Form 1 Center for States Brief Tailored Services Survey

OMB Control No.: xxxx-xxxx

Expiration Date: xx/xx/20xx

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

Brief Tailored Services Survey

Instructions for On-line Survey Development

For each Brief Tailored Service provided by the Center for States, a survey will be created in on-line survey software to gather feedback that can inform project planning. Given the changing nature and context of each Brief Tailored Service, it is important to be able to get feedback from recipients without creating undue burden by answering excessive questions that only marginally apply. To address this, the survey will be tailored to the unique information needs of each Brief Tailored Service to ensure low burden while informing high quality service provision. When creating each on-line survey, content specialists will use the required questions listed below and choose up to 25 context specific optional questions that can be added to the survey, as needed. This will allow for unique information needs to be met.

These items will be administered upon completion of the brief tailored service.

It is expected that each tailored survey will have no more than 45 questions, including 20 required questions and a maximum of 25 optional questions, with a burden of no more than 20 minutes.

Required Questions (22 required)

Please answer the following questions about your experiences with your tailored service.	Strongly Disagree	2	3	Neither	5	6	Strongly Agree	N/A
As a group, the representatives from the Center for States had the right level of subject-matter knowledge and expertise.	SD	2	3	N	5	6	SA	N/A
As a group, the representatives from the Center for States had the skills to effectively guide the tailored service.	SD	2	3	N	5	6	SA	N/A
As a group, the representatives from the Center for States facilitated a collaborative process for implementing our plan.	SD	2	3	N	5	6	SA	N/A
As a group, the representatives from the Center for States were a good match for helping us build our program capacity.	SD	2	3	N	5	6	SA	N/A
As a group, the representatives from the Center for States had a good understanding of our agency/community needs.	SD	2	3	N	5	6	SA	N/A
As a group, the representatives from the Center for States communicated with us in a way that felt relevant to the values and context of our agency/tribe.	SD	2	3	N	5	6	SA	N/A
Our ideas and desires about the tailored service process were respected by Center for States representatives.	SD	2	3	N	5	6	SA	N/A
The Center for States provided effective support for our agency/tribe throughout the service delivery process.	SD	2	3	N	5	6	SA	N/A
The materials and information we received were appropriate for our agency/tribe’s level of experience and knowledge.	SD	2	3	N	5	6	SA	N/A
Our agency/tribe’s knowledge and/or skills about the topic(s) addressed by the tailored service have increased.	SD	2	3	N	5	6	SA	N/A
The knowledge and skills our agency/tribe acquired through this tailored service are directly applicable to our work.	SD	2	3	N	5	6	SA	N/A
The Center for States helped us to identify and set milestones and measurable outcomes to track progress and success.	SD	2	3	N	5	6	SA	N/A
The Center for States helped us to use data to make adjustments to the intervention and/or implementation process as needed.	SD	2	3	N	5	6	SA	N/A
My agency/tribe is considering using a similar change process/implementation framework to support other initiatives.	SD	2	3	N	5	6	SA	N/A
I would recommend working with the Center for States to other jurisdictions.	SD	2	3	N	5	6	SA	N/A N/A
I will share what I learned during my experience with the Center for States with others.	SD	2	3	N	5	6	SA	N/A
The services provided met the needs of our agency/tribe.	SD	2	3	N	5	6	SA	N/A
Overall, I was satisfied with the services I received.	SD	2	3	N	5	6	SA	N/A

SKIP PATTERN: If Somewhat Agree, Agree, or Strongly Agree are selected for item #16 above ask:

If so, how and with what groups of colleagues will you share what you learned? Please provide the number of people that you are planning to share with/have shared with?

SKIP PATTERN: If Neither Agree nor Disagree, Somewhat Disagree, Disagree, or Strongly Disagree are selected for item above ask:

If not, why not?

19. What aspects of the tailored service were most useful for your work?

20. Could your experience with the Center for States have been improved? (Yes/No)

If yes, please describe how your experience with the Center for States could have been improved.

21. Which of the following best describes your position? (Check one)

• Administrative Leadership

• Training Department/Division

• Data Managers & IT Staff

• Program Manager

Please specify: (e.g., Child Protection, Adoption, Foster Care, etc.)

• ICWA Manager

• Supervisor

• Case Worker/ Direct Practice

• Intern/Volunteer

• Court/Legal Professional

22. Please select the various ways you [insert have already applied the information, plan to apply the information] provided to you through tailored service in your work. (Check all that apply)

• Support program improvement

• Support policy development

• Provide information to clients/families

• Share with peers

• Support public awareness/advocacy

• Grant writing/Fundraising

• Train staff/colleagues

• Conduct research & evaluation

• My own professional development (e.g., increased knowledge)

• I have not yet applied this to my work

• Other (Please describe):__________

Please provide a specific example: ___________________________

Optional Questions (choose up to 25 including the post-survey required questions)

Rating Questions (7pt likert scale)

• The time allotted was appropriate for meeting our tailored service work plan goals.

• As a result of the tailored service [Work plan goal 1] was achieved. (Insert/delete as many goals as necessary)

• The tailored service has increased my knowledge about [Topic 1 addressed by the tailored service]. (Insert/delete as many topics as necessary)

• The tailored service has increased my practical skills regarding [Topic 1 addressed by the tailored service]. (Insert/delete as many topics as necessary)

• I feel confident in my ability to [Insert the name of the skill/topic] as a result of my participation in the tailored service.

• As a result of the [information I learned, knowledge I gained] through the tailored service, I will be a more effective in my work.

• The information provided through the tailored service helped me to understand the [Topic 1 addressed by the tailored service]. (Insert/delete as many topics as necessary).

• The information provided during the tailored service helped me to understand the five dimensions of capacity.

• The information provided during the tailored service helped me to understand organizational capacity and readiness.

• The information provided during the tailored service helped me to understand the change management process.

• The Center for States has provided the right amount of contact and support during the tailored service.

• Key stakeholders were included in the tailored service.

• The Center for States’s services have increased my knowledge about the change management process.

• My agency is (better) prepared to [Insert step(s) in change process] in the future.

• My agency has gained capacity in [Insert target sub-dimensions].

• The Center for States has provided services in a way that helped us build our own capacity to do this in the future on our own.

• I expect my agency’s child welfare practice to be positively affected by our work on this tailored service.

• As a result of my involvement in the tailored service, I have improved my connections with peers/colleagues.

• The tailored service has positively impacted my attitudes concerning the [Topic 1 addressed by the tailored service]. (Insert/delete as many topics as necessary).

• The information provided during the tailored service was timely & current.

• The format of the tailored service made it easy to participate.

• I feel prepared to do this work as a result of my participation in tailored service.

• I feel that our agency had the ownership of the process during the tailored service.

• The Center for States was a true partner during the tailored service and trust was developed.

• The tailored service has increased my agency’s capacity to engage in evaluation.

• The tailored service has increased my agency’s capacity to collect data that can inform our decisions.

• The tailored service has increased my agency’s capacity to develop theory of change for our initiatives.

• The tailored service has helped us with understanding how to measure achievement of goals.

Open-ended questions:

• Was [Title of Activity 1] helpful? If so, why, and if not, how can they be improved? (Pick one or two appropriate tailored service activities)

• Please tell us how the work that you have done through tailored service impacted your agency.

• Provide a specific example of how the tailored service has improved your relationship with peers or benefitted your work.

• What additional assistance do you or your organization need with this topic?

• What additional information or resources can you recommend on this topic?

• Do you have any additional comments?

Response choice questions:

I have discovered new tools, ideas, & ways of thinking from the relationships developed during the tailored service? (Yes/No). Please explain.

As a result of my participation/involvement in the tailored service, I developed new relationships with …

• [Insert options that are relevant to the target audience]

If this tailored service was not available I would be able to get this service from somewhere else. (Yes/No) If so, please specify where.

I am involved in the following aspect of the Center for States capacity building services:

• Select all that apply:

• State team working with liaison

• Participating in constituency group

• Registered for one of the Center for State’s Learning Experiences (such as the CQI Training Academy, etc.)

How many years of service do you have in your current profession? (Check one)

• Less than 1 year

• 1–5 years of service

• 6–10 years of service

• 11–15 years of service

• 16+ years of service