Form Attitudes Question Attitudes Question Attitudes Questionnaire

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OMB No. 0930-0274
Expiration Date: XX/XX/2016
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 0930-0274. Public reporting burden for
this collection of information is estimated to average 15 minutes per client per year, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining 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 2-1057, Rockville, Maryland, 20857.

Name:___________________________
(will be replaced by ID #)

Center:________________________
(will be replaced by ID #)

Training Date:_____/_____/______
MI/SP Counselor Attitudes Questionnaire
We would like to know your current thoughts about the DVD/webinar training you have just received.
Although we have asked you to write your name and your center's name above, as soon as we receive
the survey from you, we will cut that information off of the survey and replace it with a participation
identification number. You will not be linked with your responses. No one in your crisis center will know
how you responded on this survey. Neither you nor anyone else taking part in this study will be
identified in any publication or report of the findings.
1. Were you using safety planning techniques in your work as a crisis counselor prior to today’s
DVD/webinar training?  Yes
 No
2. What was the source of the safety planning protocols you were using prior to today’s DVD/webinar
training? (please check all that apply)
 Safety planning protocols from Applied Suicide Intervention Skills Training (ASIST)
 Safety planning protocols developed by Drs. Barbara Stanley and Gregory Brown for
the Veteran’s Administration
 Safety planning protocols developed at your center
 Safety planning protocols from another source: ______________________________
 Using safety planning protocols, but unsure of the source
 Not using safety planning protocols prior to this training
3. To what degree is the Safety Planning Intervention presented in today’s DVD/webinar training
different or similar to the intervention model used at your center prior to today’s training?
(please check one)
 Very similar

 Somewhat similar

 Somewhat different

 Very different

Comment:_________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
4. How much do you think the Safety Planning Intervention presented in today’s DVD/webinar training
will help you in conducting suicide intervention with callers and/or follow-up clients? This
intervention will be: (please check one answer in each column)

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During crisis calls:

During follow-up calls:















Very helpful
Pretty helpful
Somewhat helpful
A little helpful
Not at all helpful
N/A – I don’t answer crisis lines

Very helpful
Pretty helpful
Somewhat helpful
A little helpful
Not at all helpful
N/A – I don’t conduct follow-up calls

5. Which of the following statements best expresses your opinion about the process of adopting the
Safety Planning Intervention (SPI) model presented in today’s DVD/webinar training in your work
with suicidal callers and/or follow-up clients?
a) Overall, I think the process of adopting SPI in my work handling incoming calls from suicidal
callers will be: (check one)
 Very easy (few to no adjustments or challenges)
 Somewhat easy (there will be some adjustments and some challenges)
 Somewhat difficult (there will be several adjustments and several challenges, that
can be addressed)
 Very difficult (there will be major challenges that will be difficult to overcome)
 N/A – I don’t answer crisis lines
b) Overall, I think the process of adopting SPI in my work conducting follow-up will be: (check one)
 Very easy (few to no adjustments or challenges)
 Somewhat easy (there will be some adjustments and some challenges)
 Somewhat difficult (there will be several adjustments and several challenges, that
can be addressed)
 Very difficult (there will be major challenges that will be difficult to overcome)
 N/A – I don’t conduct follow-up calls
6. What adjustments/challenges might you anticipate in adopting the SPI model in your work with
suicidal callers and/or follow-up clients? Please describe:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
7. Other Feedback:

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Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly Agree

Please circle the number (1, 2, 3, 4 or 5) to the right of each item that most closely reflects your
opinion about your use of Safety Planning (SPI) as presented in today’s DVD/webinar training.

8. I feel well prepared to use the Safety Planning (SPI) model
with clients

1

2

3

4

5

9. I am confident that I can be an effective SPI crisis worker

1

2

3

4

5

10. The activities and exercises the SPI trainers used helped
me know how to apply my learning

1

2

3

4

5

11. I feel comfortable with SPI principles and techniques

1

2

3

4

5

12. The situations used in training are very similar to those I
encounter working at my center

1

2

3

4

5

13. The way the SPI trainer(s) taught the material made me
feel confident I could apply it

1

2

3

4

5

14. It is clear to me that the people conducting the SPI training
understand how I will use what I learned

1

2

3

4

5

15. Someone will have to change my priorities before I will be
able to implement this training at my center

1

2

3

4

5

16. I am positive about my ability to implement SPI with clients

1

2

3

4

5

17. I feel that using SPI will be a burden

1

2

3

4

5

18. I have sufficient training to be able to implement SPI
successfully

1

2

3

4

5

1 - Strongly disagree
2 - Disagree
3 - Neither agree nor disagree
4 - Agree
5 - Strongly agree

Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly Agree

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19. The resources I need to implement the Safety Planning
Intervention (SPI) will be available to me

1

2

3

4

5

20. There is too much happening right now for me to
adequately implement this training

1

2

3

4

5

21. The SPI procedures are consistent with my previous crisis
training

1

2

3

4

5

22. SPI does not offer anything new beyond what I already
use with individuals in crisis

1

2

3

4

5

23. Our current training at my center (i.e., way of doing things)
is sufficient without adding the SPI model

1

2

3

4

5

1 - Strongly disagree
2 - Disagree
3 - Neither agree nor disagree
4 - Agree
5 - Strongly agree

23. Have you received ASIST training? (ASIST stands for Applied Suicide Intervention Skills Training)
 ASIST trained…..If "Yes": Date trained (mm/dd/yy) _______/_______/________
 Not ASIST trained
24. How long have you been a telephone crisis worker? (please check one and provide details)
 Less than 1 year → How many months? __________
 1 year or more → How many years? __________
25. What is your highest level of education? (please check one)






Less than high school
High school graduate or GED
Some college or technical school
College graduate
Graduate school (e.g., M.S., M.S.W., Ph.D., M.D.)

26. What is your employment status at your center?
27. Do you answer crisis lines at your center?

 Paid Employee

 Yes

29. Do you conduct follow-up calls at your center?

 No

 Yes

 No

 Volunteer

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Your Name:___________________________

Center:________________________

(will be replaced by ID #)

(will be replaced by ID #)

Today’s Date:______/________/_______
Cohort II Counselor Attitudes Questionnaire – Part II
We would like to know your current thoughts about the Safety Planning Intervention (SPI) DVD/webinar
training you received as part of your center’s grant from SAMHSA to offer and provide follow-up to
suicidal individuals. Your answers to this questionnaire will be kept confidential. Please do write your
name and your center’s name on this form, so we can link your answers with Part I of your
questionnaire. Your name will not be linked with your responses. Evaluation staff will remove your
name and your center’s name from your questionnaire and replace them with participant identification
numbers. No one in your crisis center will know how you responded on this survey. Neither you nor
anyone else taking part in this study will be identified in any publication or report of the findings.
1. Since receiving SPI training, to what extent have you made use of SPI in your crisis intervention
work with suicidal callers and/or follow-up clients? I use SPI: (please check one box in each
column)
On incoming calls from suicidal callers:

On follow-up calls:















On all calls
On many calls
On some calls
On few calls
Not at all
N/A – I do not answer crisis lines

On all calls
On many calls
On some calls
On few calls
Not at all
N/A – I do not conduct follow-up calls

2. How much do you think the Safety Planning Intervention has helped you in conducting suicide
intervention with callers and/or follow-up clients? This intervention has been: (please check one
box in each column)
On incoming calls from suicidal callers:

On follow-up calls:















Very helpful
Pretty helpful
Somewhat helpful
A little helpful
Not at all helpful
N/A – I do not answer crisis lines

Very helpful
Pretty helpful
Somewhat helpful
A little helpful
Not at all helpful
N/A – I do not conduct follow-up calls

3. What barriers have you faced in implementing SPI in your crisis intervention work at your center?
Please describe :___________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

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4. What part of SPI has been most useful to you?
Please describe:___________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
5. What part of SPI has been least useful to you?
Please describe:___________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

6. Other feedback:

THANK YOU!