Form Approved OMB No: 0920-0445 Expiration Date: 10/31/2002 Mental Health and Social Services State Questionnaire Mental Health and Social Services State Questionnaire Questions Standard Mental Health and Social Services 1 - 23 Provision of Services 1 - 6 Student Assistance Programs 1 Individualized Education and Health Plans 2 - 3 Medicaid 4 Collaboration 5 - 6 Evaluation 7 Staffing Characteristics 8 - 23 School-Based Health Center Services 24 - 25 Services Provided at Other Sites 26 Mental Health and Social Services Coordinator 27 - 37 Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, Mailstop D-24, Atlanta, GA 30333; Attention PRA (0920-0445). Special Instructions 1. This questionnaire focuses on your state practices and policies. 2. When we use the word “policy,” we mean any mandate issued by the state school board, state legislature, or other state agency that affects mental health or social services in districts or schools throughout your state. Please consider any policies officially adopted at the state level. These include policies developed by your state, or those based on model policies developed elsewhere. 3. We recognize that there may be some exceptions to the policies, but please answer the questions based on what is customary in your state. Please do not consider district or school practices or policies when answering the questions. (We will ask about district and school practices and policies when we collect information from districts and schools across the country.) 4. If you would like more information about this study or would like clarification of any questions in this survey, please call Tim Smith at 1-800-647-9664, extension 6095. Standard Mental Health and Social Services 1. Has your state adopted a policy stating that Student Assistance Programs (SAPs) will be offered to all students? SAPs provide services designed to assist students experiencing personal or social problems that can impact school performance, physical health, or overall well-being. Yes 1 No 2 2. Has your state adopted a policy stating that school mental health or social services staff (e.g., guidance counselors, psychologists, or social workers) will participate in the development of Individualized Education Plans (IEPs), when indicated? Yes 1 No 2 3. Has your state adopted a policy stating that school mental health or social services staff will participate in the development of Individualized Health Plans (IHPs), when indicated? Yes 1 No 2 4. The following questions ask about standard mental health and social services, meaning those services offered at the school, usually by a guidance counselor, psychologist, or social worker. By mental health and social services, we mean services such as crisis intervention, alcohol and other drug use treatment, or identification of or counseling for mental disorders or abuse. Later in the questionnaire, we will ask about any services offered by school-based health centers or at other sites. In your state, do any schools serve as Medicaid providers, by providing mental health or social services to students? Yes 1 No 2 5. During the past 12 months, have state mental health or social services staff worked on school mental health or social services activities with each of the following groups? Yes No a. State health education staff 1 2 b. State physical education staff 1 2 c. State food service staff 1 2 d. State health services staff 1 2 6. During the past 12 months, have state mental health or social services staff worked on school mental health or social services activities with staff or members from each of these organizations? Yes No a. State-level health organization, such as the American Heart Association or the American Red Cross 1 2 b. Colleges or universities 1 2 c. Businesses 1 2 7. During the past 2 years, have the following aspects of your state mental health or social services program been evaluated? Yes No a. Student use of the school mental health or social services program 1 2 b. The quality of the school mental health or social services program 1 2 c. Student satisfaction with the school mental health or social services program 1 2 d. Family satisfaction with the school mental health or social services program 1 2 e. School mental health or social services policies 1 2 f. Mental health or social services staff development or in-service programs 1 2 8. Based on policies adopted by your state, what is the minimum level of education required for a newly-hired guidance counselor? If specific requirements are not described, please mark this box ? and skip to Question 9. Mark ? one box. Undergraduate degree in counseling 1 Undergraduate degree in some other field 2 Master’s degree in counseling 3 Master’s degree in some other field 4 Doctoral degree in counseling 5 Doctoral degree in some other field 6 Other degree 7 9. Has your state adopted a policy stating that a newly-hired guidance counselor will be certified by a state agency or board? If your state does not certify guidance counselors, please mark this box ? and skip to Question 10. Yes 1 No 2 10. Has your state adopted a policy stating that a newly-hired guidance counselor will be certified by the National Board of Certified Counselors? Yes 1 No 2 11. Based on policies adopted by your state, what is the minimum level of education required for a newly-hired psychologist? If specific requirements are not described, please mark this box ? and skip to Question 12. Mark ? one box. Undergraduate degree in psychology 1 Undergraduate degree in some other field 2 Master’s degree in psychology 3 Master’s degree in some other field 4 Doctoral degree in psychology 5 Doctoral degree in some other field 6 Other degree 7 12. Has your state adopted a policy stating that a newly-hired psychologist will be certified by a state agency or board? If your state does not certify psychologists, please mark this box ? and skip to Question 13. Yes 1 No 2 13. Has your state adopted a policy stating that a newly-hired psychologist will be certified by the National Association of School Psychologists? Yes 1 No 2 14. Based on policies adopted by your state, what is the minimum level of education required for a newly-hired social worker? If specific requirements are not described, please mark this box ? and skip to Question 15. Mark ? one box. Undergraduate degree in social work 1 Undergraduate degree in some other field 2 Master’s degree in social work 3 Master’s degree in some other field 4 Doctoral degree in social work 5 Doctoral degree in some other field 6 Other degree 7 15. Has your state adopted a policy stating that a newly-hired social worker will be certified by a state agency or board? If your state does not certify social workers, please mark this box ? and skip to Question 16. Yes 1 No 2 16. Has your state adopted a policy stating that a newly-hired social worker will have a School Social Work Specialist credential? Yes 1 No 2 17. Has your state adopted a policy stating that mental health or social services staff will earn continuing education credits on mental health or social services topics to maintain state certification? If your state does not certify any mental health or social services staff, please mark this box ? and skip to Question 18. Yes 1 No 2 18. Based on policies adopted by your state, what is the required student-to-staff ratio for the following types of staff? If your state has not adopted a policy, please mark the “No requirement” box. Students per No staff person requirement a. Guidance counselors _____ 1 b. Psychologists _____ 1 c. Social workers _____ 1 19. Based on policies adopted by your state, what is the required school-to staff ratio for the following types of staff? If your state has not adopted a policy, please mark the “No requirement” box. Schools per No staff person requirement a. Guidance counselors _____ 1 b. Psychologists _____ 1 c. Social workers _____ 1 20. Has your state adopted a policy stating that each school will have someone to oversee or coordinate mental health or social services at the school? Yes 1 No 2 21. During the past 2 years, has your state provided any funding for or offered staff development on each of the following topics to mental health or social services staff? This might include workshops, conferences, continuing education, graduate courses, or any other kind of in-service. Yes No a. Tobacco use cessation 1 2 b. Alcohol or other drug use treatment 1 2 c. Crisis intervention for personal problems 1 2 d. Identification of or counseling for mental or emotional disorders, such as anxiety or depression 1 2 e. Stress management 1 2 f. Eating disorders treatment 1 2 g. Identification of or referral for physical, sexual, or emotional abuse 1 2 h. Human immunodeficiency virus (HIV) testing and counseling 1 2 i. After-school programs such as day-care or supervised recreation 1 2 j. Services for gay, lesbian, or bisexual students 1 2 k. Child care options for teen mothers 1 2 l. Enrollment in Special Supplemental Food Program for Women, Infants, and Children (WIC) or accessing food stamps or food banks 1 2 m. Enrollment in Medicaid or the Children’s Health Insurance Program (CHIP) 1 2 n. Job readiness skills programs 1 2 22. During the past 2 years, has your state provided any funding for or offered staff development on each of the following topics to mental health or social services staff? Yes No a. Nutrition and dietary behavior counseling, including weight management 1 2 b. Eating disorders prevention 1 2 c. Physical activity and fitness counseling 1 2 d. Pregnancy prevention 1 2 e. HIV prevention 1 2 f. Sexually transmitted disease (STD) prevention 1 2 g. Suicide prevention 1 2 h. Tobacco use prevention 1 2 i. Alcohol or other drug use prevention 1 2 j. Violence prevention, for example bullying, fighting, or homicide 1 2 k. Accident or injury prevention 1 2 23. During the past 2 years, has your state provided any funding for or offered staff development on each of the following topics to mental health or social services staff? Yes No a. Case management for students with behavioral or social problems 1 2 b. Family counseling 1 2 c. Group counseling 1 2 d. Individual counseling 1 2 e. Comprehensive assessment or intake evaluation 1 2 f. Peer counseling or mediation 1 2 g. Self-help or support groups 1 2 School-Based Health Center Services 24. The following questions ask about mental health and social services offered at school-based health centers — that is, health centers on school property where enrolled students can receive mental health and social services, including diagnostic and treatment services. These services are usually provided by a psychologist, social worker, or counselor, or other mental health or social services professional. Please do not include a traveling or mobile health center. Currently, how many school-based health centers offer mental health or social services to students in your state? _____ School-based health centers If none, please skip to Question 26. 25. In your state, do any school-based health centers serve as Medicaid providers, by providing mental health or social services to students? Yes 1 No 2 Services Provided at Other Sites 26. The next question asks about mental health and social services delivered to students at other sites not on school property regardless of whether the services are paid for by the school system. These services may be provided by mental health and social services professionals who work at school-linked health centers or who have a contract, memorandum of agreement, or other similar arrangement with a district or school to provide mental health or social services to students. Has your state adopted a policy stating that districts or schools will have such arrangements to provide mental health or social services when needed to students? Yes 1 No 2 Mental Health and Social Services Coordinator 27. Currently, does someone in your state oversee or coordinate school mental health and social services? HEB003 Yes 1 No 2 ==> That is the last question. Thank you very much for taking the time to complete this questionnaire. 28. Are you this person? Yes 1 No 2 ==> That is the last question. Thank you very much for taking the time to complete this questionnaire. 29. Who do you work for? Mark ? all that apply. State education agency 1 State mental health or social services agency 2 State public health agency 3 Other 4 30. Do you have an undergraduate degree? Yes 1 No 2 ==> That is the last question. Thank you very much for taking the time to complete this questionnaire. 31. What did you major in?HEB120 Mark ? all that apply. Counseling 1 Psychology 2 Social work 3 Nursing 4 Health care administration 5 Biology or other science 6 Business 7 Education 8 Other 9 32. Do you have an undergraduate minor?HEB121 Yes 1 No 2 ==> Skip to Question 34 33. What did you minor in?HEB122 Mark ? all that apply. Counseling 1 Psychology 2 Social work 3 Nursing 4 Health care administration 5 Biology or other science 6 Business 7 Education 8 Other 9 34. Do you have a graduate degree?HEB123 Yes 1 No 2 ==> Skip to Question 36 35. In what area or areas? Mark ? all that apply. Counseling 1 Psychology 2 Social work 3 Nursing 4 Medicine 5 Health care administration 6 Biology or other science 7 Business 8 Education 9 Other 10 36. Do you have any of the following credentials or certifications? Yes No a. School Social Work Specialist 1 2 b. National Board of Certified Counselors 1 2 c. National Association of School Psychologists 1 2 37. Are you certified by a state agency or board to provide mental health or social services? If your state does not certify mental health or social services professionals or staff, please mark this box ?. Yes 1 No 2 If you would like to provide any additional comments, please use the space below. Thank you very much for taking the time to participate in this study. Additional Comments Please return this questionnaire to: Don Evers Research Triangle Institute P.O. Box 12194 Research Triangle Park, NC 27709 Mental Health and Social Services State Questionnaire - Final Version — Revised: 10/26/99 Mental Health and Social Services State Questionnaire - Final Version — Revised: 10/26/99 2 Mental Health and Social Services State Questionnaire - Final Version — Revised: 10/26/99 Standard Mental Health and Social Services Mental Health/Social Services Coordinator