Attachment.5.Summary.of.Revisions

Attachment.5.Summary.of.Revisions.doc

National Cross-Site Assessment of Addiction Technology Transfer Centers (ATTC) Network

Attachment.5.Summary.of.Revisions

OMB: 0930-0216

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Attachment 5: Summary of Revisions

  1. Event Description Form (Attachment 1)

    1. Response choices for Question B1>SAMHSA Programs/Issues and other Special Topics have been revised as follows:

Co-occurring Disorders (no change)

Seclusion & Restraint (no change)

Children & Families (no change)

Mothers and Infants DELETED

Adolescents DELETED

Mental Health Systems Transformation (no change)

Homelessness (no change)

HIV/AIDS/Hepatitis (no change)

Clinical Supervision DELETED

Racial/Ethnic Minorities DELETED

Workforce Development ADDED

Substance Abuse Treatment Capacity (no change)

Strategic Prevention Framework (no change)

Disaster Readiness &Response DELETED

Aging CHANGED TO “Older Adults”

Criminal Justice CHANGED TO “Criminal & Juvenile Justice”

Pharmacology DELETED


    1. Response choices for Question B2>SAMHSA Cross-Cutting Principles have been RE-ORDERED and revised as follows:

Science to Services/Evidence-Based Practices (no change)

Collaboration w/ Public & Private Partners (no change to wording)

Cultural Competency/Eliminating Disparities (no change to wording)

Trauma & Violence (no change to wording)

Rural & Other Specific Settings (no change to wording)

Performance Measurement & Management CHANGED TO “Data for Performance Measurement & Management”

Recovery: Reducing Stigma & Barriers to Service CHANGED TO “Reducing Stigma & Barriers to Service”

Community & Faith-Based CHANGED TO “Community & Faith-based Approaches”

Workforce Development DELETED

Financing Strategies/Cost-effectiveness (no change to wording)

Disaster Readiness & Response ADDED


  1. Response choices for “Publication Use. Please record the TIPs, TAPs and other publications you used in this event” have been revised as follows:

TIPS ADDED at end of list:

45: Detox and SA Tx

46: Admin Issues – Intensive Outpt.

47: Clinical Issues – Intensive Outp.

48: Managing Depressive Symptom

49: Inc. Alco. Pharm. Into Med Prac.

50: Addressing Suicidal Th./Behav.


TAPS ADDED at end of list:

28: NRADAN Awards for Excellence

29: State Admin Records for Perf. Mgt

30: Buprenorphine for Nurses

31: Implementing Change


Other Publications REVISED:

Untangling the Web – DELETED


  1. Training Post Event Forms (Attachment 2-1)

    1. Questions 20 - 24 will be deleted and replaced with the following (in blue):

20. Your gender: Female Male Transgender

21. Are you Hispanic or Latino/a? Yes No

22. What is your race? (select one or more):

American Indian

Alaska Native

Native Hawaiian

Other Pacific Islander

Asian

White

Black or African American

Other (please specify) _______________

23. What is the highest degree you have received (select one)?

Some high school, but no diploma or equivalent

High school diploma or equivalent

Some college but no degree

Associate's degree

Bachelor's degree

Master's degree

Doctoral degree or equivalent

Other (please specify): _________________



24. What is your primary profession (select one)?

Counselor

Addictions professional

Social worker

Recovery specialist

Mental health professional

Criminal justice/law enforcement professional

Disease intervention specialist/investigator

Community health worker

Health educator

Educator (post-secondary or continuing)

Public or Business Administrator

Researcher

Physician

Physician assistant

Registered nurse

Licensed practical nurse

Advanced practice nurse

Pharmacist

Dentist

Other dental professional

Other (please specify)_____________

25. If you are a student, what is your primary field of study (select one)?

Not a student

Counseling

Psychology

Social Work

Medicine

Nursing

Pharmacology

Dentistry

Basic, translational or applied science

Criminal justice/law enforcement

Addiction

Education

Public health

Public or business administration

Other (please specify)


26. In which discipline(s) are you currently licensed or certified (select one or more)?

Not licensed or certified

Addictions prevention, treatment or recovery

Counseling

Psychology

Social Work

Medicine

Nursing

Pharmacology

Dentistry

Other (please specify)________________

27. Which best describes your role at your current workplace (select one)?

Clinician / care provider/direct service provider

Clinical Supervisor

Recovery Specialist

Manager / coordinator/administrator

Client / patient educator

Case manager

Prevention case manager


Counselor

Mental health therapist

Parole/Probation/Re-Entry Support

Outreach staff

Disease intervention/investigation

Resident / fellow

Teacher / faculty

Trainer / TA Provider

Group Facilitator

Not currently employed

Other (please specify)_____________

28. Which best describes your principal employment setting (select one)?

Community or Faith-based service organization (CBO/FBO)

Government (federal, state or municipal)

State/local health department

School/university (academic department)

Hospital/Hospital-affiliated clinic

HMO/managed care organization

Solo/group private practice

Addictions treatment program (inpatient)

Addictions treatment program (outpatient)

Addictions treatment program (residential)

Recovery support program


School/university-based health clinic

Correctional facility

Probation/parole office

Local law enforcement department

Military/VA

Tribal/Indian Health Service

Community health center

Not currently employed

Other: (please specify) _________________

29. What is the zipcode of your principal employment setting? 

  1. The open-ended questions which did not have numbers in the OLD form, will now be numbered 30 & 31 in the new form. The wording of these questions will not change.


  1. Meeting Post Event Form (Attachment 2-2)

    1. Questions 12 – 16 will be deleted and replaced with the following:

12. Your gender: Female Male Transgender

13. Are you Hispanic or Latino/a? Yes No

  1. What is your race? (select one or more):

American Indian

Alaska Native

Native Hawaiian

Other Pacific Islander

Asian

White

Black or African American

Other (please specify) _______________

15. What is the highest degree you have received (select one)?

Some high school, but no diploma or equivalent

High school diploma or equivalent

Some college but no degree

Associate's degree

Bachelor's degree

Master's degree

Doctoral degree or equivalent

Other (please specify): _________________

16. What is your primary profession (select one)?

Counselor

Addictions professional

Social worker

Recovery specialist

Mental health professional

Criminal justice/law enforcement professional

Disease intervention specialist/investigator

Community health worker

Health educator

Educator (post-secondary or continuing)

Public or Business Administrator

Researcher

Physician

Physician assistant

Registered nurse

Licensed practical nurse

Advanced practice nurse

Pharmacist

Dentist

Other dental professional

Other (please specify)_____________

17. If you are a student, what is your primary field of study (select one)?

Not a student

Counseling

Psychology

Social Work

Medicine

Nursing

Pharmacology

Dentistry

Basic, translational or applied science

Criminal justice/law enforcement

Addiction

Education

Public health

Public or business administration

Other (please specify)


18. In which discipline(s) are you currently licensed or certified (select one or more)?

Not licensed or certified

Addictions prevention, treatment or recovery

Counseling

Psychology

Social Work

Medicine

Nursing

Pharmacology

Dentistry

Other (please specify)________________

19. Which best describes your role at your current workplace (select one)?

Clinician / care provider/direct service provider

Clinical Supervisor

Recovery Specialist

Manager / coordinator/administrator

Client / patient educator

Case manager

Prevention case manager


Counselor

Mental health therapist

Parole/Probation/Re-Entry Support

Outreach staff

Disease intervention/investigation

Resident / fellow

Teacher / faculty

Trainer / TA Provider

Group Facilitator

Not currently employed

Other (please specify)_____________

20. Which best describes your principal employment setting (select one)?

Community or Faith-based service organization (CBO/FBO)

Government (federal, state or municipal)

State/local health department

School/university (academic department)

Hospital/Hospital-affiliated clinic

HMO/managed care organization

Solo/group private practice

Addictions treatment program (inpatient)

Addictions treatment program (outpatient)

Addictions treatment program (residential)

Recovery support program

School/university-based health clinic

Correctional facility

Probation/parole office

Local law enforcement department

Military/VA

Tribal/Indian Health Service

Community health center

Not currently employed

Other: (please specify) _________________

21. What is the zipcode of your principal employment setting? 

  1. The open-ended questions which did not have numbers in the OLD form, will now be numbered 22 & 23 in the new form. The wording of these questions will not change.


  1. Technical Assistance Post Event Form (Attachment 2-3)

    1. Questions 18 - 22 will be deleted and replaced with the following:

18. Your gender: Female Male Transgender

19. Are you Hispanic or Latino/a? Yes No

  1. What is your race? (select one or more):

American Indian

Alaska Native

Native Hawaiian

Other Pacific Islander

Asian

White

Black or African American

Other (please specify) _______________

21. What is the highest degree you have received (select one)?

Some high school, but no diploma or equivalent

High school diploma or equivalent

Some college but no degree

Associate's degree

Bachelor's degree

Master's degree

Doctoral degree or equivalent

Other (please specify): _________________

22. What is your primary profession (select one)?

Counselor

Addictions professional

Social worker

Recovery specialist

Mental health professional

Criminal justice/law enforcement professional

Disease intervention specialist/investigator

Community health worker

Health educator

Educator (post-secondary or continuing)

Public or Business Administrator

Researcher

Physician

Physician assistant

Registered nurse

Licensed practical nurse

Advanced practice nurse

Pharmacist

Dentist

Other dental professional

Other (please specify)_____________

23. If you are a student, what is your primary field of study (select one)?

Not a student

Counseling

Psychology

Social Work

Medicine

Nursing

Pharmacology

Dentistry

Basic, translational or applied science

Criminal justice/law enforcement

Addiction

Education

Public health

Public or business administration

Other (please specify)


24. In which discipline(s) are you currently licensed or certified (select one or more)?

Not licensed or certified

Addictions prevention, treatment or recovery

Counseling

Psychology

Social Work

Medicine

Nursing

Pharmacology

Dentistry

Other (please specify)________________

25. Which best describes your role at your current workplace (select one)?

Clinician / care provider/direct service provider

Clinical Supervisor

Recovery Specialist

Manager / coordinator/administrator

Client / patient educator

Case manager

Prevention case manager


Counselor

Mental health therapist

Parole/Probation/Re-Entry Support

Outreach staff

Disease intervention/investigation

Resident / fellow

Teacher / faculty

Trainer / TA Provider

Group Facilitator

Not currently employed

Other (please specify)_____________

26. Which best describes your principal employment setting (select one)?

Community or Faith-based service organization (CBO/FBO)

Government (federal, state or municipal)

State/local health department

School/university (academic department)

Hospital/Hospital-affiliated clinic

HMO/managed care organization

Solo/group private practice

Addictions treatment program (inpatient)

Addictions treatment program (outpatient)

Addictions treatment program (residential)

Recovery support program

School/university-based health clinic

Correctional facility

Probation/parole office

Local law enforcement department

Military/VA

Tribal/Indian Health Service

Community health center

Not currently employed

Other: (please specify) _________________

27. What is the zipcode of your principal employment setting? 

  1. The open-ended questions numbered 23 & 24 in the OLD form will now be numbered 28 & 29 in the new form. The wording of these questions will not change.


  1. Training Follow-Up Form – NO changes on any follow-up forms

File Typeapplication/msword
File TitleAttachment 5: Summary of Revisions
AuthorLaurie Krom
Last Modified ByDHHS
File Modified2009-12-11
File Created2009-12-11

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