Allow users to edit responses. What's this? Require NAFCM sign-in to view this form. Automatically collect respondent's NAFCM username. The State of Community Mediation: 2011 Survey Welcome to "The State of Community Mediation: 2011" Survey! Your responses to this survey will compose the core data behind the forthcoming 2011 Report. Once published, the 2011 Report will help programs better contextualize their fit within the broad community mediation movement. It will also provide programs with compelling data to further demonstrate both their extensive community impact and their value to the local funders who support their continued work. We appreciate you investing the short 20-30 minutes required to thoroughly complete this survey. In exchange for your thoughtful contributions, NAFCM will provide a FREE DIGITAL COPY OF THE 2011 REPORT (a $20 value) to each program completing this survey by the end of Friday, July 15, 2011. (One free copy per program.) As the 2011 Report will likely become a core resource for our field, we encourage you to widely share the following survey link to your community mediation colleagues: http://go.nafcm.org/2011survey. Please Note: There are four sections included in this survey. Only completed surveys are submitted using this system. Partial surveys are neither saved nor stored for later completion and submission. Thank you for participating in this important survey! If you have any questions or experience any difficulties completing this form, please feel free to contact Justin R. Corbett at (602) 633-4213 or corbett@nafcm.org. In community, Justin R. Corbett Executive Director, NAFCM Your Name Your Email Address This is the email address at which NAFCM will send instructions for a free download of "The State of Community Mediation: 2011 Report" once published. Community Mediation Program Name Is your program a current NAFCM member? Yes No Unsure Your connection with the program. Executive Director 1/13
Board Member Other staff member Volunteer mediator Program Service Address 1 Program Service Address 2 City State/Province/Region Postal/Zip Code Country Phone Number (main) Website Address Program Structure & Characteristics (Section 2 of 4) The following section requests information about how your program is structured. Providing this information will help NAFCM better understand your program, and catalogue the diversity of community mediation program designs currently serving citizens across the country. 2/13
Establishment Date Please provide the fullest known date for when your program was established using the Month/Day/Year format. (Example: 03/18/1979, or simply 1979 if the year is all that is known.) Centrality of Conflict Assistive Programming Is the program offering community mediation and/or related services the exclusive focus of your entire organization, or are these services a component of a larger organization/entity offering additional, unrelated services? Organizational Structure Service Area Please indicate the area to which your program provides community mediation services. This service area may be defined as your local neighborhood(s), school district(s), city(ies), county(ies) (or equivalent(s)), state/province/region(s), or other defined geospatial area(s). Please be as specific as possible in defining your service area so we may most accurately represent your service availability to potential clients and notify you of location-specific resources and/or opportunities. Staff Size Please indicate the current number of paid staff members associated with your program. Please report this figure using Full-Time Equivalency (FTE). (Example: two full-time staff members = 2 FTE staff, two half-time staff members = 1 FTE staff.) Changes in Staff Size (2009-2011) Based on your current staff size, how, if at all, has your staffing composition changed within the past two years? Number of Volunteer Mediators If your program relies upon volunteers to provide mediation and/or other conflict assistive services, please indicate how many you currently actively utilize. Changes in Volunteer Roster Size (2009-2011) Based on your current volunteer roster size, how, if at all, has your volunteer roster changed within the past two years? 3/13
Annual Program Budget Please indicate the total size of your current year budget for community mediation and related services. Sources of Revenue Please indicate the estimated percentage of your program's annual revenue that is represented by each of the following options. Local Government Funding State Government Funding Federal Government Funding Local Foundation Funding State Foundation Funding National Foundation Funding Corporate Support Local Charitable (personal) Giving Fee-for-Service Revenue Training Revenue Publication/Resource Sales Revenue Investment Revenue In-Kind (non-financial) Contributions 0% (N/A) 1% - 25% 26% - 50% 51% - 75% 76% - 100% Additional Sources of Revenue? Please indicate any additional sources of revenue not identified above, along with the estimated percentage of your program's annual revenue it/they represent. Changes in Annual Budget (2009-2011) Based on your current annual budget, how, if at all, has your overall budgeted revenues changed within the past 4/13
two years? Program Services & Availability (Section 3 of 4) The following section requests information about the accessibility and types of services offered by your program. Providing this information will help NAFCM better understand your program, assist us in designing benefits and services responsive to our field's needs, and detail the wide range of services offered throughout our field. Sources of Case/Conflict Referrals Please indicate through which channel(s) your case/conflict referrals originate. Please CHOOSE ALL THAT APPLY for your community mediation program. Self-Referral (direct client/citizen request) Business bureau(s)/trade association(s)/chamber(s) of commerce Housing agency/organization/association Governmental agencies (any level/jurisdiction) Local business(es) Local nonprofit/charitable organization(s) Court program(s) and/or judicial officer(s)/staff Legal representative(s) (attorneys, baristers, solicitors) Legal services organization(s) Legal/bar association(s) Mediation/ADR services association/referral network Probation department(s) Prosecutors office(s) Police department(s) Religious organization(s) School(s)/Educational organization(s) Additional Sources of Case/Conflict Referrals Please indicate any additional referral source(s) utilized by your community mediation program. Client Qualification Requirement(s) To receive community mediation services from your program, are prospective clients/citizens required to qualify using any of the following criteria? Please choose all that apply for your basic community mediation services. 5/13
No qualifications required Demographic qualification External referral qualification Income qualification Residency/Citizenship qualification Fee Structure Which of the following option(s) best represent(s) the expected compensation from your program s service recipients? Please choose the option(s) most representative of your basic community mediation services. Multiple selections are allowed. All services are offered without fee Only select services are offered without fee Rates vary based on service provided Rates vary based on service recipients' financial status or ability to pay Rates vary based on time required Rates vary based on complexity of the service requested Rates vary based on the number of staff/volunteers required Rates vary based on alternative criteria Flat rates are expected but are below market-rate Flat rates are expected and are comparable to the local market rate Service(s) Offered Please indicate the complete list of services offered by your community mediation program (multiple selections are allowed). A more detailed list of specific mediation case types will also be provided. Mediation Arbitration Community Impact Panels/Reparation Boards Conciliation Conflict Coaching Consensus Building Crisis Intervention Service(s) Dispute System Design Diversion Service(s) Facilitation - Small Group Facilitation - Large Group Facilitation - Public Forums Family Group Conferencing/Decisionmaking Hybrid ADR Service(s) (Med-Arb, Arb-Med, etc.) 6/13
Negotiations/Negotiation Coaching Ombuds Service(s) Parenting Education Peer Juries Restorative Justice Process(es) Settlement Conferences Truth & Reconciliation Process(es) Violence Interruption Additional ADR Process(es) (Case Evaluation, ENE, Mini-Trial, SJT, etc.) Additional Conflict Assistive Process(es) - Culturally-Based Additional Conflict Assistive Process(es) - Disaster Focused/Precipitated Additional Conflict Assistive Process(es) - Faith-Based Additional Conflict Assistive Process(es) - Youth-Based Public Presentations Training(s) - Pre-Established Training(s) - Customizable Mediation Case Types Served Please indicate all the specific conflict type(s) for which your program offers mediation services. Please be as specific as possible in identifying serviceable case types so we may most accurately represent your service availability to potential clients and notify you of program-specific resources and/or opportunities. Agriculture Animal/Pet-Related Arts Automotive Code Enforcement Commercial Construction Consumer/Merchant-Service Provider (including atty/cilent fee disputes) Court-Connected: Bankruptcy Court-Connected: Civil Litigation Court-Connected: Criminal: Misdemeanor Court-Connected: Criminal: Felony Court-Connected: Criminal: Formal Diversion Court-Connected: Criminal: Violence-Related Court-Connected: Probate Court-Connected: Protective/Restraining Orders Court-Connected: Small Claims Court-Connected: Other 7/13
Credit-Lender Cross-Cultural Disability Discrimination Diversity-Related Environmental Faith, Religious, Spiritual-Based Family: Adoption Family: Child Rearing Family: Child Welfare Family: Custody-Visitation Family: Divorce Family: Domestic Relations Family: Domestic Violence Family: Elder Family: Estate Family: Family Business Family: Financial Matters Family: Foster Kids Family: Grandparent Family: Parent(Guardian)/Child Family: Parenting Plans Family: Separation Family: Support Plans Family: Other Gang Related Government Related Health Care Housing: Association (Homeowner/Condominium) Housing: Eviction - Forceable Entry & Detainer Housing: Foreclosure Housing: Landlord/Tenant Housing: Other Human Rights Immigrant Insurance Intellectual Property Interpersonal Military-Related: Employment Military-Related: Family-Related 8/13
Military-Related: Veteran Re-Integration Military-Related: Other Multi-Party (Individual-Oriented) Multi-Organizational Neighbor Online-Related Organizational: Board Organizational: Member Organizational: Outside Entity Organizational: Other Personal Injury Police/Citizen Political Property/Land Use Public Policy Real Estate School: Bullying School: College Roommates School: Peer School: Special Education School: Staff/Student School: Truancy School: Other Securities/Financial Victim-Offender: Adult Victim-Offender: Juvenile Workplace: Bullying/Harassment Workplace: Business Partner Workplace: Co-Worker Workplace: Discrimination/EEO Workplace: Supervisor/Employee Workplace: Other Additional Conflict-Assistive Service(s) Please indicate any additional conflict-related services offered by your program not already indicated. 9/13
Language(s) Capacity Please indicate the language(s) for which your program has available verbal and/or written capacities using staff, volunteer, partner, and/or assistive technologies. Technology Facilitated Services Please indicate whether your program currently offers conflict-assistive services utilizing any of the following technologies. Please choose all that are currently available. Online chat rooms Teleconferencing Video/Web conferencing Disability-assistive technologies Annual Service Recipients Please estimate the number, if any, of clients/citizens served by your program in the past 12 months. Please include all clients/citizens served your program, regardless which service they may have received. Annual Case Volume Please estimate the number, if any, of case referrals/requests for service received by your program in the past 12 months. Please include all referrals/requests made to your program, regardless their ultimate appropriateness, utilization, or outcome. Changes in Annual Case Volume (2009-2011) Based on your current annual case volume, how, if at all, has your case volume changed within the past two years? Case Flow & Conversion Please estimate the percentage of all community mediation case referrals/requests within the past 12 months that concluded with the following outcomes. Please list each outcome as a percentage of ALL community mediation referrals/requests received. (Note: Depending on your program s experience, each row may report up to 100% of all referrals/requests concluding within that row. Latter rows reported percentages will likely decrease successively.) Unable to contact parties 0% - 20% 21% - 40% 41% - 60% 61% - 80% 81% - 100% Inappropriate/not amenable 10/13
for service(s) Dismissed by initiating party No parties agreed to mediate An insufficient number of parties agreed to mediate All parties agreed to mediate Resolved using conciliation/alternative service(s) Mediation service scheduled Parties did not arrive at scheduled mediation Mediation service commenced Mediation service concluded without agreement Mediation service concluded with partial agreement Mediation service concluded with full agreement Program Highlights (Section 4 of 4) The following section allows you to share specific examples of your program's operations and community impact. Your narrative examples will help readers of the "State of Community Mediation: 2011 Report" further contextualize the different program designs, markets, objectives, operations, and outcomes contained within our rich field. If applicable, please feel free to provide one or more responsive examples to the following questions. Service Example(s) or Vignette(s) Please share a descriptive example of the type(s) of services your program offers. This may include a short description of a particular service or case type, an example of how your service(s) impact your community, how your service demand/supply has changed or is evolving, and/or another example highlighting your work. 11/13
Service Recipients Example(s) or Vignette(s) Please share a descriptive example of those you serve. This may include a description of your service recipient demographics, an example of how your service recipients have changed or are evolving, and/or another example describing those whom you serve. Collaboration Example(s) or Vignette(s) Please share a descriptive example of how you partner with other entities. This may include a description of a specific collaboration, value/benefits of partnerships as experienced by your program, and/or another example describing how your program works with others to better serve the community. Annual Budget Example(s) or Vignette(s) Please share a descriptive example of how your budget has recently changed. This may include a description of how your program has been affected by the broader economic changes, the changes and programmatic impact of shifting fund availabilities/priorities, and/or another example of how your annual budget either empowers or limits your efforts to achieve your mission. Volunteer Example(s) or Vignette(s) Please share a descriptive example of how your program utilizes volunteers. This may include a descriptive list of services provided by your volunteers, key demographics of your volunteer roster, and/or another example of how volunteers serve and are served by your program. Other Notable Program Example(s) or Vignette(s) Please share any additional examples 12/13
Comments and/or Questions Please note any comments or questions you have about the 2011 Report. Any entries here will be addressed directly by NAFCM staff and not included in the Report. 13/13