We are asking your organization to complete an online survey to help the CVPH better understand how current partners and potential new partners are addressing vision and related health needs within their respective constituencies. We would also like to know how the CVPH could support you and your members/affiliates efforts.
 
We know your time is valuable.  This survey should take 10-15 minutes to complete. Please complete one survey per organization.

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* 1. Name of Organization

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* 2. Person completing this survey

The following questions will help us understand your organization’s function, structure and population you serve.

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* 3. Which of the following describes your organization’s main focus (select one)

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* 4. Which of the following describes your organization’s points of interest (check all that apply)?

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* 5. What best describes your organization’s structure?

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* 6. Describe your regional, state and/or local affiliates or members:

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* 7. Provide organization’s mission or link to mission.

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* 8. How is vision and eye health related to your mission?

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* 9. Which of the following population groups does your organization primarily serve, including: affiliates/members (check all that apply)

The Center for Vision and Population Health at Prevent Blindness (CVPH) has been established as a national coordinating body for effective practices, state-level technical assistance, and programmatic interventions. We strive to provide the right resource, for the right person, at the right time, in the right way. The following question will help us determine how your organization aligns will the CVPH.

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* 10. In this question we ask you to please rate the importance of the Center for Vision and Population Health’s seven core functions based on your organizations mission, strategic plan, programs and activities:

  Not at all important Important Very important No opinion Would like more information on this function
Support ongoing surveillance efforts, including the use of predictive analytics to determine the likelihood of future outcomes, and contribute to enhanced understanding of incidence, prevalence, and trend data about vision and eye health.
Establish and strengthen a national multi-sector network of partner organizations for the purpose of increasing information sharing and collaboration, reducing redundancies, and coordinating projects and initiatives to improve eye health and vision- related quality of life.
Create an online vision and population health resource repository to guide state and local program and policy development. This repository may include a variety of content, such as model programs, sample policies, and a foundation for peer-to-peer mentoring across states.  The online resource repository would be continually updated with the emergence of new evidence-based best practices and information.
Integrate and expand early detection initiatives (including patient education, vision screenings, and eye examinations) across diverse clinical and non-clinical settings, including but not limited to community health centers, public health programs, primary health care settings, adult and senior health programs, minority health programs, early intervention, and educational programs.
Expand the amount of vision and eye health education provided to health care professionals, allied health care providers, community health workers, and age-specific networks.
Identify and disseminate evidence-based interventions to promote vision and eye health, prevent injuries, and reduce inequities in vision and eye health.
The following questions will help us understand how your organization and the CVPH can work together.

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* 11. What information or services can the CVPH provide your organization, and/or your members/affiliates?

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* 12. What other information or services can the CVPH provide your organization, and/or your members/affiliates?

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* 13. How could you participate in CVPH programs and activities? (Please check all areas of interest)

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* 14. How could your affiliates/members participate in CVPH programs and activities? (Please check all areas of interest)

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* 15. Please list vision and eye health topics that might benefit you and your members/affiliates/constituents:

The following questions will help us design and develop products, materials and information that your organization could share with your affiliates/members/constituents.

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* 16. How do you communicate with your affiliates/members/constituents? (Select all that apply)

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* 17. Please list any other ways you communicate with your affiliates/members/constituents

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* 18. What educational opportunities does your organization provide to your affiliates/members/constituents? (Select all that apply)

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* 19. Please list any other educational opportunities your organization provides to your affiliates/members/constituents.

The following questions will help us understand how you use surveillance data related to vision and eye health and how the CVPH can help you access and use the data you need.

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* 20. Are you familiar with the CDC’s Vision and Eye Health Surveillance System (VEHSS) available online? The VEHSS brings together new and existing surveillance information on vision, eye health, and eye care.

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* 21. What sources does your organization use to access data on vision and eye health? (select all that apply)

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* 22. Please list any other sources your organization uses to access data on vision and eye health.

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* 23. What types of vision and eye health data has your organization used in the past to inform policy or decision-making? (Select all that apply)

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* 24. How would your organization like to access data on eye and vision health in the future?

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* 25. Would you like to receive regular updates from CVPH?

If you have questions about this survey and/or the CVPH please contact Kira Baldonado at Kbaldonado@preventblindness.org or 312-363-6038.

Thank you in for participating in this important survey.
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