School Leadership Capacity and Readiness Survey

Form Approved

OMB No. 0920-0941

Exp. Date: 6/30/2015

Public Reporting burden of this collection of information is estimated at 60 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 (0920-0941).

Attachment K:

School Leadership Capacity and Readiness Assessment

Dating Matters: Strategies to Promote Healthy Teen Relationships™ Initiative

Division of Violence Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Dating Matters Capacity Assessment: School Survey

The purpose of the Dating Matters Capacity Assessment Tool is to guide you in gathering information about your school’s strengths and areas for improvement. The Dating Matters Capacity Assessment Tool covers information on a wide range of capacity dimensions that are related to effective program implementation. The questions address strengths and skills relevant to preventing teen dating violence and promoting healthy relationships for young people.

The information obtained from this tool will be used to help your local health department and other stakeholders devise an action plan for capacity building. The answers you provide will be combined with answers from other respondents. Your local health department contact will share information from an assessment report and action plan geared toward participants’ specific needs. The scores in the assessment report are generally averages or totals of items reflecting important capacity/readiness areas. The scores will be graphed to show where schools as a whole rank on a range from high to low. The purpose is to provide participants with information for team building and capacity building for implementation of evidence-based programming. The Centers for Disease Control and Prevention (CDC) expects that all grantees will have capacity areas that need improvement.

This information will not be used to rate grantees on implementation. It is simply a tool to help your organization reach its highest potential for implementing the Dating Matters initiative.

The assessment report and action plan will be provided to you from the local health department. A copy of your assessment report and action plan will also be submitted to the CDC task monitor and technical assistance provider. We appreciate your honest reflection in responding to these questions.

1. What is your primary role within the school? Select one answer.

   ₁ Administrator (e.g., Principal, Assistant Principal)

   ₂ Teacher

   ₃ Counselor, Psychologist, Social Worker

   ₄ Physical or Occupational Therapist, Nurse

   ₅ School District-level Administrator

   ₆ Other

   If other, please specify: ____________________________________

2. How long have you been in this role at this school?

Years

Months

Awareness of Need

3. In the past 12 months, how much of a problem has teen dating violence been at your school? Select one answer.

₁ Major problem

₂ Moderate problem

₃ Minor problem

₄ Not a problem

₅ Don’t know

Scoring: Report 1 and 2 responses in action plan.

4. In the past 12 months, how much of a problem has teen dating violence been at other schools in the district? Select one answer.

₁ Major problem

₂ Moderate problem

₃ Minor problem

₄ Not a problem

₅ Don’t know

Scoring: Report 1 and 2 responses in action plan.

History of Teen Dating Violence Prevention Efforts

5. In the past 12 months, has your school done any of the following? Select one answer per row.

	Yes	No	Don’t know
a. Adapted a prevention curriculum (on any topic) to better meet the needs of your community	1	0	2
b. Implemented a curriculum that included healthy relationship topics (but not specific to teen dating violence)	1	0	2
c. Implemented a teen dating violence prevention curriculum with students	1	0	2
d. Implemented a teen dating violence prevention curriculum with parents/caregivers or families	1	0	2
e. Provided training for staff, teachers, or administrators about a teen dating violence prevention curriculum	1	0	2
f. Provided training for staff, teachers, or administrators on the prevalence, causes, and consequences of teen dating violence	1	0	2
g. Facilitated youth-led teen dating violence prevention programming	1	0	2
h. Identified gaps in school district policies on teen dating violence prevention	1	0	2
i. Supported the promotion of school district policies on teen dating violence prevention	1	0	2

Scoring: sum of “yes” responses. Report “no” responses in action plan.

Implementation of Other Prevention Efforts

6. In the past 12 months, has your school implemented any of the following types of prevention and/or health promotional programming? Select one answer per row.

	Yes	No	Don’t know
a. Substance abuse prevention	1	0	2
b. Gang prevention	1	0	2
c. Teen pregnancy prevention or sexual health promotion	1	0	2
d. Bullying prevention	1	0	2
e. Sexual violence prevention	1	0	2
f. School violence prevention	1	0	2
g. Suicide prevention	1	0	2
h. Positive behavioral interventions and supports (PBIS)	1	0	2
i. Healthy living (e.g., exercise, nutrition)	1	0	2
j. Other	1	0	2

If other, please specify ______________________

Score: Sum of a–j.

Access to Resources

7. Please indicate whether your school currently has the following resources to implement the Dating Matters initiative. Select one answer per row.

	Yes	No	Don’t know
a. Staff who could assist an evaluator in collecting evaluation data, such as surveys	1	0	2
b. Training for evaluation assistant	1	0	2
c. Staff who understand the importance of adhering to the curriculum implementation manual	1	0	2
d. School staff to facilitate Dating Matters	1	0	2
e. Access to a copier to prepare Dating Matters handouts	1	0	2
f. Classroom space to teach Dating Matters	1	0	2
g. Funds to hire substitute teachers when teachers receive the Dating Matters training	1	0	2
h. Funds for purchasing Dating Matters supplies (e.g., paper, markers)	1	0	2
i. Funds to pay for Dating Matters training (excluding funds to hire substitute teachers)	1	0	2
j. Access to ongoing technical assistance for implementing Dating Matters	1	0	2
k. Class time for up to 10 classroom sessions	1	0	2
l. Time allocated to show Dating Matters play	1	0	2

Scoring: sum of “yes” responses. Report “no” responses in action plan.

Support for Dating Matters

8. Sometimes, programs like Dating Matters encounter challenges with gaining full support of stakeholders. How much do you agree or disagree with each of the following statements? Select one answer per row.

	Strongly Disagree	Disagree	Neither Disagree nor Agree	Agree	Strongly Agree	Don’t Know
a. Dating Matters has support from school district leaders.	1	2	3	4	5	6
b. Dating Matters has support from administrators and staff.	1	2	3	4	5	6
c. Dating Matters has support from teachers.	1	2	3	4	5	6
d. Dating Matters has support from parents.	1	2	3	4	5	6
e. Dating Matters has support from students.	1	2	3	4	5	6

Scoring: means of items a–e.

Perceived Efficacy in Evaluation

9. How much do you agree or disagree with each of the following statements? Select one answer per row.

I am confident that my school can….

	Strongly Disagree	Disagree	Neither Disagree nor Agree	Agree	Strongly Agree	Don’t Know
a. Explain the benefits of evaluation to parents and youth.	1	2	3	4	5	6
b. Work with an evaluator to collect survey and other outcome data from Dating Matters participants.	1	2	3	4	5	6
c. Work with an evaluator to collect implementation data from Dating Matters participants and program staff.	1	2	3	4	5	6

Scoring: mean of items a–c. Report items with “disagree” response in action plan.

Leadership: Prevention Advocacy

10. In the past 12 months, have any of the following advocacy or promotional efforts occurred? Select one answer per row.

	Yes	No	Don’t Know
a. Someone in our school advocated for resources, other than Dating Matters, for teen dating violence prevention.	1	0	2
b. Someone in our school advocated for district policies on teen dating violence.	1	0	2
c. There have been school-wide or district-wide events promoting Dating Matters.	1	0	2
d. The school has organized community-wide events promoting Dating Matters.	1	0	2

Scoring: mean of items a–d.

Access to Training/Technical Assistance

11a. Have your Dating Matters school staff received training to implement Dating Matters? Select one answer.

₁ Yes  Go to 11b

₂ No  Go to 11c

₃ Don’t know  Go to 11c

11b. How much do you agree or disagree with the following statement? Select one answer.

Our Dating Matters school staff have been effectively trained to implement Dating Matters.

₁ Strongly disagree

₂ Disagree

₃ Neither disagree or agree

₄ Agree

₅ Strongly agree

₆ Don’t know

11c. Have your Dating Matters school staff received ongoing technical assistance to implement Dating Matters? Select one answer.

₁ Yes  Go to 11d

₂ No  Go to 11e

₃ Don’t know  Go to 11e

11d. How much do you agree or disagree with the following statement? Select one answer.

The ongoing technical assistance our school staff have received to implement Dating Matters has been useful. Select one answer.

₁ Strongly disagree

₂ Disagree

₃ Neither disagree or agree

₄ Agree

₅ Strongly agree

₆ Don’t know

11e. Have your Dating Matters school staff received training or information on how to adapt the Dating Matters initiative to your school? Select one answer.

₁ Yes  Go to 11f

₂ No  Go to 12

₃ Don’t know  Go to 12

11f. How much do you agree or disagree with the following statement? Select one answer.

Training or information on adapting the Dating Matters initiative has been useful to Dating Matters school staff.

₁ Strongly disagree

₂ Disagree

₃ Neither disagree or agree

₄ Agree

₅ Strongly agree

₆ Don’t know

Scoring: mean of items b and d and f.

Readiness for Preventive Interventions

12. How much do you agree or disagree with each of the following statements? Select one answer per row.

	Strongly Disagree	Disagree	Neither Disagree nor Agree	Agree	Strongly Agree	Don’t Know
a. Our school has the fiscal resources to implement the Dating Matters initiative.	1	2	3	4	5	6
b. Our school has the time to implement Dating Matters.	1	2	3	4	5	6
c. Our school has the time to participate in an evaluation of Dating Matters.	1	2	3	4	5	6
d. Our school has the knowledge needed to implement Dating Matters.	1	2	3	4	5	6
e. Our school understands the steps that are required to implement Dating Matters.	1	2	3	4	5	6
f. Dating Matters fits with our school’s educational philosophy.	1	2	3	4	5	6
g. School district policies will help facilitate the Dating Matters implementation.	1	2	3	4	5	6
h. Our school feels a strong commitment to implement Dating Matters.	1	2	3	4	5	6
i. Our school believes that Dating Matters will benefit our students.	1	2	3	4	5	6

Scoring: mean of items a–i.

Implementation Barriers

12. Please describe any barriers that may hinder implementation of the Dating Matters initiative.

Value on Program Fidelity

12. How much do you agree or disagree with each of the following statements? Select one answer per row.

In order for an evidence-based intervention to achieve results like those demonstrated in its research studies…

	Strongly Disagree	Disagree	Neither Disagree nor Agree	Agree	Strongly Agree	Don’t Know
a. The implementer should cover all of the topic areas laid out in the intervention manual.	1	2	3	4	5	6
b. The implementer should complete all of the specific activities laid out in the intervention manual.	1	2	3	4	5	6
c. The implementer should deliver intervention content in the method specified in the intervention manual (e.g., lecture vs. reading assignment).	1	2	3	4	5	6
d. The intervention should be delivered in the setting specified in the intervention manual (e.g., community vs. school, small group vs. large group).	1	2	3	4	5	6
e. Intervention activities should be delivered according to the schedule specified in the intervention manual.	1	2	3	4	5	6

Scoring: mean of items a–e.

Teacher Attitudes Toward Evidence-Based Prevention

12. How much do you agree or disagree with each of the following statements?
    Select one answer per row.

	Strongly Disagree	Disagree	Neither Disagree nor Agree	Agree	Strongly Agree	Don’t Know
a. Teachers at my school know better than researchers how to address teen dating violence prevention in our school.	1	2	3	4	5	6
b. Research-based programs are not useful in “real world” prevention efforts.	1	2	3	4	5	6
c. Frontline experience is more important than using interventions from a manual.	1	2	3	4	5	6
d. Teachers at my school would not use interventions from a manual	1	2	3	4	5	6
e. Teachers at my school believe that they should implement only those curricula lessons that they think are important.	1	2	3	4	5	6
f. Teachers at my school believe it is OK to adapt curricula to make it more relevant to their students.	1	2	3	4	5	6

Scoring: mean of items a–f. Reverse code so that higher score equals a more positive attitude.

Collaboration with Local Health Department and Community-Based Organizations

12. In the past 12 months, has your school collaborated with other organizations in any of the following ways?

	Yes	No	Don’t Know
Collaborated with local health department on violence prevention projects.	1	2	3
Collaborated with local health department on other health-related projects.	1	2	3
Collaborated with other county or city agencies on violence prevention projects.	1	2	3
Collaborated with community-based organizations on violence prevention projects.	1	2	3

Scoring: mean of items a–d.

Planning for Sustainability

12. Please rate how much these characteristics are true for your Dating Matters initiative. Select one answer per row.

	Not at All	A Little	Some-what	A Lot	Don’t Know
a. Our school is planning for sustainability of Dating Matters.	1	2	3	4	5
b. Our school is looking for other funding resources to support Dating Matters when the grant ends.	1	2	3	4	5
c. Our school leadership is committed to the long-term goals of Dating Matters.		2	3	4	5
d. Our school district leadership is committed to the long-term goals of Dating Matters.		2	3	4	5
e. Dating Matters is part of a long-term collaborative effort with other organizations to reduce youth violence.	1	2	3	4	5
f. Dating Matters addresses key needs of our students.	1	2	3	4	5
g. Dating Matters has strong local government support.	1	2	3	4	5
h. Dating Matters will have opportunities to be integrated with other violence prevention efforts.	1	2	3	4	5

Scoring: mean of items a–h.

12. Did you have to consult with anyone to answer any questions on this assessment?

₁ Yes

₂ No

12. If yes, with whom did you consult?

     

12. Is there any other relevant information about your capacity to implement the Dating Matters initiative that you would like to share?