you an opportunity to tell us about any changes that have occurred in your state 
IVPP program, your state health department, or your state in general since we conducted the 2007 State of the States 
Survey in early 2008. 

1. Were there any changes to your IVPP program, your state health department, or your
state in general in 2008 or 2009? (Please describe in detail any information that might
put into perspective comparisons between your 2007 and 2009 data. Changes might
include: reorganizations, changes in funding, changes in political dynamics or
legislation, loss of a critical staff member, increase in responsibilities, etc.)
5

6  

43. PROGRAM STAFF (FORMAL IVP PROGRAM)

We would like to know about the people who work for the state injury and/or violence prevention program (IVPP.) By 
staff, we mean all paid staff (full or part­time), fellows, and interns (paid or unpaid). Do not include staff in other programs 
(like RPE), unless they are housed directly in the formal IVPP. We'll be asking about those staff in the next section.  

This section includes questions you will need to answer for your staff as a whole. You may find it helpful to provide each 
staff member with a hard copy of this portion of the survey to complete by hand, and then whoever is completing the 
survey can compile the results into one state response for this section. 

Questions marked with an asterisk (*) require an answer. 

* 1. Please indicate how many staff
members that were part of the IVPP in
2009 in each of the following status
categories.
Paid staff member (include 
both part­time and full­
time)
Paid intern
Unpaid intern
Fellow

* 2. For each paid staff member, please
identify the role that most closely
describes the staff member's PRIMARY
role within the state IVPP. You can choose
only one primary role per staff person. If
they perform multiple roles, indicate the
one which is performed most often.
Please indicate how many paid staff
members you have within each primary
role category. Include all paid employees, 
regardless of percent time they work in the 
IVPP. (Your total should not exceed the 
number indicated for "paid staff member" 
in question 1 above.)
Management
Data collection/analysis
Coalition 
building/Coordination
Evaluation
Intervention/Program 
Coordination
Technical 
Assistance/Training
Public Policy/Advocacy
Support 
Staff/Administrative

* 3. Please indicate how many staff
members in the IVPP you have with each
of the following degree(s).
Include all paid employees, regardless of 
percent time they work in the IVPP. 
Choose ALL degrees attained, not just 
highest degree. 

High School 
Diploma/GED
AA
AS
BA
BS
RN
MS
MA
MBA
MPA
MPH
MSW
MD
PhD
DrPH
JD

* 4. Please indicate how many staff
members in the IVPP have been working
for the state IVPP program for the various
periods of time listed.
Include all paid employees, regardless of 
percent time they work in the IVPP. (Your 
total should not exceed the number 
indicated for "paid staff member" in 
question 1 above.)
Less than 1 year
1 year to less than 4 years
4 years to less than 7 years
7 years to less than 10 
years
10 years or more

* 5. Please indicate how many staff
members in the IVPP have been working
for the field of injury and violence
prevention for the various periods of time
listed.
Include all paid employees, regardless of 
percent time they work in the IVPP. (Your 
total should not exceed the number 
indicated for "paid staff member" in 
question 1 above.)
Less than 1 year
1 year to less than 4 years
4 years to less than 7 years
7 years to less than 10 
years
10 years or more

* 6. Please indicate how many staff
members in the IVPP have been working
for the field of public health for the various
periods of time listed.
Include all paid employees, regardless of 
percent time they work in the IVPP. (Your 
total should not exceed the number 
indicated for "paid staff member" in 
question 1 above.)
Less than 1 year
1 year to less than 4 years
4 years to less than 7 years
7 years to less than 10 
years
10 years or more

* 7. Please indicate how many staff
members in the IVPP spend their time
working in the IVPP according to the
various percentages below.
Include all paid employees, regardless of 
percent time they work in the IVPP. (For 
example, if you have a .5 FTE that works 
50% on IVPP, please include that staff 
person in the 26­50% category) 
1­25%
26­50%
51­75%
76­99%
100%

* 8. Please indicate how many IVPP staff
member's positions include the following
funding sources. An employee can be
funded by multiple sources.
Include all paid employees, regardless of 
percent time they work in the IVPP. 
State
Federal­CDC
Other 
Federal
Other 
Sources

* 9. How many of your staff members are current members of STIPDA?
Include all paid employees, regardless of percent time they work in the IVPP. (Your total 
should not exceed the number indicated for "paid staff member" in question 1 above.)

44. STATE HEALTH DEPARTMENT IVP STAFF NOT LOCATED IN FORMAL IVP
PROGRAM (i.e., ...

Finally, we'd like to know about the other people who work on injury and violence prevention activities that are not housed 
directly in the formal state injury and/or violence prevention program (example, RPE staff). By staff, we mean all paid 
staff (full or part­time), fellows, and interns (paid or unpaid).  

Questions marked with an asterisk (*) require an answer. 

* 1. Please indicate how many non­formal
IVPP program staff members there are in
the state health department. (You might
want to include staff such as RPE or
suicide prevention coordinators in the
maternal and child health program to
name a few.)

* 2. What programs are these staff members
in?
5
6  

45. THANK YOU

You have completed the 2009 State of the States questionnaire. THANK YOU for your time and participation. 

Please contact Amber Williams (770­690­9000 or Amber.Williams@stipda.org) at STIPDA if you have any questions 
about the survey.