Social Work Student Baseline Questionnaire
SOCIAL WORK STUDENT BASELINE QUESTIONNAIRE
SCREENING AND BRIEF INTERVENTION FOR ALCOHOL AND DRUG USE
Code Number
(Last 2 digits of birth year, 2 digit birth month, and first three letters of the town you were born in): ______
1. Which year of your MSSW are you in: a. Bachelors b. Foundation c. Concentration
2. What area of practice do you plan on working in? ______
The following questions ask about your attitudes regarding work with people who use alcohol.
Please circle the number that represents your level of agreement with each statement
Strongly StronglyAgree Disagree
3. I feel I know enough about the causes of drinking problems to carry out my role when working with clients who drink alcohol / 1 2 3 4 5 6 7 8 9 10
4. I feel I can appropriately advise my clients about drinking and its effects. / 1 2 3 4 5 6 7 8 9 10
5. I feel I have the right to ask clients questions about drinking when necessary. / 1 2 3 4 5 6 7 8 9 10
6. I feel that my clients believe I have the right to ask them questions about their drinking when necessary. / 1 2 3 4 5 6 7 8 9 10
7. I want to work with clients who drink alcohol. / 1 2 3 4 5 6 7 8 9 10
8. Pessimism is the most realistic attitude to take toward clients who drink alcohol. / 1 2 3 4 5 6 7 8 9 10
9. I feel I do not have much to be proud of when working with clients who drink alcohol. / 1 2 3 4 5 6 7 8 9 10
10. All in all I am inclined to feel I am a failure with clients who drink alcohol. / 1 2 3 4 5 6 7 8 9 10
11. In general, it is rewarding to work with clients who drink alcohol. / 1 2 3 4 5 6 7 8 9 10
12. In general I like clients who drink alcohol. / 1 2 3 4 5 6 7 8 9 10
The following questions ask about your attitudes regarding work with people who use drugs.
Please circle the number that represents your level of agreement with each statement
Strongly StronglyAgree Disagree
13. I feel I know enough about the causes of drug problems to carry out my role when working with clients who use drugs. / 1 2 3 4 5 6 7 8 9 10
14. I feel I can appropriately advise my clients about drug use and its effects. / 1 2 3 4 5 6 7 8 9 10
15. I feel I have the right to ask clients questions about drug use when necessary. / 1 2 3 4 5 6 7 8 9 10
16. I feel that my clients believe I have the right to ask them questions about their drug use when necessary. / 1 2 3 4 5 6 7 8 9 10
17. I want to work with clients who use drugs. / 1 2 3 4 5 6 7 8 9 10
18. Pessimism is the most realistic attitude to take toward clients who use drugs. / 1 2 3 4 5 6 7 8 9 10
19. I feel I do not have much to be proud of when working with clients who use drugs. / 1 2 3 4 5 6 7 8 9 10
20. All in all I am inclined to feel I am a failure with clients who use drugs. / 1 2 3 4 5 6 7 8 9 10
21. In general, it is rewarding to work with clients who use drugs. / 1 2 3 4 5 6 7 8 9 10
22. In general I like clients who use drugs. / 1 2 3 4 5 6 7 8 9 10
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23. IMPORTANCE MEASURES
DIRECTIONS: The following items present statements concerning a number of aspects of alcohol and drug intervention counseling. On each side of the item is a rating scale, one refers to client alcohol use, the other client drug use. The scale from 1 to 10 refers to how important you think each item is, with 1 being not at all important and 10 being extremely important. Please circle the number representing how important you think the corresponding item is in BOTH the ALCOHOL USE and DRUG USE COLUMNS.ALCOHOL USE / QUESTION / DRUG USE
Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10 / a. Use a validated screening tool for assessing / Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10
Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10 / b. Provide feedback on drug/alcohol risk level / Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10
Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10 / c. Use MI techniques to enhance motivation / Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10
Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10 / d. Assessing clients’ readiness to reduce their use / Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10
Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10 / e. Educating clients about lower-risk use / Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10
Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10 / f. Advising at-risk clients to stop or reduce use / Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10
Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10 / g. Negotiate a plan regarding future use / Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10
Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10 / h. Referring clients to a self-help group / Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10
Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10 / i. Referring a client to a formal treatment setting / Not Extremely
Important Important
1 2 3 4 5 6 7 8 9 10
24. CONFIDENCE MEASURES
DIRECTIONS: The following items present statements concerning a number of aspects of alcohol and drug intervention counseling. On each side of the item is a rating scale, one refers to client alcohol use, the other client drug use. The scale from 1 to 10 refers to how confident you are that you could carry out each task, with 1 being not at all confident and 10 being extremely confident. Please circle the number representing how confident you are in you ability to carry out each task in BOTH the ALCOHOL USE and DRUG USE COLUMNS.ALCOHOL USE / QUESTION / DRUG USE
Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10 / a. Use a validated screening tool for assessing / Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10
Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10 / b. Provide feedback on drug/alcohol risk level / Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10
Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10 / c. Use MI techniques to enhance motivation / Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10
Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10 / d. Assessing clients’ readiness to reduce their use / Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10
Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10 / e. Educating clients about lower-risk use / Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10
Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10 / f. Advising at-risk clients to stop or reduce use / Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10
Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10 / g. Negotiate a plan regarding future use / Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10
Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10 / h. Referring clients to a self-help group / Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10
Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10 / i. Referring a client to a formal treatment setting / Not Extremely
Confident Confident
1 2 3 4 5 6 7 8 9 10
25. FREQUENCY QUESTIONS:
25.a. Are you currently working with clients? a. Yes (if yes complete questions 25-27) b. No (if no, you have completed the survey)
DIRECTIONS: The following items present statements about practice behaviors often employed in alcohol and drug intervention counseling. On each side of the item is a rating scale, one refers to client alcohol use, the other client drug use. Please circle the number representing how frequently you engage in each of the tasks listed below in BOTH the ALCOHOL USE and DRUG USE COLUMNS.
In your clinical setting how often do you…
ALCOHOL USE / QUESTION / DRUG USENever / Some
times / ½ the time / Usually / Always / Never / Some
times / ½ the time / Usually / Always
1 / 2 / 3 / 4 / 5 / b. Use a validated screening tool for assessing / 1 / 2 / 3 / 4 / 5
1 / 2 / 3 / 4 / 5 / c. Provide feedback on drug/alcohol risk level / 1 / 2 / 3 / 4 / 5
1 / 2 / 3 / 4 / 5 / d. Use MI techniques to enhance motivation / 1 / 2 / 3 / 4 / 5
1 / 2 / 3 / 4 / 5 / e. Assessing clients’ readiness to reduce their use / 1 / 2 / 3 / 4 / 5
1 / 2 / 3 / 4 / 5 / f. Educating clients about lower-risk use / 1 / 2 / 3 / 4 / 5
1 / 2 / 3 / 4 / 5 / g. Advising at-risk clients to stop or reduce use / 1 / 2 / 3 / 4 / 5
1 / 2 / 3 / 4 / 5 / h. Negotiate a plan regarding future use / 1 / 2 / 3 / 4 / 5
1 / 2 / 3 / 4 / 5 / i. Referring clients to a self-help group / 1 / 2 / 3 / 4 / 5
1 / 2 / 3 / 4 / 5 / j. Referring a client to a formal treatment setting / 1 / 2 / 3 / 4 / 5
26. What questions do you most often use to screen clients for at risk alcohol use?
a. None b. Quantity-frequency questions c. AUDIT-C d. AUDIT e. CAGE f. Single alcohol screening question g. Other (specify): ______
27. What questions do you most often use to screen clients for at risk drug use?
a. None b. Quantity-frequency questions c. AUDIT-C d. AUDIT e. CAGE f. Single alcohol screening question g. Other (specify): ______
THANK YOU FOR TAKING THE TIME TO COMPLETE THIS SURVEY!
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