About You and The Youth You Work With

1. What is the title of your current position?

2. What is your primary role (check all that apply)?

• treatment oriented
• teaching oriented
• administrative
• other (please specify):

3. What is the grade level(s) and age range of the youth you work with?

grade level: ____________________
age range: _______________________

4. Do the youth you work with have any special characteristics (e.g., "I serve youth with a variety of disabilities, or types of offenses or crimes.")?

5. How long have you been working with youth in the juvenile justice system?

6. Do you work directly with youth who have emotional or behavioral problems?

• yes
• no
  

If yes, approximately how many hours per week? _________________

7. To what professional organizations do you belong?

Working with Youth

8. Below please indicate specific areas of information you think would help you to be more effective and efficient in working with youth. If you check or write in several information needs, please number them in terms of importance, with "1" indicating "most important."

Assessment

• ____ prereferral process
  ____ assessment for identification
  ____ assessment related to curriculum
  ____ ongoing assessment

Interventions and Accomodations

• ____ preventing emotional and behavioral problems
  ____ teaching social skills
  ____ teaching academic skills
  ____ meeting the academic needs of students with behavior problems
  ____ peer tutoring and cooperative learning
  ____ managing behavior problems in the classroom
  ____ managing behavior problems in other settings
  ____ administering medication
  ____ using technology
  ____ addressing civil rights requirements
  ____ other (specify):
  

Working with Families

9. Do you or anyone else at your facility work with familes?

• yes
• no
  

If yes, please indicate below specific areas of information that would help you or your coworkers to be more effective and efficient in working with families. If you check or write in several information needs, please number them in terms of importance, with "1" indicating "most important."

Practices

• _____ coordinating and reinforcing efforts in and out of the classroom
  _____ establishing effective communication channels
  _____ working with and connecting families to other service providers in the community
  

Families with Special Needs

• _____ working with culturally and linguistically diverse families
  _____ strategies for contacting "hard-to-reach" families
  _____ other (please specify):

Working with Other Professionals

10. Do you have access to any of the following individuals for information? Use a scale of 1 to 3 to rate your ease of access, with "1" being "very accessible" and "3" being "not very accessible."

11. We are interested in knowing how, or from whom, you get new information about your field. For example, if you want more information in any of the areas that you mentioned earlier, where would you go first? To whom else would you go? Rate your choices on a scale of 1 to 3.

12. Is there someone in your facility whose job it is to give you the assistance delineated in question 11?

• yes
• no
  

If yes, what is that person's title? ____________________________

13. Check which professionals you would care to receive information about, concerning both what they do and how to collaborate with them.

• ____ mental health counselors
  ____ probation officers/juvenile justice caseworkers
  ____ social workers
  ____ general education teachers
  ____ special education teachers
  ____ administrators
  ____ facility psychologists
  ____ community-based centers (e.g. religious centers, Department of Recreation)
  ____ advocacy groups (please specify):
  ____ other (please specify):

14. In general, who has been most helpful to you in obtaining new information about working with your youth? If you check or write in several sources, please number them in terms of importance, with "1" indicating "most helpful."

• ____ mental health counselors
  ____ probation officers/juvenile justice caseworkers
  ____ social workers
  ____ general education teachers
  ____ special education teachers
  ____ administrators
  ____ facility psychologists
  ____ community-based centers (e.g. religious centers, Department of Recreation)
  ____ advocacy groups (please specify):
  ____ other (please specify):

Information Format

15. We know that often many traditional methods of distributing information are not effective. Think of an example of information that you received recently that was, in fact, helpful to you. What was it about the information that made it useful?

16. In what form was the above information sent or given to you?

• ____ workshop or conference
  ____ written materials (such as books, magazines, journals or newsletters)
  ____ audio or video tapes
  ____ Internet (such as listservs or the World Wide Web)
  ____ teleconferences (one-way or two-way Video telecasts)
  ____ colleagues
  ____ other (please specify):

17. Among the following, how would you prefer to receive information? Please number your choices in order of importance, with "1" indicating "most preferred."

• ____ Internet (i.e., listserv or E-mail), accessed from:
  • facility
  • home
  • other

  ____ World Wide Web
  ____ postal service (hard copy)
  ____ 800 telephone number
  ____ demonstration site
  ____ videotapes
  ____ peer
  ____ conference
  ____ workshop
  ____ teleconference
  ____ other (please specify):

18. Do you have access to the Internet?

• yes
• no
  

If yes, where?____________________

19. Do you have an E-mail address?

• yes
• no
  

Your address:_______________________

20. Is there anything else about your information needs that you can tell us?

Barriers

21. If you were to name one major barrier to improving services for youth with emotional and behavioral problems and their families, what would that barrier be?

22. Thank you very much for taking your time to complete this Questionnaire. With your permission, may we keep you on our mailing list to receive updated information?

• yes
• no

23. Would it be acceptable for us to contact you in the future, if we have other questions?

• yes
• no

If yes, please record your name, address, and telephone number:

Name: ______________________________

Address:

___________________________________________________________

___________________________________________________________

___________________________________________________________

Telephone: ______________________________

24. Please check below if you would like a copy of our Center Information Booklet sent to you at the address above. Our booklet also is available here on our web site, where you can print out a copy for your personal use.

• Yes, please send me a Center Information Booklet.

If you need to reach us, our telephone number is 1-888/457-1551. BACK TO THE NEEDS ASSESSMENT PAGE