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I. Identifying information

1. What best describes your current position? (Check one)

q Psychologist q Clinical Nurse Specialist
q Psychiatrist q Allied Health Professional
q Social Worker q Case Manager/Care Coordinator
q Counselor q Program Administrator
q Paraprofessional q Other:

 

2. What best describes your employment situation? (Check one)

q Public agency q Community Mental Health Center
q Private not-for-profit organization q Solo private practice
q Private for-profit organization q Other:
q Public/private partnership

 

3. In what services setting do you primarily work with children with emotional and behavioral problems and their families? (Check one)

q Outpatient mental health clinic/center q Psychiatric hospital
q Residential treatment center q General/Community hospital
q Day treatment center q Physician’s office/Health clinic
q School program q Day care
q Crisis services q Private practice
q Wraparound services agency q Other:
q Shelter

 

4. What best describes the services you provide to children with emotional/behavioral problems and their families? (If you provide several of these services, place a "1" by the service you provide most frequently, a "2" by the service you provide second-most frequently, and so on.)

___ Individual therapy/counseling ___ Crisis intervention
___ Family therapy/counseling ___ Prescribing medication/Medication management
___ Group therapy/counseling ___ Designing/administering individual service plans
___ Substance abuse counseling ___ Program development and administration
___ Early intervention services ___ Personnel training
___ Family/Child advocacy ___ Research and evaluation
___ Behavior management consultation ___ Other:
___ Assessment and diagnosis ___ Other:

 

5. How long have you been working with children who experience emotional/behavioral problems and their families?

q 1 year or less q 11-20 years
q 1-5 years q Over 20 years
q 6-10 years

 

6. How many hours per week do you work directly with children experiencing emotional/behavioral problems and their families?

q none q 16-20 hrs
q 1-5 hrs q 21-30 hrs
q 6-10 hrs q Over 30 hrs
q 11-15 hrs

 

7. What is the age range of the children/adolescents you primarily work with?

q 0-3 years q 13-18 years
q 3-5 years q 18 years and older
q 6-12 years

 

8. In what state do you primarily work?

 

9. What best describes the geographic setting in which you work?

q large city q suburban
q small city q rural

 

10. Are there any special characteristics of children with whom you primarily work (e.g., children with developmental disabilities, children who have experienced abuse or neglect)?

 

II. Information needs in working with children, families, and other professionals

In this section, we are interested in finding out what kinds of information would help you be more effective in working with children experiencing emotional/behavioral disturbance and their families.

11. Assessment of children and adolescents

About what types of assessment processes would you like more information?

(If you have several areas of information need, place a "1" by the most important area, a "2" by the second-most important area, and so on.)

___ Outreach/Identifying children in the community ___ Assessment for family services planning
___ Assessment for diagnostic classification ___ Behavioral assessment for creation of behavior plans
___ Assessment for identification of service eligibility ___ Ongoing assessment and evaluation
___ Assessment for insurance/entitlement eligibility ___ Other:
___ Conducting strength-based assessments ___ Other:
___ Assessment for school services planning

 

12. Direct Mental Health Services

About what types of clinical interventions for children and families would you like more information?

(If you have several areas of information need, place a "1" by the most important area, a "2" by the second-most important area, and so on.)

___ Prevention of emotional and behavioral problems ___ Medication
___ Behavior management at home ___ Family therapy methods
___ Behavior management in the classroom ___ Academic skills training
___ Individual therapy for children with EBD ___ Social skills training
___ Life skills training ___ Other:
___ Drug/alcohol treatment ___ Other:

 

13. Problems experienced by children and adolescents

About which problem areas would additional information help you work more effectively?

(If you have several areas of information need, place a "1" by the most important area, a "2" by the second-most important area, and so on.)

___ Conduct disorders ___ Aggressive/oppositional behaviors
___ Learning disorders ___ Pervasive developmental disorders/Autism
___ Communication disorders ___ Developmental disabilities
___ Psychotic disorders ___ Alcohol/drug abuse
___ Anxiety disorders ___ Sexual offenses
___ Mood disorders ___ Chronic Physical Illness
___ Eating disorders ___ Other:
___ Sleep disorders ___ Other:
___ Attention problems/impulse control ___ Other:

 

14. Components of a system of care

There are a variety of components of a service delivery array for children and families. What services would you like more information about implementing and accessing in your community?

(If you have several areas of information need, place a "1" by the most important area, a "2" by the second-most important area, and so on.)

___ Outpatient therapy ___ School-based services
___ In-home services/Intensive family-based services ___ Family support groups
___ Crisis services ___ Respite care
___ Case management ___ Substance abuse services
___ Therapeutic foster care ___ Early intervention services
___ Residential treatment ___ Transition services
___ Inpatient hospitalization ___ Individualized Wraparound process
___ Employment & training/Vocational services ___ Other:
___ Day treatment ___ Other:

 

15. Principles of a system of care

There are a number of principles associated with providing a service array for children with EBD and their families. About what kinds of system of care principles and family-based practices would you like more information?

(If you have several areas of information need, place a "1" by the most important area, a "2" by the second-most important area, and so on.)

___ Creating a community-based service array ___ Coordinating with other child-serving agencies
___ Providing "child-centered, family-focused" services ___ Connecting families to other community resources
___ Conducting individualized, strength-based assessments ___ Early identification and intervention for children at risk of EBD
___ Creating individualized treatment plans ___ Delivering culturally-competent services/programs
___ Involving families in driving/developing the system of care ___ Other:
___ Involving families in service planning for their own children ___ Other:
___ Establishing effective provider-family communication channels ___ Other:
___ Providing adequate case management services

 

16. Financing Issues

About what financing issues would you like more information?

(If you have several areas of information need, place a "1" by the most important area, a "2" by the second-most important area, and so on.)

___ Pooling funds from several sources ("blended funding")
___ Operating in a managed care environment
___ Accessing Medicaid
___ Other public sector funding (e.g., education, child welfare, etc.)
___ Impact of welfare reform on children and families
___ Impact of health care reform
___ Legal requirements for reimbursement of services
___ What to do when services are not covered
___ Other:
___ Other:
___ Other:

 

17. Of the major categories listed in the current section, which are most important for you to have more information about?

(Please place a "1" by the most important area, a "2" by the second-most important area, and so on.)

___ Assessment of children and adolescents
___ Mental health services for children and adolescents
___ Components of a system of care
___ Principles of a system of care
___ Financing issues
___ Other major category:
___ Other major category:
___ Other major category:

 

III. Acquiring information

We are interested in how, or from whom, you receive information about working with children with emotional and behavioral problems and their families.

18. Where you currently get information

In order to receive more information about the areas listed in Section II, what sources do you currently utilize?

(If you have several sources you might utilize, place a "1" by the most likely source, a "2" by the second-most likely source, and so on.)

___ Professional/academic library ___ Consultation with a supervisor
___ Community library ___ Public health office
___ Professional conference/workshop ___ Community mental health center
___ Resource center ___ Local child welfare/protective services office
___ Resource materials (monographs, manuals, etc.) ___ Advocacy or support groups
___ Professional journals ___ Parent networks
___ On-line services (Internet/bulletin boards) ___ Other:
___ Consultation w/a professional within your discipline ___ Other:
___ Consultation w/an individual within your discipline ___ Other:

 

19. Accessing other professionals

From what types of professionals do you get information about working with children and families?

(Use a scale of 0-2 to rate how often you access each professional: 0 = never, 1 = sometimes, 2 = often.)

___ Mental health clinician/counselor/therapist ___ Public health nurse
___ Behavioral consultant/specialist ___ Parent advocate/liaison
___ Psychiatrist ___ Developmental pediatrician
___ Social worker ___ Other physician
___ School administrator ___ Speech/language specialist
___ School counselor ___ Occupational/physical therapist
___ School teacher ___ Other:
___ Probation officer/juvenile justice official ___ Other:

 

20. Is there someone at your agency/organization or in your local/state jurisdiction whose job it is to give you assistance in obtaining information about services or care components that are available in your jurisdiction?

q Yes
q No
q Don’t Know

If yes, what is that person’s title or position?

 

21. Preferred ways of getting information

If you were to receive information about serving children and families from a national resource center, what would be your preferred way(s) to receive information?

(Please place a "1" by the most preferred way, a "2" by the second-most preferred way, and so on.)

___ World Wide Web ___ Catalogues of available resource materials
___ Internet: E-mail, ListServ, Bulletin board ___ Fact sheets/Newsletters
___ Postal service (hard copies) ___ Conferences or workshops
___ 800 number ___ Journal articles
___ Videotapes ___ Other:
___ Faxes ___ Other:

 

22. Do you have access to the Internet?

q Yes
q No
q Don’t Know

If yes, where?

q Home
q Work
q Other:

 

23. Do you have an e-mail address?

q Yes
q No
q Don’t Know

 

IV. Further insights and correspondence information

 

24. What do you believe to be the largest barriers to improving services for children and families?

 

25. What strategies have helped you most to provide effective services to children and families?

 

26. What more can you tell us about receiving information about providing services to children and families and/or collaborating with other service providers?

 

27. Other comments?

 

28. Would it be permissible for us to contact you in the future if we have further questions?

q Yes q No

 

29. Would you like to be maintained on a mailing list to receive updated information?

q Yes q No

Preferred Address (if you responded "Yes" to either of the above):

Name

Address

Telephone and/or FAX

E-mail

 

Please return the completed survey to:

Joan Dodge
National Technical Assistance Center on Children’s Mental Health
Georgetown University Child Development Center
3307 M Street, N.W.
Washington, DC 20007-3935
Phone: 202-687-5000/Fax: 202-687-1954

Thank you very much for your time. Your efforts will assist us greatly as we endeavor to provide information about best practices to providers nationwide.

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© 2001 The CECP is part of the American Institutes for Research (AIR), and is funded under a cooperative agreement with the Office of Special Education Programs (OSEP), U.S. Department of Education (ED), with supplemental funding from the Center for Mental Health Services (CMHS), U.S. Department of Health and Human Services (HHS).