CIRCLESPLAn.docx

Pre-Post Interagency Collaboration Survey

Using the scale provided, please indicate the extent to which you currently interact with each agency.

Five Levels of Collaboration and Their Characteristics

No interaction (0)

· Not aware of organization

· No interaction that I know of

Networking (1)

· Aware of organization

· Loosely defined roles

· Little communication

· All decisions are made independently

Cooperation (2)

· Provide information to each other

· Somewhat defined roles

· Formal communication

· All decisions are made independently

Coordination (3)

· Share information and resources

· Defined roles

· Frequent communication

· Some shared decision making

Coalition (4)

· Share ideas

· Share resources

· Frequent and prioritized communication

· All members have a vote in decision making

Collaboration (5)

· Members belong to one system

· Frequent communication is characterized by mutual trust

· Consensus is reached on all decisions

1) List your community agencies and organizations (examples provided for starting point)

My organization

Not sure

No interaction

1

Networking

2

Cooperating

3

Coordinating

4

Coalition

5

Collaboration

Arc

Autism Speaks (Autism Society)

Chamber of Commerce

Community College

Community Action Programs

County Health Department

Department of Health and Human Services

Employment Security Office

Habilitation Agencies

JobLink

Transportation agencies

School District

School Board

Social Security Office

Related Services Agencies

University Extension Office

Vocational Rehabilitation