Form Survey and Letters Survey and Letters Survey and Letters

Attachment 1: Initial Invitation

Dear Community Members,

 

Congratulations on completing your New Community TA Visit!  I hope that the information, resources and strategies will prove to be beneficial to you in your system of care role.

 

The Technical Assistance Partnership for Child and Family Mental Health (TA Partnership) would like to hear from you regarding the effectiveness of the New Community TA Visit planning process and implementation.  Please click on the link [survey link] to be taken to a survey where you can share feedback about the visit with the TA Partnership. The TA Partnership will use this information to examine the current visit planning process, purpose, and procedures, and recommend changes to enhance the activity’s effectiveness and efficiency.

 

Please complete the form as soon as possible and no later than [date].  

 

Thank you very much in advance for your feedback.  If you have any questions, please feel free to contact me at [email protected] or (202) 403-5575.

Attachment 2: NCTAV Survey

OMB No. 0930-0197

Expiration Date: 01/31/11

New Community Technical Assistance Visit Quality Improvement Survey

Public Burden Statement: 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 control number for this project is 0930-0197.  Public reporting burden for this collection of information is estimated to average 10 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 8-1099, Rockville, Maryland, 20857.

Purpose:
This survey solicits your feedback on the planning, implementation, and follow-up of the New Community Technical Assistance (TA) Visit.  The Technical Assistance Partnership for Child and Family Mental Health (TA Partnership) will use this information to examine the current visit planning process, purpose, and procedures and recommend changes to enhance the effectiveness and efficiency of this activity. 

Directions:
Please respond to the questions openly and honestly to provide information about activities that went well during your New Community TA Visit and activities that could be improved.  We are asking the principal investigator, project director, TA coordinator, clinical director, family lead, youth coordinator, cultural and linguistic competence coordinator, social marketer, and evaluator from each community (if these roles exist in the community) to complete the form.  If you are the community’s principal investigator or project director, we encourage you to ask these staff members to complete this survey.

Conditions of Privacy:
Your completion of this survey is voluntary and the TA Partnership will protect your identity to the extent possible.  Only a handful of staff of the TA Partnership will have access to your individual responses – any TA Partnership staff who participated on this visit will not have access to individual responses. The TA Partnership will summarize the responses for your site and revise any recommendations and comments that may reveal the identities of respondents.  The TA Partnership will send an aggregate summary of the results (not individual survey responses) to the New Community TA Visit Team, and TA Partnership senior management.  We appreciate your time and effort providing this needed and valuable feedback.

For more information about this survey, you may contact Ivonn Ellis-Wiggan of the TA Partnership at 202.652.2390 or [email protected].  If you have concerns or questions about your rights as a participant in this activity, you can contact the American Institute for Research’s Institutional Review Board (which is responsible for the protection of project participants) by email at [email protected], or by phone toll free at 1-800-634-0797 or mail c/o IRB, 1000 Thomas Jefferson Street, NW, Washington, DC 20007. 

Survey

1. Planning

A. How effective was the planning process for the New Community TA Visit to your community?

1 = Not at all

2 = A little

3 = Somewhat

4 = Quite a bit

5 = A great deal

6 = Unable to rate

B. To what extent were staff from your system of care initiative involved in coordinating the planning process?

1 = Not at all

2 = A little

3 = Somewhat

4 = Quite a bit

5 = A great deal

6 = Unable to rate

C. Did staff from your system of care and national TA provider staff (i.e. TA Coordinator, Content Specialist, etc.) use the System of Care Implementation Self Assessment (Self-Assessment) to guide the development of the visit agenda?

1 = Yes

2 = No  If NO, skip to Section II.

3 = Don’t know  If DON’T KNOW, skip to Section II

D. How helpful was the Self-Assessment in identifying your community’s technical assistance needs?

1 = Not at all

2 = A little

3 = Somewhat

4 = Quite a bit

5 = A great deal

E. How helpful was the Self-Assessment in developing your community’s New Community TA Visit agenda?

1 = Not at all

2 = A little

3 = Somewhat

4 = Quite a bit

5 = A great deal

F. Please list your recommendation(s) to improve the planning process and (or) planning materials.

II. The New Community TA Visit Team

1. How well did the New Community TA Visit Team address the needs of your system of care initiative? (e.g., complete understanding of its strengths and the challenges)?

1 = Not at all

2 = A little

3 = Somewhat

4 = Quite a bit

5 = A great deal

6 = Unable to rate

2. To what extent were staff from your system of care involved in selecting the membership of your New Community TA Visit Team?

1 = Not at all

2 = A little

3 = Somewhat

4 = Quite a bit

5 = A great deal

6 = Unable to rate

3. To what extent did the New Community TA Visit Team membership align with the needs of your system of care initiative?

1 = Not at all

2 = A little

3 = Somewhat

4 = Quite a bit

5 = A great deal

6 = Unable to rate

4. Please rate how much you agree with each of the following statements:

• The New Community TA Visit Team conducted the visit in a respectful manner (e.g., visitors were respectful of staff including family members and youth).

1 = Not at all

2 = A little

3 = Somewhat

4 = Quite a bit

5 = A great deal

6 = Unable to rate

• The New Community TA Visit Team conducted the visit in a culturally and linguistically competent manner.

1 = Not at all

2 = A little

3 = Somewhat

4 = Quite a bit

5 = A great deal

6 = Unable to rate

• The New Community TA Visit Team conducted the visit in a family-friendly manner (limited the use of acronyms and jargon, used family inclusive language).

1 = Not at all

2 = A little

3 = Somewhat

4 = Quite a bit

5 = A great deal

6 = Unable to rate

• The New Community TA Visit Team conducted the visit in a youth-friendly manner (limited the use of acronyms and jargon, used youth inclusive language).

1 = Not at all

2 = A little

3 = Somewhat

4 = Quite a bit

5 = A great deal

6 = Unable to rate

5. Please list any recommendation(s) that would improve the New Community TA Visit Team and their work with a system of care initiatives like yours.

III. The New Community Visit

1. Please rate how much you agree with each of the following statements:

• The New Community TA Visit Team worked with members of my community to set a date and time for the visit that was most beneficial to my community

1 = Strongly disagree

2 = Disagree

3 = Neither disagree nor agree

4 = Agree

5 = Strongly agree

6 = Unable to rate

• The New Community TA Visit team worked with members from my community to develop an agenda that included TA needs identified in advance (through Self-Assessment process) of the visit.

1 = Strongly disagree

2 = Disagree

3 = Neither disagree nor agree

4 = Agree

5 = Strongly agree

6 = Unable to rate

• The New Community TA Visit supported my community’s understanding of Year One grant requirements.

1 = Strongly disagree

2 = Disagree

3 = Neither disagree nor agree

4 = Agree

5 = Strongly agree

6 = Unable to rate

• During the visit, the New Community TA Visit Team worked with my community to discuss community strengths and needs to develop

initial strategies, and identify TA resources to support those strategies.

1 = Strongly disagree

2 = Disagree

3 = Neither disagree nor agree

4 = Agree

5 = Strongly agree

6 = Unable to rate

• The New Community TA Visit provided my community with the opportunity to introduce your community partners to the resources and supports available from the TA Partnership and other national TA providers (i.e. Communications Campaign, Georgetown, Federation of Families, etc.).

1 = Strongly disagree

2 = Disagree

3 = Neither disagree nor agree

4 = Agree

5 = Strongly agree

6 = Unable to rate

2. Please list any recommendation(s) that would improve the New Community TA Visit for system of care initiatives like yours.

IV. New Community TA Visit Activities

1. Was the schedule of activities appropriate (i.e. did it include a family meeting, youth meeting)?

2. Was enough time allotted for each activity?

3. How well did the visit activities allow key staff and stakeholders to contribute meaningfully to the discussions?

1 = Not at all

2 = A little

3 = Somewhat

4 = Quite a bit

5 = A great deal

6 = Unable to rate

V. Other Comments

1. Please share any recommendations or comments that you would like to offer.

2. If applicable, list the visit’s benefits to you and your colleagues.

3. List any activities that you believe could be improved.

4. Please share any recommendations you have to improve this survey.

Attachment 3: Reminder Email

Dear Community Members,

 

This is a reminder that the deadline for completing the New Community TA Visit Survey is today.  If you have not already done so, please complete the form by the end of the day today.  

Please click on the link [survey link] to be taken to the survey. The Technical Assistance Partnership for Child and Family Mental Health will use this information to examine the current visit planning process, purpose, and procedures, and recommend changes to enhance the effectiveness and efficiency of these visits.

 

Thank you very much for your feedback.  If you have any questions, please feel free to contact me at [email protected] or (202) 403-5575.

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