Form Modified TA Networ Modified TA Networ Modified TA Network Satisfaction Survey

Appendix A

Annual General Technical Assistance Survey

OMB No. 0930-0197

Expiration Date: 1/31/17

Public Burden Statement: 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.  The OMB control number for this project is 0930-0197.  Public reporting burden for this collection of information is estimated to average 10 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 2-1057, Rockville, Maryland, 20857.

Dear Colleagues,

The Technical Assistance Network for Children’s Behavioral Health (TA Network) would like your input on the effectiveness of the technical assistance (TA) activities available to you as a System of Care Grantee site to you. Please take a few minutes to complete this survey and share your opinions. Even if you’ve never access TA from the TA Network, your opinions are very important. Your participation is voluntary.

You will have an opportunity to provide us with valuable feedback that will help us to enhance the TA we provide. In addition, you will have an opportunity to share your TA priorities for the upcoming year. The form should only take a few minutes to complete and all responses will be anonymous.

Section	Question				Response
I. General Information	The system and/or role I represent can best be described as: Please check as many as apply:				Court Representative Cultural/Linguistic Competence Coordinator Direct Service Provider Evaluator/Researcher Family Lead Local Child Welfare agency Local Early Childhood Agency Local Education Local Health Agency Local Juvenile Justice Agency Local Mental Health Agency Local substance Abuse Agency Managed Care Organization Parent Support Partner Project Director Social Marketing/Communications State Child Welfare agency State Early Childhood Agency State Education/Special Education State Health Agency State Juvenile Justice Agency State Medicaid Agency State Mental Health Agency State Substance Use and Dependence Agency TA Network Technical Assistance Coordinator Youth Lead Youth Peer Support Specialist Other (please specify)
	Is your role or position part of a currently funded Comprehensive Community Mental Health Services for Children and their Families Cooperative Agreement?				Yes No Unsure
	If No	Skip to Section II
	If Yes	In what year were you funded?			2009 2010 2011 2012 2013 2014
		What type of CMHI grant does your community have?			Expansion Planning Expansion Implementation
		How long have you been accessing technical assistance from the TA Network (e.g., conference calls, on-site TA, rapid response, website, webinars)?			years ____ months ____
	If yes & planning	Please answer the following questions as they pertain to your state or community’s efforts to develop a comprehensive strategic plan for improving, expanding and sustaining services provided through a system of care approach. This includes planning for infrastructure, services, and supports for children and youth with serious emotional disturbances.
	If yes & implementation	Please answer the following questions as they pertain to your state or community’s efforts to create infrastructure which allows for the provision of and access to systems of care-related services and supports. This may involve the provision of behavioral health and related services to children and youth with serious emotional disturbances, as well as the implementation of systemic changes in policy, financing, services and supports, training and workforce development, and other areas that are necessary for expanding and sustaining the systems of care approach.
	Have you ever accessed technical assistance from the TA Network (e.g., conference calls, on-site TA, rapid response, website, webinars, etc.)?				Yes No Unsure
	If no	Why have you not accessed technical assistance from the TA Network?			TA activities have not been relevant to my role, interests and/or area of expertise I am unsure how to access TA I was not aware of TA activities Other (open-ended):
	If yes, go to section II
II. TA Content Areas	Please select the TA content areas that you accessed from the TA Network over the past year (2014) (e.g., through TA consultation calls, rapid response TA, webinars, the TA Network website) and that you expect to access from the TA network in 2015.
	TA Content Area								Received TA in 2014	Anticipate needing TA in 2015
	Care Coordination Approaches (Wraparound)
	Center of Excellence Development
	Child Welfare
	Conflict Resolution
	Continuous Quality Improvement, Quality Management and/or evaluation
	Cost Benefit Analysis/Return on Investment Strategies
	Cultural and Linguistic Competence
	Developmental Disabilities
	Early Childhood
	Education
	Evidence-Based and Effective Practice/Clinical Interventions
	Faith Based
	Family Partnership & Leadership (including family-run organization leadership)
	Financing
	Fund Mapping and Children’s Budget
	Governance: Decision Making and Oversight at the Policy Level
	Grant Administration
	Juvenile Justice
	Medicaid
	Mental Health
	Mobile Crisis Response & Stabilization
	Organization Development and Implementation
	Parent Peer-to-Peer Support
	Primary Care
	Rural Considerations
	Screening, Assessment, Evaluation, and Service Planning
	Service Array
	Social Marketing
	Strategic Planning
	Substance Abuse
	Sustainability
	System Management and Design
	Systems of Care
	Technology (use of MIS systems, Tele-behavioral health, etc.)
	Transition-age Youth
	Workforce/Human Resource Development
	Youth Partnership and Leadership
	Youth Peer-to-Peer Support
	Other (please specify)
	Please rate the quality of the technical assistance for each of the TA content areas that you accessed from the TA Network over the past year (2014)								Needs improvement Below average Average Above average Excellent
III. Individualized TA	Please indicate how frequently you received Individualized TA via the following delivery methods during this past year (2014).
	Monthly Individualized Community TA Planning Calls—Conference calls with grant team and TA Network staff to identify/discuss TA needs, strengths, and strategies.						I did not receive TA via this method Less than 5 times 5-10 times More than 10 times Unsure
	Systems Coaches—Coaches provide site-driven TA and assist grantees in developing TA plans and tapping into specific content expertise from the TA Network partners and Consultant Pool Clearinghouse, as well as peer-to-peer opportunities.						I did not receive TA via this method Less than 5 times 5-10 times More than 10 times Unsure
	Monthly Individualized Community TA Planning Calls—Conference calls with grant team and TA Network staff to identify/discuss TA needs, strengths, and strategies.						I did not receive TA via this method Less than 5 times 5-10 times More than 10 times Unsure
	Content Experts—Members of core partner agencies of the TA Network and/or part of the TA Network Consultant Pool Clearinghouse that are matched to grantees depending on needed subject matter expertise. TA is provided through scheduled calls and/or individualized webinars.						I did not receive TA via this method Less than 5 times 5-10 times More than 10 times Unsure
	Mentoring and Coaching Support by TA Coordinator/Resource Specialist—Individualized support to individuals or teams as requested.						I did not receive TA via this method Less than 5 times 5-10 times More than 10 times Unsure
	On-Site TA and consultation—Community visits to support/problem-solve specific needs/challenges or provide training when sites request this and support travel costs.						I did not receive TA via this method Less than 5 times 5-10 times More than 10 times Unsure
	Rapid Response—Express linkage (often via email) to specific resource materials and consultants as-needed.						I did not receive TA via this method Less than 5 times 5-10 times More than 10 times Unsure
	Technical Assistance Support Coordinators—Administrative liaisons assigned to each grantee to ensure that TA needs are met. TASCs do not provide TA themselves; their role is to support the grantee, Systems Coaches and Content Experts.						I did not receive TA via this method Less than 5 times 5-10 times More than 10 times Unsure
	Peer-to-Peer Learning Opportunities—Conference calls or webinars among grantees with reciprocal needs and expertise, often facilitated by a TA Network partner or consultant						I did not receive TA via this method Less than 5 times 5-10 times More than 10 times Unsure
IV. Generalized TA	Please indicate how frequently you received Generalized TA via the following delivery methods during this past year (2014).
	TA Webinars—Topical presentations for a broad group of participants hosted online.					I did not receive TA via this method Infrequently (less than 10 times) Occasionally (10 to 50 times) Regularly (between 50-100 times) All the time (more than 100 times)
	Office Hours—Topic-focused conference calls or webinars that are open to individuals who have specific questions or discussion points related to specific topics.					I did not receive TA via this method Infrequently (less than 10 times) Occasionally (10 to 50 times) Regularly (between 50-100 times) All the time (more than 100 times)
	Clinical Distance Learning Series—Opportunities for communities to participate in a multifaceted series of webinars, office hours, and consultation on 1) established evidence-based practices that are effective in systems of care settings, 2) learning and wisdom from practice-based evidence; and 3) emerging best practices.					I did not receive TA via this method Infrequently (less than 10 times) Occasionally (10 to 50 times) Regularly (between 50-100 times) All the time (more than 100 times)
	Learning Exchange Series—Consists of an initial webinar to provide general information to participants on a particular topic (e.g., CLC, Centers of Excellence) followed by four monthly conference calls where participants discuss potential implementation strategies and receive TA from content experts to support local implementation.					I did not receive TA via this method Infrequently (less than 10 times) Occasionally (10 to 50 times) Regularly (between 50-100 times) All the time (more than 100 times)
	TA Briefs & Resources—Written resources developed by the TA Network					I did not receive TA via this method Infrequently (less than 10 times) Occasionally (10 to 50 times) Regularly (between 50-100 times) All the time (more than 100 times)
	Tuesday TA Telegram—Weekly publication available via email subscription that delivers up-to-the-minute information on resources, trainings, grants, and other news of interest to systems of care					I did not receive TA via this method Infrequently (less than 10 times) Occasionally (10 to 50 times) Regularly (between 50-100 times) All the time (more than 100 times)
	TA Telescope—Semiannual publication available via email subscription that features one important topic per issue with practical information to support systems of care expansion and implementation. The two issues you received this year were focused on financing and wraparound implementation.					I did not receive TA via this method Infrequently (less than 10 times) Occasionally (10 to 50 times) Regularly (between 50-100 times) All the time (more than 100 times)
	Other—(please specify).					I did not receive TA via this method Infrequently (less than 10 times) Occasionally (10 to 50 times) Regularly (between 50-100 times) All the time (more than 100 times)
	What is your preferred way of receiving Generalized TA?					Open-ended
V. Satisfaction with TA	Rate your agreement with the following statements, thinking about all of the TA you received from the TA Network over the past year (2014)
	TA requests were responded to in a timely manner							Strongly disagree Disagree Neutral Agree Strongly agree Not applicable
	TA was delivered in a professional manner							Strongly disagree Disagree Neutral Agree Strongly agree Not applicable
	The TA supported my community’s efforts to sustain our system of care							Strongly disagree Disagree Neutral Agree Strongly agree Not applicable
	The TA supported my community’s efforts to develop a strategic plan							Strongly disagree Disagree Neutral Agree Strongly agree Not applicable
	The TA supported my community’s efforts to implement large-scale system change (e.g., leadership, change management, strategic communication, policy change)							Strongly disagree Disagree Neutral Agree Strongly agree Not applicable
	The TA has supported my community’s efforts to:		Plan/implement systems structures and financing					Strongly disagree Disagree Neutral Agree Strongly agree Not applicable
			Plan/implement culturally and linguistically competent and responsive care					Strongly disagree Disagree Neutral Agree Strongly agree Not applicable
			Plan/implement evidence-based care and other clinical interventions					Strongly disagree Disagree Neutral Agree Strongly agree Not applicable
			Plan/implement family-driven care (e.g., parent peer support, family-run organizations, family partnership)					Strongly disagree Disagree Neutral Agree Strongly agree Not applicable
			Plan/implement youth-guided care (e.g., youth peer support, youth-run organizations, youth partnership)					Strongly disagree Disagree Neutral Agree Strongly agree Not applicable
			Collect and use data for continual quality improvement					Strongly disagree Disagree Neutral Agree Strongly agree Not applicable
			Improve/increase interagency collaboration					Strongly disagree Disagree Neutral Agree Strongly agree Not applicable
			Other – (please specify)					Strongly disagree Disagree Neutral Agree Strongly agree Not applicable
	Overall, I was very satisfied with the TA I received							Strongly disagree Disagree Neutral Agree Strongly agree Not applicable
	What suggestions do you have for further improving our TA services/activities?							Open-ended
VI. TA Provider Transition	You may recall that in January, 2014, provision of TA transitioned from the TA Partnership to the TA Network. Did you ever access technical assistance from the TA Partnership (e.g., conference calls, on-site TA, rapid response, website, webinars, etc.)?							Yes No Unsure
	If yes, unsure			Did the shift in TA providers impact your ability to access TA and support?				Yes No Unsure
				In what way(s) did the shift in TA providers impact your ability to access TA and support?				Open-ended
				Compared with the methods of the previous TA provider, the TA Network’s approach to delivering TA: (check one)				Is an improvement Has made things worse Has made no difference Non-applicable/I did not receive TA from the previous TA provider
VII. Closing	Is there anything else you would like to share about your experience with the TA Network and/or your expected TA needs in the coming year?							Open-ended

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