Form 1 Special Initiative Survey

Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery

CWIGSpecialInitiativeSurvey_forOMB_10-23-15

Special Initiative Survey

OMB: 0970-0401

Document [docx]
Download: docx | pdf

Shape1

Public reporting burden for this collection of information is estimated to be 5 minutes per response to complete this questionnaire. 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 control number for this project is 0970-0401. The control number expires on 4/20/2018.

Child Welfare Information Gateway

Special Initiative Survey


  1. Please describe why you are visiting the [insert name of special initiative] website.


  1. Is this your first time visiting the [insert name of special initiative] website?

  • Yes - If so, how did you hear about us?

  • No - If not the first time, how many times?


  1. Which of the following best describes your background or role?

  • Prevention/family support

  • Child protective services

  • Foster care

  • Adoption

  • Youth services

  • Juvenile justice

  • Health/mental health Substance use

  • Legal/courts (e.g. GAL, CASA, attorney)

  • Researcher/evaluator/consultant

  • Early childhood educator (0–5yrs)

  • Teacher (K–12)

  • Professor/faculty (higher education)

  • Kinship caregiver (optional response option)

  • Training specialist (optional response option)

  • Licensing specialist (optional response option)

  • Foster youth (current or former) (optional response option)

  • Student (optional response option)

  • Prospective Adoptive Parent (optional response option)

  • Kinship caregiver (optional response option)

  • Training specialist (optional response option)

  • Licensing specialist (optional response option)

  • Foster/Adoptive Parent (optional response option)

  • Other (please describe):


  1. Which of the following best describes your workplace? (Check one.)

  • Local or county public agency

  • State agency

  • Tribal agency/organization

  • Federal agency

  • Community-based/faith-based organization

  • National organization (e.g., nonprofit, advocacy)

  • Training and technical assistance service provider

  • Educational institution (early education, K–12, college, university)

  • Other (Please describe.)


  1. Which of the following best describes your position? (Check one.)

  • Frontline worker (e.g., caseworker, direct service worker)

  • Supervisor/manager

  • Director/administrator

  • Training Specialist

  • Other (Please describe.)

  1. How useful are the information and resources available on the [insert name of special initiative] website?

  • Very useful (Please explain.)

  • Useful (Please explain.)

  • Somewhat useful (Please explain.)

  • Not useful (Please explain.)


  1. On a scale of 1 (poor) to 5 (excellent), please rate the following regarding the [insert name of special initiative] website

  • Ease of finding information on the website

  • Website organization

  • Appeal of the website design

  • Content that matches my needs


  1. The following tools are available to help you and your organization/agency promote [insert name of special initiative]. For each tool, please indicate whether or not you and your organization/ agency have used it or intend to use it to promote [insert name of special initiative]. (Check all that apply and indicate how you intend to use each).

  • Widgets

  • Sample signature blocks

  • Sample email messages

  • Sample social media messages

  • Library search

  • Frequently Asked Questions (optional response option)

  • Meet older youth feature (optional response option)

  • AdoptUSKids Illustration (optional response option)

  • National and State PSAs (optional response option)

  • Voices of Older Youth Videos (optional response option)

  • National Foster Care Month Graphics (Infographic, FB banner, etc.) (optional response option)

  • National Foster Care Month FAQs (optional response option)

  • Sample proclamations (optional response option)

  • National Child Abuse Prevention Month calendars (optional response option)



  1. Do you have any additional comments or suggestions?



Optional Survey Questions


  1. Did you access any of the [resource specific to the initiative] on the [insert name of special initiative] website?

  • Yes (If yes, tell us how you intend to use the [resource specific to initiative] and provide any comments or suggestions).

  • No

  • I don’t remember


  1. This year’s theme for our [insert name of special initiative] is [insert current theme]. Do you have suggestions for next year’s theme? 


  1. Please select the various ways in which you (or your work) might be affected if the [insert name of special initiative] website did not exist.

  • It would take me longer to find information, resources, or tools to promote [insert name of special initiative].

  • It would cost more money to get the information, resources, or tools I need to promote [insert name of special initiative].

  • It would be more difficult to share information, resources, or tools with others about [insert name of special initiative].

  • It would be more difficult to train staff and colleagues about [insert name of special initiative].

  • I would not have adequate access to publications and products on [insert name of special initiative].

  • It would affect me in other ways. (Please describe)

  • It would not affect me


  1. Please rate your agreement with the following statements. (Strongly agree; Agree; Neutral; Disagree; Strongly disagree; N/A)

  • The [insert name of special initiative] website promotes public awareness about [issues specific to initiative]

  • The [insert name of special initiative] website promotes the social and emotional well-being of children and families.

  • The [insert name of special initiative] website enhances services for children and families.

  • The [insert name of special initiative] website increased my knowledge about [issues specific to initiative]


  1. How do you intend to use the resources offered on the [insert name of special initiative] website? (Check all that apply and please provide details)

  • Increase my knowledge or inform my attitudes

  • Share with families and/or clients

  • Share with professionals or colleagues

  • Support public awareness or advocacy efforts

  • Share in a formal training environment

  • Support practice improvement and/or sustain good practice

  • Implement, sustain, or improve programs (e.g., program management, logic model development, program evaluation)

  • Support policy change and/or sustain good policies

  • Conduct research or evaluation

  • Grant writing/fundraising

  • My own professional development

  • Personal use

  • Other (please describe):


6


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorPho, Hung
File Modified0000-00-00
File Created2021-01-22

© 2024 OMB.report | Privacy Policy