CCLHDN Peer Exchange Capacity Assessment Survey
RequiredRequired Question(s)
Thank you for completing this capacity assessment survey prior to participating in a Peer Exchange.  The information provided will help us in planning the most effective Peer Exchange programs as we as help us in developing other useful CCLHDN member resources.   Approximately 6-months after your first exchange, you will complete a follow up Capacity Assessment so that CCLHDN can evaluate the impact of the Peer Exchange on your LHDs capcaity to implement successful nutrition service programs.  If you have questions about the survey, please email Rebecca Tryon at rebecca@can-act.net
 
Required 1.
Name of Individual completing the survey
 

350 characters left.
Required 2.
Jurisdiction
 

50 characters left.
Required 3.
Job Title
 

50 characters left.
Required 4.
How would you classify your position?
Program/unit director (multiple budgets, programs, etc.)
Program manager (personnel, budget, program planning, etc.)
Supervisor (direct reports)
Program Staff/Coordinator
Required 5.
What classification best describes your jurisdiction?
Rural
Urban
I Don't Know
  • Comment:

  • 500 characters left.
Required 6.
What are the adult and childhood obesity rates in your county?
 0-20% 21-30% 31-40% 41-50% 51-60% 61+% I don't know 
Adult oesity rate (18+ years)
Childhood obesityrate
Required 7.
Briefly describe the types of nutrition programs your LHD offers (3 sentences maximum).
 

350 characters left.
Required 8.
Which of the following programs does your county offer, and for how long have they been offered?
 0 through 5 years 6 through 10 years 11+ years We don't offer this program  
CHDP  
CPPW or CTG  
Network  
WIC  
Foundation-Funded Programs  
Project LEAN  
Other (Spectify below)  
  • Comment:

  • 500 characters left.
Required 9.
Do you currently have a nutritionist (RD) on staff?
YES (answer questions 10 and 11, and skip question 12)
NO (skip to question 12)
10.
Overall, how many nutritionists (FTE) do you have on staff?  
 

50 characters left.
11.
We want to know how the FTE of your nutritionists is distributed in your LHD.  For each program, indicate the number of FTE allocated to that program.
 .1-1.0 FTE 1.1-3 FTE 3.1-5 FTE 5.1-8 FTE 8+ FTE NONE I don't know 
Network
WIC
CTG or CPPW
Project LEAN
Other
  • Comment:

  • 500 characters left.
12.
Are there currently plans to hire a nutritionists?
Yes, we are actively recruiting
Yes, but I don't know when
No
I don't know
Required 13.
ADMINISTRATIVE CAPACITY:  Use the following scale to indicate your health department's current level of capacity to address the following aspects of providing SNAP-Ed programming to your target audience: 1= capacity is very limited (significant support needed), 2= some capacity is in place (we would benefit from limited/specific support), 3= moderate capacity in place (little or no support is needed), 4= proficient in this area (we can offer support to others in this area), NA= "Not applicable to your LHD", IDK = "I don't know"( you are not sure how to respond to the question).
 NA IDK 
Implementation of SNAP-Ed/NEOP programs within the timeframes defined in our scope of work
Strategies for hiring and training a nutritionist
Leading the CNAP development process
Successful approaches to securing and utilizing funding
Coordination of services within our jurisdiction's health department to avoid duplication of services
  • Comment:

  • 500 characters left.
Required 14.
PARTNERSHIP/COLLABORATIVE DEVELOPMENT: Use the following scale to indicate your health department's current level of capacity to address the following aspects of providing SNAP-Ed programming to your target audience: 1= capacity is very limited (significant support needed), 2= some capacity is in place (we would benefit from limited/specific support), 3= moderate capacity in place (little or no support is needed), 4= proficient in this area (we can offer support to others in this area), NA= "Not applicable to your LHD", IDK = "I don't know" (you are not sure how to respond to the question)
 NA IDK 
Increasing CalFresh participation at farmer's markets
Building strong partnerships in the community
Coordinating successful WIC and Network collaborations
Engaging community partners to support NEOP prgram goals
  • Comment:

  • 500 characters left.
Required 15.
NETWORK PRIORITY GOALS AND STRATEGIES: Use the following scale to indicate your health department's current level of capacity to address the following aspects of providing SNAP-Ed programming to your target audience: 1= capacity is very limited (significant support needed), 2= some capacity is in place (we would benefit from limited/specific support), 3= moderate capacity in place (little or no support is needed), 4= proficient in this area (we can offer support to others in this area), NA= "Not applicable to your LHD", IDK = "I don't know",(you are not sure how to respond to the question).
 NA IDK 
Implementation of CX3
Implementation of Network campaigns (PowerPlay, Latino Campaign, etc.)
Strategies to iImplement "Rethink Your Drink"
Promotion of physical activity with SNAP-Ed funds
Implementation of systems and environmental changes
  • Comment:

  • 500 characters left.
16.
Are there any other areas of capacity not reflected in the previous questions that you'd like to share with us?  If so, please indicate the area of capacity and the rating you'd assign it using the scale previously provided.  
 

350 characters left.