State of the States Survey (SOTS)

Attachment C – Core VIPP Evaluation

Form Approved
OMB No. 0920-0916
Exp. Date:
Public Reporting burden of this collection of information is estimated at 3 hours per response, including the time for reviewing instructions,
research exiting 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 Reports Clearance Officer, 1600 Clifton Road NW, MS D-74, Atlanta, GA 30333; Attn:
PRA (0920-0916).

Federal Fiscal Year (FFY) 2013

State of the States (SOTS) Part 2: Core
Components with BIC Capacity Indicator Module
INTRODUCTION
Thank you for taking the time to complete the Federal Fiscal Year (FFY) 2013 State of the States (SOTS) Part 2: Core
Components. This questionnaire will be administered bi-annually to help describe the infrastructural capacity of injury and
violence prevention programs nationwide.
This questionnaire will specifically ask you about your program’s financial and staffing infrastructure in FFY 2013 (October 1,
2012 – September 30, 2013).
We know your time is valuable. Therefore, this questionnaire has been pre-populated with information you reported in
previous administrations of the State of the States (SOTS) surveys. The URL provided below is unique to your state, and
depending on the size and breadth of your program, it will take approximately 3 hours to complete this questionnaire.
PLEASE COMPLETE AND SUBMIT YOUR QUESTIONNAIRE BY FRIDAY, FEBRARY 28, 2014.
Most data collected will be presented in aggregate. If you have any questions about the questionnaire, please email
[email protected]. Thank you again for your contribution to this important initiative.
INSTRUCTIONS
The 2013 State of the States asks for information about several capacity-related aspects of your state's injury and/or
violence prevention program in Federal Fiscal Year (FFY) 2013, including:
•
•
•
•
•
•

Program infrastructure;
Funding;
Strategic plans;
Partnerships and collaborations;
Data; and
Programs and interventions.

Please answer the questions based on the status of your program in Federal Fiscal Year (FFY) 2013 (October 1, 2012 –
September 30, 2013).
There are two (2) ways to complete the questionnaire:
1.
Complete the entire questionnaire online through QuestionPro.
2.
Complete the questionnaire in hard copy first, then enter all responses online through QuestionPro.
If you cannot use one of these two methods to complete the survey, please email [email protected].

TIPS FOR COMPLETING THE QUESTIONNAIRE
•
•

•

•

Review the hard copy of the questionnaire. You may find it helpful to first review the hard copy of the questionnaire in
order to gather all necessary information before completing the questionnaire online.
Save your responses and complete the questionnaire over several days. Your responses are saved by page when you
click on the "save and continue later" button at the bottom of each page in the questionnaire. Question Pro will
administer a new link for you to continue the questionnaire. You can re-access the questionnaire by using the new
emailed link from any computer. If you try to exit the survey without saving your responses, you will have to start over
from the beginning.
Coordinate the completion of the questionnaire amongst your staff. You may want to distribute portions of the
questionnaire to appropriate staff members who are most knowledgeable about topics addressed in that section of the
questionnaire
Complete whole sections at a time. There are several sections of the survey that contain special skip logic called
“extraction.” In these sections, you must complete all of the questions before you can save your responses and/or exit
the survey.

CONTACT INFORMATION
REMINDER – While this survey is being implemented in 2014, all questions should be answered based on the status of your
program in Federal Fiscal Year (FFY) 2013 (October 1, 2012 – September 30, 2013).
First, please provide your contact information in case there are any questions when the Safe States Alliance analyzes the
information and data you provide. Contact information will not be included in the analysis or reporting of questionnaire data.

1. In which state is the injury and/or violence prevention (IVP) program located?
1. AL
2. AK
3. AZ
4. AR
5. CA
6. CO
7. CT
8. DE
9. FL
10. GA
11. HI
12. ID
13. IL
14. IN
15. IA
16. KS
17. KY
18. LA
19. ME
20. MD
21. MA
22. MI
23. MN
24. MS
25. MO
26. MT
27. NE
28. NV
29. NH
30. NJ
31. NM
32. NY
33. NC
34. ND
35. OH
36. OK
37. OR
38. PA
39. RI
40. SC
41. SD
42. TN
43. TX
44. UT
45. VT
46. VA
47. WA
48. WV
49. WI
50. WY

2. Please provide the first and last name, title/position, email address, and telephone number for the contact person
for this survey.
Name (First and Last)
Title/Position:
Phone Number
Email Address

DESCRIPTION OF STATE PROGRAM: PROGRAM LOCATION
The next set of questions focuses on the infrastructure of the states injury and/or violence prevention program (IVP
program).
3. Is the state IVP program located within the state health department?
1. Yes
2. No
4. Which best describes the structure of your state’s IVP program and activities? [SELECT ONLY ONE]
1. My state has an identified IVP program AND it is primarily or solely responsible for IVP program activities.
2. My state has an identified IVP program BUT the IVP program activities are decentralized throughout the health
department. Multiple programs are responsible for different aspects of injury and/or violence prevention. [skip to #8]
3. My state does NOT have an identified IVP program AND the IVP program activities are decentralized throughout the
health department. Multiple programs are responsible for different aspects of injury and/or violence prevention. [skip to
#8]
4. Other (please specify) _______ [skip to #8]
5. In what division/organizational unit are the identified IVP activities PRIMARILY located?
1. Health promotion/ disease prevention/ community health/ behavioral health
2. Epidemiology
3. Maternal child health/family health
4. Emergency Medical Services (EMS)
5. Environmental health
6. Other (please specify) __________________________________________________
[skip to #10]

6. In what division(s)/organizational unit(s) are ANY IVP activities located? [SELECT ALL THAT APPLY]
1. Health promotion/ disease prevention/ community health/ behavioral health
2. Epidemiology
3. Maternal child health/family health
4. Emergency Medical Services (EMS)
5. Environmental health
6. Other (please specify) __________________________________________________
7. In what division/organizational unit are the IVP activities PRIMARILY located? If you have an identified IVP program,
please select the division/organizational unit where the IVP program is located. [SELECT ONLY ONE]
1. Health promotion/ disease prevention/ community health/ behavioral health
2. Epidemiology
3. Maternal child health/family health
4. Emergency Medical Services (EMS)
5. Environmental health
6. Other (please specify) __________________________________________________
8. The IVP PROGRAM addresses:
1. Unintentional injuries only
2. Intentional injuries only
3. Both unintentional and intentional injuries

STATE MANDATE
9. Is there a state mandate (legislative or budgetary) for a comprehensive injury and/or violence prevention program (IVP
program) (i.e., Is there a mandate for a complete program and not only a specific AREA of injury and violence prevention
such as child passenger safety)?
1. Yes
2. No
3. Don’t know
10. You indicated in the previous question that your state has a mandate (legislative or budgetary) for a comprehensive
injury and/or violence prevention program (IVP program). 13. Is this mandate funded?
1. Yes
2. No
3. Don’t Know

DESCRIPTION OF STATE PROGRAM: IVP PROGRAM DIRECTOR
The next set of questions focuses on the infrastructure of the states injury and/or violence prevention program (IVP
program).
11.In FFY 2012, did the state IVP program have a director?
1. Yes, Full-time (e.g., 40+ hours a week) [Go to #2.]
2. Yes, Part-time (e.g., less than 40 hours a week) [Go to #2.]
3. NO [Go to #6.]
12. Now we would like to ask about the work experience of the state IVP program director. How many years and months has the state IVP
program director...
Year(s)
Month(s) Enter zero (0) if you are only entering years.
worked in his or her current position?
worked in the field of injury and violence prevention?
worked in the field of public health?
13. What was the highest level of education completed by the state IVP program director? (select one)
1. High School Diploma
2. Associate’s Degree
3. Bachelor’s degree
4. Graduate
5. Don’t Know
14.What injury-specific trainings and/or certifications has the state IVP program director completed? (Check all that apply).
1. No trainings/certifications: The state IVP program director has not completed any injury-specific trainings and/or certifications
2. At least one graduate-level course in injury and/or violence prevention
3. A graduate-level training program in injury and/or violence prevention (e.g., University of Washington Graduate Certificate in
Global Injury and Violence Prevention, University of Iowa Occupational Injury Prevention Program, MS/MPH/PhD with a focus on
an area of injury prevention, etc.)
4. A university-affiliated training program/fellowship, (e.g., Johns Hopkins Summer Institute, Preventing Violence through
Education, Networking, and Technical Assistance (PREVENT) training / University of North Carolina, etc.)
5. Training program/fellowship sponsored by a professional association (e.g., Safe States Alliance “Injury Prevention 101”
Self-Study Training, etc.)
6. Training program/fellowship sponsored by a federal government agency (e.g. Indian Health Service Injury Prevention Courses,
etc.)
7. The World Health Organization/Education Development Center TEACH IVP E-Learning Curriculum (one or more lessons)
8. Child Passenger Safety Technician
9. EMS professional (e.g., EMT, Paramedic, etc.)
10. Certified Health Education Specialist (CHES)
11. Certified in Public Health (CPH)
12. Registered Nurse (RN)
13. Please explain:

STATE PLANS
CAUTION: The questions in this section use a special skip logic called extraction. You must complete all of the questions
in this section before you can save your responses and/or exit the survey. There are a total of six (6) questions in this
section. You will need approximately 5-10 minutes to complete this section. If you do NOT have 5-10 minutes to dedicate
to completing this section, please save now and continue later. If you would like to continue with the survey, you must
complete all of the questions in this section before you can save your responses and/or exit the survey.
The next set of questions addresses the existence and use of strategic plans for injury and violence prevention in the state
during FFY 2013. By strategic plans, we mean any document used to guide injury and/or violence prevention efforts. There
are four types of strategic plans that we will ask you about:
1. Statewide Health Plan– A statewide plan produced by multiple state agencies; this plan includes multiple health
issues that may include chronic diseases, infectious disease, injury, violence and more.
2. State Injury and Violence Prevention Plan– A statewide plan produced by multiple agencies that only includes
health issues surrounding injury and violence
3. Health Department Strategic Plan – A strategic plan produced by multiple departments and units within the health
department; this plan includes multiple health issues that may include chronic diseases, infectious disease, injury,
violence and more.
4. Health Department Injury and Violence Prevention Plan– A health department strategic plan produced by Injury
and Violence Prevention program that only includes health issues surrounding injury and violence
CAUTION: Once you click “Continue” to submit your answer(s) the question below, you will NOT be able to change your response. The answer(s) you select for this question
will control the response options provided in subsequent questions. Therefore, please take care and be certain when selecting your response(s), as you will NOT be able to
change your answer(s) after this point.

15. Please indicate which of the following plans exist for your STATE and/or State Health Department during FFY 2013.
Yes
In FFY 2013
No
Don’t Know
we were
developing a
plan.
Statewide Health Plan
State Injury and Violence Prevention Plan
Health Department Strategic Plan
Health Department Injury and Violence Prevention Plan

16. You indicated in the previous question that there was a Statewide Health Plan and/or State Injury and Violence
Prevention Plan. Please select the option that best describes how injury and violence prevention is included within the plan.
Yes, IVP topics were specifically
included in the plan.

No, IVP topics were NOT
specifically included in the plan

Don’t Know

Statewide Health Plan
Health Department Strategic Plan

GO TO 10

17. You indicated that specific IVP topics were included in your health department strategic plan. Please select the IVP topics that were
included in the state health department strategic plan.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

All Terrain Vehicle (ATV) injury
Child abuse/neglect
Child passenger safety
Domestic/intimate partner
violence
Elder Abuse
Fall injuries
Fire and burns injury
Firearm injury
Homicide
Mass trauma/disaster-related

11. Motor vehicle injury
12. Motorcycle/motorized scooter
injury
13. Occupational injury
14. Pedestrian injury
15. Poisoning
16. Rural/agricultural injury
17. School-based injury
18. Sexual assault/rape
19. Spinal cord injury (SCI)
20. Submersion injuries/drowning

21.
22.
23.
24.
25.

Suicide/self-inflicted
Suicide attempts
Teen Dating Violence
Traumatic brain injury (TBI)
Other

PARTNERSHIPS AND COLLABORATION
CAUTION: The questions in this section use a special skip logic called extraction. You must complete all of the questions
in this section before you can save your responses and/or exit the survey. There are a total of twelve (12) questions in this
section. You will need approximately 30-45 minutes to complete this section. If you do NOT have 30-45 minutes to
dedicate to completing this section, please save now and continue later. If you would like to continue with the survey, you
must complete all of the questions in this section before you can save your responses and/or exit the survey.

PARTNERSHIPS/COLLABORATION WITHIN THE STATE HEALTH DEPARTMENT
Please indicate how the IVP program worked with other offices WITHIN the state health department in FFY 2013 to address
injuries and violence. A broad name of each office is listed below because each state names their offices differently. Please
select the name that most accurately reflects the group you are working with. For example, if your state office is called
mental health and substance abuse, but you are working with your substance abuse colleagues – please select substance
abuse and not both substance abuse and mental health. If there is overlap in offices (i.e. disease preventative medicine is
considered to be the same as health promotion/education/community health), answer the questions for only one of the
offices and choose N/A for the other office. If no other partnership exists for options Other #1 -#5, please select N/A - Agency
does not exist.
CAUTION: Once you click “Continue” to submit your answer(s) the question below, you will NOT be able to change your response. The answer(s) you select for this question
will control the response options provided in subsequent questions. Therefore, please take care and be certain when selecting your response(s), as you will NOT be able to
change your answer(s) after this point.

18. Indicate the strength of partnership with the following health department office.
Strong
New and
Needs
Relationship N/A - Agency
Developing Improvement does not exist does not exist
Aging
Alcohol/Drug Addiction/ Substance Abuse
Chronic Disease
Disease Prevention/ Preventative Medicine
Emergency Medical Services (EMS) or EMS for
Children
Emergency Preparedness
Environmental Health
Epidemiology
Health Promotion/ Education/ Community Health
Maternal & Child Health
Mental Health
Nursing Services
Occupational Health
School Health
Sexual Health
Vital Statistics
HIV/AIDS/ Viral Hepatitis
Adolescent Health
Other #1
Other #2
Other #3
Other #4
Other #5

19. Please indicate the manner in which your IVP Program partnered/collaborated with that division/unit by checking which
types of collaboration is applicable to this partnership (shared data, actively involved in IVP planning, programs, etc.)
XTR

Is
Shared Data Actively Collaborat Collaborat IVP
IVP
Collaborat
IVP
N/A
there
involved in ed on
ed on program program
ed for
program
an
IVP
evaluation communic Provided Received
Policy Provided or
legal
program activities
ation
Funding Funding
Received
agree
planning
activities
TO
FROM
Training/
ment
and/or
Technical

(e.g.
MOU)
?

implement
ation

Assistance

Aging
Alcohol/Drug Addiction/
Substance Abuse
Chronic Disease
Disease Prevention/
Preventative Medicine
Emergency Medical
Services (EMS) or EMS for
Children
Emergency Preparedness
Environmental Health
Epidemiology
Health Promotion/
Education/ Community
Health
Maternal & Child Health
Mental Health
Nursing Services
Occupational Health
School Health
Sexual Health
Vital Statistics
HIV/AIDS/ Viral Hepatitis
Adolescent Health
Other #1
Other #2
Other #3
Other #4
Other #5

20. Please indicate on the sliding bar how well integrated your program activities are with this division/unit. Click here for the
definition of INTEGRATION.
XTR
Not at all
Somewhat
Strongly
integrated
integrated
integrated
Aging
Alcohol/Drug Addiction/ Substance Abuse
Chronic Disease
Disease Prevention/ Preventative Medicine
Emergency Medical Services (EMS) or EMS for Children
Emergency Preparedness
Environmental Health
Epidemiology
Health Promotion/ Education/ Community Health
Maternal & Child Health
Mental Health
Nursing Services
Occupational Health
School Health
Sexual Health
Vital Statistics
HIV/AIDS/ Viral Hepatitis
Adolescent Health
Other #1
Other #2
Other #3
Other #4
Other #5

21. If you selected other in the previous question, please list the office/unit in the space provided.
Other #1
Other #2
Other #3
Other #4
Other #5

PARTNERSHIPS/COLLABORATION WITH OTHER STATE AGENCIES
Please indicate how the IVP program worked with other offices OTHER STATE AGENCIES in FFY 2013 to address injuries
and violence. A broad name of each agency is listed below because each state names their agencies differently. Please
select the name that most accurately reflects the group you are working with. If no other partnership exists for options Other
#1 -#5, please select N/A - Agency does not exist.
CAUTION: Once you click “Continue” to submit your answer(s) the question below, you will NOT be able to change your response. The answer(s) you select for this question
will control the response options provided in subsequent questions. Therefore, please take care and be certain when selecting your response(s), as you will NOT be able to
change your answer(s) after this point.

22. Indicate the strength of partnership with the following State Agencies.
Strong
New and
Needs
Relationship N/A - Agency
Developing Improvement does not exist does not exist
Attorney General’s Office
Child Welfare Agencies
Criminal Justice/ Law Enforcement
Education
Elder Affairs/Aging
Fire Department/ Fire Marshall
Highway Safety
Labor
Mental Health
State Universities
Department of Transportation
Other #1
Other #2
Other #3
Other #4
Other #5

23. Please indicate the manner in which you partner/collaborate with that agency by checking which types of collaboration is
applicable to this partnership (shared data, actively involved in IVP planning, programs, etc.)
XTR

Attorney General’s
Office
Child Welfare
Agencies
Criminal Justice/
Law Enforcement
Education
Elder Affairs/Aging
Fire Department/

Is there Share
Actively
Collaborate Collaborated
IVP
IVP Collaborate
IVP
an legal d Data involved in
d on
on
program program d for Policy program
agreeme
IVP program evaluation communicatio Provide Receive
Provided
nt (e.g.
planning
activities
n activities
d
d
or
MOU)?
and/or
Funding Funding
Received
implementatio
TO
FROM
Training/
n
Technical
Assistanc
e

N/A

Fire Marshall
Highway Safety
Labor
Mental Health
State Universities
Department of
Transportation
Other #1
Other #2
Other #3
Other #4
Other #5
24. If you selected other in the previous question, please list the agency(ies) in the space provided.
Other #1
Other #2
Other #3
Other #4
Other #5

PARTNERSHIPS/COLLABORATION WITH NON-GOVERNMENTALORGANIZATIONS
Please indicate how the IVP program worked with other offices NON-GOVERNMENTAL ORGANIZATIONS in FFY 2013 to
address injuries and violence. A broad name of each agency is listed below because each state names their agencies
differently. Please select the name that most accurately reflects the group you are working with.
CAUTION: Once you click “Continue” to submit your answer(s) the question below, you will NOT be able to change your response. The answer(s) you select for this question
will control the response options provided in subsequent questions. Therefore, please take care and be certain when selecting your response(s), as you will NOT be able to
change your answer(s) after this point.

25. Indicate the strength of partnership with the following non-governmental organizations. If no other partnership exists for
options Other #1 -#5, please select N/A - Agency does not exist.
Strong
New and
Needs
Relationship
N/A - Agency
Developing Improvement does not exist does not exist
Academic Institutions (other than state
universities)
American Red Cross chapters
Brain Injury Association
Businesses
Children’s Safety Network
Consumer groups
Healthcare associations
Injury Control Research Centers (ICRC)
Metropolitan Planning Organizations (MPOs)
Mothers Against Drunk Drivers (MADD)
Students Against Destructive Decisions (SADD)
Safe Kids Coalitions (state and/or local)
Safety Council
Safe Communities Coalitions
Sports associations
PTA’s
Religious organizations
Youth-serving organizations (YMCA, etc.)
Other #1
Other #2
Other #3

Other #4
Other #5
26. Please indicate the manner in which you partner/collaborate with that organization by checking which types of
collaboration is applicable to this partnership (shared data, actively involved in IVP planning, programs, etc.)
XTR

Is there Shared Actively Collaborate Collaborate
IVP
IVP
Collabora
IVP
an legal Data involved
d on
d on
program program ted for program
agreeme
in IVP evaluation communica Provided Received Policy Provided
nt (e.g.
program activities
tion
Funding Funding
or
MOU)?
planning
activities
TO
FROM
Received
and/or
Training/
implemen
Technical
tation
Assistanc
e

N/A

Academic Institutions
(other than state
universities)
American Red Cross
chapters
Brain Injury Association
Businesses
Children’s Safety Network
Consumer groups
Healthcare associations
Injury Control Research
Centers (ICRC)
Metropolitan Planning
Organizations (MPOs)
Mothers Against Drunk
Drivers (MADD)
Students Against
Destructive Decisions
(SADD)
Safe Kids Coalitions (state
and/or local)
Safety Council
Safe Communities
Coalitions
Sports associations
PTA’s
Religious organizations
Youth-serving
organizations (YMCA, etc.)
Other #1
Other #2
Other #3
Other #4
Other #5
27. If you selected other in the previous question, please list the non-governmental department/agency/organization in the
space provided.
Other #1
Other #2
Other #3
Other #4
Other #5

PARTNERSHIPS/COLLABORATION WITH NON-STATE GOVERNMENTALORGANIZATIONS
Please indicate how the IVP program worked with other offices NON-STATE GOVERNMENTAL ORGANIZATIONS (i.e.
governmental agencies that are not at the state level) in FFY 2013 to address injuries and violence. If no other partnership
exists for options Other #1 -#5, please select N/A - Agency does not exist.
CAUTION: Once you click “Continue” to submit your answer(s) the question below, you will NOT be able to change your response. The answer(s) you select for this question
will control the response options provided in subsequent questions. Therefore, please take care and be certain when selecting your response(s), as you will NOT be able to
change your answer(s) after this point.

28. Indicate the strength of partnership with the following non-state governmental organizations.
Strong
New and
Needs
Relationship
Developing Improvement does not exist
Administration on Aging
Centers for Disease Control and Prevention
(CDC)
Federal Highway Administration (FHA)
Health Resources and Services Administration
(HRSA)
Indian Health Service (IHS)
Local Health Departments
National Highway Traffic Administration (NHTSA)
Substance Abuse and Mental Health Services
Administration (SAMHSA)
Other #1
Other #2
Other #3
Other #4
Other #5

N/A - Agency
does not exist

29. Please indicate the manner in which you partner/collaborate with that organization by checking which types of
collaboration is applicable to this partnership (shared data, actively involved in IVP planning, programs, etc.)
XTR

Administration on Aging
Centers for Disease
Control and Prevention
(CDC)
Federal Highway
Administration (FHA)
Health Resources and
Services Administration
(HRSA)
Indian Health Service
(IHS)
Local Health
Departments
National Highway Traffic
Administration (NHTSA)
Substance Abuse and
Mental Health Services
Administration

Is there Shared Actively Collaborat Collabor
IVP
IVP
Collabora
IVP
an legal
Data
involved
ed on
ated on program program ted for program
agreeme
in IVP evaluation commun Provided Received Policy Provided
nt (e.g.
program activities ication Funding Funding
or
MOU)?
planning
activities
TO
FROM
Received
and/or
Training/
implemen
Technical
tation
Assistanc
e

N/A

(SAMHSA)
Other #1
Other #2
Other #3
Other #4
Other #5
30. If you selected other in the previous question, please list the non-state governmental department/agency/organization in
the space provided.
Other #1
Other #2
Other #3
Other #4
Other #5

DATA

CAUTION: The questions in this section use a special skip logic called extraction. You must complete all of the questions
in this section before you can save your responses and/or exit the survey. There are a total of five (5) questions in this
section. You will need approximately 20-30 minutes to complete this section. If you do NOT have 20-30 minutes to
dedicate to completing this section, please save now and continue later. If you would like to continue with the survey, you
must complete all of the questions in this section before you can save your responses and/or exit the survey.
The next questions focus on the availability and use of datasets useful to injury and violence prevention. Please specify the
access and use of the following datasets in the state during 2013. We want to know if the dataset was accessed or used in
2013 (the data can be from any year, not necessarily 2013).
CAUTION: Once you click “Continue” to submit your answer(s) the question below, you will NOT be able to change your response. The answer(s) you
select for this question will control the response options provided in subsequent questions. Therefore, please take care and be certain when selecting your
response(s), as you will NOT be able to change your answer(s) after this point.
This section asks about your program’s access to and use of various datasets.

31. What datasets did the state IVP program have access to in FFY 2012?
1. NONE
2. Addiction and Mental Health Surveys
3. Behavioral Risk Factor Surveillance System (BRFSS)
4. Child Death Review (CDR)
5. Emergency Department (ED) data
6. Emergency Medical Services (EMS) data
7. Fatality Analysis Reporting System (FARS)
8. Hospital Discharge Data (HDD)
9. Medical Examiner
10. Motor Vehicle Traffic Records
11. National Emergency Medical Services Information
System (NEMSIS)
12. National Intimate Partner and Sexual Violence Survey

13.
14.
15.
16.
17.
18.
19.
20.
21.
22.

(NISVS)
National Occupant Protection Use Survey (NOPUS)
National Violent Death Reporting System (NVDRS)
Nationwide Emergency Department Sample (NEDS)
Pregnancy Risk Assessment Monitoring System
(PRAMS)
Prescription Drug Monitoring Program
Uniform Crime Reporting System (UCR)
Vital Records
Web-based Injury Statistics Query and Reporting
System (WISQARS)
Youth Risk Behavior Surveillance System (YRBSS)
Other

You indicated in the previous question that the following datasets are available and your program had access to
them.
32. Please indicate how you used each dataset to identify IVP topics or populations. (Check all that apply)
To identify
To identify a
To identify specific To identify risk
topic-specific geographic region population groups and/or protective
injury and
where an injury or that are affected by factors associated
violence issues violence issue is an injury or violence with an injury or
occurring
issue
violence issue
Addiction and Mental Health Surveys
Behavioral Risk Factor Surveillance System (BRFSS)
Child Death Review (CDR)
Emergency Department (ED) data
Emergency Medical Services (EMS) data
Fatality Analysis Reporting System (FARS)
Hospital Discharge Data (HDD)
Medical Examiner
Motor Vehicle Traffic Records
National Emergency Medical Services Information System
(NEMSIS)
National Intimate Partner and Sexual Violence Survey (NISVS)
National Occupant Protection Use Survey (NOPUS)
National Violent Death Reporting System (NVDRS)
Nationwide Emergency Department Sample (NEDS)
Pregnancy Risk Assessment Monitoring System (PRAMS)
Prescription Drug Monitoring Program
Uniform Crime Reporting System (UCR)
Vital Records
Web-based Injury Statistics Query and Reporting System

(WISQARS)
Youth Risk Behavior Surveillance System (YRBSS)

33. How did the program use data / information from this dataset?
Make
programmatic
decisions
(11b)

Evaluate
progress
related to a
program or
policy

Communicate
Create
Respond to Don’t know
key findings to
scientific
data
reports or
requests
partners and
presentations
the public

Addiction and Mental Health Surveys
Behavioral Risk Factor Surveillance
System (BRFSS)
Child Death Review (CDR)
Emergency Department (ED) data
Emergency Medical Services (EMS)
data
Fatality Analysis Reporting System
(FARS)
Hospital Discharge Data (HDD)
Medical Examiner
Motor Vehicle Traffic Records
National Emergency Medical Services
Information System (NEMSIS)
National Intimate Partner and Sexual
Violence Survey (NISVS)
National Occupant Protection Use
Survey (NOPUS)
National Violent Death Reporting
System (NVDRS)
Nationwide Emergency Department
Sample (NEDS)
Pregnancy Risk Assessment
Monitoring System (PRAMS)
Prescription Drug Monitoring Program
Uniform Crime Reporting System
(UCR)
Vital Records
Web-based Injury Statistics Query and
Reporting System (WISQARS)
Youth Risk Behavior Surveillance
System (YRBSS)

34. How did the state IVP program use surveillance data to address the FFY 2012 BIC focus areas? (Check all that apply)
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To inform program or policy development
To track/monitor program or policy implementation
To inform evaluations of programs or policies
To assess costs of injury problems
To analyze cost implications of interventions (program or policy)

DATA REPORTS
35 Did the state IVP program use surveillance data of any kind to produce any of the following? (Check all that apply).
1. The state IVP program did NOT develop any data reports or summaries. [Go to #17.]
2. Fact sheets about injury generally or specific injury problems for the public and/or policy makers
3. Presentations/posters at conferences and workshops
4. Publications in peer-reviewed journals
5. Publications in print media (e.g., newspapers)
6. Technical reports
7. Other

36. For which of the following focus areas did the state IVP program produce any summary reports? Check all that apply.
• All Terrain Vehicle (ATV) injury
• Homicide
• School-based injury
• Child abuse/neglect
• Mass trauma/disaster-related
• Sexual assault/rape
• Child passenger safety
• Motor vehicle injury
• Spinal cord injury (SCI)
• Domestic/intimate partner
• Motorcycle/motorized scooter
• Submersion injuries/drowning
violence
injury
• Suicide/self-inflicted
• Elder Abuse
• Occupational injury
• Suicide attempts
• Fall injuries
• Pedestrian injury
• Teen Dating Violence
• Fire and burns injury
• Poisoning
• Traumatic brain injury (TBI)
• Firearm injury
• Rural/agricultural injury
37. To whom were the reports and/or summaries disseminated? (Check all that apply.)
1. Reports and/or summaries were NOT disseminated [Go to #17.]
2. Federal agencies
3. Injury Community Planning Group (ICPG) members
4. Injury Control Research Centers (ICRCs) or other academic centers
5. IVP programs in other states
6. Local public health departments
7. Non-governmental agencies
8. Other state agencies
9. Other state health department divisions
10. To subscribers of peer-reviewed publications
11. Other stakeholders
38. Were any next steps/action items identified in the reports and/or summaries produced?
1. NO
2. YES

PREVENTION STRATEGIES & EVALUATION
CAUTION: The questions in this section use a special skip logic called extraction. You must complete all of the questions in this section before you can
save your responses and/or exit the survey. There are a total of four (4) questions in this section. You will need approximately 20-30 minutes to complete
this section. If you do NOT have 20-30 minutes to dedicate to completing this section, please save now and continue later. If you would like to continue
with the survey, you must complete all of the questions in this section before you can save your responses and/or exit the survey.
CAUTION: Once you click “Continue” to submit your answer(s) the question below, you will NOT be able to change your response. The answer(s) you
select for this question will control the response options provided in subsequent questions. Therefore, please take care and be certain when selecting your
response(s), as you will NOT be able to change your answer(s) after this point.

This question attempts to assess the level of effort the state IVP program gives to each injury/violence topic area, and
whether the effort is led by or located within the state IVP program.
39. Please indicate if each injury/violence topic area was primary, secondary, or tertiary or minimal areas of focus for
the IVP Program in FFY 2013. **Multiple areas of primary or secondary focus are allowed.
Primary
Secondary
Tertiary or
Did not address in
Focus
Focus
Minimal Focus
FFY 2013
on this topic
All Terrain Vehicle (ATV) Injury
Child Abuse/Neglect

Child Passenger Safety
Domestic/Intimate Partner Violence
Drowning/Submersion Injury
Elder Abuse
Fall Injuries
Fire and Burn Injury
Firearm Injury
Homicide
Mass Trauma/Disaster
Motor Vehicle Injury
Motorcycle/Motorized Scooter Injury
Occupational Injury
Pedestrian Injury
Poisoning
Rural/Agricultural injury
School-based Injury
Sexual Assault/Rape
Spinal Cord Injury (SCI)
Suicide/Self-inflicted Injury
Suicide Attempts
Teen Dating Violence
Traumatic Brain Injury (TBI)
Youth Violence (including bullying and
interpersonal violence among youth)
You indicated in the previous question that the following IVP topic areas were primary areas of focus in FFY 2013.
40. Please select how the IVP program determined that the following areas of focus were primary. Choose all that apply.
XTR

All Terrain Vehicle (ATV) Injury
Child Abuse/Neglect
Child Passenger Safety
Domestic/Intimate Partner Violence
Drowning/Submersion Injury
Elder Abuse
Fall Injuries
Fire and Burn Injury
Firearm Injury
Homicide
Mass Trauma/Disaster
Motor Vehicle Injury
Motorcycle/Motorized Scooter Injury
Occupational Injury
Pedestrian Injury
Poisoning
Rural/Agricultural injury
School-based Injury
Sexual Assault/Rape
Spinal Cord Injury (SCI)
Suicide/Self-inflicted Injury
Suicide Attempts
Teen Dating Violence
Traumatic Brain Injury (TBI)

Data
(Local,
State, or
National)

Funding
directives

Needs
assessment

Political
influence

State
mandates

Other

Youth Violence (including bullying
and interpersonal violence among
youth)
41. For each of your primary areas of focus, please indicate the datasets you used to inform your work in FFY 2013. Choose
all that apply. (DOUBLE EXTRACTION)

Other

YRBSS

WISQARS

Vital
Records

Crime
Reporting
System
(UCR)
PRAMS
NEDS

NVDRS
NOPUS

NISVS
NEMSIS
Motor
Vehicle
Traffic
Records

Medical
Examiner

HDD
FARS

EMS
ED

CDR

BRFSS

Addiction
and Mental
Health
Surveys

NONE

All Terrain Vehicle
(ATV) Injury
Child Abuse/Neglect
Child Passenger
Safety
Domestic/Intimate
Partner Violence
Drowning/Submersio
n Injury
Elder Abuse
Fall Injuries
Fire and Burn Injury
Firearm Injury
Homicide
Mass
Trauma/Disaster
Motor Vehicle Injury
Motorcycle/Motorized
Scooter Injury
Occupational Injury
Pedestrian Injury
Poisoning
Rural/Agricultural
injury
School-based Injury
Sexual Assault/Rape
Spinal Cord Injury
(SCI)
Suicide/Self-inflicted
Injury
Suicide Attempts
Teen Dating Violence
Traumatic Brain Injury
(TBI)
Youth Violence
(including bullying and
interpersonal violence
among youth)

42. Thinking about each of your primary areas of focus in FFY 2013, please indicate if the IVP program was involved in
initiating/enacting or continuing/enforcing any of the following program or policy strategies in FFY 2013.
Topic Area

Strategy

Child Abuse/Neglect

Early childhood
home visitation
program (e.g.,
Nurse-Family
Partnership)
Education and skill
enhancement
programs for
parents and
caregivers (e.g.,
Triple P Program)
Pool safety policies
(e.g., fencing)
Smoke alarm
installation and
maintenance
program
Residential
sprinkler policy
(based on
International
Residential Code)
School-based teen
dating violence
program
School-based teen
dating violence
policy
Alcohol-impaired
driving policies
(e.g., BAC,
minimum legal
drinking age,
sobriety
checkpoints,
ignition interlocks,
etc.)
Bicycle helmet
policy
Child
restraint/booster
seat policy for
children up to age 8
Child safety seat
distribution program
Complete Streets
policy (state statute
or state DOT
organizational
policy)

Drowning/Submersion
Injury
Fire and Burn Injury

Domestic/Intimate
Partner Violence

Motor Vehicle Injury
(Also includes child
passenger safety,
motorcycle and bicycle
safety, and)

Yes, this
strategy was
initiated or
enacted in
FFY 2013

Yes, this strategy
was continued or
enforced in FFY
2013

No, because
this strategy
ended or was
repealed in
FFY 2013

No, because this
strategy was not
addressed by the
state IVP program
in FFY 2013

































































































Fall Injuries

Poisoning

Suicide/self-inflicted
Injury

Traumatic Brain Injury
(TBI)
Youth Violence
(including bullying and
interpersonal violence
among youth)

Distracted driving
policies (e.g., bans
on cell phone use,
etc.)
Graduated Driver
Licensing (GDL)
policy
Motorcycle helmet
policy
Primary seat belt
policy
Exercise-based fall
prevention program
(e.g., Tai Chi, Otago
Exercise Program)
Home modification
program (e.g.,
Falls-HIT Program)
Multifaceted fall
prevention program
(e.g., Stepping On)
Policy that
establishes
commissions,
coalitions, and
programs for fall
prevention
Prescription Drug
Monitoring Program
(PDMP)
Other prescription
drug-related
policies (e.g., doctor
shopping laws, pain
management clinic
oversight, etc.)
School-based
suicide prevention
program
Emergency room or
primary care
screening
intervention
School-based
sports concussion
policy
Anti-bullying policy
(statewide)

















































































































School-based
bullying prevention
program (e.g.,
Olweus Bullying
Prevention
Program)









School-based
conflict
resolution/social









skills enhancement
program
Community-based
violence
interruption and
social norms
change program
(e.g., Cure
Violence)









43. Please indicate your level of program planning, evaluation, and reporting for each of your selected primary areas of
focus.
XTR

All Terrain Vehicle (ATV) Injury
Child Abuse/Neglect
Child Passenger Safety
Domestic/Intimate Partner
Violence
Drowning/Submersion Injury
Elder Abuse
Fall Injuries
Fire and Burn Injury
Firearm Injury
Homicide
Mass Trauma/Disaster
Motor Vehicle Injury
Motorcycle/Motorized Scooter
Injury
Occupational Injury
Pedestrian Injury
Poisoning
Rural/Agricultural injury
School-based Injury
Sexual Assault/Rape
Spinal Cord Injury (SCI)
Suicide/Self-inflicted Injury
Suicide Attempts
Teen Dating Violence
Traumatic Brain Injury (TBI)
Youth Violence (including bullying
and interpersonal violence
among youth)

IVP does IVP program
IVP
IVP
IVP
IVP
IVP
N/A
NOT have a
has an
program program program
program
program
written formal implementati addresse has an
collects
collects disseminate
implementatio on plan to
outcome s evaluation
s this evaluatio process
n plan
address this area in a n plan for evaluation evaluation findings to
area
data to
data to stakeholder
state plan this area
update or update or
s
change the change the
program/ program/
policy
policy
activities
activities

44. For which topic area(s) does your IVP program have funding allocated specifically to support project/program
evaluation? Select all that apply.
1. NONE
2. All Terrain Vehicle (ATV) injury
3. Child abuse/neglect
4. Child passenger safety
5. Domestic/intimate partner
violence
6. Elder Abuse
7. Fall injuries
8. Fire and burns injury
9. Firearm injury
10. Homicide
11. Mass trauma/disaster-related
12. Motor vehicle injury
13. Motorcycle/motorized scooter
injury
14. Occupational injury
15. Pedestrian injury
16. Poisoning
17. Rural/agricultural injury
18. School-based injury
19. Sexual assault/rape
20. Spinal cord injury (SCI)
21. Submersion injuries/drowning
22. Suicide/self-inflicted
23. Suicide attempts
24. Teen Dating Violence
25. Traumatic brain injury (TBI)

BIC STATES: Will go through question 17-26 for each focus area.
NON-BIC FUNDED STATES: Will go through questions 17-22 only ONCE; will not go through
questions 23-26.
1. In FFY 2012, what types of evaluations did the state IVP program conduct for any strategy related to Drowning/submersion injuries?
The state IVP program The state IVP program was An evaluation plan for this The state IVP program did
completed this
in the process of
type was developed, but NOT have an evaluation plan
evaluation type in FFY completing this evaluation evaluation activities were or evaluation activities for this
2012.
type in FFY 2012.
not started in FFY 2012.
type in FFY 2012
Outcome evaluation
Process evaluation
Formative evaluation
2. For the outcome evaluations completed or that were in the process of being completed in FFY 2012, did any evaluation findings result
in policy/programmatic improvements within Drowning/submersion injuries?
1. YES, staff reviewed the evaluation findings AND made policy/programmatic changes
2. Staff reviewed evaluation findings, BUT DID NOT make policy/programmatic changes
3. NO, staff DID NOT review evaluation findings or make any policy/programmatic changes

3. For the outcome evaluations completed or are in the process of being completed, what types of methodologies or approaches did the
state IVP program use for Drowning/submersion injuries? (Check all that apply)
1. Surveys/Questionnaires
2. Experimental studies (e.g., RCT)
3. Quasi-experimental studies (e.g., Time Series/Analysis)
4. Interviews
5. Focus Groups
6. Participant Observation
7. Document Reviews
8. Other (please explain)
4. In FFY 2012, what types of evaluation reports and/or summaries were produced? (Check all that apply)
1. The state IVP program did NOT develop any evaluation reports or summaries [Go to #23.]
2. Article in a newsletter and/or regular communication
3. Final report to funder
4. Internal or informal report
5. Presentation during webinar/conference call
6. Posters at conferences and workshops
7. Presentations at conferences and workshops
8. Publications in peer-reviewed journals
9. Summary reports including data and narrative information
10. Other: please specify
5. To whom were the reports and/or summaries disseminated? (Check all that apply.)
1. Reports and/or summaries were NOT disseminated [Go to #23.]
2. Federal agencies
3. Injury Community Planning Group (ICPG) members
4. Injury Control Research Centers (ICRCs) or other academic centers
5. IVP programs in other states
6. Local public health departments
7. Non-governmental agencies
8. Other state agencies
9. Other state health department divisions
10. Through peer-reviewed publications
11. Other (Please specify)
6. Were any next steps/action items identified from the reports?
1. NO
2. YES

Below is a list of partners that were included in your most recent Annual Progress Report (APR) to address Drowning/submersion
injuries.
•
agencies in top 10 counties for drowning deaths for children 1 4

7. Please review this list and confirm if the list is complete and representative of your partnerships for this Focus Area in FFY 2012:
1. YES, this is a complete list. [Go to # 24.]
2. NO, this is not a complete list: [Go to i]
i. Please enter in the name of the partners that are not represented in the list above. Also, please note here if one or more of
the partners listed above should be removed from the list.
Additional Partners

Partners to be Removed

8. Thinking about all of your partners for Drowning/submersion injuries, please list up to three (3) that would be considered key or
most important partners in FFY 2012.
Partner #1:
Partner #2:
Partner #3:

9. Still thinking about the key partners identified in the previous question that supported your work in Drowning/submersion injuries,
please tell us what types of assistance your partner organizations provided in FFY 2012. (Check all that apply)
Partner #1 Partner #2

Partner #3

Provided funding to support state IVP staff for program planning, implementation, and/or
evaluation
Provided funding to support state IVP staff for data collection and/or analysis
Dedicated staff (in-kind) to assist with program planning/implementation
Loaned or purchased facilities or meeting space
Provided safety equipment for dissemination (e.g., smoke alarms, gun locks)
Provided access to key target population(s)
Provided contacts with other partners for fundraising efforts
Conducted programs/interventions for target population(s)
Provided access to experts to train/support state IVP staff
Collaborated on policy (e.g., policy development, policy implementation, advocacy, etc.)
Provided access to a dataset
Assisted with implementing evaluation activities (plan development, data collection, and/or data
analysis)
Assisted with disseminating evaluation results
Assisted with communication activities (e.g., dissemination/promotion of activities through
mailings/listservs, development of printed materials, etc.)
Other
10. Thinking about the time and resources necessary to work in the focus area of Drowning/submersion injuries, please select the
description from the list below that most accurately describes your work with partners for this Focus Area: (Choose one)
1. The state IVP program is the primary program implementer
2. The state IVP program and one or more of its partners are equal collaborators in program implementation
3. One or more partners are the primary program implementers

HEALTH IMPACT ASSESSMENT
45. In FFY 2013, was your state IVP program involved in the implementation of a Health Impact Assessment (HIA)?
1. Yes
2. No
46. Please provide 1-2 sentences describing the focus of the HIA.

47. In what way(s) did your IVP program participate in the implementation of the HIA? Select all that apply.
1. Shared data
2. Helped create the HIA proposal
3. Actively participated in planning and implementation activities
4. Coordinated and involved partner agencies
5. Collaborated for policy related to the HIA
6. IVP program provided funding to implement the HIA
7. IVP program received funding to implement the HIA
8. Provided training/technical assistance
9. Other (please specify) __________________________________________________

SUPPORT FOR LOCAL PREVENTION EFFORTS
The next set of questions focuses on how the state IVP program provides support for local injury and violence prevention
efforts. This includes both funding and in-kind support to local health departments, community based organizations, etc.

48. In FFY 2013, did the IVP program provide any funding or in-kind support for local injury/violence prevention activities?
1. Yes
2. No
49. Please check all methods used by the IVP program in FFY 2013 to provide funding and/or in-kind support for local
prevention efforts. Please check all that apply.
1. Mini-grants
2. Supplies/equipment (i.e. car seats, smoke alarms)
3. In-kind support for technical assistance
4. In-kind support for training
5. In-kind support for epi/data
6. In-kind support for program development
7. In-kind support for evaluation
8. Other (please specify) __________________________________________________
50. What sources of funding did the IVP program use to provide resources to local injury and violence prevention efforts in
FFY 2013? Please check all that apply.
1. Pass-through funds (i.e. RPE, etc)
2. Preventive Health & Human Services Block Grant funds
3. Other federal funds (i.e. smoke detector grant funds, etc)
4. State funds
5. Other (please specify) __________________________________________________

TRAINING AND TECHNICAL ASSISTANCE
This section focuses on communication, technical assistance and training efforts conducted by the state injury and/or
violence prevention program (IVP program) in FFY 2013.

51. What methods did the IVP program use in FFY 2013 to provide technical assistance and training to partners, grantees,
and others engaged in injury and violence prevention? Please check ALL that apply.
1. None
6. Conducted distance learning via satellite, video
2. Offered practical experience for students
conference, or video tape
3. Responded to requests for technical assistance
7. Conducted distance learning via computer
4. Offered courses for academic credit or CEUs
(internet based, webcast, or CD-ROM)
5. Conducted in-person training (workshops,
8. Other (please specify)
conference sessions, presentations, etc)
52. To what types of stakeholders did you provide technical assistance and training in FFY 2013? Technical assistance can
include trainings, resources, one-on-one assistance, etc. Check all that apply.
1. Businesses
2. Foundations
3. Injury Community Planning Group (ICPG) members
4. Staff from local/community-based organizations
5. Staff from local public health departments
6. Staff from other state agencies
7. Staff from other state health department divisions
8. Staff from university/academic institutions, including Injury Control Research Centers (ICRCs)
9. State IVP program staff in other states
10. Students (undergraduate, graduate, or doctoral)
11. Other (please specify)
53. On what topic area(s) did you provide technical assistance or training in FFY 2013? Check all that apply.
1. Coalition building and collaboration
2. Data collection, analysis, reporting, and quality improvement
3. Communication (e.g., storytelling, media interviews, framing techniques, etc.)
4. Evaluation methods and processes
5. Policy and legislation
6. Program strategies and interventions (e.g., child passenger safety technician training, etc.)
7. Management and leadership strategies (e.g., performance improvement, accreditation, etc.)
8. Social determinants of health
9. Other (please specify)
54. In FFY 2013, from what types of organizations or entities did you receive technical assistance? Technical assistance
can include trainings, resources, one-on-one assistance, etc. Check all that apply.
1. Businesses
10. Other national organizations (e.g., Safe Kids
2. Federal agencies (e.g., CDC, HRSA, NHTSA,
Worldwide, Prevention Institute, etc.)
SAMHSA, etc.)
11. Other state agencies (e.g., DOT, Aging, etc.)
3. Foundations
12. Other state health department divisions
4. Injury Control Research Centers (ICRCs)
13. Peer-to-peer (e.g., one-on-one with other state
5. Internet
IVP directors)
6. Local/community-based organizations
14. Regional Networks
7. Local public health departments
15. Safe States Alliance
8. Membership associations other than Safe States
16. STAT (team members or report for your state)
Alliance (e.g., APHA, SAVIR, etc.)
17. University/Academic Institutions (Other than
9. National resource centers (e.g. CSN, SPRC or
ICRCs)
CDR)
18. Other (please specify)
55. On what topic area(s) did you receive technical assistance or training in FFY 2013? Check all that apply.
1. Coalition building and collaboration
2. Data collection, analysis, reporting, and quality improvement
3. Communication (e.g., storytelling, media interviews, framing techniques, etc.)
4. Evaluation methods and processes

5.
6.
7.
8.
9.

Policy and legislation
Program strategies and interventions (e.g., child passenger safety technician training, etc.)
Management and leadership strategies (e.g., performance improvement, accreditation, etc.)
Social determinants of health
Other (please specify)

56. In what ways did your IVP program use the NTI Core Competencies for Injury and Violence Prevention? (Check all that
apply.)
1. My state IVP program did not use the NTI Core Competencies
2. To inform staff performance plans
3. Training or workshops for state IVP program staff
4. Trainings or workshops for local partners (e.g., local health departments, local organizations, etc.)
5. To develop job descriptions
6. Other (please specify)

POLICY
This section of the questionnaire addresses how the IVP program worked to inform public policy during the most recently
completed legislative session (i.e. completed during FFY 2013).Policy is a general term which includes laws, regulations,
and rules – both informal and formal. There are different subtypes of policies, and settings in which they may exist.
•
•

•

Public policies: Laws or ordinances enacted at the federal, state, or local levels of government through a legislative
process or another formal process of approval.
o Example: laws which mandate the use of motorcycle helmets.
Regulatory policies: Rules and regulations created, approved, and enforced by governmental agencies, generally
at the federal- or state-level.
o Example: The establishment by the Centers for Medicare and Medicaid of a diagnostic reimbursement
group and a reimbursement schedule for payment of child safety seats for children with special healthcare
needs.
Organizational policies: Rules and procedures created, adopted, and enforced within organizations, public or
private, affecting employees or members of the organization or individuals served by the organization.
Organizations include (but are not limited to) private companies, health care providers, health insurance companies,
national non-profit organizations, schools or entire school districts, or community groups.
o Example: Data sharing policies with emergency departments and medical examiners offices.

57. During the most recently completed legislative session (i.e. completed during FFY 2013), did the IVP program have
mechanisms or protocols for communicating with policymakers around issues related to injury and violence prevention?
1. Yes
2. No
3. My state did not have a legislative session in FFY 2013
4. Don’t know
58. Please describe the methods the IVP program used in FFY 2013 to inform public policy either directly or through
collaboration with partners
Method used Method used
by IVP program
through
collaboration/
partners
Yes, No, DK

Yes, No, DK

Did not use this method

• Did not use method, but permitted to use
• State IVP program not permitted to use this
method

Evaluated/Assessed/Monitored impact of
laws
Conducted cost-benefit analyses of IVP
policies
Drafted and submitted potential policies to
policy-makers
Invited Congressional delegates to

meetings/events
Invited state or local legislators to
meetings/events
Met with policy-makers
Participated in boards and/or commissions
Recommended health department positions
on bills
Requested opportunity to review bills
Sent materials to policy-makers
Testified at state and local hearings
Worked to increase public awareness of laws
Worked to develop/enforce regulations for
injury/violence prevention
Worked to create/encourage adoption of
organizational policies for injury/violence
prevention
59. What injury and violence prevention topic areas does your states IVP program address through policy efforts?
1. NONE
11. Firearm injury
21. Sexual assault/rape
2. All Terrain Vehicle (ATV) injury
12. Homicide
22. Smart growth/built environment
3. Child abuse/neglect
13. Mass trauma/ disaster-related
23. Spinal cord injury (SCI)
4. Childhood injury
14. Motor vehicle injury
24. Suicide/self-inflicted
5. Child passenger safety
15. Motorcycle/motorized scooter
25. Suicide attempts
6. Domestic/intimate partner
injury
26. Teen Dating Violence
violence
16. Occupational injury
27. Traumatic brain injury (TBI)
7. Drowning/submersion injuries
17. Pedestrian injury
28. Youth Violence (includes
8. Elder Abuse
18. Poisoning
bullying and interpersonal
9. Fall injuries
19. Rural/agricultural injury
violence among youth)
10. Fire and burns injury
20. School-based injury
60. In FFY 2013, did the IVP program maintain a record of existing state policies (laws, regulations, etc.) related to injury and
violence prevention?
1. Yes
2. No
3. Don’t know
61. What role does your IVP program play in helping to implement or increase awareness of new laws? (seat belt laws, child
passenger safety laws, bullying prevention, graduated driving license, etc.)

62. What are the types and extent of barriers your IVP program faces in pursuing policy changes or other advocacy efforts
related to injury and violence prevention efforts?

COMMUNICATION WITH KEY STAKEHOLDERS
63. Did your state IVP program have an official and documented communication plan in FFY 2013?
1. Yes
2. No
74. (If YES to the above question): What elements or strategies were addressed in your communication plan? (Check all
that apply.)
1. Communication goals and objectives
2. Descriptions of key audiences (internal and external)
3. Descriptions of communication channels to be utilized (e.g., listservs, social media, in-person meetings, etc.)
4. Specific messages and talking points for each key audience
5. Descriptions of communication materials (e.g., press releases, PSAs, etc.)
6. Strategies for coordinating with media
7. Descriptions of messaging tactics (e.g., storytelling, infographics, social math, etc.)

8. Description of how target audience feedback is incorporated in materials
9. Timeline for implementation
10. Evaluation plan
65. What methods did the IVPP program use to communicate with injury and/or violence-related information to target
populations, internal and external partners, and other stakeholders in FFY 2013? Please check all that apply.
1. Ads or PSAs
2. Interviews with local media (TV, radio, newspaper, etc.)
3. Listservs
4. Newsletter
5. Participation in steering committees, community meetings, professional association meetings
6. Reports, articles, presentations, data briefs, fact sheets
7. Social media platforms (e.g., Twitter, Facebook, etc.)
8. Website
1. None of the above
2. Other (please specify)
66. In FFY 2013, what was the PRIMARY methods the state IVP program communicated injury and/or violence-related
information to target populations, program partners, local groups, etc.? Please select only one.
1. Ads or PSAs
2. Interviews with local media (TV, radio, newspaper, etc.)
3. Listservs
4. Newsletter
5. Participation in steering committees, community meetings, professional association meetings
6. Reports, articles, presentations, data briefs, fact sheets
7. Social media platforms (e.g., Twitter, Facebook, etc.)
8. Website
9. None of the above
10. Other (please specify)

CHANGES IN YOUR PROGRAM SINCE 2011
In this section we would like to give you an opportunity to tell us about any changes that have occurred in your state IVP
program, your state health department, or your state in general since we conducted the 2011 State of the States Survey in
early 2012.
67. Were there any changes to your IVP program, your state health department, or your state in general in 2012 or FFY
2013? Please describe in detail any information that might put into perspective comparisons between your FFY 2011 data.
Changes might include: reorganizations, changes in funding, changes in political dynamics or legislation, loss of a critical
staff member, increase in responsibilities, etc.)

THANK YOU
You have completed the FFY 2013 State of the States Survey. Thank you for your time and participation. Once you click
“Continue,” you will have an opportunity to PRINT your completed survey. Please contact Shenee Bryan (770-690-9000 or
[email protected]) at Safe States Alliance with questions or concerns.