Form LEA CPS LEA CPS LEA CPS

ATTACHMENT 3:
LEA COLLABORATIVE PARTNER SURVEY

OMB No. 0930-XXXX
Exp. Date MM/DD/YYYY
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 0930-0xxx. Public
reporting burden for this collection of information is estimated to average 30 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, 5600 Fishers Lane, Room 15E57-B, Rockville,
Maryland, 20857.

Expanded School Mental Health Collaboration Instrument
Scale 1: Types of Collaboration
Subscale. Collaboration with Community Mental Health Professionals
In my role in this partnership, I
1. Consult with community mental health professionals
about student needs.

Never

Rarely

Sometimes

Often

Never

Rarely

Sometimes

Often

Never

Rarely

Sometimes

Often

Never

Rarely

Sometimes

Often

5. Deliver student mental health services (e.g., group
counseling, classroom prevention activities) with community
mental health professionals.

Never

Rarely

Sometimes

Often

6. Coordinate efforts to increase family involvement with
community mental health professionals.

Never

Rarely

Sometimes

Often

7. Participate in school-based teams (e.g., Student Support,
IEP) with community mental health professionals.

Never

Rarely

Sometimes

Often

Never

Rarely

Sometimes

Often

Never

Rarely

Sometimes

Often

Never

Rarely

Sometimes

Often

Never

Rarely

Sometimes

Often

Never

Rarely

Sometimes

Often

Never

Rarely

Sometimes

Often

2. Complete comprehensive student assessments with
community mental health professionals.
3. Develop plans for intervening students with community
mental health professionals.
4. Intervene in student crises with community mental
health professionals.

Subscale: Collaboration with School Colleagues
In my role in this partnership, I
8. Consult with school colleagues about student needs.
9. Complete comprehensive student assessments with
school colleagues.
10. Develop plans for intervening with student with school
colleagues.
11. Intervene in student crises with school colleagues.
12. Participate in school-based teams (e.g., Student Support,
IEP) with school colleagues.
13. Participate in school leadership activities (e.g., school
improvement planning) with school colleagues.
Subscale: Collaboration with Families
In my role in this partnership, I
Attachment 3: LEA Collaborative Partner Survey

14. Consult with families about student needs.
15. Complete comprehensive assessments with families.
16. Develop plans for intervening with students with
families.

Attachment 3: LEA Collaborative Partner Survey

Never

Rarely

Sometimes

Often

Never

Rarely

Sometimes

Often

Never

Rarely

Sometimes

Often

Scale 2: Influences on Collaboration
Subscale: Outreach and Approach by Mental Health
Professionals from Collaborating Agencies
Community mental health professionals who work in this
school…..
1. Are visible in this school.
2. Are consistent from year to year (i.e., there is little
turnover).
3. Have offices that are easily accessible to school staff.
4. Reach out to members of the school community
5. Act like they belong.
6. Understand how the school operates.
7. Make an effort to build relationships with teachers.
8. Show up for after school or evening events at the school.
9. Understand school policies and procedures.
10. Support the collaboration of families and the school staff.
Subscale: School Administrator Support
The principal of this school…..
11. Supports community mental health professionals.
12. Communicates with community mental health
professionals.
13. Advocates on behalf of community mental health
professionals' working in schools.
14. Arranges teacher/community mental health professional
meetings.
15. Trusts community mental health professionals.
16. Communicates the importance of community mental
health professionals to teachers.
17. Includes community mental health professionals in school
leadership activities.
18. Addresses students' mental health needs in meetings
with teachers.
Subscale: Interpersonal Processes
School professionals and community mental health
professionals in this school….
19. Respect each other.
20. Like one another.
21. Trust each other.
22. Frequently communicate with one another.
23. Understand each others' roles and responsibilities.
24. Share decision-making power.
25. Take supporting roles in one another's initiatives.
Attachment 3: LEA Collaborative Partner Survey

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Subscale: School Outreach to Communities and Families
This school….
26. Welcomes community involvement.
27. Values partnerships with community agencies.
28. Actively builds partnerships with community agencies.
29. Has a friendly environment.
30. Values family environment.

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

3. Families are empowered in supporting their children's
behaviors in schools.

Strongly Disagree

Disagree

Agree

Strongly Agree

4. Relationships between families and the school have
improved.

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

6. Mental health has become an integral part of daily school
activities.
7. There are additional resources for helping students.

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

8. There is increased mental health programming for
students.
9. There are more prevention services for students.

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

11. Students have increased access to mental health services.

Strongly Disagree

Disagree

Agree

Strongly Agree

12. Students are more willing to accept mental health
services.

Strongly Disagree

Disagree

Agree

Strongly Agree

13. Families are more willing to accept mental health
services.

Strongly Disagree

Disagree

Agree

Strongly Agree

Scale 3. Perceived Benefits of Collaboration
Subscale: Improved Family-School Relationships
During the past year, as a result of collaboration between
school and community mental health professionals,
1. Families are more involved in the school.
2. Families feel more comfortable in the school.

Subscale: Increased Mental Health Programming
During the past year, as a result of collaboration between
school and community mental health professionals,
5. There is an increased focus on the holistic development of
students.

10. There are increased services for students in general
education.
Subscale: Improved Access for Students and Families

Attachment 3: LEA Collaborative Partner Survey