Survey - Word version

Attachment G. TASII External Stakeholder Survey Instrument - Word Version.docx

Surveys of State, Tribal, Local and Territorial (STLT) Governmental Health Agencies

Survey - Word version

OMB: 0920-0879

Document [docx]
Download: docx | pdf

Form Approved

OMB No. 0920-0879
Expiration Date: 03/31/2014



Attachment - G: Survey Instrument



Technical Assistance and Service Improvement Initiative: External Stakeholder Survey

Introduction

Welcome! Thank you for agreeing to participate in the Technical Assistance and Service Improvement (TASI) Survey!

In order to provide meaningful analysis and specific recommendations to programs across CDC, please reflect ONLY on the technical assistance you receive from the CDC program project officer assigned to you for the administration and support of the following cooperative agreement or grant: [populate the CoAg name]. It will take an estimated 25–45 minutes to complete this survey, including time to read instructions and gather needed information.

Your privacy is important to us. Your responses to all questions will be kept in a secure manner and no personal identifiers will be recorded. A summary report of the findings will be prepared using aggregate data from survey responses and will be shared with CDC leadership, national partners, and CDC grantees.

Use the “Continue” button to proceed to the next question and the “Previous” button, not the “Back” button on your browser, to return to an earlier response. While completion of the survey in one session is strongly recommended, you can save responses and restart the survey. Partially completed surveys can be restarted for up to 2 weeks after you initially begin the survey.

Respondent Information

  1. Are you the primary point of contact for the CDC project officer assigned to this program? {Filter question}

Shape1

० Yes go to 2

Shape2

० No go to 1a

1a. Since findings from this survey will inform ongoing cross-agency and program specific efforts to meet grantees’ expectations and technical assistance needs, it is important to collect information regarding the technical assistance provided by CDC directly from the primary point of contact for the CDC project officer. Please assist us in facilitating this data collection effort by providing the contact information for primary point of contact for this program.

Last Name

First Name

Email address

Position Title





Thank you! We appreciate your support and assistance. {End Survey}

  1. How long have you worked in this program? {Numeric value}

  2. How long have you worked with the current project officer assigned to this program? {Numeric value}

  3. How many project officers have been assigned to work with you in this program over the past 2 years? {Numeric value}


Technical Assistance Delivery and Organizational Support

Please indicate the extent to which you agree or disagree with each of the following statements about the funding opportunity announcement (FOA) or program announcement (PA) for your program.

Funding Opportunity Announcements

Strongly Disagree

Disagree

Agree

Strongly Agree

Not Sure

  1. Overall, the FOA/PA clearly defines program expectations

o

o

o

o

o

  1. Overall, the FOA/PA clearly defines the goals of the program and related activities

o

o

o

o

o

  1. Overall, the goals and expectations of the FOA/PA are consistent throughout the performance period

o

o

o

o

o

  1. An adequate amount of input from grantees is used to inform the development of a new or continuation FOA/PA

o

o

o

o

o

  1. Which service delivery model best describes how you receive technical assistance from your current CDC project officer for this cooperative agreement?

Primarily through my project officer—Technical assistance requests are submitted to my project officer, who facilitates or coordinates obtaining the answer(s).

Team approach— A team of CDC subject matter experts, including my project officer, routinely responds to technical assistance requests and needs. Routine contact (e.g., monthly conference calls) is coordinated by the project officer and usually includes the CDC subject matter experts.

I typically rely on someone other than my CDC project officer (e.g., partner organization such as NACCHO or ASTHO) to meet my technical assistance needs.

Other, please specify: ____________________

Shown below is a list of content or topic areas commonly supported through technical assistance. For each topic area, please identify who typically or most often provides technical assistance or support directly to you.

Topic / Content Area

CDC Project Officer / Program Consultant

PGO

CDC Field Assignee

CDC Subject Matter Expert

National Partner

(e.g., ASTHO, NACCHO, PIHOA, CSTE)

Other

  1. Budget or fiscal management

o

o

o

o

o

o

  1. Program-specific guidance (e.g., program planning, development, or management)

o

o

o

o

o

o

  1. Program performance improvement or evaluation

o

o

o

o

o

o

  1. Detailed scientific information

o

o

o

o

o

o

  1. Training or capacity building

o

o

o

o

o

o

  1. How often are conference calls conducted by your current CDC project officer?

Never

Weekly

Monthly

Quarterly

Other, please specify:

  1. The number of conference calls conducted by my current CDC project officer is:

Insufficient

Sufficient

Too many



  1. What is the total number of onsite visits conducted or planned by your current CDC project officer for the current performance period? {Numeric Value}

  2. The number of onsite visits conducted by my CDC project officer is:

Insufficient

Sufficient

Too many

Please rate your satisfaction level with the following characteristics of technical assistance provided by your current CDC project officer for this program.

Characteristic

Extremely Unsatisfied

Unsatisfied

Satisfied

Extremely Satisfied

Not Sure

NA

  1. Responsiveness of my CDC project officer to emails and phone calls

o

o

o

o

o

  1. Usefulness of conference calls conducted by my CDC project officer

o

o

o

o

o

20a. [If 20 = “Extremely Unsatisfied” or “Unsatisfied”] How could conference calls be improved? {Alphanumeric – 500 characters}

  1. Usefulness of site visits conducted by my CDC project officer

o

o

o

o

o

21a. [If 21 = “Extremely Unsatisfied” or “Unsatisfied”] How could site visits be improved? {Alphanumeric – 500 characters}

  1. Coordination between PGO and my CDC project officer

o

o

o

o

o

  1. Accuracy of information provided by my CDC project officer

o

o

o

o

o

  1. Utility of the information provided by my CDC project officer

o

o

o

o

o

  1. Consistency of information provided by project officers within and across CDC-funded grants or cooperative agreements

o

o

o

o

o

  1. Overall, how well does the technical assistance provided by your current CDC project officer meet your needs?

Never meets my needs

Occasionally meets my needs

Usually meets my needs

Always meets my needs

  1. How have changes or turnover of your CDC project officer assigned to oversee this cooperative agreement impacted your program?

I have not experienced any changes or turnover with my CDC project officer

No impact

Minimal negative impact

Moderate negative impact

Significant negative impact

Minimal positive impact

Moderate positive impact

Significant positive impact

Not sure

27a. [If ”Minimal”, “Moderate”, or “Significant”] Please provide a brief description of how the reassignment or turnover of your CDC project officer has impacted your program. {Alphanumeric - 500 characters}







Please indicate the extent to which you agree or disagree with each of the following statements about the following Internet resources available to you for your program.

Item

Strongly Disagree

Disagree

Agree

Strongly Agree

Not Sure

  1. The State, Tribal, Local, and Territorial Public Health Professionals Gateway provides useful information about CDC policies, tools, and other resources relevant to my program

o

o

o

o

o

  1. I know where to find useful information about CDC policies, staff or subject matter experts, tools, and other resources on the webpages specific for this program.

o

o

o

o

o

  1. Please provide any recommendations for additional resources or tools that CDC should make available to grantees. (optional) {Alphanumeric – 500 characters}

Rate your level of satisfaction with the following reporting requirements for this cooperative agreement.

Reporting Requirements

Extremely Unsatisfied

Unsatisfied

Satisfied

Extremely Satisfied

Not Sure

  1. Clarity of the progress reporting requirements

o

o

o

o

o

  1. Feasibility of data collection and progress reporting

o

o

o

o

o

  1. Utility of the information collected

o

o

o

o

o

  1. Burden level of the data collection and progress reporting requirements

o

o

o

o

o

  1. Type and frequency of feedback received related to my program’s performance

o

o

o

o

o

31a-35a If you responded “Extremely Unsatisfied” or “Unsatisfied”, please provide any specific reasons for this rating. (optional) {Alphanumeric – 500 characteristics}

Project Officer Characteristics and Competencies

Please rate the extent to which you agree or disagree that the following attitudes or character traits are demonstrated by your current CDC project officer.

The project officer that I work with:

Strongly Disagree

Disagree

Agree

Strongly Agree

Not Sure

  1. Exhibits passion about and commitment to the program

o

o

o

o

o

  1. Demonstrates respect for me and my organization as an important partner

o

o

o

o

o

  1. Is trustworthy and reliable

o

o

o

o

o

  1. Demonstrates cultural sensitivity

o

o

o

o

o

  1. Demonstrates integrity and ethical standards

o

o

o

o

o

  1. Demonstrates political “acumen,” tact, and diplomacy

o

o

o

o

o

  1. Works collaboratively with me and others in the program

o

o

o

o

o

  1. Builds rapport with key stakeholders in my organization or jurisdiction

o

o

o

o

o

  1. Allows my organization to determine how we achieve the program’s goals and objectives

o

o

o

o

o

  1. Balances the interests and needs of my organization or program with the interests and needs of CDC

o

o

o

o

o

  1. Is an effective and knowledgeable representative of CDC

o

o

o

o

o

  1. Responds to our goals and needs with flexibility

o

o

o

o

o

  1. Moves my program forward in accomplishing or exceeding program goals and objectives

o

o

o

o

o

A list of skills, knowledge and abilities organized and grouped by content area / domain are presented in this next section of questions. Please indicate how important the knowledge, skill, or ability is for your CDC project officer to demonstrate in order for you to successfully implement the cooperative agreement AND your satisfaction with your current CDC project officer’s application or demonstration of the knowledge, skill, or ability.

Importance


Level of Satisfaction

How important is this knowledge, skill, or ability for your CDC project officer to demonstrate?


What is your level of satisfaction with your CDC project officer’s application or demonstration of this knowledge, skill, or ability?

Not Important / Not Applicable

Somewhat Important

Important

Very Important


Extremely Unsatisfied

Unsatisfied

Satisfied

Extremely Satisfied

Communication

  1. Verbally expresses ideas, expectations, concerns, and recommendations in a clearly organized manner

o

o

o

o


o

o

o

o

  1. Expresses ideas, expectations, concerns, and recommendations clearly in written business documents

o

o

o

o


o

o

o

o

  1. Expresses ideas, expectations, concerns, and recommendations clearly in written scientific documents

o

o

o

o


o

o

o

o

  1. Applies communication and group dynamic strategies (e.g., principled negotiation, conflict resolution, active listening, risk communication) in interactions

o

o

o

o


o

o

o

o

  1. If you scored your level of satisfaction as “Extremely Unsatisfied” or “Unsatisfied” for any of the above items, please explain why. (Optional) {Alphanumeric –750 characters}

Grant Administration and Management

  1. Educates and advises on CDC’s grant application process in general

o

o

o

o


o

o

o

o

  1. Educates and advises on program-specific grant goals, standards and expectations

o

o

o

o


o

o

o

o

  1. Advises on budget preparation and monitors the fiscal management of grant funds

o

o

o

o


o

o

o

o

  1. Educates and supports on the use of CDC information management systems or other reporting tools and resources

o

o

o

o


o

o

o

o

  1. If you scored your level of satisfaction as “Extremely Unsatisfied” or “Unsatisfied” for any of the above items, please explain why. (optional) {Alphanumeric –750 characters}








Public Health Applied Sciences and Knowledge

  1. Demonstrates basic knowledge of scientific and/or clinical terminology and relevant disease etiology that are applicable to my program

o

o

o

o


o

o

o

o

  1. Applies basic public health sciences (including, but not limited to biostatistics, epidemiology, social and behavioral health sciences) to my program activities

o

o

o

o


o

o

o

o

  1. Advises and knowledgably discusses evidence-based strategies or interventions that may be appropriate for my program

o

o

o

o


o

o

o

o

  1. Explains and/or discusses how CDC and public health policies impact my program

o

o

o

o


o

o

o

o

  1. Explains and/or discusses how CDC’s or the division’s strategic plans impact my program

o

o

o

o


o

o

o

o

  1. Explains and/or discusses how public health laws impact my program

o

o

o

o


o

o

o

o

  1. If you scored your level of satisfaction as “Extremely Unsatisfied” or “Unsatisfied” for any of the above items, please explain why. (optional) {Alphanumeric –750 characters}

Program Planning and Development

  1. Assists in designing programs that address the identified risks or needs of my program’s target population(s)

o

o

o

o


o

o

o

o

  1. Advises or assists with strategic program planning by integrating emerging trends of the fiscal, social, and political environments into program design

o

o

o

o


o

o

o

o

  1. Advises on how to incorporate CDC’s public health products or other national public health-related initiatives (e.g., public health accreditation, CDC Winnable Battles, National Prevention Strategy) into program activities

o

o

o

o


o

o

o

o

  1. Advises or assists in developing program activities, strategies, or interventions that are culturally competent or sensitive for my program

o

o

o

o


o

o

o

o

  1. If you scored your level of satisfaction as “Extremely Unsatisfied” or “Unsatisfied” for any of the above items, please explain why. (optional) {Alphanumeric –750 characters}




Program Management

  1. Develops recommendations to resolve concerns related to program operations

o

o

o

o


o

o

o

o

  1. Applies strategies for organizing tasks, as well as the resources needed, to achieve programmatic goals and prioritizes key action steps

o

o

o

o


o

o

o

o

  1. Coordinates with appropriate CDC subject matter experts or other national partners to provide technical assistance and capacity building support

o

o

o

o


o

o

o

o

  1. Identifies appropriate public health education and training to ensure that CDC-funded health agency staff possess the necessary skills and resources for program success while being sensitive to the local political and fiscal constraints (e.g., travel restrictions)

o

o

o

o


o

o

o

o

  1. If you scored your level of satisfaction as “Extremely Unsatisfied” or “Unsatisfied” for any of the above items, please explain why. (optional) {Alphanumeric –750 characters}

Program Monitoring and Improvement

  1. Provides guidance related to methods and instruments for collecting valid and reliable quantitative and qualitative data for my program

o

o

o

o


o

o

o

o

  1. Routinely monitors and/or evaluates work plan activities and objectives and provides meaningful guidance or TA to improve program performance

o

o

o

o


o

o

o

o

  1. Assesses program outcomes using required progress reports (e.g., Interim/Mid-Year Progress Report) to provide useful feedback on program performance

o

o

o

o


o

o

o

o

  1. Conducts monitoring and/or evaluation activities of standardized or program performance measures and uses the findings to guide program improvement activities

o

o

o

o


o

o

o

o

  1. Applies organizational and system-wide strategies for continuous quality improvement

o

o

o

o


o

o

o

o

  1. If you scored your level of satisfaction as “Extremely Unsatisfied” or “Unsatisfied for any of the above items”, please explain why. (optional) {Alphanumeric –750 characters}


Organizational Consultation

  1. Informs decision makers within my organization and state about the importance of my program

o

o

o

o


o

o

o

o

  1. Represents the needs, concerns, or suggestions from my program to CDC leadership

o

o

o

o


o

o

o

o

  1. Collaborates and coordinates with other CDC field staff assigned to my organization or agency

o

o

o

o


o

o

o

o

  1. Creates knowledge exchange or networking opportunities with other jurisdictions or states implementing similar programs or facing similar issues or circumstances

o

o

o

o


o

o

o

o

  1. Assists in the development of successful cross-agency, jurisdictional, sector relationships

o

o

o

o


o

o

o

o

  1. Identifies non-CDC tools or resources (financial and non-financial) relevant to program activities

o

o

o

o


o

o

o

o

  1. Identifies and analyzes problems, and generates solutions

o

o

o

o


o

o

o

o

  1. If you scored your level of satisfaction as “Extremely Unsatisfied” or “Unsatisfied” for any of the above items, please explain why. (optional) {Alphanumeric –750 characters}

  1. Please list any other knowledge, skills, and abilities that are important for project officers to have in order to effectively provide technical assistance and capacity building support for your program. (optional) {Alphanumeric – 1250 characters}

  2. Please provide your recommendations for how CDC can improve the delivery of technical assistance to grantees. (optional) {Alphanumeric – 750 characters}

  3. Please provide any additional comments or thoughts about CDC’s delivery of technical assistance and support to your program. (optional) {Alphanumeric – 500 characters}

You have successfully completed this survey. We appreciate the time and effort you took to provide your feedback, which is vital to CDC’s improvement efforts.

Thank you!

A summary report of the findings will be prepared using aggregate data from survey responses; responses will not be linked to individual respondents. This report will be shared with all survey participants, CDC leadership, national partners, and CDC-funded grantees.

Public reporting burden of this collection of information is estimated to average 35 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D- 74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879).

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