Appendix I. Grantee Process Evaluation Online Survey Form_OAHM_Final

Appendix I

Grantee Process Evaluation Online Survey

Older Adults Home Modification Program

Grantee Process Evaluation Online Survey¹

Survey #	Today’s Date (mm/dd/yyyy)	Form Completed By:
		Name	Job Title	Organization
□ Year 1 □ Year 2 □ Year 3			(dropdown menu: project manager, program manager, , other [Specify])

OMB Control No. 2528-XXXX, expiration date XX/XX/2024. This form is designed to provide HUD with information about how effective its Older Adults Home Modification Grant Program is. Your participation in the Evaluation as a grantee is mandatory as a condition of the grant. The Public reporting burden for your collection of information is estimated to be 4 hours per response. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.

Thank you for your work to-date supporting older adults in your community through HUD’s Older Adults Home Modification (OAHM) Program. To capture the lessons you have learned, HUD has contracted with Healthy Housing Solutions to ask you and the other grantees to share information about the status of your OAHM Program and what has helped or impeded your progress. Your insights will provide help HUD make the program more efficient and effective. At the midpoint and end of the Evaluation, we will provide HUD with a summary of all grantees’ process evaluation feedback, but will not identify any grantee organization or staff person by name. HUD staff will not have access to your survey responses.

We estimate this online survey may take up to one hour for you to complete. You may need additional time if you review these questions in advance to coordinate with staff members and gather materials you need to respond to the survey. Although not required, it will also help us greatly if you provide any additional information or supporting materials (such as field guides, program histories). You may upload them directly to REDCap or email them as an attachment to [insert SC name] at [insert SC email address].

Please contact [insert SC name] or any of the team listed below if you have any questions. Thank you in advance for your time.

Jill Breysse, Co-Principal Investigator, National Center for Healthy Housing, [email protected]

Noreen Beatley, Project Manager, Healthy Housing Solutions, [email protected]

Amanda Reddy, Project Director and Principal Investigator, Healthy Housing Solutions [email protected]

1. I applied for the HUD OAHM Program grant to (check all that apply) (Year 1 only):

□ Fill a funding gap

□ Meet a strategic goal for our organization

□ Expand our existing program

□ Meet a need in our community

□ Increase the number of older adults our organization is able to serve.

□ Another reason not mentioned above. Describe:_________________________________________

2. (Year 1 only) One of the reasons your organization was awarded this grant because of your prior experience providing services to older adults, including home modifications. Without HUD OAHM Program funding, would you have been able to continue your older adult services program?

□ Yes

□ No

□ Not sure

3. During this year of the OAHM Program, how often did your organization have home modifications it wanted to do in a home but could not?

□ Always

□ Usually

□ Sometimes

□ Rarely

□ Never

3.a. (ask if 3=always, usually, or sometimes) Why couldn’t your organization do these home modifications?_______________

4. HUD’s OAHM Program Notice of Funding Opportunity (NOFO) described its Program Services Model on pages 19 and 20 [Section III.F.14.f].² Have you made any adaptations, changes, or deviations from this Program Services Model, such as other ways to determine if an older adult is eligible to have their home modified or how problems with the home are identified? (REDCap: For Annual Surveys 2 and 3, add the phrase “Since the previous survey,” to the beginning of the question.)

□ Yes (Go to 4a)

□ No (Go to 5)

4a. Did HUD approve these adaptations, changes, or deviations?

□ (Allow this answer choice only in Year 1 survey) Yes, when you were first awarded the grant. (Go to 4b)

□ (Allow this choice only in the Year 2 and Year 3 surveys) Yes, during this current survey year. (Go to 4b)

□ No (Go to 5)

4b. Describe your organization’s adaptations, changes, or deviations from the HUD OAHM Program Service Model and your reasons for making them. (Allow multiple rows to be added as grantee needs.)

Adaptation/Change/Deviation	Reason

5. The HUD OAHM Program NOFO listed two discretionary Program components. Please check all that you utilize in your program:

□ Registered Nurse (RN) services

□ Social Worker services

□ Other (specify):

6. (Year 1 only, allow only one to be checked) Please check the appropriate designation for the area(s) in which you are providing HUD OAHM Program services

□ Urban

□ Substantially rural

□ Combination of urban and substantially rural

7. In the past year, did you use target areas for recruiting clients into your program?

□ Yes (Go to 7.a)

□ No (Go to 8)

7.a. What type(s) of target area(s) did you choose for recruiting clients into the HUD OAHM Program?

□ zip codes (Specify) □ census tract(s) □ your organization’s entire jurisdiction □ Other (Specify)

7.b. Why did you choose these target area(s)? ___________________

7.c. (Year 2 and 3 only) Are these target area(s) different from those you chose the previous year?

□ Yes Go to 7.c.i)

□ No (Go to 8)

7.c.i Why did you make these changes?____________________________________________

8. (Year 1 only) When did you begin recruiting new clients into the HUD OAHM Program? (mm/dd/yyyy): _______

□ Check this box if you recruited clients for the OAHM Program from an existing wait list when you began the grant program.

9. Please rate your level of success with the following methods to recruit older adults into your HUD OAHM Program. When considering these methods, please consider whether the methods helped you with any of the following: (1) meeting your target enrollment goal; (2) recruiting clients who reflect the demographic characteristics of your community or who are underserved; or (3) enrolling those who have the greatest need for the older adult home modification program. Select “not applicable” if you did not use a particular method. (REDCap: For Surveys 2 and 3, add the phrase “Since the previous survey,” to the beginning of the question.)

Recruitment Method	Very Successful	Successful	Somewhat Successful	Not Successful	Not Applicable
Posted flyers	□	□	□	□	□
Mailed materials to targeted areas	□	□	□	□	□
Other local older adult services or other service organizations agreed to refer clients to the program	□	□	□	□	□
Physicians or other healthcare providers agreed to refer patients to the program	□	□	□	□	□
Personnel working at local Senior Day Center(s) referred clients to the program	□	□	□	□	□
Held meeting(s) or exhibit(s) at local community event(s) or locations (e.g., religious institutions, libraries, etc.)	□	□	□	□	□
Advertised on social media (Facebook, Twitter, Instagram)	□	□	□	□	□
Advertised on TV or radio	□	□	□	□	□
Advertised in print media (newspapers, circulars, billboards, transit ads)	□	□	□	□	□
Made phone calls	□	□	□	□	□
Recruited door-to-door	□	□	□	□	□
Home maintenance contractor or other contractor referrals	□	□	□	□	□
Client heard about the program by “word-of-mouth” and contacted our organization	□	□	□	□	□
Another method not mentioned	□	□	□	□	□
Please specify:
Optional: Please elaborate on your recruitment methods, particularly whether they helped you enroll those most in need in your community.

10. Do you provide clients incentives to encourage participation in the HUD OAHM Program?

□ Yes Go to 10a

10a. Please list incentive(s) offered to clients:

□ No (Go to 11)

11. Please complete the following table, filling in numbers for Year X (fill in year checked at top of form) of your OAHM program grant.

OAHM Program:	Number
Enrollment Goal
Clients screened
Clients enrolled
Clients with completed home hazard/housing condition visit
Homes with home modifications initiated
Homes with home modifications completed
Homes with completed follow-up Evaluation forms (i.e., follow-up Client Program Questionnaire, follow-up Client Impact Evaluation Interview, and follow-up Home Hazard Checklist) questionnaires

12. How important have the following factors been in developing the Scope of Work (SOW) for homes of enrolled clients? For Year 2 and Year 3 surveys, consult your Year 1 answers to help you complete this section. REDCap: For Surveys 2 and 3, add the phrase “Since the previous survey,” to the beginning of the question.)

Factor	Very Important	Important	Somewhat Important	Not at all Important	Not Applicable
Personal needs and goals of client	□	□	□	□	□
Personal needs and goals of other resident(s) Specify:________	□	□	□	□	□
Items that posed a resident fall hazard	□	□	□	□	□
Deferred maintenance items	□	□	□	□	□
Accessibility hazards	□	□	□	□	□
Bathroom hazards	□	□	□	□	□
Kitchen hazards	□	□	□	□	□
General safety hazards throughout the inside of the home	□	□	□	□	□
General safety hazards on the outside of home, but still on the property	□	□	□	□	□
Other factors not mentioned above	□	□	□	□	□
Please list the other factors: (Open this row if “very important,” “important,” or “somewhat important” were checked in previous row)

13. How satisfied were you with the technical assistance you received from HUD during program implementation?

□ Very satisfied

□ Satisfied

□ Somewhat satisfied

□ Not satisfied

□ My organization didn’t receive technical assistance during program implementation.

Please elaborate on your answer (optional):

14. Does your organization have funding from some other source(s) to provide older adult home modifications or other interventions (e.g., social services) to OAHM Program clients in your community?

□ Yes Go to 14a

□ No (Go to 15)

14a. For Year X (fill in year checked at top of form), what was the estimated funding from other sources used for home modifications? $____________

14b. What is/are the source(s) of this supplemental funding? Check all that apply

□ Other federal government program. Specify:________________

□ Private foundation

□ State/local program. Specify: ________________

□ Other Source. Specify: ________________

14c. How do you use funding from other sources (e.g., to address thermal comfort issues, higher cost repairs not generally covered by the HUD OAHM program such as roof replacement, expansion of similar approaches as in the OAHM program to treat additional homes, etc.)?

15. If you encountered homes with hazards your organization could not address under the HUD OAHM Program, did you refer clients to other organizations (e.g., weatherization program if thermal comfort issues were present, healthy homes programs if mold or pest hazards were present, etc.)?

□ Yes

□ No

Did you experience any barriers to program implementation in any of the following areas? (In year 2 and year 3 survey, add “since the previous survey”) Select all answers that apply. Feel free to provide additional detail in the comment box.	Yes, I experienced a major barrier or issue	Yes, I experienced a minor barrier or issue	No, I did not experience a barrier or issue	Not applicable to my program
16.a. Recruiting clients	□	□	□	□
16.b. Recruiting specific populations	□	□	□	□
16.c. Too many applicants (i.e., unable to serve all eligible applicants)	□	□	□	□
16.d. Had to turn away some potential applicants because their homes were not structurally sound.	□	□	□	□
16.e. Some applicants were not able or declined to provide health information	□	□	□	□
16.f. Funding was not adequate to cover the costs of needed modifications	□	□	□	□
16.g. Staff shortages or other capacity issues	□	□	□	□
16.h. Other issue not mentioned. Please specify: ______________	□	□	□	□
Please provide additional details about the barriers you identified:

17. Once HUD OAHM program funding ends, do you plan to continue your program in the format you have used for the HUD Program?

□ Yes (Go to 17b) □ No Go to 17a □ Not sure Go to 17a

17.a Why not?
_________________________________________________________________ (Go to 18)

17.b Describe your continuation plan, even if you have not worked out all the details.

__________________________________________________________________________

18. Optional Please share a story or anecdote here about an experience you or one of your clients (no personal identifiers, please) had with the HUD OAHM Program. This story could illustrate a strength of the program, a challenge encountered, the program’s impact, or something else. Feel free to add links to press coverage, if available. ______________________________________________________________________________

19. Optional Please use this space to tell us anything else you want like to share about your experience implementing the HUD OAHM Program:
    ______________________________________________________________________________

Please save a copy of your completed survey and keep it for your records.

You can also print a copy, if desired.

1 Code for this document: Black font=Question asked of the grantee; Blue italics = Instruction for the grantee; yellow highlighted italics: Instruction for REDCap programmer.

2 As listed in the NOFO, the Program Services Model includes: (1) Initial interview and in-home assessment by licensed OT, licensed OTA, or CAPS whose work under the grant is overseen by licensed OT; (2) work order by OT/OTA/CAPS; (3) home modification work by licensed, or in accordance with local and state regulations, contractor qualified to perform the required work; (4) follow-up assessment and inspection by OT.