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Site Visit Protocol and Interview Guide
OMB No. 0930-xxxx
Expiration Date:
NATIONAL EVALUATION OF
THE ADDICTION TECHNOLOGY TRANSFER CENTER (ATTC) NETWORK
Site Visit Protocol
Guidelines and Instructions
The Site Visit Protocol is the data collection instrument that will be used by the
national ATTC evaluation team to collect data from the 14 Addiction Technology
Transfer Centers and the National Coordinating Center during on-site visits. The data
collected during the site visit will contribute to the Planning and Partnering Substudy of
the ATTC evaluation.
The purpose of each site visit is to understand the ATTC’s program planning
processes and how the ATTC establishes priorities within its region. During the site visit,
the national evaluation team will identify the local, State, national, and Federal partners
that collaborate with the ATTC in the planning and delivery of services and collect data
on how the ATTC acquires and leverages resources to serve State and regional needs.
Finally, the evaluation team will collect information about the range of services delivered
by the ATTC and the technology transfer objectives for these services. The evaluation
team will ask how the ATTC decides on the technology transfer objective for specific
types of services and whether the ATTC groups, or bundles, services to meet particular
objectives.
Two members of the ATTC evaluation team—a lead site visitor and associate site
visitor—will be assigned to conduct each site visit, which will occur over a two- to threeday period. The responsibilities of each member of the site visit team are shown in Table
1 below.
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-xxxx. Public reporting burden for
this collection of information is estimated to average 1.5 hours per interview, including the
time for reviewing instructions, searching existing data sources, gathering the data needed, and
completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 71044, Rockville, Maryland, 20857.
Site Visit Protocol and Interview Guide
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Table 1. Site Visitor Responsibilities
Lead Site Visitor Responsibilities
Associate Site Visitor Responsibilities
•
Contacts the ATTC director at least 6 weeks in
advance of the intended site visit to explain the
purpose and schedule the dates of the visit.
•
Supports the lead site visitor in all interviews,
which includes asking questions and taking
detailed notes.
•
Coordinates with the ATTC director (or his or
her designee) to identify individuals who will be
interviewed and develop an agenda for the visit.
•
Leads selected interviews, as agreed upon with
lead site visitor.
•
•
Supports the lead site visitor in the focus group.
Arranges for a two-hour focus group with ATTC
field staff (full- or part-time staff who serve as
the ATTC’s liaisons with States in the region).
•
Compares notes with the lead site visitor during
and after the visit to ensure data consistency.
•
Writes portions of the site visit report.
•
Leads selected interviews and the focus group,
with support from the associate site visitor.
•
Takes detailed notes of the interviews.
•
If needed, follows up with ATTC staff after
returning from the site visit to fill gaps in the
information collected.
•
Drafts the site visit report, in collaboration with
the associate site visitor, and sends it to the
director of the Planning and Partnering
Substudy for review.
•
Revises the draft report to respond to comments
received from the Substudy director.
•
Sends the revised report to the ATTC director
for review to ensure accuracy and
completeness of the data.
•
Finalizes the site visit report after receiving
comments from the ATTC.
For scheduling purposes, it will be important to arrange the site visit during a time that
the ATTC director, ATTC evaluator, and key ATTC staff, including field staff, will be
available. The lead site visitor should schedule the site visit during a time when all staff
will be on site at the ATTC’s offices. If field staff are not scheduled to be at the ATTC’s
offices, the lead site visitor should ask the ATTC director whether arrangements could be
made to bring these staff to the ATTC to participate in the site visit (see script for initial
contact). The focus group will be conducted using the Focus Group Protocol.
Site Visit Protocol and Interview Guide
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A. Sources of Data
Two critical elements of a successful site visit are 1) to become familiar with and
knowledgeable about the ATTC before the site visit by reviewing available program
documents and materials and 2) to collect all of the information that may be important to
the topics of inquiry while on site. The following summarizes the expectations related to
site visit preparation and data collection.
Note to interviewers: Highlighted comments are not to be read as part of the interview
guide.
Program Documents and Materials
Prior to the site visit, the site visitor should collect and analyze relevant documents.
These include: the ATTC’s 2007 funded application, Annual Work Plan (if one exists),
project website, Advisory Board membership lists, workforce survey reports, and training
schedules and catalog. When scheduling the site visit, the site visitor should request
other ATTC-specific documents in advance or ask that copies be provided on site. These
include: county or State strategic plans, county or State needs assessments, partnership
agreements, or other documents identified in collaboration with the ATTC project
director as being instrumental to the ATTC’s planning and partnering processes.
The Site Visit Protocol identifies the key informants and program documents that may
be relevant for each set of questions. An asterisk (*) preceding the question indicates that
one data source for the question is likely to be a program document. A plus sign (+)
preceding a question designates a question that is specifically for the ATTC evaluator.
Key Informants
Key informants, or interviewees, should include individuals who perform the
following job functions (note that the same individual may serve more than one role):
•
•
•
•
•
•
•
ATTC director
ATTC associate director or program manager
ATTC evaluator
Training coordinator
Coordinator for the National Institute on Drug Abuse (NIDA) Blending Initiative
Technology transfer specialists
Other region-specific key informants (e.g., tribal leaders, cultural experts)
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Site visitors should also interview other staff associated with the ATTC who have a role
in planning ATTC services. These individuals may include:
•
•
•
Staff affiliated with the lead agency (e.g., university) for the ATTC
Members of the ATTC’s regional advisory board
Partner organizations
It may not be possible to schedule face-to-face interviews with everyone associated
with the ATTC, as these individuals and organizations are likely to be located throughout
the ATTC region. If possible, however, interviews should be scheduled with those who
are located in close proximity to the ATTC. Site visitors will schedule key informant
interviews with others by telephone (see Key Informant Interview Guide).
Guidance regarding the length of the interviews with each key informant is provided
below (see Table 2). However, these timeframes are estimates only, and site visitors
should be flexible in scheduling interviews. Some key informants may have multiple
roles, and therefore the time needed to interview these individuals could be longer.
Table 2. Illustrative Interview Schedule
Key Informant Type
# of
Hours
ATTC Project Director
2
ATTC Program
Manager or Associate
Director
2
ATTC Evaluator
Training Coordinator
NIDA Blending
Initiative Coordinator
Technology Transfer
Specialists
Others
Name and Title
Date and Time
1.5
1
1
1
0.5 - 1
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B. Topics of Inquiry
There are 12 topics of inquiry, covering background information on the respondent,
background information on the ATTC, ATTC goals, organization and structure of the
ATTC, the ATTC Advisory Board, planning and priority setting, ATTC partners, service
delivery, technology transfer strategies, ATTC funding, program evaluation, and
challenges and successes. Specific questions, along with intended respondents and other
possible data sources, associated with each topic of inquiry are provided later in this
protocol. While answers to the questions in the Site Visit Protocol will come primarily
from the ATTC director and ATTC staff, answers to some questions will be available in
program documents (e.g., the number of States in the ATTC region).
C. Site Visit Reports
Site visit reports should follow the same heading structure as the Site Visit Protocol
and should also include the five tables provided in the Appendix. The report may also
include other tables or diagrams (e.g., organization charts), as appropriate to each section.
Site visitors are encouraged to begin the analysis and report-writing process
immediately after the site visit. This will enable site visitors to determine quickly
whether any follow-up is needed with the ATTC to fill in data gaps. Site visit reports
should be completed no later than 10 days following the site visit.
Following the site visit, the lead site visitor should send the draft report to the
Substudy director, who will review it and send it back with comments and questions.
After revising the report, the lead site visitor should then email the revised draft to the
ATTC director and ask that he or she review it for accuracy and completeness. The lead
site visitor should ask the ATTC director to send comments on the report within 2 weeks.
After receiving comments, the lead site visitor should prepare the final site visit report,
making changes as appropriate based on comments received.
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Script for Initial Telephone Call with the ATTC Director
Hello, my name is [Name] from [Name of Company]. I am a member of the team that
is conducting the National Evaluation of the ATTC Network under contract with the
Center for Substance Abuse Treatment.
As you may know, the goals of the evaluation are to:
•
•
•
Identify the successes of technology transfer efforts and build upon them in the
future;
Share lessons learned across ATTC regions for the improvement of all regions’
activities; and
Identify region-specific and cross-regional processes and outcomes.
One of the first activities of the evaluation is to conduct an on-site visit to each ATTC.
The site visit will last three days and will involve interviews with you and others on the
ATTC staff, as well as a 2-hour focus group with field staff who serve as liaisons with
States in your region. The main purpose of the site visit is to understand the ATTC’s
processes and procedures related to planning, partnering, and providing ATTC services
and activities.
I am calling to discuss potential dates for the site visit, and I’d also like to review the
topics we plan to cover during the visit, so that we can begin to work together on
developing an agenda.
We would like to conduct the site visit within the next 6 weeks. Are there specific
dates that are preferable for you for our visit? [The ATTC director may have to check his
calendar and the availability of other staff before giving you specific dates. If this is the
case, ask when you could call him/her back to discuss dates, or ask him/her that he call
you or send you an email with these dates.]
During the interview we will cover the following broad topics:
•
•
•
•
•
•
•
•
•
ATTC goals
Organization and structure of the ATTC
The ATTC Advisory Board
Planning and priority setting
ATTC partners
Service delivery
Technology transfer strategies
ATTC funding
Program evaluation
•
Challenges and successes of the ATTC to date
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Script for Initial Telephone Call with the ATTC Director (cont’d)
As the ATTC director, you will probably be able to provide us information related to
most of these topics, and we would like to schedule a 2-hour interview with you on the
first morning of our visit, and another hour at the end for a debriefing. Can you give me
the names of other staff whom we should interview?
Would you prefer that we contact these individuals ourselves to schedule the
interviews, or would you rather arrange the agenda for us? [If the director would like you
to schedule the interviews, ask for telephone numbers and email addresses for all staff.
The director may also ask you to contact someone else at the ATTC who will work with
you to arrange the site visit agenda.]
As I mentioned earlier, we would also like to conduct a focus group with the ATTC’s
field staff, and therefore we would prefer to schedule the site visit during a time when
these staff will be at the ATTC. Can the field staff be available at the ATTC’s offices
during our site visit? If convenient for you and the staff, we would like to schedule the
focus group for the morning of the last day of our site visit.
Thank you for working with me to schedule the site visit. We look forward to meeting
with you and others on the ATTC staff. Please don’t hesitate to call or contact me by
email if you have any questions about the evaluation or the site visit. [Provide your
telephone number and email address.]
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Site Visit Protocol - Face Sheet
Date of Site Visit:
Lead Site Visitor:
Associate Site Visitor:
Name of ATTC:
Lead Organization:
States in ATTC Region:
New States in Region
(with current award):
ATTC Funding Since:
Respondent (# of hrs)
Name and Title
Date of
Interview
ATTC Director (2):
ATTC Associate Director/
Program Manager (1-2):
ATTC Evaluator (1):
Training Coordinator(s) (1):
NIDA Blending Initiative
Coordinator (1):
Technology Transfer
Specialists (1):
Others (0.5 - 1):
Site Visit Protocol and Interview Guide
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Interview Guide
SECTION 1: PARTICIPANT INFORMATION
(All)
1. What is your position title?
2. How long have you been in this position?
3. What are the responsibilities of this position?
4. How long have you been with this ATTC?
5. What was your previous position?
6. How long were you in that position?
7. How long have you been in the addictions field?
8. Is this a “second career” for you? If so, what was your previous field or
discipline?
SECTION 2: BACKGROUND INFORMATION OF THE ATTC
(ATTC Director,
Associate Director,
Funded Grant
Application, ATTC
Website, Census
Data)
9. *When did the ATTC first receive SAMHSA/CSAT funding?
10. Did the ATTC exist prior to receiving funding from SAMHSA/CSAT? If so,
what was the prior program? When did it begin? What was (were) the
source(s) of funding?
11. *What States are currently in the ATTC region?
12. *Which States, if any, are new to the region in the current funding cycle?
13. *What is the geographic size of the region – e.g., square miles?
14. *What is the population of the region?
15. *How many a) treatment providers and b) recovery support providers are in
the region?
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16. *Who are the major target audiences for the ATTC?
Probe for:
Primary and secondary audiences.
SECTION 3: ATTC GOALS AND OVERVIEW OF ACTIVITIES/
SERVICES
(ATTC Director,
Associate
Director,
Funded Grant
Application,
ATTC Work
Plan, GPRA)
Program Goals:
17. *What are the goals of the ATTC?
18. Have the goals of the ATTC changed over time? If so, how have they
changed and what are the reasons for the change?
19. How are these goals established?
Probe for whether goals are set by CSAT, by the ATTC, by the Advisory
Board, by States, by treatment providers, by other stakeholders within the
region, or by some combination of these stakeholders.
20. Are the goals of the ATTC likely to change during the five-year funding
period? If so, how often, and what would influence any change in ATTC
goals?
Overview of ATTC Services/Activities:
21. *What is the range of services/activities the ATTC is engaged in (e.g.,
classroom training, online courses, technical assistance, meetings/conferences,
academic programming, research dissemination, product development,
partnership development, other)? What would you estimate is the relative
percentage of ATTC effort that goes into your 3 or 4 major types of activities?
22. *How many individuals participate in ATTC services each year? Are the
number that participate in services what you would expect?
23. Where are services delivered?
24. Are services initiated by the ATTC or by the individuals or organizations the
ATTC serves?
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25. Are there specific key issues or conditions within the region as a whole and/or
in specific States that influence the range and type of ATTC services and how
they are provided?
Probe for:
Whether geography or size of the region affects how
services are provided.
26. Are there other organizations within your region or within individual States
that provide services and activities that are similar to those provided by the
ATTC? Who are they? Do you consider these organizations your
competitors? Why or why not?
Outreach and Publicity Efforts:
27. How are individuals and organizations within the ATTC region informed
about the ATTC’s services?
28. What mechanisms are used to publicize or promote ATTC activities? Probe
for: ATTC website, brochures, posters, etc. Request a copy of promotional
materials.
29. Are other organizations/agencies within the region involved in outreach for
the ATTC?
SECTION 4: ORGANIZATION AND STRUCTURE
(ATTC Director, Associate
Director, ATTC Evaluator
[as designated by a +],
Funded Grant Application,
Organization Chart,
Strategic Plan)
Organizational Structure:
30. *What organization or institution is the lead agency for the ATTC?
31. Is this organization/institution also the fiscal agent?
32. Where does the ATTC sit within the institution’s organizational structure?
Probe for:
University center, department, medical school, etc.
Ask for a chart that shows where the ATTC sits within the larger
institution.
33. What is the organizational structure of the ATTC?
Ask for an organization chart for the ATTC.
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Staffing Structure:
34. *What is the management structure of the ATTC?
35. Please describe the number of ATTC staff and their roles and responsibilities.
36. Which of these staff are full-time? Are any staff part-time? Are any
volunteers?
37. Are any staff also employed by other agencies, organizations, or partners?
38. Are there specific qualifications required for staff of the ATTC? Probe for
previous experience in the addictions field, specific degrees, certification.
39. What percent of your staff, both full and part time, turn over in a typical year?
Over two years?
40. Where are the ATTC staff located?
Probe for:
Whether all staff are co-located or located in different
parts of the region.
41. If some staff, are dispersed throughout the region, in what organizations are
field staff located?
42. How often are meetings held with the entire ATTC staff?
43. What is the purpose of these meetings?
44. To what extent do meetings address planning and service delivery issues?
External Influences on Organizational Structure and Staffing of the ATTC:
45. +How has the type of institution where the ATTC is housed affected:
a) The organizational structure of the ATTC?
b) The services of the ATTC?
c) The staffing of the ATTC?
46. +Are there other issues or conditions within the region that influence how the
ATTC is organized?
SECTION 5: ATTC ADVISORY BOARD
(ATTC Director, Associate
Director, Advisory Board
agendas, Minutes,
Rosters, Bylaws)
47. *Is there an advisory board for the ATTC?
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48. What role does it have?
Probe for:
Whether the advisory board has procedural/operational
guidelines, bylaws, etc. and, if available, request a copy.
49. *What is the composition of the board and how are members selected?
Ask for a list of advisory board members, their contact information (name,
organizational affiliation, address, phone number, e-mail address), and
the disciplines they represent. Complete Tables A1 and A2 in the
Appendix.
50. What is the membership term?
If no formal “term limits” exist, probe for how long board members
typically stay involved.
51. How often does the advisory board meet face-to-face?
52. How often does the advisory board meet via conference call, or some method
other than face to face?
53. Do ATTC staff consult with advisory board members at times other than
scheduled meetings or conference calls? If so, for what purpose?
Probe for:
Specific examples of when and why this occurs.
SECTION 6: PLANNING AND PRIORITY SETTING
(All respondents, Funded
Grant Application,
Strategic Plan, Needs
Assessments)
Overall Planning and Priority Setting Process:
54. How does the ATTC plan its overall service delivery program? Who is
involved in this process?
Probe for:
Whether planning occurs on an annual basis (or with some
other frequency) and at what point in the year?
Probe for:
Whether a formal needs assessment is conducted? If so,
what does this involve?
Probe for:
Involvement of the ATTC Advisory Board? ATTC staff?
SSA directors? Other regional stakeholders?
55. What role do each of the participants have in the planning process?
Complete Table A3 (see Appendix).
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56. What role does the CSAT project officer have in the ATTC’s planning
process? Are other CSAT staff involved? Other Federal agencies?
57. How does the ATTC set priorities among the various needs in the region?
Who participates in this process?
58. How is CSAT involved in setting priorities for the ATTC?
59. Does the ATTC involve the SSAs in planning and priority setting? If so, how
does this occur?
60. How often do priorities change and what are the circumstances that lead to
these changes?
Ask for examples of priority changes and the circumstances that led to
them? Distinguish between changes in priorities vs. changes in a specific
activity or event. Priorities are meant to be more general, potentially
involving a number of activities or events.
61. Does the ATTC have a work plan (or strategic plan) that is developed from
the planning process? If so, what time period does it cover?
If available, request a copy of the work plan.
62. *What components are included in the work plan?
Probe for:
Mission of the ATTC? ATTC goals? Strategies for
achieving goals? Action steps? Measures for assessing
progress toward achieving goals?
63. How often is the work plan updated?
64. How is the work plan used?
Probe for:
Using the plan to guide program planning and service
delivery? To allocate resources? To measure achievement
of ATTC goals?
65. To whom has the work plan been disseminated?
66. Aside from the planning process, what role do the Advisory Board, ATTC
staff, SSA directors, and other stakeholders have in deciding on the priorities
of the ATTC?
Workforce Survey (ATTC Director, Associate Director, ATTC Evaluator):
67. When does the ATTC plan to conduct its workforce survey in the current 5year funding period?
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If not sure, probe for: What considerations or influences will determine
this (i.e. what they are waiting for in order to decide).
68. When will the results of the region’s workforce survey be available?
69. How will the ATTC use the survey data and findings?
70. Will this be the first time a workforce survey has been conducted by the
ATTC? In the region? If not, when was the last survey conducted and what
part of the ATTC region and treatment workforce did it cover?
71. If a previous survey was conducted, how has the ATTC used the survey
findings? How have other organizations/agencies used the survey findings?
Best Practices:
72. In your opinion, are there specific planning processes that the ATTC has
implemented that you would consider “best practices”? Why?
SECTION 7: ATTC PARTNERS
(ATTC Director, Associate
Director, Partnership
Agreements, Committee
Meeting Agendas, ATTC
Work Plans, Strategic
Plan)
Planning Committees and Consortia:
73. In addition to the Advisory Board, does the ATTC have other committees or
consortia that collaborate with the ATTC for planning purposes?
74. If so, what is the composition of these committees/consortia?
Ask for a list of the members of each committee/consortium.
75. When were these committees/consortia created?
76. How often do they meet?
77. Do the committees/consortia have other roles in addition to planning?
Other Partners and Collaborators in the Delivery of Services:
78. At present, what organizations and/or agencies is the ATTC collaborating
with to provide technology transfer services?
Probe for:
Local, State, and Federal partners.
Complete Table A4 (see Appendix).
79. How long has the ATTC partnered with each organization/agency?
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80. What services/activities is each partner collaborating on?
81. What is each partner’s role?
Complete Table A4 (see Appendix).
82. Are any formal or informal agreements in place related to these
collaborations?
83. *Do organizational or agency partners provide funding to help support ATTC
activities?
If so, ask for details of these funding arrangements – e.g., how much, for
how long, to cover what activities?
Remind respondents of the privacy of their responses—i.e., no individual
ATTC will be associated with a specific response to any of these questions
AND the evaluation is not focusing on specific regions, but rather, the full
ATTC Network.
84. Does the ATTC provide funding or other resources to any of its partners to
support their collaboration with the ATTC?
If so, ask for details of these funding arrangements – e.g., how much, for
how long, to cover what activities?
85. Are there other organizations that the ATTC plans to collaborate with in the
future?
If so, for what purpose?
86. Are there organizations/agencies that the ATTC has wanted to collaborate
with, but has not been able to, to date?
Processes of Building New Partnerships and Relationships:
87. How has the ATTC gone about building new partnerships or relationships—
e.g., with new State directors (e.g., when there is turnover)? With new States
(for ATTCs that have had new States added to their regions)? With new
organizational partners?
Probe for:
Specific activities that were involved in building
relationships with States that are new to the ATTC region.
Ask for examples of two new partners (including SSAs) and the activities
that went into building a relationship with the partner.
88. When the director of the SSA turns over or when the ATTC has had to build a
relationship with a new State in the region, what has been important to the
ATTC’s success in building this relationship?
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89. Has the ATTC ever tried to build a new relationship or partnership and not
been as successful as you would like? If so, why were the ATTC’s efforts not
entirely successful?
90. What would you recommend that other ATTCs do when they are faced with
having to build new relationships?
Best Practices:
91. In your opinion, are there specific practices that the ATTC has used that you
would consider “best practices” for building and maintaining successful
collaborative relationships with States? With organizational partners? With
other stakeholders?
(ATTC Director,
Associate Director,
Technology Transfer
Specialists, NIDA
Blending Initiative
Coordinator, ATTC
Evaluator)
92. *What activities and services has the ATTC planned to provide during the
first year of its grant?
Complete Table A5 (see Appendix).
SECTION 7: SERVICE DELIVERY
93. What are the principal components of each activity/service?
Probe for:
Name of activity/service, duration of activity (e.g., 2-day
training), frequency of activity (e.g., same activity offered 2
times during the year).
94. Who is the target audience for each activity/service?
95. Has the ATTC planned its services for Year 2? If so, what activities and
services will the ATTC provide in the second year of the grant? What are the
principal components of each activity/service? Target audience(s)?
Probe for:
The reasons for any differences in Year 1 and Year 2
activities/services.
96. How did the ATTC decide on the activities and services it would provide each
year?
97. What influenced the types and mix of activities and services the ATTC is
providing?
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98. Are there specific activities that the ATTC is providing that are aimed at
preparing the treatment and recovery workforce to deliver services in
recovery-oriented systems of care?
99. Are there regional needs that are within the mission of the ATTC that cannot
be met because of resource constraints or staff capacity issues?
NIDA Blending Initiative:
100. *How many NIDA-funded Clinical Trials Network (CTN) nodes are located
in your region? Do you work closely with any of them? How, or in what
topical areas?
Probe for:
Examples and relate back to previous discussion about
partners and collaborators.
101. *Are there particular evidence-based practices (EBPs) in addictions
treatment that are the focus of the ATTC’s activities? Which EBPs are you
focusing on? What services/activities are related to these EBPs?
102. What activities does your ATTC provide to support the NIDA Blending
Initiative?
103. What ATTC staff are involved in these activities?
104. Are you working with other regional ATTCs? Which ones and on which
EBPs?
105. Which ATTC partners work with the ATTC to support the Blending
Initiative? For each, what is their role?
Bundling of ATTC Activities and Services:
106. Does the ATTC “bundle” activities and services within a topical/content area
and, if so, how is this done?
Note: Bundling means that multiple activities and services are connected
to each other—e.g., training that is followed by technical assistance on the
same topic; development of products that support training or technical
assistance, etc.; or activities/services aimed at raising awareness followed
by activities/services that are aimed at skill building and/or practice
change.
107.
What activities/services address:
a) Regional needs?
b) State needs?
c) National needs?
108.
What determines this mix of services?
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Immediate Service Needs:
109. Are some activities planned well in advance and others planned in response
to more immediate issues or needs as they arise?
Ask for examples of each, including 2-3 examples of activities that occur
in response to immediate needs.
110. How does the ATTC become aware of these immediate needs and what are
the factors that affect decision making about whether the ATTC will respond
to these needs or service requests?
Probe for:
Whether requests from particular entities/individuals
(SSAs, CSAT) have higher priority. If an explicit set of
criteria or decision tree exists, request a copy.
111. What proportion of the ATTC’s activities is planned in advance vs. activities
that are responsive to more immediate needs?
112. Is there a formal stance taken on this proportion, or some notion that a
certain proportion of resources are reserved for immediate needs? If not, how
do immediate needs fit in or affect more formally developed service plans?
Do they force revisions?
113. Are there occasions when the ATTC is asked to provide a service to meet a
specific, targeted need and is not able to provide the service? If so, how often
does this happen and what are the reasons why the service cannot be
provided?
Probe for:
Resource constraints? Staff capacity? Requests that fall
outside the mission of the ATTC? Other reasons?
Coordination of Services:
114. How does the ATTC avoid duplicating efforts of other agencies and
organizations within the region—e.g., SSAs, CAPTs, NIATx or other
discretionary funding grantees, other HHS training centers, etc.?
115. How does the ATTC collaborate with other organizations in delivering its
services?
Ask for examples of collaboration with each of these
agencies/organizations. If they are discretionary funding grantees, be
explicit about the funding agency (e.g., CSAT, NIDA) and the
discretionary grant program (e.g., SBIRT, CTN).
116. How does the ATTC collaborate or coordinate with other ATTCs to provide
services? Please explain.
Site Visit Protocol and Interview Guide
19
Best Practices:
117. In your opinion, are there specific practices that the ATTC has used that you
would consider “best practices” for delivering services within the region?
(ATTC Director,
Associate Director,
Technology Transfer
Specialists, Blending
Initiative Coordinator,
ATTC Evaluator,
Strategic Plan, ATTC
Work Plan)
118. In general, what are the expected outcomes of the ATTC’s technology
transfer activities?
SECTION 9: TECHNOLOGY TRANSFER STRATEGIES
119. What are the technology transfer objective(s) for each of the ATTC’s
activities/services?
Complete Table A3 (see Appendix). We are not looking for narrative
statements of TT objectives here but, rather, a selection among the 3 TT
objectives specified in the evaluation logic model: (a) awareness raising,
(b) skill building, or (c) practice change.
120. How does the ATTC decide on the specific technology transfer objective(s)
for each of its activities?
121. Are the Advisory Board and/or other planning committees involved in these
decisions?
122. What proportion of ATTC activities fall within each technology transfer
objective—awareness raising, skill building, changing practice?
Refer to February 2007 Activity Inventory for this ATTC, if available,
when asking this question.
123. Has the emphasis on these different technology transfer objectives changed
over time? If so, how and why? Do you see it changing during the 4 or 5
years remaining in the current funding period? If so, how and why?
124. What range of technologies does the ATTC use to provide services?
Probe for:
Online courses, Web conferencing, video/audio
teleconferencing, CD-ROM, streaming video, information
dissemination via ATTC website, etc.
125. How does the ATTC select the technology transfer strategies to use?
Site Visit Protocol and Interview Guide
20
Best Practices:
126. In your opinion, are there specific strategies that the ATTC has used that you
would consider “best practices” for technology transfer?
SECTION 10: ATTC FUNDING
(ATTC Director, Funded
Grant Application, ATTC
Work Plan)
127. *What is the ATTC’s total budget?
Ask for a copy of the budget.
128. What are the ATTC’s current and anticipated sources of funding in the
current year?
129. What amount is from what source?
130. Are certain funding sources designated for particular activities?
131. What proportion of the ATTC’s budget is the ATTC grant it receives from
SAMHSA/CSAT?
132. Has the ATTC been able to leverage its SAMHSA/CSAT grant to obtain
resources from other sources? Please explain.
133. Does the ATTC receive revenue (tuition, fees) from any of its
activities/services? How much and for what?
134. What are the ATTC’s greatest resource needs?
(ATTC Director, Evaluator,
Evaluation Plan,
Evaluation Reports)
135. Is there a formal, written evaluation plan for the ATTC? How long a period
of time does it cover? Is it shared with or reviewed by anyone?
Request a copy.
SECTION 11: PROGRAM EVALUATION
136. What kinds of data are routinely collected to monitor and evaluate ATTC
activities and services?
137. Who collects the data?
Site Visit Protocol and Interview Guide
21
138. How are the data maintained (computerized or on paper)?
139. What is done with the data that are collected? How are the data used?
140. Does the ATTC prepare evaluation reports? If so, what reports? How often?
With whom are the reports shared?
Request copies of any reports that are available.
141. From your perspective, what could the ATTC do to improve its services and
activities?
142. From your perspective, what could the ATTC do to enhance the outcomes of
its activities and services?
SECTION 12: CHALLENGES AND SUCCESSES
(ATTC Director, Associate
Director, ATTC Evaluator,
Evaluation Reports)
143. What have been the ATTC’s major challenges?
144. How have these challenges been overcome (if at all)?
145. What do you consider the biggest success(es) of the ATTC so far? What
factor(s) led to this success?
146. If you could make any change in the way the ATTC plans and provides its
services, what would it be and why?
147. Is there anything you would like to add to what we have already discussed?
Site Visit Protocol and Interview Guide
22
APPENDIX
Site Visit Protocol and Interview Guide
23
Table A1: Types of Organizations Represented on the ATTC Advisory Board, Fiscal Year
2008
Type of Organization
Number of Individuals
% of Total
Addiction Education
(College/ University)
Certification Board
Child Welfare
Criminal Justice
Federal Agency
Healthcare Agency/Organization
Professional Association
Recovery Organization
Research Center/ Organization
SSA
Treatment Provider Organization
Other:____________________________
Other:____________________________
TOTAL
Site Visit Protocol and Interview Guide
24
Table A2. Disciplines Represented on the ATTC Advisory Board, Fiscal Year 2008
Discipline
Number of Individuals
% of Total
Addiction Research
Addiction Treatment
Counseling
Criminal Justice
Education
General Medicine/Primary Care
Law
Mental Health
Nursing
Psychology
Substance Abuse Prevention
Other:____________________________
Other:____________________________
Other:____________________________
TOTAL
Site Visit Protocol and Interview Guide
25
Table A3: Agency and Organizational Partners Involved in Planning ATTC Services, Fiscal Year 2008
Partner Agency or Organization
Site Visit Protocol and Interview Guide
Scope of
Agency/Organization
(Local, State,
Regional, National)
Advisory Board or
Other Planning
Committee
(Provide name)
# of Years
Involved in
ATTC Planning
Activities
Role in Planning ATTC Services
26
Table A4: Agency and Organizational Partners Involved in Delivering ATTC Services, Fiscal Year 2008
Partner Agency or
Organization
Scope of
Agency/Organization
(Local, State,
Regional, National)
Site Visit Protocol and Interview Guide
# of Years
Partnering
with ATTC
to Deliver
Services
ATTC Activity(ies)
Role in Delivering ATTC Services
27
Table A5. Activities and Services Provided by the [Name of ATTC], Fiscal Year 2008
Activity/Service
Principal Components of
Activity/Service
Tech Transfer
Objective(s)
(a) Awareness
(b) Skill Building
(c) Practice
Change
Organizational or
Agency Partners
Frequency
(# of Times
Provided
During
Year)
Target
Population
REGION-WIDE ACTIVITIES
STATE-SPECIFIC ACTIVITIES
NATIONAL ACTIVITIES
Site Visit Protocol and Interview Guide
28
Attachment C
Focus Group Protocol
OMB No. 0930-xxxx
Expiration Date:
NATIONAL EVALUATION OF
THE ADDICTION TECHNOLOGY TRANSFER CENTER (ATTC) NETWORK
Focus Group Protocol
General Guidelines for Conducting Focus Groups with ATTC Field Staff
The national evaluation of the Addiction Technology Transfer Center Network includes
focus groups with ATTC field staff at each ATTC. These two-hour focus groups will be
conducted during three-day site visits to each ATTC. The purpose of the focus groups is to
gather information about the technology transfer process at each ATTC, including how
ATTCs plan and deliver services within their regions and how staff participate in the
planning and service delivery process. Focus group participants will also be asked to
identify potential best practices in planning and service delivery, and to offer suggestions
about how planning and service delivery processes could be improved.
The lead site visitor will arrange the focus group, with assistance from the ATTC
director, while planning for the site visit (see Site Visit Protocol) and may contact ATTC
field staff individually before the visit to discuss the purpose of the focus group and ask for
their participation. Each staff person should be given a copy of the consent form and be
asked to read and sign it before the focus group begins.
During the focus group, participants will be asked to offer their opinions about a
number of topics. In some instances, individuals’ opinions may be erroneous or
misinformed. However, it is important for the focus group moderator to understand that
the discussion is not about right or wrong answers. Instead, the purpose is to uncover
ideas and opinions about ATTC planning and service delivery practices. Participants
should be encouraged to be honest and will be guaranteed privacy.
The Focus Group Protocol includes four main sections and a series of questions within
each section. The role of the focus group moderator is to facilitate the discussion so that
all topics of interest are addressed. However, the questions do not need to be asked
word-for-word or in order. Often the discussion happens in a circuitous manner,
depending on the individuals involved and their interest in and knowledge of the topic
areas. The moderator should be familiar with all questions on the protocol and return to
topics that are “skipped over” in the course of the discussion.
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-xxxx. Public reporting burden for
this collection of information is estimated to average 2 hours per group, including the time for
reviewing instructions, searching existing data sources, gathering the data needed, and
completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 71044, Rockville, Maryland, 20857.
Focus Group Protocol
1
INFORMED CONSENT FORM: ATTC STAFF
Voluntary Consent to Participate in a Focus Group:
Discussing the ATTC and Your Role
in the ATTC’s Planning and Service Delivery Process
INTRODUCTION
You are being invited to take part in a focus group that is being conducted as part of the
national evaluation of the Addiction Technology Transfer Center (ATTC) Network. A
focus group is a small group discussion of 4-6 people. You have been asked to participate
because you are a staff member who works for the ATTC and serves as a liaison with one or
more States in the ATTC region or with one or more of the ATTC’s potential target
audiences.
Focus groups are being held with staff at each ATTC during site visits that are being
conducted for the national evaluation. The Center for Substance Abuse Treatment
(CSAT), Substance Abuse and Mental Health Services Administration, is sponsoring this
study. The MANILA Consulting Group, a research company in McLean, Virginia, along
with two subcontractors—RMC Research Corporation and Abt Associates Inc.—is
carrying out the evaluation. At MANILA Consulting Group, Richard Finkbiner is the
Project Director. These focus groups will help the evaluation team, and CSAT,
understand how ATTCs plan and deliver services within their regions; how staff
participate in the planning and service delivery process; and best practices in planning
and service delivery, along with how these processes could be improved. The evaluation
team wants to learn about these issues from ATTC field staff. You are being asked to
sign a consent form to participate in the focus group.
PURPOSE
The purpose of this focus group is to learn about the experiences of ATTC staff.
If you choose to participate you will be asked to join with other ATTC staff in a 2 hour
discussion about your work with the ATTC. The group will be facilitated by an
interviewer from the MANILA evaluation team.
The focus group will last approximately 2 hours and will be audiotaped so the
evaluation team can ensure accurate quotes (without attribution) in project reports and full
documentation of the discussion. Information collected during the focus groups will be used
to describe the ATTC planning and service delivery processes from the perspective of field
staff. The discussion will be kept private. The findings from the discussion will be
summarized, along with other data that are collected. Your name will not be associated with
any comments you make. You can choose not to answer a particular question during the
focus group, without affecting your continued participation in the group.
RISKS OF TAKING PART IN THE STUDY
The main risk to you of participating in this focus group is that your privacy might not
be preserved by other participants in the group. The evaluation team will do everything
Focus Group Protocol
2
allowable by law to assure that your privacy is protected.
COSTS AND FINANCIAL RISKS
There are no costs for participating in the focus group.
POSSIBLE BENEFITS OF TAKING PART IN THE STUDY
As staff of the ATTC, you are supporting the national evaluation effort and the future
improvement of the Network by participating in this focus group. You may also benefit
from the opportunity to hear about other staff member’s experiences within the ATTC
region.
COMPENSATION
You will not receive compensation for participating in the focus group.
PRIVACY
Information collected in the focus group will be kept private to the maximum extent
allowed by law.
The focus group discussion and its audiotapes will be labeled with a study code, and
will not include your name or the names of others in the group. The tapes will be kept in
a locked file in the offices MANILA Consulting Group, RMC Research Corporation, or
Abt Associates Inc. The tapes may be transcribed for use by the evaluation team, and any
information that can be linked to an individual will be removed. The comments made
during the focus group, will be used in reports to the government, in summary form only;
no names will be included in the report.
PARTICIPATION IS VOLUNTARY
It is up to you to decide whether to be in the focus group. If you decide not to
participate in the focus group, you will not be penalized in any way. Even if you agree to
participate, you are not required to answer all the questions you are asked.
QUESTIONS
You may call Richard Finkbiner of MANILA Consulting Group (703-772-4906) to
have your questions answered.
STATEMENT BY PERSON AGREEING TO PARTICIPATE IN THIS FOCUS
GROUP
I have read and understand this information. I have had all my questions answered
fully and I freely and voluntarily choose to participate in the focus group. I have been
given a copy of this consent form.
___________________________
__________________________
Name (Please print)
Signature
Focus Group Protocol
Date
3
Focus Group Protocol – Interview Guide
A. Introduction (5 minutes)
Note to moderators: Highlighted comments are not to be read as part of the guide.
Comments in brackets are to be read when appropriate.
Hi, my name is [name of lead site visitor] and this is [name of associate site visitor].
I’m with [name of company] and [first name of associate site visitor] is with [name of
company]. We’ll be leading the discussion today.
We’re conducting this focus group as part of the national evaluation of the ATTC
Network. We are not evaluating this ATTC, but rather the Network as a whole. The
purpose of our discussion today is to learn how you work with States and others in the
region to plan and deliver services. We are interested in learning about differences in
how each of you does this across the region, and about best practices that might benefit
the Network as a whole. The overall goal of the national evaluation is to identify
successful technology transfer efforts across the Network and to share best practices and
lessons learned among the ATTC regions for the improvement of all regions’ activities.
We’ll be holding focus groups like this one with staff at each ATTC.
You should have received an informed consent form to sign. Is there anyone here
who did not sign the form?
IF YES, give the individual a Consent Form to read and sign.
IF NO, Does anyone have any questions about the evaluation or about your
participation?
Answer any questions raised by participants.
How Focus Group Will Work
Before we get started, I just want to go over how this focus group will work:
•
We want to keep the discussion informal and relaxed.
•
You may eat or leave to use restroom as you like.
•
If anyone wants to take a break during the discussion, just let me know.
•
During the discussion, you should feel free to ask each other questions if
something is not clear.
•
There are no right or wrong answers.
•
If you disagree with what someone else says or do something differently in your
work, please say so.
Focus Group Protocol
4
•
If something isn’t clear, please ask me to explain it.
•
Please don’t talk all at once; I don’t want to miss anything that is said.
•
I also want to make sure we hear from everyone; don’t take it personally if I am
encouraging a quiet person to speak or not encouraging a talkative person to
continue.
•
Before we get started, I’d like to ask that we maintain privacy of responses. It is
up to each of you to keep what we discuss today private and not repeat what’s
been said outside the group. Can everyone agree to that?
•
We’ll be taking notes and also audiotaping the discussion. Is everyone OK with
this? Our reports may contain quotes from this focus group, but will not include
names or identifying information.
•
Does anyone have any questions?
Introductions
I’d now like to go around the table and ask each of you to introduce yourselves.
Please say:
•
•
•
•
•
•
Your name;
How long you’ve worked at the ATTC;
Where your office is located;
Whether you work full-time or part-time at the ATTC;
If you work part-time with the ATTC, what percentage of your time is with the
ATTC, and whether you work with an other organization; and finally
What States or parts of the region you work with.
Consider writing these six points on a flip chart, so participants can refer to them as
they make their introductions.
B. Getting Started (15 minutes)
1. First, tell us what you find to be the most rewarding aspects of your job.
Probe: Why is this the most rewarding aspect?
2. And, what are the most challenging aspects of your job?
Probe: Why is this the most challenging aspect?
3. What three activities or job responsibilities take up most of your time?
Focus Group Protocol
5
C. Technology Transfer Process (65 minutes)
Now I’d like to discuss the technology transfer process and hear about your role in
each part of this process: the needs assessment process, the planning process, the process
of working with partners and the delivery of services, and follow-up after service
delivery. Please answer the questions as they relate to the scope of your own work. In
other words, if you work with a particular State in the region, please answer the questions
as they relate to your experience with this State. On the other hand, if your work
involves all (or several) States, please answer the questions from this perspective.
Needs Assessment Process (20 minutes)
4. How does the ATTC learn about needs within the region?
Probe:
Is there a formal needs assessment process, or is it more
informal?
Are the field staff involved in assessing needs?
5. In your opinion, does the ATTC have good information about the needs within
each State?
6. Do you think the ATTC is well informed about the needs of various stakeholders
within the State, such as treatment providers, certification boards, clinicians,
special populations, related professions, and others?
7. When identifying needs, does the ATTC determine whether the need is for (a)
awareness about a particular issue, topic, or practice, (b) skill building, or (c)
change in practice or policy?
8. How do you think the ATTC could improve its needs assessment process?
Planning Process (20 minutes)
9. Once the ATTC identifies needs within the region, how does it decide on the
services it will provide overall and within a particular State?
Probe:
What factors are important to these decisions:
• Budget
• Staffing resources
• Balancing priorities and needs across the region
• Balancing regional needs with national or Federal
needs and priorities
• Availability of services in other agencies/organizations
(including other ATTCs)
• Amount of time needed to plan/design the service
• Other?
Focus Group Protocol
6
10. How are you involved in the service planning process?
11. When needs arise outside the regular needs assessment or planning process, how
are these needs or requests for services handled?
12. What do you think are the key factors that make the ATTC’s planning process
successful?
13. What could be done to make the planning process better?
Partnering and the Service Delivery Process (20 minutes)
14. From your experience, to what extent is the ATTC proactive vs. reactive in its
provision of services?
Probe:
What proportion of the ATTC’s services are proactive?
What proportion are reactive?
15. What proportion of the ATTC’s services is focused on promoting the adoption of
evidence-based practices vs. addressing other issues within the region?
16. Which evidence-based practices are being addressed?
17. What are the other key issues that the ATTC is focusing on?
18. To what extent does the ATTC partner with other organizations to provide
services?
Probe for:
How often and when does this occur?
What are some examples of partnering and, for each
example, who are the partner organizations?
19. What strengths do you utilize to build partnerships with others?
20. Have there been barriers or challenges to partnering with others?
21. What types of technologies or innovative technology transfer strategies has the
ATTC used to deliver services?
Probe for:
Examples of when web-based or other strategies have been
used.
Focus Group Protocol
7
Technology Transfer Process
As technology transfer specialists, we are also interested in learning more about your
perspective on the technology transfer process.
22. How is addiction science – for example, best practices, treatment models,
technology, and so on – translated for clinicians, providers, and others in your
region?
Probe for:
Is there a formal process?
Who is involved in the process?
Does the process vary by audience served?
Is feedback collected?
23. How is addiction science (best practices, treatment models, technology, etc)
adapted or made relevant culturally within your region?
Probe for:
Is there a formal process?
Who is involved in the process?
Does the process vary by audience served?
Is feedback collected?
24. How often do you participate in the development of national products?
25. How often do you contribute to the development of products for other regions?
26. Can you provide examples of culturally appropriate products and services that
you have developed or helped to develop to meet specific needs in the region?
Probe for:
Their involvement in the development process, what the
process has entailed, and what needs were met.
27. Do you think the ATTC is doing a good job of addressing unique cultural issues?
Probe for:
Why they give the responses they do.
28. From your perspective, are States and others you work with getting their needs
met by the ATTC?
Probe for:
Why they give the responses they do.
29. From your perspective, do you receive the support you need to do your job and to
meet the needs within the region?
Follow-up After Service Delivery (5 minutes)
30. To what extent is there follow-up to assess whether additional services are
needed, after the ATTC has provided a particular service?
Probe for:
The type of follow-up, whether it happens routinely or is ad
hoc, and how participants are involved.
Focus Group Protocol
8
31. When other services are provided to the same individual or organization as a
follow-up to a previous service, is the technology transfer objective usually the
same or different?
Probe for:
Examples and how the technology transfer objective is
established.
32. Please think about one ATTC service or activity that you’ve been involved with
over the past year. I’d like each of you to give us the name of the activity, tell us
who was involved in providing the service, who the recipients were, and what the
impact or outcomes of the service have been to date.
D. Wrap-Up (15 minutes)
To wrap-up, I’d like you to think broadly about what the ATTC is doing especially well
and what it could do differently.
33. If you could name one thing that the ATTC is doing especially well and that
could be considered a best practice for this ATTC, what would it be?
Probe for:
Why they give the responses they do.
34. If you could recommend that the ATTC do one thing differently, what would it
be?
Probe for:
Why they give the responses they do.
Thank you for your participation in the focus group today! We will be here for a few
more minutes, if you have questions or other comments.
Focus Group Protocol
9
Attachment D
Key Informant Interview Protocol
OMB No. 0930-xxxx
Expiration Date:
NATIONAL EVALUATION OF
THE ADDICTION TECHNOLOGY TRANSFER CENTER (ATTC) NETWORK
Key Informant Interview Protocol
Guidelines and Instructions
The Key Informant Interview Protocol will be used by the national ATTC evaluation
team to collect data from a sample of key stakeholders in each ATTC region. Stakeholders
will include Single State Agency Directors, addiction educators, treatment provider
association presidents, cultural leaders, and leaders of recovery associations. Interviews with
these stakeholders will be conducted by telephone.
The purpose of the key informant interviews is to understand how the ATTCs engage
stakeholders in their planning processes and the partnerships they develop with stakeholders
for service delivery. The key informant interviews will also provide information about the
types of services for which stakeholders contact the ATTCs, their general satisfaction with
these services, and their perceptions of the benefit and impact of the ATTCs within the
addictions treatment and recovery field.
Interviewers will call each informant in advance to schedule a time for the interview. A
script for this call is provided on the next page.
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-xxxx. Public reporting burden for
this collection of information is estimated to average 1 hour per interview, including the time
for reviewing instructions, searching existing data sources, gathering the data needed, and
completing and reviewing the collection of information. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 71044, Rockville, Maryland, 20857.
Key Informant Interview Protocol
1
Introductory Script
Hello, my name is [name]. I am a member of the team that is conducting the national
evaluation of the ATTC Network under contract with the Center for Substance Abuse
Treatment.
The National Evaluation is interviewing key stakeholders in each ATTC region to learn
how ATTCs work with organizations and individuals in their region to plan and deliver
services. Interviews will be conducted by telephone and will last approximately 1 hour.
Everything you say in the interview will be kept private, and we will not identify you by name
in our reports.
May we interview you for the evaluation?
IF NO:
Thank you for speaking with me today. Goodbye.
IF YES:
We are scheduling interviews over the next two weeks. Is there a particular
date and time during this period that would be convenient for you?
IF THE INFORMANT IS NOT AVAILABLE DURING THIS PERIOD, ASK WHEN HE/SHE
WOULD BE AVAILABLE.
DATE AND TIME: _________________________________________
NAME OF INFORMANT: ____________________________________
What number should I call to reach you for the interview?
TELEPHONE NUMBER: ____________________________________
May I also get your email address, so that I can send you an email confirming the date
and time of the interview?
EMAIL ADDRESS: _________________________________________
Would you like me to e-mail you in advance a copy of the questions I will be asking you
in the interview?
Thank you for your interest in participating in the evaluation. I look forward to speaking
with you on [date]. Goodbye.
SUGGESTED TEXT FOR FOLLOW-UP EMAIL:
Thank you for your interest in participating in the National Evaluation of the Addiction
Technology Transfer Centers. As we discussed, I will call you on [date] at [time] to
interview you for the evaluation. The interview will last approximately 1 hour. I will
call you at [telephone number]. (If applicable: Attached are the questions I will ask
you during the interview).
If you have questions or need to reschedule, please don’t hesitate to contact me by
email orInterview
phone (your
telephone number). I look forward to talking with you.
Key Informant
Protocol
2
Key Informant Interview Guide
Note to interviewers: Highlighted comments are not to be read. Comments in brackets are to
be read when appropriate.
A. Background Information
1. What is your position title?
2. How long have you been in this position?
3. What are the responsibilities of this position?
4. What position did you hold previously?
4a. What organization was this with?
If organization is the same as current organization, SKIP to Question 6.
5. Where is this organization located?
6. How long were you in that position?
7. How long have you worked in the addictions treatment and recovery field?
B. Nature of Interaction with ATTC
8. In the past 3 years, have you had any interaction with the [name of ATTC]?
If No:
8a. Have you had interaction with any other ATTC?
If No to Question 8a, SKIP to Question 14 and ask Questions 15 - 18. Then
SKIP to Question 31.
If Yes:
8b. Which one?
9. What type of interaction have you had with the [name of ATTC] during the past 3
years?
Probe for:
9a. Have you participated in training events offered by the ATTC? If Yes¸ what
training events did you participate in? (Focus on training topics, rather than
dates or places)
Key Informant Interview Protocol
3
9b. Have you been the recipient of technical assistance provided by the ATTC? If
Yes, what technical assistance did you receive? (Focus on TA topics, rather
than dates or places)
9c. Have you attended any meetings or conferences sponsored by the ATTC? If
Yes, what meetings or conferences did you attend?
9d. Have you received or used any ATTC products? If Yes, what 3 – 5 products
were most significant or useful to you?
9e. Have you visited the ATTC’s website? If Yes, what were you searching for
on the ATTC website?
9f. Have you participated on any ATTC planning committees? If Yes, which
one(s)? Are you currently a member of this (these) committee(s)?
9g. Have you (or your organization/agency) partnered with the ATTC to jointly
sponsor an event? If Yes, which one(s)?
C. Planning and Priority Setting
10. What are the three most important needs or highest priorities for your organization,
and the addictions treatment field more generally?
10a. In your opinion, is there a role for the ATTCs in addressing these issues?
10b. How well do you think the ATTC’s services meet these needs?
11. What role have you (or anyone in your organization) had in helping to identify the
regional priorities that should be addressed by the ATTC?
12. What role have you (or anyone in your organization) had in helping to plan the
services offered by the [name of ATTC]?
13. If informant has had a role in identifying priorities and/or planning: In what
ways do you think your participation in priority setting and/or planning has
influenced the services offered by the [name of ATTC]?
14. In your opinion, are there specific planning processes that the ATTC has
implemented that you would consider “best practices”? Why?
15. From your point of view, what other needs, if any, are not being met by the [name of
ATTC] at this time?
16. What do you believe the reasons for this are? Probe for: higher priorities exist,
resource constraints, need to balance priorities across the region?
D. Partnering
17. Have you or your organization partnered with the ATTC on specific activities or
services during the past 3 years?
Key Informant Interview Protocol
4
If Yes:
17a. Who initiated the partnering relationship?
17b. Why did you want to partner with the ATTC?
17c. When did you begin to partner?
17d. On which activities or services have you partnered?
17e. What was your (your organization’s) role as a partner? Probe for whether
the partnership involved collaboration on planning and/or service delivery,
financial support, etc.
If No:
17f. Have you tried to partner with the ATTC and not been able to? If No, SKIP
to Question 22.
18. What barriers or issues have you encountered, if any, when partnering (or trying to
partner) with the ATTC?
18a. How have you overcome these barriers or issues?
18b. On any occasion, have you found partnering to be difficult because:
• You and the ATTC had different philosophies about a topic?
• The ATTC was constrained due to federal policy on an issue?
• Your agreed upon statement of work with CSAT placed limitations on
what you could work on?
• There was inadequate time to pursue certain topics or interests?
19. What is important to you (or your organization) when deciding whether to partner
with the ATTC?
20. What benefits have you received from partnering with the ATTC?
21. Are there plans for you (or your organization) to partner with the ATTC in the
future?
If Yes:
21a. On what activities or services?
E. ATTC Service
22. For what kinds of needs do you contact the ATTC, or view them as a resource? Why
do you see them as a resource in these areas?
23. Are there other types of needs where you would contact another resource rather than
the ATTC?
Key Informant Interview Protocol
5
If Yes:
23a. Who would you contact and why?
24. In your opinion, how well does the ATTC do in translating the latest research on
addictions treatment to practical knowledge and tools that are of use to the field?
24a. How well does the ATTC do compared to the other groups or resources you
mentioned (i.e., in 23a)?
25. Have there been occasions when you’ve asked for assistance from the ATTC and
they have not been able to help you? When has this happened?
26. In general, how satisfied are you with the services you’ve received from the [name of
ATTC]?
Probe for: very satisfied, satisfied, dissatisfied, very dissatisfied and for reasons why
the respondent feels this way?
27. In general, how strong is your (or your organization’s) relationship with the [name of
ATTC]? If informant says the relationship is strong or very strong, probe for:
Specific practices that the ATTC has used that the informant would consider “best
practices” for building and maintaining successful relationships. If not very strong,
probe for reasons and see if they converge to the barriers and issues discussion in
item 18 above.
F. Benefit and Impact of ATTC
28. In summary, how has the [name of ATTC] benefited you (or your organization)?
29. Are there specific achievements or changes in practice or policy that you would point
to as examples of the value of the ATTC?
If Yes:
29a. How has the ATTC supported or contributed to this achievement or change?
30. Given your exposure to the [name of ATTC] and its work, what impact if any has the
[name of ATTC] had on the addictions field?
30a. Would you consider this impact to be more short or long term?
30b. What are the keys to sustaining this impact?
30c. Has the provision of addiction treatment benefited?
30d. Do you feel there is a stronger substance abuse treatment workforce as a
result of the ATTC’s efforts?
31. In your opinion, what one improvement could the ATTC make to serve you better?
Key Informant Interview Protocol
6
32. From the perspective of your organization, if the ATTC Network were to go away,
would addiction treatment field be worse off?
If Yes:
32a. What would be the biggest loss?
33. This is the end of my questions. Is there anything else you would like to add that we
have not covered?
Thank you for sharing your comments with me today.
Key Informant Interview Protocol
7
Attachment E
Collaborative Functioning Survey
OMB No. 0930-xxxx
Expiration Date:
NATIONAL EVALUATION OF
THE ADDICTION TECHNOLOGY TRANSFER CENTER (ATTC) NETWORK
Regional Advisory Board Survey
This survey is part of a federally funded evaluation of the Addiction Technology
Transfer Center (ATTC) network. It is intended to gather your opinions about the
planning processes you are involved in with your regional ATTC. Throughout the survey
we use the terminology “Regional Advisory Board” to refer to a region-wide group
formally convened and consulted by the ATTC to advise its product development and
service delivery. We realize that you may be involved in a number of planning groups,
and that you may have been involved in planning groups for other ATTC regions in the
past. For purposes of this survey, however, please respond to the questions with reference
to this particular ATTC region (pre-coded just prior to Section 1 below). Furthermore,
please respond to the questions with reference to all the years you have been involved
with this ATTC group. Please be candid in your responses to all items on the survey, as
this will allow us to better understand the planning and collaboration that exists among
key stakeholders in all ATTC regions.
While we ask for some background information about you, your responses will
remain anonymous and kept private. The analysis and reporting of data collected via this
survey will always be done at a group level, and no responses will ever be associated
with the individual who provided them.
Please note that while your responses are highly valued, your participation in this
survey is strictly voluntary. You have the right to refuse to complete this survey. Any
questions regarding this survey, should be directed to Richard Finkbiner, Ph.D., ATTC
Evaluation Project Director, (571) 633-9797, ext. 206.
ATTC Region: _______________________
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-xxxx. Public reporting burden for
this collection of information is estimated to average 30 minutes per interview, including the
time for reviewing instructions, searching existing data sources, gathering the data needed, and
completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 71044, Rockville, Maryland, 20857.
1
Collaborative Functioning Survey
SECTION 1: BACKGROUND INFORMATION
1. How long have you been a member of this ATTC Regional Advisory Board?
Less than a year
1-3 years
4-6 years
6-10 years
More than 10 years
2. In addition to this group, how long had you been a member of another
ATTC’s Regional Advisory Board?
I have not been a member of any other regional ATTC’s Regional Advisory
Board
Less than 4 years
4-10 years
More than 10 years
3. In the ATTC’s current funding period (beginning October, 2007),
approximately how many new members have been added to the membership
of the Regional Advisory Board?
No new members
One or two new members
3-5 new members
6-10 new members
More than 10 new members
Not sure
4. How long have you worked in the addictions field?
Less than 5 years
6-10 years
11-15 years
16-20 years
More than 20 years
2
Collaborative Functioning Survey
5. Which of the following best characterizes the constituency you are
representing (or the person you are representing if you do so on a regular
basis)?
Single State Agency (SSA)
Treatment provider association
Local treatment agency directors
Addictions counselors
Addiction educators
Certification board
Other. (Please specify: ________________________________)
6. How regularly have you attended these Regional Advisory Board meetings?
I rarely attend or participate in the meetings (i.e., less than 20% of the
meetings)
I attend or participate in some, but fewer than half, of these meetings (20% 40%)
I attend or participate in about half or a little more than half of these meeting
(40% - 60%)
I attend almost all of the meetings (60% - 80%)
I hardly ever miss these meetings (80% - 100%)
7. Outside of these formal regional planning meetings, how frequently do you
interact with the ATTC staff in this region?
Rarely. Most of my contact with the ATTC is in the context of these meetings
Several times a year
Almost monthly
More than once a month
The questions in the following sections attempt to tap into the ways in which the members of the
Regional Advisory Board collaborate with each other in this ATTC planning process, and the
ways in which the ATTC interacts with the group.
3
Collaborative Functioning Survey
SECTION 2: ATTC INTERACTION WITH THE REGIONAL ADVISORY BOARD
Interactions between ATTC and Board
1 = “strongly disagree”
5 = “strongly agree”
8.
The ATTC leadership understands the values and culture of the organization I
represent on this Regional Advisory Board.
1
2
3
4
5
9.
The ATTC leadership encourages expressions of all points of view in
discussions among Regional Advisory Board members.
1
2
3
4
5
10. The ATTC leadership effectively manages different points of view and/or
resolves any conflicts in discussions among Regional Advisory Board members.
1
2
3
4
5
11. The ATTC leadership makes effective use of the skills and expertise of its
Regional Advisory Board members.
1
2
3
4
5
12. Regional Advisory Board meetings are well organized and well run by the
ATTC.
1
2
3
4
5
13. The services and products provided by the ATTC accurately reflect the needs
determined and decisions made in consultation with this Regional Advisory
Board.
1
2
3
4
5
14. The ATTC is effective in assembling sufficient resources and expertise to
address the most important priorities and needs identified by this Regional
Advisory Board.
1
2
3
4
5
15. The ATTC is making sufficient progress in meeting the needs of substance
abuse treatment systems across the region
1
2
3
4
5
16. Please elaborate on your response to Item 15. Why (or why not) do you feel
the ATTC is making sufficient progress in meeting the needs of the region?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
4
Collaborative Functioning Survey
SECTION 3: REGIONAL ADVISORY BOARD COMPOSITION AND MEMBER
PARTICIPATION
Board Composition and Member Participation
1 = “strongly disagree”
5 = “strongly agree”
17. The key organizations and stakeholders in the substance abuse treatment
community in this region are included in the Regional Advisory Board.
1
2
3
4
5
18. The Regional Advisory Board includes members that sufficiently represent the
geographic area spanned by the region.
1
2
3
4
5
19. The cultural diversity across the region is well represented in this Regional
Advisory Board.
1
2
3
4
5
20. There is a mechanism for adding new members to the Regional Advisory Board
if the need arises.
1
2
3
4
5
21. Members of the Regional Advisory Board are able to speak for their agencies or
constituencies, rather than just as individuals.
1
2
3
4
5
22. Members of the Regional Advisory Board feel their input is valued and influence
decisions made by the ATTC.
1
2
3
4
5
23. The purpose of this Regional Advisory Board is clear.
1
2
3
4
5
24. I am clear about my role on the Regional Advisory Board.
1
2
3
4
5
25. My input is sufficiently considered in determining the needs and services
provided by the ATTC.
1
2
3
4
5
26. Members of this Regional Advisory Board work well together in providing input
to the ATTC.
1
2
3
4
5
27. Members of the Regional Advisory Board share a common vision as to the
primary needs of the substance abuse treatment system and workforce in the
region.
1
2
3
4
5
28. I communicate with other Regional Advisory Board members outside the
context of these meetings without the involvement of the ATTC.
1
2
3
4
5
29. In addition to discussion, members of the Regional Advisory Board present data
to demonstrate needs for ATTC services.
1
2
3
4
5
30. In relation to assisting the ATTC in determining needs and planning services,
the discussion among Regional Advisory Board members is open and active.
1
2
3
4
5
31. Please elaborate on your response to Item 29 above. In relation to their
participation in discussion of regional priorities and needs, do you feel that
certain stakeholders’ or individuals’ points of view get more attention than
others? Less attention? Please specify.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
5
Collaborative Functioning Survey
SECTION 4: PERCEIVED OUTCOMES OF PARTICIPATING IN THIS REGIONAL
ADVISORY BOARD
As a result of participating in this
Regional Advisory Board, I feel that. . .
1 = “strongly disagree”
5 = “strongly agree”
32. . . . . the services and products provided by the ATTC are more on target with
the system’s needs.
1
2
3
4
5
33. . . . . ATTC services and products are better defined and more effectively
delivered.
1
2
3
4
5
34. . . . . I have gained a better perspective on the substance abuse treatment
system across the region.
1
2
3
4
5
35. . . . . I have formed relationships and alliances with other colleagues in the
substance abuse treatment field that benefit me in my work.
1
2
3
4
5
36. . . . . I have gained greater knowledge of effective substance abuse treatment
practices.
1
2
3
4
5
As a member of the ATTC Regional Advisory Board, we would like to know more about
the role you see the Board playing in a variety of ATTC activities and functions. We will
ask you to characterize your role in any of the following four ways (in addition to playing
no role at all):
Advisory — in which the Board provides general guidance or ideas to the
development and planning of ATTC products and services.
Development — in which Board members actively participate in the development
of products or specific planning of services.
Review — in which Board members provide comments and reactions to specific
products or services of the ATTC.
Approval — in which Board members exercise final approval of products or
services before they can be used in the field.
6
Collaborative Functioning Survey
Please complete the table below, selecting one or more of these roles as they apply to
each of ATTC activities and functions provided.
ATTC Activity or Function
No role
Regional Advisory Board Role
Advise
Develop
Review
Approve
37. Designing the ATTC’s goals and
objectives for each year.
1
2
3
4
5
38. Developing the ATTC’s plan for
services.
1
2
3
4
5
39. Determining the technology transfer
objective(s) for specific ATTC
services.
1
2
3
4
5
40. Determining the target audience for
specific services.
1
2
3
4
5
41. Evaluating the effectiveness of ATTC
products and services.
1
2
3
4
5
42. Revising and refining ATTC products
and services after they have been
used in the field.
1
2
3
4
5
43. Finally, the questions above relate to a range of roles the ATTC may have in
mind for you as a member of its Regional Advisory Board. We would also
like to know (a) what your expectations were in agreeing to serve on the
Regional Advisory Board and (b) whether they have been met? Please
elaborate.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Thank you very much for completing this survey!
7
Collaborative Functioning Survey
Attachment F
Customer Satisfaction and Benefit Survey
OMB No. 0930-xxxx
Expiration Date:
NATIONAL EVALUATION OF
THE ADDICTION TECHNOLOGY TRANSFER CENTER (ATTC) NETWORK
Customer Satisfaction and Benefit Survey
This survey is being conducted as part of a federally funded, external evaluation of
the national Addiction Technology Transfer Center (ATTC) Network. You have been
selected to participate in this survey because you have received services from one or more of
the regional ATTCs and/or are a member of one of the key constituencies served by the
ATTCs.
Please respond to the items on this survey as honestly and candidly as possible. Your
privacy is assured in that we are not asking for any personally identifying information and
you will send your completed survey directly to the MANILA Consulting Group, lead
contractor for the national evaluation of the ATTC Network. Evaluation staff at MANILA
will be responsible for all data handling and analysis. The surveys do include a code number
for purposes of tracking who responds to this survey and who does not. MANILA will
engage in follow-up contacts with non-respondents in an effort to get as complete a sample
as possible. Absolutely no respondent identification or specific comments will be shared with
anyone, including the ATTCs or their funders, or anyone at your agency or in the state
substance abuse treatment system.
Please note that while your opinion is highly valued, your participation in this
evaluation is strictly voluntary. You have the right to refuse to complete this survey, and/or
to participate in a follow up interview. If you have questions or concerns about filling out this
survey, please contact the Richard Finkbiner, MANILA Consulting Group, telephone
number: 571-633-9797 or [email protected].
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-xxxx. Public reporting burden for
this collection of information is estimated to average 30 minutes per interview, including the
time for reviewing instructions, searching existing data sources, gathering the data needed, and
completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 71044, Rockville, Maryland, 20857.
Customer Satisfaction and Benefit Survey
1
SECTION 1: PARTICIPANT INFORMATION
1. Which of the following roles best describes your current involvement in the
addictions field?
□ Single State Agency (SSA) director or staff
□ State substance abuse treatment provider association staff
□ Addictions educator
□ Community-based substance abuse treatment agency director or staff
□ None of the above, but I have received services from an ATTC.
(Please describe your profession: ______________________________________)
2. Please indicate which other roles you have played in your experience in the
addictions field. (Check all that apply)
□ Single State Agency director or staff
□ State substance abuse treatment provider association staff
□ Addictions educator
□ Community-based substance abuse treatment agency director or staff
□ I serve on planning committees with the ATTC
□ None of the above, my current role is the only one I’ve had since I entered the
addictions field
3. How many years have you worked in the addictions field?
□ 0 to 4 years
□ 5 - 9 years
□ 10 -14 years
□ 15 - 19 years
□ 20 + years
4. Please check the response that best describes you in each of the following
categories:
Age:
□ Under 20 years old
□ 20 - 29 years old
□ 30 - 39 years old
□ 40 - 49 years old
□ 50 - 59 years old
□ 60 + years old
Customer Satisfaction and Benefit Survey
Are you of Hispanic/Latino origin?
□ Yes
□ No
Gender:
□ Male
□ Female
Race Categories (check all that apply):
□ American Indian/Alaskan Native
□ Asian
□ Black/African American
□ Native Hawaiian/Other Pacific Islander
□ White
2
SECTION 2: EXPERIENCE WITH THE ADDICTION TECHNOLOGY TRANSFER
CENTER
5. Please indicate below the approximate number of each of these services you
have participated in or received from the ATTC in the past 3 years.
None
1-2
3-5
6-8
More
than 8
ATTC . . .
Training Events
Technical Assistance
Meetings/Conferences
None
1-10
11-20
More than
20
ATTC . . .
Products
Web site visits
If you checked “None” for all 5 of these ATTC service types, please skip to
question 14 of the survey.
6. For those ATTC products or services you have received in the past 3 years
(i.e., those for which you did not reply “None” in Question 5 above), please
rate your overall satisfaction in the table below.
ATTC Services
Very
Satisfied
Very
Dissatisfied
One or more ATTC training events
5
4
3
2
1
Targeted technical assistance from ATTC staff
5
4
3
2
1
Meetings or Conferences
5
4
3
2
1
ATTC Products
5
4
3
2
1
Visits to ATTC Web Site
5
4
3
2
1
Customer Satisfaction and Benefit Survey
3
7. Please indicate which ATTCs you have had these experiences with in the past
3 years. (Check all that apply)
□ Caribbean Basin and Hispanic ATTC (CBATTC)
□ Central East ATTC (CEATTC)
□ Great Lakes ATTC (GLATTC)
□ Gulf Coast ATTC (UTATTC)
□ Mid-America ATTC (MATTC)
□ Mid-Atlantic ATTC (MID-ATTC)
□ Mountain West ATTC (MWATTC)
□ ATTC of New England (ATTC-NE)
□ Northeast ATTC (NEATTC)
□ Northwest Frontier ATTC (NFATTC)
□ Pacific Southwest ATTC (PSATTC)
□ Prairielands ATTC (PATTC)
□ Southeast ATTC (SATTC)
□ Southern Coast ATTC (SCATTC)
□ ATTC National Office (NATTC)
8. In the table below, please indicate which of the following addiction
treatment-related topics you have received ATTC products or services on in
the past 3 years (Yes/No) and your satisfaction with each of these ATTC
services.
Topic of ATTC Product or
Service
Received
Product/
Service?
Yes No
Satisfaction with Product or Service
Very
Satisfied
Very
Dissatisfied
General knowledge of addiction
5
4
3
2
1
Addiction treatment planning
5
4
3
2
1
Screening and assessment of
substance use disorders
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
Drug-specific knowledge or related
treatment approaches (e.g.,
methamphetamine)
Specific evidence-based treatment
practices (e.g., motivational
interviewing, cognitive behavioral
therapy, multi-systemic therapy)
Customer Satisfaction and Benefit Survey
4
Adolescent treatment
5
4
3
2
1
Clinical supervision
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
Pharmacological treatment practices
Co-occurring (substance abuse and
mental health) treatment
Working with special populations in
addiction treatment (e.g., offenders,
cultural groups, homeless)
Working with other professions in
dealing with addictions (e.g., criminal
justice, faith community,
nurses/physicians)
9.
In addition to those topics listed above, please identify up to 3 other specific
topics on which you have received significant ATTC products or services in
the past 3 years and your satisfaction with each.
Topic of ATTC Product or Service
(Please write in)
1) _________________________
_________________________
2) _________________________
_________________________
3) _________________________
_________________________
Very
Satisfied
Very
Dissatisfied
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
10. What motivated you to seek or participate in ATTC products or services?
(Please check one that is most descriptive of your motivation)
□ I didn’t seek them. They were provided to me
□ I was interested in the topic and knew the ATTC had expertise in it
□ I needed Continuing Ed credit and ATTC services were available
□ My supervisor or agency asked/required me to go
□ Other reason. (Specify: _________________________________)
Customer Satisfaction and Benefit Survey
5
11. Are there any barriers that keep you from participating in more ATTC
services? (Check all that apply)
□ No, I am able to participate when I want to or am required/asked to
□ Yes, it is difficult to take time away from my daily work
□ Yes, there are travel and/or tuition/registration costs that are not supported
□ Yes, there are other less expensive ways to get this assistance. (Specify these
other sources of assistance: _____________________________________)
Customer Satisfaction and Benefit Survey
6
SECTION 3: PERCEIVED BENEFITS OF ATTC SERVICES
We will now ask you a series of questions about your experience with the ATTC in each
of these topical areas. Please check the response that most closely indicates your
experience. Please respond only for those topics you indicated you participated in from
questions 8 and 9 above.
12. For the set of topics previously listed, in the table below we would like you to
answer the following three questions:
As a result of receiving ATTC products or services in this topical area:
•
•
•
Have you increased your knowledge of this topic?
Have you improved your skills in this topical area?
Are you doing your job better related to this topic?
Topic of ATTC Product or Service
Increased my
Knowledge
Yes
No
Improved my
Skills
Yes
Am Doing
my Job
Better
Yes
No
No
General knowledge of addiction
Addiction treatment planning
Screening and assessment of substance use disorders
Drug-specific knowledge or related treatment approaches (e.g.,
methamphetamine)
Specific evidence-based treatment practices (e.g., motivational
interviewing, cognitive behavioral therapy, multi-systemic therapy)
Adolescent treatment
Clinical supervision
Pharmacological treatment practices
Co-occurring (substance abuse and mental health) treatment
Working with special populations in addiction treatment (e.g.,
offenders, cultural groups, homeless)
Working with other professions in dealing with addictions (e.g.,
criminal justice, faith community, nurses/physicians)
Other topics you listed (please write in the blanks
below)
1) ________________
________________
2) ________________
________________
3) ________________
________________
Customer Satisfaction and Benefit Survey
7
13. If you have received assistance in the topical areas listed in question 12 above
from other experts or agencies, how satisfied were you with this assistance in
relation to your satisfaction with ATTC products and services in these areas?
I am more satisfied with ATTC products and services than those provided by
others in these addiction-related topical areas.
I am equally satisfied with ATTC products and services and those provided by
others in these addiction-related topical areas.
I am less satisfied with ATTC products and services than those provided by
others in these addiction-related topical areas.
Not applicable. I have not received products or services from other sources in
these topical areas.
Customer Satisfaction and Benefit Survey
8
14. How interested would you be in receiving products or services in the future
from the ATTC in each of these topical areas?
Topic of ATTC Product
or Service
Very
Interested
Somewhat
Interested
Neutral
Not Very
Interested
Not at all
Interested
General knowledge of addiction
Addiction treatment planning
Screening and assessment of substance
use disorders
Drug-specific knowledge or related
treatment approaches (e.g.,
methamphetamine)
Specific evidence-based treatment
practices (e.g., motivational interviewing,
cognitive behavioral therapy, multi-systemic
therapy)
Adolescent treatment
Clinical supervision
Pharmacological treatment practices
Co-occurring (substance abuse and mental
health) treatment
Working with special populations in
addiction treatment (e.g., offenders, cultural
groups, homeless)
Working with other professions in dealing
with addictions (e.g., criminal justice, faith
community, nurses/physicians)
Other topics you listed (please write in
the blanks below)
1) ________________
________________
2) ________________
________________
3) ________________
________________
Customer Satisfaction and Benefit Survey
9
15. In addition to the general areas of assistance listed above, how interested
would you be in receiving products or services from the ATTCs in the
following more specific topical areas?
Specific Topic of ATTC Product
or Service
Very
Interested
Somewhat
Interested
Neutral
Not Very
Interested
12-Step Principles
Behavior Modification
Cognitive Behavioral Therapy
Community Reinforcement
Dialectic Behavior Model
Family Therapy
Harm Reduction
Motivational Interviewing
Multi-systemic Therapy
Opiate Substitution
Pharmacotherapy
Relapse Prevention
Strengths-based Treatment
16. What other addiction-related topical areas would you like ATTC assistance
with?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
We conclude the survey with a series of questions that ask about your experience and
views of ATTC services across all types of service (products, training events, etc.) and
topical areas. So we ask you to shift your perspective here away from specific topical
areas and toward your overall experience with ATTC products and services.
17. In general, across all types of services and topical areas, how satisfied are you
with products and services you have received from the ATTC(s)?
□ Very satisfied
□ Somewhat satisfied
□ Neutral
□ Somewhat dissatisfied
□ Very dissatisfied
Customer Satisfaction and Benefit Survey
10
Not at all
Interested
18. In general, across all types of services and topical areas, to what extent do
you feel you have learned more or increased your knowledge as a result of
products or services of the ATTC(s)?
□ A great deal
□ Somewhat
□ A little
□ Not at all
19. In general, across all types of services and topical areas, to what extent do
you feel you have improved your skills as a result of products or services of
the ATTC(s)?
□ A great deal
□ Somewhat
□ A little
□ Not at all
20. In general, across all types of services and topical areas, to what extent do
you feel you are able to do your job better as a result of the products or
services you have received from the ATTC(s)?
□ A great deal better
□ Somewhat better
□ A little better
□ No better
21. In general, across all types of services and topical areas, to what extent do
you feel the overall addiction treatment system has improved due to the
products and services of the ATTC(s)?
□ Great improvement
□ Slight improvement
□ No effect on the system
□ A decline in the system due to ATTC products and services
Customer Satisfaction and Benefit Survey
11
22. In your own words how else would you, as a professional in the addictions
field, describe the benefits you feel you have obtained from ATTC products
and services.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
23. Again in your own words, is there any one thing that you would change
about ATTC services and products to make them more beneficial to you?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Thank you very much for completing this survey!
Customer Satisfaction and Benefit Survey
12
Attachment G
Evidence-Based Critical Action Survey
on Clinical Supervision
OMB No. 0930-xxxx
Expiration Date:
NATIONAL EVALUATION OF
THE ADDICTION TECHNOLOGY TRANSFER CENTER (ATTC) NETWORK
Clinical Supervision Training Initiative
Participant Survey
The following survey is intended to assess the value of the ATTC Clinical
Supervision Training Initiative. By completing the following items, you will help us
understand your involvement in the initiative and what impact it had on your practice of
clinical supervision.
In addition to completing the survey, a sample of participants will be asked to take
part in a 30 minute follow-up telephone interview that will focus on more in-depth issues
of training experience and impact. Interviews are an extremely important part of the
evaluation as they will focus on more in-depth issues of training experience and impact.
Interviews will be scheduled in approximately 30 days.
Due to the need to conduct follow-up interviews with participants, you are asked to
provide your name and telephone number below. Contact information will be housed in a
separate database, and will be used only for follow-up purposes. RMC Research will be
responsible for all data handling and analysis, and will utilize personal codes, not names,
when reporting data. Absolutely no participants or specific comments will be individually
identified to anyone, including the ATTC or anyone at your agency.
Please note that while your involvement is highly valued, your participation is this
evaluation is strictly voluntary. You have the right to refuse to complete this survey,
and/or to participate in a follow up interview.
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-xxxx. Public reporting burden for
this collection of information is estimated to average 30 minutes per interview, including the
time for reviewing instructions, searching existing data sources, gathering the data needed, and
completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 71044, Rockville, Maryland, 20857.
Evidence-based Critical Action Survey on Clinical Supervision
1
Clinical Supervision Training Initiative – Participant Survey
Personal Code Form
This form and your contact information will be kept separate from the survey.
Contact Information:
Name ____________________________________________________________________
Phone ____________________________________
Contact Address____________________________________________________________
_____________________________________________________________
City __________________________
State ______
Zip Code ____________
Email address ______________________________________________________________
Personal Code:
First letter of mother’s first name: _____
First letter of mother’s maiden name: _____
First digit of social security number: _____ Last digit of social security number: _____
Month of Birth (circle): Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Evidence-based Critical Action Survey on Clinical Supervision
2
The following survey is intended to assess the value of the ATTC Clinical Supervision
Training Initiative. Please complete the following items, which will allow us to detail your
involvement in the initiative and what impact it had on your practice of clinical
supervision.
SECTION 1: PARTICIPANT INFORMATION
1. Personal code:
First letter of mother’s first name: ___ First letter of mother’s maiden name: ___
First digit of social security number: ___ Last digit of social security number: ___
Month of Birth (circle): Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
2. Name of organization/chemical dependency treatment agency:
3. Is your agency affiliated with a NIDA Clinical Trials Network Node?
ο Yes
ο No
ο Not Sure
4. How many direct service treatment staff work at your facility? _______
5. How often is clinical supervision provided in your facility?
ο Daily
ο Weekly
ο Bi-weekly
ο Monthly
ο Not applicable
6. What is your primary role at your agency: (Please select one)
ο Agency director/administrator (if selected, end survey)
ο Clinician (if selected, end survey)
ο Clinical supervisor
ο Other. (Specify: _______________________) (if selected, end survey)
7. How many years have you worked? (If less than one year, please record as
< 1.)
Total number of years:
In the chemical dependency treatment field? _____
In your current role? _____
At your current position in your agency? _____
Evidence-based Critical Action Survey on Clinical Supervision
3
8. How many clinical staff do you supervise?
_______ Staff members
9. On average, how many hours per week do you spend providing clinical
supervision?
_______ Hours
10. Do you provide direct services?
ο Yes
ο No
a. If you provide direct services, please estimate the average number of
clients on your caseload (over the past six months?
_______ Number of clients
11. What is your certification/ licensing status as a clinical supervisor in the
substance abuse treatment field? (Check only one)
ο Never certified/licensed
ο Previously certified/licensed, but not currently
ο Certification/licensure pending
ο Currently certified/licensed
ο There is no certification or license for clinical supervision in this state
12. Have you completed any clinical supervision coursework before?
ο Yes
ο No (skip to Q13)
a. If you have completed coursework in clinical supervision, where?
(Check all that apply)
ο 2 year college
ο 4 year college / university
ο Graduate school
ο Other. (Specify: ____________________________)
b. Please indicate how many clinical supervision courses you have
completed.
ο 1–3
ο 4–10
ο More than 10
Evidence-based Critical Action Survey on Clinical Supervision
4
13. Have you previously completed any clinical supervision training before your
participation in this ATTC Clinical Supervision Training Initiative?
ο Yes
ο No (skip to Q14)
a. If you have, what organization(s) provided the training? Please
specify __________________________
b. Please indicate approximately how many hours of clinical supervision
training you have previously completed:
___________ Hours
14. Please indicate your agreement or disagreement with the following
statements regarding clinical supervision at your agency.
Statement
Strongly
Agree
Agree
Neutral
Disagree
Strongly
Disagree
a.
Clinical supervision only
occurs at my agency when
there is a problem.
ο
ο
ο
ο
ο
b.
Clinical supervision plays
an important role in the
operation and
management of my
agency.
ο
ο
ο
ο
ο
There is a strong
relationship between
clinical supervision and
quality treatment provision
at my agency.
ο
ο
ο
ο
ο
Clinical supervision is
supported at my agency in
terms of policy and
management.
ο
ο
ο
ο
ο
e.
Clinical supervision is
supported at my agency in
terms of resources.
ο
ο
ο
ο
ο
f.
Clinical supervision is
primarily an administrative
or disciplinary task at my
agency.
ο
ο
ο
ο
ο
Clinical supervision is
primarily a mentoring or
professional development
task at my agency.
ο
ο
ο
ο
ο
c.
d.
g.
Evidence-based Critical Action Survey on Clinical Supervision
5
SECTION 2: PARTICIPATION IN ATTC CLINICAL SUPERVISION TRAINING
INITIATIVE
15. Approximately how many hours of clinical supervision training would you
estimate you received as a part of the ATTC Clinical Supervision Training
Initiative (include related meetings and technical assistance):
______ Hours
16. Was the amount of training you received as a part of the ATTC Clinical
Supervision Training Initiative:
ο More than needed
ο About what was needed
ο Less than was needed
17. Upon completion of the ATTC Clinical Supervision Training Initiative, how
confident were you that you could improve the quality of your clinical
supervision practice?
ο I was very confident that I had acquired knowledge, skills, and/or attitudes,
and that I would be able to use them to improve the quality of my clinical
supervision practice
ο I felt that I had acquired some knowledge, skills, and/or attitudes, but was
uncertain about whether or not I would be able to improve the quality of my
clinical supervision practice as a result
ο
I did not feel that the training gave me the knowledge, skills, and/or attitudes
necessary to improve the quality of my clinical supervision practice
Evidence-based Critical Action Survey on Clinical Supervision
6
SECTION 3: CHANGES IN CLINICAL SUPERVISION PRACTICE
18. Prior to the ATTC Clinical Supervision Training Initiative, how much
experience had you had with the clinical supervision activities listed below.
(Check the appropriate box in each row)
Before Initiative
None
(I had never
completed
the activity)
Limited
(I had tried
the activity to
some extent)
Moderate
(I had completed
the activity from
time to time, as
necessary)
Extensive
(I had completed
the activity often,
as an integral part
of my work)
a.
Creating a professional
development/ learning plan with
supervisees
ο
ο
ο
ο
b.
Conducting supervisory interviews
with supervisees
ο
ο
ο
ο
c.
Observing clinical staff in their work,
either in person or using audio and
video taping
ο
ο
ο
ο
d.
Using rating forms or rubrics to
evaluate counselor performance and
assess skills
ο
ο
ο
ο
e.
Acknowledging supervisees’
development and celebrate
accomplishments through frequent
rewards and recognition
ο
ο
ο
ο
Providing adequate and appropriate
feedback to clinical staff
ο
ο
ο
ο
f.
Evidence-based Critical Action Survey on Clinical Supervision
7
19. Since participating in the ATTC Clinical Supervision Training Initiative, to
what extent have you been able to implement the Clinical Supervision
activities listed below? (Check the appropriate box in each row)
After Initiative
I have no
plans to
try the
activity
I have not
yet tried
the
activity,
but intend
to
I am in the
process of
trying the
activity,
but have
not
finished
I have tried
the activity
but have
not yet
experience
d clear
results
I have tried
the activity
and
experience
d positive
results
Unsure
how to
rate
a.
Creating a professional
development/ learning
plan with supervisees
ο
ο
ο
ο
ο
ο
b.
Conducting supervisory
interviews with
supervisees
ο
ο
ο
ο
ο
ο
c.
Observing clinical staff in
their work, either in
person or using audio
and video taping
ο
ο
ο
ο
ο
ο
Using rating forms or
rubrics to evaluate
counselor performance
and assess skills
ο
ο
ο
ο
ο
ο
Acknowledging
supervisees’
development and
celebrate
accomplishments through
frequent rewards and
recognition
ο
ο
ο
ο
ο
ο
Providing adequate and
appropriate feedback to
clinical staff
ο
ο
ο
ο
ο
ο
d.
e.
f.
Evidence-based Critical Action Survey on Clinical Supervision
8
20. Please rate your proficiency with the following clinical supervision
techniques both before and after participating in the ATTC Clinical
Supervision Training Initiative using the following scale.
Not at all
Mostly Lacking
Somewhat
Mostly
Completely
Proficient
Proficiency
Proficient
Proficient
Proficient
1………………………2……………………3…………………..4……………….….5
Proficiency
Before Training
After Training
a.
Creating a professional
development/ learning plan with
supervisees
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
b.
Conducting supervisory interviews
with supervisees
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
c.
Observing clinical staff in their
work, either in person or using
audio and video taping
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
d.
Using rating forms or rubrics to
evaluate counselor performance
and assess skills
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
e.
Acknowledging supervisees’
development and celebrate
accomplishments through frequent
rewards and recognition
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
f.
Providing adequate and
appropriate feedback to clinical
staff
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
Evidence-based Critical Action Survey on Clinical Supervision
9
21. Please indicate whether or not you have seen change in the following areas as
a result of your participation in the Clinical Supervision Training Initiative.
For those areas where you have seen change, please rate the amount of
change.
Change Area
Change?
Amount of Change
A little
Some
A lot
a.
Improved clinical supervision knowledge
ο yes ο no
1
2
3
4
5
b.
Increased clinical supervision skills
ο yes ο no
1
2
3
4
5
c.
Increased clinical supervision abilities
ο yes ο no
1
2
3
4
5
d.
Improved comfort in clinical supervision
knowledge and skills
ο yes ο no
1
2
3
4
5
e.
Improved confidence in clinical supervision
knowledge and skills
ο yes ο no
1
2
3
4
5
f.
More focus on job performance of clinical staff
ο yes ο no
1
2
3
4
5
g.
Improved skills of clinical staff
ο yes ο no
1
2
3
4
5
h.
Attitude shift in clinical staff, marked by
increased interest in professional development
and individual learning
ο yes ο no
1
2
3
4
5
SECTION 4: FACTORS IMPACTING ABILITY TO CHANGE
22. As you review your experience in the ATTC Clinical Supervision Training
Initiative, what factors (if any), helped you implement the clinical supervision
knowledge, skills, and/or attitudes you acquired: (Check all that apply)
ο
Not applicable, I did not acquire knowledge, skills, or attitudes
ο
My understanding before the training of the clinical supervision activities I
received training on and how they relate to the role and duties of the clinical
supervisor
ο
My belief that clinical supervision is essential to quality client care
ο
Clear management direction that provision of clinical supervision is to be
taken seriously
ο
Availability of coaching and support related to the implementation of new
clinical supervision knowledge and skills
ο
Budgeted and planned clinical supervision time and resources
ο
A supportive work environment in which clinical supervision is valued and
promoted
ο
Other. (Specify: ___________________________________________)
Evidence-based Critical Action Survey on Clinical Supervision
10
23. As you review your experience in the ATTC Clinical Supervision Training
Initiative, what factors (if any), hindered your ability to implement the
clinical supervision knowledge, skills, and/or attitudes you acquired: (Check
all that apply)
ο
Not applicable, I did not acquire knowledge, skills, or attitudes
ο
My incomplete understanding before the training of the clinical supervision
activities I received training on and how they relate to the role and duties of
the clinical supervisor
ο
My belief that clinical supervision is not essential to quality client care
ο
Lack of clear management direction that provision of clinical supervision is
to be taken seriously
ο
Lack of available coaching and support related to the implementation of
new clinical supervision knowledge and skills
ο
Lack of budgeted and planned clinical supervision time and resources
ο
A work environment in which clinical supervision is neither valued nor
promoted
ο
Other. (Specify: ___________________________________________)
Thank you very much for completing this survey!
Evidence-based Critical Action Survey on Clinical Supervision
11
Attachment H
Evidence-Based Critical Action Survey
on Motivational Interviewing
OMB No. 0930-xxxx
Expiration Date:
NATIONAL EVALUATION OF
THE ADDICTION TECHNOLOGY TRANSFER CENTER (ATTC) NETWORK
Motivational Interviewing Training Initiative
Participant Survey
The following survey is intended to assess the value of the ATTC Motivational
Interviewing Training Initiative. By completing the following items, you will help us
understand your involvement in the initiative and what impact it had on your clinical
practice.
In addition to completing the survey, a sample of participants will be asked to take
part in a 30 minute follow-up telephone interview that will focus on more in-depth issues
of training experience and impact. Interviews are an extremely important part of the
evaluation as they will focus on more in-depth issues of training experience and impact.
Interviews will be scheduled in approximately 30 days.
Due to the need to conduct follow-up interviews with participants, you are asked to
provide your name and telephone number below. Contact information will be housed in a
separate database, and will be used only for follow-up purposes. RMC Research will be
responsible for all data handling and analysis, and will utilize personal codes, not names,
when reporting data. Absolutely no participants or specific comments will be individually
identified to anyone, including the ATTC or anyone at your agency.
Please note that while your involvement is highly valued, your participation is this
evaluation is strictly voluntary. You have the right to refuse to complete this survey,
and/or to participate in a follow up interview.
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-xxxx. Public reporting burden for
this collection of information is estimated to average 30 minutes per interview, including the
time for reviewing instructions, searching existing data sources, gathering the data needed, and
completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 71044, Rockville, Maryland, 20857.
Evidence-Based Critical Action Survey on Motivational Interviewing
1
Motivational Interviewing Training Initiative – Participant Survey
Personal Code Form
This form and your contact information will be kept separate from the survey.
Contact Information:
Name ____________________________________________________________________
Phone ____________________________________
Contact Address____________________________________________________________
_____________________________________________________________
City __________________________
State ______
Zip Code ____________
Email address ______________________________________________________________
Personal Code:
First letter of mother’s first name: _____
First letter of mother’s maiden name: _____
First digit of social security number: _____ Last digit of social security number: _____
Month of Birth (circle): Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Evidence-Based Critical Action Survey on Motivational Interviewing
2
The following survey is intended to assess the value of the ATTC Motivational Interviewing
Training Initiative. Please complete the following items, which will allow us to detail your
involvement in the initiative and what impact it had on your clinical practice.
SECTION 1: PARTICIPANT INFORMATION
1. Personal code:
First letter of mother’s first name: ___ First letter of mother’s maiden name: ___
First digit of social security number: ___ Last digit of social security number: ___
Month of Birth (circle): Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
2. Name of organization/chemical dependency treatment agency:
3. Is your agency affiliated with a NIDA Clinical Trials Network Node?
ο Yes
ο No
ο Not sure
4. How many direct service treatment staff work at your facility? _______
5. How often is clinical supervision provided in your facility?
ο Daily
ο Weekly
ο Bi-weekly
ο Monthly
ο Not applicable
6. What is your primary role at your agency (please select one):
ο Agency director/administrator
ο Clinician
ο Clinical supervisor
ο Other. (Specify: _______________________)
7. How many years have you worked? (If less than one year, please record as < 1.)
Total number of years:
In the chemical dependency treatment field? _____
In your current role? _____
At your current position in your agency? _____
Evidence-Based Critical Action Survey on Motivational Interviewing
3
8. Over the past six months, please estimate the average number of clients on your
caseload at any given time.
Number of clients ______
ο I do not provide direct service
9. Have you completed any Motivational Interviewing coursework before?
ο Yes
ο No (skip to Q10)
a. If you have completed coursework in Motivational Interviewing, where?
(Check all that apply)
ο 2 year college
ο 4 year college/university
ο Graduate school
ο Other. (Specify: ____________________________)
b. Please indicate how many Motivational Interviewing courses you have
completed.
ο 1–3
ο 4–10
ο More than 10
10. Have you previously completed any Motivational Interviewing training before
your participation in this ATTC Motivational Interviewing Training Initiative?
ο Yes
ο No (skip to Q11)
a. If you have, what organization(s) provided the training?
Please specify _________________________________
b. Please indicate approximately how many hours of Motivational Interviewing
training you have previously completed:
___________ Hours
11. Does your agency currently use Motivational Interviewing?
Yes
No (skip to Section Q13)
Evidence-Based Critical Action Survey on Motivational Interviewing
4
12. If your agency does use Motivational Interviewing (MI), to what extent does the
delivery of MI emphasize the following. (Use a 0-to-5 scale where 0 = “not at all
emphasized” and 5 = “heavily emphasized”, or indicate “don’t know.”)
MI Delivery
0 = “not at all
emphasized”
5 = “heavily emphasized”
a. Assessing clients with regard to the 5 stages of change
(precontemplation, contemplation, preparation, action,
maintenance)
0
1
2
3
4
5
Don’t
Know
b. Confronting clients about their substance-related problems
0
1
2
3
4
5
Don’t
Know
0
1
2
3
4
5
Don’t
Know
d. Allowing clients to compare the costs and benefits of continuing or
stopping their substance abuse
0
1
2
3
4
5
Don’t
Know
e. Exploring the areas in which the client wants to achieve change
0
1
2
3
4
5
Don’t
Know
f.
0
1
2
3
4
5
g. Expressing support for the client’s ability to succeed
0
1
2
3
4
5
h. The use of “reflective listening”
0
1
2
3
4
5
c.
Encouraging clients to evaluate how their behaviors are different
from their goals and ideals
Avoiding the use of argumentation with clients
i.
Encouraging clients to develop their own “change plan” with goals
and plans for dealing with barriers to those goals
0
1
2
3
4
5
j.
Confronting clients about resistance
0
1
2
3
4
5
Evidence-Based Critical Action Survey on Motivational Interviewing
5
Don’t
Know
Don’t
Know
Don’t
Know
Don’t
Know
Don’t
Know
SECTION 2: PARTICIPATION IN ATTC MOTIVATIONAL INTERVIEWING TRAINING
INITIATIVE
13. Approximately how many hours of Motivational Interviewing training would
you estimate you received as a part of this ATTC Motivational Interviewing
Training Initiative (include related meetings and technical assistance):
______ Hours
14. Was the amount of training you received as a part of this initiative:
ο More than needed
ο About what was needed
ο Less than was needed
15. Upon completion of this training initiative, how confident were you that you
could improve the quality of your clinical practice?
ο I was very confident that I had acquired knowledge, skills, and/or attitudes, and
that I would be able to use them to improve the quality of my clinical practice
ο I felt that I had acquired some knowledge, skills, and/or attitudes, but was
uncertain about whether or not I would be able to improve the quality of my
clinical practice as a result
ο I did not feel that the training gave me the knowledge, skills, and/or attitudes
necessary to improve the quality of my clinical practice
Evidence-Based Critical Action Survey on Motivational Interviewing
6
SECTION 3: IMPLEMENTATION OF MI
16. Prior to the ATTC Motivational Interviewing Training Initiative, what was your
experience with the following therapist behaviors characteristic of Motivational
Interviewing? (Check the appropriate box in each row)
Before MI Training Initiative
None
(I never
engaged in the
behavior)
Limited
(I engaged in
the behavior to
some extent)
Moderate
(I engaged in
the behavior
from time to
time, as
necessary)
Extensive
(I engaged in
the behavior
often, as an
integral part of
my work)
a.
Asking open rather than close ended
questions
ο
ο
ο
ο
b.
Reflecting rather than disagreeing with
client resistance or denial
ο
ο
ο
ο
c.
Seeking to understand your clients’ frame
of reference via reflective listening
ο
ο
ο
ο
d.
Expressing acceptance and affirmation to
your clients
ο
ο
ο
ο
e.
Eliciting and selectively reinforcing your
clients’ own self motivational statements,
expressions of problem recognition,
concern, desire and intention to change,
and ability to change
ο
ο
ο
ο
Monitoring your clients’ degree of
readiness to change, and ensuring that
resistance is not generated by jumping
ahead of the client
ο
ο
ο
ο
Affirming your clients’ freedom of choice
and self-direction
ο
ο
ο
ο
f.
g.
Evidence-Based Critical Action Survey on Motivational Interviewing
7
17. Since participating in the ATTC Motivational Interviewing Training Initiative,
to what extent have you been able to implement the following therapist
behaviors characteristic of Motivational Interviewing? (Check the appropriate
box in each row)
After MI Training Initiative
I have no
plans to
engage in
the behavior
I have not
yet engaged
in the
behavior,
but intend to
I have
engaged in
the
behavior,
but have not
yet
experienced
clear results
I have
engaged in
the behavior
and
experienced
positive
results
Unsure how
to rate
a.
Asking open rather than
close ended questions
ο
ο
ο
ο
ο
b.
Reflecting rather than
disagreeing with client
resistance or denial
ο
ο
ο
ο
ο
c.
Seeking to understand your
clients’ frame of reference
via reflective listening
ο
ο
ο
ο
ο
d.
Expressing acceptance and
affirmation to your clients
ο
ο
ο
ο
ο
e.
Eliciting and selectively
reinforcing your clients’ own
self motivational statements,
expressions of problem
recognition, concern, desire
and intention to change, and
ability to change
ο
ο
ο
ο
ο
Monitoring your clients’
degree of readiness to
change, and ensuring that
resistance is not generated
by jumping ahead of the
client
ο
ο
ο
ο
ο
Affirming your clients’
freedom of choice and selfdirection
ο
ο
ο
ο
ο
f.
g.
Evidence-Based Critical Action Survey on Motivational Interviewing
8
18. Please rate your proficiency with the following therapist behaviors characteristic
of Motivational Interviewing both before and after participating in the ATTC
Motivational Interviewing Training Initiative using the following scale.
Not at all
Proficient
Mostly Lacking
Proficiency
Somewhat
Proficient
Mostly
Proficient
Completely
Proficient
1………………………2………………………3…………………4……………….….5
Proficiency
Before Training
After Training
a.
Asking open rather than close
ended questions
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
b.
Reflecting rather than disagreeing
with client resistance or denial
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
c.
Seeking to understand your
clients’ frame of reference via
reflective listening
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
d.
Expressing acceptance and
affirmation to your clients
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
e.
Eliciting and selectively reinforcing
your clients’ own self motivational
statements, expressions of
problem recognition, concern,
desire and intention to change,
and ability to change
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
f.
Monitoring your clients’ degree of
readiness to change, and ensuring
that resistance is not generated by
jumping ahead of the client
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
g.
Affirming your clients’ freedom of
choice and self-direction
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
Evidence-Based Critical Action Survey on Motivational Interviewing
9
19. Please indicate whether or not you have seen change in the following areas as a
result of your participation in the Motivational interviewing Training Initiative.
For those areas where you have seen change, please rate the amount of change.
Change Area
Change?
Amount of Change
A little
Some
A lot
a.
Improved Motivational Interviewing knowledge
ο yes ο no
1
2
3
4
5
b.
Increased Motivational Interviewing skills
ο yes ο no
1
2
3
4
5
c.
Decreased client resistance
ο yes ο no
1
2
3
4
5
d.
Improved client engagement
ο yes ο no
1
2
3
4
5
e.
Improved client retention
ο yes ο no
1
2
3
4
5
f.
Better client outcomes
ο yes ο no
1
2
3
4
5
SECTION 4: FACTORS IMPACTING ABILITY TO CHANGE
20. As you review your experience in the ATTC Motivational Interviewing Training
Initiative, what factors (if any), helped you implement the knowledge, skills,
and/or attitudes acquired (check all that apply):
ο
Not applicable, I did not acquire knowledge, skills, or attitudes
ο
My understanding before the training of the Motivational Interviewing
behaviors I received training on and how they relate to counseling
ο
My belief that Motivational Interviewing is a technique essential to the
provision of quality client care
ο
Ability to “try out” Motivational Interviewing during training
ο
Ability to “try out” Motivational Interviewing back at work
ο
Clear management direction to use Motivational Interviewing
ο
Monitoring and feedback from my clinical supervisor
ο
Availability of coaching and support related to the implementation of new
Motivational Interviewing knowledge and skills
ο
A supportive work environment in which Motivational Interviewing is
valued and promoted
ο
Other. (Specify:_________________________________________)
Evidence-Based Critical Action Survey on Motivational Interviewing
10
21. As you review your experience in the ATTC Motivational Interviewing Training
Initiative, what factors (if any), hindered your ability to implement the
knowledge, skills, and/or attitudes acquired (check all that apply):
ο
Not applicable, I did not acquire knowledge, skills, or attitudes
ο
My incomplete understanding before the training of Motivational
Interviewing techniques and how they relate to counseling
ο
My belief that Motivational Interviewing is not essential to quality client care
ο
Inability to “try out” Motivational Interviewing during training
ο
Inability to “try out” Motivational Interviewing back at work
ο
Lack of clear management direction to use Motivational Interviewing
ο
Lack of clinical supervision concerning the implementation of Motivational
Interviewing
ο
Lack of available coaching and support related to the implementation of new
Motivational Interviewing knowledge and skills
ο
A work environment in which Motivational Interviewing is neither valued
nor promoted
ο
Other. (Specify:_________________________________________)
Thank you very much for completing this survey!
Evidence-Based Critical Action Survey on Motivational Interviewing
11
Attachment I
Evidence-Based Critical Action Survey
on Treatment Planning M.A.T.R.S.
OMB No. 0930-xxxx
Expiration Date:
NATIONAL EVALUATION OF
THE ADDICTION TECHNOLOGY TRANSFER CENTER (ATTC) NETWORK
Treatment Planning M.A.T.R.S Training Initiative
Participant Survey
The following survey is intended to assess the value of the ATTC Treatment Planning
M.A.T.R.S. Training Initiative. By completing the following items, you will help us
understand your involvement in the initiative and what impact it had on your clinical
practice.
In addition to completing the survey, a sample of participants will be asked to take part
in a 30 minute follow-up telephone interview that will focus on more in-depth issues of
training experience and impact. Interviews are an extremely important part of the
evaluation as they will focus on more in-depth issues of training experience and impact.
Interviews will be scheduled in approximately 30 days.
Due to the need to conduct follow-up interviews with participants, you are asked to
provide your name and telephone number below. Contact information will be housed in a
separate database, and will be used only for follow-up purposes. RMC Research will be
responsible for all data handling and analysis, and will utilize personal codes, not names,
when reporting data. Absolutely no participants or specific comments will be individually
identified to anyone, including the ATTC or anyone at your agency.
Please note that while your involvement is highly valued, your participation is this
evaluation is strictly voluntary. You have the right to refuse to complete this survey, and/or
to participate in a follow up interview.
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-xxxx. Public reporting burden for
this collection of information is estimated to average 30 minutes per interview, including the
time for reviewing instructions, searching existing data sources, gathering the data needed, and
completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 71044, Rockville, Maryland, 20857.
Evidence-Based Critical Action Survey on Treatment Planning M.A.T.R.S.
1
Treatment Planning M.A.T.R.S. Training Initiative – Participant Survey
Personal Code Form
This form and your contact information will be kept separate from the survey.
Contact Information:
Name ____________________________________________________________________
Phone ____________________________________
Contact Address____________________________________________________________
_____________________________________________________________
City __________________________
State ______
Zip Code ____________
Email address ______________________________________________________________
Personal Code:
First letter of mother’s first name: _____
First letter of mother’s maiden name: _____
First digit of social security number: _____ Last digit of social security number: _____
Month of Birth (circle): Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Evidence-Based Critical Action Survey on Treatment Planning M.A.T.R.S.
2
The following survey is intended to assess the value of the ATTC Treatment Planning
M.A.T.R.S. Training Initiative. Please complete the following items, which will allow us to
detail your involvement in the initiative and what impact it had on your clinical practice.
SECTION 1: PARTICIPANT INFORMATION
1. Personal code:
First letter of mother’s first name: ___ First letter of mother’s maiden name: ___
First digit of social security number: ___ Last digit of social security number: ___
Month of Birth (circle): Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
2. Name of organization/chemical dependency treatment agency:
3. Is your agency affiliated with a NIDA Clinical Trials Network Node?
ο Yes
ο No
ο Not sure
4. How many direct service treatment staff work at your facility?
______
5. How often is clinical supervision provided in your facility?
ο Daily
ο Weekly
ο Bi-weekly
ο Monthly
ο Not applicable
6. What is your primary role at your agency (please select one):
ο Agency director/ administrator
ο Clinician
ο Clinical supervisor
ο Other _______________________
7. How many years have you worked? (If less than one year, please record as < 1.)
Total number of years:
In the chemical dependency treatment field? _____
In your current role? _____
At your current position in your agency? _____
Evidence-Based Critical Action Survey on Treatment Planning M.A.T.R.S.
3
8. Have you completed any treatment planning coursework before?
ο Yes
ο No (skip to Q9)
a. If you have completed coursework in treatment planning, where?
(Check all that apply)
ο 2 year college
ο 4 year college / university
ο Graduate school
ο Other. (Specify: ____________________________)
b. Please indicate how many treatment planning courses you have
completed.
ο 1–3
ο 4–10
ο More than 10
9. Have you previously completed any treatment planning training before your
participation in this ATTC Treatment Planning M.A.T.R.S. Training
Initiative?
ο Yes ο No (skip to Q10)
a. If you have, what organization(s) provided the training?
Please specify __________________________________
b. Please indicate approximately how many hours of treatment planning
training you have previously completed:
___________ Hours
10. Prior to the Treatment Planning M.A.T.R.S. training, did your agency use any
standardized tools to assess clients at intake?
ο Yes
ο No (skip to Q11)
a. If yes, please indicate which tools (check all that apply):
i. ο ASI
For how long? ____ yrs ____ months
ii. ο GAIN
For how long? ____ yrs ____ months
iii. ο Other:______________ For how long? ____ yrs ____ months
iv. ο Other: ______________For how long? ____ yrs ____ months
v. ο Other: ______________For how long? ____ yrs ____ months
Evidence-Based Critical Action Survey on Treatment Planning M.A.T.R.S.
4
vi. ο Other: ______________For how long? ____ yrs ____ months
vii. ο Other: ______________For how long? ____ yrs ____ months
b. How were assessments completed? (Check all that apply)
ο On computer
ο Paper and pencil
ο Face-to-face interviews between client and agency staff
ο Other. (Specify: _______________________________)
c. How were data from completed assessments stored? (Check all that
apply)
ο Computer software package designed for specific assessment tool
ο Internal electronic database
ο In file cabinets
ο Other. (Specify: _______________________________)
11. Prior to the ATTC Treatment Planning M.A.T.R.S. Training Initiative, did
your agency use other, less-standardized, tools to assess clients at intake?
ο Yes ο No (skip to Q12)
a. If yes, please indicate the tools:
Name of Instrument
Information/ Content of Instrument
i. ____________________________________________________________
ii. ____________________________________________________________
iii. ____________________________________________________________
iv. ____________________________________________________________
v. ____________________________________________________________
b. How were assessments completed? (Check all that apply)
ο On computer
ο Paper and pencil
ο Face-to-face interviews between client and agency staff
ο Other. (Specify: _______________________________)
c. How were data from completed assessments stored? (Check all that
apply)
ο Computer software package designed for specific assessment tool
Evidence-Based Critical Action Survey on Treatment Planning M.A.T.R.S.
5
ο Internal electronic database
ο In file cabinets
ο Other. (Specify: _______________________________)
12. Since participating in the ATTC Treatment Planning M.A.T.R.S. Training
Initiative, does your agency use any standardized tools to assess clients at
intake?
ο Yes ο No (skip to Section Q13)
a. If yes, please indicate which tools (Check all that apply):
i. ο ASI
For how long? ____ yrs ____ months
ii. ο GAIN
For how long? ____ yrs ____ months
iii. ο Other:______________ For how long? ____ yrs ____ months
iv. ο Other: ______________For how long? ____ yrs ____ months
v. ο Other: ______________For how long? ____ yrs ____ months
b. How are assessments completed? (Check all that apply)
ο On computer
ο Paper and pencil
ο Face-to-face interviews
ο Other. (Specify: _______________________________)
c. How are data from completed assessments stored? (Check all that
apply)
ο Computer software package designed for specific assessment tool
ο Internal electronic database
ο In file cabinets
ο Other. (Specify: _______________________________)
Evidence-Based Critical Action Survey on Treatment Planning M.A.T.R.S.
6
SECTION 2: PARTICIPATION IN ATTC TREATMENT PLANNING M.A.T.R.S.
TRAINING INITIATIVE
13. Approximately how many hours of Treatment Planning M.A.T.R.S. training
would you estimate you received as a part of this initiative (include related
meetings and technical assistance):
______ Hours
14. Was the amount of training you received as a part of this initiative:
ο More than needed
ο About what was needed
ο Less than was needed
15. Upon completion of this training initiative, how confident were you that you
could improve the quality of your treatment planning practice?
ο I was very confident that I had acquired knowledge, skills, and/or attitudes, and
that I would be able to use them to improve the quality of my treatment planning
practice
ο I felt that I had acquired some knowledge, skills, and/or attitudes, but was
uncertain about whether or not I would be able to improve the quality of my
treatment planning practice as a result
ο I did not feel that the training gave me the knowledge, skills, and/or attitudes
necessary to improve the quality of my treatment planning practice
Evidence-Based Critical Action Survey on Treatment Planning M.A.T.R.S.
7
SECTION 3: IMPLEMENTATION OF TREATMENT PLANNING M.A.T.R.S.
16. Prior to the ATTC Treatment Planning M.A.T.R.S. Training Initiative, what
was your experience with the following treatment planning activities? (Check
the appropriate box in each row)
None
(I had never
completed
the activity)
Limited
(I had tried
the activity to
some extent)
Moderate
(I had
completed
the activity
from time to
time, as
necessary)
Extensive
(I had
completed
the activity
often, as an
integral part
of my work)
a.
Using the ASI or other standardized
assessment tool for client
assessment
ο
ο
ο
ο
b.
Using a reporting system/ computer
software to produce client level
reports from standardized
assessment tool
ο
ο
ο
ο
Producing individualized treatment
plans that include: problem
statements (reflecting domains in
assessment tool)
ο
ο
ο
ο
d.
Producing individualized treatment
plans that include: goals (reflecting
what client wants to achieve)
ο
ο
ο
ο
e.
Producing individualized treatment
plans that include: objectives
(reflecting what will client say or do)
ο
ο
ο
ο
f.
Producing individualized treatment
plans that include: interventions
(reflecting what counselor/ staff will
do to assist client)
ο
ο
ο
ο
Using progress note technique(s) to
monitor and update treatment plans
ο
ο
ο
ο
c.
g.
Evidence-Based Critical Action Survey on Treatment Planning M.A.T.R.S.
8
17. Since participating in the ATTC Treatment Planning M.A.T.R.S. Training
Initiative, to what extent have you been able to implement the following
treatment planning activities? (Check the appropriate box in each row)
I have no
plans to try
the activity
I have
not yet
tried the
activity,
but
intend
to
I am in the
process of
trying the
activity,
but have
not
finished
I have tried
the activity
but have not
yet
experienced
clear results
I have tried
the activity
and
experienced
positive
results
Unsure how
to rate
a.
Using the ASI or other
standardized assessment
tool for client assessment
ο
ο
ο
ο
ο
ο
b.
Using a reporting system/
computer software to
produce client level
reports from standardized
assessment tool
ο
ο
ο
ο
ο
ο
Producing individualized
treatment plans that
include: problem
statements (reflecting
domains in assessment
tool)
ο
ο
ο
ο
ο
ο
Producing individualized
treatment plans that
include: goals (reflecting
what client wants to
achieve)
ο
ο
ο
ο
ο
ο
Producing individualized
treatment plans that
include: objectives
(reflecting what will client
say or do)
ο
ο
ο
ο
ο
ο
Producing individualized
treatment plans that
include: interventions
(reflecting what
counselor/ staff will do to
assist client)
ο
ο
ο
ο
ο
ο
Using progress note
technique(s) to monitor
and update treatment
plans
ο
ο
ο
ο
ο
ο
c.
d.
e.
f.
g.
Evidence-Based Critical Action Survey on Treatment Planning M.A.T.R.S.
9
18. Please rate your proficiency with the following treatment planning activities
both before and after participating in the ATTC Treatment Planning
M.A.T.R.S. Training Initiative using the following scale.
Not at all
Proficient
Mostly Lacking
Proficiency
Somewhat
Proficient
Mostly
Proficient
Completely
Proficient
1………………………2……………………3…………………..4……………….….5
Proficiency
Before Training
After Training
□1
□2
□3
□4
□5
a.
Using the ASI or other standardized assessment
tool for client assessment
□1
□2
□3
□4
□5
b.
Using a reporting system/ computer software to
produce client level reports from standardized
assessment tool
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
c.
Producing individualized treatment plans that
include: problem statements (reflecting domains in
assessment tool)
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
d.
Producing individualized treatment plans that
include: goals (reflecting what client wants to
achieve)
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
e.
Producing individualized treatment plans that
include: objectives (reflecting what will client say or
do)
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
f.
Producing individualized treatment plans that
include: interventions (reflecting what counselor/
staff will do to assist client)
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
g.
Using progress note technique(s) to monitor and
update treatment plans
□1
□2
□3
□4
□5
□1
□2
□3
□4
□5
Evidence-Based Critical Action Survey on Treatment Planning M.A.T.R.S.
10
19. Please indicate whether or not you have seen change in the following areas as a
result of your participation in the Treatment Planning M.A.T.R.S. Training
Initiative. For those areas where you have seen change, please rate the amount
of change.
Amount of Change
Change Area
Change?
a.
Improved quality of treatment plans
ο yes ο no
1
2
3
4
5
b.
Improved quality of progress reports
ο yes ο no
1
2
3
4
5
c.
More quantifiable measures of program
success
ο yes ο no
1
2
3
4
5
d.
Better client–service matching
ο yes ο no
1
2
3
4
5
e.
Better clinician–client matching
ο yes ο no
1
2
3
4
5
f.
Improved client–clinician rapport
ο yes ο no
1
2
3
4
5
g.
More empowered clinical staff
ο yes ο no
1
2
3
4
5
h.
Increased client retention
ο yes ο no
1
2
3
4
5
i.
Improved client outcomes
ο yes ο no
1
2
3
4
5
A little
Some
A lot
SECTION 4: FACTORS IMPACTING ABILITY TO CHANGE
20. As you review your experience in the ATTC Treatment Planning M.A.T.R.S.
Training Initiative, what factors (if any), helped you implement the knowledge,
skills, and/or attitudes acquired (check all that apply):
ο
Not applicable, I did not acquire knowledge, skills, or attitudes
ο
An understanding before the training of the ASI and how it and other
standardized assessment tools relate to treatment planning
ο
A belief that treatment planning plays an essential role in the provision of
quality client care
ο
Clear management direction that treatment planning is to be taken seriously
ο
Technological resources necessary to make use of standardized assessment
data in the treatment planning process
ο
Technological know-how necessary to make use of standardized assessment
data in the treatment planning process
ο
Monitoring and feedback from clinical supervisors to assure quality of
treatment plans
ο
Availability of coaching and support related to the implementation of new
treatment planning knowledge and skills
ο
A supportive work environment in which treatment planning is valued and
promoted
ο
Other. (Please specify: ___________________________________________)
Evidence-Based Critical Action Survey on Treatment Planning M.A.T.R.S.
11
21. As you review your experience in the ATTC Treatment Planning M.A.T.R.S.
Training Initiative, what factors (if any), hindered your ability to implement
the knowledge, skills, and/or attitudes acquired (check all that apply):
ο
Not applicable, I did not acquire knowledge, skills, or attitudes
ο
An incomplete understanding of the ASI and how it and other standardized
assessment tools relate to treatment planning
ο
A belief that treatment planning is not essential to quality client care
ο
Lack of clear management direction that treatment planning is to be taken
seriously
ο
Agency lacks the technological resources necessary to make use of
standardized assessment data in the treatment planning process
ο
Agency lacks the technological know-how necessary to make use of
standardized assessment data in the treatment planning process
ο
Lack of clinical supervision concerning treatment planning
ο
Lack of available coaching and support related to the implementation of new
treatment planning knowledge and skills
ο
A work environment in which treatment planning is neither valued nor
promoted
ο Other. (Please specify: ___________________________________________)
Thank you very much for completing this survey!
Evidence-Based Critical Action Survey on Treatment Planning M.A.T.R.S.
12
Attachment J
Success Case Interview Protocol
on Clinical Supervision
OMB No. 0930-xxxx
Expiration Date:
NATIONAL EVALUATION OF
THE ADDICTION TECHNOLOGY TRANSFER CENTER (ATTC) NETWORK
Clinical Supervision Training Initiative
Success Case Interview Protocol
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-xxxx. Public reporting burden for
this collection of information is estimated to average 1 hour per interview, including the time
for reviewing instructions, searching existing data sources, gathering the data needed, and
completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 71044, Rockville, Maryland, 20857.
Success Case Interview Protocol on Clinical Supervision
1
Clinical Supervision Training Initiative
Success Case Interview Protocol
Questions 1- 3 are intended only for those clinicians deemed “successful” based on
survey results. Question 4 is intended for both those deemed “successful” and
“unsuccessful.”
Categories for Success Interviews:
What was
used?
What results
were
achieved?
What good
did it do?
(value)
What
helped?
Suggestions?
yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy
1. Success of application of learning after engaging in process:
From your survey responses, it looks like you’ve used your learning from the
ATTC Clinical Supervision Training Initiative effectively and have achieved
some positive results. I’d like to understand in more detail how you applied your
learning and what positive things have happened because of and since the
training.
•
•
•
•
•
•
•
How have you used any of the clinical supervision skills/activities emphasized
in this training?
[For each skill/activity mentioned] And then what? What did this lead to?
Have products been developed in your agency? Systems changed in your
agency? Has the way you conduct supervision changed?
What has implementing these new skills/activities achieved? How has it
helped you?
What strikes you as the most important benefit you got from implementing
clinical supervision skills/activities?
What benefits to your agency/clients have resulted?
Are there any particular stories that illustrate the impact of the training?
2. Factors that supported the application of your learning:
What supports/factors contributed to your being able to successfully implement
the clinical supervision skills/activities discussed above? As you think about your
job, your organization, your work environment, your professional colleagues, etc.,
what made this all work for you?
Probe for:
•
Your work environment
Success Case Interview Protocol on Clinical Supervision
2
•
•
•
•
•
•
•
•
Timing of the ATTC training
Expectations of supervisor/agency director
Personal expectations
Incentives/rewards at your agency
Experienced peers and/or support personnel to help you use what you learned
Other supports?
Other motivators?
Specifically, how much of a support was your ATTC trainer to the process?
o Value as a trainer?
o Value outside of training sessions?
o Sufficient availability?
3. Characteristics of the ATTC Clinical Supervision Training Initiative that
worked/helped:
It seems like the ATTC Clinical Supervision Training Initiative resulted in some
positive outcomes. What about the experience itself made it especially successful
for you?
•
•
•
•
•
•
The curriculum/approach (the clinical supervision activities taught)
The design of the training (length of time, materials, etc)
Delivery (facilitator)
Timing
Consultation/assistance from ATTC after the training initiative
Other
Categories for Nonsuccess Interviews:
Barriers?
Suggestions?
yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy
4. Barriers to learning/implementation:
In instances where you were unable to implement the clinical supervision skills/
activities taught in the training initiative:
•
•
•
What got in the way of using the clinical supervision skill/activity?
Why did the skill/activity not fit?
What barriers/resistance did you experience?
Success Case Interview Protocol on Clinical Supervision
3
In instances where you were able to implement clinical supervision skills/
activities, but did not experience any valuable results:
•
•
•
Was the activity not a good fit?
What barriers/resistance did you experience?
What results (if any) were experienced? Were they negative, or just not
valuable?
Success Case Interview Protocol on Clinical Supervision
4
Attachment K
Success Case Interview Protocol
on Motivational Interviewing
OMB No. 0930-xxxx
Expiration Date:
NATIONAL EVALUATION OF
THE ADDICTION TECHNOLOGY TRANSFER CENTER (ATTC) NETWORK
Motivational Interviewing Training Initiative
Success Case Interview Protocol
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-xxxx. Public reporting burden for
this collection of information is estimated to average 1 hour per interview, including the time
for reviewing instructions, searching existing data sources, gathering the data needed, and
completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 71044, Rockville, Maryland, 20857.
Success Case Interview Protocol on Motivational Interviewing
1
Motivational Interviewing Training Initiative
Success Case Interview Protocol
Questions 1- 3 are intended only for those clinicians deemed “successful” based on
survey results. Question 4 is intended for both those deemed “successful” and
“unsuccessful.”
Categories for Success Interviews:
What was
used?
What results
were
achieved?
What good
did it do?
(value)
What
helped?
Suggestions?
yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy
1. Success of application of learning after engaging in process:
From your survey responses, it looks like you’ve used your learning from the
ATTC Motivational Interviewing Training Initiative effectively and have
achieved some positive results. I’d like to understand in more detail how you
applied your learning and what positive things have happened because of and
since the training.
•
•
•
•
•
•
•
How have you used any of the Motivational Interviewing skills/activities
emphasized in this training?
[For each skill/activity mentioned] And then what? What did this lead to?
Have products been developed? Systems changed? Has the way you conduct
supervision changed?
What has implementing these new skills/activities achieved? How has it
helped you?
What strikes you as the most important benefit you got from implementing
Motivational Interviewing skills/activities?
What benefits to your agency/clients have resulted?
Any particular stories that illustrate the impact of the training?
2. Factors that supported the application of your learning:
What supports/factors contributed to you being able to successfully implement the
Motivational Interviewing skills/activities discussed above? As you think about
your job, your organization, your work environment, your professional
colleagues, etc, what made this all work for you?
Probe for:
•
Your work environment
Success Case Interview Protocol on Motivational Interviewing
2
•
•
•
•
•
•
•
•
Timing of the ATTC training
Expectations of supervisor/agency director
Personal expectations
Incentives/rewards
Experienced peers and/or support personnel to help you use what you learned
Other supports?
Other motivators?
Specifically, how much of a support was the ATTC trainer to the process?
o Value as a trainer?
o Value outside of training sessions?
o Sufficient availability?
3. Characteristics of the ATTC Motivational Interviewing Training Initiative
that worked/helped:
It seems like this training initiative resulted in some positive outcomes. What
about the experience itself made it especially successful for you?
•
•
•
•
•
•
The curriculum/approach (the Motivational Interviewing skills/activities
taught)
The design of the training (length of time, materials, etc)
Delivery (facilitator)
Timing
Consultation/assistance from ATTC after the training initiative
Other
Categories for Nonsuccess Interviews:
Barriers?
Suggestions?
yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy
4. Barriers to learning/implementation:
In instances where you were unable to implement the motivational interviewing
skills/ activities taught in the training initiative:
•
•
•
What got in the way of using the motivational interviewing skill/activity?
Why did the skill/activity not fit?
What barriers/resistance did you experience?
Success Case Interview Protocol on Motivational Interviewing
3
In instances where you were able to implement motivational interviewing
skills/activities, but did not experience any valuable results:
•
•
•
Was the activity not a good fit?
What barriers/resistance did you experience?
What results (if any) were experienced? Were they negative, or just not
valuable?
Success Case Interview Protocol on Motivational Interviewing
4
Attachment L
Success Case Interview Protocol
on Treatment Planning M.A.T.R.S.
OMB No. 0930-xxxx
Expiration Date:
NATIONAL EVALUATION OF
THE ADDICTION TECHNOLOGY TRANSFER CENTER (ATTC) NETWORK
Treatment Planning M.A.T.R.S. Training Initiative
Success Case Interview Protocol
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-xxxx. Public reporting burden for
this collection of information is estimated to average 1 hour per interview, including the time
for reviewing instructions, searching existing data sources, gathering the data needed, and
completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 71044, Rockville, Maryland, 20857.
Success Case Interview Protocol on Treatment Planning M.A.T.R.S.
1
Treatment Planning M.A.T.R.S. Training Initiative
Success Case Interview Protocol
Questions 1- 3 are intended only for those clinicians deemed “successful” based on
survey results. Question 4 is intended for both those deemed “successful” and
“unsuccessful.”
Categories for Success Interviews:
What was
used?
What results
were
achieved?
What good
did it do?
(value)
What
helped?
Suggestions?
yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy
1. Success of application of learning after engaging in process:
From your survey responses, it looks like your agency has used knowledge and
skills from the Treatment Planning M.A.T.R.S. Training Initiative effectively and
have achieved some positive results. I’d like to understand in more detail how
your agency applied its learning and what positive things have happened because
of and since the training.
•
•
•
•
•
•
•
How have you used any of the Treatment Planning skills/activities
emphasized in this training?
[For each skill/activity mentioned] And then what? What did this lead to?
Have products been developed? Systems changed? Has the way you conduct
supervision changed?
What has implementing these new skills/activities achieved? How has it
helped you?
What strikes you as the most important benefit you got from implementing
Treatment Planning skills/activities?
What benefits to your agency/clients have resulted?
Any particular stories that illustrate the impact of the training?
2. Factors that supported the application of your learning:
What supports/factors contributed to you being able to successfully implement the
Treatment Planning skills/activities discussed above? As you think about your
job, your organization, your work environment, your professional colleagues, etc.,
what made this all work for you?
Probe for:
• Your work environment
• Timing of the program
• Expectations of supervisor/agency director
Success Case Interview Protocol on Treatment Planning M.A.T.R.S.
2
•
•
•
•
•
•
Personal expectations
Incentives/rewards
Experienced peers and/or support personnel to help you use what you learned
Other supports?
Other motivators?
Specifically, how much of a support was the ATTC trainer to the process?
o Value as a trainer?
o Value outside of training sessions?
o Sufficient availability?
3. Characteristics of the Treatment Planning M.A.T.R.S. Training Initiative
that worked/helped:
It seems like the Treatment Planning M.A.T.R.S. Training Initiative resulted in
some positive outcomes. What about the experience itself made it especially
successful for you?
•
•
•
•
•
•
The curriculum/approach (the Treatment Planning skills/activities taught)
The design of the training (length of time, materials, etc)
Delivery (facilitator)
Timing
Consultation/assistance from ATTC after the training initiative
Other
Categories for Nonsuccess Interviews:
Barriers?
Suggestions?
yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy
4. Barriers to learning/implementation:
In instances where you were unable to implement the Treatment Planning skills/
activities taught in the training initiative:
•
•
•
What got in the way of using the Treatment Planning skill/activity?
Why did the skill/activity not fit?
What barriers/resistance did you experience?
In instances where you were able to implement Treatment Planning skills/
activities, but did not experience any valuable results:
Success Case Interview Protocol on Treatment Planning M.A.T.R.S.
3
•
•
•
Was the activity not a good fit?
What barriers/resistance did you experience?
What results (if any) were experienced? Were they negative, or just not
valuable?
Success Case Interview Protocol on Treatment Planning M.A.T.R.S.
4
Attachment N
Motivational Interviewing Adherence
Clinician Self-Assessment Form
OMB No. 0930-xxxx
Expiration Date:
NATIONAL EVALUATION OF
THE ADDICTION TECHNOLOGY TRANSFER CENTER (ATTC) NETWORK
Motivational Interviewing Adherence
Clinician Self-Assessment Form
Instrument is borrowed from: Martino, S., Ball, S.A., Gallon, S.L., Hall, D., Garcia, M., Ceperich, S.,
Farentinos, C., Hamilton, J., and Hausotter, W. (2006) Motivational Interviewing Assessment: Supervisory
Tools for Enhancing Proficiency. Salem, OR: Northwest Frontier Addiction Technology Transfer Center,
Oregon Health and Science University.
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-xxxx. Public reporting burden for
this collection of information is estimated to average 30 minutes per interview, including the
time for reviewing instructions, searching existing data sources, gathering the data needed, and
completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 71044, Rockville, Maryland, 20857.
Motivational Interviewing Adherence, Clinician Self-Assessment Form
1
Clinician ID: _______
Tape #: ______
Date: ____________
MOTIVATIONAL INTERVIEWING
CLINICIAN SELF-ASSESSMENT REPORT
Listed below are a variety of Motivational Interviewing consistent and inconsistent skill areas.
Please rate the degree to which you incorporated any of these strategies or techniques into your
session with your client. Feel free to write comments below each item about any areas you want
to discuss with your supervisor. For each item please rate your best estimate about how
frequently you used the strategy using the definitions for each scale point.
1
2
3
4
5
6
7
(NOT AT ALL) ........ Never used the strategy
(A LITTLE)............. Used the strategy 1 time briefly
(INFREQUENTLY)... Used the strategy 2 times briefly
(SOMEWHAT)......... Used the strategy 3–4 times briefly or once or twice extensively
(QUITE A BIT) ........ Used the strategy 5–6 times briefly or thrice extensively
(CONSIDERABLY) .. Used the strategy during more than half of the session
EXTENSIVELY ........ Used the strategy almost the entire session
MOTIVATIONAL INTERVIEWING CONSISTENT ITEMS
1. Motivational Interviewing Style or Spirit:
To what extent did you provide low-key feedback, roll with resistance (e.g.,
avoiding arguments, shifting focus), and use a supportive, warm, non-judgmental,
collaborative approach? To what extent did you convey empathic sensitivity
through words and tone of voice, demonstrate genuine concern and an awareness
of the client’s experiences? To what extent did you follow the client’s lead in
discussions instead of structuring the discussion according to your agenda?
......1 ................ 2................ 3 ................. 4 ................ 5 ................ 6 .................. 7 ......
NOT AT ALL
A LITTLE
INFREQUENTLY
SOMEWHAT
QUITE A BIT
CONSIDERABLY
EXTENSIVELY
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Motivational Interviewing Adherence, Clinician Self-Assessment Form
2
2. Open Ended Questions:
To what extent did you use open-ended questions (i.e., questions or requests that
elicit more than yes/no responses) to elicit the client’s perception of his/her
problems, motivation, change efforts, and plans? These questions often begin with
the interrogatives: “What,” “How,” and “In what” or lead off with the request,
“Tell me…” or “Describe…”
......1 ................ 2................ 3 ................. 4 ................ 5 ................ 6 .................. 7 ......
NOT AT ALL
A LITTLE
INFREQUENTLY
SOMEWHAT
QUITE A BIT
CONSIDERABLY
EXTENSIVELY
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
3. Affirmation of Strengths and Change Efforts:
To what extent did you verbally reinforce the client’s strengths, abilities, or
efforts to change his/her behavior? To what extent did you try to develop the
client’s confidence by praising small steps taken by the client in the direction
of change or by expressing appreciation for the client’s personal qualities that
might facilitate successful change efforts?
......1 ................ 2................ 3 ................. 4 ................ 5 ................ 6 .................. 7 ......
NOT AT ALL
A LITTLE
INFREQUENTLY
SOMEWHAT
QUITE A BIT
CONSIDERABLY
EXTENSIVELY
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4. Reflective Statements:
To what extent did you use reflective listening skills such as repeating (exact
words), rephrasing (slight rewording), paraphrasing (e.g., amplifying the
thought or feeling, use of analogy, making inferences) or making reflective
summary statements of what the client says?
......1 ................ 2................ 3 ................. 4 ................ 5 ................ 6 .................. 7 ......
NOT AT ALL
A LITTLE
INFREQUENTLY
SOMEWHAT
QUITE A BIT
Motivational Interviewing Adherence, Clinician Self-Assessment Form
CONSIDERABLY
EXTENSIVELY
3
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
5. Fostering a Collaborative Atmosphere:
To what extent did you convey in words or actions that counseling is a
collaborative relationship in contrast to one where you are in charge? How much
did you emphasize the (greater) importance of the client’s own decisions,
confidence, and perception of the importance of changing? To what extent did
you verbalize respect for the client’s autonomy and personal choice?
......1 ................ 2................ 3 ................. 4 ................ 5 ................ 6 .................. 7 ......
NOT AT ALL
A LITTLE
INFREQUENTLY
SOMEWHAT
QUITE A BIT
CONSIDERABLY
EXTENSIVELY
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
6. Motivation to Change:
To what extent did you try to elicit client discussion of change (selfmotivational statements) through evocative questions or comments designed to
promote greater awareness/concern for the problem, recognition of the
advantages of change, increased intent/optimism to change, or elaboration on a
topic related to change? To what extent did you discuss the stages of change,
help the client develop a rating of current importance, confidence, readiness or
commitment, or explore how motivation might be strengthened?
......1 ................ 2................ 3 ................. 4 ................ 5 ................ 6 .................. 7 ......
NOT AT ALL
A LITTLE
INFREQUENTLY
SOMEWHAT
QUITE A BIT
CONSIDERABLY
EXTENSIVELY
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Motivational Interviewing Adherence, Clinician Self-Assessment Form
4
7. Developing Discrepancies:
To what extent did you create or heighten the internal conflicts of the client
relative to his/her substance use? To what extent did you try to increase the
client’s awareness of a discrepancy between where his or her life is currently
versus where he or she wants it to be in the future? How much did you explore
how substance use may be inconsistent with a client’s goals, values, or selfperceptions?
......1 ................ 2................ 3 ................. 4 ................ 5 ................ 6 .................. 7 ......
NOT AT ALL
A LITTLE
INFREQUENTLY
SOMEWHAT
QUITE A BIT
CONSIDERABLY
EXTENSIVELY
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
8. Pros, Cons, and Ambivalence:
To what extent did you address or explore with the client the positive and
negative effects or results of his or her substance use and what might be gained
and lost by abstinence or reduction in substance use? To what extent did you
conduct a decisional balance activity consisting of a cost-benefits analysis or list
of pros and cons of substance use? How much did you develop and highlight the
client’s ambivalence, support it as a normal part of the change process, and reflect
back to the client the mixed thoughts and feelings that underpin the client’s
ambivalence?
......1 ................ 2................ 3 ................. 4 ................ 5 ................ 6 .................. 7 ......
NOT AT ALL
A LITTLE
INFREQUENTLY
SOMEWHAT
QUITE A BIT
CONSIDERABLY
EXTENSIVELY
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Motivational Interviewing Adherence, Clinician Self-Assessment Form
5
9. Change Planning Discussion:
To what extent did you develop a change plan with the client in a collaborative
fashion. How much did you cover critical aspects of change planning such as
facilitating discussion of the client’s self-identified goals, steps for achieving
those goals, supportive people available to help the client, what obstacles to the
change plan might exist, and how to address impediments to change?
......1 ................ 2................ 3 ................. 4 ................ 5 ................ 6 .................. 7 ......
NOT AT ALL
A LITTLE
INFREQUENTLY
SOMEWHAT
QUITE A BIT
CONSIDERABLY
EXTENSIVELY
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
10. Client-Centered Problem Discussion and Feedback:
To what extent did you facilitate a discussion of the problems for which the client
entered treatment instead of directing the conversation to problems identified by
you but not by the client? To what extent did you provide feedback to the client
about his or her substance use or problems in other life areas only when solicited
by the client or when you explicitly sought the client’s permission first?
......1 ................ 2................ 3 ................. 4 ................ 5 ................ 6 .................. 7 ......
NOT AT ALL
A LITTLE
INFREQUENTLY
SOMEWHAT
QUITE A BIT
CONSIDERABLY
EXTENSIVELY
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
11. Unsolicited Advice, Direction-Giving, or Feedback:
To what degree did you provide unsolicited advice, direction, or feedback (e.g.,
offering specific, concrete suggestions for what the client should do)? To what
extent was your style one of instructing the client how to be successful in
his/her recovery?
......1 ................ 2................ 3 ................. 4 ................ 5 ................ 6 .................. 7 ......
NOT AT ALL
A LITTLE
INFREQUENTLY
SOMEWHAT
QUITE A BIT
Motivational Interviewing Adherence, Clinician Self-Assessment Form
CONSIDERABLY
EXTENSIVELY
6
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Motivational Interviewing Adherence, Clinician Self-Assessment Form
7
| File Type | application/pdf |
| File Title | Microsoft Word - Attachment B Site Visit Protocol.doc |
| Author | SheedyC |
| File Modified | 2008-03-10 |
| File Created | 2008-02-19 |