Form SEA CPS SEA CPS SEA CPS

ATTACHMENT 2:
SEA COLLABORATIVE PARTNER SURVEY

OMB No. 0930-XXXX
Exp. Date MM/DD/YYYY
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control number. The OMB control number for this project is 0930-0xxx. 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, 5600 Fishers Lane, Room 15E57-B, Rockville, Maryland, 20857.

Levels of Collaboration Survey
This form is designed for those who work in one of the organizations of programs that are partners in the Now is the Time Project Aware initiative for
_______(enter State). Please review these relationship characteristics or descriptions of different levels of collaboration. Please circle the name of the
organization or groups for which you are associated. Using the scales provided indicate the extent to which you currently interact with each of the partners
listed below (please skip your own row). If there are additional partners not listed please add in the blank rows.
Five Levels of Collaboration and Their Characteristics
Networking 1
Relationship
Characteristics

Cooperation 2

Coordination 3

Coalition 4

Collaboration 5

Aware of
organization
Loosely defined roles

Provide information to
each other
Somewhat defined roles

Share information and
resources
Defined roles

Share ideas

Little communication

Formal communication

Frequent
communication

All decisions made
independently

All decisions made
independently

Some shared decision
making

Frequent and
prioritized
communication
All members have a
vote in decision making

NITT Project Aware Partners

No
Interaction at
All

Name of Partner
Name of Partner
Name of Partner
Name of Partner
Name of Partner
Name of Partner
Attachment 2: SEA Collaborative Partner Survey

0
0
0
0
0
0

Networking
1
1
1
1
1
1

Share resources

Cooperation

Coordination
2
2
2
2
2
2

3
3
3
3
3
3

Members belong to one
system
Frequent communication
is characterized by
mutual trust
Consensus is reached on
all decisions

Coalition

Collaboration
4
4
4
4
4
4

5
5
5
5
5
5
1

Name of Partner
Name of Partner
Name of Partner
Name of Partner

0
0
0
0

1
1
1
1

2
2
2
2

3
3
3
3

4
4
4
4

5
5
5
5

Interprofessional Team Collaboration for Expanded School Mental Health (IITC-ESMH)
Rate the frequency for each of the following : 1= never to 5= always).

1. Team members discuss strategies to improve their working relationship.
2. The team works together to resolve problems among members.
3. The team incorporates feedback about its process to strengthen its effectiveness.
4. The team informally and/or formally evaluates how they work together.
5. Team members talk about similarities and differences among their professional roles in working with youth.
6. Members of the team address conflicts with each other directly.
7. The team discusses the degree to which each professional should be involved with a particular youth.
8. Team members talk about ways to involve additional professionals with various expertise in the team.
9. There are ‘‘turf’’ issues among members of the team.
10. The team does not welcome new ideas about how to help youth.
11. Team members respect one another even when they have different ideas about how to help youth.
12. The team has appropriate expectations of the roles of members in supporting youth.
13. The team respects the opinion and input of each member.
14. There is open communication among team members.
Attachment 2: SEA Collaborative Partner Survey

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15. Team members focus on understanding the perspectives of others rather than defending their own specific opinions.
16. The team supports each member in his or her work with youth.
17. There is freedom to be different and disagree within the team.
18. New practices related to working with youth occur as a result of the diversity of ideas among team members.
19. Working with team members who have multiple perspectives results in new programs available to help youth.
20. The roles and/or responsibilities of team members change as a result of teamwork.
21. As a result of working as a team, services/supports for youth are delivered in new ways.
22. Team members take on tasks outside their role when necessary.
23. The team depends on members with varying roles (e.g., teacher, mental health professional, paraprofessional, special educator, family
member, etc) to implement specific activities.
24. The team relies on members with varying roles (e.g., teacher, mental health professional, paraprofessional, special educator, family member,
etc) to accomplish its goals.
25. The team makes distinctions among the roles and responsibilities of each member.
26. The team consults with members who have a variety of perspectives about how to address the needs of youth.

Attachment 2: SEA Collaborative Partner Survey

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