CCOE Center Director and Program Coordinator Survey
DataCollection for the Identification ofComparisonGroups for the National Com. Ctrs of Excellencein Women's Health (CCOE) Program
Round_II_CCOE_CtrDirector_PC_Survey_20061020
CCOE Center Director and Program Coordinator Survey
OMB: 0990-0271
NATIONAL COMMUNITY CENTERS OF EXCELLENCE
(CCOE) IN WOMEN’S HEALTH
NATIONAL EVALUATION: ROUND II
CCOE Center Director and Program Coordinator Survey
You have been selected to participate in Round II of the National Evaluation of the National Community Centers of Excellence in Women’s Health (CCOE) program. The Department of Health and Human Services (DHHS) Office on Women’s Health (OWH) is conducting this evaluation. Your response is vital to helping OWH understand what community resources the CCOE programs leverage and how. Additionally, your responses will help OWH learn how services are integrated between each CCOE and their community partners.
Data gathered from this evaluation will be aggregated at a national level and the individual CCOE-level. CCOE-level information will be used for program improvement purposes. Your responses will be kept confidential.
The following topic areas are covered in this survey:
CCOE General Information
Health Service Delivery
Training Health Care Providers
Community-Based Research
Public Education and Outreach
Leadership Development
Technical Assistance
Community Awareness
Your feedback is critical in helping us obtain the necessary data that could influence future decisions about the CCOE program. It is estimated the survey will take approximately 30 to 45 minutes to complete. Please complete a working draft of this survey on paper prior to completing the actual online survey. This draft will assist you in filling out the Internet survey. (Note: You must complete the entire Internet survey at one time. Any data entered but not submitted will not be saved. Partially completed surveys cannot be accepted.)
The information you provide will be kept confidential, and will not be disclosed to anyone but the Department of Health and Human Services (DHHS) Office on Women’s Health (OWH) in the aggregate form only, except as otherwise required by law. If you have any questions on how to complete this survey please contact: Fatima Riaz at (240) 314-5675 or at 1101 Wootton Parkway, Suite 9246, Rockville, MD 20852.
Thank you in advance for your participation!
Please select your CCOE.
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Provide a demographic breakdown of CCOE patients using the categories below.
Approximately how many women are currently enrolled/served by your CCOE? _______ |
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Has CCOE participant enrollment increased/decreased since your CCOE program’s inception? ______ |
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How many intake points does your CCOE have?
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Please select the non-clinical services offered to CCOE participants that help improve access to care and other CCOE programs. Select all that apply.
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Select the language(s) spoken by the CCOE’s target population.
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What mechanisms do you have in place for quality and overall program improvement? Select all that apply.
Please provide some examples on how these mechanisms helped improve service at the CCOE. Include any suggestions or lessons learned that would be helpful for newly designated CCOE programs. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ |
Please describe how the CCOE designation has impacted your organization and its ability to provide services to women. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
If your organization has graduated from the CCOE program and is now part of the Ambassadors for Change program, please describe how your ability to provide services has changed as a result of the change in status and in funding? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Is there value to having a program with reduced funding and level of effort?
Please explain why there is or is not value to having the Ambassadors for Change program. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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For each category listed, please indicate how many full-time equivalent (FTE) non-clinical CCOE program staffs are currently dedicated to providing service to CCOE participants (e.g., 1 full-time family care coordinator = 1 FTE). Decimals are acceptable. Please provide a description of key activities for each Program Staff position in the last year, and the amount of Office on Women’s Health (OWH) funds spent annually to maintain those staff. If your organization is a part of the AFC program, please provide the same information for staff that are dedicated to the AFC and provide services to CCOE—AFC participants.
CCOE Program Staff |
# of FTEs |
Was Position created since 2003 (Y/n)? (Note: If the CCOE was established after 2003, use column to describe key activities performed by each staff position listed) |
OWH funds per year |
Example: Director |
1 |
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$65,000 |
Center Director |
$ |
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Program Coordinator |
$ |
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Office Manager |
$ |
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Family Care Coordinator |
$ |
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Health Educator |
$ |
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Medical Advisor/ Director |
$ |
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Nurse Manager |
$ |
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Research Director |
$ |
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Administrative Assistant |
$ |
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Other: ___________ |
$ |
Have the Program Staff roles evolved since 2003?
Yes
No
Not sure
If yes, how are they different than in 2003?
If no, how could staff roles change to make the CCOE more efficient and/or effective in the community?
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If your program has graduated and become part of the AFC program, can you please describe how staff roles have changed as a result of the change in status and in funding?
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If you received funding (including grants) from sponsors other than the Office on Women’s Health, please complete the following table.
Indicate funding received since the end of 2003. For each funding award indicate the month and year during which the funding was received, the name of the funding sponsor, the total funding amount, and the reason or purpose of the funding.
MONTH/YR FUNDING RECEIVED |
name of funding sponsor |
amount |
purpose for funding |
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March |
2002 |
Example: March of Dimes |
$5000 |
To conduct community based research related to folic acid |
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$ |
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$ |
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$ |
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Do you know or believe that having the CCOE grant positively influenced or contributed to the award of these funds to your program?
Yes
No
Has a written plan or goals been established for the sustainability of the CCOE programs?
Yes
No
If yes, please describe the plan and describe which components will be continued and which will not and why those decisions were made.
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Has the CCOE established local community financial support for the CCOE program?
Yes
No
If yes, please describe the types of support that are in place that will help with future sustainability of the CCOE program.
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If your program has graduated and become part of the AFC program, can you please describe whether and how your services have changed as a result of the change in status and in funding?
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For current community partners, list their name; circle the type of arrangement (such as Memorandums of Understanding (MOU), Inter-Agency Agreement (IAA), formal contract, or other formal or informal agreement); and list the point of contact’s (POC) name, address, phone number, and email address. In the last column, list the main service(s) provided by the partner.
community partner name |
type of arrangement |
POC name, address, PHONE & email
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service provided |
E
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MOU IAA Contract Other: Formal Other: Informal |
Stella Smith, 1000 Baptist Road Arlington, VA 11111 555.555.5555 |
Mammograms |
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MOU IAA Contract Other: Formal Other: Informal |
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MOU IAA Contract Other: Formal Other: Informal |
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MOU IAA Contract Other: Formal Other: Informal |
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MOU IAA Contract Other: Formal Other: Informal |
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MOU IAA Contract Other: Formal Other: Informal |
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MOU IAA Contract Other: Formal Other: Informal |
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xample:
Baptist Hospital
What has contributed to the success of your partnerships? Select all that apply:
Contract
Length of relationship
Physical location of the partner
Interpersonal relationship between coordinators
CCOE board membership and involvement
Mutual benefit to both organizations
Other, please specify ________________________
Has a written plan or goals been established for the sustainability of the CCOE partnerships?
Yes
No
If yes, please describe how partnerships will be sustained.
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If your program has graduated and become part of the AFC program, can you please describe whether and how your relationships with your partners have changed as a result of the change in status and in funding?
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If your program has graduated and become part of the AFC program, and you are sustaining any of your CCOE partnerships, what role, if any, has the contribution of funds or lack of contribution of funds from OWH played in your ability to sustain those partnerships?
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For each health professional listed, please indicate how many current full-time equivalents (FTEs) provide care to CCOE participants (e.g., part time nurse practitioner = 0.5 FTE). Decimals are acceptable. For each health professional, estimate the number of female staff and the number of multilingual staff. Please also indicate languages spoken by health professionals.
health professional |
# of FTE’s providing care |
# of female staff |
# of MULTILINGUAL staff (languages spoken) |
Example: Community Health Worker/ Outreach Worker |
5 |
4 |
1 (Spanish) |
Community Health Worker/ Outreach Worker |
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Family Physician or General Practitioner |
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Health or Peer Educator |
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Internist or Internal Medicine Physician |
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Mental Health Professional (e.g., Licensed Counselor, Psychiatrist, Psychologist, Social Worker) |
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Nurse Midwife |
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Nurse Practitioner (NP) |
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Nutritionist |
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Obstetrician or Gynecologist |
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Pediatrician |
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Physician’s Assistant (PA) |
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Registered Nurse (RN) |
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Substance Abuse Counselor |
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Other: __________________ |
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Does your clinical care center(s) have procedures for tracking women served by the CCOE program?
Yes
No
If yes, how do you track these women?
Electronic medical record system
Paper record
Stand alone database
Other: ______________________________
If yes, what types of information do you track?
Cost of services
Services rendered by CCOE
Services rendered by Partner Organizations
Non-health care services rendered by CCOE
Non-health care services rendered by Partner Organizations
CCOE patient referrals
CCOE patient referral compliance
Wellness check compliance
Number of women receiving health care services
Other: ______________________________
If you track the number of women receiving health care services, can you provide an estimate of how many women received these services in the last year? _________
If you track referrals, what percent of CCOE participants use the referrals they receive?
25% or less
26-50%
51-75%
76-100%
Not Sure
Does the CCOE utilize electronic health/medical records?
Yes
No
Do you share your patients’ clinical data with your partners (within the confines and in compliance of HIPAA and any other statute or regulation governing privacy)?
Yes
No
Please describe how health care service delivery is integrated with other components of the CCOE program?
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What are the best practices related to health service delivery provided by your CCOE? What are your lessons learned?
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What are the biggest issues or concerns related to health service delivery?
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If your program has graduated and become part of the AFC program, can you please describe whether and how your delivery of health services has changed as a result of the change in status and in funding?
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If your program has graduated and become part of the AFC program, what role, if any, has the contribution of funds or lack of contribution of funds from OWH played in your ability to sustain the delivery of health services at your organization?
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Please describe how training is integrated with other components of the CCOE program.
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
How is the CCOE program fostering interest in health sciences/service provider disciplines?
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What information or metrics does the CCOE collect regarding the impact and effectiveness of programs designed to foster interest in these disciplines? Please indicate if data is available on the metrics described. The evaluation team may request samples of data during the National Evaluation Round II: Site Visit.
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Does your CCOE track the number of individuals who go on from CCOE training to receive formal training in the health sciences/service provider disciplines?
Yes
No
If yes, can you provide an estimate of the number of women who participated in CCOE training and have gone on to receive formal training in the health sciences/service provider disciplines in the last year?
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Does your CCOE offer programs that help service providers complete their requirements for Continuing Medical Education (CMS)/Continuing Educational Units (CEU)?
Yes
No
If yes, does your CCOE track the number of providers who participate in such programming who successfully met their CMS/CEU requirements in the last year?
Yes
No
If yes, can you provide an estimate of the number of service providers who met their CMS/CEU requirements in the last year through their participation in CCOE-sponsored programming?
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What are the best practices related to implementation of training services offered by your CCOE? What are your lessons learned?
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What are the biggest issues or concerns related to implementation of training services offered?
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If your program has graduated and become part of the AFC program, can you please describe whether and your how training services have changed as a result of the change in status and in funding?
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If your program has graduated and become part of the AFC program, what role, if any, has the contribution of funds or lack of contribution of funds from OWH played in your ability to sustain training services?
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What community resources are involved in the research development process? Select all that apply.
CCOE Advisory Board
Other Advisory Board
Partner organizations
Centers of Excellence (CoE)
Patients
Other, please specify: _______________________________________________
How are research results communicated to the public? Please select all that apply.
Internet
Newspaper
Internal newsletter
Journal or magazine advertisements
Published in a journal or magazine
Television/radio
Lectures
Educational materials/brochures
During an office visit (staff or doctor communicate results)
Other, please specify: _______________________________________________
Please describe how research results are integrated into the CCOE program and/or the local community.
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What are the best practices related to implementation of community-based research activities at the CCOE? What are your lessons learned?
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What are the biggest issues or concerns related to implementation of community-based research activities at the CCOE?
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If your program has graduated and become part of the AFC program, can you please describe whether and how your community-based research activities have changed as a result of the change in status and in funding?
If your program has graduated and become part of the AFC program, what role, if any, has the contribution of funds or lack of contribution of funds from OWH played in your ability to sustain community-based research activities?
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Please describe the CCOE’s goals and/or mission statement for public education and outreach.
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What topics of interest are included in your public education and outreach program? Check all that apply:
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_________________________ |
_________________________ |
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_________________________ |
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_________________________ |
List any non-CCOE community organizations that have contributed resources (in-kind donations) to your CCOE for the production and dissemination of educational materials during the last year. Describe what the resources and/or services were. (Partners should be excluded.)
MONTH/YR DONATION RECEIVED
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Community organization
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resources/services contributed
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June |
2002 |
Kinko’s |
100 free copies of one-page brochure |
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Please rate the extent to which you agree with each of the following statements.
Educational materials distributed by the CCOE… |
Strongly Agree |
Agree |
Neither agree nor disagree |
Disagree |
Strongly Disagree |
• …are available in large font |
O |
O |
O |
O |
O |
• …are available in language(s) other than English |
O |
O |
O |
O |
O |
• …are appropriate to the reading level of the targeted audience |
O |
O |
O |
O |
O |
• …address important issues in the community |
O |
O |
O |
O |
O |
• …are geared toward prevention (i.e., smoking cessation, drug avoidance, nutrition guidance, etc.,) |
O |
O |
O |
O |
O |
• …help patients improve their health literacy |
O |
O |
O |
O |
O |
• …are aimed at empowering patients to manage their own health |
O |
O |
O |
O |
O |
Who does the CCOE partner with in conducting education and/or outreach?
Partner organizations
Non-CCOE community resources
Both
None
How does your CCOE choose health topics for education and outreach? Select all that apply.
Local health concerns/issues
National health concerns/issues (e.g., Healthy People 2010, CDC warnings)
Input from CCOE women
Partner input
CCOE staff input
Polling the local community
Other, please specify: _____________________________________________
What percentage of health topics covered through education and outreach are initiated from community input? ____%
Does your CCOE track the number of women participating in your education and outreach activities?
Yes
No
If yes, can you provide an estimate of the number of women participating in these activities over the last year? If you have estimates by type of activity participated in, please provide this information. This information will be cross referenced with information provided in your quarterly reports to OWH.
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Does your CCOE track the number of women using your resource center?
Yes
No
If yes, can you provide an estimate of the number of women who used the resource center over the last year? If you have estimates by type of resources used, please provide this information.
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Please describe how education and outreach activities are integrated with other components of the CCOE program.
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How does the CCOE measure the success of one method of outreach versus another?
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What are the top three most successful methods?
1. |
2. |
3. |
What are the best practices related to public education and outreach at the CCOE? What are your lessons learned?
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What are the biggest issues or concerns related to public education and outreach at the CCOE?
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If your program has graduated and become part of the AFC program, can you please describe whether and how your public education and outreach activities have changed as a result of the change in status and in funding?
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If your program has graduated and become part of the AFC program, what role, if any, has the contribution of funds or lack of contribution of funds from OWH played in your ability to sustain public education and outreach activities services?
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When conducting leadership, mentoring, and/or skills development activities for young girls, minorities, or women in the community what does your CCOE hope to accomplish?
Young Girls:
Minorities:
Women:
What leadership opportunities does the CCOE offer women?
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How do these activities support the promotion of minorities to leadership positions?
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Please describe the opportunities and any successes or lessons learned.
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Do other organizations, besides the CCOE and its partners, provide free or low cost leadership training and/or skills development opportunities to women in the community?
Yes
No
If yes, please describe what the opportunities are and the community organizations that provide them.
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Please describe how leadership development activities are integrated with other components of the CCOE program.
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What are the best practices related to implementation of leadership development activities at the CCOE? What are your lessons learned?
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What are the biggest issues or concerns related to implementation of leadership development activities at the CCOE?
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If your program has graduated and become part of the AFC program, can you please describe whether and how your leadership development activities have changed as a result of the change in status and in funding?
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If your program has graduated and become part of the AFC program, what role, if any, has the contribution of funds or lack of contribution of funds from OWH played in your ability to sustain leadership development activities?
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Does your CCOE provide on-going technical assistance to another community (so as to help the community replicate the CCOE model)?
Yes
No
If yes, how long (in months) has this relationship existed? ______
If you have more than one on-going relationship, list the length of time your relationship with each community has existed.
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Please describe how technical assistance activities are integrated with other components of the CCOE program.
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What are the best practices related to technical assistance activities at the CCOE? What are your lessons learned?
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What are the biggest issues or concerns related to technical assistance activities at the CCOE?
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If your program has graduated and become part of the AFC program, can you please describe whether and how your technical assistance activities have changed as a result of the change in status and in funding?
If your program has graduated and become part of the AFC program, what role, if any, has the contribution of funds or lack of contribution of funds from OWH played in your ability to sustain technical assistance activities?
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There are several mechanisms that can be used to create an awareness of the CCOE’s existence and services to the community. Please list all mechanisms your CCOE used during the last year. For each communication mechanism, list the type of topic covered, how often or the frequency of the communication mechanism, and the approximate number in the targeted audience.
communication mechanisms
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types of topics |
frequency in past year |
# in targeted audience |
Example: Newspaper |
Community Research Educational Events |
6 2 |
3000 100 |
Newspaper |
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Radio |
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Television |
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Website |
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Church relationships: (please describe) ________________ |
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Community Center relationships |
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Other: ___________________ |
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Please describe the impact or outcome of your current community awareness efforts, including any increases in service utilization.
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What are the best practices related to raising community awareness about the CCOE and its services? What are your lessons learned?
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What are the biggest issues or concerns related to raising community awareness about the CCOE and its services?
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If your program has graduated and become part of the AFC program, can you please describe whether and how your community awareness efforts have changed as a result of the change in status and in funding?
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If your program has graduated and become part of the AFC program, what role, if any, has the contribution of funds or lack of contribution of funds from OWH played in your ability to sustain community awareness efforts?
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| File Type | application/msword |
| File Title | Center Director and Program Coordinator Survey |
| Author | L. Snyder |
| Last Modified By | DHHS |
| File Modified | 2006-12-18 |
| File Created | 2006-12-18 |
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