Institutional Awareness and Commitment Survey (Partner Organizations)

Attachment D

Institutional Awareness and Commitment Survey

Form Approved

OMB No. 0920-XXXX

Exp. Date:

Institutional awareness and commitment to ensure safe, stable, nurturing relationships and environments and prevent child maltreatment

The purpose of this survey is to get a better understanding of your agency’s (or institution, organization, business, or department) level of awareness and current efforts and partnerships around ensuring safe, stable, nurturing relationships and environments and preventing child maltreatment. We are asking the same questions about other agencies so there may be some questions that do not apply to yours. Ideally, you will bring in others from your agency to answer the survey collectively (just one survey please). If you answer the survey alone, please try to answer from your agency’s perspective. For the purposes of this survey, “staff” refers to both staff and leadership. . The information collected will contribute to tracking efforts in this direction.

Completion of this survey is voluntary.  You do not have to answer every question and can skip those that you do not feel comfortable answering. You can stop answering the survey at any time.  There are no foreseeable or expected risks for participation in this survey. The mechanism for collecting this information is Survey Monkey, a secure website that meets the Safe Harbor and EU Data Protection Requirements.  All information collected will be maintained in a secure manner.

1. NAME OF AGENCY: ______________________________________

2. SCOPE OF YOUR AGENCY’s WORK:

State-wide 2+ counties or cities but not state-wide one-county or city neighborhood(s) not city- or county-wide

3. How often does your agency have presentations or discussions reviewing scientific evidence related to policies, programs, or services for children and families at staff meetings?

A lot (this topic is regularly scheduled)

Often (this topic comes up in many discussions although not specifically scheduled or there have been >4 planned meetings around this topic)

A little (this topic comes up once in a while or there has been 1-3 planned meetings around this topic

Not at all

The following questions ask about your agency’s level of knowledge and its positions or beliefs.

4. What percent of the staff in your agency do you think knows that 1 in 10 children in the US have experienced some form of child maltreatment (this includes physical, sexual and emotional abuse and any form of neglect)? ____%

5. What percent of the staff in your agency do you think knows that just one case of child maltreatment costs the nation about $200,000 when you add up health care, child welfare, special education, and criminal justice costs and losses in earnings across the lifespan of a victim? ___%

6. Which of the following conditions do you think most people at your agency (> 50%) would identify as consequences of child maltreatment (check all that apply):

__Death __Physical injury __Paraplegia __Blindness __Mental retardation __Developmental delay __Changes in genetic expression __Difficulty controlling emotions __Impulsive behavior __Difficulty learning __Difficulty paying attention __Aggressive behaviors __Depression

__Smoking __Substance abuse __Suicide attempts __Sexually transmitted diseases __Teen pregnancy __Juvenile delinquency __Eating disorders __Obesity __Diabetes __Chronic pain __Heart disease __Chronic obstructive pulmonary disease __Cancer __None

Thinking about your agency, how much would most of the staff agree or disagree with the following statements?	Most strongly agree	Most somewhat agree	Most neither agree or disagree	Most somewhat disagree	Most strongly disagree	Most probably haven’t thought about it
Safe, stable and nurturing relationships and environments can buffer children against the effects of adverse childhood experiences like child maltreatment or exposure to partner violence.
Safe, stable and nurturing relationships and environments set children on a positive path for optimal child development.
Whether a child grows up to be a healthy adult is determined by their genes.
Whether a child grows up to be a healthy adult is determined by their parents’ choices.
The cumulative impact of family stressors such as poverty or partner violence shape children’s brains.
Our agency considers the impacts on child well-being when setting priorities.
Our agency considers the impacts on child well-being when making decisions.
Ensuring safe, stable, nurturing relationships and environments for children is in alignment with our agency’s priorities.
Our agency considers the scientific evidence before making decisions about policies, programs, or services.

8. How often does your agency discuss impacts on child well-being or promoting safe, stable, nurturing relationships and environments for children and families at staff meetings?

A lot (this topic is a regular agenda item)

Often (this topic comes up in many discussions although not on the agenda or there have been >4 planned meetings around this topic)

A little (this topic comes up once in a while or there has been 1-3 planned meetings around this topic)

Not at all

9. How often does your agency have presentations or discussions reviewing scientific evidence related to policies, programs, or services for children and families at staff meetings?

A lot (this topic is regularly scheduled)

Often (this topic comes up in many discussions although not specifically scheduled or there have been >4 planned meetings around this topic)

A little (this topic comes up once in a while or there has been 1-3 planned meetings around this topic)

Not at all

The following policies, programs, or resources may contribute to employees’ families’ or their children’s health or development.

Using your best estimate, during the past year in your agency:

10. What percentage of employees was allowed to negotiate flexible starting and quit times?

80%-100% 60%-79% 40% and 59% 20%-39% 1%-20% 0

11. What percentage of employees was allowed to negotiate alternative work days (e.g., compressed workweeks)?

80%-100% 60%-79% 40% and 59% 20%-39% 1%-20% 0

12. What percentage of employees was allowed to telework (work from home) at least one day a week?

80%-100% 60%-79% 40% and 59% 20%-39% 1%-20% 0

13.What was the maximum number of days teleworking employees were allowed to telework?

5 4 3 2 1 0

13. What percentage of employees was obligated to change their hours or days of work from week to week?

80%-100% 60%-79% 40% and 59% 20%-39% 1%-20% 0

14. What percentage of employees was allowed to change their hours or days of work from week to week?

80%-100% 60%-79% 40% and 59% 20%-39% 1%-20% 0

15. What percentage of employees was allowed to job share or work part time?

80%-100% 60%-79% 40% and 59% 20%-39% 1%-20% 0

16. How many weeks of paid leave are parents able to take for the birth of a child (not using accrued vacation leave or accrued credit time)?

>12 weeks 8-12 weeks 4-7 weeks 1-3 weeks < 1week (1-6 days) 0

17. How many days of paid leave (not using accrued vacation leave or accrued credit time) are parents able to take to care for a sick child?

51-60 41-50 31-40 21-30 11-20 5-10 1-4 0

18. How many hours of paid leave (not using accrued vacation leave or accrued credit time) in a year are parents able to take to attend child related events (e.g., parent/ teacher conferences, school presentations, or sports events)?

>24 16-24 8-15 4-7 1-3 0

19. What percentage of employees earn less than ($22.70 for CA; $20.56 for CO; $24.84 for MA; $18.92 for NC; $19.49 for WA¹) an hour?

80%-100% 60%-79% 40% and 59% 20%-39% 1%-20% 0

20. Employees were allowed to bring babies to work during their first 6 months:

Every day 3-4 days a week 1-2 days a week Occasionally 0 days

21. Employees were allowed to bring children older than 6 months babies to work:

Every day 3-4 days a week 1-2 days a week Occasionally 0 days

22. Child care was:

Provided on site for all who needed with a sliding-scale fee

Provided on site but there was a waiting list or no sliding-scale fee

No child care on site but subsidies provided for employees with lower wages

Not provided or supported

23. Breastfeeding mothers were:

Allowed additional break time and a private lactation room

Allowed additional break time or a private lactation room

No additional break time or a private lactation room

24. Health benefits (health insurance options):

Are provided to both full time and part time employees

Are provided to full time employees only

Are NOT provided

25. Transportation subsidies for lower income employees:

Are provided to both full time and part time employees

Are provided to full time employees only

Are NOT provided

26. Work site is located near (< 1 mile) public transit or there’s a shuttle provided from work site to public transit?

Yes No

27. What services/benefits were provided to employees (check all that apply)?

Mental health counseling

Substance abuse treatment

Parenting training

Help in finding day care for children

Flexible spending accounts for health care or medications

Flexible spending accounts for child care

Support for professional development (e.g., tuition assistance, on-the-job training)

28. The following activities or services may contribute to families’ or children’s health or development in your state. Please indicate whether your agency directly provides this service, refers clients to this service, supports this service with funding, or supports this service or activity by any other means (e.g., advocating, advertising, networking, etc.)

Activities or services	Directly provides or does	Refers clients to	Provides funds for	Other support
Pre- or inter-conception health care	YES/NO	YES/NO	YES/NO	YES/NO
Contraception
Prenatal care
Home visits
Parent training programs
Screen and referral of parents experiencing partner violence, mental illness or substance abuse
Legal, mental, financial or other counseling for women experiencing partner violence
Job training
Financial literacy training
Low cost financial services for unbanked or underbanked
Anticipatory guidance to parents around common parenting issues
Preschool with family support services
Family resource center (lending books or toys, linking to services)
K-12 education
Developmental screening
Intervention for children exposed to child maltreatment
Services for children with or at risk of developmental delays
Services for children manifesting behavioral problems
Individualized Family Service Plan
Mentoring children
After-school care or activities
Summer child care or activities
Recreational activities for children
Child care
Child care subsidies
Health insurance for children
Affordable housing
Urban planning, development, or transportation
Zoning decisions
Crime prevention
Juvenile justice
Income support for unemployed or low-income families
SNAP or WIC
Food pantries
Dissemination of information around parenting or child development
Campaigns to change social norms around parenting or children
Campaigns to promote family friendly work policies
Other (please describe):
Other (please describe)

29. Please indicate with “X” which data your agency/organization have used in the last year to make decisions about policies or programs that affect children or families in your state. Add a √ if these data were examined by race/ethnicity or income.

	Used past year	Examined by race/ ethnicity	Examined by income
Number (#) of child homicides
Child fatality review reports
# of hospital discharges due to children’s intentional injuries
# of ER visits due to children’s intentional injuries
Rate of reports to CPS
% of children reporting ACEs in the 2011-12 National Children’s Health Survey
% of pregnant women receiving prenatal care in the first trimester
% of pregnant women or parents of young children with depression, exposure to partner violence, or substance abuse
% of pregnant women receiving information about depression, exposure to partner violence, or substance abuse from their health care provider
% births to teen parents
# of 911 calls attributed to partner violence
length of wait list for treatment of substance abuse or mental illness among adults
% children with no medical insurance
% of children <5 evaluated for social emotional development
% of parents of children under five who received anticipatory guidance using Bright Futures guidelines
% of unplanned pregnancies
% of women between 15-45 with access to family planning services
% of services provided to parents and children reported to CPS that are evidence-based
% of parents who physically punished their child in the past year
% of parents reporting parental stress (i.e., child is harder to care for than most; child does things that bother them; felt angry with child; has someone they can turn to for help with parenting)
% children with a mentor
% children who are read, sung, or told stories to
% children < 2 who watch TV
% children > 2 in front of a screen > 2 hours a day
Affordability of child care
Child care slots available / # of children < 6 potentially needing child care
Length of wait list for infant or toddler childcare and education programs such as Early Head Start
Length of wait list for childcare subsidies
% of families who are eligible for Temporary Assistance to Needy Families (TANF) who actually receive TANF
% of families who are eligible for Supplemental Nutrition Assistance Program (SNAP) or WIC vouchers who actually receive SNAP/WIC
% of children who are food insecure
% of families who are eligible for State Children’s Health Insurance Program (SCHIP)/Medicaid who actually receive SCHIP/Medicaid
High school dropout rates
Length of wait list for state-funded pre-K program or Head Start
% of schools with evidence-based education programs to prevent teen pregnancy
% children treated unfairly because of race/ethnicity
% of children living in poverty
% of children living in high poverty neighborhoods
% children living in neighborhoods with low social capital
% of families with children who pay > 30% of income for housing
% of children living in crowded households
% of homeless school-age children
% of homeless pre-school age children
Cost of living for a family with 2 children		NA	NA
% of children with no parent fully employed year round
Average interest rates for payday, auto title, or pawnshop loans
% of businesses with family-friendly work policies (e.g., flex-time, telework) or state policies that are family friendly
other, please describe:____________________________________________________

30.Please write Y (for YES) or N (for NO) in each column indicating how your agency/organization collaborates with other agencies/organizations. Please specify the name of the agency/organization where space is provided. If your agency/organization collaborates with more than one type of these agencies/organizations, use the row below to specify name and type off collaboration. Leave blank if this is your agency. Check NA if this agency doesn’t exist in your state.

	Referral resource	Coordinating services or programs	Serve on an advisory group	Sharing data	Serve on planning group	Legislative/ policy development	Cross-training	Sharing materials	Evaluation	Other, pls specify
Governor’s Office
Dept of Educ
Family & children services
Human services
Public Health
Developmental disabilities
Child support
Consumer protection
Transportation
Early Care/ learning
Police
Justice
Labor
Housing
Finance
CBCAP
PCAA
Childcare agency
Children’s Trust Fund
	Referral resource	Coordinating services or programs	Serve on an advisory group	Sharing data	Serve on planning group	Legislative/ policy development	Cross-training	Sharing materials	Evaluation	Other, pls specify
Chamber of Commerce
Businesses with state-wide coverage ___________
_____________
Non-profits ___________
____________
Technical college(s) ___________
____________
Universities ___________
____________
Coalitions/grass root organizations ___________
___________
Public broadcasting
Regional TV station
Regional newspaper
Other:________

1 Glasmeier AK. (updated 2013). About the living wage calculator. Available at: http://www.livingwage.geog.psu.edu