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2012
November
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Official Use Only
IGSR Questionnaire Administration Staff: JF
CY
LW
_____
____
DJS Office Name/Location: ________________________________________
Today’s Date: ____/_____/
08
ID: ____________
_
SCREENING & ASSESSMENT
3. Please indicate the extent to which you agree or disagree with each of the following statements about screening and assessment. (Check R one for each row)
Possible factor in referral decision
21. 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 R one for each row)
My office needs additional guidance or training in…
26. Please indicate the extent to which you agree or disagree with the following statements about your immediate supervisor. (Check R one for each row)
My immediate supervisor…
30. What is your job title? (Check R one)
¨ Unit Director ¨ Assistant Unit Director
¨ Probation Officer I ¨ Probation Officer II
¨ Administrative ¨ Community Service Probation Officer
¨ Intake Officer ¨ Diversion Counselor
¨ Hearing Officer ¨ Adult Probation Officer
¨ SVSE Counselor ¨ Custody Investigator
¨ Family Counselor ¨ Teacher
¨ Parole Officer ¨ Special Placement Coordinator
¨ Other
33. What is your primary responsibility? (Check R ONLY one)
¨ Juvenile Intake ¨ Adult Intake
¨ Juvenile Probation/Aftercare Supervision¨ Adult Probation
¨ Diversion ¨ Pre-Court Supervision
¨ Domestic Relations ¨ Residential Treatment
¨ Pre-Disposition Investigations ¨ Residential Care
¨ Other :
What are your other significant responsibilities?
¨ Juvenile Intake ¨ Adult Intake
¨ Juvenile Probation/Aftercare Supervision¨ Adult Probation
¨ Diversion ¨ Pre-Court Supervision
¨ Domestic Relations ¨ Residential Treatment
¨ Pre-Disposition Investigations ¨ Residential Care
¨ Other : __________________________________
10.What are your primary job responsibilities? (Fill in O all that apply)
O Discipline clients
O Conduct searches on offenders person
35. Do you currently supervise any clients on informal probation? (Check R one)
¨ No
¨ Yes
a. If
yes
, please indicate the number of
clients
who are on informal supervision
36. Do you currently supervise any clients on probation or aftercare? (Check R one)
¨ No →
¨ Yes
↓
a. How many
clients
are currently assigned to your caseload?
Of these:
b. How many are on probation? _______
c. How many are on standard aftercare? _________
d. How many are on intensive aftercare? _________
e.
If you supervise
clients
on aftercare
, p
lease indicate the
number
of these aftercare
clients
who currently reside in a facility _________
f. Approximately how often do you visit clients on aftercare while they reside in a facility?
¨ Once a week
¨ Every other week
¨ Once a month
¨ Less than once a month
¨ I do not supervise clients on aftercare.
37. How long have you worked for DJJ?
38. How long have you worked with juvenile offenders (at DJJ and other agencies)?
39. How long have you/did you provide direct case management/supervision
services for juvenile offenders?
years
months
40. 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 R one)
¨ Probation agent that enforces the orders of the court.
¨ Counselor
¨ Case manager
¨ Support staff
¨ A supervisor/manager of other DJJ staff
¨ Administrator
41. What is the highest academic degree you hold? (Check R one)
¨ HS diploma ¨ Associates
¨ Bachelors ¨ Masters
¨ RN/LPN ¨ PhD
¨ Other
42. Do you hold any professional credentials, certifications, or licenses?
¨ No
¨ Yes
↓
If yes, please specify:
43. How would you describe yourself? (Check R all that apply)
¨ White/Caucasian ¨ Black/African-American
¨ Hispanic/Latino ¨ Asian/Pacific Islander
¨ American Indian/Alaska Native ¨ Other :
45. What is your gender? (Check R one)
¨ Male
¨ Female
Official use only
ID:
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