National Evaluation of

The Safe Schools/Healthy Students Initiative

School-Level Survey

April 1, 2008

***Sponsored by:***

U.S. Department of Health and Human Services

U.S. Department of Education

U.S. Department of Justice

*Conducted by:*

MANILA Consulting Group, Inc.

Battelle Centers for Public Health Research and Evaluation

RMC Research Corporation

Safe Schools/Healthy Students Initiative

School-Level Survey

***Welcome***

The Safe Schools/Healthy Students (SS/HS) School-Level Survey is part of
the National Evaluation of the SS/HS Initiative. The initiative is
jointly supported by the U.S. Department of Health and Human Services,
U.S. Department of Education, and U.S. Department of Justice. The
information gathered through this survey will enable Federal agencies to
evaluate and improve the initiative nationwide.

You have been asked to complete this survey with information pertinent
to your school. The survey solicits information on your school's efforts
relating to the SS/HS Initiative since grant award. The questions ask
about your school's involvement in implementing and supporting a wide
range of SS/HS programs and activities and the nature of your school's
involvement. In answering these questions, it may be useful to consult
with other people at your school.

The survey also asks your assessment of the local initiative's partners
who have worked in your school, such as law enforcement, juvenile
justice, and prevention and treatment professionals. Please be assured
your responses will be kept strictly confidential and will be used only
in aggregate form for analytic and reporting purposes.

Thank you for your participation!

  -----------------------------------------------------------------------
  GENERAL INFORMATION ABOUT YOUR SCHOOL

  -----------------------------------------------------------------------

**School name:      **

**1. Please tell us what grades are served at your school. (Check all
that apply.)**

> **Pre-K**
>
> **K**
>
> **1st**
>
> **2nd**
>
> **3rd**
>
> **4th**
>
> **5th**
>
> **6th**
>
> **7th**
>
> **8th**
>
> **9th**
>
> **10th**
>
> **11th**
>
> **12th**

**Survey Tips**

-   To navigate through this survey, use the **Next** button to proceed
    forward. Please use the **Previous** button to review your answers.
    Do not click your browser's back or forward button to navigate.

```{=html}
<!-- -->
```
-   If you cannot complete the survey all at one time, click on **Stop
    for Now**, and return at a later time. When you return, you may
    resume where you left off.

  -----------------------------------------------------------------------
  GENERAL INFORMATION ABOUT YOU

  -----------------------------------------------------------------------

**1a. Please check the role that best describes you:**

> **Coordinator/Director**
>
> **Counselor**
>
> **Principal**
>
> **Program Specialist**
>
> **School System Administration**
>
> **SS/HS Project Director/Coordinator**
>
> **Teacher**
>
> **Other**

  ------------------- -------------------------------------------------------------------
  ORGANIZATIONAL      
  STRUCTURE,          
  CHARACTERISTICS,    
  AND ACTIVITIES      

                      

  2\. Check           
  [all]{.underline}   
  of the boxes that   
  apply to            
  organization of the 
  SS/HS initiative at 
  your school.        

                      a\. Since grant award, the school has established a new formal
                      team, committee, or council specifically to implement a wide range
                      of activities supported by the SS/HS initiative.

                      b\. Since grant award, the responsibility for implementation of a
                      wide range of activities supported by the SS/HS initiative has been
                      awarded to an existing school-wide team or work group, such as a
                      School Prevention Council.

                      c\. Within the school, a single individual has been specifically
                      designated to coordinate the implementation of a wide range of
                      activities supported by the SS/HS initiative.

                      d\. A single individual is specifically designated to represent the
                      school at discussions which occur at the School District level on
                      implementation of a wide range of SS/HS activities.

                      e\. Several different individuals have been brought into the school
                      to implement SS/HS activities. These individuals report directly to
                      supervisors outside of the school, such as mental health
                      coordinators, nursing coordinators, law enforcement officials, etc.

                      f\. To the best of your knowledge, responsibility for
                      implementation of all SS/HS initiative activity lies outside of
                      your school.
  ------------------- -------------------------------------------------------------------

**3a. Have SS/HS programs or activities been implemented in your
school?**

**Yes**

**No**

**If response is NO:**

**Since there are no SS/HS programs or activities in your school, there
are no further questions. Please click the "Submit" button to complete
the survey.**

**If response is YES:**

**See below.**

+--------------------+------+-------+---+-----+-----+-------+------+
| **ORGANIZATIONAL   |      |       |   |     |     |       |      |
| STRUCTURE,         |      |       |   |     |     |       |      |
| CHARACTERISTICS,   |      |       |   |     |     |       |      |
| AND ACTIVITIES**   |      |       |   |     |     |       |      |
+--------------------+------+-------+---+-----+-----+-------+------+
| **3b. Please       |      |       |   |     |     |       |      |
| indicate the       |      |       |   |     |     |       |      |
| degree to which    |      |       |   |     |     |       |      |
| each of the        |      |       |   |     |     |       |      |
| following          |      |       |   |     |     |       |      |
| statements         |      |       |   |     |     |       |      |
| describes how      |      |       |   |     |     |       |      |
| decisions on       |      |       |   |     |     |       |      |
| implementation of  |      |       |   |     |     |       |      |
| SS/HS activities   |      |       |   |     |     |       |      |
| are made at your   |      |       |   |     |     |       |      |
| school.**          |      |       |   |     |     |       |      |
+--------------------+------+-------+---+-----+-----+-------+------+
| **[The             | **   | **[   | * | *   | **  | **[   | **[  |
| Leadership.        | [Str | Moder | * | *[N | [Di | Moder | Stro |
| ...]{.smallcaps}** | ongl | ately | [ | eit | sag | ately | ngly |
|                    | y]{. | Agree | A | her | ree | Dis   | Dis  |
|                    | smal | ]{.sm | g | ]{. | ]{. | agree | agre |
|                    | lcap | allca | r | sma | sma | ]{.sm | e]{. |
|                    | s}** | ps}** | e | llc | llc | allca | smal |
|                    |      |       | e | aps | aps | ps}** | lcap |
|                    | **[  |       | ] | }** | }** |       | s}** |
|                    | Agre |       | { |     |     |       |      |
|                    | e]{. |       | . | **  |     |       |      |
|                    | smal |       | s | [Ag |     |       |      |
|                    | lcap |       | m | ree |     |       |      |
|                    | s}** |       | a | Nor |     |       |      |
|                    |      |       | l | ]{. |     |       |      |
|                    |      |       | l | sma |     |       |      |
|                    |      |       | c | llc |     |       |      |
|                    |      |       | a | aps |     |       |      |
|                    |      |       | p | }** |     |       |      |
|                    |      |       | s |     |     |       |      |
|                    |      |       | } | **  |     |       |      |
|                    |      |       | * | [Di |     |       |      |
|                    |      |       | * | sag |     |       |      |
|                    |      |       |   | ree |     |       |      |
|                    |      |       |   | ]{. |     |       |      |
|                    |      |       |   | sma |     |       |      |
|                    |      |       |   | llc |     |       |      |
|                    |      |       |   | aps |     |       |      |
|                    |      |       |   | }** |     |       |      |
+--------------------+------+-------+---+-----+-----+-------+------+
| a\. A single       |      |       |   |     |     |       |      |
| person in the      |      |       |   |     |     |       |      |
| school makes       |      |       |   |     |     |       |      |
| nearly all         |      |       |   |     |     |       |      |
| decisions          |      |       |   |     |     |       |      |
| pertaining to      |      |       |   |     |     |       |      |
| SS/HS activities.  |      |       |   |     |     |       |      |
+--------------------+------+-------+---+-----+-----+-------+------+
| b\. Decisions are  |      |       |   |     |     |       |      |
| made by a small    |      |       |   |     |     |       |      |
| group within the   |      |       |   |     |     |       |      |
| school.            |      |       |   |     |     |       |      |
+--------------------+------+-------+---+-----+-----+-------+------+
| c\. Many school    |      |       |   |     |     |       |      |
| staff members have |      |       |   |     |     |       |      |
| effective input    |      |       |   |     |     |       |      |
| into how SS/HS is  |      |       |   |     |     |       |      |
| implemented.       |      |       |   |     |     |       |      |
+--------------------+------+-------+---+-----+-----+-------+------+
| d\. There is a     |      |       |   |     |     |       |      |
| formal process for |      |       |   |     |     |       |      |
| making decisions   |      |       |   |     |     |       |      |
| (e.g., a voting    |      |       |   |     |     |       |      |
| system).           |      |       |   |     |     |       |      |
+--------------------+------+-------+---+-----+-----+-------+------+
| e\. Most decisions |      |       |   |     |     |       |      |
| are made with      |      |       |   |     |     |       |      |
| little input from  |      |       |   |     |     |       |      |
| the school         |      |       |   |     |     |       |      |
| instructional      |      |       |   |     |     |       |      |
| staff.             |      |       |   |     |     |       |      |
+--------------------+------+-------+---+-----+-----+-------+------+
| f\. The            |      |       |   |     |     |       |      |
| implementation     |      |       |   |     |     |       |      |
| process for SS/HS  |      |       |   |     |     |       |      |
| activities within  |      |       |   |     |     |       |      |
| the school         |      |       |   |     |     |       |      |
| promotes           |      |       |   |     |     |       |      |
| cohesiveness and   |      |       |   |     |     |       |      |
| team spirit.       |      |       |   |     |     |       |      |
+--------------------+------+-------+---+-----+-----+-------+------+
| g\. The            |      |       |   |     |     |       |      |
| implementation     |      |       |   |     |     |       |      |
| process for SS/HS  |      |       |   |     |     |       |      |
| activities in the  |      |       |   |     |     |       |      |
| school fosters     |      |       |   |     |     |       |      |
| respect and trust  |      |       |   |     |     |       |      |
| between            |      |       |   |     |     |       |      |
| professions.       |      |       |   |     |     |       |      |
+--------------------+------+-------+---+-----+-----+-------+------+
| h\. The school     |      |       |   |     |     |       |      |
| administrative     |      |       |   |     |     |       |      |
| staff has          |      |       |   |     |     |       |      |
| effective input on |      |       |   |     |     |       |      |
| the implementation |      |       |   |     |     |       |      |
| of most SS/HS      |      |       |   |     |     |       |      |
| activities.        |      |       |   |     |     |       |      |
+--------------------+------+-------+---+-----+-----+-------+------+
| i\. The way that   |      |       |   |     |     |       |      |
| SS/HS is           |      |       |   |     |     |       |      |
| implemented within |      |       |   |     |     |       |      |
| the school         |      |       |   |     |     |       |      |
| combines the       |      |       |   |     |     |       |      |
| perspectives,      |      |       |   |     |     |       |      |
| resources, and     |      |       |   |     |     |       |      |
| skills of a wide   |      |       |   |     |     |       |      |
| range of           |      |       |   |     |     |       |      |
| professionals in   |      |       |   |     |     |       |      |
| the school.        |      |       |   |     |     |       |      |
+--------------------+------+-------+---+-----+-----+-------+------+
| j\. Many members   |      |       |   |     |     |       |      |
| of the school      |      |       |   |     |     |       |      |
| staff probably     |      |       |   |     |     |       |      |
| feel \"left out of |      |       |   |     |     |       |      |
| the loop\" on the  |      |       |   |     |     |       |      |
| SS/HS initiative.  |      |       |   |     |     |       |      |
+--------------------+------+-------+---+-----+-----+-------+------+
| k\. The            |      |       |   |     |     |       |      |
| implementation     |      |       |   |     |     |       |      |
| process for SS/HS  |      |       |   |     |     |       |      |
| activities has     |      |       |   |     |     |       |      |
| improved relations |      |       |   |     |     |       |      |
| between personnel  |      |       |   |     |     |       |      |
| at the District    |      |       |   |     |     |       |      |
| level and school   |      |       |   |     |     |       |      |
| staff.             |      |       |   |     |     |       |      |
+--------------------+------+-------+---+-----+-----+-------+------+

+-----------------+------+---------+--------+---------+--------------+
| 4\. For each of |      |         |        |         |              |
| the following   |      |         |        |         |              |
| items, please   |      |         |        |         |              |
| indicate        |      |         |        |         |              |
| whether         |      |         |        |         |              |
| decisions on    |      |         |        |         |              |
| SS/HS           |      |         |        |         |              |
| activities in   |      |         |        |         |              |
| your school are |      |         |        |         |              |
| made primarily  |      |         |        |         |              |
| by the SS/HS    |      |         |        |         |              |
| Project         |      |         |        |         |              |
| Direc           |      |         |        |         |              |
| tor/Coordinator |      |         |        |         |              |
| (and his or her |      |         |        |         |              |
| staff and       |      |         |        |         |              |
| representatives |      |         |        |         |              |
| of local        |      |         |        |         |              |
| partner         |      |         |        |         |              |
| agencies), by   |      |         |        |         |              |
| personnel       |      |         |        |         |              |
| within your     |      |         |        |         |              |
| school, or by a |      |         |        |         |              |
| combination of  |      |         |        |         |              |
| both.           |      |         |        |         |              |
+-----------------+------+---------+--------+---------+--------------+
| **[Area         | **   | **[     | **     | **[De   | **[Other,    |
| ]{.smallcaps}** | [Not | Project | [Major | cisions | Specify]{.   |
|                 | A    | Dir     | Dec    | Made    | smallcaps}** |
|                 | ppli | ector/] | isions | Jointly |              |
|                 | cabl | {.small | Made   | by the  |              |
|                 | e]{. | caps}** | and    | Project |              |
|                 | smal |         | Imple  | Dir     |              |
|                 | lcap | **[Coor | mented | ector/] |              |
|                 | s}** | dinator | at     | {.small |              |
|                 |      | Makes   | School | caps}** |              |
|                 |      | Major   | Le     |         |              |
|                 |      | De      | vel]{. | **[Coor |              |
|                 |      | cisions | smallc | dinator |              |
|                 |      | and     | aps}** | and     |              |
|                 |      | School  |        | School  |              |
|                 |      | Facil   |        | Level   |              |
|                 |      | itates] |        | Per     |              |
|                 |      | {.small |        | sonnel] |              |
|                 |      | caps}** |        | {.small |              |
|                 |      |         |        | caps}** |              |
+-----------------+------+---------+--------+---------+--------------+
| a\. Selection   |      |         |        |         |              |
| of              |      |         |        |         |              |
| SS/HS-related   |      |         |        |         |              |
| programs and/or |      |         |        |         |              |
| curricula to be |      |         |        |         |              |
| implemented at  |      |         |        |         |              |
| your school     |      |         |        |         |              |
+-----------------+------+---------+--------+---------+--------------+
| b\. Program     |      |         |        |         |              |
| implementation  |      |         |        |         |              |
+-----------------+------+---------+--------+---------+--------------+
| c\. Ongoing,    |      |         |        |         |              |
| informal        |      |         |        |         |              |
| program         |      |         |        |         |              |
| monitoring and  |      |         |        |         |              |
| feedback        |      |         |        |         |              |
+-----------------+------+---------+--------+---------+--------------+
| d\.             |      |         |        |         |              |
| SS/HS-related   |      |         |        |         |              |
| protocols, such |      |         |        |         |              |
| as crisis       |      |         |        |         |              |
| response plans  |      |         |        |         |              |
+-----------------+------+---------+--------+---------+--------------+
| e\.             |      |         |        |         |              |
| Collaboration   |      |         |        |         |              |
| with other      |      |         |        |         |              |
| ag              |      |         |        |         |              |
| encies/partners |      |         |        |         |              |
+-----------------+------+---------+--------+---------+--------------+
| f\. Long-term   |      |         |        |         |              |
| plans for       |      |         |        |         |              |
| enhancement or  |      |         |        |         |              |
| continuation of |      |         |        |         |              |
| SS/HS           |      |         |        |         |              |
| activities at   |      |         |        |         |              |
| your school.    |      |         |        |         |              |
+-----------------+------+---------+--------+---------+--------------+
| g\. Funding     |      |         |        |         |              |
| and/or resource |      |         |        |         |              |
| allocations     |      |         |        |         |              |
+-----------------+------+---------+--------+---------+--------------+
| h\.             |      |         |        |         |              |
| Regu            |      |         |        |         |              |
| larly-scheduled |      |         |        |         |              |
| evaluation and  |      |         |        |         |              |
| data collection |      |         |        |         |              |
+-----------------+------+---------+--------+---------+--------------+
| i\. Technical   |      |         |        |         |              |
| assistance and  |      |         |        |         |              |
| training        |      |         |        |         |              |
+-----------------+------+---------+--------+---------+--------------+
| j\.             |      |         |        |         |              |
| Proced          |      |         |        |         |              |
| ures/operations |      |         |        |         |              |
| (e.g., steps to |      |         |        |         |              |
| refer students  |      |         |        |         |              |
| to outside      |      |         |        |         |              |
| help)           |      |         |        |         |              |
+-----------------+------+---------+--------+---------+--------------+
| k\. Routine     |      |         |        |         |              |
| logistical      |      |         |        |         |              |
| matters (e.g.,  |      |         |        |         |              |
| scheduling of   |      |         |        |         |              |
| SS/HS-related   |      |         |        |         |              |
| meetings, etc.) |      |         |        |         |              |
+-----------------+------+---------+--------+---------+--------------+

  ------------- -------------------------------------------------------------------
  5a. Identify  
  the groups    
  who           
  collaborate   
  with your     
  school on the 
  SS/HS         
  Initiative.   

                1\. Representatives from school district's central office

                2\. Representatives from local law enforcement agencies

                3\. Representatives from local juvenile justice entity

                4\. Representatives from local public mental health authority

                5\. Representatives from other health and social services,
                including both public sector (e.g., county substance abuse agency)
                and private sector (e.g., Big Brothers/Big Sisters, for-profit
                hospital, Boys & Girls Club, YMCA)

                6\. School principal/administrator

                7\. Teachers

                8\. Family members/parents, guardians

                9\. Local businesses

                10\. Student services personnel (e.g., school resource officers,
                school counselor, school psychologist, nurse, social worker)

                11\. Nonprofit community organization (e.g., civic, fraternal,
                faith-based)

                12\. Students
  ------------- -------------------------------------------------------------------

  --------------- -------------------------------------------------------------------
  5b. Identify    
  the groups with 
  whom your       
  school had no   
  collaboration   
  prior to grant  
  award.          

                  1\. Representatives from school district's central office

                  2\. Representatives from local law enforcement agencies

                  3\. Representatives from local juvenile justice entity

                  4\. Representatives from local public mental health authority

                  5\. Representatives from other health and social services,
                  including both public sector (e.g., county substance abuse agency)
                  and private sector (e.g., Big Brothers/Big Sisters, for-profit
                  hospital, Boys & Girls Club, YMCA)

                  6\. School principal/administrator

                  7\. Teachers

                  8\. Family members/parents, guardians

                  9\. Local businesses

                  10\. Student services personnel (e.g., school resource officers,
                  school counselor, school psychologist, nurse, social worker)

                  11\. Nonprofit community organization (e.g., civic, fraternal,
                  faith-based)

                  12\. Students
  --------------- -------------------------------------------------------------------

  --------------------------------------- ------------------------------- ------------ ------------ --------------------------------- ------------ -------- ---------
  SCHOOL EMPHASIS ON AND STUDENT                                                                                                                            
  PARTICIPATION IN ACTIVITIES AND                                                                                                                           
  PROGRAMS                                                                                                                                                  

  *Please characterize the Priority for                                                                                                                     
  Implementation of each of the following                                                                                                                   
  SS/HS grant activities and programs. If                                                                                                                   
  your school has previously implemented                                                                                                                    
  the activity or program prior to the                                                                                                                      
  SS/HS Initiative, check "Not part of                                                                                                                      
  SS/HS initiative at this school."                                                                                                                         
  Similarly, if the activity or program                                                                                                                     
  is not planned for implementation at                                                                                                                      
  your school, select "Not part of SS/HS                                                                                                                    
  initiative at this school."*                                                                                                                              

  **6. What is the Priority for                                                                                                                             
  Implementation of the activities and                                                                                                                      
  programs for the Safe School                                                                                                                              
  Environment?**                                                                                                                                            

  **[Activities/Programs]{.smallcaps}**   **[Priority for                                           **[Percentage of Students                               
                                          Implementation]{.smallcaps}**                             Involved in the                                         
                                                                                                    Activity/Program]{.smallcaps}**                         

                                          **not part of SS/HS initiative  **high       **low        **few (less than 30%)**           **about half **most   **all**
                                          at this school**                priority**   priority**                                     (30-70%)**   (more    
                                                                                                                                                   than     
                                                                                                                                                   70%)**   

  a\. Provide curricula or programs to                                                                                                                      
  students involving knowledge, skills,                                                                                                                     
  attitudes, or values intended to                                                                                                                          
  promote a safe school environment                                                                                                                         

  b\. Use outside resources in classrooms                                                                                                                   
  such as parent or community volunteers                                                                                                                    

  c\. Set behavior goals for creating and                                                                                                                   
  maintaining a safe school environment                                                                                                                     
  for students                                                                                                                                              

  d\. Provide recreational or enrichment                                                                                                                    
  activities                                                                                                                                                

  e\. Provide activities to establish and                                                                                                                   
  enforce classroom rules                                                                                                                                   

  f\. Provide outreach or service to                                                                                                                        
  families to improve their child                                                                                                                           
  management and supervision practices                                                                                                                      

  g\. Promote student participation in                                                                                                                      
  resolving disputes or responding to                                                                                                                       
  problem behavior (e.g., student court,                                                                                                                    
  peer mediation, or student conflict)                                                                                                                      

  h\. Communicate school's expectations                                                                                                                     
  on safe school environment                                                                                                                                

  i\. Track students' behavior in                                                                                                                           
  achieving the goals on promoting safe                                                                                                                     
  school environment                                                                                                                                        

  j\. Organize supervised \"safe places\"                                                                                                                   
  on school grounds for before and/or                                                                                                                       
  after school time                                                                                                                                         

  k\. Provide training to school staff on                                                                                                                   
  safe school environment issues                                                                                                                            

  l\. Develop crisis preparedness plans,                                                                                                                    
  tools or guidelines                                                                                                                                       

  m\. Conduct security assessment/search                                                                                                                    
  for security gaps                                                                                                                                         

  n\. Test and/or perform maintenance on                                                                                                                    
  security devices and procedures                                                                                                                           

  o\. Install or replace safety equipment                                                                                                                   
  (e.g., fire extinguishers, security                                                                                                                       
  cameras)                                                                                                                                                  

  p\. Provide for bike patrols on/near                                                                                                                      
  school grounds                                                                                                                                            

  q\. Conduct random inspections of                                                                                                                         
  student lockers                                                                                                                                           

  r\. Issue identification cards to                                                                                                                         
  students and staff                                                                                                                                        
  --------------------------------------- ------------------------------- ------------ ------------ --------------------------------- ------------ -------- ---------

  --------------------------------------- ------------------------------- ------------ ------------ --------------------------------- ------------ -------- ---------
  7a. What is the Priority for                                                                                                                              
  Implementation of the activities and                                                                                                                      
  programs to Prevent Alcohol and Other                                                                                                                     
  Drug Use?                                                                                                                                                 

  **[Activities/Programs]{.smallcaps}**   **[Priority for                                           **[Percentage of Students                               
                                          Implementation]{.smallcaps}**                             Involved in the                                         
                                                                                                    Activity/Program]{.smallcaps}**                         

                                          **not part of SS/HS initiative  **high       **low        **few (less than 30%)**           **about half **most   **all**
                                          at this school**                priority**   priority**                                     (30-70%)**   (more    
                                                                                                                                                   than     
                                                                                                                                                   70%)**   

  1\. Provide curricula or programs to                                                                                                                      
  students involving knowledge, skills,                                                                                                                     
  attitudes, or values related to                                                                                                                           
  preventing use of alcohol or drugs                                                                                                                        

  2\. Track students' behavior in                                                                                                                           
  achieving the goals on alcohol and                                                                                                                        
  other drug use                                                                                                                                            

  3\. Provide feedback or consequences to                                                                                                                   
  reinforce prevention of the use of                                                                                                                        
  alcohol and other drugs                                                                                                                                   

  4\. Use outside resources in classrooms                                                                                                                   
  such as parents or community volunteers                                                                                                                   
  to convey information on alcohol and                                                                                                                      
  other drug use                                                                                                                                            

  5\. Set behavior goals for creating and                                                                                                                   
  maintaining alcohol- and drug-free                                                                                                                        
  students                                                                                                                                                  

  6\. Communicate school's expectations                                                                                                                     
  on zero tolerance of alcohol and other                                                                                                                    
  drug use                                                                                                                                                  

  7\. Provide families with information                                                                                                                     
  on alcohol and other drug use                                                                                                                             
  prevention activities                                                                                                                                     

  8\. Provide training to school staff on                                                                                                                   
  alcohol and other drug use issues                                                                                                                         

  9\. Involve representatives of selected                                                                                                                   
  families and communities in the design                                                                                                                    
  and delivery of alcohol and other drug                                                                                                                    
  use prevention programs                                                                                                                                   

  7b. What is the Priority for                                                                                                                              
  Implementation of the activities and                                                                                                                      
  programs on Violence Prevention?                                                                                                                          

  1\. Provide curricula or programs to                                                                                                                      
  students involving knowledge, skills,                                                                                                                     
  attitudes, or values intended to                                                                                                                          
  prevent violence                                                                                                                                          

  2\. Track students' behavior in                                                                                                                           
  achieving the goals on violence                                                                                                                           
  prevention                                                                                                                                                

  3\. Provide feedback or consequences to                                                                                                                   
  decrease undesired behavior or increase                                                                                                                   
  desired behavior related to prevention                                                                                                                    
  of violence                                                                                                                                               

  4\. Use outside resources in classrooms                                                                                                                   
  such as parent or community volunteers                                                                                                                    
  to convey information on preventing                                                                                                                       
  violence                                                                                                                                                  

  5\. Set behavior goals for preventing                                                                                                                     
  violence for students                                                                                                                                     

  6\. Communicate school's expectations                                                                                                                     
  on violence issues                                                                                                                                        

  7\. Provide families with information                                                                                                                     
  on violence prevention activities                                                                                                                         

  8\. Provide training to school staff on                                                                                                                   
  violence prevention issues                                                                                                                                

  9\. Involve representatives of selected                                                                                                                   
  families and communities in the design                                                                                                                    
  and delivery of violence prevention                                                                                                                       
  programs                                                                                                                                                  
  --------------------------------------- ------------------------------- ------------ ------------ --------------------------------- ------------ -------- ---------

  --------------------------------------- ------------------------------- ------------ ------------ --------------------------------- ------------ -------- ---------
  8\. What is the Priority for                                                                                                                              
  Implementation of the activities and                                                                                                                      
  programs for School and Community                                                                                                                         
  Mental Health Prevention and Treatment                                                                                                                    
  Services?                                                                                                                                                 

  **[Activities/Programs]{.smallcaps}**   **[Priority for                                           **[Percentage of Students                               
                                          Implementation]{.smallcaps}**                             Involved in the                                         
                                                                                                    Activity/Program]{.smallcaps}**                         

                                          **not part of SS/HS initiative  **high       **low        **few (less than 30%)**           **about half **most   **all**
                                          at this school**                priority**   priority**                                     (30-70%)**   (more    
                                                                                                                                                   than     
                                                                                                                                                   70%)**   

  a\. Provide school-based mental health                                                                                                                    
  prevention and early intervention                                                                                                                         
  services for at-risk students and their                                                                                                                   
  families                                                                                                                                                  

  b\. Provide mental health screening and                                                                                                                   
  assessment in the school setting (e.g.,                                                                                                                   
  screening for depression or other                                                                                                                         
  mental health disorders)                                                                                                                                  

  c\. Provide supportive services to                                                                                                                        
  families so that they may participate                                                                                                                     
  fully in the educational, social, and                                                                                                                     
  healthy development of their children                                                                                                                     

  d\. Provide referral and follow-up with                                                                                                                   
  local public mental health agencies                                                                                                                       
  when needed services are not available                                                                                                                    
  at school                                                                                                                                                 

  e\. Change students' attitudes and                                                                                                                        
  beliefs on mental health (e.g., reduce                                                                                                                    
  stigma of seeking help for mental                                                                                                                         
  health problems)                                                                                                                                          

  f\. Involve representatives of selected                                                                                                                   
  families and communities in the design                                                                                                                    
  and delivery of mental health                                                                                                                             
  prevention programs                                                                                                                                       

  g\. Develop a formal arrangement                                                                                                                          
  between schools and public or nonprofit                                                                                                                   
  mental health entities concerning the                                                                                                                     
  delivery of mental health services for                                                                                                                    
  children and adolescents with more                                                                                                                        
  serious mental health problems                                                                                                                            

  h\. Provide training and consultation                                                                                                                     
  to school personnel to improve their                                                                                                                      
  knowledge and skills on mental health                                                                                                                     
  promotion                                                                                                                                                 

  i\. Support enhanced integration,                                                                                                                         
  coordination, and resource sharing                                                                                                                        
  among mental health and social service                                                                                                                    
  providers in schools and other                                                                                                                            
  community-based programs                                                                                                                                  
  --------------------------------------- ------------------------------- ------------ ------------ --------------------------------- ------------ -------- ---------

  --------------------------------------- ------------------------------- -------------- --------------
  9\. What is the Priority for                                                           
  Implementation of the activities and                                                   
  programs for Early Childhood                                                           
  Psychosocial and Emotional Development?                                                

  **[Activities/Programs]{.smallcaps}**   **[Priority for                                
                                          Implementation]{.smallcaps}**                  

                                          **not part of SS/HS initiative  **high         **low
                                          at this school**                priority**     priority**

  a\. Provide activities or opportunities                                                
  to preschool children to be ready for                                                  
  school                                                                                 

  b\. Provide mental health services and                                                 
  parenting programs for parents                                                         

  c\. Provide family support services to                                                 
  families with preschool children                                                       

  d\. Provide case consultation, crisis                                                  
  intervention, or therapies to parents                                                  
  of preschool children                                                                  

  e\. Train teachers or caregivers to                                                    
  work collaboratively with families to                                                  
  address the social and emotional needs                                                 
  of children                                                                            

  f\. Overcome barriers to identifying                                                   
  and serving families in need                                                           
  --------------------------------------- ------------------------------- -------------- --------------

  --------------------------------------- ------------------------------- ------------ ------------
  10\. What is the Priority for                                                        
  Implementation of the activities and                                                 
  programs for Supporting and Connecting                                               
  Schools and Communities?                                                             

  **[Activities/Programs]{.smallcaps}**   **[Priority for                              
                                          Implementation]{.smallcaps}**                

                                          **not part of SS/HS initiative  **high       **low
                                          at this school**                priority**   priority**

  a\. Provide staff training on knowledge                                              
  and skills needed to maintain order and                                              
  discipline                                                                           

  b\. Provide staff training on knowledge                                              
  and skills needed to prevent bullying                                                
  and other harassing behaviors                                                        

  c\. Involve families in school                                                       
  activities                                                                           

  d\. Involve communities in school                                                    
  activities                                                                           

  e\. Involve families in mentoring                                                    

  f\. Involve communities in mentoring                                                 

  g\. Involve families in academic                                                     
  enrichment                                                                           

  h\. Involve communities in academic                                                  
  enrichment                                                                           

  i\. Involve families in alternative                                                  
  education (e.g., internships and                                                     
  apprenticeships)                                                                     

  j\. Involve communities in alternative                                               
  education                                                                            

  k\. Involve families in after-school                                                 
  programs                                                                             

  l\. Involve communities in after-school                                              
  programs                                                                             
  --------------------------------------- ------------------------------- ------------ ------------

  --------------------------------------- ------------------------------- ------------ ------------
  11\. What is the Priority for                                                        
  Implementation of the activities and                                                 
  programs for Safe School Policies?                                                   

  **[Activities/Programs]{.smallcaps}**   **[Priority of                               
                                          Implementation]{.smallcaps}**                

                                          **not part of SS/HS initiative  **high       **low
                                          at this school**                priority**   priority**

  a\. Develop safe school policies and/or                                              
  procedures based on needs assessment or                                              
  outcome evaluation data                                                              

  b\. Develop safe school policies and/or                                              
  procedures based on research literature                                              
  and identified best practices                                                        

  c\. Develop safe school policies and/or                                              
  procedures based on marketing                                                        
  information (e.g., brochures)                                                        

  d\. Develop safe school policies and/or                                              
  procedures based on conferences in                                                   
  school district or outside school                                                    
  district                                                                             

  e\. Establish clear standards of                                                     
  student behavior                                                                     

  f\. Enforce standards                                                                

  g\. Disseminate information on                                                       
  disciplinary code to ensure it is                                                    
  widely understood by teachers,                                                       
  students, administrative staff, and                                                  
  parents                                                                              

  h\. Monitor the application of                                                       
  disciplinary practices to see if actual                                              
  practice conforms to the discipline                                                  
  policy                                                                               

  i\. Impose penalties fairly and                                                      
  equitably and commensurate with the                                                  
  severity of the infraction                                                           

  j\. Provide alternative interventions                                                
  to penalties that teach positive                                                     
  behaviors                                                                            

  k\. Zero tolerance for firearms on                                                   
  school grounds and at school-sponsored                                               
  events                                                                               

  l\. Reintegrate students from the                                                    
  juvenile justice system                                                              

  m\. Establish a management information                                               
  system for reporting and analyzing                                                   
  violent and noncriminal incidents                                                    

  n\. Ensure that parents and community                                                
  members have opportunities for                                                       
  meaningful participation in planning                                                 
  and carrying out the school's safety                                                 
  policies                                                                             
  --------------------------------------- ------------------------------- ------------ ------------

  ---------------------------- ----------------------- ---------------- ------------- ------------ --------------------- ------------- ------------- --------------------- ------------- ----------
  12\. Please identify your                                                                                                                                                              
  school's collaboration                                                                                                                                                                 
  activities with potential                                                                                                                                                              
  partners in the SS/HS                                                                                                                                                                  
  Initiative. (Check all that                                                                                                                                                            
  apply.)                                                                                                                                                                                

  **[Partners]{.smallcaps}**   **[Collaboration                                                    **[Collaboration                                  **[Interaction                      
                               Activities\                                                         Satisfaction\                                     Frequency\                          
                               (check all that                                                     (check                                            (check                              
                               apply)]{.smallcaps}**                                               one)]{.smallcaps}**                               one)]{.smallcaps}**                 

                               **no collaboration with **plan/conduct   **share       **provide    **satisfied**         **somewhat    **not         **weekly**            **monthly**   **at least
                               this partner**          joint programs** resources**   feedback**                         satisfied**   satisfied**                                       once in
                                                                                                                                                                                         past 3
                                                                                                                                                                                         months**

  a\. Representatives from                                                                                                                                                               
  School District's Central                                                                                                                                                              
  Office                                                                                                                                                                                 

  b\. Local law enforcement                                                                                                                                                              
  agencies                                                                                                                                                                               

  c\. Local juvenile justice                                                                                                                                                             
  authority                                                                                                                                                                              

  d\. Local public mental                                                                                                                                                                
  health authority                                                                                                                                                                       

  e\. Other local health and                                                                                                                                                             
  social service organizations                                                                                                                                                           
  (public and private)                                                                                                                                                                   

  f\. School                                                                                                                                                                             
  principal/administrator                                                                                                                                                                

  g\. Community organizations                                                                                                                                                            
  (e.g., fraternal, civic,                                                                                                                                                               
  faith-based)                                                                                                                                                                           

  h\. Teachers                                                                                                                                                                           

  i\. Family members/parents,                                                                                                                                                            
  guardians                                                                                                                                                                              

  j\. Local businesses                                                                                                                                                                   

  k\. Student services                                                                                                                                                                   
  personnel (e.g., school                                                                                                                                                                
  resource officers, school                                                                                                                                                              
  counselor, school                                                                                                                                                                      
  psychologist, nurse, social                                                                                                                                                            
  worker)                                                                                                                                                                                

  l\. Nonprofit community                                                                                                                                                                
  organizations (e.g., civic,                                                                                                                                                            
  faith-based)                                                                                                                                                                           

  m\. Students                                                                                                                                                                           
  ---------------------------- ----------------------- ---------------- ------------- ------------ --------------------- ------------- ------------- --------------------- ------------- ----------

*Finally, please provide your assessment of the outcomes of the SS/HS
Initiative in your school since grant award.*

  --------------------------------------- -------------------- ----------------------- ----------------------- ----------------------- -----------------------
  13\. To what extent has the SS/HS                                                                                                    
  Initiative helped your school to                                                                                                     
  accomplish the following?                                                                                                            

                                          **[Not at            **[To a Small           **[To Some              **[To a Great           **[To a Very Great
                                          All]{.smallcaps}**   Extent]{.smallcaps}**   Extent]{.smallcaps}**   Extent]{.smallcaps}**   Extent]{.smallcaps}**

  a\. Improve overall school safety                                                                                                    

  b\. Reduce alcohol and other drug use                                                                                                

  c\. Reduce violence on campus                                                                                                        

  d\. Reduce violence in community                                                                                                     

  e\. Provide early detection of                                                                                                       
  students' mental health problems                                                                                                     

  f\. Provide more effective treatment of                                                                                              
  students' mental health problems                                                                                                     

  g\. Improve the connection between                                                                                                   
  school and community                                                                                                                 

  h\. Improve the connections between                                                                                                  
  schools and families                                                                                                                 

  i\. Improve early childhood development                                                                                              

  j\. Help develop effective school                                                                                                    
  policies                                                                                                                             

  k\. Help enforce effective school                                                                                                    
  policies                                                                                                                             
  --------------------------------------- -------------------- ----------------------- ----------------------- ----------------------- -----------------------

  ------------- ------------------------------------------------------------------
  14\.          
  Considering   
  all the       
  sources of    
  financial and 
  other support 
  for your      
  school's      
  program, how  
  important are 
  the resources 
  your school   
  receives from 
  the SS/HS     
  grant in      
  improving and 
  maintaining   
  the safety    
  and           
  orderliness   
  of your       
  school and in 
  preventing    
  problem       
  behavior?     

                a\. Very important---SS/HS is essential

                b\. Important---SS/HS makes a big difference

                c\. Significant---SS/HS makes a difference

                d\. Unimportant---SS/HS makes a small difference

                e\. Not important at all---SS/HS makes no difference

                f\. Don't know
  ------------- ------------------------------------------------------------------

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