Form VA Partner Survey VA Partner Survey VA Partner Survey

OMB No.: xxxx-xxxx
Expiration Date: xx/xx/xxxx

Partner Survey
Regional Partnership Grants National
Cross-Site Evaluation
November 5, 2013

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INTRODUCTION

The Regional Partnership Grants (RPG) program supports interagency collaborations and program integration
designed to increase the well-being, improve the permanency, and enhance the safety of children who are in,
or at risk of, out-of-home placements as a result of a parent or caretaker’s substance abuse. The Children’s
Bureau within the U.S. Department of Health and Human Services, Administration for Children and Families
(ACF) has contracted with Mathematica Policy Research to complete the national cross-site evaluation of the
program. The evaluation will describe the interventions that were implemented, the nature of the partnerships,
the types of services provided, and their impacts.
You are being asked to complete this survey because you were identified as a representative of a partner
organization working with the RPG grantee, [RPG GRANTEE]. Representatives from partner organizations are
asked to complete this survey to provide information about their own organizations, relationships with the
grantee and other collaborating organizations, and program implementation. The length of this survey is
different for different people, but on average it should take about 20 minutes.
Your participation in this survey is important and will help us understand more about the partnerships
implementing RPG-funded programs. Please provide responses for your organization, [ORGANIZATION]. If
you represent a specific branch or program within your organization that is engaged with the RPG
partnership, rather than the organization as a whole, please provide information about that branch or program
rather than the organization as a whole. If you are unsure of how to answer a question, please give the best
answer you can rather than leaving it blank.
Your responses will be kept private and used only for research purposes. They will be combined with the
responses of other staff and reported in the aggregate; and no individual names will be reported. Participation
in the survey is completely voluntary and you may choose to skip any question.
If you have any questions about the survey, please contact the team at Mathematica by emailing
xxxxxxx@mathematica-mpr.com or calling xxx-xxx-xxxx (toll-free).
Please read and answer the statement below and then click the “Next” button in the lower right-hand corner to
begin the survey.
i1.

I have read the introduction and understand that the information I provide will be kept private and used
only for research purposes. My responses will be combined with the responses of other staff and no
individual names will be reported.
1

0

□

I agree with the above statement and will complete the survey

□

I do not agree with the above statement and will not complete the survey

Prepared by Mathematica Policy Research

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GO TO END

A. YOUR ORGANIZATION

The first questions are about your organization, [ORGANIZATION].

1.

2.

Which of the following best describes your
organization?

MARK ALL THAT APPLY

MARK ONE ONLY
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

□

Child welfare services provider

□

Substance abuse treatment provider

□

Mental health services provider

□

□
2 □
3 □
4 □
5 □
6 □
7 □
8 □
9 □
10 □
11 □
12 □
13 □
14 □
1

School district, school, or early childhood
education or services provider

□

Housing/homeless services provider

□

Medical or dental services provider

□

University

□

Court/judicial agency

□

Corrections or law enforcement agency

□

Home visiting services provider

□

Department in state or tribal government

□

Department in local government

□

Foundation

□

Research/evaluation organization

□

Other (Describe)

What are the main activities your organization
conducts in general?

3.

Regulation and oversight
Child welfare services
Substance abuse treatment
Family therapy
Medical or dental services
Education or early childhood intervention
Legal processes
Law enforcement
Home visiting
Funding
Evaluation
Program planning and policy development
Advocacy
Other (Describe)

Does your organization currently provide
program or other services or plan to serve
RPG program clients?
MARK ONE ONLY

□
2 □
3 □
1

4.

Currently provides services to RPG clients
Plans to provide services to RPG clients
No

GO TO Q.6

Approximately how many RPG program clients
does your organization currently serve or plan
to serve each year?
Your best estimate is fine.
|

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| CLIENTS

5.

MARK ALL THAT APPLY

Which of the following programs does your
organization provide or plan to provide to RPG
program clients?

□
31 □
32 □
33 □
34 □
35 □
36 □
37 □
38 □
39 □
40 □
41 □
42 □
43 □
44 □
30

MARK ALL THAT APPLY

□
2 □
1

3

□

□
5 □
6 □
7 □
8 □
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11 □
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13 □
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15 □
16 □
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18 □
4

□
20 □
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22 □
23 □
24 □
25 □
26 □
27 □
28 □
29 □
19

24/7 Dad
Alternatives for Families-Cognitive
Behavioral
Attachment, Self-Regulation, and
Competence (ARC)
Celebrating Families!
Centering Pregnancy
Child-Parent Psychotherapy (CPP)
Cognitive Behavior Therapy (CBT)
Dialectical Behavior Therapy (DBT)
Family Behavior Therapy (FBT)
Family Group Conferencing
Family Treatment Drug Court (FTDC)
Guiding Good Choices (GGC)

□
46 □
47 □
48 □
49 □
50 □
45

Hazelden Co-Occurring Disorders Program
Hazelden Living Balance Programs
Helping Men Recover
Head Start
Healthy Families
Homebuilders Intensive Family Preservation
Services

51

Incredible Years Parenting Class
Kelly Bear

52

Keys for Interactive Parenting (KIPS)

□
□

□
54 □

Lifespan Integration

53

Matrix Model Program

My Baby and Me (Ages 0-3)
Nurse-Family Partnership (NFP)
Nurturing Parenting Programs
Parent and Child Interactive Therapy
Parent Child Assistance Program (PCAP)
Parents and Children Together (PACT)
Parents as Teachers Curriculum
Partners in Parenting
Prolonged Exposure
Recovery Coach
Relapse Prevention Therapy (RPT)
Resource Mothers
SafeCare
Sanctuary Model
Screening, Brief Intervention, and Referral
to Treatment (SBIRT)
Seeking Safety
Solution Focused Brief Therapy (SFBT)
Staying Connected with Your Teen
Strengthening Families
Strong Kids
Structured Psychotherapy for Adolescents
Responding to Chronic Stress (SPARCS)
Supportive Education for Children of
Addicted Parents
Trauma Focused Cognitive Behavioral
Therapy (TF-CBT)
Untangling Relationships
Other (Describe)

MindUP
Modified Therapeutic Community (MTC)

55

Moral Reconation Therapy
Motivational Enhancement Therapy
Motivational Interviewing
Multisystemic Family Therapy (MST)

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□

None of these

6.

Approximately how much funding from the Regional Partnership Grants program did your organization
receive this fiscal year, if any? If your organization did not receive RPG funding this fiscal year, please
answer $0.00.
$|

□

d

7.

|

|

|,|

|

|

|.00 AMOUNT OF FUNDING RECEIVED FROM RPG PROGRAM

Don’t know

Which of the following in-kind resources is your organization is contributing to the RPG program this
fiscal year?
MARK ALL THAT APPLY

□
2 □
3 □
4 □
5 □
6 □
7 □
1

8

□

Staff time
Office space
Volunteers
Office supplies
RPG program materials
Computer/Internet, telephone, or fax service
Other (Describe)

None of these

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B. PERSPECTIVES ON GOALS AND RELATIONSHIPS IN THE PARTNERSHIP

Partner Goals
8.

In your own words, what are the main goals of the RPG partnership?

Relationships/Communication Systems
9.

Do you currently serve on a steering, implementation, governance, or some other committee for the
RPG grant?

□
0 □
1

10.

Yes
No

Other than formal RPG partnership meetings, how frequently does your organization communicate
about RPG with the organizations listed below?
First, please indicate if you were previously working with a member of the RPG partnership prior to the
beginning the RPG grant in 2012. Next, please indicate if you do not communicate at all, if you
communicate infrequently (a few times each month), or if you communicate regularly (every day or
nearly every day) with that partner. Please choose the answer that best represents the frequency of
communication. Please ignore the row that contains your organization.
Were you
previously
working with this
partner prior to
receiving the
RPG grant
funds?
Organization

(MARK IF YES)

Yes
[ROSTER OF ORGANIZATIONS]
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________

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1

1

1

1

1

1

□
□
□
□
□
□
□

We do not
communicate at all
outside of RPG
partnership
meetings

We communicate
infrequently (a few
times each month)
outside of RPG
partnership
meetings

We communicate
regularly (every day
or nearly every day)
outside of RPG
partnership
meetings

No
0

0

0

0

0

0

0

□

1

□

1

□

1

□

1

□

1

□

1

□

1

4

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2

2

2

2

2

2

2

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3

3

3

3

3

3

3

□
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11.

To what extent do you disagree or agree with each of the following statements about the current status
of the collaboration among RPG partner organizations?

Strongly
Disagree
a. Our collaborative effort was started because we wanted to do
something about an important problem ....................................

1

b. Our RPG program’s top priority was having a concrete impact
on the real problem ...................................................................

1

c.

The organizations involved in our RPG program included
those organizations affected by the issue .................................

□
□

d. Participation was not dominated by any one group or sector ...

□
1 □

e. Our partner organizations have access to credible information
that supports problem solving and decision making .................

1

f.

1

RPG partner organizations agree on what decisions will be
made by the group ...................................................................

1

g. Partner organizations agree to work together on this issue......

1

h. Organizations involved in our RPG program have set ground
rules and norms about how we will work ..................................

1

i.

We have a method for communicating the activities and
decisions of the group to all partner organizations ...................

□
□
□
□

j.

There are clearly defined roles for RPG partner organizations

□
1 □

k.

Partner organizations are more interested in getting a good
decision for the RPG program than improving the position of
their own organization ...............................................................

1

Staff who participate in RPG program meetings are effective
liaisons between their home organizations and the group .......

1

m. Partner organizations trust each other sufficiently to honestly
and accurately share information, perceptions, and feedback .

1

n. Partner organizations are willing to let go of an idea for one
that appears to have more merit ...............................................

1

o. Partner organizations are willing to devote whatever effort is
necessary to achieve the goals .................................................

1

p. Divergent opinions are expressed and listened to ....................

1

q. The openness and credibility of the process helps partner
organizations set aside doubts and skepticism ........................

1

l.

r.

1

Our group sets aside vested interests to achieve our common
goal ...........................................................................................

1

s.

Our group has an effective decision making process ...............

1

t.

Our group is effective in obtaining the resources it needs to
accomplish its objectives ..........................................................

1

u. The time and effort of the collaboration is directed at
achieving our goals rather than keeping the collaboration in
business ....................................................................................

1

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□
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Disagree
2

2

□
□

□
2 □
2

2

2

2

2

□
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2 □
2

2

2

2

2

2

2

2

2

2

2

2

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□
□
□
□
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□

Agree
3

3

□
□

□
3 □
3

3

3

3

3

□
□
□
□

□
3 □
3

3

3

3

3

3

3

3

3

3

3

3

□
□
□
□
□
□
□
□
□
□
□

Strongly
Agree
4

4

□
□

□
4 □
4

4

4

4

4

□
□
□
□

□
4 □
4

4

4

4

4

4

4

4

4

4

4

4

□
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12.

Using the two columns below, please indicate the organizational levels at which collaboration most
often occurs among all of the organizations in the partnership to fill in the following statement:
Generally speaking, collaboration among organizations in the partnership typically occurs at the
following levels: (column A) to (column B).
MARK ONE ONLY IN COLUMN A

□
2 □
1

13.

MARK ONE ONLY IN COLUMN B

□
2 □

Administrators/organization leaders

1

Front-line staff/mid-level supervisors

a. We developed strategies to recruit community
participation .....................................................

1

b. Community members are included in program
planning and development ..............................

1

We developed formal mechanisms to solicit
support and input from community members
and consumers................................................

1

d. Front-line staff have up-to-date resource
directories for family support centers and
resources ........................................................

1

e. Community-wide accountability systems are
used to monitor substance abuse and child
welfare issues .................................................

1

f.

Front-line staff/mid-level supervisors

Indicate the degree to which you disagree or agree with each of the following statements about RPG
programming:

Strongly
Disagree

c.

Administrators/organization leaders

Consumers, patients in recovery, and
program graduates have active roles in
planning, developing, implementing, and
monitoring services .........................................

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1

□
□
□
□
□

□

6

Disagree

2

2

2

2

2

2

□
□
□
□
□

□

Agree

3

3

3

3

3

3

□
□
□
□
□

□

Strongly
Agree

4

4

4

4

4

4

□
□
□
□
□

□

Does not
apply/
Don’t know

d

d

d

d

d

d

□
□
□
□
□

□

C. PARTNERSHIP OUTPUTS

14.

Indicate the degree to which you disagree or agree with each of the following statements about clients
receiving RPG programming:

Strongly
Disagree
a. Services provided to families are coordinated
across multiple partners .......................................

1

b. Case management is coordinated across both
substance abuse treatment providers and child
welfare agencies ..................................................

1

c.

Families receiving joint case management
receive regular cross-agency assessments .........

1

d. Staff from both substance abuse treatment
providers and child welfare agencies participate
in joint case management activities such as
family team conferences, case plan reviews, or
intake or permanency staffings ............................

1

e. Judicial officers and attorneys are viewed as
partners in developing new approaches to serve
families with substance use disorders in the
child welfare system .............................................

1

f.

Substance abuse and child welfare agencies
and the courts have negotiated shared
principles or goal statements ...............................

1

g. Region/partnership developed responses to
conflicting time frames associated with child
welfare services, substance abuse treatment,
Temporary Assistance for Needy Families, and
child development ................................................

1

h. Substance abuse treatment and child protective
service case plans are coordinated .....................

1

i.

j.

k.

l.

Formal working agreements have been
developed on how courts, child welfare, and
treatment agencies will share client information ..

1

Data tracking child welfare and substance abuse
clients across systems is used to monitor
outcomes ..............................................................

1

Substance abuse agencies, child welfare
agencies, and court systems have developed
shared outcomes for families and agree on how
to use information on outcomes with families ......

1

Joint training programs for the three main
systems staff have been developed to help staff
and providers work together effectively ...............

1

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□
□
□

□
□
□

□
□
□
□
□
□

Disagree
2

2

2

2

2

2

2

2

2

2

2

2

□
□
□

□
□
□

□
□
□
□
□
□

Agree
3

3

3

3

3

3

3

3

3

3

3

3

□
□
□

□
□
□

□
□
□
□
□
□

Strongly
Agree
4

4

4

4

4

4

4

4

4

4

4

4

□
□
□

□
□
□

□
□
□
□
□
□

Does not
apply/
Don’t
know
d

d

d

d

d

d

d

d

d

d

d

d

□
□
□

□
□
□

□
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15.

Below is a list of organizations identified as part of your RPG partnership. Which RPG-related services
does your organization coordinate with or collaborate on with each organization? If you do not
coordinate or collaborate with the organization on any of the listed activities, leave the row blank.
Please ignore the row that contains your organization.

Organization

Screening
and/or
Assessment

[ROSTER OF
ORGANIZATIONS]

1

_____________________

1

_____________________

1

_____________________

1

_____________________

1

_____________________

1

_____________________

1

_____________________

1

_____________________

1

□
□
□
□
□
□
□
□
□

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Case
Management
or
Coordination

RPG
Program
Referrals
2

2

2

2

2

2

2

2

2

□

3

□

3

□

3

□

3

□

3

□

3

□

3

□

3

□

3

8

□
□
□
□
□
□
□
□
□

Substance
Abuse
Treatment
4

4

4

4

4

4

4

4

4

□
□
□
□
□
□
□
□
□

Mental
Health /
Trauma
Services
5

5

5

5

5

5

5

5

5

□
□
□
□
□
□
□
□
□

Other Social
or Family
Services
6

6

6

6

6

6

6

6

6

□
□
□
□
□
□
□
□
□

END OF SURVEY

16.

Thank you for your participation in this survey. If there is anything else that you would like to tell us
about your work on the RPG program or about the partnership as a whole, please share it here.

(End of survey for those who opt out in the first screen)
Thank you for considering participation in this survey. Please click the “Submit survey” button in the lower
right hand corner so that we have a record of your desire NOT to participate. This will result in your removal
from our contact list.
(End of survey for respondents)
Thank you for completing the Regional Partnership Grant Partner Survey!
Please click the “Submit survey” button in the lower right hand corner to submit your completed survey.

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