Community Capacity/Readiness Assessment

Attachment JJJJ:

Community Capacity /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

Form Approved

OMB No. 0920-0941

Exp. Date: 06-30-2015

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-74, Atlanta, GA 30333; Attn: PRA (0920-0941).

Dating Matters™ Capacity Assessment: Community Advisory Board Survey

The purpose of this survey is to look at how your Community Advisory Board (CAB) works and to get your perceptions on the strengths and challenges of implementing the Dating Matters™ initiative in your community.

The CAB, local health department, and key partners will use information summarized in the Assessment Report to help support the Dating Matters™ initiative. Responses from each individual completing the CAB Survey will be combined with other responses and reported as an average or summary across all responses. Neither your local health department nor any members of your CAB or from your community will be able to connect your responses with your name.

This information will not be used to rate grantees. This survey and the report are tools to help your community reach its highest potential for implementing the Dating Matters™ initiative. We appreciate your honest and thoughtful reflection in responding to these questions.

Thank you for your participation!

Community Advisory Board Involvement, Structure, and Functioning

Many of the questions in this survey refer to your “community.” When answering these questions, please think about the geographic area served by your Dating Matters™ program. If you do not know about the entire area served by your Dating Matters™ program, please think about the part of the community you know best.

To begin, we would like to gather some information about you and your participation on the Community Advisory Board (CAB).

1. How long have you done each of the following? Select one answer per row.

	Never	Less than 6 months	6-12 months	1-2 years	3-4 years	5 years or more
a. Been a member of the CAB?	1	2	3	4	5	6
b. Been actively involved in the community served by the Dating Matters™ initiative?	1	2	3	4	5	6
c. Been involved with youth prevention efforts?	1	2	3	4	5	6
d. Been involved with parent or family prevention efforts?	1	2	3	4	5	6
e. Been involved with teen dating violence prevention efforts?	1	2	3	4	5	6
f. Been involved with other violence prevention efforts?	1	2	3	4	5	6

2. The CAB was designed to represent key stakeholders in dating violence prevention efforts. What best describes the sector of the community you represent on the CAB? Please select one answer. If more than one sector applies, please check the one that reflects your primary affiliation.

₁ Schools

₂ Youth-serving organizations (e.g., Boys and Girls Club, Big Brothers/Big Sisters, Scouts)

₃ Domestic or sexual violence agencies

₄ Law enforcement

₅ Faith-based organizations

₆ Substance abuse organizations

₇ Local recreation departments

₈ Other local public health or social service departments

₉ State public health or social service departments

₁₀ Private social service agencies

₁₁ Business community

₁₂ Courts or judicial system (including juvenile justice department)

₁₃ Health care agencies (e.g., hospitals, doctors’ offices, clinics)

₁₄ Citizen groups or service organizations (e.g., block groups, crime watch groups, Kiwanis, or Lions Clubs)

₁₅ Parents of school-aged children

₁₆ Youth (age 10 to 24)

₁₇ Media, including social media

₁₈ Other, please specify _________________________

Now, we would like to ask you some questions about your involvement and satisfaction with the CAB.

3. In the past 12 months, how often did you serve in the following roles on the CAB? Select one answer per row.

	Never	Some-times	Often	Not Applicable
a. I attended CAB meetings.	1	2	3	0
b. I participated in decision-making.	1	2	3	0
c. I participated in committee meetings.	1	2	3	0
d. I helped plan for Dating Matters™.	1	2	3	0
e. I helped implement Dating Matters™.	1	2	3	0
f. I served in a formal leadership role on the CAB.	1	2	3	0
g. I facilitated collaborations between the CAB and other organizations.	1	2	3	0

4. How much do you agree or disagree with the statements below about your experience on the CAB in the past 12 months? Select one answer per row.

   	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree	Don’t Know
   a. The amount of time I am expected to devote to the CAB is not feasible.	5	4	3	2	1	0
   b. My role on the CAB is meaningful.	1	2	3	4	5	0
   c. I have a voice in what the CAB decides.	1	2	3	4	5	0
   d. The CAB is heading in the right direction.	1	2	3	4	5	0
   e. The CAB does not have a clear sense of purpose.	5	4	3	2	1	0
   f. I am dissatisfied with how the CAB functions.	5	4	3	2	1	0
   g. I feel a strong sense of loyalty to the CAB.	1	2	3	4	5	0

5. What do you see as the primary goal of the CAB?

The next set of questions are about the representativeness of the CAB.

6. Do you think the CAB membership reflects the following key populations targeted in the Dating Matters™ initiative? Select one answer per row.

	Yes	No	Don’t Know
a. Parents of school-aged children (i.e., elementary through high school)	1	0	2
b. Youth (age 10 to 24)	1	0	2
c. Targeted racial and ethnic groups	1	0	2
d. Low-income neighborhoods	1	0	2
e. High crime neighborhoods	1	0	2
f. Other target groups f (a). (please specify):____________________________________	1	0	2

Scoring: mean of items a–d.

Now we would like to ask you some questions about how the CAB functions. Your information, along with others, will be used to identify areas for improvement.

7. How much do you agree or disagree with the statements below about your CAB? Select one answer per row.

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree	Don’t Know
a. A mission statement drives the direction of the CAB.	1	2	3	4	5	0
b. Goals and objectives of the CAB were clearly communicated to members.	1	2	3	4	5	0
c. The CAB has regular, structured meetings.	1	2	3	4	5	0
d. There is regular communication from the CAB leaders to members.	1	2	3	4	5	0
e. CAB meetings are at accessible locations.	1	2	3	4	5	0
f. CAB meetings are at inconvenient times.	1	2	3	4	5	0

8. The next set of questions is about the experiences and resources that your CAB brings to the Dating Matters™ Initiative. About how many members of your CAB have the following experience or resources? Select one answer per row.

	None	A few	Some	Many	Don’t Know
a. CAB members are experienced in planning prevention programs for youth and/or families.	1	2	3	4	0
b. CAB members are experienced in implementing prevention programs for youth and/or families.	1	2	3	4	0
c. CAB members have access to parents targeted for the Dating Matters™ program.	1	2	3	4	0
d. CAB members have access to youth targeted for the Dating Matters™ program.	1	2	3	4	0
e. CAB members have connections to influential people in the community.	1	2	3	4	0
f. CAB members have access to resources such as money, equipment, space, or volunteers willing to help the Dating Matters™ initiative.	1	2	3	4	0
g. CAB members have advocated on behalf of teen dating violence prevention.	1	2	3	4	0
h. CAB members have advocated on behalf of general violence prevention.	1	2	3	4	0

9. How much do you agree or disagree with each of the following statements about the members of the CAB based on the past 12 months? Select one answer per row.

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree	Don’t Know
a. The CAB members get along well.	1	2	3	4	5	0
b. There is a lot of tension among the CAB members.	5	4	3	2	1	0
c. The CAB members work together as a team.	1	2	3	4	5	0
d. The CAB members are quick to help one another when needed.	1	2	3	4	5	0
e. There is mutual trust among CAB members.	1	2	3	4	5	0
f. Some CAB members do not do their share of the work.	5	4	3	2	1	0

Think about the relationship between the CAB and other key stakeholders that work in the area of teen dating violence prevention in your community.

10. How much do you agree or disagree with each of the following statements about the relationship between the CAB and other key stakeholders involved in teen dating violence prevention? Select one answer per row.

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree	Don’t Know
a. The CAB collaborates with key stakeholders to share ideas or information.	1	2	3	4	5	0
b. The CAB members are well-networked with other key stakeholders.	1	2	3	4	5	0
c. There is mutual support between the CAB and key stakeholders (i.e., support operates in both directions).	1	2	3	4	5	0
d. Key stakeholders know about the CAB and its mission.	1	2	3	4	5	0

The next questions ask about activities meant to increase the chances of sustainability.

11. How much do you agree or disagree with each of the following statements? Please select one answer per row. In the past 12 months…

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree	Don’t Know
a. The CAB planned for the sustainability of Dating Matters™.	1	2	3	4	5	0
b. The CAB has looked for other funding resources to support Dating Matters™.	1	2	3	4	5	0

Community Context and Capacity

This next set of questions is designed to capture information on the community characteristics that may influence the implementation of the Dating Matters™ initiative.

As a reminder, when we refer to “community” in the questions below, please think about the geographic area served by your Dating Matters™ program. If you do not know about the entire area served by your Dating Matters™ program, please think about the part of the community you know best.

12. Consider your community’s violence prevention efforts with youth, other than Dating Matters.™ How much do you agree or disagree with each of the following statements about these efforts in the past 12 months? Select one answer per row.

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree	Don’t Know
a. Community groups have a history of successfully collaborating to address violence prevention.	1	2	3	4	5	0
b. Although community groups may disagree over ideas, these disagreements do not typically lead to a breakdown in progress of violence prevention efforts.	1	2	3	4	5	0
c. The community never seems to be able to accomplish much in the way of violence prevention efforts.	5	4	3	2	1	0
d. There are turf conflicts between groups in the community over violence prevention efforts.	5	4	3	2	1	0

13. How much do you agree or disagree with each of the following statements about your community in general? Select one answer per row.

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree	Don’t Know
a. Community residents are willing to help each other.	1	2	3	4	5	0
b. Community residents trust each other.	1	2	3	4	5	0
c. Community residents get along with each other.	1	2	3	4	5	0
d. Community residents do not share the same values.	5	4	3	2	1	0
e. Residents perceive the community as close-knit.	1	2	3	4	5	0

14. In the past 12 months, how much of a problem have the following issues been in your community? Select one answer per row.

	Not a Problem	Minor Problem	Moderate Problem	Major Problem	Don’t Know
a. Teen dating violence	1	2	3	4	0
b. Intimate partner/domestic violence	1	2	3	4	0
c. Sexual violence	1	2	3	4	0
b. Gang violence	1	2	3	4	0
e. Bullying	1	2	3	4	0
f. Child maltreatment or abuse	1	2	3	4	0
g. Other youth violence	1	2	3	4	0
h. Gender equity	1	2	3	4	0
i. Parent-child relationships	1	2	3	4	0
j. Sexual risk (e.g., STD, teen pregnancy, etc.)	1	2	3	4	0
k. Mental illness	1	2	3	4	0
l. Adolescent substance use	1	2	3	4	0
m. School failure/dropout	1	2	3	4	0

15. How much do you agree or disagree with each of the following statements about your community leaders? Select one answer per row.

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree	Don’t Know
a. Community leaders are aware of the teen dating violence problem.	1	2	3	4	5	0
b. Community leaders exhibit a strong commitment to teen dating violence prevention.	1	2	3	4	5	0
c. Community leaders share a common vision for teen dating violence prevention.	1	2	3	4	5	0
d. Community leaders are strong advocates for teen dating violence prevention.	5	4	3	2	1	0

16. What is the likelihood that the Dating Matters™ initiative will be integrated with the following types of programs in your community? Please select one answer per row.

	Not at all Likely	Somewhat Likely	Moderately Likely	Very Likely	Don’t Know
a. Other health-related prevention programs	1	2	3	4	0
b. Other violence prevention efforts	1	2	3	4	0