Atmt MMM LHD Capacity Readiness Screenshots

Dating Matters Capacity Assessment: Local Health Departments Survey
 

Thank you for participating in the development of the Dating Matters Capacity Assessment. The survey includes 
questions on your health department’s functioning, climate for change, prevention knowledge and experience, 
partnerships, leadership support, program planning, and likelihood of sustainability. The survey should take about 45 
minutes. 
 
Your responses will assist us in revising the assessment for use with grantees who receive funding from the Centers for 
Disease Control and Prevention to implement teen dating violence prevention programs and policies. 
 
Your participation is voluntary and you may refuse to answer any question. 

Before getting started, please enter the survey respondent code.
 

 
1. How long have you worked at this local health department?
Years
Months

2. What is your primary role within the local health department?
Select one answer.
j Administrator (program manager or director)
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j Clinician
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j Administrative support
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j Public health or outreach educator
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j Counselor/Social worker
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j Youth program or prevention program specialist
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j Other
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If other, please specify 

3. How long have you worked with youth prevention programs (of any type) at this local
health department?
Years
Months

4. Outside of this local health department, how long have you worked with youth
prevention programs?
Years
Months

 

Dating Matters Capacity Assessment: Local Health Departments Survey
5. How much do you agree or disagree with each of the following statements
about your local health department?
Select one answer per row.
Strongly 
Disagree
Everyone knows how their own job relates to the overall mission 

Neither 
Disagree Agree nor  Agree
Disagree

Strongly 

Don't 

Agree

Know

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The work standards expected of people are clear.

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Staff gets well defined feedback about how well they are doing.

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Staff participates in other parts of the local health department 

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Staff can take part in the decisions that affect them.

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The local health department uses a clear procedure for conflict 

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of the local health department.

enough to be able to appreciate their role in that wider 
environment.

resolution.

 
6. Programs like Dating Matters sometimes experience organizational
challenges. How much do you agree or disagree with each of the following
statements about Dating Matters?
Select one answer per row.
Strongly 
Disagree

Disagree

Strongly 

Don't 

Agree

Know

Staff working on the Dating Matters initiative get along well.

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There is much friction among the staff working on the Dating 

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Matters initiative.
The staff working on the Dating Matters initiative work together 
as a team.
The staff working on the Dating Matters initiative are quick to 
help one another when needed.
Mutual trust and cooperation is strong among the staff working 
on the Dating Matters initiative.
Some staff working on the Dating Matters initiative do not do 
their share of the work.
Staff understand their role in implementing the Dating Matters 
initiative.

 

Neither 
Disagree Agree nor  Agree

Dating Matters Capacity Assessment: Local Health Departments Survey
7. How much do you agree or disagree with each of the following statements
about the local health department?
Select one answer per row.
Strongly 
Disagree
The local health department has a history of participating in 
innovative public health initiatives.
Within the local health department, ideas for new approaches 
are welcomed.
Staff are encouraged to try new things within the local health 
department.
The local health department has a flexible structure to allow for 
new processes to be adopted.

Neither 
Disagree Agree nor  Agree
Disagree

Strongly 

Don't 

Agree

Know

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8. Staff members vary in their knowledge about teen dating violence
prevention. How much do you agree or disagree with each of the following
statements? Please think about the administrative division within your local
health department where Dating Matters is located.
Select one answer per row.
Strongly 
Disagree
Staff are knowledgeable about the causes of teen dating 
violence.
Staff are knowledgeable about evidence­based teen dating 
violence prevention.
Staff are experienced in overseeing community­based 
prevention efforts like the Dating Matters initiative.
Staff are encouraged to attend training specific to teen dating 
violence prevention.
Staff have the necessary skills to support the Dating Matters 
initiative.

 

Neither 
Disagree Agree nor  Agree
Disagree

Strongly 

Don't 

Agree

Know

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Dating Matters Capacity Assessment: Local Health Departments Survey
9. How much do you agree or disagree with the following statements about the
local health department as a whole?
Select one answer per row.
Our local health department leadership is...
Strongly 
Disagree

Neither 
Disagree Agree nor  Agree
Disagree

Strongly 

Don't 

Agree

Know

Able to build consensus within the local health department.

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Willing to involve other health department staff members in 

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decision making.
Able to manage conflict within the local health department.

 
10. How much do you agree or disagree with the following statements about
the local health department as a whole?
Select one answer per row.
Our local health department leadership is...
Strongly 
Disagree

Disagree

Strongly 

Don't 

Agree

Know

Knowledgeable about teen dating violence prevention.

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Committed to preventing teen dating violence.

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Able to obtain the necessary financial resources for teen dating 

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A strong advocate for the Dating Matters Initiative.

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Motivated to ensure that the Dating Matters initiative is a 

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violence prevention initiatives.

success.
Knowledgeable about the extent of other teen dating violence 
efforts in the community.
Supportive of staff implementing Dating Matters.

 

Neither 
Disagree Agree nor  Agree

Dating Matters Capacity Assessment: Local Health Departments Survey
11. How much do you agree or disagree with each of the following statements
about the local health department?
Select one answer per row.
Strongly 
Disagree
The Dating Matters initiative is consistent with our local health 
department’s mission.
There is a common vision in the health department about the 
methods needed for preventing teen dating violence.
Most staff members see using evidence­based approaches as an 
essential part of our health department’s work.

Neither 
Disagree Agree nor  Agree
Disagree

Strongly 

Don't 

Agree

Know

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12. Please think about the administrative division within your local health
department where Dating Matters is located. How much do you agree or
disagree with each of the following statements?
Select one answer per row.
My administrative unit has staff who can...
Strongly 
Disagree

Disagree

Strongly 

Don't 

Agree

Know

Explain the benefits of evaluation to schools.

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Overcome barriers to evaluation participation.

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Obtain internal approvals for participation in evaluation data 

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collection.
Work with a local evaluator to develop procedures for collecting 
evaluation data from parents and/or youths.
Work with local evaluator to develop procedures for collecting 
implementation data from program staff.
Work with a local evaluator to interpret evaluation findings for 
the Dating Matters initiative.
Disseminate findings from the evaluation of the Dating Matters 
program.

 

Neither 
Disagree Agree nor  Agree

Dating Matters Capacity Assessment: Local Health Departments Survey
13. In the past 12 months, has your local health department done any of the
following to prepare for the Dating Matters initiative?
Select one answer per row.
Don't 

Yes

No

Collected or compiled data on the incidence of teen dating violence in your community.

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Collected or compiled data on risk and protective factors related to teen dating violence in your 

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Collected or compiled data on teen dating violence­related intervention outcomes in your community.

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Added or recommended adding questions about teen dating violence to surveillance surveys.

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community.

know

 
14. In the past 12 months, has your local health department done any of the
following to prepare for the Dating Matters initiative?
Select one answer per row.
Don't 

Yes

No

Included dating violence prevention in the agency strategic plan.

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Included the Dating Matters initiative specifically in the agency strategic plan.

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Assessed the fit between the Dating Matters initiative requirements and staff skills.

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Assessed whether the Dating Matters intervention options overlap with programs that already exist in the 

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community.
Developed a communication plan to keep internal and external stakeholders informed on the Dating 
Matters initiative.

know

 
15. In the past 12 months, has your local health department done any of the
following?
Select one answer per row.
No

Supported a teen dating violence prevention curriculum with adolescents.

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Supported a teen dating violence prevention curriculum with parents or families.

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Adapted a teen dating violence prevention curriculum to better meet the needs of your community.

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Supported or coordinated training for a teen dating violence prevention curriculum.

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Facilitated youth­led efforts to prevent teen dating violence.

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Identified gaps in local policy related to teen dating violence prevention.

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Supported the development and enhancement of policy related to teen dating violence prevention.

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Convened an advisory group to address teen dating violence prevention.

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Used media, including but not limited to print, online and social media, for teen dating violence 

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prevention.

 

Don't 

Yes

know

Dating Matters Capacity Assessment: Local Health Departments Survey
In the past 2 years, has your local health department done any of the following? 

16a. Conducted an inventory of existing policies related to violence prevention 
…
Don't 

Yes

No

On the state level

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m
n

On the local level

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

On the school and/or school district level

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

know

16b. Identified gaps in existing policies related to violence prevention...
Don't 

Yes

No

On the state level

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

On the local level

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

On the school and/or school district level

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

know

16c. Supported the development or enhancement of policies related to violence 
prevention...
Don't 

Yes

No

On the state level

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

On the local level

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

On the school and/or school district level

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

know

 
17. How much do you agree or disagree with each of the following statements
about the local health department?
Select one answer per row.
Strongly 
Disagree
Our local health department shares ideas or information about 
teen dating violence prevention with other organizations.
The local health department is part of a network of organizations 
committed to preventing teen dating violence.
Local organizations know about each other and their respective 
roles in teen dating violence prevention.
Organizations that have a stake in teen dating violence 
prevention collaborate on projects.

 

Neither 
Disagree Agree nor  Agree
Disagree

Strongly 

Don't 

Agree

Know

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Dating Matters Capacity Assessment: Local Health Departments Survey
18. How much do you agree or disagree with each of the following statements?
Select one answer per row.
Strongly 
Disagree
Organizations across your local public health service area come 

Neither 
Disagree Agree nor  Agree
Disagree

Strongly 

Don't 

Agree

Know

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Interagency meetings occur regularly.

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Local agencies coordinate with each other.

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

State­level agencies coordinate with our local health 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

together to discuss teen dating violence prevention.

department.
Agencies have managed to work together in spite of differences 
that may arise between them.

 
19. In the past 12 months, how much has your local health department
collaborated with the following organizations?
Select one answer per row.
Not at All A Little

A Lot

Don't 
know

K­12 Schools

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Colleges and/or Universities

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Youth serving organizations (e.g., Boys and Girls Clubs, Big Brothers/Big 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Local domestic violence agencies

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Police or juvenile justice department

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Faith community

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Local substance abuse organizations

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Local recreation department

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Local public health or social service departments

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

State public health or social service departments

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Private social service agencies

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Business community

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Courts or judicial system

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other health care agencies (e.g., hospitals, doctors’ offices, clinics, etc.)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Citizen groups or service organizations (e.g. crime watch groups, Kiwanis, 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Batterer intervention programs

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sisters, Scouts)

Rotary, or Lions clubs)

If other, please specify 

 

Some

Dating Matters Capacity Assessment: Local Health Departments Survey
20. Describe any challenges in collaborating with other organizations (e.g., schools or
community­based organizations) on teen dating violence issues in the past 12 months.
5
6  

21. Describe the strengths of your local health department’s collaborative efforts in the
past 12 months.
5
6  

 
22. Please consider the leadership in your local health department. How much
do you agree or disagree with each of the following statements?
Select one answer per row.
Strongly 
Disagree
Local health department leaders can gain support from elected 
or appointed figures when needed.
Local health department leaders can influence laws and policies 
that could reduce teen dating violence.
Elected or appointed political figures are aware of the Dating 
Matters initiative.

Neither 
Disagree Agree nor  Agree
Disagree

Strongly 

Don't 

Agree

Know

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

 
23. In the past 12 months, has someone from your local health department
done any of the following?
Select one answer per row.
Don't 

Yes

No

Advocated for more resources or opportunities for teen dating violence prevention.

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Advocated to influence policies to promote teen dating violence prevention.

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Educated legislators on the need for violence prevention efforts.

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

know

 
24. How many employees support violence prevention efforts, including employees that
work on the Dating Matters initiative?
Full­time
Part­time

Dating Matters Capacity Assessment: Local Health Departments Survey
25. Including contracted staff, how many employees currently work on the Dating
Matters initiative?
Full­time
Part­time

 
26. How much do you agree or disagree with each of the following statements
about the Dating Matters initiative?
Select one answer per row.
Strongly 
Disagree
There are enough local health department staff members to 
implement the Dating Matters initiative.
Frequent staff turnover at the local health department is a 
problem that may interfere with implementing the Dating 

Neither 
Disagree Agree nor  Agree
Disagree

Strongly 

Don't 

Agree

Know

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Matters initiative.
Our organization has the fiscal resources it needs to implement 
the Dating Matters initiative.
Staff time allocated for the Dating Matters initiative is protected 
(i.e. staff members are not pulled away to do other work.
Staff members have skills in developing prevention programs 
that reflect the service needs and context of the population.

 
27. In the past fiscal year, has your local health department applied for violence
prevention funds from resources other than the Dating Matters initiative?
Select one answer.
 

j Yes
k
l
m
n
j No
k
l
m
n

 

j Don't know
k
l
m
n

 

 
28. In the past fiscal year, has your local health department received funding for violence
prevention from sources other than the Dating Matters initiative?
Select one answer.
 

j Yes
k
l
m
n
j No
k
l
m
n

 

j Don't know
k
l
m
n

 

 

Dating Matters Capacity Assessment: Local Health Departments Survey
29. Which of the following statements apply to your local health department, if
any?
Select one answer per row.
The local health department has sufficient local data on the 
prevalence of teen dating violence.
Our local health department’s data system is linked with other 
relevant government agencies.
There is a systematic approach to gathering data on the 
prevalence of dating violence across local agencies.
Data are routinely shared across the public health system.

Yes

No

Don't Know

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

 
30. How much do you agree or disagree with each of the following statements?
Select one answer per row.
Strongly 
Disagree
State leaders exhibit strong and sustained commitment to teen 
dating violence prevention.
There is a common vision for teen dating violence prevention 
across the leadership spectrum at the State level.
The State has strong leadership advocating for teen dating 
violence prevention.

 

Neither 
Disagree Agree nor  Agree
Disagree

Strongly 

Don't 

Agree

Know

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Dating Matters Capacity Assessment: Local Health Departments Survey
31. How much do you agree or disagree with each of the following statements?
Select one answer per row.
Strongly 
Disagree
Other violence prevention efforts supported by our health 

Neither 
Disagree Agree nor  Agree
Disagree

Strongly 

Don't 

Agree

Know

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Dating Matters is unlikely to be sustained when the grant ends.

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Our local health department has multiple funding sources for 

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

department have demonstrated sustainability.
Our local health department includes violence prevention efforts 
in the annual budget.
Our local health department has at least one staff position 
devoted to violence prevention efforts.
Violence prevention is integrated with other health­related 
prevention programs.
Our local health department is planning for sustainability of 
Dating Matters.
Our local health department is looking for other funding 
resources to support Dating Matters when the grant ends.
Our local health department is committed to the long­term goals 
of Dating Matters.
Dating Matters is part of a long­term collaborative effort with 
other agencies to reduce youth violence.

teen dating violence prevention.

32. What factors may hinder sustaining Dating Matters when the grant ends?
5
6  

33. What factors may support sustaining Dating Matters when the grant ends?
5
6