Form 1 Special Initiative Survey

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.

2. 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?

3. 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):

4. 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.)

5. 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.)

6. 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.)

7. 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

8. 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)

9. Do you have any additional comments or suggestions?

Optional Survey Questions

10. 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

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

12. 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

13. 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]

14. 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):

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