3. Collaboration Questionnaire Items 1.14.21

OMB Control No: 1230-0NEW

Expiration Date: XX/XX/20XX

State-Level Collaboration Questionnaire

(1) Demographics of Participants

Agency type:

• Vocational rehabilitation (VR)

• Juvenile justice

• Adult Justice/Department of Corrections

• Child Welfare

• Title I WIOA-funded Workforce

• Title II WIOA Adult Education

• Education

  • K-12

  • Higher Education

  • Career Technical Education

  • Other (Please describe): ___________________________________

• Social security

• Developmental disability

• Mental health

• Other (Please describe): ___________________________________

Total years of experience in the field: _______________

Total years of experience in your agency: _______________

Describe your role at your current agency:

• Supervisory

• Direct service provider

• Both

• Other (Please describe): ___________________________________

Describe the setting in which you or your agency provides services (check all that apply):

• Urban

• Suburban

• Rural

Gender:

• Female

• Male

• Non-binary

• Prefer to self-describe: _______________________________

• Prefer not to say

Do you consider yourself to be Hispanic/Latino?

• Yes

• No

• Prefer to self-describe: _______________________________

• Prefer not to say

Race – check all that apply:

• African American

• American Indian/Alaskan Native

• Asian

• Native Hawaiian/Pacific Islander

• White

• Prefer to self-describe: _______________________________

• Prefer not to say

Do you have a disability?

• Yes

• No

• Prefer to self-describe: _______________________________

• Prefer not to say

(2) Levels of Collaboration Questionnaire (from Frey et al., 2006)

Using the scale provided, please indicate the extent to which you currently interact with each other partner (skip your own row)	0 No Interaction	1 Networking	2 Cooperation	3 Coordination	4 Coalition	5 Collaboration
Relationship Characteristics		Aware of organization Loosely defined roles Little communication All decisions made independently	Provide information to each other Somewhat defined roles Formal communication All decisions made independently	Share information and resources Defined roles Frequent communication Some shared decision making	Share ideas Share resources Frequent and prioritized collaboration All members have a vote in decision making	Members belong to one system Frequent communication is characterized by mutual trust Consensus is reached on all decisions
Partners
Vocational rehabilitation (VR)	0	1	2	3	4	5
Juvenile Justice	0	1	2	3	4	5
Child Welfare	0	1	2	3	4	5
Title I Workforce	0	1	2	3	4	5
Title II Adult Education	0	1	2	3	4	5
K-12 Education (including special education and CTE)	0	1	2	3	4	5
Higher Education, community colleges, 4 year, institutions	0	1	2	3	4	5
Social Security	0	1	2	3	4	5
Developmental Disability	0	1	2	3	4	5
Mental Health	0	1	2	3	4	5
Housing	0	1	2	3	4	5
SNAP	0	1	2	3	4	5
State or local youth coordinating group (i.e. youth committees)	0	1	2	3	4	5

(3) Specific Transition Coordination Practices between Systems and Strategies for Developing External Partnerships

Please indicate the frequency with which you perform the following tasks:

	Never	Very Rarely	Rarely	Occasionally	Frequently	Very frequently
Refer participants to collaborators
Invite collaborators to participant meetings
Hold regular systems of care meetings where multiple participants are discussed
Coordinate services between agencies
Seek out partners based on your participant’ needs

(4) Understanding of other agencies’ eligibility criteria, policies, and procedures

Please indicate your level of confidence in performing the following functions:

	Not at all confident					Very confident
Identifying populations of youth who are not being served
Understanding of other agencies’ eligibility criteria
Understanding of other agencies’ policies and procedures
Understanding of other agencies’ definitions of successful outcomes
Understanding of shared cross-agency performance measures

(5) Existing Organizational Attitudes and Experiences (Adapted from Thomson, Perry, & Miller, 2007)

Please rate your level of agreement with the following statements:	Don’t know	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
Partner organizations meetings accomplish what is necessary for the collaboration to function well
Partner organizations (including your organization) agree about the goals of the collaboration
Your organization’s tasks in the collaboration are well coordinated with those of partner organizations
Partner organizations (including your organization) have combined and used each other’s resources so all partners benefit from collaborating
You feel what your organization brings to the collaboration is appreciated and respected by partner organizations
Partner organizations (including your organization) work through differences to arrive at win-win solutions

(6) Frequency and Success in Serving Diverse Populations of Youth with Disabilities

Please indicate your level of confidence in your ability or your staff’s ability in providing effective services to youth with disabilities who are:

	Not at all confident					Very confident
In-school
Out-of-school (ages 16-24) and high school dropouts
Pregnant and parenting youth
Receiving SSI/SSDI and/or other public assistance.
Minorities (Racially and ethnically diverse)
Foreign language speakers
Immigrant, migrant, and/or refugees
LGBTQ+
Homeless
Justice system- involved
Foster care
Rural residents

(7) Data Sharing and Collaboration.

Does your agency have data exchange agreements with partner agencies? Yes/No.

If yes, please list agencies that you have data exchange agreements with: _________________

How would you describe your holistic use of data through the full complement of shared data exchange agreements with partner agencies?

	Don't know	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
Using data to identify shared program participants for administrative purposes only.
Using data to coordinate the planning and delivery of employment services (e.g., sharing aggregate student counts)
Using data to meet state and federal program reporting requirements (e.g., WIOA)

(8) Barriers and Opportunities for Collaboration Related to the COVID-19 Pandemic and Economic Downturn.

Please rate your level of agreement with the following statements:

	Don’t know	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
The COVID-19 pandemic has improved my organization’s level of collaboration with partner organizations
The COVID-19 pandemic has negatively affected my organization’s level of collaboration with partner organizations
My organization has had to develop different practices for collaborating with partner organizations during the COVID-19 pandemic
The COVID-19 pandemic has affected my organization’s ability to collaborate with partner organizations as required by the WIOA State Plan

[Narrative questions] To what extent are the disruptions/adaptations of services during COVID-19 affecting your collaboration efforts, both internally and externally?

Are there practices of collaborating that you developed or adopted during the COVID-19 pandemic that you feel were effective and would continue using after the pandemic?

Has the COVID-19 pandemic affected your ability to collaborate with partners in rural, urban, or suburban areas? If so, how?

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