Collaborative Assessment Tool (THRIVE Awardees)

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

ATTACHMENT 6.

ANNUAL COLLABORATION ASSESSMENT TOOL (CAT)

Public reporting burden of this collection of information is estimated to average 20 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 NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx)

There are many ways that the collaborative (coalitions or partnerships) develop and function dependent upon the various needs of the collaborators and the communities they operate in and serve. In order to assess the processes that are developing among members of health department collaborative and the potential outcomes of their work, CDC ask that health departments use the following survey questions as guidance on developing their own electronic instrument and submit it on an annual basis.

A	Context
	Please rate how much you agree with statement using the following scale:				1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree
A1	The agency/organization that I represent in this collaborative has a history of collaborating with other local agencies/organizations in my county.				1			2		3			4		5
A2	Participating agencies/organizations represented within this collaborative encourage and support the activities of this collaborative.				1			2		3			4		5
A3	Members of our collaborative represent the cultural diversity of our community.				1			2		3			4		5
A4	Community members are aware of this collaborative.				1			2		3			4		5
A5	Community members’ view this collaborative as a leader in relation to the collaborative’s goals and activities.				1			2		3			4		5
A6	Political leaders in our community support the mission of this collaborative.				1			2		3			4		5
A7	Key community leaders in our community support the mission of this collaborative.				1			2		3			4		5
A8	Community members support the mission of this collaborative.				1			2		3			4		5
A9	Key stakeholders are members of this collaborative.				1			2		3			4		5
A10	Policies, laws, requirements, or regulations that support the efforts of this collaborative are in place.				1			2		3			4		5
B	Members
B1	Collaborative members share an understanding and respect for each other.				1			2		3			4		5
B2	Collaborative members share an understanding and respect for the various organizations represented within this collaborative.				1			2		3			4		5
B3	Collaborative members trust one another.				1			2		3			4		5
B4	Collaborative members are willing to compromise [recognizing that many decisions cannot fit the preferences of every member perfectly].				1			2		3			4		5
B5	Collaborative members believe the benefits of the collaboration will offset costs (e.g., such as loss of autonomy and turf issues).				1			2		3			4		5
B6	Collaborative members agree that a comprehensive response is needed to address the goals and objectives of this collaborative.				1			2		3			4		5
B7	Collaborative members understand the roles, rights, and responsibilities of all participating members.				1			2		3			4		5
B8	Collaborative members bring unique skills to address this collaborative’s needs.				1			2		3			4		5
B9	Collaborative members and the agencies they represent are willing to distribute power in a manner that is in the collaborative’s best interest.				1			2		3			4		5
B10	Collaborative members feel ownership in the way the group works.				1			2		3			4		5
B11	Collaborative members feel ownership in the results/products of their work.				1			2		3			4		5
B12	Collaborative members and their respective agencies/organizations share credit for collaborative successes.				1			2		3			4		5
C	Process
C1	This collaborative is as adaptable as necessary in meeting the needs of a changing community.				1			2		3			4		5
C2	This collaborative meets on a regular basis.				1			2		3			4		5
C3	All collaborative members participate in decision-making.				1			2		3			4		5
C4	Strategies to carry out the goals and objectives of this collaborative are clearly articulated.				1			2		3			4		5
C5	Collaborative members select or are assigned roles and responsibilities according to their interests and strengths.				1			2		3			4		5
C6	There is a system in place for resolving conflicts between the demands of partnering agencies and demands of this collaborative.				1			2		3			4		5
C7	This collaborative has an established system to regularly assess community needs and resources.				1			2		3			4		5
C8	There is a system in place by which progress toward goal attainment is measured.				1			2		3			4		5
C9	This collaborative markets its efforts and accomplishments to the community to obtain support.				1			2		3			4		5
D	Communication
D1	A system of communication is in place for collaborative members to discuss their efforts.				1			2		3			4		5
D2	Collaborative members frequently communicate formally (e.g., meetings, trainings, and interagency work groups).				1			2		3			4		5
D3	Collaborative members frequently communicate informally (e.g., memos, e-mail, phone, and social contact).				1			2		3			4		5
D4	Collaborative members’ communication is adequate (in frequency) to effectively work towards meeting the collaborative’s goals and objectives.				1			2		3			4		5
D5	Members of this collaborative interact to discuss issues openly.				1			2		3			4		5
D6	This collaborative provides a safe environment in which disagreements and conflicts between members can be discussed.				1			2		3			4		5
D7	Communication among collaborative members is effective (promotes understanding, cooperation, and transfer of information).				1			2		3			4		5
D8	This collaborative has established communication channels with local community leaders.				1			2		3			4		5
D9	This collaborative has established communication channels with the broader community.				1			2		3			4		5
E	Function
E1	This collaborative has clearly defined the problem that it wishes to address.				1			2		3			4		5
E2	The goals and objectives of this collaborative are based upon key community needs.				1			2		3			4		5
E3	This collaborative has clearly defined short term goals and objectives.				1			2		3			4		5
E4	This collaborative has clearly defined long term goals and objectives.				1			2		3			4		5
E5	Members agree upon the goals and objectives for this collaborative.				1			2		3			4		5
E6	The goals and objectives set for this collaborative can be realistically attained.				1			2		3			4		5
E7	Members view themselves as interdependent in achieving the goals and objectives of this collaborative.				1			2		3			4		5
E8	The goals and objectives of this collaborative differ, at least in part, from each of the partner organizations.				1			2		3			4		5
F	Resources
F1	There is adequate financial support to maintain collaborative operations.				1			2		3			4		5
F2	There is adequate in-kind support to maintain collaborative operations.				1			2		3			4		5
F3	There are plans in place to secure future funding for collaborative operations.				1			2		3			4		5
F4	There are sufficient funds to sustain collaborative operations or the next two years.				1			2		3			4		5
F5	Agencies/organizations represented in this collaborative provide resources to support the collaborative operations.				1			2		3			4		5
F6	Collaborative members seek outside sources of financial and in-kind support for collaborative operations.				1			2		3			4		5
F7	Collaborative members recruit additional partners that can offer financial and in-kind support for collaborative operations.				1			2		3			4		5
F8	The professional expertise, skills, and specialization of collaborative members have been identified and are used to advance the goals of the collaborative.				1			2		3			4		5
F9	Resources within our community (e.g., clerical assistance, time, and financial support) have been identified and are used to advance the goals of this collaborative.				1			2		3			4		5
F10	Our collaborative utilizes the cultural assets of our community.				1			2		3			4		5
G	Leadership
G1	The collaborative leader(s) has (have) strong organizational skills.				1			2		3			4		5
G2	The collaborative leader(s) has (have) strong interpersonal skills.				1			2		3			4		5
G3	The collaborative leader(s) support(s) and facilitate(s) team building.				1			2		3			4		5
G4	The collaborative leader(s) utilize(s) members’ skills and strengths to meet collaborative goals and objectives.				1			2		3			4		5
G5	The collaborative leader(s) carries (carry) out the role with fairness.				1			2		3			4		5
G6	The collaborative leader(s) maintain(s) a focus on the goals and objectives of the collaborative.				1			2		3			4		5
G7	The collaborative leader(s) support(s) members in carrying out their roles and responsibilities.				1			2		3			4		5
G8	The collaborative leader(s) has (have) knowledge of potential funding sources and plans for future funding.				1			2		3			4		5
G9	The collaborative leader(s) is (are) effective.				1			2		3			4		5
H	Perceptions of Collaborative Success
	Please rate how successful the collaborative has been so far using the following 10-pont scale: Completely unsuccessful 1 … 2 … 3 … 4 … 5 … 6 … 7 … 8 … 9 … 10 Completely successful
H1	How successful is this collaborative at implementing strategies to address collaborative goals and objectives?	1	2	3		4	5		6		7	8		9		10
H2	How successful is this collaborative at achieving its current goals and objectives?	1	2	3		4	5		6		7	8		9		10
H3	How successful is this collaborative in making a difference within the community it serves?	1	2	3		4	5		6		7	8		9		10
	Please rate how confident you are about the future success of the collaborative using the following 10-pont scale: Not confident at all 1 … 2 … 3 … 4 … 5 … 6 … 7 … 8 … 9 … 10 Very confident for future success
H4	How confident are you that this collaborative will still exist in the community two years from now?	1	2	3		4	5		6		7	8		9		10
H5	How confident are you that this collaborative will continue to successfully achieve its goals and objectives?	1	2	3		4	5		6		7	8		9		10
H6	How confident are you that this collaborative will continue to make a difference within the community it serves?	1	2	3		4	5		6		7	8		9		10
	Please rate how effective or efficient the collaborative has been compared to a single partner agency/organization using the following 10-pont scale: Not effective or efficient at all 1 … 2 … 3 … 4 … 5 … 6 … 7 … 8 … 9 … 10 Very effective or efficient
H7	In comparison to the efforts of a single partnering agency/organization, how effective is this collaborative in achieving its goals and objectives?	1	2	3		4	5		6		7	8		9		10
H8	In comparison to the efforts of a single partnering agency/organization, how efficient is this collaborative in achieving its goals and objectives?	1	2	3		4	5		6		7	8		9		10

Adapted from: Marek, L.I., Brock, D.P., and Salva, J. (2015). Evaluation Collaboration for Effectiveness: Conceptualization and Measurement. American Journal of Evaluation, 16(1), 1-19. Used by permission of first author.