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3. Please indicate your job class. (check all that apply:) |
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| 4. Please write in your working title (i.e. intake officer, unit director, juvenile probation counselor, etc.) | | |
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5. Please estimate the percentage of clients on your caseload or in your program who you screen or assess with any of the following instruments. If there are screening or assessment tools used in the community that are not listed, please add them into the rows provided at the end of the table. (For each row, check the box closest to the estimated percentage.)
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| If other, please specify: | | |
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6. Please indicate the extent to which you agree or disagree with each of the following statements about screening and assessment. (Check one for each row)
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PROGRAM AND SERVICE REFERRALS |
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7. Below are a number of factors that may be considered when making a program referral decision for your clients. Using the scale shown, rate the importance you would assign to each factor. (Check one for each row)
Possible factors in referral decision
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| 7a. Now review the list of factors above and indicate in the box below the three factors you would rank as most important in making a referral decision. | | |
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TREATMENT PLANNING AND PLACEMENT |
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8. For each of the following types of clients in your office or program, please estimate the proportion for which a formal treatment planning meeting or mental health meeting takes place (including the case manager, supervisor, resource coordinator or other specialist, etc.). (For each row, check the one box closest to the estimated percentage of those clients for whom a formal treatment planning meeting is held.)
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9. For each of the following types of clients in your office or program, please estimate the proportion for which a formal treatment service plan is created and tracked. (For each row, check the one box closest to the estimated percentage of those clients with formal service plans.)
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10. To what extent are the following used routinely in creating treatment service plans for clients on your caseload or in your program? (Please check one for each row)
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| If other, please specify: | | |
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11. Please indicate the proportion of clients on your caseload or in your program who actively participate in each of the following activities. (For each row, check the one box closest to the estimated percentage of clients.)
The client actively participates in...
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12. Please indicate the proportion of clients on your caseload or in your program who have at least one family member or guardian actively participate in each of the following activities. (For each row, check the one box closest to the estimated percentage of clients.)
A family member or guardian actively participates in...
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13. What types of services are available to clients in your unit and which ones have you used for clients on your caseload or in your program? For each service listed, first indicate its level of availability by checking one of the three boxes. Then indicate if you formally referred a client to this type of service at some point during the past year by checking yes or no. If you made a referral to a program or service not listed, please specify in the last row. |
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| If other, please specify: | | |
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14. It is recognized that there is a need for programs and services geared towards different cultures and ethnic groups. In the list below, please indicate whether you feel there are sufficient programs for the identified groups and whether you have made referrals to other organizations in the past year. |
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| If other, please specify: | | |
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CASE MANAGEMENT & MONITORING |
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15. Please indicate the extent to which you feel comfortable in doing the following. (Check one for each row)
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16. Below is a list of common activities between agencies. Please check all activities that apply to your unit’s working relationship with the judiciary and other community-based agencies on issues specific to assessment, treatment planning, service referrals, and placement.
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17. Please indicate the extent to which you agree or disagree with the following statements. (Fill in one O for each row)
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ABOUT THE COURT SERVICES UNIT WHERE YOU WORK |
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18. Please indicate the extent to which you agree or disagree with the following statements about your unit. (Fill in one O for each row)
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19. Please indicate how much you agree or disagree with each of the following statements about the condition in and functioning of your unit. (Fill in one O for each row)
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20. Please indicate how much you agree or disagree with each of the following statements about the conditions and functioning of your unit. (Fill in one O for each row)
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21. Please indicate the extent to which you agree or disagree with the following statements about efforts to make changes in your unit.
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22. Please indicate how much you agree or disagree with each of the following statements about the need for additional guidance or training in your unit. (Check one for each row)
My office needs additional guidance or training in...
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23. Please respond to the following statements about training in your unit and agency. (Check one for each row)
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24. Please indicate the extent to which you agree or disagree with the following statements about your immediate supervisor. (Check one for each row)
My immediate supervisor...
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25. Please indicate the extent to which you agree or disagree with the following statements about coordination between different units within this agency. (Check one for each row)
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| 26. Please give a description of an average day working in your position. | | |
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| 27. How many hours per week do you work in this position? | | |
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28. What are your primary job responsibilities? (Fill in all that apply)If you do not see an option that applies to you, please fill in the blank next to "other" |
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29. Do you currently supervise any clients on probation, aftercare or pre-dispositional supervision? (Check one) |
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| 29a. How many clients are currently assigned to your caseload? | | |
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| 29b. How many are on probation? | | |
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| 29c. How many are on standard aftercare? | | |
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| 29d. How many are on intensive aftercare? | | |
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| 29e. How many are on pre-dispositional supervision? | | |
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| 29f. If you supervise clients on aftercare, please indicate the number of these aftercare clients who currently reside in a facility | | |
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29g. Approximately how often do you visit clients on aftercare while they reside in a facility? (Check one) |
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| 30. How Long have you worked for CSU? (____Years____Months) ex. 1.6 | | |
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| 31. How Long have you worked with juvenile offenders (at CSU and other agencies)? (____Years____Months) ex. 1.6 | | |
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| 32. How long have you/did you provide direct case management/supervision services for juvenile offenders?(____Years____Months) ex. 1.6 | | |
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33. CSU staff wear many hats. Please check only one of the following which you would consider as your primary role in CSU. We are interested in how you define your work and not your actual job title, training, education, or certifications. (Check one) |
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34. What is the highest academic degree you hold? (Check one) |
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35. Do you hold any professional credentials, certifications, or licenses? |
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36. How would you describe yourself? (Check all that apply) |
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38. What is your gender (check one) |
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