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This survey template is designed to collect data via self-report of consumers of community services. It is intended to be used at the end of, or at a set time after, the delivery of services.

We have developed a semi-automated survey template based on the Community Services Outcomes Tree.

This is because we know that identifying, selecting, adapting or developing data collection methods is a resource-intensive activity and many community services do not have the capacity to invest resources in this.

To create a survey using the Community Services Outcomes Tree (CSOT), please fill in the boxes below.

Remember: you can modify the content of each box or choose to discard any question/section if you do not wish for it to appear in your survey.

Once you have completed the sections below you can download a Word copy of the full survey. If you are wanting to use an online platform for data collection you can generate a version that is compatible with Survey Monkey, Microsoft Forms and Qualtrics.

If you would prefer a version without filled-in fields, you can download it by clicking on this link.

      You have no outcomes in your library.

Notes about the various types of exports:

  • Word document survey exports include all questions and other items of text such as introduction and conclusion that you choose to include. They also include any page breaks you specify in the form below.
  • Qualtrics survey exports also include all chosen questions, text elements and page breaks in a specially encoded text file that can be imported into a Qualtrics survey.
  • Survey Monkey survey exports only include the questions you choose and are exported as text that you will need to copy and paste into a Survey Monkey survey.
  • Microsoft Forms survey exports also include only your questions, but are exported as a Word document that can be imported into an MS Forms form.

Community Services Outcomes Tree Survey

The service name appears at various locations in the survey questions. The name that is entered here will be used instead of the "[Name of service]" placeholders that appear at those locations.

2. Survey Introduction

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You may choose to include a short survey introduction at the beginning of the survey. The introduction can help to explain the purpose of the survey and how long it may take participants to complete.

3. Outcomes

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Please select the outcomes you would like to include in your survey. To do this:

  • Click on this link
  • Review the Community Services Outcomes Tree
  • Add the outcomes you would like to include in your survey by going to the page for that outcome and clicking on the 'Add to Library' button (which will then turn black and say 'Added to Library'.)
  • Once you have added all your outcomes to the library, click the 'Done' button at the bottom of the page. You will then return to this page with your outcomes pre-loaded.

The outcomes question is the first question asked in the survey

In the survey, the outcomes question is followed by a table listing each of the outcomes you have selected. Respondents will be able to select one of the following six options for each outcome:

  • Got a lot better
  • Got a bit better
  • No change
  • Got a bit worse
  • Got a lot worse
  • Not relevant to me

4. Outcome Descriptors

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It can be helpful to include a short descriptor of the outcomes so respondents clearly understand what the outcome is.

In the boxes below is a pre-filled descriptor for each of the outcomes you have selected. You may choose to use this descriptor or modify it to suit the particular context of your service/programme. If you do not think the outcome you have chosen requires a descriptor you may leave the box blank.

5. Biggest Change in Respondent's Life

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Consumers have indicated that they often prefer to tell their story of change not tick boxes. This qualitative question allows respondents to tell their story of change. This can provide important and illuminating detail about services and programmes.

6. Contribution of the Service/Programme to the Achievement of Your Outcomes

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It can be difficult to establish clear causality between outcomes and specific services/programmes, particularly as consumers may be engaging with a range of services/programmes and/or receive supports such as assistance from family. As a result, this question aims to capture a sense of the contribution made by the service/programme without claiming clear and define attribution.

7. Main Thing Done by the Service/Programme to Help Achieve Outcomes

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This question aims to capture consumer perspectives on the key aspects or components of the service/programme that helped in the achievement of their outcomes.

8. Barriers to Outcomes

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This question:

  • helps identify barriers to outcomes. This can assist in service design and delivery or other change actions (e.g. advocacy)
  • recognises that not all outcomes are achievable without systemic or other changes.

Below the barriers question, a table of example barriers can be included. Please select from the list below the barriers that are appropriate to your cohort.

In the box below, please list any additional barriers that the service/program would like to include in the survey. Add each additional barrier on a new line.

9. Biggest Barrier Preventing Positive Change

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This qualitative question allows consumers to tell the story of the main barrier which has prevented positive change. This can provide important and illuminating detail about the life contexts of consumers and the socio structural barriers faced.

10. Service Improvement

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This question aims to identify suggestions for service improvement.

11. Anything Else?

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This question ensures that consumers have the opportunity to report all of the information that they believe to be important about their interaction with the service/programme.

12. Demographic Questions

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Services/Programmes may choose to ask a range of demographic questions. Please select from the list below any demographic question you would like included in your survey.

In the box below, please list any demographic questions that the service/program would to include in the survey. Add each additional question on a new line.

13. Survey Conclusion

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The service/program may choose to include a concluding message at the end of the survey.

Export Auto-Filled Short Survey