Form 2 State of the States Survey in Word Format

Attachment C-2

State of the States (SOTS) Survey

Non-Funded State Health Department

Form Approved

OMB No. 0920-XXXX

Exp. Date:

Public Reporting burden of this collection of information is estimated at 180 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 Reports Clearance Officer, 1600 Clifton Road NW, MS D-24, Atlanta, GA 30333; Attn: PRA (0920-XXXX).

NOTE to OMB: These questions will be used for the proposed data collection from 2012 through 2014

Note to OMB: This document was developed in Survey Monkey. This MS Word version is a conversion from PDF format, thus some formatting errors may have occurred.

U.S. state health department's injury and/or violence prevention program to develop a comprehensive picture of the status of these programs over time.

We know your time is valuable. In designing and testing this questionnaire, Safe States Alliance has made every effort to limit the questions to those most essential in developing a profile of state injury and/or violence prevention programs. Depending on the size and breadth of your program, it will take approximately 2-8 hours to gather the needed information and complete this questionnaire. Based on results from the pilot, it seems the most efficient way to finish the survey is to complete the hard copy first and then enter the data online. You may also complete the hard copy and then fax or email the survey to Safe States Alliance to enter the data online.

The information collected through this questionnaire will:

•

Provide an annual description of each state's injury and/or violence prevention program;

•

Be used to generate an annual report on the state of injury and violence prevention programs in the U.S.;

•

Provide the third year of data for measuring changes in these injury and violence prevention programs over time;

•

Inform partners at the federal, national, state and local levels about the activities in the states or nation;

•

Be used by SAFE STATES ALLIANCE to conduct in-depth analyses and create special reports; and

•

Help SAFE STATES ALLIANCE develop future programs and services. The information collected through this questionnaire will be included in the next State of the States Highlights Report and shared as needed to strengthen and draw awareness to state injury and violence prevention programs. Most data collected will be presented in aggregate. If you have any questions about the questionnaire, please contact Amber Williams at 770-690-9000 or amber.williams@Safe States Alliance.org.

To express our appreciation for your participation, SAFE STATES ALLIANCE will prepare a special report for your state including national comparison data.

THANK YOU again for your contribution to this important and exciting project.

The 2009 State of the States questionnaire asks for information about several aspects of your state's injury and/or violence prevention program, including program infrastructure, funding, partnerships, projects/interventions, data, strategic plans, and staff roles and FTEs. While the survey is being implemented in 2010, please answer the questions based on the status of your program in the 2009 calendar year.

You may find it helpful to first review the hard copy of the questionnaire (emailed to your State Representative) in order to gather all necessary information before completing the questionnaire. You also may find it helpful to coordinate completion of the questionnaire among your staff by distributing hard copies of the staffing section and other portions of the questionnaire to appropriate staff members who are most knowledgeable about topics addressed in the questionnaire.

There are several ways to complete the questionnaire:

•

Complete the entire questionnaire online through survey monkey.

•

Complete the questionnaire in hard copy first, then enter all responses online through survey monkey.

•

Complete the entire questionnaire in hard copy and FAX or email it to SAFE STATES ALLIANCE for data entry (770-690-8996 FAX or geri.stahl@Safe States Alliance.org EMAIL).

If you cannot use one of these methods to complete the survey, please contact Amber Williams at SAFE STATES ALLIANCE (770-690­9000) to identify an alternative arrangement. WHICHEVER METHOD YOU CHOOSE, PLEASE COMPLETE THE QUESTIONNAIRE BY Friday, March 26, 2010.

If you complete the survey online, you can complete the questionnaire over several days or weeks. Your responses are saved by page when you click on the "next" button at the bottom of each page in the questionnaire. You can re-access the questionnaire to edit or complete it by using the same computer each time. If you try to complete the remainder of the survey on a different computer, you will not see any of your previous data. HOWEVER, UPON RE-ACCESSING THE QUESTIONNAIRE ON THE SAME COMPUTER, YOU CAN ONLY GO TO THE LAST COMPLETED PAGE, NOT THE BEGINNING OF THE QUESTIONNAIRE.

Funding Source Questions In previous State of the States Surveys, SAFE STATES ALLIANCE has asked questions about the funding sources of the state's injury and violence prevention program. SAFE STATES ALLIANCE plans to do this again in the 2009 survey; however, the questions will be asked in a different format. We will be conducting a 30 minute to one hour telephone survey with each state representative to obtain this information. In advance of the call, the state representative will be given a copy of the questions to answer. A SAFE STATES ALLIANCE staff member will then go over these questions with the representative during the call to ensure that SAFE STATES ALLIANCE accurately captures the information. Look for more information about this portion of the survey coming later this year.

Please note that throughout the questionnaire, the acronym IVPP is used to indicate "injury and/or violence prevention program."

Finally, a word about questionnaire focus and terminology. The intent of this survey is to assess the program within the state health department that is considered the PRIMARY or CENTRAL FOCUS of injury and/or violence prevention activities. Some state injury prevention programs may address only unintentional injury, as violence (intentional injury) is addressed by another organizational unit(s) within the state health department. In other states, the primary program may address both unintentional injury and violence (intentional injury). In completing the questionnaire, please focus your responses (especially those about staff and FTEs) on the one program that is considered the PRIMARY or CENTRAL injury and/or violence prevention program. Information about injury or violence prevention activities in other areas of the state health department will be captured in questions about partnerships and collaboration. In some states, however, there simply is no central injury and/or violence prevention program. Perhaps there is no funding or personnel, or prevention activities may be spread among programs and units with no coordinating program or staff. Regardless of how your program is defined, the individual or program charged with program planning, strategic planning and/or policy development for injury and/or violence prevention should answer the questions to the best of their ability based on what is considered to be the PRIMARY or CENTRAL FOCUS of your state’s injury and/or violence prevention activities.

If you have any questions or concerns about how to define the boundaries of your state's program, please contact Amber Williams (Amber.Williams@Safe States Alliance.org, 770-690-9000) at SAFE STATES ALLIANCE to discuss. Clarification before completing the questionnaire will help ensure that the data collected for the State of the States report are comparable among states.

Please note that throughout the questionnaire, the acronym IVPP is used to indicate "injury and/or violence prevention program."

First, please provide the following contact information in case there are any questions when SAFE STATES ALLIANCE analyzes the information and data you provided. Contact information will not be included in the analysis or reporting of questionnaire data.

Questions marked with an asterisk (*) require an answer.

*1. In which state is the injury and/or violence prevention program (IVPP) located?

State:

*2. Please provide the first and last name, title/position, email address, and telephone number for the contact person for this survey.

First Name:

Last Name:

Title/Position:

Email Address:

Phone Number:

*3. Are you the SAFE STATES ALLIANCE State Representative? Yes No

Questions marked with an asterisk (*) require an answer.

*1. Does the state IVPP have a full-time director?

Yes

No

*2. Is the state IVPP located within the state health department?

Yes

No

*3. Who is responsible for the IVPP activities conducted at the state health department?

There is an identified injury/violence prevention program that is solely/primarily responsible for IVPP activities.

There is no single identified IVPP program. IVPP activities are decentralized throughout the health department with multiple programs responsible for different aspects of injury and/or violence prevention.

*4. In what division/organizational unit is the IVPP located?

Health promotion/disease

Emergency Medical Services (EMS) prevention/community health Environmental health Epidemiology

Maternal child health/family health

Other (please specify)

*5. Where are the following programs located in your state? (Please indicate the health department division/organizational unit, or if the program is located outside of the health department, please indicate the agency/office and division.)

Child Maltreatment

Intimate Partner Violence/Sexual Assault

Poisoning

Motor Vehicle Safety/Child Passenger

Safety

Senior Falls

Suicide

Teen Dating Violence

*6. Does the IVPP address/include:

Unintentional injuries only

Intentional injuries only

Both unintentional and intentional injuries

7. In what year was the IVPP established?

Year

*8. Is there a state mandate (legislative or budgetary) for a comprehensive injury and/or violence prevention program (IVPP)(i.e., not a specific silo of injury and violence prevention such as child passenger safety)?

Yes

No

Don't know

*1. You indicated in the previous question that your state has a mandate (legislative or budgetary) for a comprehensive injury and/or violence prevention program (IVPP)?

Is this mandate funded?

Yes

No

*1. You indicated in the previous question that your state does not have a mandate (legislative or budgetary) for a comprehensive injury and/or violence prevention program (IVPP)?

Would the development of a state mandate significantly benefit your program? If yes, how? Select all that apply.

No

Yes, by increasing resources (e.g., personnel, etc.)

Yes, by increasing expertise (e.g., surveillance, data analysis, etc.)

Yes, by improving leadership

Yes, by policy development

Yes, for other reasons (please specify)

Questions marked with an asterisk (*) require an answer.

*1. In 2009, in your state, which types of plans included activities to prevent injuries and violence. Please check ALL that apply.

State-wide health plan, which includes injury and violence prevention and other health issues (multiple agencies) State-wide injury and violence prevention plan (multiple agencies) Health department's plan, which includes injury and violence prevention and other health issues Health department's injury and violence prevention plan A plan(s) has/have been developed for specific injury/violence problems such as suicide, child occupant safety, falls, etc. We do not have a plan In 2009 we were developing a plan

Other (please specify)

*1. Did the IVPP use this plan(s) to monitor/evaluate progress in 2009?

Yes

No

Don't know

*2. In a previous question, you indicated that there was a state-wide injury and violence

prevention plan or a health department injury and violence prevention plan in 2009.

When was this plan created? (If you have both plans, consider the one which is the most recent.)

less than 1 year ago

1-2 years ago

3-4 years ago

more than 5 years ago

*1. You indicated in the previous question that there was a state-wide health plan and/or a health department plan that includes injury and violence prevention.

Please selected the option that best describes how injury and violence are included within the plan. (If you have both types of plans, consider the one which is most recent.)

Injury and/or violence prevention was included generally within the plan

Specific injury and/or violence prevention topics were included within the plan

Don't Know

Other (please specify)

*2. Did the IVPP use this plan(s) to monitor/evaluate progress in 2009?

Yes

No

Don't know

*3. In a previous question, you indicated that there was a state-wide health plan and/or a health department plan that includes injury and violence prevention.

When was this plan created? (If you have both plans, consider the one which is the most recent.)

less than 1 year ago

1-2 years ago

3-4 years ago

more than 5 years ago

*1. You indicated in a previous question that there is a state-wide health plan and/or a health department plan that includes injury and violence prevention that was over 5 years old. Does your state/health department have any plans to revise or update that plan?

Currently revising

Revising within 1-2 years

Revising within 3-4 years

No plans to revise at this time

Other (please specify)

*1. In 2009 in your state, did you have a plan which focused on activities to prevent violence?

Yes, one plan

Yes, multiple plans

No

In 2009 we were developing a plan

*1. In the previous question you indicated that there was a plan(s) for violence prevention in 2009. What topics are included in that plan(s)? CHOOSE ALL THAT APPLY

Bullying

Sexual Violence Child Maltreatment School Violence

Community Violence Suicide

Elder Abuse Teen Dating Violence

Gang Violence Youth Violence

Gun Violence Violence in the Workplace

Intimate Partner Violence

Other (please specify)

*2. Did the IVPP use this plan(s) to monitor/evaluate progress in 2009?

Yes

No

Don't know

*3. In a previous question, you indicated you had a violence prevention plan(s) for your state.

When was this plan created? (If there is more than one plan, please consider the one which is the most recent.)

less than 1 year ago

1-2 years ago

3-4 years ago

more than 5 years ago

*1. You indicated in a previous question that you have a violence prevention plan that was over 5 years old. Do you have any plans to revise or update that plan?

Currently revising

Revising within 1-2 years

Revising within 3-4 years

No plans to revise at this time

Other (please specify)

This next section focuses on collaboration within the state health department.

Questions marked with an asterisk (*) require an answer.

1. Please indicate how the IVPP worked with other offices WITHIN the state health department in 2009 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 prevention/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.

For ease of data entry, this question continues with additional state health department offices in Question #2.

INSTRUCTIONS:

1.

Indicate the strength of partnership with the office (New and Developing, Strong, Needs Improvement, None or N/A) from the drop down menu.

2.

If a partnership exists, please indicate the manner in which you partner/collaborate with that agency by selecting "Yes" or "No" in the drop down menu under each type of collaboration (shared data, actively involved in IVPP planning, programs, etc.)

3.

If a partner/office does NOT exist, choose "N/A" and then disregard the remaining questions.

4.

If a relationship does NOT exist with the partner/office, choose "None" and then disregard the remaining questions.

Part 1

Actively involved IVP

Strength of Partnership Shared Data in IVPP planning, IVPP Provided Funding TO IVPP Received Funding FROM Collaborated for Policy/Advocacy Provided/ Training/

Research

Centers

Against Drunk Drivers (MADD)

Questions marked with an asterisk (*) require an answer.

1. Please specify the availability, access, and use of the

following datasets in the state in 2009. We are interested in

learning about the availability of the data sources in your

state IN 2009, not the availability OF 2009 data. We want to

know if the data source was available (any year's data) in

2009.

INSTRUCTIONS:

1.

Indicate the whether or not the data source is available

in your state (Available, Available but Incomplete, Not

Available, Don't Know) from the drop down menu.

2.

If data source is available in your state, please indicate

whether or not you had access to Raw, Summary or No

data in 2009 and if you used the data in 2009 by

selecting "Yes" or "No" in the drop down menus

(Access to Data, Use of Data). Please also indicate if the

data is available for specific age and racial/ethnic

categories by selecting "Yes" or "No" in the drop down

menus.

3.

If the data source is NOT available in your state select

"Not Available" and disregard the remaining questions

about that data source.

4.

If you do not know if data source is available in your

state select "Do Not Know" and disregard the remaining

questions about that data source.

Is the data Is the data Data Availability Access to the Use of Data in available for available by in Your State Data in 2009 2009 specific age racial/ethnic

Review (Child Death Review (CDR)) Services (EMS)

Protection Use Survey (NOPUS)

Death Reporting System (NVDRS)

Surveillance System (YRBSS)

2. Please specify the availability, access, and use of the following data in the state in 2009. We are interested in learning about the availability of the data in your state IN 2009, not the availability OF 2009 data. We want to know if the data source was available (any year's data) in 2009.

INSTRUCTIONS:

1.

Indicate the whether or not the data source is available

in your state (Available, Available but Incomplete, Not

Available, Don't Know) from the drop down menu.

2.

If data source is available in your state, please indicate

whether or not you had access to Raw, Summary or No

data in 2009 and if you used the data in 2009 by

selecting "Yes" or "No" in the drop down menus

(Access to Data, Use of Data). Please also indicate if the

data is available for specific age and racial/ethnic

categories by selecting "Yes" or "No" in the drop down

menus.

3.

If the data source is NOT available in your state select

"Not Available" and disregard the remaining questions

about that data source.

4.

If you do not know if data source is available in your

state select "Do Not Know" and disregard the remaining

questions about that data source.

For ease of data entry, this question continues in Question #3 below.

Is the data Is the data Data Availability Access to the Use of Data in available for available by in Your State Data in 2009 2009 specific age ethnic/racial

3. Please specify the availability, access, and use of the following data in the state in 2009. We are interested in learning about the availability of the data in your state IN 2009, not the availability OF 2009 data. We want to know if the data source was available (any year's data) in 2009.

INSTRUCTIONS:

1.

Indicate the whether or not the data source is available

in your state (Available, Available but Incomplete, Not

Available, Don't Know) from the drop down menu.

2.

If data source is available in your state, please indicate

whether or not you had access to Raw, Summary or No

data in 2009 and if you used the data in 2009 by

selecting "Yes" or "No" in the drop down menus

(Access to Data, Use of Data). Please also indicate if the

data is available for specific age and racial/ethnic

categories by selecting "Yes" or "No" in the drop down

menus.

3.

If the data source is NOT available in your state select

"Not Available" and disregard the remaining questions

about that data source.

4.

If you do not know if data source is available in your

state select "Do Not Know" and disregard the remaining

questions about that data source.

Is the data Is the data Data Availability Access to the Use of Data in available for available by in Your State Data in 2009 2009 specific age racial/ethnic

4. Are there other data sets you used or had access to in 2009 in addition to those that were listed in the previous questions?

Other #1

Other #2

Other #3

Other #4

Other #5

*5. Does your state IVPP have sufficient access to epidemiologists, statisticians, or other data professionals to analyze data for the IVP program?

Yes

No

*6. What percent time does your program have access to an epidemiologist to conduct injury and violence data analyses?

0%

1-25%

26-50%

51-75%

76-99%

100% (i.e., equivalent to one FTE)

More than 100% (i.e., equivalent to more than one FTE)

*7. Have you or another representative of the IVPP received a copy of the following Injury Surveillance Workgroup (ISW) Reports published by SAFE STATES ALLIANCE?

Received a Copy of the ISW Report

Consensus Recommendations for Injury Surveillance in State Health Departments (1999)

Consensus Recommendations for Using Hospital Discharge Data for Injury Surveillance (2003)

Consensus Recommendations for Surveillance of Falls and Fall-Related Injuries (2006)

Consensus Recommendations for Injury Surveillance in State Health Departments (2007)

Assessing an Expanded Definition for Injuries in Hospital Discharge Data Systems (2008)

8. In the coming year, SAFE STATES ALLIANCE plans to commission an external evaluation to examine the dissemination, use, and potential effects of the ISW reports released to date. The evaluator might like to follow up with the individual in your state who is most likely to have a need for the ISW reports (e.g. epidemiologist who works with injury data). Please provide the contact information for the individual our evaluator should contact in the space below.

Name:

Email Address:

Phone Number:

Questions marked with an asterisk (*) require an answer.

*1. In 2009, did the IVPP publish any publications in peer-reviewed journals?

Yes

No

In process

*2. In 2009, did the IVPP present data at a national or state meeting? Check all that apply.

Abstracts

Oral Presentations

Poster Presentations

Did Not Present

*3. In 2009, did the IVPP release a report, paper, or other document specific to falls or fall-related injuries?

No Yes (please provide the title of the report)

*4. In 2009, did the IVPP release a report, paper, or other document that specifically focused on examining injuries documented in hospital discharge data?

No

Yes (please provide the title of the report)

*5. Which of the following reports, if any, did the IVPP release in 2009 on the status of injury and/or violence in your state? Please check ALL that apply.

Comprehensive report on unintentional injuries

Comprehensive report on intentional injuries

Comprehensive report on both unintentional and intentional injuries

Report on childhood injuries

Issue/topic specific report(s), papers or other documents

None

Other (please specify)

*1. In the previous question you indicated that you had released at least one report in 2009. For the types of reports listed below, please provide the citation of the most recent report developed. Skip any categories in which you did not release a report.

Comprehensive report on unintentional injuries

Comprehensive report on intentional injuries:

Comprehensive report on both intentional and unintentional injuries

Report on childhood injuries

Issue or topic specific reports, papers or documents (beyond fall or fall-related, or hospital discharge)

*2. In a previous question you indicated the state IVPP released at least one report in 2009. How does your state use these reports? Choose all that apply.

Evaluation Policy Development

Funding Justification Program Design/Planning

Grant Requirements Strategic Planning

Information Sharing

Other (please specify)

Questions marked with an asterisk (*) require an answer.

*1. This question attempts to assess the level of effort the state IVPP gives to each injury/violence area, whether or not it is lead by or located within the state IVPP.

Please select from the drop down

menu to indicate the level of

program focus during 2009 in

each injury/violence area that the

state IVPP addresses through its

programs and activities.

Choices include primary focus,

secondary focus, minimal focus,

or did not focus on in 2009. You

can choose multiple areas of

primary or secondary focus.

For ease of data entry, this

question continues with

additional Prevention Programs

in Question #2 below.

Part 1

All Terrain Vehicle (ATV) injury

Child abuse/neglect

Child passenger safety

Domestic/intimate partner violence

Elder Abuse

Fall injuries

Submersion injuries/drowning

Suicide/self-inflicted

Suicide attempts

Teen Dating Violence

Traumatic brain injury (TBI)

Injuries to children

Injuries to adolescents

Injuries to elderly

Injuries to a racial/ethnic group

Injuries to gender-specific group

Other #1

Other #2

Other #3

Other #4

Other #5

*3. For the primary areas of focus you indicated in the previous questions above (#1 and #2), please select how the IVPP determined that those areas of focus were primary. Choose all that apply.

Data

Funding directives

Needs assessment

Political influence

State mandates

Other (please specify)

*4. In questions #1 and #2 above, you indicated the areas of primary focus for your state IVPP in 2009. Please tell us more about how you evaluated activities in these primary focus areas. For the areas indicated as primary focus in 2009, for how many of them did you complete the following types of evaluation? The total number entered for each type of evaluation should not exceed the total number of primary focus areas. For example, if you had four (4) areas of primary focus in 2009, the total number of formative evaluations completed should not be more than four (4).

Definitions are provided below for each type of evaluation:

•

Formative Evaluation – testing program plans, messages, materials, strategies, or modifications for weaknesses and strengths before they are put into effect

•

Process Evaluation – testing whether the program’s procedures for reaching the target population are working as planned

•

Impact Evaluation – assessing the program’s progress toward its goals (i.e.,

measuring the immediate changes brought about by the program in the target

population such as changes in knowledge, attitudes and beliefs that may lead to

changes in health behavior)

•

Outcome Evaluation – measuring whether your program met its ultimate goal of

reducing morbidity and mortality due to injury

Citation: Thompson NJ, McClintock HO. Demonstrating Your Program’s Worth: A Primer on Evaluation for Programs To Prevent Unintentional Injury. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 1998.

Formative Process Impact Outcome

*5. Did your state IVPP use the CDC "Framework for Program Evaluation in Public Health" to plan and implement program evaluations in 2009? Yes No

*6. Does your IVPP have access to a program evaluator?

Yes, within IVPP program

Yes, within state health department

Yes, by consultant

No

Other (please specify)

Questions marked with an asterisk (*) require an answer.

The following definition was agreed upon at a CDC forum with the Evaluation Standards Work Group / Program Integration & Sub-Group:

Integration: Process whereby formal units jointly pursue a shared objective in order to improve the health of the population (1). They do this through joint (2,3):

•

Decision-making, priority-setting, planning

•

Responsibility for program development, co-investment, resource sharing & development, implementation,

evaluation, program improvement

•

Mutual accountability for results & stewardship

•

Sharing of risks and rewards

Citation:

(1)

Mark, Henry, and Julnes (2000). Evaluation: An integrated framework for understanding, guiding, and improving policies and programs. Jossey-Bass: San Francisco, CA. [Social betterment]

(2)

Himmelman, AT. Collaboration for a Change: Definitions, Decision-making models, Roles, and Collaboration Process Guide. http://depts.washington.edu/ccph/pdf_files/4achange.pdf. [Continuum from networking through collaboration]

(3)

Slonim AB, et al. Recommendations for integration of chronic disease programs; are your programs linked? Prev Chronic Dis [serial online] 2007 Apr [date cited]. Available from http//www.cdc.gov/pcd/issues/2007/apr/06_0163.htm.

*1. In 2009, what injury/violence prevention efforts were integrated with other areas of the health department, state agencies, and/or outside agencies/organizations?

*2. What priority does your state IVPP place on integrating injury and/or violence prevention activities into these state offices/programs? Priority for Integrating

Chronic Disease

Environmental Health

Maternal and Child Health

Questions marked with an asterisk (*) require an answer.

*1. Did your state IVPP have programs or activities for Preventing Falls Among Older Adults in 2009?

Yes

No

Not Applicable (not a priority area for the state)

Questions marked with an asterisk (*) require an answer.

*1. What programs or activities for Preventing Falls Among Older Adults did your state IVPP in 2009? Check all that apply.

Multi-factorial (must include at least two of the following: exercise, medication adjustment, vision correction, home modification) Exercise Program Home Modification Education and Awareness

Other (please specify)

*2. How were these programs or activities evaluated in 2009?

Check all that apply.

Number of participants enrolled Media reports

Participants' reports of falls Policy changes

Pre-and post-surveys of participants Program costs

Emergency department or hospital

admissions for falls

Other (please specify)

Questions marked with an asterisk (*) require an answer.

*1. Did your IVPP provide funding to local health departments or other organizations in your state for Preventing Falls Among Older Adults programs in 2009?

Yes (Funding given to the local health department or other organization)

No (Funding available, but not given to the local health department or other organization)

Not applicable (No funding available to give to local health department or other organization)

Questions marked with an asterisk (*) require an answer.

*1. Did your state IVPP have programs or activities for Preventing Child Maltreatment in 2009?

Yes

No

Not Applicable (not a priority area for the state)

*1. What types of interventions and program activities did your IVPP have that focused on Preventing Child Maltreatment in 2009? Please check all that apply.

Parenting training/parent skill building

Concrete assistance/support for families

Home visitation (Nurse or other trained professional deliverer) Home visitation (Paraprofessional deliverer) Home visitation (Other deliverer)

Other (please specify)

(financial or transportation assistance, child care, respite care) Social support/network building for families Parent literacy/career/employment skills Parental mental health/substance abuse services

*2. What outcomes did you measure to evaluate these programs and activities in 2009? Please check all that apply.

Process indicators (e.g. number of participants,

Knowledge gain/retention/refresh

number of materials distributed, etc.)

Anecdotes/informal measures (e.g., word of

mouth; newspaper stories)

Institutional/policy change

Media reports/presence

Likeability/acceptability

Other (please specify)

Behavior change/maintenance

Long term outcomes (e.g., CPS reports of child maltreatment, children in foster placement, emergency department data, child fatalities due child maltreatment, child well-being/developmental status)

Environment change

None

*

1. You indicated in a previous question that programs or activities for Preventing Child Maltreatment are not a priority in your state. What needs to happen to make this injury and violence prevention area a priority in your state?

*

1. Did your IVPP provide funding to local health departments or other organizations in your state for Preventing Child Maltreatment programs in 2009?

Yes (Funding given to the local health department or other organization)

No (Funding available, but not given to the local health department or other organization)

Not applicable (No funding available to give to local health department or other organization)

*2. What are the barriers to using child maltreatment data in your state? Check all that apply.

*3. What are the types and extent of barriers you face in pursuing policy changes or other advocacy efforts related to child maltreatment?

*4. Do you and/or your staff have the capacity to participate in distance learning opportunities? Yes No

Questions marked with an asterisk (*) require an answer.

*1. What child maltreatment prevention topics would be most beneficial for your program in a distance learning opportunity?

Data analysis

Report writing

Data collection

Review of evidence base for child

maltreatment (What works?)

Partnership development

Evaluation

Policy

Other (please specify)

Questions marked with an asterisk (*) require an answer.

*1. You indicated in a previous question that you and/or your staff did not have the capacity to participate in distance learning opportunities.

What would you need to develop this capacity? Check all that apply.

Information technology network capacity

Training

Other (please specify)

Questions marked with an asterisk (*) require an answer.

*1. Did your state IVPP have programs or activities for Preventing Teen Dating Violence in 2009?

Yes

No

Not Applicable (not a priority area for the state)

Questions marked with an asterisk (*) require an answer.

*1. What types of interventions and program activities did your IVPP have that focused on Preventing Teen Dating Violence in 2009? Please check all that apply.

Strategic planning

Surveillance Educational sessions Evaluation

Training for professionals Policy

Information and awareness raising

Partnership/coalition building materials Capacity building Media campaigns

Other (please specify)

*2. What outcomes did you measure to evaluate these programs and activities in 2009? Please check all that apply.

Process indicators (e.g. number of participants,

Knowledge gain/retention/refresh

number of materials distributed, etc.)

Anecdotes/informal measures (e.g., word of

mouth; newspaper stories)

Institutional/policy change

Media reports/presence

Likeability/acceptability

Other (please specify)

Behavior change/maintenance Long term outcomes (e.g., such as the reduced

incidence of TDV) Environment change None

Questions marked with an asterisk (*) require an answer.

*1. Did your IVPP provide funding to local health departments or other organizations in your state for Preventing Teen Dating Violence programs in 2009?

Yes (Funding given to the local health department or other organization)

No (Funding available, but not given to the local health department or other organization)

Not applicable (No funding available to give to local health department or other organization)

Questions marked with an asterisk (*) require an answer.

*

1. In 2009, did the IVPP provide any funding or in-kind support for local injury/violence prevention activities?

*

1. Please check all methods used by the IVPP in 2009 to provide funding and/or in-kind support for local prevention efforts. Check all that apply.

Yes

No Mini-grants

In-kind support for epi/data

Supplies/equipment (i.e. car seats,

In-kind support for program development

smoke alarms)

In-kind support for evaluation

In-kind support for technical assistance

In-kind support for training

Other (please specify)

*2. What sources of funding did the IVPP use to provide resources to local injury and violence prevention efforts in 2009? Please check all that apply.

Questions marked with an asterisk (*) require an answer.

*1. In 2009, how did the IVPP communicate injury and/or violence-related information to target populations, program partners, local groups, etc.? Please check ALL that apply.

Website

Listserv

Newsletter

Regular mailings

TV/radio/newspaper

Participated in steering committees, community meetings, professional association

meetings

None of the above

Other (please specify)

*1. In 2009, what was the PRIMARY way in which your IVPP communicated injury and/or violence-related information to target populations, program partners, local groups, etc.? Please select only one.

Website

TV/radio/newspaper Listserv Participated in steering committees,

community meetings, professional association Newsletter

meetings

Regular mailings

None of the above

Other (please specify)

*1. What methods did the IVPP use in 2009 to provide technical assistance and training to partners, grantees, and others engaged in injury and violence prevention? Please check ALL that apply.

Offered practical experience for students

Conducted distance learning via satellite, video

conference, or video tape

Responded to requests for technical assistance

Conducted distance learning via computer

Offered courses for academic credit or CEUs

(Internet based, Webcast, or CD-ROM)

Conducted in-person training (workshops,

None

conference sessions, presentations, etc)

Other (please specify)

*2. What are the technical assistance resources your program uses?

Check all that apply.

Businesses

Federal Agencies (such as CDC, HRSA, NHTSA,

SAMHSA)

Injury Prevention Research Centers

Internet

Peer to Peer

Regional Networks

Resource Centers (such as Children’s Safety Network (CSN), Suicide Prevention Resource Center

(SPRC) or CDR) Other (please specify)

SAVIR Self Assessment STAT Report (for your own state) SAFE STATES ALLIANCE Other National Organizations University/Academic Institutions (other than Injury Prevention Research Centers (IPRC))

*3. Is your IVPP aware of the National Training Initiative for Injury and Violence Prevention's Core Competencies? (See list below)

1.

Ability to describe and explain injury and/or violence as a major social and health problem.

2.

Ability to access, interpret, use and present injury and/or violence data.

3.

Ability to design and implement injury and/or violence prevention activities.

4.

Ability to evaluate injury and/or violence prevention activities.

5.

Ability to build and manage an injury and/or violence prevention program.

6.

Ability to disseminate information related to injury and/or violence prevention to the community, other professionals, key policy makers and leaders through diverse communication networks.

7.

Ability to stimulate change related to injury and/or violence prevention through policy, enforcement, advocacy and education.

8.

Ability to maintain and further develop competency as an injury and/or violence prevention professional.

9.

Demonstrate the knowledge, skills and best practices necessary to address at least one specific injury and/or violence topic (e.g. motor vehicle occupant injury, intimate partner violence, fire and burns, suicide, drowning, child injury, etc.) and be able to serve as a resource regarding that area.

Yes

No

*4. Do you create staff performance plans that explicitly include the above listed National Training Initiative for Injury and Violence Prevention's Core Competencies?

Yes

No

Don't know

*5. How many trainings or other professional development sessions did you offer to the local health department or other partners in your state in 2009?

# of Sessions

*6. Do any of these trainings explicitly incorporate the National Training Initiative for Injury and Violence Prevention's Core Competencies?

Yes

No

No trainings/professional development offered in 2009

Don't know

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. 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. 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. Example: Data sharing policies with emergency departments and medical examiners offices.

Questions marked with an asterisk (*) require an answer.

*1. During the most recently completed legislative session (i.e. completed prior to 12/31/2009), did the IVPP have mechanisms or protocols for communicating with policy-makers around issues related to injury and violence prevention?

Yes

No

Don't know

*2. Please describe the methods the IVPP program used in 2009 to influence public policy either directly or through collaboration with partners. Please check all that apply.

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

State IVPP not

Method used by Method used through

Method not used permitted to use

IVPP collaboration/partners

this method

*3. What injury and violence prevention topic areas does your state's

IVPP address through policy efforts?

None

All Terrain Vehicle (ATV)

injury Child abuse/neglect Childhood injury Child passenger safety Domestic/intimate partner

violence Elder Abuse Fall injuries Fire and burns injury Firearm injury

Mass trauma/ disaster-related Motor vehicle injury Motorcycle/motorized scooter

injury Occupational injury Pedestrian injury Poisoning Rural/agricultural injury School-based injury Sexual assault/rape Smart growth/built environment

Submersion injuries/drowning Suicide/self-inflicted Suicide attempts Teen Dating Violence Traumatic brain injury (TBI Injuries to children Injuries to adolescents Injuries to elderly Injuries to a racial/ethnic group

Injuries to gender-specific

group

Homicide

Spinal cord injury (SCI)

Other (please specify)

*4. In 2009, did the IVPP maintain a record of existing state policies (laws, regulations, etc) related to injury and violence prevention?

Yes

No

Don't know

*5. What role does your IVPP play in helping to implement or increase awareness of new laws? (seat belt laws, child passenger safety laws, bullying prevention, graduated driving license, etc.)

*6. What are the types and extent of barriers you face in pursuing policy changes or other advocacy efforts related to injury and violence prevention efforts?

1. Were there any changes to your IVPP program, your state health department, or your state in general in 2008 or 2009? (Please describe in detail any information that might put into perspective comparisons between your 2007 and 2009 data. Changes might include: reorganizations, changes in funding, changes in political dynamics or legislation, loss of a critical staff member, increase in responsibilities, etc.)

This section includes questions you will need to answer for your staff as a whole. You may find it helpful to provide each staff member with a hard copy of this portion of the survey to complete by hand, and then whoever is completing the survey can compile the results into one state response for this section.

Questions marked with an asterisk (*) require an answer.

*1. Please indicate how many staff members that were part of the IVPP in 2009 in each of the following status categories.

Paid staff member (include

both part-time and full-

time)

Paid intern

Unpaid intern

Fellow

*2. For each paid staff member, please identify the role that most closely describes the staff member's PRIMARY role within the state IVPP. You can choose only one primary role per staff person. If they perform multiple roles, indicate the one which is performed most often.

Please indicate how many paid staff members you have within each primary role category. Include all paid employees, regardless of percent time they work in the IVPP. (Your total should not exceed the number indicated for "paid staff member" in question 1 above.)

Management

Data collection/analysis

Coalition

building/Coordination

Evaluation

Intervention/Program

Coordination

Technical

Assistance/Training

Public Policy/Advocacy

Support

Staff/Administrative

*3. Please indicate how many staff members in the IVPP you have with each of the following degree(s).

Include all paid employees, regardless of percent time they work in the IVPP. Choose ALL degrees attained, not just highest degree.

High School

Diploma/GED

AA

AS

BA

BS

RN

MS

MA

MBA

MPA

MPH

MSW

MD

PhD

DrPH

JD

*4. Please indicate how many staff members in the IVPP have been working for the state IVPP program for the various periods of time listed.

Include all paid employees, regardless of percent time they work in the IVPP. (Your total should not exceed the number indicated for "paid staff member" in question 1 above.)

Less than 1 year 1 year to less than 4 years 4 years to less than 7 years 7 years to less than 10

years 10 years or more

*5. Please indicate how many staff members in the IVPP have been working for the field of injury and violence prevention for the various periods of time listed.

Include all paid employees, regardless of percent time they work in the IVPP. (Your total should not exceed the number indicated for "paid staff member" in question 1 above.)

Less than 1 year

1 year to less than 4 years

4 years to less than 7 years

7 years to less than 10

years

10 years or more

*6. Please indicate how many staff members in the IVPP have been working for the field of public health for the various periods of time listed.

Include all paid employees, regardless of percent time they work in the IVPP. (Your total should not exceed the number indicated for "paid staff member" in question 1 above.)

Less than 1 year

1 year to less than 4 years

4 years to less than 7 years

7 years to less than 10

years

10 years or more

*7. Please indicate how many staff members in the IVPP spend their time working in the IVPP according to the various percentages below.

Include all paid employees, regardless of percent time they work in the IVPP. (For example, if you have a .5 FTE that works 50% on IVPP, please include that staff person in the 26-50% category)

1-25%

26-50%

51-75%

76-99%

100%

*8. Please indicate how many IVPP staff member's positions include the following funding sources. An employee can be funded by multiple sources.

Include all paid employees, regardless of

percent time they work in the IVPP.

State

Federal-CDC

Other

Federal

Other

Sources

*9. How many of your staff members are current members of SAFE STATES ALLIANCE?

Include all paid employees, regardless of percent time they work in the IVPP. (Your total should not exceed the number indicated for "paid staff member" in question 1 above.)

Finally, we'd like to know about the other people who work on injury and violence prevention activities that are not housed directly in the formal state injury and/or violence prevention program (example, RPE staff). By staff, we mean all paid staff (full or part-time), fellows, and interns (paid or unpaid).

Questions marked with an asterisk (*) require an answer.

*1. Please indicate how many non-formal IVPP program staff members there are in the state health department. (You might want to include staff such as RPE or suicide prevention coordinators in the maternal and child health program to name a few.)

*2. What programs are these staff members in?

Please contact Amber Williams (770-690-9000 or Amber.Williams@Safe States Alliance.org) at SAFE STATES ALLIANCE if you have any questions about the survey.