Does your clinic employ an initial screening interview in determining whether or not potential clients are appropriate for your services? If YES, or possible under answer C above, please indicate all areas covered by the screening interview (Mark all that apply):
If NO, how is it determined whether clients are appropriate for services through your clinic?
(Specify)
How does this initial screening (or its equivalent) typically occur? (Circle all that apply) If No to item 1, go to item 6.
Who performs this initial screening interview? (Mark all that apply) Do you have a more in-depth formal intake interview in addition to or instead of an initial screening interview? Does your clinic provide trainees with a standard format for conducting and writing intake interviews? If YES, or possible under answer C above, what is the format 9.List any tests or formal assessment measures routinely used during intakes
a) For adults: 9.c) For couples or families: .What populations are served by your clinic? (Answer all that apply) Please estimate the percentage in each category:
a) Trainees (college) b) Staff, faculty, and their dependents c) General population adults d) General population couples and families Who decides if a particular client is not appropriate for your clinic? (Mark all that apply) Are there certain clients (e.g., diagnostic categories, client situations) that you routinely do not accept as clients (i.e., that are automatically ruled out based on information obtained during screening or intake procedures)? How effective/accurate are your screening procedures at excluding clients/situations inappropriate for your clinic? Who assigns clients to trainee therapists/evaluators? (Mark all that apply) 16.Please rate the degree of opportunity for practicum trainees to gain assessment experience at your clinic. Mark "N" for none, "L" for low (1%-20%, "M" for medium (21%-80%), or "H" for high (81%-100%) for each of the population assessment strategy combinations for children below.
17.Please rate the degree of opportunity for practicum trainees to gain assessment experience at your clinic. Mark "N" for none, "L" for low (1%-20%), "M" for medium (21%-80%), or "H" for high(81%-100%) for each of the population and assessment strategy combinations for adolescents below.
18.Please rate the degree of opportunity for practicum trainees to gain assessment experience at your clinic. Mark "N" for none, "L" for low (1%-20%), "M" for medium (21%-80%), or "H" for high(81%-100%) for each of the population and assessment strategy combinations for adults below.
19.Please rate the degree of opportunity for practicum trainees to gain assessment experience at your clinic. Mark "N" for none, "L" for low (1%-20%), "M" for medium (21%-80%), or "H" for high(81%-100%) for each of the population and assessment strategy combinations for elderly below.
20.Please rate the degree of opportunity for practicum trainees to gain intervention experience at your clinic. Mark "N" for none, "L" for low (1%-20%), "M" for medium (21%-80%), or "H" for high (81%-100%)for each of the poplulation and intervention modality combinations for children below.
21.Please rate the degree of opportunity for practicum trainees to gain intervention experience at your clinic. Mark "N" for none, "L" for low (1%-20%), "M" for medium (21%-80%), or "H" for high (81%-100%)for each of the poplulation and intervention modality combinations for adolescents below. 22.Please rate the degree of opportunity for practicum trainees to gain intervention experience at your clinic. Mark "N" for none, "L" for low (1%-20%), "M" for medium (21%-80%), or "H" for high (81%-100%)for each of the poplulation and intervention modality combinations for adults below. 23.Please rate the degree of opportunity for practicum trainees to gain intervention experience at your clinic. Mark "N" for none, "L" for low (1%-20%), "M" for medium (21%-80%), or "H" for high (81%-100%)for each of the poplulation and intervention modality combinations for elderly below
24.Please rate the degree of opportunity for practicum trainees to gain research experience at your clinic. Mark "N" for none, "L" for low (1%-20%), "M" for medium (21%-80%), "H" for high (81%-100%) for each of the population and intervention modality combinations for children below.
25.
Please rate the degree of opportunity for practicum trainees to gain research experience at your clinic. Mark "N" for none, "L" for low (1%-20%), "M" for medium (21%-80%), "H" for high (81%-100%) for each of the population and intervention modality combinations for adolescents below. 26.Please rate the degree of opportunity for practicum trainees to gain research experience at your clinic. Mark "N" for none, "L" for low (1%-20%), "M" for medium (21%-80%), "H" for high (81%-100%) for each of the population and intervention modality combinations for adults below. 27.Please rate the degree of opportunity for practicum trainees to gain research experience at your clinic. Mark "N" for none, "L" for low (1%-20%), "M" for medium (21%-80%), "H" for high (81%-100%) for each of the population and intervention modality combinations for elderly below. With which of the following areas of diversity do trainees gain experience at your site? (Mark all that apply)
Does your clinic provide trainees with opportunities to provide consultation? If Yes, in which of the following settings do you provide opportunities for trainees to engage in consultation activities? (Mark all that apply)
31.With which of the following settings do you provide opportunities for trainees to engage in consultation activities. (Mark all that apply)
Does your clinic have training workshops for practicum trainees, faculty, and/or on professionally related topics? If Yes, how many typically occur in an academic year? No funds necessary, all services donated Does your clinic have case conferences in which graduate trainees and/or faculty present? If Yes, how many case conferences typically occur in one year? What is the theoretical orientation of the services provided by your clinic? (Mark all that apply) 38.Listed below are a variety of topics pretaining to training issues. Please mark all A,B,C, or D categories that apply:
A. Your clinic routinely offers training in a formal setting (such as courses or workshops)
B. Topics that are services of the routine clinic caseload
C. Topics that are occasionally services of the clinic caseload
D. Topics that are services of a "speciality clinic" within or affiliated with your clinic Does your clinic offer outpatient therapy groups or special topic groups on an ongoing basis? Does your clinic provide any services to wait-listed clients? If yes, please describe. In what programs are students in your clinic enrolled? What is the total number of graduate trainees in your program: How many at the master's level? How many at the doctoral level? How many at the bachelor's level (program doesn't require master's prior to doctorate) At what level are trainees involved in clinic activities? (Mark all that apply) Are students required to work in your clinic? BY the end of their training at your clinic, your trainees typically will have observed how many of your clinical faculty members performing therapy? Are your trainees permitted/encouraged/required to observe fellow trainees performing therapy or evaluations? 49.How many of the trainees in your clinic are involved on a regular basis in the following activities?
If some trainees are excluded from any of the above activities that are not uniformly required of all clinic trainees, describe the criteria for exclusion: How many full-time faculty are in your department (total)? How many full-time faculty in your department are in your training area? How many full-time faculty in your training area regularly supervise or rotate through supervision in the clinic? How many part-time faculty in yoru training area regularly supervise or rotate through supervision in the clinic? 55.How many of the clinic faculty supervisors are involved on a regular basis in the following clinic activities?
If some faculty are excluded from the above activities that are not uniformly required of all clinical faculty, describe the criteria for the exclusion: Are any trainees from related disciplines engaged in training or research activities at your clinic? Counseling (guidance, personnel, community, school, ect.) Trainees from speech pathology, rehabilitation, gerontology |
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