Attachment D – Partner Survey
OMB Control No: ____-____
Expiration Date: __/__/____
OMB Package
SUPPORT Act Evaluation Partner Survey
Note that the partner survey will be administered online and will be programmed with skip patterns to omit questions not applicable to the partner based on responses to previous questions.
Part B. Organization Background 5
Part C. Enrollment Levels and Staffing 7
Part D. Organizational Partnerships 8
Part E. Recruitment, Intake, and Enrollment 10
Part G. Education, Training and Employment Services 13
Welcome
SUPPORT Act Grants Evaluation
Thank you for your assistance in responding to the SUPPORT Act Grants Evaluation Survey.
Th survey will contribute to the U.S Department of Labor’s (DOL) Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act grant programs evaluation. Abt Associates and MDRC are conducting the evaluation for DOL’s Chief Evaluation Office, in partnership with the Employment and Training Administration. You have been identified by [PRE-FILL NAME OF SUB-GRANTEE] due to your involvement as a partner in their grant. Your responses will help provide important information on promising practices and implementation challenges in providing services that address both employment and treatment needs for those with substance use or opioid use disorders. The goal of the study is to document best practices, challenges, and lessons for both policymakers and program administrators.
On the next page we will provide you with detailed information about the survey. This is a part of our informed consent process. After reviewing the information, you will be directed to the survey.
Thank you again for your participation!
Sincerely,
Hannah Betesh, Project Director
Thank you for taking the time to participate in the SUPPORT Act Grants Evaluation Survey.
Who is administering this survey? Abt Associates and MDRC, nonpartisan research organizations, are conducting the survey as part of the SUPPORT Act Grants Evaluation for the U.S. Department of Labor (DOL). The data collected will be used by Abt Associates and its partner MDRC for research purposes.
What is the purpose of the survey? This survey will collect consistent information about grant activities from all 4 SUPPORT Act grantees, 18 subgrantees, and their partners and will provide critical information for the SUPPORT Act Grants Evaluation. The survey covers grantee program context; program development; partners and their involvement; program implementation, including participant recruitment and services provided; employer engagement; and grantee perspectives on participant experiences.
How long will it take to complete? This survey will take approximately 30 minutes. Your responses will be automatically saved. If you start the survey but do not complete it, you can use the same link you received via email to be taken to the last response you completed.
Is participation mandatory? Your participation is voluntary. However, your input is valuable and only you can tell us about your organization’s experiences with the SUPPORT Act grants. Your participation will help provide important information on promising practices and implementation challenges in providing services that address both employment and treatment needs for those with substance use disorders.
Who will see my responses? The researchers conducting this survey are committed to keeping your organization’s information private. Responses to the survey will not be identified by any person in any publication.
What are the benefits and risks of participation? Although any data shared involves some risk of loss of confidentiality, the researchers take strong precautions to protect your information. Your responses will help provide important information on promising practices and implementation challenges in providing services that address both employment and treatment needs for those with substance use disorders. Your responses will not affect your organization’s funding under the SUPPORT Act grant.
Who can I contact with questions? If you have any questions about the evaluation please email the Project Director, Hannah Betesh, at [email protected] or call at (301) 347-5990. For questions or concerns about your rights as a study participant, please contact the Abt IRB Administrator at 1-877-520-6835 (toll free).
Thank you again for participating in this survey. We greatly appreciate your time and assistance.
Agreement to Participate. By checking this box, you acknowledge that you read the information outlined above and allow our research team to use your survey responses as described. Please complete this survey by [Insert Date].
Yes, I have read and understand the information above, and I agree to participate in this.
No, I do not agree to participate in this.
[If yes, move to first question
If no, close the survey]
The Paperwork Reduction Act Statement: This collection of information is voluntary and will be used to understand programs that integrate employment and substance use disorder services. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, 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. The OMB number and expiration date for this collection are OMB #: XXXX-XXXX, Exp: XX/XX/XXXX. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Hannah Betesh (Abt Associates); [email protected].
What is your name?
_____________________
Please confirm the name of your company or organization: [PRE-FILL NAME FROM NOMINATION FORM].
Yes, this is correct
No, the name of my company or organization is: _______________________
What is your position or job title at [PRE-FILL ORGANIZATION NAME]?
_______________________ insert job title
How long have you worked in this role?
________ (dropdown years/months)
How long have you worked at [PRE-FILL NAME OF ORGANIZATION]?
_________ (dropdown years/months)
Please specify the type of company or organization you work for:
(Please select only one.)
Local government agency
State government agency
Local workforce development agency
American Job Center
Nonprofit (e.g., community or faith-based) service/training provider
Community or technical college
Substance use disorder treatment or recovery provider
Local housing assistance / continuum of care provider
Justice system
Employer
Other (please specify): _______________________
What type of services does your company or organization provide? [DO NOT ASK EMPLOYER PARTNERS]
(Please select all that apply.)
Substance use disorder treatment/recovery services
Mental health services
Case management and supportive services
Housing assistance
Occupational skills and training
Education services (basic skills/GED)
Career services (e.g., employment and treatment plans, job readiness, job coaching and placement)
Justice services
Other (please specify): _______________________
What is your industry? [ONLY ASK EMPLOYER PARTNERS]
Business services
Commercial or residential cleaning
Construction
Healthcare
Information Technology
Leisure and hospitality
Maintenance
Manufacturing
Retail
Substance use disorder treatment/recovery services
Transportation
Other (please specify): _______________________
(Please select all that apply.)
Federal funding
State funding
Grants, please specify: ___________________
Fee-for-service
Insurance/Medicaid reimbursement
Other (please specify): __________________
How many full-time staff equivalents (FTEs) does your company or organization employ?
____________ insert number of paid FTEs
How many people does your company or organization serve annually? [DO NOT ASK EMPLOYERS]
_____________ insert number of individuals served per year
Prior to this grant, did your company or organization have specific programs or policies for supporting people experiencing substance use disorder (SUD)?
Yes
No
Not Sure
How many participants have you enrolled to-date under this grant?
____________ number of participants
How many referrals have you received from [PRE-FILL SUB-GRANTEE NAME] for this grant program?
____________ number of referrals
We do not track this information (Skip to 2.4)
Don’t know (Skip to 2.4)
Of those referrals, how many have you enrolled into services?
____________ insert number of enrollments
Did you hire staff specifically for this grant?
Yes
No
Don’t know
What type of arrangement do you have with [PRE-FILL SUB-GRANTEE NAME] to provide services under this grant?
Formal financial contract
Memorandum of Understanding (MOU)
Informal collaboration
Is this a new partnership with [PRE-FILL SUB-GRANTEE NAME], or did you work with them previously?
Yes, new partnership
No, previous or ongoing relationship
3.6. How involved is your company or organization with [PRE-FILL SUBGRANTEE NAME] in providing services under this grant?
Low levels of direct interaction. Attend meetings where [PRE-FILL SUBGRANTEE NAME] described their work, or your organization described work to them. Occasional phone calls or emails
Medium levels of direct interaction. Target your efforts in consultation with [PRE-FILL SUBGRANTEE NAME], where you both direct your efforts to best serve clients covered under the grant
High levels of interaction. Meet or speak regularly. Partners may divide up responsibilities, share formal or informal resources, and/or work together to assess progress.
What services do you provide to participants through your partnership with [PRE-FILL SUB-GRANTEE NAME]?
(Please select all that apply.)
OUD/SUD treatment and recovery services
Mental health services
Job search assistance
Hosting participants for on-the-job training or other work experience
Hiring participants for unsubsidized positions
Participant referrals to [PRE-FILL SUB-GRANTEE NAME]
Education services (e.g., basic skills/GED)
Occupational and skills training
Other (please specify): _______________________
Don’t know; we do not track if individuals are referred through this partnership.
Prior to your partnership with [PRE-FILL SUB-GRANTEE NAME], how much experience did your company or organization have with providing or supporting employment for people seeking treatment or in recovery for SUDs?
No experience
Some experience
A lot of experience
The following questions focus specifically on recruitment, intake and enrollment for participants served by the [PRE-FILL NAME OF STATE/LOCAL SUPPORT ACT GRANT].
What type of participants do you serve under this grant or partnership?
(Please select all that apply.)
Individuals experiencing SUD/OUD
Friends and/or family members of individuals experiencing SUD/OUD
Community members in areas with high rates of SUD/OUD
Don’t know; we do not track if individuals are referred through this partnership
[Partners] Do you have recruitment efforts specific to this partnership to identify and enroll individuals experiencing SUD/OUD or their friends and/or family members?
Yes
No
If yes, go to questions 4.3. If no, skip to question 4.4.
Which of the following activities does your company or organization use to recruit potential participants for the grant?
(Please select all that apply.)
TV or radio public service announcements
Distribution of print materials
Use of grantee/partner websites
Facebook, Twitter, Instagram, other social media
Partnerships or referrals from substance use treatment providers
Partnerships with or referrals from employers
Partnerships with or referrals from education or training providers
Referrals from Workforce Investment Board or American Job Centers
Referrals from community/ faith-based organizations
In-person presentations in the community
Word of mouth
Other (please specify): ________________________
Do you have a specific staff member(s) dedicated to conducting intake and enrollment into services provided under this grant?
Yes
No
Don’t know; we do not track if individuals are referred through this partnership.
If yes, go to question 4.5. If no, skip to next section.
Which staff roles?
Please specify roles/titles: _______________________
The following questions focus specifically on support services provided to participants served by the [PRE-FILL NAME OF STATE/LOCAL SUPPORT ACT GRANT].
Which of the following treatment and supportive services do you offer to participants served by the [PRE-FILL NAME OF STATE/LOCAL SUPPORT ACT GRANT]?
(Please select all that apply.)
Substance use disorder treatment
Mental health counseling
Transportation assistance
Peer support
One-on-one case management
Financial stipend
Work expenses or tools
Tuition for education and training programs
Other education and training-related supports such as application fees, licensing test, certifications
Other (please specify): _____________________
None, we do not provide treatment and/or supportive services
Don’t know; we do not track if individuals receiving services were referred through this partnership
How does your company or organization coordinate with SUD treatment programming? [DO NOT ASK SUD TREATMENT/RECOVERY PROVIDERS]
(Please select all that apply.)
Offer SUD treatment programming through my company/organization
Refer participants for treatment services
Receive referrals from treatment providers
Coordination of care (medical or SUD/OUD treatment) to meet participant needs
On-the-job support for employees
On-the-job support for employers
Other (please specify): _________
None of the above
The following questions focus specifically on education, training, and employment services provided to participants served by the [PRE-FILL NAME OF STATE/LOCAL SUPPORT ACT GRANT].
Which of the following employment services do you offer to participants served by the [PRE-FILL NAME OF STATE/LOCAL SUPPORT ACT GRANT]?
(Please select all that apply.)
Employment readiness skills (e.g., time management skills, appropriate workplace behavior)
Job search assistance skills (e.g., interview practice, resume development, etc.)
Job development (e.g., finding appropriate job openings, working with employers to locate job openings)
Career guidance and counseling
Other (please specify): _______________________
None; we do not provide employment services.
Don’t know; we do not track if individuals receiving services were referred through this partnership.
Which of the following training and education services do you offer as part of this grant?
(Please select all that apply.)
Paid work experience (e.g., on the job training)
Unpaid work experience (e.g., internships)
Basic skills training or educational classes (e.g., GED)
Occupational training
Registered apprenticeships
Other (please specify): _________
Which of the following training and education services do you offer to participants served by the [PRE-FILL NAME OF STATE/LOCAL SUPPORT ACT GRANT]?
(Please select all that apply.)
Paid work experience (e.g., on the job training)
Unpaid work experience (e.g., internships)
Basic skills training or educational classes (e.g., GED)
Occupational training
Registered apprenticeships
Other (please specify): _________
None; we do not provide training and education services.
Don’t know; we do not track if individuals receiving services were referred through this partnership.
Do you provide training or supports about hiring and employing workers with SUD/OUD?
Yes
No
If yes, go to question 6.5. If no, skip to end of survey.
What does this training or support include?
(Please select all that apply.)
Training on SUD/OUD prevalence and treatment and recovery
Training on how to recognize employee SUD/OUD
Improving employee assistance programs to be inclusive of SUD/OUD treatment and recovery
Training and support for creating inclusive and welcoming workplaces for employees with SUD/OUD
On-the-job support for participants under the grant program hired by employer
On-the job support for employers who hire participants from the grant program
Other (please specify): ____________
Thank you very much for your time.
END OF SURVEY
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Siobhan Mills De La Rosa |
| File Modified | 0000-00-00 |
| File Created | 2022-08-04 |