Counselor Survey 

Please help us evaluate our training and the use of the SAVR-S screening instrument. Your honesty isappreciated and your answers are all confidential. This is a fillable PDF. Click the arrow to the right ofthe question to choose your answer where applicable. Please return by May 30, 2008. If using JAWShit the tab button now to proceed, then hit enter to turn on forms mode. 

Before proceeding, please tell us what state you are in? 
(First, choose your state abbreviation from list. then answer question one. Have you attended an in person training session?) 


1. Did you attend an in-person training session? Did you attend an in person training session?
(If no, skip #2) 

2. To what extent was the in-person training helpful? 
(combobox) 


3. Are you aware of on-line training modules at Òwww.myVRtraining.comÓ? 
(Are you aware of on line training modules at www.myvrtraining.com? ) 
(If no, go to #4) 

If yes, have you used the online training modules? 
(combobox) 


If yes, how helpful are they?
(combobox) 


Have you received CEUs for completing any of the on-line training modules? 
(combobox) 


4. Have you administered the SAVR-S? 
(Have you administered the SAVR-S, if no end survey.) 
(If no, end survey) 

5. How easy, or difficult, is it to: 

(a) use 

(b) download 
(How easy or difficult is it to fax?) 
(How easy, or difficult is it to use?) 


(c) print
(How easy or difficult is it to download?) 


 (d) fax 
(How easy or difficult is it to print?) 


6. Do you have any suggestions for improvement? 
(text) 


7. If you could go to the internet on a computer and have the SAVR-S appear so consumers could sit
(combobox) 
at the computer and answer the questions, how likely would you be to use it? 

8. Does your office have computers with internet access available for consumers to complete a
(combobox) 
web-based SAVR-S?

 (If Other, please explain 
(If you answered other to the question does your office have computers with internet access available for consumers to complete a web based SAVR-S type in explanation here) 


9. Do you screen every consumer? 
(Do you screen every consumer?) 


If no, how do you decide which ones to screen?
(If you do not screen every consumer, how do you decide which ones to screen?) 


(If Other, please explain 
(If other, type in explanation here) 


10. Please rate your typical consumersÕ level of cooperation with the screening process: 
(combobox) 


11. How easy is it to read the screening reports on consumersÕ SAVR-S results? 
(combobox) 


12. Are the reports timely? 
(combobox) 


13. Are the results easy to understand? 
(combobox) 


14. Are the results helpful? 
(combobox) 


Continued


15. Have you had a positive screening report on a consumer (a report of high probability of an 
alcohol/drug problem)?
(combobox) 


 If yes, what action is taken when a SAVR-S screening report is positive? Check all that apply: 
(check If you had a positive screening report and referral for further alcohol and drug evaluation was done) Unchecked


(a) referral for further alcohol and drug evaluation 
(Check if you had a positive screeening report and referral to treatment (various levels) was done) Unchecked


(b) referral to treatment (various levels) 
(check if you had a positive screening and you talked to the consumer about their drinking or use of drugs ) Unchecked


(c) talk to the consumer about their drinking or use of drugs 
(check if you had a positive screening and you closed the case) Unchecked


(d) close the case 
(check if you had a positive screening and nothing was done) Unchecked


(e) nothing 
(check if you had a positive screening and something other than the other choices was done) Unchecked


(f) other, please explain 
(Enter explanation here) 


16. Please rate consumers' cooperation with attending follow-up substance use evaluations
(combobox) 
, if any: 

17. How easy is it to find a substance use treatment provider or program for consumers who need
(combobox) 
one? 

18. Are the substance use treatment resources listed on the SAVR-S reports helpful? 
(combobox) 


19. How helpful do you think 
(combobox) 
screening for substance use problems is in reducing barriers toemployment? 

20. How likely do you think the 
(combobox) 
SAVR-S screening and referrals will be to increase successful case 
closures? 

21. How useful are the monthly summary reports on your SAVR-S administrations? 
(combobox) 


22. How useful are the reports showing cumulative results on all your SAVR-S administrations? 
(combobox) 


23. Do you have suggestions for improving the usefulness of SAVR-S utilization reports showing
(Type in suggestions you have for improving the usefulness of SAVR-S utilization reports showing summary results of SAVR-S administrations) 
summary results of SAVR-S administrations? 

24. Do you have comments on barriers or benefits regarding administering, interpreting, referring,
and/or following up with clients regarding SAVR-S screening? 
(Type in comments you have on barriers or benefits regarding administering, interpreting, referring and or following up with clients regarding SAVR-S screening) 


Thank you for your time. Please return this survey via Email by clicking the submit button (an emailwith a data file will be generated). 
(button) Submit by Email
If you prefer, or should you encounter technical difficulties upon 
submission, please print the completed survey form and fax to: 800-546-7995 


(button) Submit