0920-0879 Web-based Assessment Instrument

Assessment of Partnerships Impacting Sexually Transmitted
Diseases Outcomes in Areas of Service Reduction

Form Approved
OMB No. 0920-0879
Expiration Date 01/31/2021
Introduction and Instructions
Welcome! The Cloudburst Group, with funding and support from the Centers for Disease Control
and Prevention’s (CDC) Division of STD Prevention (DSTDP), are conducting this assessment to
assess the value, need, gaps, and impact of strategic partnerships between territorial and local
health departments (LHD) with the highest STD morbidity (syphilis, chlamydia and gonorrhea) and
their STD clinical partners.
Completing the questionnaire is voluntary and takes approximately 60 minutes.Cloudburst will not
publish or share any identifying information about individual respondents with CDC. There are no
known risks or direct benefits to you from participating or choosing not to participate, but your
answers will help CDC improve and inform partner engagement practices and case studies for STD
programs nationwide on how to develop effective partnerships to further STD prevention and
control goals.
This assessment is distributed to one county/city STD program with significant STD morbidity in all
59 DSTDP funded project areas. Aggregated results of the assessment will be shared with other
DSTDP funded programs and CDC. The assessment should be completed by the county/city STD
Program with assistance from management of the STD Clinic. If you have more than one STD clinic,
we will ask you to select one for the purposes of completing this assessment. Portions of the
assessment relate to the selected STD Clinic, and other portions are related to the STD program in
general.
After beginning the online assessment, you can save your responses and continue the assessment
later, if necessary. If you need to return to a previous page that you have already completed, please
use the previous button at the bottom of each page (rather than the internet browser back arrow at
the top of the screen).
Your responses should be answered on behalf of your county/city health department.
Thank you in advance for your time and attention to this assessment. If you have any questions or
concerns about this assessment, please contact Dr. Steven Sullivan, Senior Project Director, at
[email protected] or 301-385-6693.
By clicking the OK button, you are providing your consent to participate voluntarily in this activity.
To begin, please click next.
CDC estimates the average public reporting burden for this collection of information as60 minutes
per response, including the time for reviewing instructions, searching existing data/information
sources, gathering and maintaining the data/information needed, and completing and reviewing the

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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 burden to CDC/ATSDR Information Collection
Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879).

Assessment of Partnerships Impacting Sexually Transmitted
Diseases Outcomes in Areas of Service Reduction

Program context/background
1. Jurisdiction Name:

2. In your county/city, is/are there specialized STD Clinics? (These are defined as those that provide
specialized STD care, delivering more comprehensive and expert STD clinical services beyond risk
assessment, screening and treatment services such as: on-site stat diagnosis, advanced diagnostics, or on
site injectable antibiotics to treat syphilis and gonorrhea.)
Yes
No

Assessment of Partnerships Impacting Sexually Transmitted
Diseases Outcomes in Areas of Service Reduction

Program context/background
3. In your county/city, have any specialized STD clinics permanently closed in the last 3 years? [If no, skip
to question 4.]
Yes
No

Assessment of Partnerships Impacting Sexually Transmitted
Diseases Outcomes in Areas of Service Reduction

Program context/background

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4. If you answered yes to question 3, how many specialized STD clinics have permanently closed in the
last 3 years?

Assessment of Partnerships Impacting Sexually Transmitted
Diseases Outcomes in Areas of Service Reduction

5. Currently, what is the primary point of care for safety net STD services in your county/city? If there are
multiple clinics that provide safety net STD services, please select the clinic that diagnoses the most STDs,
which can include your health department’s clinic. Please select the clinic type that best describes this
clinic.
Specialized STD clinic

HIV prevention or care clinic

Family planning/reproductive health clinic

Hospital-affiliated health clinic

Federally-qualified health center (FQHC) or other community
health center

University-affiliated health clinic
Other, please specify:

General public health clinic
Other (please specify)

6. What is the name of the clinic you selected in the previous question? (This is the clinic you will be
answering questions about in this assessment)

Assessment of Partnerships Impacting Sexually Transmitted
Diseases Outcomes in Areas of Service Reduction

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7. In addition to STD screening/testing and treatment, which of the following services does this STD clinic
offer onsite? Select all that apply.
Behavioral sexual risk reduction counseling/patient education
Community education/outreach
Expedited partner therapy
HCV testing
Hep B Vaccine
HIV Prep or PEP (referral, re-engagement, or actual
meds/prescription provided)
HIV testing
HIV treatment (excluding PrEP and PEP)
HPV vaccine
Linkage to HIV care (referral to case manager/navigator for
linkage or staff actually do it)
Partner services

8. Over the last 3 years, what kind of change or trend has there been in the STD clinic’s staff and funding?
Please fill out the table below.
Resources are
increasing a lot

Resources are
increasing
somewhat

No change in
resources

Resources are
decreasing
somewhat

Resources are
decreasing a lot

Staff
Funding

9. Over the last 3 years, what STD clinical services have decreased as a result of the decrease in
resources? Select all that apply.
Decreased clinic hours
Decreased patient volume
Decreased STD screening/testing
Decreased STD treatment
None of the above decreased
Other clinical services (please specify)

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10. Which of the following funding sources currently contribute to the funding of any of the services
provided by that clinic? Select all that apply
STD program funding

Health insurance claims

HIV prevention funding

Patient self-pay

HIV care/treatment funding

I don't know

11. In the past 3 years, which of the items below has the clinic received in-kind (free/donated) from a partner
organization? Select all that apply.
Care coordination and case management
Clinical staff time
Clinical supplies (e.g. test/diagnostic kits, drugs for treatment)
Clinic or office space
Assistance with data collection, analysis, or assessment
Patient education materials
Lab services
Marketing and outreach efforts to promote the clinic
Staff training r professional development
Other (please specify)

12. In the past 3 years, has there been any change or trend in in-kind resources for the clinic?
Resources are increasing a lot

Resources are decreasing somewhat

Resources are increasing somewhat

Resources are decreasing a lot

No change in resources

13. In the past 3 years, how has this change in in-kind resources affected the services provided by the
clinic?
Decrease in clinic hours

Decreased STD treatment

Decreased patient volume

None of the above have decreased

Decreased STD screening/testing
Other clinical service decreased (please specify)

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Assessment of Partnerships Impacting Sexually Transmitted
Diseases Outcomes in Areas of Service Reduction

[This portion of the assessment applies to the STD program, not the clinic.]
14. Over the last 3 years, what kind of change or trend has there been in the STD program’s staff and
funding? Please fill out the table below.
Resources are
increasing a lot

Resources are
increasing
somewhat

No change in
resources

Resources are
decreasing
somewhat

Resources are
decreasing a lot

Staff
Funding

15. Which of the following funding sources currently contribute to the funding of the STD program? Select
all that apply.
STD program funding
HIV prevention funding
HIVE care/treatment funding
I don't know

16. In the past 3 years, which of the items below has the STD program received in-kind (free/donated) from
a partner organization? Select all that apply.
Care coordination and case management
Office space
Assistance with data collection, analysis, or assessment
Patient/client educational materials
Lab services
Marketing or outreach efforts to promote the clinic
Staff training or professional development
Other (please specify)

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17. In the past 3 years, has there been any change or trend in in-kind resources for the STD program?
Resources are increasing a lot
Resources are increasing somewhat
No change in resources
Resources are decreasing somewhat
Resources are decreasing a lot

18. In the past 3 years, have the STD program’s services increased or decreased?
Non-clinical STD program services are increasing
Non-clinical STD program services are decreasing
No change in Non-clinical STD program services

Assessment of Partnerships Impacting Sexually Transmitted
Diseases Outcomes in Areas of Service Reduction

A partnership is defined as a collaborative relationship between organizations. For the purposes of this assessment, a clinical partner is
defined as an entity that supports STD clinical services and may include private health care provider or organization, community health
center or federally qualified health center, correctional facility, educational institution, family planning/ reproductive health clinic,
HIV/AIDS prevention or care program, hospital, maternal and child health program, behavioral or mental health agency, tribal
organization or other community based organizations. The purpose of this relationship is to work toward shared goals through a
division of labor that all parties agree on. A partner is an entity with which you work on clinical or programmatic activities regularly. A
partner is not someone with whom you exchange information with infrequently.

19. Does the STD program currently have any collaborative partnerships with other organizations, for the
purpose of maintaining or supplementing STD clinical services available in the city/county?
Yes
No (If no, skip to the end of assessment)

Assessment of Partnerships Impacting Sexually Transmitted
Diseases Outcomes in Areas of Service Reduction

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20. Please indicate the types of agencies/organizations that the STD program has partnerships with to
maintain or supplement clinical STD services for at-risk populations in the community. Please click yes or
no for each partner type.
Yes

No

Don't Know

Private health care
provider or organization
Community health center
or federally qualified
health center
Correctional facility
Educational institution
Family planning/
reproductive health clinic
HIV/AIDS prevention or
care program
Hospital
Maternal and child
health program
Behavioral or mental
health agency
Tribal organization
Other community based
organization
Other (please specify)

Assessment of Partnerships Impacting Sexually Transmitted
Diseases Outcomes in Areas of Service Reduction

In the next set of questions, we would like you to focus on the STD programs’ top three clinical
partnerships that the program has developed to maintain or supplement clinical STD services,
including addressing service gaps, for at-risk populations in the community.

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21. Please select the top three clinical partnerships that the STD program developed to ensure
maintenance of or strengthen/expand clinical STD services. To help fill out this assessment in Survey
Monkey, you might want to write down the name of each partner and its number as you fill out the rest of
the assessment to remind you which partner you are referring to.
Partner 1
Partner 2
Partner 3

22. Please select the type of organization for Partner 1, 2, and 3
Partner 1

Partner 2

Partner 3

Private health care
provider or organization
Community health center
or federally qualified
health center
Correctional facility
Educational institution
Family planning/
reproductive health clinic
HIV/AIDS prevention or
care program
Hospital
Maternal and child
health program
Behavioral or mental
health agency
Tribal organization
Other community based
organization

23. About how long has this priority partnership been in place?
Partner 1

Partner 2

Partner 3

Less than one year
2 - 4 years
5 - 10 years
More than 10 years

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24. What is the primary reason that you selected this partner as high priority? Select one answer for each
partner
Partner 1

Partner 2

Partner 3

STD Clinic
closures/reduction in
services
Funded to work together
Long history of working
together
Mission alignment
Other (please specify)

25. How formal are the agreements with your priority partners? Select one for each partner?
Partner 1

Partner 2

Partner 3

Formal, written
agreement (e.g., MOU)
Formal, contract
Informal, verbal
agreement
Informal, just part of the
culture
Other (please specify)

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26. Please indicate which STD clinical services outcomes the STD program hopes to improve through
each partnership. Select all that apply for each partner.
Partner 1

Partner 2

Partner 3

Expand clinic hours
Increase number of
providers offering STD
services for at-risk
populations
Reduce duplication of
services
Increase community
outreach/education
efforts
Increase in STD
screening/testing
Increase in STD
treatment
Increase in new cases
identified
Increase in partner
services
Increase in
counseling/patient
education
Increase in expedited
partner therapy (EPT)
Increase in HPV vaccine
Increase in HCV testing
Increase in HIV PrEP
Increase in linkages to
HIV care
Increase in HIV
treatment
Improve data sharing
Increase lab services

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27. Please indicate which STD clinical services outcomes have been improved as a result of this
partnership, over the past 12 months? Select all that apply for each partner.
Partner 1

Partner 2

Partner 3

Expand clinic hours
Increase number of
providers offering STD
services for at-risk
populations
Reduce duplication of
services
Increase community
outreach/education
efforts
Increase in STD
screening/testing
Increase in STD
treatment
Increase in new cases
identified
Increase in partner
services
Increase in
counseling/patient
education
Increase in expedited
partner therapy (EPT)
Increase in HPV vaccine
Increase in HCV testing
Increase in HIV PrEP
Increase in linkages to
HIV care
Increase in HIV testing
Increase in HIV
treatment
Improve data sharing
Increase lab services

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28. Which priority at-risk population(s) are these partnerships meant to serve? Select up to three at-risk
populations for each partner.
Partner 1

Partner 2

Partner 3

Adolescents and young
adults
Incarcerated persons
Men who have sex with
men (MSM)
People who inject drugs
or in drug treatment
Pregnant women
Racial/ethnic minorities
All persons at risk of
STDs (not populationspecific)
Other (please specify)

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29. In the past 12 months, what resources and collaborative activities have your priority partners provided?
Partner 1 Provides

Partner 2 Provides

Partner 3 Provides

Care coordination and
case management
Clinical staff time
Clinical supplies (i.e.
test/diagnostic kits,
drugs for treatment)
Community/public
education
Co-location of services
(i.e. office space)
Data collection and
analysis (i.e. conduct
program assessments,
develop questionnaires,
prepare reports)
Data sharing with other
public health programs
(i.e. HIV, primary care,
school health)
Patient educational
materials
Lab services
Marketing and outreach
efforts to promote STD
services
Monitoring clinical
outcomes (i.e.
conducting research,
providing
recommendations)
Needs assessment
Professional trainings
and staff development
Other (please specify)

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30. Over the past 12 months, how frequently has your STD program engaged in these partnerships?
Engaged can be defined as working together on shared objectives, holding frequent meetings with each
other, working together on funding proposals, etc. Select one for each partner.
Partner 1

Partner 2

Partner 3

Weekly
Monthly
Quarterly
Bi-annually
Yearly

31. In the past 12 months, which of the following best describes the structure of the partnership? Select
one for each partner.
Partner 1

Partner 2

Partner 3

Cooperative
Coordinated
Integrated

Assessment of Partnerships Impacting Sexually Transmitted
Diseases Outcomes in Areas of Service Reduction

For this last set of questions, please think about those three priority partnerships as a group and
provide responses based on your role as STD Program Manager.

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32. Thinking about your priority partnerships, what barriers or issues have you encountered in those
partnerships in the prior 3 years? Select all that apply.
Cultural barriers
Cultural competency
Different agendas and priorities
Lack of financial resources
Lack of partner organization leadership support
Lack of staff resources (staff time, competing priorities of staff)
Lack of STD program leadership support
Political and historical issues/barriers
Turf protection (protecting organization’s control of certain
projects or areas of work)

33. Thinking about your priority partnerships, how important are the following components? Please rank the
components for this group from 1—5, with 1 being the most important to 5 being the least important.
Group One
Mutual trust and respect: partners do not fear ridicule or reprisal.

Compatibility: open to discussion and mission alignment.

Open communication: partners openly communicate with each other.

Common understanding: understand each other’s organizational framework, culture, values, and approach,
individual members’ roles, responsibilities, and the partnership’s division of labor

Mutual support: partners give and receive support.

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34. Thinking about your priority partnerships, how important are the following components? Please rank the
components for this group from 1—4, with 1 being the most important to 4 being the least important.
Group Two
Use of resources: each partner’s knowledge, ability, and experience are fully utilized

Purpose: guided by a shared vision and purpose that builds trust and recognizes the value and contribution of
all members

Leadership: shared leadership among respected individuals who are recognized and empowered by their own
organizations to build consensus and resolve conflicts

Culture and values: Shared “can-do” values, mutual understanding, and an acceptance of differences (e.g.,
norms, ways of working)

35. How often, in the last 3 years, has the STD programexplicitly defined the desired outcomes or
explicit goals of those priority partnerships?
We always defined the desired outcomes or goals
We sometimes defined the desired outcomes or goals
We rarely or never defined the desired outcomes or goals

36. How often, in the last 3 years, has the STD programassessed any aspect of those priority
partnerships, in any way?
We always assessed these partnerships in some way
We sometimes assessed these partnerships in some way
We rarely or never assessed these partnerships in some way

37. How often, in the last 3 years, has the STD programmeasured any quantitative outcomes
associated with those priority partnerships?
We always measured quantitative outcomes
We sometimes measured quantitative outcomes
We rarely or never measured quantitative outcomes

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38. How often in the last 3 years has the STD program assessed the economic value or costs
associated with those priority partnerships?
We always measured economic value or costs
We sometimes measured economic value or costs
We rarely or never measured economic value or costs

Assessment of Partnerships Impacting Sexually Transmitted
Diseases Outcomes in Areas of Service Reduction

Thank you for your time and effort to complete this assessment. Please press SUBMIT to confirm your submission.

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