OMB No. 0930-XXXX
Expiration Date XX/XX/XXXX
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 25 minutes per respondent, 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.
ATTACHMENT 7: Core Staff Web Survey
INSTRUCTIONS
This survey is to help understand your experiences helping youth in the _______ program develop and work toward the goals in their person-centered plans. By this, we mean the plans you help youth develop to guide their services and supports in the _____ program. Usually, these are focused on advancing their future goals in areas such as employment and education as well as addressing mental health or substance abuse problems. They are often labeled things like “futures plans”, “transition plans”, etc.
As the name implies, person-centered planning emphasizes the input of the young person in identifying the goals and steps towards achieving those goals. Strong person-centered plans do not require goals to be “good”, only that they are what the young adult wants to pursue and that there the plan for achieving them is clear.
Most people have the experience of being able to perform better and worse when they attempt to implement a practice like person-centered planning. We would like to know about your different experiences performing person-centered planning with a young person (ages 16-26). Specifically, we want you to think the young adults with whom your performance was: 1) typical for you (your usual), 2) better than your usual, and 3) worse than your usual. You should choose these young adults based on YOUR performance, not how well planning went for the young adult. For example, you may have the experience of doing really strong person-centered planning with a young person who is very disengaged and struggles to think of even one goal. Use your best judgment. If you feel unsure you understand what we mean by “strong” person-centered planning, you can scan the questions first; these represent strong person-centered planning practice. Once you have identified these young adults, please retrieve their person-centered plans. You will be asked specific questions for which it may be helpful to have these documents on hand.
RESPONSE SCALE FOR “i”s, below: up to 3 months; up to 6 months; 6-12 months; a year or more.
Young Adult #1: Your “better than usual” performance, where you believe you did person-centered planning especially well. Remember, in selecting this “best case”, the emphasis should be on your performance, NOT the outcomes of the young adult. Please select an individual you have worked with in the past year and tell us roughly how long you worked with that person:
1a) ______ Provide the initials of the individual that represents your “strong” person-centered planning.
1ai) ______ How long has/did the young adult participate in the program, roughly?
Young Adult #2: Your “weak” young adult, where you believe you performed less well than usual in helping the young adult plan.
1b) ______ Provide the initials of the individual that represents your “weak” person-centered planning
1bi) ______ How long has/did the young adult participate in the program, roughly?
Young Adult #3: Your “typical” young adult, where you believe your performance helping with planning was typical for you.
1c) ______ Provide the initials of the individual that represents your “typical” person-centered planning.
1ci) ______ How long has/did the young adult participate in the program, roughly?
*NOTE: Note, all items below are labeled “#a”. These items would be repeated twice and labeled “b” and “c” in the actual survey, for the a), b), and c) sets of questions*
Questions about your experience with: __ __ [insert initials from 1a]
Please answer the following questions about planning with this young adult.
RESPONSE SCALE FOR ITEMS #2a through #27a: Strongly Disagree, Disagree, Undecided, Agree, Strongly Agree
2a) __ [insert initials] always made the major decisions about the plan.
___’s strengths and interests are identified and used in the plan (“used” means that plan goals or objectives specifically refer to these strengths)
Plans were written so that ____understood them and were in their own words as much as possible.
The services and supports in the plan focus on connecting ____ to integrated/natural settings and supports (e.g., competitive work or “mainstream” secondary, post-secondary education and training, family, friends) rather than just services.
In the interventions section of the plan, specific roles and action step(s) were identified for each person, including both formal (professional) and natural supports (family, friends, work, etc.).
I made sure that ____’s plan included goals that were important to him/her.
I updated the plan regularly with ____ so that it continued to reflect his/ her goals.
Please describe any changes (even minor ones) that you have made in ____’s plans in the last three months that you worked with ___. If there were no changes, please state this and indicate why:
RESPONSE SCALE FOR #9a: Yes or No
Does/did ___ have a team?
SKIP RULE: If yes, respond to items #10 through #15; if no, skip to #16
RESPONSE SCALE FOR #11a: Once, A few (2-5) times, About Monthly, 2-3 times
Since ____ has been/was in the program, how frequently did the team meet?
RESPONSE SCALE FOR #12a through 16a: Strongly Disagree, Disagree, Undecided, Agree, Strongly Agree
The team met at times and places that were convenient for _____.
In team meetings, we spent a lot of time talking about _____’s plan.
I helped _____ lead all of the team meetings, strongly encouraging him/her to do so as much as ____ possibly could.
Next steps toward goals were identified in each meeting.
When there were differences between what _____ and other team members wanted, the team went with what _____wanted.
INSTRUCTIONS, ITEMS #17-22, VRS A [to be presented to those who responded to the preceding questions on teams]: For the following items, please tell us about your work with _____, outside of formal teams (i.e., one-on-one).
INSTRUCTIONS, ITEMS #17-22, VRS B [all respondents not receiving “A” instructions]: For the following items, please tell us about your work with _____.
RESPONSE SCALE FOR ITEMS #17-#22: Strongly Disagree, Disagree, Undecided, Agree, Strongly Agree
We met at times and places that were convenient for _____.
I supported _____ in pursuing his/her goals right away in areas like employment, school, or housing, even if ___ was still struggling with medication adherence, sobriety, or clinical symptoms.
YOUNG ADULT ITEM: The person helped me to work on goals right away, instead of waiting until things in my life got easier.
I reminded _____ wherever I had the opportunity about ways to get natural supports like family members, friends, people at work or school, etc. involved.
I helped _____ arrange meetings with supports, either professional or natural, that helped with ____’s goals.
Please indicate a specific professional or natural support you helped ____connect with (NOTE: this does not have to be through arranging a meeting, but if not explain what your role was in creating the connection) [OPEN ENDED RESPONSE FORMAT]
I helped ____ identify community resources (e.g., programs, support groups, recreational resources) and how to use them.
Please indicate a specific community resource that you helped ____ connect with
I discussed with ____how to deal with challenges in reaching his/her goals.
Please indicate a specific challenge that you discussed with ____related to reaching his/her goals and how you addressed it together (if no specific challenges were discussed, indicate WHY). [OPEN-ENDED RESPONSE FORMAT]
RESPONSE SCALE #26-27: Strongly Disagree, Disagree, Undecided, Agree, Strongly Agree
I feel that I have addressed ____’s most important needs.
I believe _____ has been/was satisfied with the program.
On the following pages there are sentences that describe some of the different ways a person might think or feel about young adults they work with. As you read the sentences mentally insert __________ in place of _____________in the text. Below each statement there is a seven point scale:
RESPONSE SCALE FOR (1-7): Never Rarely Occasionally Sometimes Often Very Often Always
_______________ and I agree about the steps to be taken to improve his/her situation.
_______________ and I both feel confident about the usefullness of our current activities.
I believe _______________ likes me.
I have doubts about what we are trying to accomplish.
I am confident in my ability to help _______________.
We are working towards mutually agreed upon goals.
I appreciate _______________ as a person.
We agree on what is important for _______________ to work on.
_______________ and I have built a mutual trust.
_______________ and I have different ideas on what his/her real problems are.
We have established a good understanding between us of the kind of changes that would be good for _______________.
_______________ believes the way we are working with her/his problem is correct.
Core Staff, Barriers to Person-centered Planning
INSTRUCTIONS: The following statements refer to barriers or challenges related to implementing person-centered planning in your program, following your program guidelines for transition-age youth and young adults. Please carefully read each one, and then indicate the extent to which you agree or disagree with each statement. In responding to these, think about your experiences with ALL young adults that you have served, not just those that you picked for the previous section.
Following person-centered planning is difficult in our program for transition-age youth and young adults because…
SCALE: Strongly disagree, somewhat disagree, neither agree nor disagree, somewhat agree, Strongly Agree.
In following guidelines, we may not be able to establish medical necessity or meet regulations.
In individualizing plans to young adults, we may identify services and supports that are not reimbursable (i.e., for which our agency, state, etc. may not pay).
NOTE: For next item, add the response option “NA – I have only served young adults in this organization”
I don’t understand how planning with young adults is supposed to differ from planning with other populations (e.g., younger youth, older adults).
Forms that we are supposed to use don’t have the right fields or are otherwise set up poorly.
Planning approach conflicts with other practices used (e.g., is not consistent with evidence-based practices)
Planning approach is overly simplistic
There is not enough time to do this approach, given our caseload size and other responsibilities.
Plans are ignored by others who work with the young adult; plans are not integrated into young adults’ overall services.
Young adults are too impaired to participate.
Young adults don’t want to participate in planning.
Young adults want to make “bad choices” in their plans that would put them at risk.
Attachment 7: Core Staff Web Survey
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Napier, Ariana |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |