Form Alumni Fellows Sur Alumni Fellows Sur Alumni Fellows Survey

OMB NO. 0930-0304

Exp. Date MM/DD/YYYY

SURVEY OF ALUMNI SAMHSA MFP FELLOWS

Informed Consent Form

Please review before beginning the survey.

Purpose of the Survey

This survey is being conducted by Development Services Group, Inc. (DSG), on behalf of the federal Substance Abuse and Mental Health Services Administration (SAMHSA) Minority Fellowship Program (MFP). DSG is the technical assistance provider for the MFP. As a part its requirements under the Government Performance and Results and Modernization Act, SAMHSA has asked DSG to survey the alumni MFP Fellows to determine whether the MFP’s goals, objectives, and outcomes are being achieved. You have been selected for this evaluation because you are a former MFP Fellow.

What Will Be Done

You are being asked to respond to a survey that will take about 20 minutes to complete. The survey includes questions about your experiences in the MFP (from recruitment into the program through your participation in the various activities provided your MFP sponsoring organization).

Benefits of This Evaluation

You will be contributing to knowledge about the SAMHSA–funded MFP.

Risks or Discomforts

No risks or discomforts are anticipated from taking part in this survey. If you feel uncomfortable with a question, you can skip that question or withdraw from the survey altogether without any consequences to you.

Confidentiality

Your responses will be kept completely confidential. Any information that we learn about you will be protected against release to unauthorized persons. The primary purpose of this evaluation is to compile data that can be aggregated to characterize alumni MFP Fellows, their accomplishments, and the impacts of the MFP on their educations and their careers.

Decision to Quit at Any Time

Your participation is voluntary; you are free to withdraw your participation from this evaluation at any time. If you do not wish to continue, you can simply leave this website. You may also choose to skip any questions you do not wish to answer.

How the Findings Will Be Used

The aggregated results of this survey will be reported to SAMHSA, the Office of Management and Budget (OMB), Congress, MFP grantees, and the public.

Contact Information

If you have concerns or questions about this evaluation, please contact Marcia Cohen at [email protected] or at 301.951.0056.

By beginning the survey, you acknowledge that you have read this information and agree to participate in this research, with the knowledge that you are free to withdraw your participation at any time.

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 0930-0304. The public reporting burden for this collection of information is estimated to average 40 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, One Choke Cherry Road, Room 2-1057, Rockville, MD 20857.

1. In which SAMHSA Minority Fellowship Program (MFP) did you participate?

   1. ____ MFP traditional doctoral/M.D.

   2. ____ MFP addictions counselors

   3. ____ MFP transition-age youth

2. Which MFP organization administered the program you participated in?

   1. ____ American Association for Marriage and Family Therapy

   2. ____ American Nurses Association

   3. ____ American Psychiatric Association

   4. ____ American Psychological Association

   5. ____ Council on Social Work Education

   6. ____ International Certification and Reciprocity Consortium

   7. ____ National Association for Alcoholism and Drug Abuse Counselors

   8. ____ National Board for Certified Counselors

   9. ____ Other (please specify):

3. Which of the following best describes your general area of specialization within your former graduate/residency training program?

   1. ____ Mental health

   2. ____ Substance abuse (prevention, treatment, recovery)

   3. ____ Co-occurring disorders (mental illness and substance abuse)

   4. ____ Disparities (health, behavioral health)

   5. ____ Transition-age youth (behavioral health services)

   6. ____ Other (please specify):

Could you please tell us a little about your background?

4. What is your gender?

1. ____ Male

2. ____ Female

3. ____ Other (please specify):

5. What is your current age?

6. What is your marital status?

1. ____ Never been married

2. ____ Married

3. ____ Cohabitating

4. ____ Long-term partnership

5. ____ Separated

6. ____ Divorced

7. ____ Widowed

8. ____ Other (please specify):

7. Which of the following would best characterize the type of community in which you have professionally practiced? (If more than one, please select the one in which you have practiced the longest.)

6. ____ Urban

7. ____ Suburban

8. ____ Rural

9. ____ Frontier area

Please answer BOTH question 8 about Hispanic origin and question 9 about race. For this survey, Hispanic origins are not races.

8. Are you of Hispanic, Latino, or Spanish origin?

   1. ____ No, not of Hispanic, Latino, or Spanish origin

   2. ____ Yes, Mexican, Mexican American, Chicano

   3. ____ Yes, Puerto Rican

   4. ____ Yes, Cuban

   5. ____ Yes, another Hispanic, Latino, or Spanish origin (please specify, for example, Argentine, Salvadorian, Dominican, Spaniard): __________________________________________________________________

9. What is your race?

   1. ____ White

   2. ____ Black, African American, or Negro

   3. ____ American Indian or Alaska Native (please specify name of enrolled or principal tribe): _____________________________________________________

   4. ____ Asian Indian

   5. ____ Chinese

   6. ____ Filipina/Filipino

   7. ____ Japanese

   8. ____ Korean

   9. ____ Vietnamese

   10. ____ Native Hawaiian

   11. ____ Guamanian or Chamorro

   12. ____ Samoan

   13. ____ Other Pacific Islander (please specify, for example, Fijian, Tongan): ______________________________________________________________

   14. ____ Other Asian (please specify, for example, Hmong, Lao, Thai, Pakistani, Cambodian): ______________________________________________

   15. ____ Some other race (please specify): __________________________________

Could you please tell us about your activities during and since the MFP program?

10. How did you learn about the Minority Fellowship Program?

1. ____ Teacher

2. ____ Current Fellow

3. ____ Past Fellow

4. ____ Friend

5. ____ At a conference

6. ____ SAMHSA website

7. ____ Professional association website

8. ____ Other (please specify):

11. a. What university were you enrolled in as an MFP Fellow?

University or institution name:

b. What institution did you receive your post-doctorate or residency training?

University or institution name:

12. How old were you when you first became an MFP Fellow?

13. For how many years did you receive MFP funding?

14. Identify the years you received a Fellowship from the MFP.

    1. Year 1: _______________

    2. Year 2: _______________

    3. Year 3:_______________

Check here ____ if you did not complete the Minority Fellowship Program.

Can you please tell us a little bit about why you did not complete the Minority Fellowship Program? _____________

15. What degree were you pursuing during your Fellowship?

    1. ____ Doctorate

       1. ____ Ph.D.

       2. ____ DSW

       3. ____ Psy.D.

       4. ____ DNP

       5. ____ Ed.D.

       6. ____ DMFT

       7. ____ D.Min.

       8. ____ DCFT

    2. ____ M.D.

    3. ____ Master’s level

       1. M.S.

       2. M.A.

       3. MSW

       4. MPH

       5. M.Ed.

    4. ____ Certificate (please specify): ______

    5. ____ Other (please specify):

    6. ____ None

16. In what year did you complete your advanced educational requirements, such as your Ph.D., your psychiatric residency training, or other?

Check here ____ if you did not complete your advanced educational requirements.

Can you please tell us a little bit about why you did not complete your advanced educational requirements?

17. We are interested in any mentoring you received from your MFP sponsoring organization. Did you receive MFP–sponsored mentoring while you were in the MFP?

1. ____ Yes (if yes, please answer questions 18 through 24)

2. ____ No (if no, skip to question 25)

18. From whom did you receive MFP–sponsored mentoring? (Please check all that apply.)

1. MFP staff person(s)

2. ____ MFP alumna, alumnae, alumnus, alumni

3. ____ MFP advisory committee member(s)

4. ____ Other (please specify):

Questions 19 through 24 pertain to mentoring provided by your MFP sponsoring organization. If you did not receive any MFP–sponsored mentoring, please skip to question 25.

19. How often did you receive MFP–sponsored mentoring?

1. ____ Daily

2. ____ Weekly

3. ____ Monthly

4. ____ Yearly

5. ____ As needed

20. On average, how many hours of MFP–sponsored mentoring did you receive each month? _____

21. What type of MFP–sponsored academic/professional mentoring did you receive? (Please check all that apply.)

1. ____ General advice

2. ____ Professional support

3. ____ Problem-solving advice

4. ____ Collaboration

5. ____ Skill building

6. ____ Networking

7. ____ References

8. ____ Other (please specify):

22. What topics did your MFP–sponsored mentoring primarily focus on?

(Please select all that apply and rank the top five topics of primary interest)

Ranking

1. Underserved populations ______

2. Health disparities ______

3. Urban populations ______

4. Rural populations ______

5. Telehealth ______

6. Professional development ______

7. Promising practices in your field of study ______

8. Substance abuse ______

9. Mental health ______

10. Transition-age youth ______

11. Other (please specify):

1. What type of other MFP–sponsored support have you received?

1. ____ Personal/social support

2. ____ Financial advice

3. ____ Other

24. How satisfied were you with the MFP–sponsored mentoring you received?

1. ____ Very satisfied

2. ____ Satisfied

3. ____ Uncertain

4. ____ Dissatisfied

5. ____ Very dissatisfied

Please provide additional information on your reasons for satisfaction or dissatisfaction as reported in question 24.

25. Did you receive mentoring from any other source(s) outside the MFP? (Please select all that apply.)

1. ____ Advisor from your doctoral or graduate program

2. ____ Professional at your institution (not an advisor)

3. ____ Colleague or peer

4. ____ Organizations outside your institution (specify):

5. ____ Other (please specify):

25. How satisfied were you with the other mentoring you received?

1. ____ Very satisfied

2. ____ Satisfied

3. ____ Uncertain

4. ____ Dissatisfied

5. ____ Very dissatisfied

Please provide additional information on your reasons for satisfaction or dissatisfaction as reported in question 26.

25. Since you completed or left the MFP program, have you provided any kind of mentoring?

1. ____ Yes (if yes, please answer questions 28 through 32)

2. ____ No (if no, skip to question 33)

25. How often do/did you provide mentoring?

1. ____ Daily

2. ____ Weekly

3. ____ Monthly

4. ____ Yearly

5. ____ As needed

25. On average, how many hours of mentoring do/did you provide per month?

25. Whom do/did you mentor? (Please select all that apply.)

1. ____ Current MFP Fellow(s) [if yes, how many?]:

2. ____ Students at my university

3. ____ Community mentoring program, such as Big Brothers Big Sisters

4. ____ Other (please specify):

25. What type of mentoring do/did you provide? (Please select all that apply)

1. ____ General advice

2. ____ Professional support

3. ____ Personal support

4. ____ Financial advice

5. ____ Problem-solving advice

6. ____ Collaboration

7. ____ Skill building

8. ____ Networking

9. ____ References

10. ____ Other (please specify):

25. What topics do/did your mentoring primarily focus on? (Please select all that apply.)

    1. Working with underserved populations

    2. Health disparities

    3. Urban populations

    4. Rural populations

    5. Telehealth

    6. Professional development

    7. Promising practices in your field of study

    8. Substance abuse

    9. Mental health

    10. Transition age youth

    11. Other (please specify):

Please tell us about your work history since leaving the MFP.

25. What was your primary type of employment setting 1 year after completing the MFP? (If you had more than one job, please check the one you held the longest. If you were still in school, please indicate that as well.)

1. ____ College or university

2. ____ School setting (prekindergarten through 12)

3. ____ Community-based center

4. ____ Hospital or medical center

5. ____ Research organization

6. ____ Human services administration

7. ____ Private practice

8. ____ Mental health program

9. ____ Substance abuse program

10. ____ Co-occurring mental health and substance abuse program

11. ____ Association/foundation

12. ____ Business/consulting

13. ____ Still in school

14. ____ Criminal justice setting (courts/penal system)

15. ____ Other (please specify):

25. What was your position type?

    1. ____ Direct service

    2. ____ Executive management

    3. ____ Supervision/management

    4. ____ Administrative

    5. ____ Teaching

    6. ____ Research

    7. ____ Consulting

    8. ____ Policy analyst/policy advisor

    9. ____ Other (please specify):

25. Was your first job at a public or private organization?

1. ____ Public

2. ____ Private, for profit

3. ____ Private, nonprofit

25. Whom did the organization serve?

1. ____ Primarily minority populations

2. ____ Primarily nonminority (white)

3. ____ Mixed (minority/nonminority)

25. Was your employment in any of the following?

    1. ____ Mental health/psychiatric services (check all that apply)

    2. ____ Substance abuse and addictions

    3. ____ Youth counseling/youth behavioral health services

25. What was your primary type of employment setting 5 years after being in the Fellowship program? (If you had more than one job, please check the one you held the longest. If you were still in school, please indicate that as well.)

    1. ____ College or university

    2. ____ School setting (prekindergarten through 12)

    3. ____ Community-based center

    4. ____ Hospital or medical center

    5. ____ Research organization

    6. ____ Human services administration

    7. ____ Private practice

    8. ____ Mental health program

    9. ____Substance abuse program

    10. ____Co–occurring mental health and substance abuse

    11. ____ Association/foundation

    12. ____ Business/consulting

    13. ____ Still in school

    14. ____ Criminal justice setting (courts/penal system)

    15. ____ Other (please specify):

25. What was your position type?

    1. ____ Direct service

    2. ____ Executive management

    3. ____ Supervision/management

    4. ____ Administrative

    5. ____ Teaching

    6. ____ Research

    7. ____ Consulting

    8. ____ Policy analyst/policy advisor

    9. ____ Other (please specify):

25. Was this job at a public or private organization?

1. ____ Public

2. ____ Private, for profit

3. ____ Private, nonprofit

25. Whom did the organization serve?

1. ____ Primarily minority populations

2. ____ Primarily nonminority (white)

3. ____ Mixed (minority/nonminority)

25. Was your employment in any of the following (please select all that apply):

    1. ____ Mental health /psychiatric services

    2. ____ Substance abuse and addictions services

    3. ____ Youth counseling/youth behavioral health services

25. Since completing your Fellowship, which of the following have you done? (Please select all that apply.)

1. ____ Taught at a largely minority institution (including but not limited to

Historically Black Colleges and Universities)

2. ____ Taught at a nonminority university

3. ____ Provided community-based clinical services in minority communities

4. ____ Provided clinical services to minorities in other settings

5. ____ Administered human service programs in minority communities

6. ____ Held a clinical position in a hospital or medical institution serving large

minority populations

7. ____ Worked on federal policies for ethnic and racial minorities in mental health

and/or substance abuse

8. ____ Worked on state policies for ethnic and racial minorities in mental health

and/or substance abuse

9. ____ Worked on local community policies for ethnic and racial minorities in

mental health and/or substance abuse

10. ____ Had articles published in peer-reviewed publications about mental health

and/or substance abuse issues that affect ethnic and racial minorities

11. ____ Researched mental health and substance abuse issues with a focus on the

experiences of ethnic and racial minorities

12. ____ Engaged in other types of service to minority communities (please specify):

25. Since completing your MFP Fellowship, in which of the following professional development activities have you participated?

a. Submitted one or more articles to a peer-reviewed journal

1. ____Yes (if yes, how many?)

(If yes, was the article on minority-related issues in mental health and/or substance abuse? ____ Yes____ No )

2. ____ No

b. Submitted one or more articles to a non-peer-reviewed journal

1. ____ Yes (if yes, how many?)

(If yes, was the article on minority-related issues in mental health and/or substance abuse? ____ Yes____ No )

2. ____ No

c. Given a presentation at a professional conference

1. ____ Yes (if yes, how many?)

(If yes, was the presentation on minority-related issues in mental health and/or substance abuse? ____ Yes____ No )

2. ____ No

d. Published a book

1. ____ Yes (if yes, how many?)

(If yes, was the book on minority-related issues in mental health and/or substance abuse?) ____ Yes____ No)

2. ____ No

e. Published a book review

1. ____ Yes (if yes, how many?)

(If yes, was the book review on minority-related issues in mental health and/or substance abuse? ____ Yes____ No )

2. ____ No

1. Published a book chapter

1. ____ Yes (if yes, how many?)

(If yes, was the book chapter on minority-related issues in mental health and/or substance abuse? ____ Yes____ No )

2. ____ No

2. Submitted a grant proposal

1. ____ Yes (if yes, how many?)

(If yes, was the grant proposal on minority-related issues in mental health and/or substance abuse? ____ Yes____ No )

2. ____ No

3. Received any honors or citations?

1. ____ Yes (if yes, please name)

(If yes, how many honors or citations have you received?) _______

ii.____ No

4. Received any licenses or certificates?

1. ____ Yes (if yes, please describe)

(If yes, how many licenses or certificates have you received?)

2. ____No

5. Other (please specify):

25. Since being in the Fellowship program, have you served on any advisory committees?

1. ____ Yes (if yes, how many?)

2. ____ No

25. Have you sat on the boards of any community-based organizations primarily serving minority populations?

1. ____ Yes (if yes, how many?)

2. ____ No

If yes, please indicate whether this organization/these organizations focused on (please select all that apply)…

1. ____ Mental health

2. ____ Substance abuse

3. ____ Transition-aged youth

4. ____ Other (please specify):

How many years (total) have you sat on this board/these boards?

Did you take on any of the following leadership roles?

1. ____ President

2. ____ Vice president

3. ____ Chair or co-chair

4. ____ Secretary

5. ____ Other (please specify):

25. Since leaving the MFP as a Fellow, have you made other contributions to the fields of minority mental health and substance abuse treatment that you would like to share?

So that we may learn additional information about your contributions to the field, without linking your identity to this survey, please email (or send a hardcopy) of your current résumé to

Tom Vischi, Project Director

SAMHSA MFP Data Tracking and Evaluation Project

Development Services Group, Inc.

7315 Wisconsin Avenue, Suite 800E

Bethesda, MD 20814

[email protected]

25. In what ways do you believe the MFP helped you realize your professional accomplishments?

25. What suggestions (if any) do you have for enhancing the SAMHSA MFP? ____________________________________________________________

26. Is there anything else that you would like to tell us about your experience with the MFP, both while you were an MFP Fellow and afterward?

Thank you for participating in this survey.

We appreciate your taking the time to share your thoughts with us!

SURVEY OF ALUMNI SAMHSA MFP FELLOWS 25