FSHP_State - public use Form Approved OMB No: 0920-0445 Expiration Date: 11/30/2008 Faculty and Staff Health Promotion State Questionnaire Faculty and Staff Health Promotion State Questionnaire Questions Health Insurance 1 - 4 Required Examinations and Screenings 5 - 11 Health Promotion Activities and Services 12 - 16 Employee Assistance Programs 17 Health Risk Appraisals 18 - 19 Planning and Coordination 20 - 22 Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, Mailstop D-74, Atlanta, GA 30333; Attention PRA (0920-0445). NOTE: THROUGHOUT THIS QUESTIONNAIRE, TEXT THAT APPEARS IN ALL CAPITAL LETTERS WILL NOT BE READ ALOUD TO RESPONDENTS. THIS QUESTIONNAIRE WILL BE ADMINISTERED USING COMPUTER-ASSISTED TELEPHONE INTERVIEWING TECHNOLOGY. THE INTERVIEWER WILL READ THE QUESTIONS ALOUD AND TYPE RESPONSES TO THE QUESTIONS INTO THE COMPUTER. THE INTERVIEW PROGRAM WILL 1) DISPLAY THE CORRECT TENSE OF VERBS, 2) PROVIDE ALTERNATE ANSWERS TO QUESTIONS (E.G., NOT APPLICABLE, “I DON’T KNOW”), 3) NAVIGATE COMPLEX SKIP PATTERNS, AND 4) PERFORM OTHER USEFUL FUNCTIONS. THE PROGRAMMING SPECIFICATIONS FOR THE INTERVIEW ARE NOT INCLUDED IN THIS PRINTED VERSION OF THE QUESTIONNAIRE. 1. This questionnaire focuses on your state’s policies and practices regarding faculty and staff health promotion. 2. When I use the word “policy,” I mean any law, rule, regulation, administrative order, or similar kind of mandate issued by the state board of education, state legislature, or other state agency with authority over schools in your state. I am most interested in what is required by the state, not what is recommended or contained in non-binding guidance documents, unless the question specifically asks about recommendations. 3. If a state policy is worded in such a way that it requires districts or schools to develop and adopt their own policies on a given topic, for the purpose of this questionnaire please consider it the same as a statewide requirement. 4. I recognize that the state may sometimes grant policy exceptions or waivers, but please answer each question based on what is considered the general policy and standard practice. 5. Please do not consider district or school practices or policies when answering the questions. We will ask about district and school practices and policies when we collect information from districts and schools across the country. 6. Please include activities or services offered by your state, districts, schools, or by anyone outside the school system. However, please consider only those activities or services that are offered to faculty and staff because they work in your state’s districts or schools. The first question asks about health insurance that may be offered by your state. By offer, I mean that the state pays for some or all of the cost of the insurance or makes the insurance available to faculty and staff at their own expense. 1. Does your state offer health insurance to faculty and staff? Yes 1 No 2-->SKIP TO THE INTRODUCTION TO Q3 2. Does this health insurance cover all or part of the following for faculty and staff? Yes No a. Preventive health care, such as physicals 1 2 b. Vision care 1 2 c. Dental care 1 2 d. Immunizations 1 2 e. Mental health care 1 2 f. Alcohol or other drug use treatment 1 2 SKIP TO THE INTRODUCTION TO Q5. The next question asks about health insurance that may be offered by districts in your state. By offer, I mean that the district pays for some or all of the cost of the insurance or makes the insurance available to faculty and staff at their own expense. 3. Has your state adopted a policy stating that districts will offer health insurance to faculty and staff? Yes 1 No 2-->SKIP TO THE INTRODUCTION TO Q5 4. Has your state adopted a policy stating that the health insurance will cover all or part of the following for faculty and staff? Yes No a. Preventive health care, such as physicals 1 2 b. Vision care 1 2 c. Dental care 1 2 d. Immunizations 1 2 e. Mental health care 1 2 f. Alcohol or other drug use treatment 1 2 Next, I would like to ask about policies your state has adopted on health examinations and screenings that faculty and staff are required to receive prior to employment. 5. I’m going to read you four statements. Please tell me which one of the following statements best describes the requirement for physical health examinations of faculty and staff in your state. The state requires physical health examinations of all faculty and staff prior to employment, 1 The state requires physical health examinations prior to employment depending on the position the person will have, 2 The state requires physical health examinations prior to employment depending on something other than the person’s position, or 3 The state does not require physical health examinations of any faculty or staff prior to employment. 4 6. Now I’m going to read you four statements related to policies on illegal drug use screening. Please tell me which one of the following statements best describes the requirement for illegal drug use screening of faculty and staff in your state. The state requires drug screening of all faculty and staff prior to employment, 1 The state requires drug screening prior to employment depending on the position the person will have, 2 The state requires drug screening prior to employment depending on something other than the person’s position, or 3 The state does not require drug screening of any faculty or staff prior to employment. 4 7. Now please tell me which of the following four statements best describes your state’s requirement for tuberculosis or TB testing for faculty and staff prior to employment. The state requires TB testing of all faculty and staff prior to employment, 1 The state requires TB testing prior to employment depending on the position the person will have, 2 The state requires TB testing prior to employment only for faculty and staff meeting certain risk criteria, for example those born or recently living in other countries, or 3 The state does not require TB testing of any faculty and staff prior to employment. 4 These next questions ask about health examinations and screenings that the state requires faculty and staff to receive periodically while they are employed. 8. Please tell me which one of the following four statements best describes the requirement for physical health examinations of faculty and staff while they are employed. The state requires periodic physical health examinations of all faculty and staff while employed, 1 The state requires periodic physical health examinations depending on the person’s position, 2 The state requires periodic physical health examinations depending on something other than the person’s position, or 3 The state does not require periodic physical health examinations of any faculty or staff while employed. 4 9. Now I’m going to read you four statements related to policies on illegal drug use screening. Please tell me which one of the following statements best describes the requirement for illegal drug use screening of faculty and staff in your state. The state requires periodic drug screening of all faculty and staff while employed, 1 The state requires periodic drug screening depending on the person’s position, 2 The state requires periodic drug screening depending on something other than the person’s position, or 3 The state does not require periodic drug screening of any faculty or staff while employed. 4 10. Now please tell me which of the following four statements best describes your state’s requirement for routine TB testing for faculty and staff while they are employed. Please do not include TB testing that might be done during a school outbreak. The state requires periodic TB testing of all faculty and staff while employed, 1 The state requires periodic TB testing for faculty and staff depending on the person’s position, 2 The state requires periodic TB testing only for faculty and staff meeting certain risk criteria, for example those born or recently living in other countries, or 3 The state does not require periodic TB testing for any faculty or staff while employed. 4 IF Q7 IS 4 AND Q10 IS 4, SKIP TO Q12. 11. Which method are districts and schools required to use when initially screening faculty and staff for TB? PPD skin test done by Mantoux method, 1 Skin test not otherwise specified, 2 Chest x-ray, or 3 Is no specific testing method required? 4 The remainder of the interview asks about faculty and staff health promotion activities or services. Faculty and staff health promotion activities or services focus on prevention of physical illnesses or injuries, promotion of physical fitness, promotion of mental health, or other activities or services designed to assist faculty and staff experiencing problems that can impact job performance, physical health, or overall well-being. We are interested in activities and services the state, districts, or schools may provide to faculty and staff because they are employees, not because they take part in the state, district, or school health insurance. The next questions ask about health screenings for faculty and staff. 12. Has your state adopted a policy stating that districts or schools will provide funding for or offer the following screenings for faculty and staff? Yes No a. Oral health screening 1 2 b. Height and weight or body mass screening 1 2 c. Serum cholesterol screening 1 2 d. Blood pressure screening 1 2 e. Diabetes screening 1 2 f. Skin cancer screening 1 2 g. Breast cancer screening 1 2 h. Colorectal cancer screening 1 2 The next questions ask about health promotion activities for faculty and staff. These activities might include classes, workshops, distribution of materials, or individual or group counseling sessions. 13. Has your state adopted a policy stating that districts or schools will provide funding for or offer activities for faculty and staff related to the following? Yes No a. Nutrition education 1 2 b. Weight management 1 2 c. Worksite safety education 1 2 d. Emergency preparedness 1 2 e. Cardiopulmonary resuscitation or CPR education 1 2 f. Stress management education 1 2 g. Pre- or post-natal education 1 2 h. Conflict resolution education 1 2 i. Asthma management education 1 2 j. Diabetes management education 1 2 k. Tobacco use cessation 1 2 l. Physical activity and fitness counseling 1 2 m. Counseling for emotional disorders, such as anxiety or depression 1 2 n. Crisis intervention for personal problems 1 2 The next questions ask about services for faculty and staff. 14. Has your state adopted a policy stating that districts or schools will provide funding for or offer the following services for faculty and staff? Yes No a. Referrals for child care or elder care 1 2 b. Referrals for oral health problems 1 2 c. Immunizations, not including those covered through health insurance, for example flu vaccines 1 2 d. Identification of or referrals for physical, sexual, or emotional abuse 1 2 15. Has your state adopted a policy stating that districts or schools will provide funding for or offer any physical activity programs for faculty and staff, such as aerobics classes, basketball leagues, or walking or jogging clubs? Yes 1 No 2 The next question asks about school facilities or equipment that could be used for physical activity and might be made available to faculty and staff. This would include any school facilities or equipment such as gyms, cafeterias, swimming pools, weight-lifting equipment, or cardiovascular exercise equipment. 16. Has your state adopted a policy stating that indoor or outdoor school facilities or equipment that could be used for physical activity will be made available for faculty and staff to use? Remember, we are talking about facilities or equipment that are available to faculty and staff because they work in your state's schools. Do not consider facilities or equipment that are available to all residents of a community. Yes 1 No 2 Next I’d like to ask you about Employee Assistance Programs, or EAPs, that may be offered by districts or schools in your state. EAPs provide services designed to assist employees experiencing personal or social problems that can impact work performance, physical health, or overall well-being. 17. Has your state adopted a policy stating that districts or schools will provide funding for or offer an Employee Assistance Program, or EAP, for faculty and staff? Yes 1 No 2 The next two questions ask about health risk appraisals. A health risk appraisal is a questionnaire used to assess self-reported risk factors, such as smoking and physical inactivity. Some people may refer to this as a health risk survey. 18. Has your state adopted a policy stating that districts or schools will provide funding for or offer health risk appraisals for faculty and staff? Yes 1 No 2-->SKIP TO Q20 19. Has your state adopted a policy stating that follow-up services or referrals will be offered if the health risk appraisal identifies individual problems? Yes 1 No 2 20. Does someone at the state level oversee or coordinate health promotion activities or services for faculty and staff throughout the state? Yes 1 No 2-->SKIP TO THE INTRODUCTION TO Q22 21. Are you this person? Yes 1 No 2 Now I’d like to ask about any assistance your state may have provided to districts or schools to develop or implement faculty and staff health promotion activities or services. This might include providing model policies, model programs, or other written materials. 22. During the past two years, has your state provided any assistance to districts or schools on how to develop or implement faculty and staff health promotion activities or services? Yes 1 No 2 Thank you very much for taking the time to participate in this study. If you would like more information about this study or would like clarification of any questions in this survey, please call 800-287-1815.