Form 1 CQI Workship Follor Up Survey

OMB Control No.: xxxx-xxxx

Expiration Date: xx/xx/20xx

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Cross-Center Evaluation of the Capacity Building Collaborative

CIP Sub-Study

CQI Workshop Follow-Up Survey

(Will be entered into Survey Gizmo)

Background: James Bell Associates, a program evaluation firm contracted by the Children’s Bureau to do an independent evaluation of the Capacity Building Collaborative, is conducting a sub-study of capacity building services delivered by the Center for Courts during and following CQI Workshops as part of the Cross-Center Evaluation of the Capacity Building Collaborative.

Instructions: You are being asked to complete this survey because your CIP team participated in a CQI Workshop on [insert workshop topic] on [insert workshop date]. This survey asks questions about your CIP teams’ implementation of the CQI process and achievement of the action steps your CIP team set during the CQI Workshop.

There are 2 sections in this survey.

• Section 1: Progress Towards Goals: This section asks about the extent to which your CIP has achieved the goals you set during the workshop.

• Section 2: The Implementation Process: This section asks about where you feel your CIP team is in the CQI process.

You will be asked to complete this survey twice: 6 months after the workshop and again 12 month after the workshop. The survey should take approximately X minutes to complete. Your responses are very important to us because they will help to improve our delivery of capacity building services.

Please complete the survey by [enter due date]. Questions may be directed to Anne Fromknecht at fromknecht@jbassoc.com or 703-247-2631.

CQI Workshop Follow-Up Survey

What is the name of your State/Territory/Tribe? ________________________________________________

What is your name? _____________________________________

What is your email address? _______________________________

What is your title? ________________________________________

SECTION ONE: PROGRESS TOWARDS GOALS

After the CQI Workshop, your CIP Team set the following action steps. Please answer the following questions about the progress your CIP team has made since attending the CQI Workshop.

[Insert list of CQI Action Steps pulled from CapTRACK fields on Work Plan Topic Form]

CQI Project Topic: [Text pulled from CapTRACK]

Action Step 1: [Text pulled from CapTRACK] Due Date of Action Step 1: [Date field]

Action Step 2: [Text pulled from CapTRACK] Due Date of Action Step 2: [Date field]

Action Step 3: [Text pulled from CapTRACK] Due Date of Action Step 3: [Date field]

Action Step 4: [Text pulled from CapTRACK] Due Date of Action Step 4: [Date field]…

Action Steps	Yes	No	If the Action Step was not completed by the due date, please explain why not.
Did your CIP Team complete/achieve [insert text of Action Step 1]?	☐	☐
Did your CIP Team complete/achieve [insert text of Action Step 2]?	☐	☐
Did your CIP Team complete/achieve [insert text of Action Step 3]?	☐	☐
Did your CIP Team complete/achieve [insert text of Action Step 4]?	☐	☐
[Insert additional rows for additional Action Steps as needed]

SECTION TWO: THE IMPLEMENTATION PROCESS

Prior to the Workshop, your team identified that your CQI project was in the: [insert step and sub-step in change process indicated on Liaison Handout].

You also indicated that you thought your project would progress through: [list step and sub-step indicated on the work plan] by this time.

1. Do you feel your CQI project is currently in this step/sub-step? ☐ Yes ☐ No

[Skip Pattern: If Yes is selected, survey will move to question 5. If No is selected, survey will move to question 2.]

2. If not, why not?

3. If not, where do you feel your CIP team is now in your efforts to implement your CQI project?

☐ Step 1: Identify a need to be addressed. For example, improving youth participation in court.

☐ Step 2: Form teams to guide the change process. For example, if you want to address youth participation in hearings, youth or parent's attorneys may need to be on the team as they can contribute valuable insight into current practice and needs.

☐ Step 3: Gather data, explore the problem in depth, and identify who is most affected. For example, if you are trying to learn more about quality representation to see how clients perceive their attorney, you might be holding focus groups with parents or youth, or talking to other stakeholders about whether they see this as an issue. You may also be examining your case management system to see what timeliness and permanency outcomes could be impacted by quality representation.

☐ Step 4: Develop a theory of change about the causes of the need and how to address them. For example, your theory of change may be that training youth attorneys on the importance of engaging the youth in the process will lead to more youth participation in the hearings and better well-being outcomes for youth.

☐ Step 5: Identify, research, and select best possible solutions that will address the need and reflect the theory of change. For example, researching what others have done to select an intervention that should lead to the desired change.

☐ Step 6: Adapt existing interventions or design new ones. In this phase you would be determining how the program/practice could be integrated into practice in your state or a specific jurisdiction or creating a new program/practice that you would like to pilot.

☐ Step 7: Assess readiness and plan for implementation of the intervention(s).

☐ Step 8: Build capacity to support implementation. For example, in this step, you might be determining what resources are available to ensure the program is implemented fully and monitored.

☐ Step 9: Pilot and/or stage implementation of the interventions(s). In this step, you begin making a change to practice or starting a new program.

☐ Step 10: Collect and use data to adjust the intervention and/or implementation strategies. In this phase you are assessing fidelity of the program, and using data to determine if tweaks or small changes need to be made.

☐ Step 11: Evaluate to measure implementation quality and short- and long-term outcomes. This data collection phase assesses the short and long-term outcomes of interest, as expressed in your theory of change. For example, if you think that improving children's attorney practice will result in more youth in court, and potentially better well-being outcomes for youth, you would be measuring those things.

☐ Step 12: Make decisions to further spread, adjust, or discontinue the intervention.

[Once a step is selected, the corresponding sub-steps will appear and the following question will be asked.]

4. Please select which sub-step you feel your CQI project is currently in.

Step	Sub-Step
1	Identify a need (via assessment data/work plan or an inquiry) Clarify the needs and desired outcomes Assess whether the need is at the system, policy, or practice level Assess the external and internal environments associated with this need
2	Identify team purpose Identify prospective team members Charter or empanel team Develop Communication Plan Work together to guide process and perform the task
3	Identify data sources to help further clarify the need Gather additional information Conduct additional research Draft a general opinion about root cause of problem
4	Consider and develop a list of possible causes and engage with multiple sources to verify the theory of causes Categorize, prioritize, and select root causes Verify and vet root causes with team Develop theory of change Develop a logic model to identify program components and summarize theory of change
5	Brainstorm different approaches to addressing the need Collaborate with partners and use Capacity Building Collaborative Resources Research existing intervention and solutions Determine which solution will have the greatest impact and is feasible to implement given circumstances and constraints Obtain agreement on proposed and feasible solutions
6	Gather stakeholder input Investigate evidence-based programs Identify and engage constituency groups Identify components of existing interventions and determined if the intervention can be adapted to address this need Draft proposal for intervention Revisit team composition Plan and develop intervention
7	Gather information on the readiness of the agency, program or other community partner that will implement the intervention Identify the implementation team Design or Adapt Implementation Plan Identify measures of success and a data collection plan Develop implementation plan
8	Build capacity as needed Evaluate the degree to which capacity has advanced
9	Determine timing of intervention Identify sites for intervention Pilot intervention Review progress with stakeholders
10	Complete usability testing/collect initial data as planned (See Step 7) Analyze initial data Identify modifications to intervention or solution based on initial data Adjust intervention as necessary Continue to track progress and adjust as necessary Review progress with stakeholders
11	Review data and assess progress of short and long-term outcomes Make adjustments to the intervention as necessary to achieve short and long term outcomes Review progress with stakeholders
12	Determine sustainability and value of intervention Meet with stakeholders and partners to make determination whether to further spread, adjust or discontinue the intervention If decided to move forward, assess and adjust Implementation plan Assess Supports and Implementation Activities to Prepare Next Sites Sustain Improvement

5. Please explain why you think you are in the step and sub-step you have identified.

5

CQI Workshop Follow-Up Survey | April 2016 | JBASSOC.COM

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