PACT 360 Needs Assessment Survey Instrument

OMB Control Number: 1103­XXXX Expiration Date:

The following is a voluntary survey developed by The Partnership at Drugfree.org, in conjunction with the U.S. Department of Justice, Office of 
Community Oriented Policing Services. The purpose of this survey is to collect valuable information from law enforcement professionals in order to 
develop a training module reflecting the needs and best practices of the field when building collaborative partnerships with community 
organizations and educators to address and prevent substance abuse in teens and young adults.  

This survey is voluntary and will take approximately 10 to 15 minutes to complete. We encourage all participants to answer the questions as 
honestly as possible so that the results of the survey reflects what is really happening in your community. The goal of this survey is to provide The 
Partnership with a better understanding into the kinds of obstacles that need to be overcome in order to deliver the best substance abuse 
prevention programs. We appreciate your input, and thank you for your time. 

OMB Control Number: 1103­XXXX Expiration Date:

1. How did you hear about this survey?

2. Please check the setting in which you work NOW:
j Precinct
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n
j Jail
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j Substance Abuse Treatment
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n

j Substance Abuse Prevention
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n

j Prison
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n

j School­based setting
k
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n

j Probation/parole facility
k
l
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n

j Mental Health Clinic
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l
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n

j Other community corrections
k
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m
n
j Other (please specify)
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n

j Halfway house
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n

j Community­based program
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n

j Advocacy Agency
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n

j School
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n

3. What is the exact title of your position?

4. How old are you?
j 21­30
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j 31­40
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n

j 41­50
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n

j 51­60
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n

5. What is your gender?
j Male
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n

j Female
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n

j Over 60
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n

OMB Control Number: 1103­XXXX Expiration Date:

6. How many years have you worked in law enforcement?
j 0­2
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n

j 3­5
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n

j 6­10
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n

j 11­14
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n

j 15 or more
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n

7. Which best describes the area that you work in?
j Large city
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n

j Small/medium sized city
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n
j Suburban
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n
j Rural
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n

j Other (please specify)
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n

8. Approximately what percentage of your population is non­English speaking?
j 0­20
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n

j 21­40
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n

j 41­60
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n

j 61­80
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n

j 81­100
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n

9. What percentage of arrests in your area would you consider are related to substance
abuse in some way?
j 0­20
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n

j 21­40
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n

j 41­60
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n

j 61­80
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n

j 81­100
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n

OMB Control Number: 1103­XXXX Expiration Date:

10. Assuming you had unlimited resources, please rate the following options that you
believe would be MOST HELPFUL in preventing substance use in your community, using
a scale from 1 to 5, with 1 indicating the most helpful and 5 indicating least helpful.
1­ Most Helpful

2­ 2nd Most 

3­ 3rd Most 

4­ 4th Most 

Helpful

Helpful

Helpful

5­ Least Helpful

Arresting drug dealers

j
k
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n

j
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n

j
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n

j
k
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n

j
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n

Substance abuse prevention directly to kids

j
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n

j
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n

j
k
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n

j
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n

j
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n

Increased treatment options for individuals arrested for 

j
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n

j
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n

j
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n

j
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n

j
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n

Increasing penalties for substance use offenses

j
k
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n

j
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n

j
k
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m
n

j
k
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n

j
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n

Substance abuse prevention directly to parents

j
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n

j
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n

j
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n

j
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n

j
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n

substance use offenses

11. By contrast, based on the resources available to you please rate the following options
from 1 to 5 according to which you think would be MOST FEASIBLE/POSSIBLE or that you
think could actually be implemented to help prevent substance use in your community
with 1 being the MOST feasible/possible and 5 being the LEAST feasible/possible.
1­ Most Feasible

2­ 2nd Most 

3­ 3rd Most 

4­ 4th Most 

Feasible

Feasible

Feasible

5­ Least Feasible

Arresting drug dealers

j
k
l
m
n

j
k
l
m
n

j
k
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m
n

j
k
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m
n

j
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n

Substance abuse prevention directly to kids

j
k
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m
n

j
k
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m
n

j
k
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m
n

j
k
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m
n

j
k
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m
n

Increased treatment options for individuals arrested for 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
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m
n

Increasing penalties for substance use offenses

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
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m
n

Substance abuse prevention directly to parents

j
k
l
m
n

j
k
l
m
n

j
k
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m
n

j
k
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m
n

j
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n

substance use offenses

OMB Control Number: 1103­XXXX Expiration Date:

12. Please rate the following statements based on your level of agreement ranging from
"Strongly Agree" to "Strongly Disagree".
I am an “expert” in delivering substance abuse prevention 

Strongly Agree

Agree

Disagree

Strongly Disagree

j
k
l
m
n

j
k
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n

j
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n

j
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n

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j
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interventions.
Substance abuse prevention programs are NOT effective 
in stopping/reducing problem substance use among 
young people.
Law enforcement should play a role in delivering 
prevention programs to teens and parents.
Substance abuse prevention programs will have the 
biggest impact on reducing teen substance abuse if 
delivered by law enforcement.
Substance abuse prevention programs will have the 
biggest impact on reducing teen substance abuse if 
delivered by substance abuse prevention professionals.
Substance abuse prevention programs will have the 
biggest impact on reducing teen substance abuse if 
delivered by teachers/educators.
Our community will NOT respond to prevention programs 
if delivered by law enforcement.
A team approach to delivering substance abuse 
prevention programs will have the biggest impact on 
reducing teen substance abuse.
My agency would grant me the time to deliver a 
substance abuse prevention program to parents and 
teens.

OMB Control Number: 1103­XXXX Expiration Date:

13. Please rate the following statements based on your level of agreement ranging from
"Strongly Agree" to "Strongly Disagree".
If I was trained properly, I would want to deliver 

Strongly Agree

Agree

Disagree

Strongly Disagree

j
k
l
m
n

j
k
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n

j
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n

j
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n

j
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substance abuse prevention programs to parents and 
teens.
If I were trained properly, I would have enough time to 
devote to delivering substance abuse programs to parents 
and teens.
My agency regularly integrates new services, programs, 
and/or initiatives into our operations at this 
facility/location.
We have a high level of coordination across units, and/or 
departments when it comes to delivering services and 
programs.
We have the support we need from our community for 
important priorities, new programs, and/or initiatives for 
community problems.
We have the support we need from ORGANIZATIONS in 
the community for important priorities, new programs, 
and/or initiatives for community problems.
Delivering community based substance abuse programs 
would be consistent with the goals of my job.
Delivering community based substance abuse programs 
would be consistent with the goals of my agency.
I believe substance abuse prevention programs are a 
good way of helping reduce the onset of substance abuse 
in teens.

OMB Control Number: 1103­XXXX Expiration Date:

14. How confident are you that YOU can deliver effective substance abuse prevention
programs to parents and teens NOW.
j 1 Not 
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n

j 2
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n

j 3
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n

j 4
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j 5 
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n

j 6
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j 7
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j 8
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j 9
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j 10 
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at all 

Somewhat 

Extremely 

Confident 

Confident 

Confident 

15. Have you ever received at least a half day training on substance abuse prevention?
j No
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n

j Yes
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n

OMB Control Number: 1103­XXXX Expiration Date:

16. About how many hours of training have you received in substance abuse prevention in
your lifetime?

17. Have you ever delivered a substance abuse prevention/intervention program in your
community?
j No
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n

j Yes
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n

OMB Control Number: 1103­XXXX Expiration Date:

18. How many hours per month, if any, do you spend on substance abuse prevention
activities?
j 0
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n

j 1­3
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j 4­6
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n

j 7­10
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j 10 or More
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n

19. About how many officers do you currently have in your precinct that have been trained
in substance abuse prevention techniques?
j 0
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n

j 1­3
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n

j 4­6
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n

j 7­10
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n

j 10 or More
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n

20. What are the biggest barriers/obstacles to YOU being trained on substance abuse
prevention?
5
6  

21. What are the biggest barriers/obstacles to YOU delivering substance abuse prevention
programs to your community?
5
6  

OMB Control Number: 1103­XXXX Expiration Date:

22. To your knowledge does your agency have any relationships with substance abuse
prevention programs?
j No
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n

j Yes
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n

j I don't know
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n

23. With what types of organizations/agencies have you built the most effective
community linkages/collaborations? These can be any type of agency including those not
specific to substance abuse prevention.
j We have no community linkages/collaborations
k
l
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n

j We have linkages with the following types of organizations/agencies (Please List)
k
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n

5
6  

OMB Control Number: 1103­XXXX Expiration Date:

24. Why are these particular relationships effective in meeting the needs of your
community?
5
6  

OMB Control Number: 1103­XXXX Expiration Date:

25. Please list the agencies you have in your community that you would like to work with
or have a relationship with even if you do not at present.
5
6  

26. What are the biggest barriers/obstacles you face BETWEEN community
organizations/agencies in developing collaborations and delivering substance abuse
prevention programs to your community?
5
6  

27. Anything else??? Please write down any other comments that you think will help us
understand the best ways to deliver effective substance abuse prevention programs to
parents and teens.
5

6  
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The public reporting burden for this collection of information is estimated to be 15 minutes per response, depending upon the COPS program 
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collection of this information, including suggestions for reducing this burden to the Office of Community Oriented Policing Services, U.S. 
Department of Justice, 145 N. Street, NE, Washington, DC 20530; and to the Public Use Reports Project, Office of Information and Regulatory 
Affairs, Office of Management and Budget, Washington, DC 20503. 

You are not required to respond to this collection of information unless it displays a valid OMB Control number. The OMB Control number for this 
application is 1103­XXXX and the expiration date is MM/DD/YYYY.