About You and Your Students

1. What is your current teaching situation?

• regular class
• resource room
• special class within a regular school
• special class within a special school
• itinerant or consulting
• residential setting
• other (specify) :

2. What is the grade level(s) or age range of your students?

grade levels _____________
age range ________________

3. Are there any special characteristics of your students or class (e.g., "I serve students with a variety of disabilities.")?

4. How long have you been teaching students with emotional and behavioral problems?

_____________________ years

5. How many hours per day do you work directly with students with emotional and behavioral problems?

_____________________hours/day

6. Please list professional organizations to which you belong.

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

Working with Students

Assessment

____ prereferral process
____ assessment for identification
____ curriculum relevant assessment
____ ongoing assessment
____ other (specify):

Interventions

____ strategies to prevent emotional and behavioral problems
____ teaching social skills/problem solving
____ teaching academic skills
____ curricula that meet the academic needs of students with behavior problems
____ instructional methods to meet the academic/behavior needs of students with behavior problems
____ strategies such as peer tutoring and cooperative learning
____ techniques for managing behavior problems in the classroom
____ medication
____ technology
____ other (specify:

8. Please indicate specific areas of information that would help you 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."

Working with Families

Practices

____ coordinating school and home efforts
____ establishing effective communication channels
____ connecting families to other service providers in the community
____ other (specify):

Special Families

____ working with culturally and linguistically diverse families
____ strategies for working with hard-to-reach families
____ other (specify):

Working with Other Professionals

9. Do you have access to any of the following resources 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."

____ school counselor
____ school psychologist
____ school administrator
____ general education teacher
____ special education teacher
____ behavior consultant/specialist/analyst
____ mental health counselor
____ social worker
____ probation officer/juvenile justice
____ professional libraries
____ professional conferences/workshops
____ resource centers
____ other (specify):

10. 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 you mentioned earlier, where would you go first? To whom else would you go?

____ school counselor
____ school psychologist
____ school administrator
____ general education teacher
____ special education teacher
____ behavior consultant/specialist/analyst
____ mental health counselor
____ social worker
____ probation officer/juvenile justice
____ professional libraries
____ professional conferences/workshops
____ resource centers
____ other (specify:

11. Is there someone in your school or district whose job it is to give you such assistance?

• yes
• no
  

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

12. 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
____ social workers
____ general education teachers
____ special education teachers
____ administrators
____ school psychologists
____ school counselors
____ other (specify:

13. In general, who has been most helpful to you in obtaining new information about working with your students? 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
____ social workers
____ general education teachers
____ special education teachers
____ administrators
____ school psychologists
____ counselors
____ other (specify:

Information Format

14. We understand that many of the traditional ways of distributing information to teachers often are not effective. Think of an example of information that you received recently that was helpful to you. What was it about the information that made it useful?

15. In what format was the information given to you?

____ workshop or conference
____ written materials
____ audio or video tapes
____ Internet
____ other teachers
____ college or university course
____ other (specify:

16. Which of the following would be your preferred way(s) to receive information? If you check or write in several choices, please number them in terms of importance with "1" indicating "most preferred."

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

• school
• home
• other (specify):
  

____ World Wide Web
____ postal service
____ 800 telephone number
____ demonstration site
____ videotapes
____ peer
____ conference or workshop
____ computer disk
____ other (specify:

17. Do you have access to the Internet?

• yes
• no
  

If yes, where?____________________

18. Do you have an E-mail address?

• yes
• no
  

Your address:_______________________

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

Barriers

20. Please name one major barrier to improving services for your students and their families.

21. 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

22. 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: ______________________________

23. 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