Addictions Services Scan Question Title * 1. Please respond to the following: Agency Name City State Addictions Services Contact Person Title Email Question Title * 2. Please indicate your agency's addictions staff FTE (number): Program Director Direct Services/Counseling Staff Other Staff Total FTE Question Title * 3. How does the Addictions staff interface with the rest of the agency? Totally separate department Addictions staff is part of a larger counseling department but works solely on addictions issues Addictions staff members also work on other counseling issues Other (please specify) Question Title * 4. Please indicate your agency's approximate total operating budget size: $10 million or higher $5 million - $9,999,999 $2 million - $4,999,999 $1 million - $1,999,999 $500,000 - $999,999 Under $500,000 Question Title * 5. Please indicate your Addictions Program approximate budget size: $100,000 or higher $50,000 - $99,999 $25,000 - $49,999 Under $25,000 Question Title * 6. Please indicate the following information to the best of your knowledge: Number of unique addictions clients per year Size of Jewish populations in your catchment area Approximate percent of addictions clients that are Jewish Question Title * 7. How does your agency address the issue of addiction in the community? Never Sometimes Often Key Program Individual Counseling Individual Counseling Never Individual Counseling Sometimes Individual Counseling Often Individual Counseling Key Program Community Education Community Education Never Community Education Sometimes Community Education Often Community Education Key Program Group Meetings Group Meetings Never Group Meetings Sometimes Group Meetings Often Group Meetings Key Program Peer Support Peer Support Never Peer Support Sometimes Peer Support Often Peer Support Key Program Speakers Speakers Never Speakers Sometimes Speakers Often Speakers Key Program Former Client Speakers Former Client Speakers Never Former Client Speakers Sometimes Former Client Speakers Often Former Client Speakers Key Program Skill-Building Workshops Skill-Building Workshops Never Skill-Building Workshops Sometimes Skill-Building Workshops Often Skill-Building Workshops Key Program Other (please specify) Question Title * 8. If your agency provides community education, please rate the importance of the following partners: Not a Partner Collaborate Sometimes Collaborate Often Key Partner Local School System Local School System Not a Partner Local School System Collaborate Sometimes Local School System Collaborate Often Local School System Key Partner Synagogues Synagogues Not a Partner Synagogues Collaborate Sometimes Synagogues Collaborate Often Synagogues Key Partner JCC’s JCC’s Not a Partner JCC’s Collaborate Sometimes JCC’s Collaborate Often JCC’s Key Partner Treatment facilities Treatment facilities Not a Partner Treatment facilities Collaborate Sometimes Treatment facilities Collaborate Often Treatment facilities Key Partner Other addictions providers Other addictions providers Not a Partner Other addictions providers Collaborate Sometimes Other addictions providers Collaborate Often Other addictions providers Key Partner Other (please specify) Question Title * 9. Please BRIEFLY describe your outreach program (e.g., most successful methods, use of speakers, use of statistics, age groups or locations). Question Title * 10. If your agency provides group meetings, please give us more specifics on the groups. Open to public Closed groups/pre-registration required Drop-in Question Title * 11. If your agency provides group meetings, which of the following groups do your agency's addictions programming currently serve? Never Sometimes Often Key Group Women only Women only Never Women only Sometimes Women only Often Women only Key Group Men only Men only Never Men only Sometimes Men only Often Men only Key Group Women and men together Women and men together Never Women and men together Sometimes Women and men together Often Women and men together Key Group Young adults Young adults Never Young adults Sometimes Young adults Often Young adults Key Group Teens Teens Never Teens Sometimes Teens Often Teens Key Group Children/Pre-Teens Children/Pre-Teens Never Children/Pre-Teens Sometimes Children/Pre-Teens Often Children/Pre-Teens Key Group Family of addicted person (parents, spouse, children) Family of addicted person (parents, spouse, children) Never Family of addicted person (parents, spouse, children) Sometimes Family of addicted person (parents, spouse, children) Often Family of addicted person (parents, spouse, children) Key Group Jewish Jewish Never Jewish Sometimes Jewish Often Jewish Key Group Orthodox Orthodox Never Orthodox Sometimes Orthodox Often Orthodox Key Group Non-Jewish/General Population Non-Jewish/General Population Never Non-Jewish/General Population Sometimes Non-Jewish/General Population Often Non-Jewish/General Population Key Group Other (please specify) Question Title * 12. Which addictions do your agency's programming currently target? Check ALL applicable answers. Alcohol Prescription Drugs Illegal Drugs Gambling Internet Tobacco Eating Disorders Other (please specify) Question Title * 13. Which approaches does your agency use with clients? Check ALL applicable answers. Abstinence Harm Reduction Motivational Interviewing Jewish 12-Step Program Question Title * 14. Which (if any) of these sources funds your addictions program? Check ALL applicable answers. Donors Private Foundations Public/Government Funding Other (please specify) Question Title * 15. Which residential facilities have your referred clients to and would you recommend them to others? Facility Name & Location Recommend: Y/N Facility Name & Location Recommend: Y/N Facility Name & Location Recommend: Y/N Done
