OMB Control No.: 0970-0484
Expiration Date: XX/XX/XXXX
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.
Constituency Group survey
Instructions for On-line Survey Development
For each Constituency Group run 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 constituency group, 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 group 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 20 context specific optional questions that can be added to the survey, as needed. This will allow for unique information needs to be met.
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 (20 required)
|
Strongly Disagree |
2 |
3 |
Neither |
5 |
6 |
Strongly Agree |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
What aspects of the [Name of Peer Networking Experience, Event, Webinar] were most useful for your work?
As a result of this [Name of Group/Peer Networking Activity, Name of Learning Experience], how often do you anticipate engaging with other attendees outside of official activities?
Never
Once
Every Few Months
Monthly
A Few Times a Month
Weekly
Two to Three Times a Week
Provide a specific example of how the [Name of Learning Experience, Name of Peer Networking Activity, Event] has improved your relationship with peers or benefitted your work.
As a result of my participation/involvement in the [Name of Peer Networking Activity, Event or Webinar], I developed new relationships with …
[Insert options that are relevant to the target audience]
I have discovered new tools, ideas, & ways of thinking from the relationships developed during the [Name of Learning Experience, Name of Peer Networking Activity]?
Never
Once
Every Few Months
Monthly
A Few Times a Month
Weekly
Two to Three Times a Week
Were there ways in which the [Name of Peer Networking Activity, Event, or Webinar] could have been more useful to you? (Yes/No)
If yes, please describe how this [Name of Peer Networking Activity, Event, or Webinar] could have been more useful?
Please indicate which of the following resources you have utilized
[Skip logic will add questions below to ask about the related publications/ learning experiences/events.]
In which State/Territory do you work?___________
Please select the various ways you [insert have already applied the information, plan to apply the information] from the [Name of Peer Networking Activity, Event, or Webinar] in your work. (Check all that apply)
Increase my knowledge
Inform my attitudes
Support program improvement
Support policy development
Provide information to clients/families
Provide information to my peers
Support public awareness/advocacy efforts
Grant writing/Fundraising
Train staff/colleagues
Conduct research & evaluation
Create new programs
Create new tool
My own professional development
I have not yet applied this to my work
I will not be able to apply the information to my work
Other (Please describe):__________
Please provide a specific example: ___________________________
Optional Questions (choose up to 24)
Publication (3 questions per publication, up to 2 publications)
My opinion was valued in reviewing [Name of Publication]
I appreciated the chance to help the Center for States create [Name of Publication]
The information provided in the [Name of Product] helped me to understand [topic].
I will share what I learned [on the Capacity Building Center for States webpage, from [Name of Product], during [Name of Learning Experience/Module] with others.
SKIP
PATTERN: If Somewhat Agree, Agree, or Strongly Agree are selected
for item 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?
Learning Experience (6 questions per L.E., up to 1 publications)
The [Name of Learning Experience] has increased my knowledge about [Topic 1]. (Insert/delete as many topics as necessary)
The [Name of Learning Experience] has increased my practical skills regarding [Topic 1]. (Insert/delete as many topics as necessary)
As a result of the [information I learned, knowledge I gained] through the [Name of Learning Experience], I have been more effective in my work.
I will share what I learned [on the Capacity Building Center for States webpage, from [Name of Product], during [Name of Learning Experience/Module] with others.
SKIP
PATTERN: If Somewhat Agree, Agree, or Strongly Agree are selected
for item 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? Please
select the various ways you [insert
have already applied the information, plan to apply the
information]
from the [Name of Peer Networking Activity, Event, or Webinar] in
your work. (Check all that apply)
Increase my knowledge
Inform my attitudes
Support program improvement
Support policy development
Provide information to clients/families
Provide information to my peers
Support public awareness/advocacy efforts
Grant writing/Fundraising
Train staff/colleagues
Conduct research & evaluation
Create new programs
Create new tool
My own professional development
I have not yet applied this to my work
I will not be able to apply the information to my work
Other (Please describe):__________
Please provide a specific example: ___________________________
I feel confident in my ability to [Insert the name of the skill/topic] as a result of my participation in []
I feel prepared to do this work as a result of my participation in [Name of Learning Experience, Name of Peer Networking Activity].
What additional training would be useful for you or your organization?
Webinar/Event (6 questions per webinar/event, up to 3 webinar/event)
The [Name of Webinar] has increased my knowledge about [Topic 1]. (Insert/delete as many topics as necessary)
The [Name of Webinar] has increased my practical skills regarding [Topic 1]. (Insert/delete as many topics as necessary)
The [Name of Webinar] has motivated me to continue learning in this topic area.
As a result of the [information I learned, knowledge I gained] through the [Name of Webinar], I will be a more effective in my work.
Please select the various ways you [insert have already applied the information, plan to apply the information] from the [Name of Peer Networking Activity, Event, or Webinar] in your work. (Check all that apply)
Increase my knowledge
Inform my attitudes
Support program improvement
Support policy development
Provide information to clients/families
Provide information to my peers
Support public awareness/advocacy efforts
Grant writing/Fundraising
Train staff/colleagues
Conduct research & evaluation
Create new programs
Create new tool
My own professional development
I have not yet applied this to my work
I will not be able to apply the information to my work
Other (Please describe):__________
Please provide a specific example: ___________________________
What additional training would be useful for you or your organization?
I will share what I learned [on the Capacity Building Center for States webpage, from [Name of Product], during [Name of Learning Experience/Module] with others.
SKIP
PATTERN: If Somewhat Agree, Agree, or Strongly Agree are selected
for item 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?
Constituency Groups (7pt likert scale)
The technology (I.E. list serve, CapSHARE, Web platforms) enhanced the [Name of Peer Networking Group].
The time allotted was appropriate for meeting the [Name of Peer Networking Group] goals.
I liked the format of this [Name of Peer Networking Group].
Trainer/Presenter/Consultant
1 (insert/delete as many trainers/presenters/consultants as
necessary):
The knowledge and expertise of this
trainer/presenter/consultant were appropriate for this [Name of
Peer Networking Group].
Trainer/Presenter/Consultant
1 (insert/delete as many trainers/presenters/consultants as
necessary):
The trainer/presenter/consultant tailored and
delivered the content of the [Name of Peer Networking Group]
effectively.
The trainer/facilitator helped me to see how the [Name of Peer Networking Group] can be applied to my work.
The trainer/facilitator provided sufficient opportunities to practice new information/skills.
The [Name of Peer Networking Group] has motivated me to continue learning in this topic area.
As a result of the [information I learned, knowledge I gained] through the [Name of Peer Networking Group], I will be a more effective in my work.
I feel prepared to do this work as a result of my participation in [Name of Peer Networking Group].
The leadership in our organization is interested in hearing my ideas about how we can improve agency results.
I have a way of sharing my ideas to improve practices, policies or results for children and families.
We are encouraged to work with staff in other departments to solve problems.
I have opportunities to learn new things that will help me improve my work.
I feel empowered to try different strategies that might improve outcomes for children and families.
We work as a team in my office to understand and improve outcomes for children and families.
We share learning across the state and between regions.
I feel confident in my ability to [Insert the name of the skill/topic] as a result of my participation in [Name of Peer Networking Group]
My agency will support me in applying the knowledge and skills I learned in [Name of Peer Networking Group] to my work.
Open-ended questions:
What did you primarily use CapSHARE for?
What suggestions do you have for making CapSHARE more useful?
Was [Title of Activity 1] helpful? If so, why, and if not, how can they be improved?
Pick one or two appropriate training activities
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:
How often do I anticipate (or am I) applying what was learned?
Daily
Weekly
Monthly
Quarterly
Annually
Never
As a result of this/Prior to this [Name of Peer Networking Group] over the past 6 months I have engaged with other attendees outside of official activities
Never
Once
Every Few Months
Monthly
A Few Times a Month
Weekly
Two to Three Times a Week
Which of the following best describes your professional background or role? (Check all that apply)
Prevention/Family Support
Child Protective Services
Juvenile Justice
Adoption
Youth Services
Birth Parent (First Parent)
Foster Care/Foster Parenting
Kinship caregiver
Health/Mental Health
Legal/Courts (e.g., GAL, CASA, attorney)
Public Information Officer
Youth
Researcher/Evaluator/Consultant
Media
Other (Please describe)
Which of the following best describes your workplace? (Check one)
State public agency
Local or county public agency/organization
Federal agency
Non-profit (e.g. community-based organization, faith-based organization, advocacy)
Legislature
Tribal agency/organization
Training and technical assistance provider
Capacity Building Center for States
Capacity Building Center for Tribes
Capacity Building Center for Courts
Other (Please describe)
Which of the following best describes your position? (Check one)
Administrative Leadership (directors/deputies)
Training Department
Supervisors
Case Workers/Direct Practice Workers
Data Mangers & IT staff
Court/Attorney Data Managers & IT Staff
Foster Care Managers
Adoption Mangers
Intern/Volunteer
Other (Please describe)
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
How did you learn about the [Name of Peer Networking Group]? (Check all that apply)
Capacity Building Collaborative webpage
Center’s Liaison
Listserv
Colleague who is familiar with Center’s resources
Hard-copy publication
Advertisement (please specify)
Search engine (e.g., Google, Yahoo)
Social media (e.g., Facebook, Twitter, YouTube)
Conference or presentation (please specify)
Link from another webpage (please specify)
Other (please specify):__________
How often do you <visit the Capacity Building Center for States webpage/ use Information & Referral Services>? (Check one)
I am a first time visitor
Rarely (Every few months or less often)
About once a month
Every week
Every few days
Once a day or more
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’s learning
Experiences (such as the CQI Training Academy, etc.)
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | CBC States Notes Template |
Author | Emily Manbeck |
File Modified | 0000-00-00 |
File Created | 2021-01-15 |