Form 0920-23AA Att. 5a Prevention Infrastructure Assessment Tool Update

Attachment 5a. Prevention Infrastructure
Assessment (PIA) DELTA AHEAD Category B

Form Approve
OMB No: xxxx-xxxx
Exp. Date: xx-xx-xxxx
Public Reporting burden of this collection of information is estimated at 30 minutes, 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 (xxxx-xxxx).

Recipient:
Reporting Period:
Contact Person:
INTRODUCTION
Information for Recipients:
Please note that the term "Coalition" refers to your State Domestic Violence Coalition (SDVC). This survey has
been sent to you as the Project Lead on the DELTA AHEAD project for your SDVC. However, you may complete
the survey with any other Coalition staff that you feel would be appropriate. Please submit only ONE survey per
Coalition.
Primary Prevention refers to activities and strategies that keep intimate partner violence (IPV) or domestic
violence (DV) from first occurring.
Community and Societal Level IPV Prevention refers to prevention strategies that are designed to impact
characteristics of the settings (e.g., school, workplace, and neighborhood) in which social relationships occur, or
social and physical environment factors such as reducing social isolation, improving economic and housing
opportunities, and improving climate within school and workplace settings. This is different from individual level
strategies (usually designed to promote attitudes, beliefs, skills, and behaviors) and relationship level strategies
(focus on parenting, family, mentoring, or peers to reduce conflict, foster problem-solving skills, promote healthy

Att. 5 - PIA

relationships, and address factors related to the social circle, peers, partners, family members and other adult
allies who influence an individual behavior and experience).
Program staff refers to any staff at your coalition that work on any programs, practices or policy efforts of the
coalition including response. It would not include staff that are only involved in administrative or operational
tasks at the Coalition
Risk factor refers to a characteristic that increases the likelihood of a person becoming a victim or perpetrator of
violence. Factors that put individuals at risk for perpetrating IPV include (but are not limited to) demographic
factors such as age, low income, low educational attainment, and unemployment; childhood history factors such
as exposure to violence between parents, experiencing poor parenting, and experiencing child abuse and neglect.
Relationship level factors include hostility or conflict in the relationship, aversive family communication and
relationships, and having friends who perpetrate/experience IPV. Community and societal level factors include
poverty, low social capital, low collective efficacy in neighborhoods, and harmful gender norms in societies.
Protective factors are characteristics that decrease the likelihood of a person becoming a victim or perpetrator
of violence because they provide a buffer against risk. Factors associated with lower chances of perpetrating or
experiencing IPV include high empathy, good grades, high verbal IQ, a positive relationship with one’s mother,
and attachment to school. Community and societal factors such as lower alcohol density, community norms that
are intolerant of IPV, and increased economic opportunities may also be protective against IPV.
Health Equity refers to the attainment of the highest possible standard of health for all people and giving special
attention to the needs of those at greatest risk of poor health, based on social conditions. Health equity is the
state in which everyone has a fair and just opportunity to attain their highest level of health (CDC). Achieving
heath equity means valuing everyone equally with focused efforts to address avoidable inequities, historical and
contemporary injustices, and the elimination of health and healthcare disparities.
Social Determinants of Health refers to the conditions in the environments in which people are born, live, learn,
work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and
risks. Healthy People 2030 groups social determinants of health into 5 domains: economic stability, education
access and quality, health care access and quality, neighborhood and built environment, and social and
community context.

It should take you about 30 minutes to complete this survey.

Att. 5 - PIA

In what state is your coalition? _______

COMMUNITY AND SOCIETAL PRIMARY PREVENTION
EXPERTISE AND KNOWLEDGE

1
1.

At this point in time, how knowledgeable would you rate your Coalition
program staff overall about preventing domestic violence from first occurring
(primary prevention)? (1=lowest, 5=highest)

2.

How well do Coalition program staff understand the difference between the
primary prevention of IPV and the secondary prevention of IPV (response and
advocacy after IPV has occurred)?
In general, how knowledgeable are Coalition program staff about primary
prevention at the community and societal level?
How well do Coalition program staff understand the difference between
primary prevention approaches at the individual/relationship level and at the
community/societal level?
In general, how knowledgeable are program staff about the risk and protective
factors that IPV shares with other types of violence?

3.
4.
5.

0%

6.

What percentage of your program staff have previous
experience planning and implementing community and
societal level primary prevention?

7.

What percentage of your program staff have previous
experience evaluating community and societal level primary
prevention?
What percentage of your program staff has expertise or
knowledge in the area of social norms change (efforts to
change group-level beliefs and expectations behavior)?

8.

9.

What percentage of your program staff has expertise or
knowledge in the area of environmental change (efforts to
make a physical or material change to the economic, social,
or physical environment)?

10. What percentage of your program staff has expertise or
knowledge around policy change related to IPV prevention?
This includes: analyzing data to identify areas where policy
change may be needed, analyzing and understanding policy
options, collaborating with stakeholders to educate about policy
issues, providing evidence and education to key stakeholders and

Att. 5 - PIA

LESS
THAN
25%

2

BETWEEN
25%-50%

3

BETWEEN
51%-75%

4

5

MORE
THAN
75%

policymakers, educating the public about existing policies, or
evaluating the impact of policies

11. Is there anything else you would like us to know about the expertise of your Coalition staff as it relates to Community
and Societal Level Primary Prevention?____________________________________________
SECTION A: STATE ACTION PLAN PROGRESS
TRAINING OPPORTUNITIES

Question
12. To what extent is information or training about
community and societal level primary prevention
included in new program staff
orientation/onboarding?

Response Options
• Not included at all
• We have started discussing this kind of change, but no
formal changes to training yet
• Community and societal level primary prevention is
included in trainings, but is not as much of a focus as
other areas of training
• Community and societal level primary prevention is
included above or at the same level as other areas of
training

13. If this information is included in new staff orientation
or onboarding, is it only provided to program staff that
will be directly involved with Community or Societal
Level Primary Prevention?

•
•
•
•

14. To what extent is ongoing training or professional
development related to community and societal level
primary prevention offered to coalition program staff?

•
•
•

•

15. Are these training opportunities only available to
program staff that are directly involved with
Community or Societal Level Primary Prevention?

•
•
•
•

Att. 5 - PIA

It is provided only to staff who will be working directly
on community or societal level primary prevention
It is provided to staff working on any kind of
prevention
It is provided to all staff regardless of if they are
working on prevention or response
N/A – Information is not included in new staff
orientation or onboarding
Not offered at all
We have started discussions, but no formal changes to
training yet
Community and societal level primary prevention is
included in trainings, but is not as much as other areas
of professional development/training
Community and societal level primary prevention is
included above or at the same level as other areas of
professional development/training
It is offered only to staff who are working directly on
community or societal level primary prevention
It is offered to staff working on any kind of prevention
It is offered to staff regardless of if they are working
on prevention or response
N/A – Training opportunities are not offered

LEADERSHIP SUPPORT AND PRIORITIZATION
A lot lower

Somewhat
lower

About
equal

Somewhat
higher

LESS
THAN
25%

BETWEEN
25%-50%

BETWEEN
51%-75%

A lot higher

16. How much does leadership at the Coalition support
IPV prevention efforts compared to other Coalition
priorities?
17. How much does leadership at the Coalition support
IPV prevention at the community and societal levels
compared to other Coalition priorities?

0%

18. Across all staff at your Coalition, approximately what
percentage of program staff work on primary
prevention (versus response) at any level (individual,
relationship, community or societal)?
19. Across staff at your Coalition, approximately what
percentage of program staff work on primary
prevention at the community and societal levels?
20. What percentage of the total programs or policy
efforts that the Coalition funds or implements focus
on primary prevention?
21. Of the primary prevention programs or policy efforts
that the Coalition funds or implements, what
percentage focus on community and societal levels
(versus individual/relationship level)?
22. Is there anything else you would like us to know about prioritization of Community and Societal Level Primary
Prevention at your Coalition?

STRUCTURES AND PROCESSES
Question
23. Does your Coalition mission statement include primary
prevention?

Att. 5 - PIA

Response Options
• Yes
• No

MORE
THAN
75%

24. To what extent does your Coalition’s strategic plan (or
equivalent document) include discussion of primary
prevention?

•
•
•
•
•

25. Does the strategic plan include specific goals or action
steps related to primary prevention at the community
and societal level?

26. Is a shared risk and protective factor framework used
when planning the Coalition’s work?
27. To what extent is your Coalition’s strategic plan
aligned with the state-level priorities identified in the
State Action Plan (SAP)?

•
•
•
•
•
•
•
•
•
•
•
•
•

Not at all
We have started discussions, but no formal changes
yet
Prevention is included, but is not as much of a focus as
other work of our coalition
Prevention is included at the same level of focus as
every other focus of our coalition
Prevention is included more than other focus areas of
our coalition
Unsure
No
We have started discussions but no specific goals or
action steps at this time
Yes
Unsure
No
Yes
Unsure
No alignment
Our plan is aligned with a few of the SAP priorities
Our plan is aligned with many of the SAP priorities
Our plan is aligned with all of the SAP priorities
Unsure

28. Please mark whether your Coalition has done any of the following IN THE PAST YEAR: (check all that apply)
 Included primary prevention messages in promotion materials (e.g., newsletter, web site)
 Made primary prevention resources available (e.g., curricula or materials in resource library, web site)
 Distributed written materials specific to primary prevention to your membership agencies
 Trained local programs (e.g., victim service providers) on primary prevention
 Provided technical assistance to local programs related to primary prevention
 Implemented or coordinated online trainings specific to primary prevention of IPV (e.g. webinars, web
conferences)
 Implemented or coordinated a statewide or regional primary prevention campaign
 Implemented or coordinated regional trainings specific to the primary prevention of IPV
 Initiated and/or participated in a campaign to secure more state resources or influence statewide policies to
promote primary prevention of IPV
 Served as IPV prevention representative/expert on state task forces or committee
 Added questions concerning IPV risk and protective factors to statewide health survey

Question
29. To what extent does your Coalition use data (such as
publicly available data, surveys, interviews, reports,
focus groups) in planning prevention efforts?
30. To what extent does your Coalition track risk and
protective factors related to IPV at the state and/or
local level?

Att. 5 - PIA

Response Options
To no extent

To little
extent

To some
extent

To a large
extent

To a very
large extent

To no extent

To little
extent

To some
extent

To a large
extent

To a very
large extent

31. To what extent does your Coalition collect information
about the outcomes of the primary prevention
programs or activities it implements?
32. To what extent do Coalition staff have adequate
access to data needed for planning community and
societal level IPV primary prevention activities?

To no extent

To little
extent

To some
extent

To a large
extent

To a very
large extent

To no extent

To little
extent

To some
extent

To a large
extent

To a very
large extent

33. Is there anything else you would like us to know about the structure and processes related to primary prevention at
your Coalition?

COORDINATED COMMUNITY RESPONSE TEAMS

1

2

3

4

5

34. In general, how knowledgeable is the Community Coordinated Response
Team(s) (CCRT) about preventing intimate partner violence from first occurring
(primary prevention)? (1=lowest, 5=highest)
35. In general, how knowledgeable is the CCRT(s) about community and societal
level primary prevention?
36. In general, how would you rate the willingness or openness of the CCRT(s) to
implement community and societal level primary prevention?
37. In general, how would you rate the capacity of the CCRT(s) to implement
community and societal level primary prevention?
38. In general, how would you rate the capacity of the CCRT(s) to evaluate
community and societal level primary prevention?

A lot lower

Somewhat
lower

About
equal

Somewhat
higher

A lot higher

39. How much do CCRT(s) support primary prevention
efforts at the individual or relationship levels
compared to other priorities?
40. How much do CCRT(s) support community and
societal level primary prevention efforts compared to
other priorities?
41. Is there anything else you would like us to know related to primary prevention at CCRT(s)?______________

HEALTH EQUITY
Questions

Att. 5 - PIA

Response Options

42. To what extent do coalition staff have a clear
understanding of health equity concepts?
43. To what extent do coalition staff have a clear
understanding of the social determinants of health
that impact intimate partner violence?
44. To what extent do coalition staff have experience with
providing programming or services for populations
disproportionately impacted by violence?
45. To what extent is coalition leadership committed to
advancing health equity?

To no extent

To little
extent

To some
extent

To a large
extent

To a very
large extent

To no extent

To little
extent

To some
extent

To a large
extent

To a very
large extent

To no extent

To little
extent

To some
extent

To a large
extent

To a very
large extent

To no extent

To little
extent

To some
extent

To a large
extent

To a very
large extent

46. How, if at all, does your coalition provide training to
staff on health equity?
47. Is achieving health equity an explicit goal of your
coalition (e.g., is included in the mission statement or
strategic plan)?
48. Does the coalition currently have a dedicated arm for
health equity (such as a health equity team, advisory
group, etc.)?

No

Yes

Unsure

No

Yes

Unsure

SUMMARY
What do you see as the major barriers or challenges to increasing capacity, resources and prioritization of community and
societal level primary prevention of IPV?

Is there anything else you would like to share with us?

Att. 5 - PIA