Attachment C - Survey Screenshots

EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

Form Approved
OMB No. 0920-XXXX
Exp. Date:
Public Reporting burden of this collection of information is estimated at 28 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. An agency many not conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer,
1600 Clifton Road NW, MS D-74, Atlanta, GA 30333; ATTN: PRA 0920-XXXX.

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EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

Institutional awareness and commitment to ensure safe, stable, nurturing relationships and environments and prevent child
maltreatment
The purpose of this survey is to get a better understanding of your agency’s (or institution, organization, business, or department)
level of awareness and current efforts and partnerships around ensuring safe, stable, nurturing relationships and environments and
preventing child maltreatment. We are asking the same questions about other agencies so there may be some that do not apply to
yours. Ideally, you will bring in others from your agency to answer the survey collectively (just one survey please). If you answer the
survey alone, please try to answer from your agency’s perspective. For the purposes of this survey, “staff” refers to both staff and
leadership. Please do not consult outside resources (e.g., internet, library materials, experts outside your agency/organization). The
information collected will contribute to tracking efforts in this direction.
Completion of this survey is voluntary. You do not have to answer every question and can skip those that you do not feel
comfortable answering. You can stop answering the survey at any time. There are no foreseeable or expected risks for participation
in this survey. The mechanism for collecting this information is Survey Monkey, a secure website that meets the Safe Harbor and
EU Data Protection Requirements. All information collected will be maintained in a secure manner.

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EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

1. NAME OF AGENCY:

2. Scope of Your Agency's Work:
State-wide
2+ counties or cities, but not state-wide
1 county or city
Neighborhood/community

3. Our agency considers the scientific evidence before making decisions about policies, programs, or
services?
Yes
No

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EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

The following questions ask about your agency’s/organization’s level of knowledge and its positions or beliefs.
4. How often does your agency have presentations or discussions reviewing scientific evidence related to
policies, programs, or services for children and families at staff meetings?
A lot (this topic is regularly scheduled)
Often (this topic comes up in many discussions although not specifically scheduled or there have been >4 planned meetings around this topic)
A little (this topic comes up once in a while or there has been 1-3 planned meetings around this topic
Not at all

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EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

5. What percent of the staff in your agency do you think knows that 1 in 10 children in the US have
experienced some form of child maltreatment (this includes physical, sexual and emotional abuse and
any form of neglect)?

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EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

6. What percent of the staff in your agency do you think knows that just one case of child maltreatment
costs us about $200,000 when you add up health care, child welfare, special education, and criminal
justice costs and losses in earnings across the lifespan of a victim?

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EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

7. Which of the following conditions do you think most people at your agency (> 50%) would identify as
consequences of child maltreatment (check all that apply):
Death
Physical injury
Paraplegia
Blindness
Mental retardation
Developmental delay
Changes in genetic expression
Difficulty controlling emotions
Impulsive behavior
Difficulty learning
Difficulty paying attention
Aggressive behaviors
Depression
Smoking
Substance abuse
Suicide attempts
Sexually transmitted diseases
Teen pregnancy
Juvenile delinquency
Eating disorders
Obesity
Diabetes
Chronic pain
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EfC Institutional Awareness & Commitment Test Survey

Heart disease
Chronic obstructive pulmonary disease
Cancer
None

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EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

8. Thinking about your agency, how much would most of the staff agree or disagree with the following
statements?
Strongly agree

Somewhat
agree

Neither agree
or disagree

Safe, stable and nurturing relationships and environments can
buffer children against the effects of adverse childhood
experiences like child maltreatment or exposure to partner
violence.
Safe, stable and nurturing relationships and environments set
children on a positive path for optimal child development.
Whether a child grows up to be a healthy adult is determined
by their genes.
Whether a child grows up to be a healthy adult is determined
by their parents’ choices.
The cumulative impact of family stressors such as poverty or
partner violence shape children’s brains.
My agency considers the impacts of child maltreatment when
setting priorities.
My agency considers the impacts on child well-being when
making decisions.
Ensuring safe, stable, nurturing relationships and
environments for children is in alignment with my agency’s
priorities.

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Somewhat
disagree

Strongly
disagree

Probably hasn’t
thought about it

EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

9. How often does your agency discuss impacts on child well-being or promoting safe, stable, nurturing
relationships and environments for children and families at staff meetings?
A lot (this topic is a regular agenda item)
Often (this topic comes up in many discussions although not on the agenda or there have been >4 planned meetings around this topic)
A little (this topic comes up once in a while or there has been 1-3 planned meetings around this topic)
Not at all

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EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

The following policies, programs, or resources may contribute to employees’ families’ or their children’s health or development.
Using your best estimate, during the past year in your agency:
10. What percentage of employees were allowed to negotiate flexible starting and quit times?
80%-100%

60%-79%

40%-59%

20%-39%

1%-20%

0

11. What percentage of employees were allowed to negotiate alternative work days (e.g., compressed
workweeks)?
80%-100%

60%-79%

40%-59%

20%-39%

1%-20%

0

12. What percentage of employees were allowed to telework (work from home) at least one day a week?
80%-100%

60%-79%

40%-59%

20%-39%

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1%-20%

0

EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

Using your best estimate, during the past year in your agency:
13. What was the maximum number of days (per week) teleworking employees were allowed to telework?

14. What percentage of employees were obligated to change their hours or days of work from week to
week?
80%-100%

60%-79%

40%-59%

20%-39%

1%-20%

0

15. What percentage of employees were allowed to change their hours or days of work from week to
week?
80%-100%

60%-79%

40%-59%

20%-39%

1%-20%

0

16. What percentage of employees were allowed to job share or work part time?
80%-100%

60%-79%

40%-59%

20%-39%

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1%-20%

0

EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

Using your best estimate, during the past year in your agency:
17. How many weeks of paid leave were parents able to take for the birth of a child (not using accrued
vacation leave or accrued credit time)?

18. How many days of paid leave (not using accrued vacation leave or accrued credit time) were parents
able to take to care for a sick child?
51-60

41-50

31-40

21-30

11-20

5-10

1-4

0

19. How many hours of paid leave (not using accrued vacation leave or accrued credit time) in a year
were parents able to take to attend child related events (e.g., parent/ teacher conferences, school
presentations, or sports events)?

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EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

Using your best estimate, during the past year in your agency:
20. Employees were allowed to bring babies to work during their first 6 months:
Every day
3-4 days a week
1-2 days a week
Occasionally
0 days

21. Employees were allowed to bring children older than 6 months to work:
Every day
3-4 days a week
1-2 days a week
Occasionally
0 days

22. Child care was:
Provided on site for all who needed with a sliding-scale fee
Provided on site but there was a waiting list or no sliding-scale fee
No child care on site but subsidies provided for employees with lower wages
Not provided or supported

23. Breastfeeding mothers were:
Allowed additional break time and a private lactation room
Allowed additional break time or a private lactation room
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EfC Institutional Awareness & Commitment Test Survey

No additional break time or a private lactation room

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EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

Using your best estimate, during the past year in your agency:
24. What percentage of employees earn less than ($22.70 for CA; $20.56 for CO; $24.84 for MA; $18.92 for
NC; $19.49 for WA ) an hour?
80%-100%

60%-79%

40%-59%

20%-39%

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1%-20%

0

EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

Using your best estimate, during the past year in your agency:
25. Health benefits (health insurance options):
Are provided to both full time and part time employees
Are provided to full time employees only
Are NOT provided

26. Transportation subsidies for lower income employees:
Are provided to both full time and part time employees
Are provided to full time employees only
Are NOT provided

27. Work site is located near (< 1 mile) public transit or shuttle is provided to/from public transit
Yes
No

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EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

Using your best estimate, during the past year in your agency:
28. What services/benefits were provided to employees (check all that apply)?
Mental health counseling
Substance abuse treatment
Parenting training
Help in finding day care for children
Flexible spending accounts for health care or medications
Flexible spending accounts for child care
Support for professional development (e.g., tuition assistance, on-the-job training)

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EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

The following activities or services may contribute to families’ or children’s health or development in your state.
29. Please indicate whether your agency directly provides this service, refers clients to this service,
supports this service with funding, or supports this service or activity by any other means (e.g.,
advocating, advertising, networking, etc.)
Directly provides or
does

Refers clients to

Pre- or inter-conception health care
Contraception
Prenatal care
Home visits
Parent training programs
Screen and referral of parents experiencing
partner violence, mental illness or substance
abuse
Legal, mental, financial or other counseling for
women experiencing partner violence
Job training
Financial literacy training
Low cost financial services for unbanked or
underbanked
Anticipatory guidance to parents around
common parenting issues
Preschool with family support services
Family resource center (lending books or toys,
linking to services)
K-12 education
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Provides funds for

Other support

No support

EfC Institutional Awareness & Commitment Test Survey

Developmental screening
Intervention for children exposed to child
maltreatment
Services for children with or at risk of
developmental delays
Services for children manifesting behavioral
problems
Individualized Family Service Plan
Mentoring children
After-school care or activities
Summer child care or activities
Recreational activities for children
Child care
Child care subsidies
Health insurance for children
Affordable housing
Urban planning, development, or
transportation
Zoning decisions
Crime prevention
Juvenile justice
Income support for unemployed or low-income
families
SNAP or WIC
Food pantries
Dissemination of information around parenting
or child development
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EfC Institutional Awareness & Commitment Test Survey

Campaigns to change social norms around
parenting or children
Campaigns to promote family friendly work
policies
Other (please specify service in box below)

Other (please specify)

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EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

30. Please indicate which data your agency/organization have used in the last year to make decisions
about policies or programs that affect children or families in your state. Add another √ if these data are
examined by race/ethnicity or income.
Used past year
Number (#) of child homicides
Child fatality review records
# of hospital discharges due to children’s intentional injuries
# of ER visits due to children’s intentional injuries
% of pregnant women receiving prenatal care in the first trimester
% of pregnant women or parents of young children with depression, exposure
to partner violence, or substance abuse
% births to teen parents
# of 911 calls attributed to partner violence
% of ambulatory care visits for mental illness, including substance abuse
among women 15-45 yrs. old
length of wait list for treatment of substance abuse among adults
% of children <5 evaluated for social emotional development
% of parents of children under five who received anticipatory guidance using
Bright Futures guidelines
% of women between 15-45 with access to family planning services
# of reports to child protective services (CPS)
% of services provided to parents and children reported to CPS that are
evidence-based
% of parents who physically punished their child in the past year
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Examined by
race/ethnicity

Examined by
income

Did not use

EfC Institutional Awareness & Commitment Test Survey

% of parents reporting parental stress (i.e., child is harder to care for than most;
child does things that bother them; felt angry with child; has someone they can
turn to for help with parenting)
% of parents without dependable childcare arrangements
Length of wait list for infant or toddler childcare and education programs such
as Early Head Start
Length of wait list for childcare subsidies
% of families who are eligible for Temporary Assistance to Needy Families
(TANF) who actually receive TANF
% of families who are eligible for Supplemental Nutrition Assistance Program
(SNAP) or WIC vouchers who actually receive SNAP/WIC
% of families who are eligible for State Children’s Health Insurance Program
(SCHIP)/Medicaid who actually receive SCHIP/Medicaid
High school dropout rates
Length of wait list for state-funded pre-K program or Head Start
% of schools with evidence-based education programs to prevent teen
pregnancy
% of children living in poverty
% of children living in high poverty neighborhoods
% of families with children who pay > 30% of income for housing
% of children living in crowded households
# of homeless school-age children
# of homeless pre-school age children
% of children with no parent fully employed year round
% of children with an incarcerated parent
interest rates for payday, auto title, or pawnshop loans
% of businesses with family-friendly work policies (e.g., flex-time, telework)
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EfC Institutional Awareness & Commitment Test Survey

Other

Please specify other data source used in last year:

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EfC Institutional Awareness & Commitment Test Survey

EfC Institutional Awareness & Commitment Test

31. Please indicate whether your agency directly provides this service, refers clients to this service,
supports this service with funding, or supports this service or activity by any other means or whether your
agency does not support this service at this time. Check N/A if your state doesn't have a specific
agency/organization.
Referral
resource

Coordinating Serve on an
Serve on Legislative/
services or advisory Sharing data planning
policy
programs
group
group
development

Governor’s
Office
Dept of
Education
Family &
children
services
Human services
Public health
Developmental
disabilities
Child support
Consumer
protection
Transportation
Early care/
learning
Police
Justice
Labor

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Crosstraining

Sharing
materials

No
Evaluation relationship
with agency

N/A

EfC Institutional Awareness & Commitment Test Survey

Housing
Finance
CommunityBased Child
Abuse
Prevention
(CBCAP)
program
Prevent Child
Abuse state
affiliate
Childcare
agency
Children’s Trust
Fund
Parents
Anonymous
Chamber of
Commerce
Businesses
with state-wide
coverage
Non-profits
Technical
college(s)
Universities
Coalitions/grass
root
organizations
Public
broadcasting
Regional TV
station
Regional
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EfC Institutional Awareness & Commitment Test Survey

newspaper
Other (please
specify
organization in
box below)
Other 2
Other 3

Please specify other organizations you collaborate with.

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