Form 0920-1010 ICR Attachment D old survey w-tracked changes

2

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

INTRODUCTION

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 aimed to ensure safe, stable, nurturing relationships and environments and prevent child maltreatment both within your agency andand partnerships around the state. The information you provide will be used to begin tracking the collective impact of agencies’ efforts towards the goal of ensuring safe, stable, nurturing relationships and environments for all children.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.

Compliance: 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.  

Risks and Benefits: There are no foreseeable or expected risks for participation in this survey. The expected benefit may be that you/your agency develops a heightened awareness of actions and data sources that may contribute to promoting safe, stable, nurturing relationships and environments for children.

Confidentiality:  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. Your answers are confidential and will only be viewed by the evaluation team and shared with your Steering Committee in aggregate (not identifying any agency).

INSTRUCTIONS

We would like this survey to represent the perspective of your whole agency. Please, either bring in a group of representatives from your agency to reflect on the position of the agency or answer the survey alone reflecting the position of the agency to the best of your knowledge (not your personal opinions).

We are collecting this information from a variety of agencies. Some questions may not apply to yours.

Agency Characteristics

Lets’ start with some basic questions about the characteristics of your agency.

NAME OF AGENCY: _________________________________________ DATE: __________________________________________________

Agency’s website: __________________________________________

SCOPE OF YOUR AGENCY’s WORK:

State-wide 2+ counties or cities but not state-wide one-county one-or city

neighborhood(s) not city- or county-wide Other; Please specify_________________________

WhatHow often does your agency do?

Who are your “clients”? (e.g., to whom does your agency respond to or providehave presentations or discussions reviewing scientific evidence related to policies, programs, or services?) for children and families at staff meetings?

About how many people does your agency employ?

Respondent Characteristics

In your agency, are you: 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 senior manager A little (this topic comes up once in a while or there has been 1-3 planned meetings around this topic

A middle manager Not a managerat all

How many years have you been with this agency?

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

1. 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)? ____%

2. 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? ___%

3. 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):

How much influence do you have in your agency over:__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	Little	Some	A lot		All
Its strategic direction	0	1		2	3		4
How the budget gets allocated	0	1		2	3		4
Starting new programs or activities	0	1		2	3		4
Changing agency policies	0	1		2	3		4
Who your agency partners with	0	1		2	3		4
The messages your agency releases	0	1		2	3		4
Meeting agendas	0	1		2	3		4
Presentations	0	1		2	3		4

Agency’s Collective Values and Beliefs

Please check the answer that best corresponds to your agency.Thinking about your agency, how much would most of the staff agree or disagree with the following statements?	Not at all Most strongly agree	Most somewhat agree	Most neither agree or disagree	Most somewhat disagree	Com pletelyMost strongly disagree	DKMost probably haven’t thought about it
Agency leadership values the wellbeing of employees’ families	0	1		2			3	4	99
Agency leadership values the well-being of all childrenSafe, stable and nurturing relationships and environments can buffer children against the effects of adverse childhood experiences like child maltreatment or exposure to partner violence.	0	1	2	3	4	99
Staff in the a agency value the well-being of all childrenSafe, stable and nurturing relationships and environments set children on a positive path for optimal child development.	0	1	2	3	4	99
Agency leadership considers scientific evidence important to inform policies, programs, or services.Whether a child grows up to be a healthy adult is determined by their genes.	0	1	2	3	4	99

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.

Agency leadershipOur agency considers the impacts on child well-being when setting priorities.

0

1

2

3

4

99

Our agency considers the impacts on child well-being when making decisions.

Ensuring safe, stable, nurturing relationships and environments for all children is in alignment with yourour agency’s mission priorities.

0

1

2

3

4

99

Our agency considers the scientific evidence before making decisions about policies, programs, or services.

Agency Knowledge and Awareness

4. 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

5. 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:

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

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

Yes No

23. 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)

24. 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.)

Thinking about your agency’s leadership, to what extent would they agree or disagree with the following statements?Activities or services			Disagree completelyDirectly provides or does	Refers clients to		Provides funds for		Agree completelyOther support	DK
Pre- or inter-conception health care	YES/NO	YES/NO			YES/NO		YES/NO
Contraception
Prenatal care
Home visits
Parent training programs
Safe, stable, nurturing relationshipsScreen and environments can buffer adverse childhood experiences like child maltreatment or exposure toreferral of parents experiencing partner violence, mental illness or substance abuse			1	2		3		4	99
Safe, stable, nurturing relationships and environments set children on a positive path for optimal development and healthLegal, mental, financial or other counseling for women experiencing partner violence			1	2		3		4	99
Job training
Financial literacy training
Low cost financial services for unbanked or underbanked
Whether a child grows up to be a healthy adult is heavily influenced by his/her genesAnticipatory guidance to parents around common parenting issues			1	2		3		4	99
Preschool with family support services
Family resource center (lending books or toys, linking to services)
K-12 education
Developmental screening
Whether a child grows up to be a healthy adult is heavily influence by his/her parents’ choicesIntervention for children exposed to child maltreatment			1	2		3		4	99
The cumulative impact of childhood stressors such as poverty or partner violence shape children’s brainsServices for children with or at risk of developmental delays			1	2		3		4	99
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 developmentThe cumulative impact of childhood stressors such as poverty or partner violence lead to risky health behaviors in adolescence			1	2		3		4	99
Campaigns to change social norms around parenting or childrenThe cumulative impact of childhood stressors such as poverty or partner violence lead to adult chronic health conditions			1	2		3		4	99
Campaigns to promote family friendly work policies
Other (please describe):
Other (please describe)

Agency Activities

25. 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

Please check the degree to which your agency engages in the following activities during staff meetings% of children reporting ACEs in the 2011-12 National Children’s Health Survey

Not at all

A lot

DK

% 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

Agency leadership discusses promoting safe, stable, and nurturing relationships for children and families% of children <5 evaluated for social emotional development

0

1

2

3

4

99

% 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

Agency staff discusses promoting safe, stable, and nurturing environments for children and families % of services provided to parents and children reported to CPS that are evidence-based

0

1

2

3

4

99

% 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

Agency leadership considers scientific% of schools with evidence when making decisions about policies,-based education programs, or services to prevent teen pregnancy

0

1

2

3

4

99

% 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

Agency staff reviews scientific evidence related to policies, programs, or services for children and families % of families with children who pay > 30% of income for housing

0

1

2

3

4

99

% 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:____________________________________________________

Services for Families or Children’s Health or Development in your State

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.

Please indicate if your agency directly provides this service, refers clients to this service, or funds this service							Directly provides										Refers clients																	Provides funds														DK
							Yes				No						Yes					No												Yes								No						99
Pre- or inter-conception health care							1				2						1					2												1								2						99
Contraception							1				2						1					2												1								2						99
Prenatal care							1				2						1					2												1								2						99
Home visits for new parents							1				2						1					2												1								2						99
Referral resource	Parent trainingCoordinating services or programs	1Serve on an advisory group	2Sharing data		1Serve on planning group																									2Legislative/ policy development						1Cross-training			2Sharing materials					99Evaluation	Other, pls specify
Parent training programs							1						2						1						2						1									2									99
Screening and referral of parents experiencing partner violence, mental illness or substance abuseGovernor’s Office							1						2						1						2						1									2									99
Legal, mental, financial or other counseling for women experiencing partner violence							1						2						1						2						1									2									99
Anticipatory guidance to parents around common parenting issues							1						2						1						2						1									2									99
Developmental screening of childrenDept of Educ							1						2						1						2						1									2									99
Health insurance forFamily & children services							1						2						1						2						1									2									99
Health insurance for parents							1						2						1						2						1									2									99
Preschool without parent supportHuman services							1						2						1						2						1									2									99
Public Health
Developmental disabilities
Preschool with familyChild support services							1						2							1						2						1									2									99
Family resource centers (lending books or toys, linking to services)Consumer protection							1						2							1						2						1									2									99
K-12 educationTransportation							1						2							1						2						1									2									99
Tutoring childrenEarly Care/ learning							1						2							1						2						1									2									99
Mentoring childrenPolice							1						2							1						2						1									2									99
Recreational activities for children Justice							1						2							1						2						1									2									99
Labor
Housing
Finance
CBCAP
PCAA
Please indicate if your agency directly provides this service, refers clients to this service, or funds this service Childcare agency							Directly provides													Refers clients to														Provides funds for														DK
Children’s Trust Fund							Yes						No							Yes						No						Yes									No									99
Child care during work hours							1						2							1						2						1									2									99
After-school child care							1						2							1						2						1									2									99
Summer child care							1						2							1						2						1									2									99
Child care on week-ends or evenings							1						2							1						2						1									2									99
Child care subsidies							1						2							1						2						1									2									99
Interventions for maltreated children or their parents							1						2							1						2						1									2									99
Services for children with or at risk of developmental delays or manifesting behavioral problems (IEPs or IFSPs)							1						2							1						2						1									2									99
Job training							1						2							1						2						1									2									99
Financial literacy training							1						2							1						2						1									2									99
Low cost financial services for families without savings or checking bank accounts							1						2							1						2						1									2									99
Temporary shelters							1						2							1						2						1									2									99
Affordable housing							1						2							1						2						1									2									99
Urban planning, development or transportation						1								2							1						2								1								2									99
Crime prevention							1								2						1					2									1								2								99
Juvenile justice							1								2						1					2									1								2								99
Rehabilitation of juvenile offendersChamber of Commerce							1								2						1					2									1								2								99
Rehabilitation of adult offendersBusinesses with state-wide coverage ___________							1								2						1					2									1								2								99
Income support for unemployed or low-income families_____________							1								2						1					2									1								2								99
SNAP or WICNon-profits ___________							1								2						1					2									1								2								99
Food pantries____________							1								2						1					2									1								2								99
Technical college(s) ___________Dissemination of information around parenting or child development							1								2						1					2									1								2								99
____________Campaigns to change social norms around parenting or children							1								2						1					2									1								2								99
Campaigns to promote family friendly work policiesUniversities ___________							1								2						1					2									1								2								99
Policy development, evaluation, or analysis____________							1								2						1					2									1								2								99
Research or Think TankCoalitions/grass root organizations ___________							1								2						1					2									1								2								99
Other (please describe): ___________
Public broadcasting
Regional TV station
Regional newspaper
Other (please describe):________

Agency’s Policies on Work-Life Balance

% of employees supported

Please indicate the percent of employees at your agency (to the best of your knowledge) who are supported by the following policies:	0%	1%-33%	34%-66%	67%+	DK
Flex start and quit times?	0	1	2	3	99
Alternative work days (e.g. compressed work weeks)?	0	1	2	3	99
Telework from home at least once a week?	0	1	2	3	99
Living wages ($22.70/hr for CA; $20.56 for CO; $24.84 for MA; $18.92 for NC; $19.49 for WA)?	0	1	2	3	99
Job sharing or part-time opportunities?	0	1	2	3	99
Paid leave to care for a new or sick child?	0	1	2	3	99
Paid leave to attend school or other child-related events	0	1	2	3	99
Paid sick leave or vacation for employees	0	1	2	3	99
Child care (sliding-fee on site or subsidies for lower income)?	0	1	2	3	99
Transportation subsidies provided to low-income employees?	0	1	2	3	99
Housing subsidies provided to low-income employees?	0	1	2	3	99
Breast feeding mothers given break time?	0	1	2	3	99
Breast feeding mothers given private lactation room?	0	1	2	3	99
Mental health counseling services provided?	0	1	2	3	99
Substance abuse treatment services provided?	0	1	2	3	99
Parenting training provided?	0	1	2	3	99
Flexible spending accounts for health care or medications?	0	1	2	3	99
Flexible spending accounts for child care?	0	1	2	3	99
Support for professional development (e.g. tuition assistance, on-the-job-training)?	0	1	2	3	99

Data Used by Agency in Past Year to Inform Decision-making

In this next section, we would like to document the use of data to inform decisions. Collecting, analyzing, and/or reporting data are not considered “using data to inform decisions” even if the data were used by another agency. Answer yes only if your agency used the data to inform a decision. If “yes” (i.e., the specific data were used to inform a decision in your agency), please indicate whether the data were examined by race/ethnicity or income.

Please indicate (Yes or No) which data your agency/organization used in the past year to make decisions about policies or programs that affect children or families in your state. Then, indicate if these data were examined by race/ethnicity and/or income.

Used Past Year

Examined by race/ ethnicity

Examined by income

Yes

No

Don’t Know

Yes

No

Yes

No

Number (#) of child homicides

Y

N

DK

Y

N

Y

N

Child fatality review reports

Y

N

DK

Y

N

Y

N

# of hospital discharges due to children’s intentional injuries

Y

N

DK

Y

N

Y

N

# of Emergency Room visits due to children’s intentional injuries

Y

N

DK

Y

N

Y

N

Rate of reports to Child Protective Services (CPS)

Y

N

DK

Y

N

Y

N

% of children reporting 2+ Adverse Childhood Experiences in the National Children’s Health Survey

Y

N

DK

Y

N

Y

N

% of pregnant women receiving prenatal care in the first trimester

Y

N

DK

Y

N

Y

N

% of pregnant women or parents of young children with depression, exposure to partner violence, or substance abuse

Y

N

DK

Y

N

Y

N

% of pregnant women receiving information about or referral for depression, exposure to partner violence, or substance abuse from their health care provider

Y

N

DK

Y

N

Y

N

% births to teen parents

Y

N

DK

Y

N

Y

N

Teen access to contraception

Y

N

DK

Y

N

Y

N

# of 911 calls attributed to partner violence

Y

N

DK

Y

N

Y

N

length of wait list for treatment of substance abuse or mental illness among adults

Y

N

DK

Y

N

Y

N

% children with no medical insurance

Y

N

DK

Y

N

Y

N

% of infants breastfed

Y

N

DK

Y

N

Y

N

% of parents of children under five who received anticipatory guidance using Bright Futures guidelines

Y

N

DK

Y

N

Y

N

Please indicate (Yes or No) which data your agency/organization used in the past year to make decisions about policies or programs that affect children or families in your state. Then, indicate if these data were examined by race/ethnicity and/or income.

Used Past Year

Examined by race/ ethnicity

Examined by income

Y

Yes

No

Don’t Know

Yes

No

Yes

No

% of unplanned pregnancies

Y

N

DK

1

N

1

N

% of women between 20-45 with access to family planning services

Y

N

DK

1

N

1

N

% of CBCAP dollars allocated evidence-based programs

Y

N

DK

1

N

1

N

% of parents who physically punished their child in the past year

Y

N

DK

1

N

1

N

% 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)

Y

N

DK

1

N

1

N

% children who are read, sung, or told stories to

Y

N

DK

1

N

1

N

% children < 2 who watch TV

Y

N

DK

1

N

1

N

% children > 2 in front of a screen > 2 hours a day

Y

N

DK

1

N

1

N

Affordability of child care

Y

N

DK

1

N

1

N

Child care slots available / # of children < 6 potentially needing child care

Y

N

DK

1

N

1

N

Length of wait list for infant or toddler childcare and education programs such as Early Head Start

Y

N

DK

1

N

1

N

Length of wait list for childcare subsidies

Y

N

DK

Y

N

Y

N

% of families who are eligible for Temporary Assistance to Needy Families (TANF) who actually receive TANF

Y

N

DK

Y

N

Y

N

% of families who are eligible for Supplemental Nutrition Assistance Program (SNAP) or WIC vouchers who actually receive SNAP/WIC

Y

N

DK

Y

N

Y

N

% of children who are food insecure

Y

N

DK

Y

N

Y

N

% of families who are eligible for State Children’s Health Insurance Program (SCHIP)/Medicaid who actually receive SCHIP/Medicaid

Y

N

DK

Y

N

Y

N

High school dropout rates

Y

N

DK

Y

N

Y

N

Length of wait list for state-funded pre-K program or Head Start

Y

N

DK

Y

N

Y

N

% of schools with evidence-based education programs to prevent teen pregnancy

Y

N

DK

Y

N

Y

N

Distribution of funding for schools in high vs low poverty districts

Please indicate (Yes or No) which data your agency/organization used in the past year to make decisions about policies or programs that affect children or families in your state. Then, indicate if these data were examined by race/ethnicity and/or income.

Used Past Year

Examined by race/ ethnicity

Examined by income

Yes

No

Don’t Know

Yes

No

Yes

No

% children treated unfairly because of race/ethnicity

Y

N

DK

Y

N

Y

N

% of children living in poverty

Y

N

DK

Y

N

Y

N

% of children living in high poverty neighborhoods

Y

N

DK

Y

N

Y

N

% children living in neighborhoods with low social capital

Y

N

DK

Y

N

Y

N

% of families with children who pay > 30% of income for housing

Y

N

DK

Y

N

Y

N

% of children living in crowded households

Y

N

DK

Y

N

Y

N

% of homeless school-age children

Y

N

DK

Y

N

Y

N

% of homeless pre-school age children

Y

N

DK

Y

N

Y

N

Cost of living for a family with 2 children

Y

N

DK

Y

N

Y

N

% of children with no parent fully employed year round

Y

N

DK

Y

N

Y

N

% of children with an incarcerated parent

Y

N

DK

Y

N

Y

N

Average interest rates for payday, auto title, or pawnshop loans

Y

N

DK

Y

N

Y

N

% of businesses with family-friendly work policies (e.g., flex-time, telework, paid leave for children) or state policies that are family friendly

Y

N

DK

Y

N

Y

N

Other, please describe

Other, please describe

Please indicate YES, NO, or Don’t know for the following questions about collaboration. If “YES”, please indicate how your agency collaborates with them. For this survey, collaboration includes referral to an agency; coordinating services or programs; serving on an advisory or planning group; sharing data; developing legislation or policy; cross-training; or sharing materials, information, or other resources. If it is your own agency, please choose “YES” and indicate the kinds of collaborations your agency engages in. Where the name of an agency is blank, please specify the name of the agency/organization where space is provided.

Agency or organization.

Our agency collaborates with this organization

Refers to this organiza-tion

Coordinates or blends services or programs with this organization

Serves on an advisory or planning group for this organiza-tion

Shares data with this organiza-tion.

Develops legislation or policy with this organization

Cross-trains with this organiza-tion

Shares materials, information, or other resources with this organization

Don’t know how my agency collabo-rates with this org

Yes

No

Don’t know

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

DK

Governor’s Office

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Dept of Educ

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Family & children services

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Human services

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Public Health

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Developmental disabilities

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Child support

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Consumer protection

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Transportation

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Early Care or learning

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Police

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Justice

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Labor

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Housing

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Finance

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Environment

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

CBCAP

Agency or organization.

Our agency collaborates with this org

Refers to this org.

Coordinates services or programs with this org

Serves on n advisory or planning group with this org

Shares data with this org.

Develops legislation or policy with this org.

Cross-trains with this org,

Shares materials With this org.

Don’t know how my agency collabo-rates with this org

Yes

No

Don’t know

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

DK

State Prevent Child Abuse

Y

N

DK

N

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Children’s Alliance

Y

N

DK

N

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Children’s Trust Fund

Y

N

DK

N

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Chamber of Commerce

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Businesses with state-wide coverage ___________

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

_____________

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Non-profits ___________

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

____________

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Foundations ____________

Technical college(s) ___________

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

____________

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Universities ___________

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

____________

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Coalitions/grass root organizations ___________

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Public broadcasting

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Regional TV station

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

DK

Regional newspaper

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

Y

N

N

DK

Other: ___________

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

Y

N

N

DK

___________

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

Y

Y

N

N

DK

___________

Y

N

DK

Y

N

Y

N

Y

N

Y

N

Y

N

N

Y

N

N

DK

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