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Diane Rae Davis, PhD and Amber Cleverly, MSW - page 75 / 80

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APPENDIX B. Perception of Change Survey

Type of job

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Region

_______

Date

_________

Perception of Change Survey

INSTRUCTIONS: This survey asks you to think back to how effectively services were delivered to Child Protective referred parents (with substance abuse issues) before the Pre-Treatment Program and the addition of the Substance Abuse Liaison in your Region. Then the survey asks you about how effectively you think services are delivered now (Fall, 2004) with the Substance Abuse Liaison and Pre-Treatment Program in place.

1. Please complete the following table relating to services for Child Protective referred parents

with substance abuse issues by checking two answers for each service: one answer for the effectiveness before the Pre-Treatment Program began, and one answer for the current effectiveness (Summer, 2004).

Please check one box for each service listed. Please make sure to check one box for each time period.

How Effective Prior to Pre- Treatment Program ( one )

Not at all

Somewhat

Greatly

How Effective Now ( one )

Not at all

Somewhat

Greatly

1. Motivating parent to agree to substance abuse assessment.

  • 2.

    Getting a substance abuse assessment complete with parent.

  • 3.

    Motivating parent to enter substance abuse treatment.

  • 4.

    Coordinating Child

Protective

plans with substance abuse treatment. 5. Collaborating with substance

abuse treatment professionals

re: parent. 6. Following up parents progress

in substance abuse treatment.

74

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