OMB 0970-0564 [valid through MM/DD/2024]
(Revised: 8/13/2020)
LTFC Staff Questionnaire – Clinician/Lead Clinician
Interview Details |
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Program Name: |
Interviewer Name: |
Full Name: |
Date/Time of Interview: |
Past and Current Position(s) at Program: |
*Note: Before beginning the interview and/or providing this questionnaire to staff, provide a brief introduction, including monitor role and purpose of monitoring visit, confidentiality of staff interview, and clarify any questions. See Introduction Prompt for Staff for additional guidance as needed.
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NOTES |
Tell me about your role and main responsibilities as a clinician.
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Tell me about your educational background and how you ended up working as a clinician here.
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What is your typical caseload?
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Do you have any concerns related to the confidentiality of mental health services? (i.e. designated confidential space, confidential record management system) If so, please describe.
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What approach do you implement in providing individual and group counseling sessions for UACs?
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What does trauma-informed care mean to you?
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What are the things that you love/enjoy about your job? What are the challenges you face in your job?
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What system do you use to track and document clinical sessions?
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Do you feel that you have received adequate training to perform your clinician duties? If not, please explain.
(Lead Clinician) Do you have a system to assess ongoing staff training needs?
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How does the program, including foster parents, handle UACs’ behavioral challenges? How effective do you think the behavior management system is?
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Do you have any concerns about the treatment of UACs in care?
Do you have concerns about any particular staff members or foster parents (any staff members or foster parents you think should NOT be working with UAC)? |
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Describe the procedures when there is an allegation of child abuse or maltreatment in the foster home. |
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If a UAC in care is presenting with mental health concerns that warrant additional services, how does the program respond?
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How is risk of runaway evaluated? What happens once a UAC is identified as being at risk of running away? What procedures/safeguards are implemented?
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How does the clinical team collaborate and communicate with other departments?
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What is the program’s plan for dealing with a mental health emergency?
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Please describe your relationship with your supervisor.
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(Lead Clinician) Do you have enough input and resources to make changes to improve mental health services at the program?
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What general recommendations do you have to strengthen the program? What improvements would you put in place?
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What recommendations do you have for ORR that I can take back to share with our headquarter teams?
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Enter Additional Notes.
THE
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF
PUBLIC BURDEN: The purpose of this information collection is to
allow ORR Monitoring Team staff to interview and document responses
from clinicians and lead clinicians during biennial site visits.
Public reporting burden for this collection of information is
estimated to average 1.0 hour per response (plus an additional 1.0
hour if the site visit is performed by a contractor monitor),
including the time for reviewing instructions, gathering and
maintaining the data needed, and reviewing the collection of
information. This is a mandatory collection of information
(Homeland Security Act, 6 U.S.C. 279). An agency may not conduct or
sponsor, and a person is not required to respond to, a collection
of information subject to the requirements of the Paperwork
Reduction Act of 1995, unless it displays a currently valid OMB
control number. If you have any comments on this collection of
information please contact [email protected].
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Poole, Laura (ACF) (CTR) |
File Modified | 0000-00-00 |
File Created | 2024-07-28 |