Q.1
Name (optional)
Q.2
Years of clincal service:
*
0-2
3-10
10-20
20+
Other:
Q.3
Discipline
*
PhD
PsyD
ED
MSW
MFT
LPC
Coach
Other:
Q.4
Advanced training/certification
*
APSATS
CSAT
ATPSB
NA
Other:
Q.5
Please identify your professional role in working with your partner?
*
Individual therapist
Couples therapist
Case manager
Individual coach
Group therapist
Group coach
NA
Other:
Q.6
How long have you worked with your partner?
*
0-6 months
6 12 months
1-2 years
2 + years
Other:
Q.7
Were you the referral source?
*
Yes
No
Other:
Q.8
Why was this particular program chosen? (select all that apply)
*
Location
Treatment specialty
Length of stay?
Cost
Other:
Please help us understand why you selected the above answers
Q.9
Prior to admission, was your input requested by this particular program?
*
Yes
No
Other:
Q.10
Who were you contacted by at this particular program?
*
Case manager:
Family Liaison:
Individual therapist:
I was not contacted
Other:
Q.11
During the treatment process, was your input requested by the program clinical team?
*
Yes
No
Other:
Q.12
Who were you contacted by?
*
Case manager:
Family Liaison:
Individual therapist:
I was not contacted
Other:
Q.13
What was the frequency of the contact?
*
One time
1-4 times
4+ times
None
Other:
Q.14
How satisfied were you with the level and quality of the communication?
*
1 - strongly dissatisfied
2 - moderately dissatified
3 - don’t know/not sure
4 - moderately satisfied
5 - strongly satisfied
Please explain your answer
Q.15
Did you find that your input was welcomed and integrated into the treatment process?
*
Yes
No
Other:
If no, please describe.
Q.16
The treatment program was sensitive to the needs of the partner.
*
1 - strongly disagree
2 - disagree
3 - don’t know/not sure
4 - agree
5 - strongly agree
Q.17
The treatment program was sensitive to the needs of the children.
*
1 - strongly disagree
2 - disagree
3 - don’t know/not sure/NA
4 - agree
5 - strongly agree
Q.18
Did you think that the partner felt understood and respected throughout the treatment process?
*
Yes
No
If no, please describe.
Q.19
Was there any degree of re-traumatization for your partner throughout the treatment process?
*
Yes
No
If yes, please describe.
Q.20
With regard to the needs of the partner and family, what was positive about this program? Please explain.
*
Q.21
Were you included in the discharge process?
*
Yes
No
If yes, how were you included? Please explain.
Q.22
What particular challenges, if any, did you face throughout this treatment process? Please describe.
Q.23
Did this treatment experience impact your therapeutic alliance with your partner?
*
Yes
No
If yes, please describe
Q.24
Would you refer another client to this program?
*
Yes
No
Please explain your answer
Q.25
Do you have specific recommendations for all programs that would better serve partners and their families in the future?