Forces of Change Survey, United States, 2015, Restricted-Use Level 2 Data

The National Association of County and City Health Officials' (NACCHO) Forces of Change Survey is an evolution of NACCHO's Job Losses and Program Cuts Surveys (also known as the Economic Surveillance Surveys) which measured the impact of the economic recession on local health departments' budgets, staff, and programs. The Forces of Change Survey continues to measure changes in Local Health Department (LHD) budgets, staff, and programs and assess more broadly the impact of forces affecting change in LHDs, such as health reform and accreditation. More specifically, the survey collected information about LHD staffing levels, workforce reductions, and changes in budget sizes; provided services or functions; changes in the level of service delivery; billing for clinical services; efforts to help people enroll in health insurance from exchanges under the Affordable Care Act; awareness of and involvement in the State Innovation Models Initiative; participation in the Public Health Accreditation Board's national accreditation program for LHDs; and whether LHDs were part of a combined health and human services agency. The collection is comprised of the restricted-use version (Restricted-Use Level 2) of the Forces of Change 2015 dataset, which includes 103 variables for 690 cases and demographic variables related to the size of population served and LHD budgets.