Form State Collaborator State Collaborator State Collaborator Survey

Mulit-Site Evaluation of the Safe Schools/Healthy Students (SS/HS) State Program

Attachment C_State Collaborator Survey

State Collaborator Survey

OMB: 0930-0347

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OMB No 0930-XXXX

Expiration Date: XX/XX/XXXX



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-xxxx.  Public reporting burden for this collection of information is estimated to average 30 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.

Substance Abuse and Mental Health Services Administration

Multi-Site Evaluation of the Safe Schools Healthy Students State Program


State Collaborator Informed Consent and Survey



The U.S. Substance and Mental Health Services Administration is sponsoring a multi-site evaluation of the Safe Schools / Healthy Students (SS/HS) State Program in seven states. The Program funds participating states to disseminate and support planning and implementation of the SS/HS Framework for early childhood development, violence and substance abuse prevention, mental health services, and school safety in three select school districts in each state. The purpose of the multi-site evaluation is to gather and assess information on state and district implementation, collaboration and delivery of evidence-based services for children and youth.



The purpose of this survey is to learn from your experience as a participant in your state’s collaborative planning, guidance, and support of the program. The survey is part of the Multi-Site Evaluation which is designed to produce lessons that may help design and implement future SS/HS state programs, or strengthen existing programs. Existing evaluation and research has established the effectiveness of well implemented SS/HS programs. Your response to this survey will contribute to successful expansion of this proven program nationwide.

The SS/HS State Collaborator Survey asks for information about you and your agency/organization’s role in the collaboration, and your perceptions of how the collaboration functions.

Here are some things we want you to know about completing the survey:

  • Completing this survey is completely voluntary.

  • You may choose not to answer any question or to stop answering questions at any time, for any reason.

  • Completing the survey will take approximately 30 minutes. You may stop and restart the survey. You can stop the survey by closing your internet browser. All of your responses to that point will be saved. To continue the survey, reenter your SHEDS username and password on the website to continue the survey where you left off.

  • Any information that you provide will be kept strictly confidential. No one other than evaluation staff will know who you are and what answers you gave. Any reports from this survey will share results in group form. Your name will not be used in any reports produced from information collected by this survey, and no quotes will be used that will identify you individually.

  • There will be no direct benefit to you from participating in this evaluation. There are no foreseeable risks associated with participation in this survey.

  • A report that combines what is learned from all of the completed surveys will be sent to SAMHSA and be accessible to grantees. Grantees may share that report with others at their discretion.

  • Any questions you have about the study can be answered at any time by Mary Spooner of ICF International at (404) 321-3211, or at [email protected].

By completing and submitting the survey, you certify that you have read the above, that you understand its content, and that you freely agree to participate in this survey. Thank you in advance for your willingness to participate.

Shape1 I do not consent

Shape2 I consent





While state collaborations take different forms, we will use several standard terms to designate collaboration components about which we will ask.

  • Partnership includes all persons who are part of the network of agencies, organizations, and individuals who are involved in the SS/HS State Program work. It is the most inclusive network of contributors.

  • Project refers to the program primarily funded through the SS/HS State Program grant from the Substance Abuse and Mental Health Services Administration.

  • Members refers to individual representatives and organizations that are on the State Management Team


What is your role in the partnership? (check all that apply)

  • Member of the State Management Team

  • Member of a state working or advisory committee

  • SS/HS state program staff

  • Collaborating state agency staff

  • Representative of an LEA/district

  • Representative of local collaborating public agency(ies)

  • Representative of a non-governmental collaborating organization

  • Youth representative

  • Parent representative

  • Evaluation representative

  • Other consultant or contractor representative: please specify content area: _________________

  • Other: please specify _______________

Which sector does your agency or organization represent?

  • Education

  • Juvenile Justice

  • Law Enforcement

  • Mental Health

  • Other: Please specify: ____________________

What is the name of the agency/organization you represent?

__________________________________________________

Approximately what percentage of your work time do you spend on SS/HS matters?

  • 91 to 100%

  • 51 to 90 %

  • 26 to 50 %

  • 11 to 25 %

  • 6 to 10 %

  • 5 % or less



Please rate your level of agreement with the following statements:

Statement

Strongly Agree

Somewhat Agree

Neither Agree nor Disagree

Somewhat Disagree

Strongly Disagree

Insufficient familiarity/ knowledge to Respond

The partnership is a valuable asset of the project

The project does not have the needed resources (facilities, in-kind, financial, and human)

The partnership has clear communication among members

One or more partners have not been participating effectively

The partners have changed policies, laws, and/or regulations to facilitate achieving the project’s goals

The members of the partnership share a common vision of what should be accomplished

The members of the partnership share a common vision of how the vision should be implemented

Members of the partnership do not feel connected with one another (e.g., there is no feeling of synergy)

The leadership facilitates and supports teambuilding by capitalizing on diversity

The leadership facilitates and supports teambuilding by capitalizing on individual, group, and organizational strengths

Partners have limited influence on the important decisions made by the partnership

The partners understand the community, including its people, cultures, values, and norms

The partnership is not contributing significantly to your organization’s central mission and goals

The partnership is achieving its intended goals

The partners contribute resources (e.g., money, personnel, facilities)

The partners share responsibility for the project

There is a sense of excitement associated with the project

The organization is satisfied with the quality of collaboration among partners

The multiagency partnership has effective leadership

The partnership leaders are able to continually energize the members

The partnership leaders are able to mobilize members toward common goals

The partnership leaders make me feel welcome at meetings

The partnership leaders understand the values and culture of each partner agency


Our partnership builds social time for members into meetings and events

Members participate in social activities outside formal meetings

All members are treated equally and with respect

Members are asked about their interests and needs

Member contributions are recognized

Successes are celebrated

Members actively participate in the decisionmaking process

Members feel free to speak their views without being criticized

I feel strongly committed to this partnership

The organizers stay with the effort even through the hard times to help the partnership overcome obstacles

The partnership has kept the demands on members simple and realistic

The partnership does not rely too heavily on any one member

The partnership has explored ways of securing continued financial support

As a result of this partnership, services/programs to address the identified need in the community have improved

As a result of this partnership, accessibility to services and programs has improved

As a result of this partnership, policies, rules, or laws have been changed to support a new, effective way of “doing business”

As a result of this partnership, people are better off in our community



Partners play different roles in a collaborative effort, bringing unique capacity, expertise, and resources. Using the following rating scale, describe the degree of contribution you have made or the organization you represent has made during the pas over the past year:

No Contribution / role

Minor Contribution

Moderate Contribution

Significant Contribution

Leading Contribution

Insufficient famil-iarity/ knowledge to Respond

STRATEGIC PLANNING: e.g., providing materials, writing assistance, decision input to the state comprehensive plan (preparation / revision/ application).

ACTIVITY PLANNING:e.g., Planning for specific tasks within the SS/HS state grant collaborative effort

PROVIDING/ LEVERAGING FUNDING RESOURCES; e.g., Participating in providing specific funding for SS/HS collaborative tasks; collaborative budget requests;

PROVIDING / LEVERAGING HUMAN RESOURCES: e.g., reallocating staff to participate in SS/HS tasks and activities; enabling local reallocation of staff to SS/HS tasks and activities







PROVIDING / LEVERAGING INFORMATION RESOURCES: e.g., providing passive informational resources (any media), participating in dissemination networks








PROVIDING / LEVERAGING TRAINING / TA RESOURCES; e.g., providing face-to-face or web-based training or TA to SS/HS related audiences; participating or providing support to SS/HS sub-grantee trainings







MONITORING / ACCOUNTABILITY; e.g., Evaluation activities, providing/ collecting monitoring or evaluation data; disseminating and making use of performance monitoring and evaluation data







Characterize your interactions with each of the partner sector representatives. Identify the number of agencies / organizations with which you interacted in each listed sector. Each specific agency should be counted for just one category.

  • Rarely worked or participated in SS/HS meetings with them (Monthly or less)

  • Occasionally worked or participated in SS/HS meetings with them

  • Often worked with them in task-focused meetings in addition to SS/HS meetings

  • Regularly worked with them by exchanging data, information, or resources to plan for a specific piece of the SS/HS project

  • Regularly and extensively worked with them to plan and implement across one or more major components of the SS/HS project


# of Agencies / Organbizations

Rarely

Occasionally

Often

Regularly

Regularly and Extensively

I Represent This Partner

Insufficient famil-iarity/ knowledge to Respond

State educational agency (ies)









School district(s)


School(s)









State justice system agency(ies)









Local law enforcement









Local court systems









State mental health agency(ies)


Local mental health agency(ies)


State substance abuse agency(ies)









Local substance abuse agency(ies)









State family / child agency(ies)









Local family / child agency(ies)









State consultants / contractors (excluding SS/HS evaluator)


Local consultants / contractors









Other (specify)












Please indicate the response that best indicates the relative emphasis that your SS/HS collaboration places on each of the following objectives:


No emphasis/ Not Addressed

Minor Emphasis

Moderate Emphasis

Significant Emphasis

Priority Emphasis

Insufficient famil-iarity/ knowledge to Respond

The use of evidence based practices

Reducing health disparities among youth

Integrating mental health services in schools

Cultural and linguistic inclusion







Involving families in their schools







Creating a more positive school climate







Promoting restorative school discipline policies (e.g., reduced suspension / expulsion







Increasing early childhood social / emotional development services and access







Involving community members / organizations in their schools







Preventing / reducing substance use among youth







Improving use of technology to advance SS/HS objectives







Reducing violent behavior in youth







Promoting positive youth development







Creating safe schools







Strengthening the communities capacity to achieve SS/HS goals







Increasing services and opportunities for high need populations







Sustaining SS/HS principles and strategies







Other specify:









Thank you for sharing your experiences with the SS/HS State Program!

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