Attachment_F_Instrument_2_ProgramOperationsSurvey_clean

OMB No.: 0970-0566

Expiration Date: 4/30/2024

Program Operations Survey

Healthy Marriage and Responsible Fatherhood Programs

Thank you for participating in this program. Throughout the program we will ask you to provide information so that we can better support you, and to help monitor the program’s performance. We hope you will answer all the questions asked by program staff or in surveys, but you may skip any questions you do not want to answer. Your answers will be kept private as required by law.

PRINCIPAL PURPOSE: The information you provide will be used primarily to (a) provide you with services, (b) monitor and help improve the performance of Healthy Marriage and Responsible Fatherhood (HMRF) programs, and (c) help understand HMRF services and participants across programs.

ROUTINE USES: Your information will be kept private and cannot be used against you in any law enforcement action. Your information may be combined with information from other individuals but you will not be personally identifiable. However, there may be circumstances where disclosure of your personal information may be requested; in these cases, processes are in place to further protect your information for such requests. These requests may include: (a) by a congressional office if you ask that office to help obtain a copy of your records; (b) to coordinate and respond to a data security breach; (c) for research or evaluation purposes; (d) for administrative or legal actions; or (e) by contractors supporting the purpose and uses described here, but only on a must know basis in order to perform their duties. Please see the sources below for more information about these routine uses.

DISCLOSURE: This request is voluntary. The relevant SORN is 09-80-0361, OPRE Research and Evaluation Project Records.

AUTHORITY: 42 U.S.C. 613 - Research, evaluations, and national studies; 42 U.S.C. 628b - National random sample study of child welfare; 42 U.S.C. 1310 - Cooperative research or demonstration projects; 42 U.S.C. 9836 - Designation of Head Start agencies; 42 U.S.C. Subchapter II-B - Child Care and Development Block Grant; and Pub L. No. 110-161, Division G, Title II, Payments to States for the Child Care and Development Block Grant (121 STAT. 2179).

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to support program performance monitoring and program improvement activities for Healthy Marriage and Responsible Fatherhood programs. Public reporting burden for this collection of information is estimated to average 19 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. The answers you give will be kept private. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0566 and the expiration date is 04/30/2024. If you have any comments on this collection of information, please contact [Current Point of Contact Name] at nform2helpdesk@mathematica-mpr.com.

A. Mass Marketing, Outreach, and Recruitment

A1. Which of the following types of advertising did you purchase, earn, have donated, or conduct in the current reporting period?

SELECT ALL THAT APPLY

1 □ Newspaper ads or publicity

2 □ TV spots

3 □ Billboards, including those on public transportation or at bus stops (that is, bench ads)

4 □ Radio ads or announcements

5 □ Internet ads

6 □ Social marketing (such as Facebook or Twitter)

7 □ Flyers

8 □ Presentations to external organizations

9 □ Word-of-mouth campaign/outreach by program graduates

10 □ Other

A2. Which recruitment methods did you use in the current reporting period?

SELECT ALL THAT APPLY

1 □ Phone, mail, or email

2 □ Social media (such as Facebook, blogs, or Instagram)

3 □ Street outreach (recruiting people in person in their neighborhoods or places they frequent)

4 □ Referrals from inside your organization

5 □ Referrals from external organizations

6 □ On-site recruitment at external agencies or events

7 □ Other

A3. Which agencies and organizations provided referrals in the current reporting period?

SELECT ALL THAT APPLY

1 □ Hospitals, maternity clinics, or doctors’ offices

2 □ Schools

3 □ Places of worship or faith-based community centers

4 □ Child support agencies (voluntary enrollment)

5 □ Child support agencies (court ordered to enroll in a program like this)

6 □ Employment assistance centers or one-stops

7 □ Temporary Assistance for Needy Families (TANF) offices

8 □ Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) agencies

9 □ Head Start

10 □ Healthy Start

11 □ Child protective services (voluntary enrollment)

12 □ Child protective services (court ordered to enroll in a program like this)

13 □ Other child welfare agencies (voluntary enrollment)

14 □ Other child welfare agencies (court ordered to enroll in a program like this)

15 □ Probation and parole

16 □ Correctional facilities

17 □ External organizations

18 □ Self-referrals

19 □ Other

A4. In the current reporting period, did you conduct on-site recruitment for [PROGRAM] in any of the following?

SELECT ALL THAT APPLY

1 □ Hospitals, maternity clinics, or doctors’ offices

2 □ Schools

3 □ Places of worship or faith-based community centers

4 □ Child support agencies (voluntary enrollment)

5 □ Child support agencies (court ordered to enroll in a program like this)

6 □ Employment assistance centers or one-stops

7 □ Temporary Assistance for Needy Families (TANF) offices

8 □ Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) agencies

9 □ Head Start

10 □ Healthy Start

11 □ Child welfare agencies/child protective services (voluntary enrollment)

12 □ Child welfare agencies/child protective services (court ordered to enroll in a program like this)

13 □ Probation and parole

14 □ Correctional facilities

15 □ External organizations

16 □ Self-referrals

17 □ Other

A5. On average, how many full-time and part-time staff worked for your Healthy Marriage or Responsible Fatherhood grant program (exclusive of their other responsibilities at your organization) on the first day of the current reporting period? (NOTE: please include all staff who are funded in whole or in part by this grant, including primary and partner sites; 35 or more hours per week = full time; fewer than 35 hours per week = part time.)

| | | | number of staff funded full-time by grant

| | | | number of staff funded part-time by grant

A6. How many full-time and part-time staff ended their employment for your grant program during the current reporting period? (NOTE: please include staff who are funded in whole or in part by this grant, including primary and partner sites; 35 or more hours per week = full time; fewer than 35 hours per week = part time)

| | | | number of staff funded full-time by grant who left

| | | | number of staff funded part-time by grant who left

A7. How many full-time and part-time people began working for your grant program during the current reporting period? (NOTE: please include staff who are funded in whole or in part by this grant, including primary and partner sites; 35 or more hours per week = full time; fewer than 35 hours per week = part time)

| | | | number of staff funded full-time by grant who started

| | | | number of staff funded part-time by grant who started

A8. How many full-time equivalents (FTEs) were dedicated to recruitment in the current reporting period, where each FTE equals 35 or more hours per week in staff time dedicated to recruitment?

SELECT ONE ONLY

1  < 1 FTE

2  1 to 1.9 FTEs

3  2 to 2.9 FTEs

4  3 to 3.9 FTEs

5  4 to 4.9 FTEs

6  5 or more FTEs

B. Staff Characteristics

B1a. What proportion of your facilitators have received, as their highest degree…

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. A high school diploma or less?	1 	2 	3 	4 	5 
b. An associate’s degree?	1 	2 	3 	4 	5 
c. A bachelor’s degree?	1 	2 	3 	4 	5 
d. A master’s or doctorate degree?	1 	2 	3 	4 	5 

B1b. What proportion of your case management staff have received, as their highest degree…

na  Do not have case management staff

[SOFT CHECK: IF CASE MANAGER DEGREE = NA; DISABLE OTHER OPTIONS.]

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. A high school diploma or less?	1 	2 	3 	4 	5 
b. An associate’s degree?	1 	2 	3 	4 	5 
c. A bachelor’s degree?	1 	2 	3 	4 	5 
d. A master’s or doctorate degree?	1 	2 	3 	4 	5 

B1c. What proportion of your employment specialists have received, as their highest degree…

na  Do not have employment specialists

[SOFT CHECK: IF EMPLOYMENT SPECIALIST DEGREE = NA; DISABLE OTHER OPTIONS.]

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. A high school diploma or less?	1 	2 	3 	4 	5 
b. An associate’s degree?	1 	2 	3 	4 	5 
c. A bachelor’s degree?	1 	2 	3 	4 	5 
d. A master’s or doctorate degree?	1 	2 	3 	4 	5 

B1d. What proportion of your managerial/supervisory staff have received, as their highest degree…

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. A high school diploma or less?	1 	2 	3 	4 	5 
b. An associate’s degree?	1 	2 	3 	4 	5 
c. A bachelor’s degree?	1 	2 	3 	4 	5 
d. A master’s or doctorate degree?	1 	2 	3 	4 	5 

B1e. What proportion of your other staff have received, as their highest degree…

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. A high school diploma or less?	1 	2 	3 	4 	5 
b. An associate’s degree?	1 	2 	3 	4 	5 
c. A bachelor’s degree?	1 	2 	3 	4 	5 
d. A master’s or doctorate degree?	1 	2 	3 	4 	5 

B2a. What proportion of your facilitators have…

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. Less than 2 years in this role?	1 	2 	3 	4 	5 
b. At least 2 years but less than 5 years in this role?	1 	2 	3 	4 	5 
c. At least 5 years but less than 10 years in this role?	1 	2 	3 	4 	5 
d. 10 or more years in this role?	1 	2 	3 	4 	5 

B2b. What proportion of your case management staff have…

na  Do not have case management staff

[SOFT CHECK: IF CASE MANAGER YEARS = NA; DISABLE OTHER OPTIONS.]

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. Less than 2 years in this role?	1 	2 	3 	4 	5 
b. At least 2 years but less than 5 years in this role?	1 	2 	3 	4 	5 
c. At least 5 years but less than 10 years in this role?	1 	2 	3 	4 	5 
d. 10 or more years in this role?	1 	2 	3 	4 	5 

B2c. What proportion of your employment specialists have…

na  Do not have employment specialists

[SOFT CHECK: IF EMPLOYMENT SPECIALIST YEARS = NA; DISABLE OTHER OPTIONS.]

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. Less than 2 years in this role?	1 	2 	3 	4 	5 
b. At least 2 years but less than 5 years in this role?	1 	2 	3 	4 	5 
c. At least 5 years but less than 10 years in this role?	1 	2 	3 	4 	5 
d. 10 or more years in this role?	1 	2 	3 	4 	5 

B2d. What proportion of your managerial/supervisory staff have…

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. Less than 2 years in this role?	1 	2 	3 	4 	5 
b. At least 2 years but less than 5 years in this role?	1 	2 	3 	4 	5 
c. At least 5 years but less than 10 years in this role?	1 	2 	3 	4 	5 
d. 10 or more years in this role?	1 	2 	3 	4 	5 

B3a. What proportion of your facilitators are…

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. Male	1 	2 	3 	4 	5 
b. Female	1 	2 	3 	4 	5 
c. Other gender	1 	2 	3 	4 	5 

B3b. What proportion of your case managers are…

na  Do not have case management staff

[SOFT CHECK: IF CASE MANAGER GENDER = NA; DISABLE OTHER OPTIONS.]

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. Male	1 	2 	3 	4 	5 
b. Female	1 	2 	3 	4 	5 
c. Other gender	1 	2 	3 	4 	5 

B3c. What proportion of your employment specialists are…

na  Do not have employment specialists

[SOFT CHECK: IF EMPLOYEMENT SPECIALIST GENDER = NA; DISABLE OTHER OPTIONS.]

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. Male	1 	2 	3 	4 	5 
b. Female	1 	2 	3 	4 	5 
c. Other gender	1 	2 	3 	4 	5 

B3d. What proportion of your managerial/supervisory staff are…

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. Male	1 	2 	3 	4 	5 
b. Female	1 	2 	3 	4 	5 
c. Other gender	1 	2 	3 	4 	5 

B4a. What proportion of your facilitators are…

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. Hispanic or Latino	1 	2 	3 	4 	5 
b. Not Hispanic or Latino	1 	2 	3 	4 	5 

B4b. What proportion of your case managers are…

na  Do not have case management staff

[SOFT CHECK: IF CASE MANAGER ETHNICITY = NA; DISABLE OTHER OPTIONS.]

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. Hispanic or Latino	1 	2 	3 	4 	5 
b. Not Hispanic or Latino	1 	2 	3 	4 	5 

B4c. What proportion of your employment specialists are…

na  Do not have employment specialists

[SOFT CHECK: IF EMPLOYMENT SPECIALIST ETHNICITY = NA; DISABLE OTHER OPTIONS.]

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. Hispanic or Latino	1 	2 	3 	4 	5 
b. Not Hispanic or Latino	1 	2 	3 	4 	5 

B4d. What proportion of your managerial/supervisory staff are…

	SELECT ONE RESPONSE PER ROW
	None	Fewer than half	Half	More than half	All
a. Hispanic or Latino	1 	2 	3 	4 	5 
b. Not Hispanic or Latino	1 	2 	3 	4 	5 

B5a. What proportion of your facilitators are…

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. American Indian or Alaska Native	1 	2 	3 	4 	5 
b. Asian	1 	2 	3 	4 	5 
c. Black or African American	1 	2 	3 	4 	5 
d. Native Hawaiian or other Pacific Islander	1 	2 	3 	4 	5 
e. White	1 	2 	3 	4 	5 
f. Other race	1 	2 	3 	4 	5 
g. More than one race	1 	2 	3 	4 	5 

B5b. What proportion of your case managers are…

na  Do not have case management staff

[SOFT CHECK: IF CASE MANAGER RACE = NA; DISABLE OTHER OPTIONS.]

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. American Indian or Alaska Native	1 	2 	3 	4 	5 
b. Asian	1 	2 	3 	4 	5 
c. Black or African American	1 	2 	3 	4 	5 
d. Native Hawaiian or other Pacific Islander	1 	2 	3 	4 	5 
e. White	1 	2 	3 	4 	5 
f. Other race	1 	2 	3 	4 	5 
g. More than one race	1 	2 	3 	4 	5 

B5c. What proportion of your employment specialists are…

na  Do not have employment specialists

[SOFT CHECK: IF EMPLOYMENT SPECIALIST RACE = NA; DISABLE OTHER OPTIONS.]

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. American Indian or Alaska Native	1 	2 	3 	4 	5 
b. Asian	1 	2 	3 	4 	5 
c. Black or African American	1 	2 	3 	4 	5 
d. Native Hawaiian or other Pacific Islander	1 	2 	3 	4 	5 
e. White	1 	2 	3 	4 	5 
f. Other race	1 	2 	3 	4 	5 
g. More than one race	1 	2 	3 	4 	5 

B5d. What proportion of your managerial/supervisory staff are…

	SELECT ONE RESPONSE PER ROW
	None	Less than half	Half	More than half	All
a. American Indian or Alaska Native	1 	2 	3 	4 	5 
b. Asian	1 	2 	3 	4 	5 
c. Black or African American	1 	2 	3 	4 	5 
d. Native Hawaiian or other Pacific Islander	1 	2 	3 	4 	5 
e. White	1 	2 	3 	4 	5 
f. Other race	1 	2 	3 	4 	5 
g. More than one race	1 	2 	3 	4 	5 

C. Quality Assurance and Monitoring

C1. In the current reporting period, did the following staff receive their initial training on the program curriculum(a)?

		SELECT ONE RESPONSE PER ROW
	Yes		No	Do not have this position on staff
a. Facilitators	1 		0 	na 
b. Case managers	1 		0 	na 
c. Employment specialists	1 		0 	na 
d. Supervisors	1 		0 	na 
e. Program managers	1 		0 	na 
f. Other program staff (please specify)	1 		0 	na 

C2. In the current reporting period, did the following staff receive follow-up or refresher training on the program curriculum(a)?

		SELECT ONE RESPONSE PER ROW
	Yes		No	Do not have this position on staff
a. Facilitators	1 		0 	na 
b. Case managers	1 		0 	na 
c. Employment specialists	1 		0 	na 
d. Supervisors	1 		0 	na 
e. Program managers	1 		0 	na 
f. Other program staff (please specify)	1 		0 	na 

C3. In the current reporting period, did the following staff receive training other than on the program curriculum(a)?

		SELECT ONE RESPONSE PER ROW
	Yes		No	Do not have this position on staff
a. Facilitators	1 		0 	na 
b. Case managers	1 		0 	na 
c. Employment specialists	1 		0 	na 
d. Supervisors	1 		0 	na 
e. Program managers	1 		0 	na 
f. Other program staff (please specify)	1 		0 	na 

C4. For the two types of facilitators shown below, were they observed by a supervisor or another experienced facilitator in the current reporting period?

		SELECT ONE RESPONSE PER ROW
	Yes		No
a. Facilitators hired in the reporting period	1 		0 
b. Experienced facilitators	1 		0 

C5. In the current reporting period, on average, how often did the following staff meet with their supervisors one-on-one?

	SELECT ONE RESPONSE PER ROW
	At least weekly	Biweekly	Monthly	Once	Not in reporting period	Do not have this position on staff
a. Facilitators	1 	2 	3 	4 	5 	na 
b. Case managers	1 	2 	3 	4 	5 	na 
c. Employment specialists	1 	2 	3 	4 	5 	na 
d. Supervisors	1 	2 	3 	4 	5 	na 
e. Program managers	1 	2 	3 	4 	5 	na 
f. Other program staff (please specify)	1 	2 	3 	4 	5 	na 

C6. In the current reporting period, how often were staff meetings held (such as discussions about continuous quality improvement and team-building meetings) that included the following staff?

	SELECT ONE RESPONSE PER ROW
	At least weekly	Biweekly	Monthly	Once	Not in reporting period	Do not have this position on staff
a. Facilitators	1 	2 	3 	4 	5 	na 
b. Case managers	1 	2 	3 	4 	5 	na 
c. Employment specialists	1 	2 	3 	4 	5 	na 
d. Supervisors	1 	2 	3 	4 	5 	na 
e. Program managers	1 	2 	3 	4 	5 	na 
f. Other program staff (please specify)	1 	2 	3 	4 	5 	na 

D. Implementation Challenges

D1. Please indicate how much of a problem each of the following has been in the current reporting period.

		SELECT ONE RESPONSE PER ROW
	Not a problem		Somewhat of a problem	A serious problem
a. Obtaining referrals from external organizations	1 		2 	3 
b. Recruiting participants	1 		2 	3 
c. Enrolling the intended target population	1 		2 	3 
d. Getting enrollees to start participating in services	1 		2 	3 
e. Getting enrollees to attend regularly	1 		2 	3 
f. Keeping participants engaged during sessions	1 		2 	3 
g. Getting enrollees to complete the program	1 		2 	3 
h. Recruiting qualified staff	1 		2 	3 
i. Maintaining staff performance	1 		2 	3 
j. Ensuring facilitators understand content	1 		2 	3 
k. Covering all program content in the time allotted	1 		2 	3 
l. Implementing curriculum with fidelity	1 		2 	3 
m. Having adequate program facilities	1 		2 	3 
n. Cooperation of recruitment and referral sources	1 		2 	3 
o. Working with service delivery partners	1 		2 	3 
p. Experiencing extreme weather or natural disasters	1 		2 	3 
q. Getting participants to complete pre-test or post-test	1 		2 	3 
r. Retaining staff	1 		2 	3 
s. Filling open staff positions	1 		2 	3 
t. Providing comprehensive case management services	1 		2 	3 
u. Providing grant-funded participation supports	1 		2 	3 
v. Entering and reporting data	1 		2 	3 

Thank you for completing this survey!