# Sustainability Survey

## Informed Consent Form

Purpose of the Survey

The Center for Mental Health Services (CMHS) in the United States Department of Health and Human Services has sponsored a national evaluation of programs that are funded to improve community-based mental health system-of-care services for children and families. A key issue for systems of care is the ability to sustain the infrastructure and services over time, and to continue to develop and evolve after the five- or six-year federal funding cycle is completed. Observations during system-of-care assessment visits conducted as part of the national evaluation suggest that there is significant variation among grant communities in their experiences and expectations regarding the ability to maintain the services and infrastructure when federal funding ends. System leaders have also alluded to many factors that may affect the sustainability of the systems of care developed with the support of federal CMHS grants--some related to the approach used to develop and finance the system of care and some related to the larger policy context and environment in which the system of care operates.

The current study is designed to assess the potential of funded grant communities to sustain their systems of care beyond their federal grant period and to provide information that will be useful to federal and state policymakers as well as local systems of care to enhance sustainability. The study approach involves learning about sustainability from the experience of earlier grantees in order to assess the potential sustainability of the systems of care and services of newer grantees that are in earlier states of system-of-care implementation.

You are invited to participate in this study because your community has received funding to improve community-based mental health services for children and families. Your input is important to helping us understand how systems of care serve children and what works best. We are asking you to complete this Web-based survey about the children's mental health system of care in your community. The national evaluation is authorized by Section 565 of the Public Health Service Act. Here are some things we want you to know about completing the survey:

- Completion of the survey is completely voluntary.
- Completion of the survey will take approximately 45 minutes of your time.
- You may choose to cease completion of the survey at any time, for any reason.
- Your name will not be used in any reports about this survey, and no quotes will be attributed to you.
- There will be no direct benefit to you for completing the survey. The risk may be the discomfort some people feel when expressing their opinions when their names are known.
- A report that combines what is learned from all of the completed surveys will be sent to the children's mental health services program director and other program partners. They may share that report with others at their discretion.
- Any questions you have about the study at any time can be answered by ______ at ORC Macro, Atlanta, Georgia, (404) 321-3211.