14 Mental Health and Social Services State Questionnaire

Form Approved

OMB No: 0920-0445

Expiration Date: xx/xx/xxxx

Mental Health and Social Services
State Questionnaire

6 January 2011

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, Mailstop D-74, Atlanta, GA 30333; Attention PRA (0920-0445).

Mental Health and Social Services
State Questionnaire

Questions

State Assistance to Districts and Schools 1 - 3

Funding/Medicaid 4 - 5

Collaboration 6 - 7

Evaluation 8

Professional Development 9 - 12

Mental Health and Social Services Coordinator 13 - 22

THIS QUESTIONNAIRE WILL BE ADMINISTERED USING WEB-BASED INTERVIEW TECHNOLOGY. AS THE RESPONDENT TYPES RESPONSES TO THE QUESTIONS INTO THE COMPUTER, THE INTERVIEW PROGRAM WILL 1) DISPLAY THE CORRECT TENSE OF VERBS, 2) PROVIDE ALTERNATE ANSWERS TO QUESTIONS (E.G., NOT APPLICABLE, “I DON’T KNOW”), 3) NAVIGATE COMPLEX SKIP PATTERNS, AND 4) PERFORM OTHER USEFUL FUNCTIONS. THE PROGRAMMING SPECIFICATIONS FOR THE INTERVIEW ARE NOT INCLUDED IN THIS PRINTED VERSION OF THE QUESTIONNAIRE.

For the purposes of this questionnaire, “elementary school” refers to a school that contains any of grades K–5. “Middle school” refers to a school that contains any of grades 6–8. Some jurisdictions may refer to these schools as “junior high schools.” “High school” refers to a school that contains any of grades 10–12. Some jurisdictions may refer to these schools as “senior high schools.”

The first questions ask about state assistance to districts and schools.

1. During the past 2 years, did your state develop, revise, or assist in developing model policies, policy guidance, or other materials to inform district or school policy on…

Yes No

1. Providing mental health or social services to students? 1 2

2. Student assistance programs? 1 2

3. Student support teams? 1 2

4. Linking students to community mental health or social
   services providers? 1 2

2. During the past 2 years, did your state distribute to district or school staff model policies, policy guidance, or other materials to inform district or school policy on each of the following topics?

Yes No

1. Providing mental health or social services to students 1 2

2. Student assistance programs 1 2

3. Student support teams 1 2

4. Linking students to community mental health or social
   services providers 1 2

The next questions ask about technical assistance your state may have provided to district or school staff. Technical assistance refers to tailored guidance to meet the specific needs of the district or school that may be provided through phone, e-mail, Internet, or in-person meetings.

3. During the past 12 months, has your state provided technical assistance to district or school staff on…

Yes No

1. Providing mental health or social services to students? 1 2

2. Student assistance programs? 1 2

3. Student support teams? 1 2

4. Linking students to community mental health or social
   services providers? 1 2

The next question asks about funding for standard mental health and social services in your state. For the purposes of this question, “standard” means services offered to all students.

4. In your state, how are standard mental health and social services for students funded? MARK ALL THAT APPLY

State budget 1

School district budgets 2

Medicaid 3

State Children’s Health Insurance
Program (SCHIP) 4

Private insurance 5

Public grants 6

Private grants 7

Other 8

The next question asks about schools in your state that serve as Medicaid providers by providing standard mental health or social services to students. For the purposes of this question, “standard” means services offered to all students in your state.

5. In your state, do any schools serve as Medicaid providers, by providing standard mental health or social services to students?

Yes 1

No 2

The next questions ask about collaboration among mental health or social services staff and other staff in your state.

6. During the past 12 months, have state-level mental health or social services staff worked on school mental health or social services activities with state-level…

State does
not have staff
Yes No in this area

1. Health education staff? 1 2 3

2. Physical education staff? 1 2 3

3. Child nutrition or nutrition services staff? 1 2 3

4. Health services staff? 1 2 3

7. During the past 12 months, have state mental health or social services staff worked on school mental health or social services activities with staff or members from…

State does
not have this
agency or
Yes No organization

1. The state health department? 1 2 3

2. The state mental health or social services
   agency? 1 2 3

3. The state child welfare agency? 1 2 3

4. The state foster care system? 1 2 3

5. The state juvenile justice department? 1 2 3

6. A state-level school counselors’,
   psychologists’, or social workers’
   association or organization? 1 2 3

7. A state-level school nurses’ association
   or organization? 1 2 3

8. A state-level physicians’ organization, such
   as the American Academy of Pediatrics? 1 2 3

9. A state-level health organization, such as
   the American Heart Association or the
   American Red Cross? 1 2 3

10. A state-level school health committee,
    council, or team? 1 2 3

(Q7 continued)

11. Colleges or universities? 1 2 3

12. Businesses? 1 2

The next questions ask about different aspects of your state’s mental health or social services program that might have been evaluated during the past two years.

8. During the past two years, has the state evaluated…

Yes No

1. School mental health or social services programs? 1 2

2. School mental health or social services policies? 1 2

3. Mental health or social services professional
   development or in-service programs? 1 2

4. Student use of school mental health or social services? 1 2

5. Student or family satisfaction with school mental health
   or social services? 1 2

My next questions are about professional development which might include workshops, conferences, continuing education, graduate courses, or any other kind of in-service.

9. During the past two years, has your state provided funding for or offered professional development to mental health or social services staff on…

Yes No

1. Tobacco use cessation? 1 2

2. Alcohol or other drug use treatment? 1 2

3. Counseling after a natural disaster or other emergency
   or crisis situation? 1 2

4. Crisis intervention for personal problems? 1 2

5. Emergency preparedness? 1 2

6. Identification of emotional or behavioral disorders,
   such as anxiety, depression, or ADHD? 1 2

7. Counseling for emotional or behavioral disorders,
   such as anxiety, depression, or ADHD? 1 2

8. Stress management? 1 2

9. Weight management? 1 2

10. Eating disorders treatment? 1 2

11. HIV counseling, testing, and referral? 1 2

12. Identification of or referral for physical, sexual,
    or emotional abuse? 1 2

13. Identification of or referral for students
    with family problems, such as parental divorce,
    substance abuse, or violence? 1 2

14. After-school programs for students,
    such as supervised recreation? 1 2

15. Child care options for teen mothers? 1 2

16. Services specifically for gay, lesbian, or bisexual students? 1 2

17. Enrolling in WIC or accessing food stamps or food banks? 1 2

18. Securing temporary or permanent housing? 1 2

19. Enrolling in Medicaid or SCHIP? 1 2

20. Accessing benefits for students with disabilities? 1 2

21. Job readiness skills programs? 1 2

10. During the past two years, has your state provided funding for or offered professional development to mental health or social services staff on…

Yes No

1. Nutrition and dietary behavior counseling? 1 2

2. Physical activity and fitness counseling? 1 2

3. Pregnancy prevention? 1 2

4. Human immunodeficiency virus (HIV) prevention? 1 2

5. Other sexually transmitted disease (STD) prevention? 1 2

6. Suicide prevention? 1 2

7. Tobacco use prevention? 1 2

8. Alcohol or other drug use prevention? 1 2

9. Violence prevention, for example bullying, fighting,
   or dating violence prevention? 1 2

10. Injury prevention and safety counseling? 1 2

The next question asks about professional development for teachers, administrators, and school staff other than mental health and social services staff.

11. During the past two years, has your state provided funding for or offered professional development to mental health or social services staff on…

Yes No

1. Case management for students with emotional
   or behavioral problems? 1 2

2. Family counseling? 1 2

3. Group counseling? 1 2

4. Individual counseling? 1 2

5. Comprehensive assessment or intake evaluation? 1 2

6. Peer counseling or mediation? 1 2

7. Self-help or support groups? 1 2

8. Student assistance programs? 1 2

9. Student support teams? 1 2

12. During the past two years, has your state provided funding for or offered professional development to any teachers, administrators, or other school staff on…

Yes No

1. Recognizing signs and symptoms of physical, sexual,
   or emotional abuse? 1 2

2. Recognizing signs and symptoms of substance abuse? 1 2

3. Recognizing signs and symptoms of depression
   and suicidality? 1 2

4. Recognizing signs and symptoms of dating violence? 1 2

5. Recognizing signs and symptoms of bullying victimization? 1 2

6. Making appropriate referrals to a school counselor,
   psychologist, or social worker? 1 2

7. Managing students with emotional or behavioral problems? 1 2

13. Currently, does someone in your state oversee or coordinate school mental health and social services?

Yes 1

No 2 That is the last question.
Thank you very much for taking the time to complete this questionnaire.

14. Are you this person?

Yes 1

No 2 That is the last question.
Thank you very much for taking the time to complete this questionnaire.

15. Who do you work for?
    MARK ALL THAT APPLY

State education agency 1

State mental health or social services agency 2

State public health agency 3

Other 4

The last questions ask about your educational background.

16. Do you have an undergraduate degree?

Yes 1

No 2 That is the last question.
Thank you very much for taking the time to complete this questionnaire.

17. What did you major in?
    MARK ALL THAT APPLY

Counseling 1

Psychology 2

Social work 3

Education 4

Other (Specify) 5

18. Did you have an undergraduate minor?

Yes 1

No 2 SKIP TO Q19

19. What did you minor in?
    MARK ALL THAT APPLY

Counseling 1

Psychology 2

Social work 3

Education 4

Other (Specify) 5

20. Do you have a graduate degree?

Yes 1

No 2 SKIP TO Q21

21. In what area or areas was your graduate work?
    MARK ALL THAT APPLY

Counseling 1

Psychology 2

Social work 3

Education 4

Other (Specify) 5

22. Are you licensed, certified, or credentialed by a state agency or board to provide school mental health or social services?

Yes 1

No 2

State does not license, certify,
or credential school mental health
or social services professionals 3

Thank you very much for taking the time to participate in this study.

If you would like more information about this study or would like clarification of any questions in this questionnaire, please call 800-287-1815.