Midwest Modified Index Colloboration Pre-test and Follow-up - Word

Attachment F7 Form Approved
OMB No. XXXX-XXXX
Exp. Date xx/xx/xxxx

Modified Index of Interdisciplinary Collaboration, Pre-test

DIRECTIONS: With regard to your current primary work setting/organization, please indicate the extent to which you agree or disagree with each of the following statements by circling the appropriate number beside each statement.

Email Address: ________________________________________________________(for follow-up only)

Please answer all questions to the best of your ability using the scale below.

1= Strongly Agree 2= Agree 3= Neutral 4= Disagree 5= Strongly disagree

1. I utilize other professionals in different disciplines for their particular expertise.	1	2	3	4	5
2. I consistently give feedback to other professionals in my setting.	1	2	3	4	5
3. Professionals in different disciplines in my setting utilize me for a range of tasks.	1	2	3	4	5
4. Teamwork with professionals from other disciplines is not important in my ability to help clients.	1	2	3	4	5
5. The colleagues from other professional disciplines and I rarely communicate.	1	2	3	4	5
6. The colleagues from other disciplines with whom I work have a good understanding of the distinction between my role and their role(s).	1	2	3	4	5
7. My colleagues from other disciplines make inappropriate referrals to me.	1	2	3	4	5
8. I can define those areas that are distinct in my professional role from that of professionals from other disciplines with whom I work.	1	2	3	4	5
9. I view part of my professional role as supporting the role of others with whom I work.	1	2	3	4	5
10. My colleagues from other disciplines refer to me often.	1	2	3	4	5
11. Cooperative work with colleagues from other disciplines is not a part of my job description.	1	2	3	4	5
12. My colleagues from other professional disciplines do not treat me as an equal.	1	2	3	4	5
13. My colleagues from other disciplines believe that they could not do their jobs as well without my professional discipline.	1	2	3	4	5
14. Distinct new programs emerge from the collective work of colleagues from different disciplines.	1	2	3	4	5
15. Organizational protocols reflect the existence of cooperation between professionals from different disciplines.	1	2	3	4	5
16. Formal procedures/mechanisms exist for facilitating dialogue between professionals from different disciplines (i.e., at staffing, in-service, rounds, etc)	1	2	3	4	5
17. I am not aware of situations in my agency in which a coalition, task force, or committee has developed out of interdisciplinary efforts.	1	2	3	4	5
18. Working with colleagues from other disciplines leads to outcomes that we could not achieve alone.	1	2	3	4	5
19. Creative outcomes emerge from my work with colleagues from other professions that I could not have predicted.	1	2	3	4	5
20. I am willing to take on tasks outside of my job description when that seems important.	1	2	3	4	5
21. I am not willing to sacrifice a degree of autonomy to support cooperative problem solving.	1	2	3	4	5
22. I utilize formal and informal procedures for problem-solving with my colleagues from other disciplines.	1	2	3	4	5
23. The professional colleagues from other disciplines with whom I work stick rigidly to their job descriptions.	1	2	3	4	5
24. Colleagues from other disciplines and I work together in many different ways.	1	2	3	4	5
25. Professionals from other disciplines with whom I work encourage family members’ participation in the treatment process.	1	2	3	4	5
26. My colleagues from other disciplines are not committed to working together.	1	2	3	4	5
27. My colleagues from other disciplines work through conflicts with me in efforts to resolve them.	1	2	3	4	5
28. When colleagues from different disciplines make decisions together they go through a process of examining alternatives.	1	2	3	4	5
29. My interactions with colleagues from other disciplines occurs in a climate where there is freedom to be different and to disagree.	1	2	3	4	5
30. Clients/patients/students participate in interdisciplinary planning that concerns them.	1	2	3	4	5
31. Colleagues from all professional disciplines take responsibility for developing treatment plans.	1	2	3	4	5
32. Colleagues from all professional disciplines do not participate in implementing treatment plans.	1	2	3	4	5
33. Professionals from different disciplines are straightforward when sharing information with clients/patients/students.	1	2	3	4	5
34. My colleagues from other disciplines and I often discuss different strategies to improve our working relationships.	1	2	3	4	5
35. My colleagues from other professions and I talk about ways to involve other professionals in our work together.	1	2	3	4	5
36. Colleagues from other disciplines do not attempt to create a positive climate in our organization.	1	2	3	4	5
37. I am optimistic about the ability of my colleagues from other disciplines to work with me to resolve problems.	1	2	3	4	5
38. I help my colleagues to address conflict with other professionals directly.	1	2	3	4	5
39. Colleagues from other disciplines are as likely as I am to address obstacles to our successful collaboration.	1	2	3	4	5
40. My colleagues from other disciplines and I talk together about our professional similarities and differences including role, competencies, and stereotypes.	1	2	3	4	5
41. My colleagues from other professions and I do not evaluate our work together.	1	2	3	4	5
42. I discuss with professionals from other disciplines the degree to which each of us should be involved in a particular case.	1	2	3	4	5

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