Form 0920- Staff Survey -- Preparation Phase

Form Approved

OMB No. 0920-New

Expiration Date: XX/XX/XXXX

Red Carpet Entry (RCE) Program Implementation Project

Attachment # 3a

Staff Survey – Preparation Phase

Public reporting burden of this collection of information is estimated to average 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 NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)

Form Approved

OMB No. 0920-New

Expiration Date: XX/XX/XXXX

Red Carpet Entry

Instrument: Staff Survey – Preparation Phase

Data Collection Details:

• Participant(s): Key RCE implementation staff, including the clinic champion, RCE concierge, internal CTR counselor, and external CTR counselor

• Frequency of Data Collection: Once at the end of the pre-implementation phase

• Participant Time Required: 15 minutes

Thank you for taking this online survey. Please note that when completing this survey, ‘RCE implementation staff’ refers to staff involved in the project whether they are involved day to day (such as CTR counselors, the RCE concierge, or the data manager) or periodically (such as the clinic champion). Additionally, when asked about ‘organization staff’, please consider all those employed by your organization such as health care providers and administrative support staff.

1. Select your clinic:

   1. Rutgers Infectious Disease Clinic

   2. Florida Department of Health in Hillsborough County

2. What is your role on the Red Carpet Entry project? (select all that apply)

Clinic Champion

RCE Concierge

Internal CTR Counselor

External CTR Counselor

Other:______

Public reporting burden of this collection of information is estimated to average 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 NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)

Section 1: Implementation Strategies

Please indicate whether your organization used the activities listed below in preparation for delivering RCE, including to:

[RCE Concierge and Clinic Champion]

• establish a referral network

• establish a discrete password to request RCE service

• prepare your organization to schedule and implement the RCE Visit within 72 hours of referral

• prepare your organization to implement RCE Outreach and Reengagement

[Internal and External CTR Counselors]

• establish a referral network

• establish a discrete password to request RCE service

• prepare your organization to identify and refer clients to RCE

• prepare your organization to implement RCE Outreach and Reengagement

For each activity, select whether the activity was used or not used in the last three months to prepare for delivering RCE.

3. In the last three months, did your organization use any of the following infrastructure strategies in preparation for delivering RCE?

	Used 1	Not used 2	Unsure 99
Change the physical layout of or equipment included in a space (e.g., rearranging furniture in a room to accommodate the RCE Concierge’s orientation sessions with clients)	1	2	99
Change record systems to better implement or assess outcomes related to RCE (e.g., create a new visit type in your EHR to track RCE visits)	1	2	99
Share data with other organizations or departments within your organization (e.g., to facilitate referrals to the RCE Concierge)	1	2	99
Have leadership declare that RCE is a priority and that they are determined to have it implemented	1	2	99
Identify community resources that your organization can connect clients to, such as health departments, non-profit organizations, resources related to addressing social determinants of health, and organizations focused on self-management techniques and support	1	2	99
Other (specify: _________)	1	2	99

4. In the last three months, did your organization use any of the following financial strategies in preparation for delivering RCE?

	Used 1	Not used 2	Unsure 99
Access new funding sources to facilitate implementation of RCE (e.g., funds to cover uninsured clients)	1	2	99
Make it easier to bill for the RCE visit (e.g., creating new billing codes for RCE)	1	2	99
Other (specify: _________)	1	2	99

5. In the last three months, did your organization use any of the following technical assistance and supervision strategies in preparation for delivering RCE?

	Used 1	Not used 2	Unsure 99
Supervise staff involved in preparing for RCE (e.g., RCE Concierge, staff conducting wraparound referrals, front desk staff receiving clients with the RCE password) to ensure that RCE will be implemented as intended	1	2	99
Other (specify: _________)	1	2	99

6. In the last three months, did your organization use any of the following staff support strategies in preparation for delivering RCE?

	Used 1	Not used 2	Unsure 99
Share evidence of RCE’s effectiveness (such as the orientation video or previous evaluation studies) with staff to garner buy-in, including staff who are not directly involved in the implementation of RCE, to increase its acceptability	1	2	99
Revise roles of existing staff to implement RCE (e.g., training existing staff to conduct screenings and make referrals to wraparound services)	1	2	99
Other (specify: _________)	1	2	99

7. In the last three months, did your organization use any of the following training and education strategies in preparation for delivering RCE?

	Used 1	Not used 2	Unsure 99
Have trained RCE implementation staff (e.g., RCE Concierge, clinic champion, or CTR counselors) train other organization staff to implement RCE	1	2	99
Hold meetings with stakeholder groups (e.g., providers, administrators, organizational stakeholders, or patients/consumers) to educate them about RCE	1	2	99
Share educational materials (e.g., the orientation video or quick guide) with other staff members	1	2	99
Train staff to implement RCE by having them shadow a previously trained staff member (e.g., train backup RCE Concierges by having them shadow the main RCE Concierge)	1	2	99
Other (specify: _________)	1	2	99

8. In the last three months, did your organization use any of the following evaluative strategies in preparation for delivering RCE?

	Used 1	Not used 2	Unsure 99
Complete the readiness assessment and/or identify barriers and facilitators to RCE implementation at your organization	1	2	99
Collect information from clients and/or staff for the purpose of quality assurance and improvement (e.g., timing the length of the RCE visit, obtaining informal feedback on the client’s experience)	1	2	99
Assess your organization’s current process for linkage to care and/or identify your organization’s target population for RCE	1	2	99
Other (specify: _________)	1	2	99

9. In the last three months, did your organization use any of the following RCE client engagement strategies in preparation for delivering RCE?

	Used 1	Not used 2	Unsure 99
Obtain feedback from RCE Clients and/or their informal caregivers	1	2	99
Use mass media (e.g., social media or advertisements) to market RCE	1	2	99
Other (specify: _________)	1	2	99

10. In the last three months, did your organization use any of the following stakeholder engagement strategies in preparation for delivering RCE?

	Used 1	Not used 2	Unsure 99
Share challenges and lessons learned with other sites implementing RCE	1	2	99
Include organization staff and other stakeholders in discussions about whether delayed linkage to care is a problem among your client population and whether RCE is an appropriate intervention to address this problem	1	2	99
Obtain written commitments from key partners that state what they will do to implement the innovation	1	2	99
Recruit new staff to champion RCE implementation or oversee day-to-day management of RCE	1	2	99
Distribute a list of terms describing RCE, its implementation, and key stakeholders (e.g., a document describing the RCE Concierge role or warm handoffs)	1	2	99
Engage opinion leaders in your organization to support RCE to influence perceptions of RCE among staff and garner buy-in	1	2	99
Engage administrative leadership, clinic leadership, or other existing governing structures in the implementation of RCE (e.g., providing updates on the progress of implementation)	1	2	99
Conduct walkthrough simulation exercises to model how RCE will be implemented	1	2	99
Establish regular meetings with implementation staff to reflect on the implementation effort, share lessons learned, and support one another’s learning	1	2	99
Use working relationships with other staff within and outside your organization to problem solve issues related to integrating RCE into clinic workflow and promote information sharing and a shared vision/goal for implementation of RCE	1	2	99
Seek guidance from within or outside of your organization on implementation of RCE	1	2	99
Identify and prepare individuals who will support, market, and drive through the implementation of RCE to overcoming indifference or resistance at your organization	1	2	99
Other (specify: _________)	1	2	99

11. In the last three months, did your organization use any of the following strategies to adjust RCE for your organization’s context and integrate RCE into your organization workflow in preparation for delivering RCE?

	Used 1	Not used 2	Unsure 99
Involve or consult with data experts at your organization on how to use data generated from RCE implementation	1	2	99
Identify how RCE can be adapted to meet your organization’s needs	1	2	99
Choose strategies that address barriers and facilitators identified using the readiness assessment, through technical assistance, or through other methods	1	2	99
Observe current work processes, identify changes in work processes necessary to accommodate RCE, and plan and incentivize these changes	1	2	99
Other (specify: _________)	1	2	99

Section 2: Acceptability, Appropriateness, and Feasibility of Intervention

These questions ask about your perceptions of Red Carpet Entry.

12. [Validated Acceptability, appropriateness and feasibility measures from Weiner et al. (2017)] Please indicate how much you agree or disagree with the following statements. As you answer these questions, think about the implementation of RCE within your clinic.

	Completely disagree 1	Disagree 2	Neither Agree nor Disagree 3	Agree 4	Completely agree 5	Don’t know 99
[Acceptability of Intervention Measure]
Red Carpet Entry meets my approval.	1	2	3	4	5	99
Red Carpet Entry is appealing to me.	1	2	3	4	5	99
I like Red Carpet Entry.	1	2	3	4	5	99
I welcome Red Carpet Entry.	1	2	3	4	5	99
[Intervention Appropriateness Measure]
Red Carpet Entry seems fitting.	1	2	3	4	5	99
Red Carpet Entry seems suitable.	1	2	3	4	5	99
Red Carpet Entry seems applicable.	1	2	3	4	5	99
Red Carpet Entry seems like a good match.	1	2	3	4	5	99
[Feasibility of Intervention Measure]
Red Carpet Entry seems implementable.	1	2	3	4	5	99
Red Carpet Entry seems possible.	1	2	3	4	5	99
Red Carpet Entry seems doable.	1	2	3	4	5	99
Red Carpet Entry seems easy to use.	1	2	3	4	5	99

Section 3: Implementation Climate and Implementation Readiness

These questions are asking about your organization’s readiness for implementing Red Carpet Entry. When answering these questions, please think about your overall impressions related to implementing Red Carpet Entry.

13. [Organizational Readiness for Implementing Change measure (Shea, 2014)] In the last three months, RCE implementation staff…

	Strongly Disagree 1	Disagree 2	Neither Agree nor Disagree 3	Agree 4	Strongly Agree 5	Don’t know 99
… wanted to implement RCE.	1	2	3	4	5	99
… were committed to implementing RCE.	1	2	3	4	5	99
… understood the benefits to patients for implementing RCE.	1	2	3	4	5	99
….were motivated to implement RCE.	1	2	3	4	5	99
… would do whatever it takes to implement RCE.	1	2	3	4	5	99
… felt confident that they can keep track of progress in implementing RCE.	1	2	3	4	5	99
… felt confident that the clinic management can keep staff invested in implementing RCE.	1	2	3	4	5	99
… felt confident that they can coordinate tasks so that implementation goes smoothly.	1	2	3	4	5	99
… felt confident that the organization can support staff as they adjust to implementing RCE.	1	2	3	4	5	99
…felt confident that they can keep implementing RCE according to protocol.	1	2	3	4	5	99
…felt confident that they can handle the challenges that might arise in implementing RCE.	1	2	3	4	5	99
…felt confident that they can manage implementing RCE in a busy clinic environment with multiple competing demands.	1	2	3	4	5	99

Section 4: Toolkit Materials Testing

These questions ask about your perceptions of the Red Carpet Entry Toolkit.

14. How frequently did you reference the following toolkit components as you/your organization prepared to implement RCE?

	Not at all 1	Rarely 2	Sometimes 3	Often 4	Don’t know 99
Training Module 1: Red Carpet Entry (RCE) Referrals and Outreach and Reengagement	1	2	3	4	99
Training Module 2: The Red Carpet Entry (RCE) Visit	1	2	3	4	99
Training Module 3: Measuring Success	1	2	3	4	99
Quick Guide	1	2	3	4	99
Implementation Manual	1	2	3	4	99
Readiness Checklist	1	2	3	4	99
RCE Orientation Video	1	2	3	4	99

15. [For those that were used] How useful did you find the following toolkit components in your organization’s preparation to implement RCE?

	Not at all useful 1	Somewhat useful 2	Very useful 3	Extremely useful 4	Don’t know 99
Training Module 1: Red Carpet Entry (RCE) Referrals and Outreach and Reengagement	1	2	3	4	99
Training Module 2: The Red Carpet Entry (RCE) Visit	1	2	3	4	99
Training Module 3: Measuring Success	1	2	3	4	99
Quick Guide	1	2	3	4	99
Implementation Manual	1	2	3	4	99
Readiness Checklist	1	2	3	4	99
RCE Orientation Video	1	2	3	4	99

Section 5: Participant Background

16. What is your age? _______

17. What sex was originally listed on your birth certificate?

Male

Female

Decline to answer

18. Do you think of yourself as:

Male

Female

Transgender man/trans man/female-to-male (FTM)

Transgender woman/trans woman/male-to-female (MTF)

Genderqueer/gender nonconforming neither exclusively male nor female

Additional gender category (or other); please specify:__________________

Decline to answer

19. Ethnicity:

Hispanic or Latino

Not Hispanic or Latino

20. Race (select all that apply):

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

21. What is your highest degree?

Less than High School

High School or equivalent

Associate’s degree

Bachelor’s degree

Master’s degree

Doctoral degree or equivalent

22. What is your role within your clinic? (select all that apply)

Clinic Director

Pharmacist/Pharmacy staff

Case manager

Social Worker

Peer/Peer-volunteer

Physician

Nurse

Nurse practitioner

Physician Assistant

Psychologist (PhD)

Master’s level counselor (eg., MSW, MA Psychologist)

Substance abuse counselor

Volunteer (non-peer)

Front desk staff

Other:________

23. How long have you worked in your current profession?

Years: __________________

Months: ________________

24. How long have you worked at your current organization?

Years: __________________

Months: ________________