ICP&P Community Collaboration Project Survey

1. ICP&P Community Collaboration Project Survey

The mission of the Community Collaboration Project is to explore ways for ICP&P to become engaged in the broader Washington Metropolitan community by volunteering professional services. Our intention is for ICP&P to partner with community organizations for mutual service, education, training and support within diverse cultural contexts.

We would like to ask your help in guiding the committee at this initial stage by answering this survey.

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* 1. Does this mission statement reflect your interest as a member of ICP&P?

not at all

somewhat

very much

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* 2. How important would it be for you to become involved in a Community Collaboration Project?

not at all interested

possibly interested

very interested

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* 3. if you were to join this ICP&P volunteer effort, which of the following would you most important to you?

	Not Important	Neutral	Very Important
opportunity to "give back"	opportunity to "give back" Not Important	opportunity to "give back" Neutral	opportunity to "give back" Very Important
opportunity to provide service to different parts of the community	opportunity to provide service to different parts of the community Not Important	opportunity to provide service to different parts of the community Neutral	opportunity to provide service to different parts of the community Very Important
opportunity to work collaboratively with other community organizations	opportunity to work collaboratively with other community organizations Not Important	opportunity to work collaboratively with other community organizations Neutral	opportunity to work collaboratively with other community organizations Very Important
opportunity to develop new skills	opportunity to develop new skills Not Important	opportunity to develop new skills Neutral	opportunity to develop new skills Very Important
opportunity to learn from other organizations and populations	opportunity to learn from other organizations and populations Not Important	opportunity to learn from other organizations and populations Neutral	opportunity to learn from other organizations and populations Very Important

Other (please specify)

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* 4. Indicate all the areas in which you would like to participate:

	Least Interested	Neutral	Most Interested
individual therapy	individual therapy Least Interested	individual therapy Neutral	individual therapy Most Interested
couples therapy	couples therapy Least Interested	couples therapy Neutral	couples therapy Most Interested
group therapy	group therapy Least Interested	group therapy Neutral	group therapy Most Interested
support groups	support groups Least Interested	support groups Neutral	support groups Most Interested
psycho-education	psycho-education Least Interested	psycho-education Neutral	psycho-education Most Interested
training and supervising clinicians	training and supervising clinicians Least Interested	training and supervising clinicians Neutral	training and supervising clinicians Most Interested
program development	program development Least Interested	program development Neutral	program development Most Interested
organizational consulting	organizational consulting Least Interested	organizational consulting Neutral	organizational consulting Most Interested
community partnerships e.g. developing conferences	community partnerships e.g. developing conferences Least Interested	community partnerships e.g. developing conferences Neutral	community partnerships e.g. developing conferences Most Interested

Other (please specify)

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* 5. Indicate the community settings that might interest you:

	Least Interested	Neutral	Most Interested
schools	schools Least Interested	schools Neutral	schools Most Interested
military	military Least Interested	military Neutral	military Most Interested
penal	penal Least Interested	penal Neutral	penal Most Interested
senior facilities	senior facilities Least Interested	senior facilities Neutral	senior facilities Most Interested
hospice/medical	hospice/medical Least Interested	hospice/medical Neutral	hospice/medical Most Interested
inner city agencies	inner city agencies Least Interested	inner city agencies Neutral	inner city agencies Most Interested
community clinics	community clinics Least Interested	community clinics Neutral	community clinics Most Interested
immigrant/refugee agencies	immigrant/refugee agencies Least Interested	immigrant/refugee agencies Neutral	immigrant/refugee agencies Most Interested

Other (please specify)

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* 6. How many hours each month are you currently involved as a mental health professional in the community outside of your office (private office or other regular professional setting)?

1-3

4-7

8-12

more than 12

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* 7. Are there under-served populations with which you have prior experience?

inner city

school

veteran

immigrant

abused and victim services

foster family, adoption

prison

Other (please specify)

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* 1. Does this mission statement reflect your interest as a member of ICP&P?

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* 2. How important would it be for you to become involved in a Community Collaboration Project?

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* 3. if you were to join this ICP&P volunteer effort, which of the following would you most important to you?

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* 4. Indicate all the areas in which you would like to participate:

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* 5. Indicate the community settings that might interest you:

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* 6. How many hours each month are you currently involved as a mental health professional in the community outside of your office (private office or other regular professional setting)?

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* 7. Are there under-served populations with which you have prior experience?

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* 8. We would like to hear any ideas or comments on this potential ICP&P project. Please write your comments here: