Last Name:

Organization:(please incude the name of your organization if you want mailings to go there)

Street:

City/State/Zip:

Telephone Number:

Fax Number:

E-mail Address:

DPH Region:

CHNA Number:

Do you work for a Bureau of Substance Abuse Service funded agency?
Yes No

Please choose the appropriate selection under each heading. Choose the one item under each heading which best describes your job/program.

Modality:

choose one Prevention Program Youth Prevention Program DAE Program Prevention Center HIV Risk Reduction Services Acute Treatment Services Detoxification Program Public Inebriate Program Family Treatment Shelter Youth Residential Rehabilitation Adult Residential Rehabilitation Outpatient Counseling Methadone Acupuncture Compulsive Gambling Criminal Justice I wish to leave this blank

Other:

Primary State Agency Affiliation:
choose one DPH DOC Criminal Justice DMH DMR DOE DSS DTA DYS I wish to leave this blank

Other:

About You:

Please choose the appropriate selection under each heading. Choose the one item under each heading which best describes your situation.

Primary Job Function:
choose one Executive Director Program Director Supervisor Administrator Prevention Specialist Health Educator Substance Abuse Counselor Outpatient Clinician Mental Health Counselor Case Manager Outreach Worker Private Practice Board Member I wish to leave this blank
Other:

Length of Time Working in Field:
choose one Less than one year 1-3 years 3-5 years 5-10 years 10+ years

Highest Education Level Completed:
choose one High School Associates Degree Bachelors Degree Masters Degree Certificate of Advanced Graduate Studies (CAGS) Doctorate Degree Medical Degree

Please check the appropriate box(es) to respond to the following item:

Certifications/Licensure:
CAC/CDC/CADAC
CAS
CRC/LRC
LMFT
LMHC
Licensed Psychologist
LSW/LCSW/LICSW
RN/LPN
None
Other:

The following is a list of workshops that may be of interest to you. Please check any workshop(s) that you would like to see offered by AdCare Educational Institute, Inc.:

Basic Competencies

ABC's of Assessment
Basic Concepts of Addiction Counseling
Basic Group Therapy
Biological Aspects of Addiction
Boundary Issues for Non-Clinical Staff
Case Management in Substance Abuse
Chemical Dependency & Post Traumatic Stress Disorder
Confidentiality of Alcohol and Drug Records
Current Drugs, Addiction, and the Brain
Ethics for Substance Abuse Professionals
Exploring Boundary Dilemmas
Recordkeeping/Aftercare Planning
Relapse Prevention
Review of the CAC/CADAC Process
Speed Still Kills: The Growing Methamphetamine Problem
Suicide and Chemical Dependency
Treating Shame and Guilt
Treatment Planning and Documentation
Understanding Substance Use and Abuse
Understanding & Using the Twelve-Step Program
Using the DSM-IV
Women & Chemical Dependency

Diversity & Inclusivity Issues

Adolescent Groups
Adolescents and Substance Abuse
Americans with Disabilities Act
Building a Culturally Competent Organization
Diversity Challenges in the Workplace
Dual Diagnosis Issues for Women
Gay, Lesbian, Bisexual & Transgender Substance Abuse Issues
Gay, Lesbian, Bisexual & Transgender Youth Substance Abuse Issues
Homelessness and Addictions
Multicultural Perspectives on Substance Abuse Treatment
Racism of the Well Intended
Sharing the Vision of Cultural Competence
Strategies for Cultural Diversity
Substance Abuse and Disabilities
Substance Abuse and the Elderly
Treatment Planning for Women and Children
Women and HIV/AIDS
Working with African Americans in Substance Abuse Treatment
Working with Latinos/as

Alcohol, Tobacco, and Other Drugs/Related Issues/Advanced Topics

Advanced Counseling Skills
Advanced Ethics: A Training for the Substance Abuse Professional
Advanced Group Therapy
Anger Management
Assessing Nicotine Addiction in Recovery
Assessment & Treatment of Dual Disorders
Brief Treatment
Chemical Dependency and the Family
Childhood Sexual Abuse
Coerced Clients: Overcoming Resistance to Substance Abuse Treatment
Cognitive Treatment for Substance Abusers
Counter-Transference and Other Issues
Crack/Cocaine
DBT Dialectic Behavior Therapy
Domestic Violence and Substance Abuse for Women
Dual Diagnosis - HIV and Addiction
Dual Diagnosis Groups
Engaging Clients in Groups: Icebreakers, Energizers, Warm-Ups & Wind Downs
Exercise in Recovery:Spiritual, Emotional, Physical
Holistic Approaches to Recovery
Inhalant Substance Abuse
Injection Drugs
Interviewing and Assessing for Compulsive Gambling
Introduction to Alternative (Complementary) Medicines
Managed Care Issues
Managing Personal Boundaries: An Interactive Workshop for the Substance Abuse Professional
Meditation and Recovery
Motivational Interviewing Techniques
Navigating the Legal System
Nicotine Dependence: Education, Assessment and Treatment
Opiates and Opiate Addiction
Parenting Approaches and Strategies for Parents in Recovery
Professionals in recovery
Psychopharmacological Aspects of Chemical Dependency
Spirituality and Recovery
Talking to Your Clients About Mental Health Issues
Too Much Too Soon? Myths & Facts About Nicotine Addiction & Recovery
Trauma and the Recovering Male
Understanding and Recognizing Compulsive Gambling
Understanding Conflict, Aggression, and Violence
Working with Clients with PTSD and Addiction
Yoga Exercise and the 12 Step Recovery Program

Management and Leadership

Board Development
Clinical Supervision: Counselor Development & Professional Responsibilities
Clinical Supervision: Supervision, Management, Counselor Assessment & Evaluations
Coaching Skills for Managers and Supervisors
Supervisory Leadership Seminar
Time and Stress Management on the Job and in Our Lives
Total Quality Management
Transitioning from Clinician to Manager/Supervisor

HIV/AIDS

Case Management Technical Assistance
Developing Client HIV Education Groups
Fundamentals of HIV, Hepatitis and STDs
Hepatitis ABCs
HIV Behavioral Risk Assessment and Risk Reduction
HIV Case Management
HIV and Confidentiality: Implications for Substance Abuse Service Providers
HIV Counseling and Testing
HIV Risk Assessments: Implications for Substance Abuse Providers
HIV-101: An Introduction
Improving HIV Testing Return Rates: Skills to Engage and Retain Clients
Integrating Harm Reduction Techniques into Substance Abuse Treatment
Legal Issues: Substance Abuse and HIV
Prevention Strategies for HIV-positive People
Relapse Prevention and HIV/AIDS
Sexuality and HIV/AIDS
Supporting Client Adherence
Supporting Women Living with HIV/AIDS
Talking to Your Clients About Sexuality and HIV/AIDS
Teaching Others About HIV/AIDS
What's in Store for HIV Antibody Testing: A Look at New Technologies

Prevention

Building Citizen Leadership
Coalition Building
Gay/Lesbian/Bisexual Youth and Substance Abuse Prevention
Group Development and Facilitation
Inhalant Abuse Prevention
Introduction to Strategic Planning
It Takes a Village to Raise a Child
Media Advocacy
Partnering with Youth for Prevention
Peer Institute
Preventing Homophobia
Prevention Evaluation Models
Primary Prevention Strategies
Retail Alcohol Availability
Sexual Assault Prevention
Suicide Prevention
Words Not Weapons

AdCare Educational Institute is committed to meeting the training needs of its customers. Please indicate below the top five trainings or topics you or the individuals in your organization NEED:

AdCare Educational Institute is committed to meeting the training needs of its customers. We are interested in hearing from you about your ideas and suggestions for future workshops:

Primary Reason for Attending Training:
choose one CEUs Enhance Skills Increase Knowledge Topic(s) Presenter(s) Price Required in my Job I wish to leave this blank
Other:

Formats You Prefer:

Formats You Prefer:
choose one Half Day One Day Two Day Three Day On-site, In-service Series of 2-3 Hour Workshops Over Time Multi-Day Workshops Paced Out Over Time I wish to leave this blank
Other:

Best Days and Times to Attend Training

Best Days/Times to Attend Trainings:
choose one Monday Tuesday Wednesday Thursday Friday Saturday Sunday Evenings No Preference I wish to leave this blank

Technologies

If made available as an option, I would prefer to make payment for training by credit card.
I have access to the Internet
I would be interested in being able to receive notification of upcoming trainings via the internet.
If made available as an option, I would prefer to register via the Internet for training.
if made available as an option, I would participate in training via the Internet.

Optional Information

What is your gender?
Female Male

Which of the following best describes your race or family background? br> choose one Asian/Pacific Islander Black/African American Hispanic/Latino(a) Native American White I wish to leave this blank
Other:

Number of Training Sessions You Attended in the Last Year:

choose one None 1 to 2 3 to 5 5 to 7 7 to 10 I wish to leave this blank

If you answered "None" to the above question: Please answer the next question, then skip to the bottom of this web page.

If you did attend any training sessions: Please skip the next question, and answer the questions about the workshops.

Barriers to Attending Training

choose one Price Distance Time Off Staffing Issues/Coverage Topic Relevancy Site Accessibility Training advertisement not passed along to me in time I wish to leave this blank
Other:

What did you think about the workshops you attended? Please use the following categories to rate your experience.

Process/Logistics

Calendar

Poor
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Above Average
Excellent
Not Applicable

Cost of Training

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Not Applicable

Location(s) of Training

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Telephone Assistance

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Not Applicable

Responsiveness to Requested Accommodations

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Not Applicable

Mail-In Registration

Poor
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Not Applicable

On-Site Registration

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Not Applicable

Payment Methods Available

Poor
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Not Applicable

CEU Process

Poor
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Not Applicable

Impact of Training

Professional Needs Addressed in Training Content

Poor
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Not Applicable

Training Content Informative

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Not Applicable

Training Content Relavent to My Work

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Information Captured Current Trends

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Training Identified Emerging Client Population(s)

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New Working Skills Acquired

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Positively Affected My Delivery of Service

Poor
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Resulted in Better Treatment Work with Clients

Poor
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Not Applicable

Content and Delivery of Training were Culturally Inclusive

Poor
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Not Applicable

The staff of AdCare Educational Institute, Inc., thanks you most sincerely for assisting us by taking the time to complete this Needs Assessment and Satisfaction Survey.