Licensure: Please check all that apply:
Years of post-graduate experience:
Current Practice Setting:
9.
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Primary Theoretical Orientation:
What is your secondary theoretical approach used most often?
Are you participating in a peer consultation group?
15.If participating in a peer consultation group, what types of activities do you participate in? Please check all that apply.
16.Estimated hours per week devoted to designated activites:
17.Please list any other activites and hours devoted to them, if not listed above:
18.Please indicate what type and how many hours/week are devoted to the following counseling/therapeutic activites?
Estimated hours /week devoted to informal or formal research activites:
How do you evaluate the effectiveness of clinical interventions and/or clinical outcomes?
What percentage of your clients receive medicaid funding for their mental health care?
How long have you been an approved provider for a managed care company?
23.Please indicate to what degree you agree or disagree with the following statments:
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