Key Informant Selection Tool

Form Approved

OMB No.: 0920-xxxx

Expiration Date: XX/XX/XXXX

Public Reporting burden of this collection of information is estimated at 15 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 NW, MS D-74, Atlanta, GA  30333; Attn:  PRA (0920-XXXX).

Key Informant Selection Tool – Non-Layperson

Dear ________________,

Battelle plans to interview approximately 10-12 people annually in each state as part of our qualitative evaluation. We need your assistance to help us select key informants for our evaluation in each of the following categories:

• PDO Naloxone Grant program directors and program staff;

• PDO advisory committee members;

• Professional communities (non-layperson) targeted for naloxone education/training and distribution. These can be police officers, EMS, pharmacists, or other professional audiences you have targeted for your work;

• Key community partners that you work with. These can be partner organization or organizations that sub-funding is provided to;

• Key decision makers in your community. This group might be policy makers or other individuals who have the potential to influence naloxone or related policies;

• Other individuals you think are important to speak with that are not included in the above groups.

[Please do not use this tool for identifying lay-persons]

In selecting which people to interview, we wish to consider not only their roles in the PDO/Naloxone grant, but also the perspectives they offer based on their history within the community, their professional background, and their personal connections to this work. We want to talk to people who cover the range from those who have been involved in this work for many years, to those who may be newly engaged.

We would like you to help us select those individuals in your community that as a group will provide a rich understanding of how the PDO/Naloxone work is being conducted in your state and the roles that staff, partners and decision makers play in this work.

Please use the following table to organize possible candidates (list as many as appropriate). We will use this list to talk with you about the candidates and select the best mix of key informants from among these.

Name	Organization	Role in PDO/Naloxone Grant	Comments on individual’s perspective
PDO Naloxone grant program staff
PDO advisory committee members
Professional communities (non-layperson) targeted for naloxone education/training and distribution. (These can be individuals from among police officers, EMS, pharmacists, or other professional audiences you have targeted for your work)
Key community partners that you work with. These can be partner organization or organizations that sub-funding is provided to.
Key decision makers in your community. This group might be policy makers or other individuals who have the potential to influence naloxone or related policies.
Other individuals you think are important to speak with that are not included in the above groups.