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pdfJanuary 2019
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
MULTI-SITE IMPLEMENTATION EVALUATION OF TRIBAL HOME VISITING (MUSE)
PROGRAM DIRECTOR SURVEY
This collection of information is voluntary. Public reporting burden for this collection of information is estimated
to average 45 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.
The OMB number and expiration date for this collection are OMB #: 0970-0521, Exp: 12/31/2021. Send
comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden to Kate Lyon, James Bell Associates; 3033 Wilson Blvd. Suite 650,
Arlington, VA 22201; MUSE.info@jbassoc.com.
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director
Survey
1
January 2019
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
MUSE Program Director Survey
Thank you for taking part in the Multi-Site Implementation Evaluation of Tribal Home Visiting (MUSE).
The purpose of this study is to learn about tribal home visiting program implementation and the
experiences of families receiving home visiting services.
We are asking you to complete this survey because your role includes oversight of one of the home
visiting programs participating in MUSE. Your answers will help us understand your role in the home
visiting program and your perspective on the program. Because program directors’ jobs are complex and
involve many different tasks, this survey is also complex and a bit lengthy.
Your participation in this survey is voluntary. If you choose to participate, it will take about 45 minutes
to complete this survey. If you are unsure how to answer a question, please give the best answer you
can instead of leaving it blank.
Your answers will be kept private. Only the MUSE study team will have access to this information. Your
answers will not be shared with anyone at your program or any other agencies. We will not report
information collected in this study in a way that could identify you or your program.
We would appreciate your response by MM/DD/YYYY. If you have questions about the survey or at any
time during the study, please call Tess Abrahamson at James Bell Associates at ### or email ____.
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director
Survey
2
January 2019
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
A. BACKGROUND AND WORK EXPERIENCE
1.
What was the highest level/degree you completed in school?
Some high school, no diploma
High school/GED
Some college/no degree
Technical training or certification
Associate’s degree (e.g. AA, AS, ADN)
Bachelor’s degree (e.g. BA, BS, BSN)
Master’s degree or higher (e.g. MA, MS, MSW, MSN, PhD)
2. What were your main field(s) of study? CHECK ALL THAT APPLY. (Responses not limited to
highest degree completed.)
Child development
Early childhood education
Education
Psychology
Social work/Social welfare
Public health
Nursing
Other (specify) ___________________
3. Prior to your current position, did you have experience in home visiting? This could include managing another home
visiting program, working as a home visitor, or working in another position related to home visiting.
No [→ SKIP to #4]
Yes [→ GO TO #3a & 3b]
3a. [If Question 3=Yes] How many total years of experience do you have in home visiting, including your current
home visiting program and any other home visiting programs?
Less than 1 year
1-2 years
3-5 years
6-10 years
More than 10 years
3b. [If Question 3=Yes] Before taking your current job that includes oversight of the tribal home visiting
program, had you worked as a home visitor for this program or any other home visiting program?
No [→ SKIP to #4]
Yes [→GO TO #3c]
3c. [If Question 3b=Yes] How many total years of experience did you work as a home visitor?
Less than 1 year
1-2 years
3-5 years
6-10 years
More than 10 years
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
3
January 2019
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
4. Do you have experience working with families in any of the following settings? CHECK ALL THAT APPLY.
In-home day care
Center-based daycare
Preschool
School, grades K-12 (non-nurse)
School nurse
After school program
Special education program
Nursing
Home health care
Other health care
Social services
Mentoring programs
Mental health agencies
No prior experience
Other (specify): ________________
5. How many total years of professional experience do you have working with families and young children, including
home visiting jobs and other jobs doing related work (e.g., years of nursing experience plus years as a parent
educator in different settings)?
Less than 1 year
1-2 years
3-5 years
6-10 years
More than 10 years
6. Before taking the job that includes oversight of the tribal home visiting program, had you worked as a manager or
director for another program?
No [→ SKIP to #7]
Yes [→ GO TO #6a]
6a. [If Question 6=Yes] How many total years of experience do you have managing programs and staff?
Less than 1 year
1-2 years
3-5 years
6-10 years
More than 10 years
7. Aside from your professional experience, how many years of experience do you have raising
children? Please include experience you have as a primary caregiver for any child(ren) including
your own and other's children. Please count experience providing regular, consistent care for a
child as a primary caregiver. Do not include babysitting or infrequent assistance with children.
Years of experience: ___________
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
4
January 2019
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
B. CURRENT POSITION
1. How many years have you worked for your home vising program? Include years worked for your home visiting
program in positions other than your current one.
Less than 1 year
1-2 years
3-5 years
6-10 years
More than 10 years
2. In what month and year did you begin your present job that includes oversight of the tribal home visiting program?
Month (Enter two digits for the month. For example, if you started in January, enter “01”. If you cannot recall which
month you began, leave this blank) _______
Year (Enter four digits for the year. For example, if you started in 2012, enter “2012”) ________
3. Some home visiting program directors manage multiple programs or have other responsibilities within the agency
they work for. How many hours do you spend in your role as the home visiting program director in a typical week?
(For example, enter “1.5” if you spend an hour and a half.)
Hours: __________
4. In your role as a home visiting program director, how often do you interact directly with families?
Daily
Weekly
Monthly
Less than monthly
Never
5. How likely is it that you will continue in your current position 6 months from now?
Very likely [→ SKIP to #5]
Somewhat likely [→ GO TO #4a]
Somewhat unlikely [→ GO TO #4a]
Very unlikely [→ GO TO #4a]
5a. [If Question 4= somewhat likely, somewhat unlikely, or very unlikely] What factors affect whether you will
stay in your position? [CHECK ALL THAT APPLY]
Salary
Opportunities for advancement within the organization
Funding for my position is uncertain
Caring for children or other family members
Pursue additional education or training
Retire or stop working
Moving out of the area
Challenging work environment
Other (specify) ________________________________________
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
C. PERCEPTIONS OF PROGRAM
Instructions: In this section, we would like to learn how staff members perceive their program’s intended outcomes. In
general, a program outcome is a benefit to a child, parent, or family. For example, some programs might see the
improvement of prenatal health as an important outcome.
Below is a list of possible outcomes for home visiting programs. We know your program may care about all of these
benefits, but we would like to know which is most important. We would like to get a sense of which outcomes you think
your program believes may be more important than others. Select the response that best represents what you think
your program believes about the outcome.
To help you decide on an outcome’s rank, think about whether it is discussed routinely in training and supervision.
Think about what staff in your agency is told about its importance. Select the response that best describes your
program’s ranking of this outcome.
1. How much of a priority is each of the following outcomes for your program, on a scale of 0 to 10?
0 = Not a Priority
5 = Moderate priority
10 = Highest priority
1
2
3
4
5
6
7
8
9
Supporting prenatal health and
obtaining prenatal care (including
dental health/dental care)
Supporting postpartum health and
obtaining postpartum care (including
dental health/dental care)
Supporting breastfeeding
Supporting physical health outside of
pregnancy and postpartum health
(including dental health/dental care)
Supporting family planning
Preventing and reducing alcohol,
commercial tobacco, and other drug
use
Promoting caregiver emotional wellbeing and preventing and reducing
mental health problems or stress
Preventing and reducing domestic
violence
Supporting healthy adult
relationships (with
boyfriends/girlfriends,
husbands/wives, partners, coparents)
0
1
2
3
4
5
6
7
8
9
10
Not
sure
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Increasing social support (support
from family, friends, and community)
Furthering a caregiver’s education
and job training
Supporting getting a job, or getting a
better job
Supporting child health (including
dental health/dental care)
Ensuring appropriate child care
arrangements
Supporting parenting to promote
child development
Basic needs like food, utilities,
housing, transportation, and
identification
Legal system and services
Supporting good nutrition and
physical activity
Supporting caregivers in budgeting
and making ends meet
Addressing unresolved issues from
past caregiver trauma
Connecting to community and
culture (attending community and/or
cultural activities, learning cultural
teachings, making new relationships
with others in your community)
Supporting parent-child interaction
Supporting positive discipline and
behavior management
Supporting caregivers in feeding
children (including formula and
solids, and not including
breastfeeding)
Helping caregivers to establish and
maintain developmentally
appropriate care/routines (daily
routines like bedtime, mealtime,
bath time)
Supporting effective co-parenting
Supporting child and home safety
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
0
1
2
3
4
5
6
7
8
9
10
Not
sure
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
In your role as a home visiting program director, you likely have a good sense of how well your program prepares and
supports home visitors to do their jobs well. The next two sets of questions ask about your program’s overall ability to
assure that home visitors do the following parts of their jobs well. When answering these questions, please think about
all aspects of your program including the curriculum, training, materials and support home visitors receive from the
home visiting model. Please also think about any supplemental curriculum, material or resources developed or selected
by your program. Please also consider any training home visitors receive from your program or other agencies, one-onone and group supervision, and support they may receive from other staff (including other home visitors), evaluators
and consultants.
2. Rate your program's overall ability to assure that home visitors do the following parts of their job well.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Your program's overall ability to assure that home
visitors do this part of their job well
Balance family preferences with program priorities
Communicate warmth, respect, and appreciation to
the family
Develop and use family goal plans
Conduct required screenings
Tailor activities in response to family interests,
concerns, and preferences
Build relationships and trust with caregivers and their
families
Deliver home visiting curriculum the way the
program and model intends
Model and coach parenting skills
Identify and communicate strengths to caregivers
Helping families access needed services
Collect data and information from caregivers
Enter data and document what happens during home
visits
Plan home visits for families
Retain families and keep caseload slots filled
Deliver the expected number of home visits for each
family
Support families in managing crises
Manage their time so that they can get everything
done that they need to do
Engage an uninterested or distracted caregiver during
a home visit
Engage an uninterested or fussy child during a home
visit
Ensure their safety when making home visits
Could be
greatly
improved
Could be
somewhat
improved
Could be
slightly
improved
Already top
notch
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
8
January 2019
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
3. Rate your program's overall ability to assure that home visitors can address the following topics with caregivers.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Could be
greatly
improved
Could be
somewhat
improved
Could be
slightly
improved
Already
top
notch
Program
doesn’t
focus on
this
Basic needs like food, utilities, housing,
transportation, and identification
Legal system and services
Nutrition and physical activity
Budgeting/making ends meet
Trauma (things that happened in the past
that affect caregiver today)
Your program's overall ability to assure
that home visitors can address the
following topics with families
Prenatal health/prenatal care (including
dental health/dental care)
Postpartum health/postpartum care
(including dental health/dental care)
Breastfeeding
Physical health outside of pregnancy and
postpartum health (including dental
health/dental care)
Family planning
Alcohol, commercial tobacco, and other
drug use
Caregiver emotional well-being, mental
health or stress
Domestic violence
Healthy adult relationships (with
boyfriends/girlfriends, husbands/wives,
partners, co-parents)
Social support (support from family,
friends, and community)
Furthering a caregiver’s education and
job training
Getting a job, or getting a better job
Child health (including dental
health/dental care)
Making child care arrangements
Child development
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
22
Your program's overall ability to assure
that home visitors can address the
following topics with families
Connecting to community and culture
(attending community and/or cultural
activities, learning cultural teachings,
making new relationships with others in
your community)
Parent-child interaction
23
Discipline/behavior management
24
Feeding children (including formula and
solids, and not including breastfeeding)
Developmentally appropriate
care/routines (daily routines like
bedtime, mealtime, bath time)
Co-parenting
Child/home safety
21
25
26
27
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
Could be
greatly
improved
Could be
somewhat
improved
Could be
slightly
improved
Already
top
notch
Program
doesn’t
focus on
this
4. How much should home visitors focus on improving outcomes for…
1
2
3
4
Index child
Primary caregiver
Other children in the family or household
Other adults in the family or household
Not at all
Very little
Somewhat
A lot
5. What does your program expect home visitors to do DURING THE VISIT if something comes up that they haven't
been prepared/trained to address?
My program expects home visitors just to explain that they can only work on things
covered in the program.
My program expects home visitors to direct the mother to a resource that CAN address
this issue.
My program expects home visitors to try to work on this issue even though they are not
trained to address it.
My program has no stated expectation for what home visitors do.
Not sure
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
10
January 2019
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
6. What does your program expect home visitors to do DURING THE VISIT if a caregiver wants to do things differently
than in the program curricula or protocols?
My program expects home visitors to explain that I must follow the program curricula
and protocols.
My program expects home visitors to modify visit activities to align with the caregiver’s
preferences while still being true to the 'spirit' of the curriculum or protocol.
My program expects home visitors to do things the way the caregiver prefers, even if this
is very different from program curricula and protocols.
My program has no stated expectation for what home visitors do in this situation.
Not sure
7. How effective is your program overall at MAKING A DIFFERENCE for families in the following areas?
Not at
Somewhat
Mostly
all
effective
effective
effective
1
Prenatal health/prenatal care (including dental health/dental
care)
2
Postpartum health/postpartum care (including dental
health/dental care)
3
Breastfeeding
4
Physical health outside of pregnancy and postpartum health
(including dental health/dental care)
5
Family planning
6
Alcohol, commercial tobacco, and other drug use
7
Caregiver emotional well-being, mental health or stress
8
Domestic violence
9
Healthy adult relationships (with boyfriends/girlfriends,
husbands/wives, partners, co-parents)
10 Social support (support from family, friends, and community)
11 Furthering a caregiver’s education and job training
12 Getting a job, or getting a better job
13 Child health (including dental health/dental care)
14 Making child care arrangements
15 Child development
16 Basic needs like food, utilities, housing, transportation, and
identification
17 Legal system and services
18 Nutrition and physical activity
19 Budgeting/making ends meet
20 Trauma (things that happened in the past that affect caregiver
today)
21 Connecting to community and culture (attending community
and/or cultural activities, learning cultural teachings, making
new relationships with others in your community)
22 Parent-child interaction
23 Discipline/behavior management
Very
effective
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
24
25
26
27
Feeding children (including formula and solids, and not
including breastfeeding)
Developmentally appropriate care/routines (daily routines like
bedtime, mealtime, bath time)
Co-parenting
Child/home safety
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
Not at
all
effective
Somewhat
effective
Mostly
effective
Very
effective
D. SELF-EFFICACY
1. Program directors take on many tasks in order to administer and monitor the program, support and manage home
visiting staff, and successfully meet the Tribal MIECHV grant requirements. The next set of questions asks you to
consider your own knowledge, skills and abilities needed to accomplish tasks related to providing oversight of a
home visiting program. If you are not responsible for some of the tasks below, please mark “Not part of my job.”
Please do not consider external barriers like lack of funding or staff time, agency policies, or geography. How
confident are you that you can do the following tasks related to managing your home visiting program?
Not at all
Not very
Somewhat
Mostly
Completely Not part of
confident
confident
confident confident
confident
my job
1 Develop and maintain
program policies and
procedures
2 Monitor program
performance
3 Support staff to enroll enough
families to keep caseload slots
filled
4 TRecruit job candidates that
have the right skills and
experience to be effective
home visiting program staff
5 Successfully hire home visitors
and other program staff
6 Provide adequate training for
program staff
7 Retain home visiting staff
8 Adequately compensate staff
9 Support staff through the
challenging aspects of their
work
10 Build and maintain
relationships with other
service providers in the
community
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
11 Implement our program the
way we intend to, as
described in our
implementation plan
12 Balance model requirements
with local priorities
13 Ensure high quality data
collection
14 Use data to make decisions
guiding program
implementation
15 Sustain program funding
16 Provide a supportive work
environment for program staff
17 Convene a local advisory
board for your program
18 Help program staff work
together as a team
19 Appropriately monitor fidelity
of program implementation
20 Tailor our program to be
relevant to our local
community and culture
21 Cultivate community support
for the program
22 Monitor fiscal planning and
oversight
23 Cultivate tribal/agency
leadership support for the
program
24 Manage subcontractors (e.g.,
contracted evaluators, clinical
supervisors, data consultants,
etc.)
25 Effectively disseminate
information about our
program to professional
audiences
26 Effectively disseminate
information about our
program to tribal/
organizational leadership
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
Not at all
confident
Not very
confident
Somewhat
confident
Mostly
confident
Completely
confident
Not part of
my job
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
27 Effectively disseminate
information about our
program to community
audiences
28 Monitor employee
performance and
communicate with them
about improvement plans, if
needed
29 Balance multiple
requirements across different
funders
30 Utilize technical assistance to
achieve program goals
31 Submit required reports in a
timely manner (to funders,
tribe, agency, model, etc.)
32 Communicate effectively with
funders
33 Meet Tribal MIECHV grant
requirements without putting
in unreasonable time and
effort
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
Not at all
confident
Not very
confident
Somewhat
confident
Mostly
confident
Completely
confident
Not part of
my job
2. The following questions ask about your approach to being the home visiting program’s team leader. How much do
you agree or disagree with the following statements?
1
2
3
4
5
6
7
8
9
10
I initiate meetings to discuss the team's progress.
I am available for consultation on problems.
I am engaged in our team’s day-to-day work.
I manage crises in a calm and dependable way.
I help the team get through challenges they face in their
work.
I handle personnel issues thoughtfully.
I would go to bat for the team.
I have enough training and experience to be an effective
leader.
I treat all team members fairly.
I don’t really know what the team needs to do its job
well.
Strongly
agree
Agree
Disagree
Strongly
disagree
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
E. JOB SATISFACTION
1. The following questions ask how you feel about your job overall. How often do you feel this way?
1
2
3
4
5
6
7
8
9
The work I do is satisfying.
My job is boring.
My job allows me to be creative.
I feel respected at work.
My job is frustrating.
My work gives me a sense of
accomplishment.
My job is interesting.
The work I do is important.
My job is overwhelming.
None of
the time
A little of
the time
Some of
the time
Most of the
time
All of the
time
2. Think about your pay from this job. How much do you agree or disagree with the following about your pay?
1
2
3
I can depend on my paycheck to be regular
and on time.
The pay I get from this job is less than I
deserve for the work that I do.
The pay I get from this job is fair for my
qualifications.
Strongly
agree
Agree
Disagree
Strongly
disagree
Not sure
3. As you think about the pay you get from this job, which statement best describes your thoughts? The pay I
get from this job is…
Barely enough to live on
Enough to cover my normal expenses
Enough to live comfortably
4. For each job characteristic listed below, how satisfied or dissatisfied are you with your current job at the home visiting
program in this regard?
1
2
3
4
My job security
The amount of vacation time I receive
The amount of on-the-job stress
My chances for promotion
Very
dissatisfied
Dissatisfied
Satisfied
Very satisfied
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
5
6
7
8
9
10
11
12
The number of people I supervise
The amount of time required of me to get
the job done
The amount of time I spend travelling for
my day-to-day job
The flexibility of my schedule
The health insurance benefits my employer
offers
The retirement plan my employer offers
The amount of leave or schedule flexibility
available for family and community
obligations
The control I have over my daily work
schedule
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
Very
dissatisfied
Dissatisfied
Satisfied
Very satisfied
13
The physical workspace
14
Balancing the different tasks that are
required of me
15
Being able to get my work done with the
amount of interruptions I experience
16
The recognition I receive at work for my
accomplishments
17
The amount of money I earn
18
My relationship with my immediate
supervisor
19
My physical safety while doing my job
20
My relationships with coworkers
21
The training and professional development
opportunities available to me
22
How interesting the work is
23
24
My work-life balance
The mentoring and support I receive
My ability to contribute to others in a
meaningful way
My job overall
25
26
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
5. We are interested in learning about how your job relates to the community that your home visiting program serves.
How much do you agree or disagree with the following statements?
1
2
3
4
5
6
The local community is very involved in shaping the home
visiting services your home visiting program provides.
My job makes me feel more connected to my community.
I worry that my job has negatively impacted how I'm
perceived in the local community.
My job is meaningful to the local community.
My job makes a positive difference in the local community.
My job is contributing to a brighter future for the local
community.
Strongly
agree
Agree
Disagree
Strongly
disagree
Not
sure
F. PROFESSIONAL QUALITY OF LIFE
1. When you work in home visiting you have direct contact with people’s lives. As you may have found, your
compassion for those you serve can affect you in positive and negative ways. Below are some questions about your
experiences, both positive and negative, as a home visiting program director. Consider each of the following
questions about you and your current work situation. How often did you experience these things in the last 30 days?
1
2
3
4
5
6
7
8
9
10
I am happy.
I am preoccupied with more than one person
our program serves.
I get satisfaction from being able to make home
visiting services available to people.
I feel connected to others.
I jump or am startled by unexpected sounds.
I feel invigorated after working with those our
program serves.
I find it difficult to separate my personal life
from my life as a home visiting program director.
I am not as productive at work because I am
losing sleep over the traumatic experiences of a
person our program serves.
I think that I might have been affected by the
traumatic stress of those our program serves.
I feel trapped by my job as a home visiting
program director.
Never
Rarely
Sometimes
Often
Always
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Because of my role with the home visiting
program, I have felt "on edge" about various
things.
I like my work as a home visiting program
director.
I feel depressed because of the traumatic
experiences of the people our program serves.
I feel as though I am experiencing the trauma of
someone our program has served.
I have beliefs that sustain me.
I am pleased with how I am able to keep up with
home visiting techniques and protocols.
I am the person I always wanted to be.
My work makes me feel satisfied.
I feel worn out because of my work as a home
visiting program director.
I have happy thoughts and feelings about those
our program serves and how I could help them.
I feel overwhelmed because my work seems
endless.
I believe I can make a difference through my
work.
I avoid certain activities or situations because
they remind me of frightening experiences of
the people our program serves.
I am proud of what I can do as a home visiting
program director.
As a result of home visiting, I have intrusive,
frightening thoughts.
I feel "bogged down" by the system.
I have thoughts that I am a "success" as a home
visiting program director.
I can't recall important parts of my work with
trauma victims.
I am a very caring person.
I am happy that I chose to do this work.
The chronic stresses in the lives of people our
program serves make me depressed.
I take the stress of people our program serves
home with me.
I get overwhelmed by the ongoing challenges
faced by the people our program serves.
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
Never
Rarely
Sometimes
Often
Always
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
G. TRAINING
We would like to know whether home visiting program directors receive the training and supervisory support they need
to do their jobs well. Please tell us whether you would like additional training and support in order to successfully
accomplish the tasks related to being the home visiting program director.
1. How much additional training and supervisory support do you need to do the following parts of your job well:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
Develop and maintain program policies and
procedures
Monitor program performance
Support staff to enroll enough families to
keep caseload slots filled
Recruit job candidates that have the right
skills and experience to be effective home
visiting program staff
Successfully hire home visitors and other
program staff
Provide adequate training for program staff
Retain home visiting staff
Adequately compensate staff
Support staff through the challenging aspects
of their work
Build and maintain relationships with other
service providers in the community
Implement our program the way we intend
to, as described in our implementation plan
Balance model requirements with local
priorities
Ensure high quality data collection
Use data to make decisions guiding program
implementation
Sustain program funding
Provide a supportive work environment for
program staff
Convene a local advisory board for your
program
Help program staff work together as a team
Appropriately monitor fidelity of program
implementation
Tailor our program to be relevant to our local
community and culture
Cultivate community support for the program
None
A little bit
A good
amount
A lot
Not part
of my job
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
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23
24
25
26
27
28
29
30
31
32
33
Monitor fiscal planning and oversight
Cultivate tribal/agency leadership support for
the program
Manage subcontractors (e.g., contracted
evaluators, clinical supervisors, data
consultants, etc.)
Effectively disseminate information about our
program to professional audiences
Effectively disseminate information about our
program to tribal/ organizational leadership
Effectively disseminate information about our
program to community audiences
Monitor employee performance and
communicate with them about improvement
plans, if needed
Balance multiple requirements across
different funders
Utilize technical assistance to achieve
program goals
Submit required reports in a timely manner
(to funders, tribe, agency, model, etc.)
Communicate effectively with funders
Meet Tribal MIECHV grant requirements
without putting in unreasonable time and
effort
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
None
A little bit
A good
amount
Not part
of my job
A lot
2. How much do you agree or disagree with the following statement: Overall, the training I receive provides me with
everything I need to direct the home visiting program.
Strongly agree
Agree
Disagree
Strongly disagree
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
3. How important is each of the following in preparing and supporting home visitors?
1
2
3
4
5
6
7
8
9
10
Shadowing another home visitor
One-on-one time with his/her direct
supervisor
[Model] training sessions
Receiving reflective supervision
Talking with other home visitors
Case conferencing
Watching videos of other home
visitors
Debriefing with co-workers
Coursework/education in early
childhood development or a related
field
Continuing education opportunities
Not at all
important
Minimally
important
Somewhat
important
Very
important
H. ORGANIZATIONAL CULTURE AND CLIMATE
1. The following questions ask you to think about how your home visiting team does its work. We want to know how
your team works together, takes in information, and makes decisions about the team’s approach to home visiting.
When answering questions about your team, please think about the staff that make up your home visiting program.
This would include home visitors, program coordinators/managers, supervisors, evaluators, data managers and
anyone else that might work closely with your program. How much do you agree or disagree with the following
statements?
1
2
3
4
5
6
7
Our team gets all the information it needs to do our
work and plan our schedules.
It is easy for our team to obtain expert assistance when
something comes up that we don't know how to handle.
Our team is kept in the dark about decisions that impact
day-to-day work and what may happen with the
program and its staff in the future.
Our team lacks access to useful training on the job.
Excellent work pays off in this organization.
It is clear what our team is supposed to accomplish.
Our team spends time making sure every team member
understands their role and responsibilities.
Strongly
agree
Agree
Disagree
Strongly
disagree
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
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9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Our team has invested plenty of time to clarify our
goals.
If you make a mistake on our team, it is often held
against you.
Members of our team are able to bring up problems and
tough issues.
People on our team are expected to conform to the
group.
It is safe to try something new on our team.
It is difficult to ask other members of our team for help.
No one on our team would deliberately act in a way that
undermines my efforts.
Working with members of our team, my unique skills
and talents are valued and utilized.
Achieving our team's goals is well within our reach.
Our team can complete work as assigned without being
required to put in unreasonable time or effort.
With focus and effort, our team can do anything we set
out to accomplish.
Most people in our team have the ability to solve the
problems that come up in our work.
All members of our team have more than enough
training and experience for the kind of work they have
to do.
Certain individuals in our team lack the special skills
needed for good team work.
We regularly take time to figure out ways to improve
our team's work processes.
Our team tends to handle differences of opinion
privately, rather than addressing them directly as a
group.
Team members go out and get all the information they
possibly can from others-such as families, community
members, and other program partners.
Our team frequently uses information and data that
leads us to make important changes.
In our team, someone always makes sure that we stop
to reflect on the team's work process.
People on our team often speak up to test assumptions
we might have.
People on our team are encouraged to think outside the
box.
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
Strongly
agree
Agree
Disagree
Strongly
disagree
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
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30
31
32
33
We invite people from outside our team to present
information or have discussions with us.
Our team uses data to see if our processes are leading
to the results we want.
Members of our team are encouraged to try new
strategies to see if they will work.
Members of our team support each other as we work to
master new skills.
The quality of work provided by our team is improving
over time.
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
Strongly
agree
Agree
Disagree
Strongly
disagree
I. CONNECTION TO COMMUNITY SERVED
1. Do you live in the same community or neighborhoods your program provides services to?
Yes [→ GO TO #1a]
No [→ GO TO #1b]
1a. [If Question 1 = Yes] In total, how many years have you lived in the same community or neighborhoods you
provide services to?
Less than 1 year
1-2 years
3-5 years
6-10 years
More than 10 years
1b. [If Question 1 = No] If you ever previously lived in the same community or neighborhoods you provide
services to, how long did you live there?
I never lived there
Less than 1 year
1-2 years
3-5 years
6-10 years
More than 10 years
2. Do you consider yourself a member of the same tribal or urban Indian community your program provides
services to?
Yes
No
Somewhat
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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January 2019
OMB Control No.: 0970-0521
Expiration Date: 12/31/2021
Length of time for instrument: 45 minutes
3. In general, do you feel as though you and the families your program serves share a similar
cultural background?
Yes, with most families
Yes, with some families
Yes, with a few families
No
J. DEMOGRAPHICS
1. What is your Ethnicity?
Hispanic or Latino
Not Hispanic or Latino
2. What is your Race? (Select one or more)
American Indian or Alaska Native [→ GO TO #2a]
Asian [→ SKIP to #3]
Black or African American [→ SKIP to #3]
Native Hawaiian or Other Pacific Islander [→ SKIP to #3]
White [→ SKIP to #3]
2a. [If Question 2 = American Indian or Alaska Native] What is your tribal affiliation and/or identity?
_____________________________________________________________________
3. What is your age?
25 and under
26-29
30-39
40-49
50-59
60 or older
[NEXT SCREEN]
THANK YOU FOR TAKING THE TIME TO COMPLETE THIS SURVEY.
Please click NEXT to exit the survey.
Multi-Site Implementation Evaluation of Tribal Home Visiting OMB Supporting Documents: Program Director Survey
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| File Type | application/pdf |
| Author | Lyon@jbassoc.com |
| File Modified | 2019-02-06 |
| File Created | 2019-02-06 |