Survey for Social Work Associations

Please take a few moments to answer the following questions.

Question Title

* 1. Using the following 0-5 scale, please answer these questions related to the value of palliative social work training:

	0 (Not at all)	1	2	3	4	5 (Extremely)
Would a 6 hour CE course on Palliative Social Work for front-line clinicians have value in terms of the quality of care provided to seriously-ill patients?	Would a 6 hour CE course on Palliative Social Work for front-line clinicians have value in terms of the quality of care provided to seriously-ill patients? 0 (Not at all)	Would a 6 hour CE course on Palliative Social Work for front-line clinicians have value in terms of the quality of care provided to seriously-ill patients? 1	Would a 6 hour CE course on Palliative Social Work for front-line clinicians have value in terms of the quality of care provided to seriously-ill patients? 2	Would a 6 hour CE course on Palliative Social Work for front-line clinicians have value in terms of the quality of care provided to seriously-ill patients? 3	Would a 6 hour CE course on Palliative Social Work for front-line clinicians have value in terms of the quality of care provided to seriously-ill patients? 4	Would a 6 hour CE course on Palliative Social Work for front-line clinicians have value in terms of the quality of care provided to seriously-ill patients? 5 (Extremely)
Would a 6 hour CE course on Palliative Social Work for front-line clinicians have value in terms of improving the competencies and comfort level of social workers as they perform clinical tasks related to caring for seriously-ill patients?	Would a 6 hour CE course on Palliative Social Work for front-line clinicians have value in terms of improving the competencies and comfort level of social workers as they perform clinical tasks related to caring for seriously-ill patients? 0 (Not at all)	Would a 6 hour CE course on Palliative Social Work for front-line clinicians have value in terms of improving the competencies and comfort level of social workers as they perform clinical tasks related to caring for seriously-ill patients? 1	Would a 6 hour CE course on Palliative Social Work for front-line clinicians have value in terms of improving the competencies and comfort level of social workers as they perform clinical tasks related to caring for seriously-ill patients? 2	Would a 6 hour CE course on Palliative Social Work for front-line clinicians have value in terms of improving the competencies and comfort level of social workers as they perform clinical tasks related to caring for seriously-ill patients? 3	Would a 6 hour CE course on Palliative Social Work for front-line clinicians have value in terms of improving the competencies and comfort level of social workers as they perform clinical tasks related to caring for seriously-ill patients? 4	Would a 6 hour CE course on Palliative Social Work for front-line clinicians have value in terms of improving the competencies and comfort level of social workers as they perform clinical tasks related to caring for seriously-ill patients? 5 (Extremely)

Question Title

* 2. Using the following 0-5 scale, please answer these questions related to the value of palliative social work training for you, your staff, and your home institution:

	0 (Not likely)	1	2	3	4	5 (Extremely likely)
If the 6 hour CE course were given as a workshop at an annual conference/society meeting, would you attend?	If the 6 hour CE course were given as a workshop at an annual conference/society meeting, would you attend? 0 (Not likely)	If the 6 hour CE course were given as a workshop at an annual conference/society meeting, would you attend? 1	If the 6 hour CE course were given as a workshop at an annual conference/society meeting, would you attend? 2	If the 6 hour CE course were given as a workshop at an annual conference/society meeting, would you attend? 3	If the 6 hour CE course were given as a workshop at an annual conference/society meeting, would you attend? 4	If the 6 hour CE course were given as a workshop at an annual conference/society meeting, would you attend? 5 (Extremely likely)
If the 6 hour CE course were given at your work, and you had not participated before, would you attend?	If the 6 hour CE course were given at your work, and you had not participated before, would you attend? 0 (Not likely)	If the 6 hour CE course were given at your work, and you had not participated before, would you attend? 1	If the 6 hour CE course were given at your work, and you had not participated before, would you attend? 2	If the 6 hour CE course were given at your work, and you had not participated before, would you attend? 3	If the 6 hour CE course were given at your work, and you had not participated before, would you attend? 4	If the 6 hour CE course were given at your work, and you had not participated before, would you attend? 5 (Extremely likely)
If given the opportunity to devote 1 day to becoming a trainer for this program—defined as a local champion who would present the 6 hour course to front-line social workers—would you sign up?	If given the opportunity to devote 1 day to becoming a trainer for this program—defined as a local champion who would present the 6 hour course to front-line social workers—would you sign up? 0 (Not likely)	If given the opportunity to devote 1 day to becoming a trainer for this program—defined as a local champion who would present the 6 hour course to front-line social workers—would you sign up? 1	If given the opportunity to devote 1 day to becoming a trainer for this program—defined as a local champion who would present the 6 hour course to front-line social workers—would you sign up? 2	If given the opportunity to devote 1 day to becoming a trainer for this program—defined as a local champion who would present the 6 hour course to front-line social workers—would you sign up? 3	If given the opportunity to devote 1 day to becoming a trainer for this program—defined as a local champion who would present the 6 hour course to front-line social workers—would you sign up? 4	If given the opportunity to devote 1 day to becoming a trainer for this program—defined as a local champion who would present the 6 hour course to front-line social workers—would you sign up? 5 (Extremely likely)
If given the opportunity to nominate someone to become a trainer—and by doing so, cover the time away from work—would you do this?	If given the opportunity to nominate someone to become a trainer—and by doing so, cover the time away from work—would you do this? 0 (Not likely)	If given the opportunity to nominate someone to become a trainer—and by doing so, cover the time away from work—would you do this? 1	If given the opportunity to nominate someone to become a trainer—and by doing so, cover the time away from work—would you do this? 2	If given the opportunity to nominate someone to become a trainer—and by doing so, cover the time away from work—would you do this? 3	If given the opportunity to nominate someone to become a trainer—and by doing so, cover the time away from work—would you do this? 4	If given the opportunity to nominate someone to become a trainer—and by doing so, cover the time away from work—would you do this? 5 (Extremely likely)
If asked to commit to 1 or more trainings at your site, would you do this?	If asked to commit to 1 or more trainings at your site, would you do this? 0 (Not likely)	If asked to commit to 1 or more trainings at your site, would you do this? 1	If asked to commit to 1 or more trainings at your site, would you do this? 2	If asked to commit to 1 or more trainings at your site, would you do this? 3	If asked to commit to 1 or more trainings at your site, would you do this? 4	If asked to commit to 1 or more trainings at your site, would you do this? 5 (Extremely likely)
If given the opportunity to send front-line social workers at your site to the 6 hour CE course on Palliative Social Work—and in doing so, cover the time away from work—would you do this?	If given the opportunity to send front-line social workers at your site to the 6 hour CE course on Palliative Social Work—and in doing so, cover the time away from work—would you do this? 0 (Not likely)	If given the opportunity to send front-line social workers at your site to the 6 hour CE course on Palliative Social Work—and in doing so, cover the time away from work—would you do this? 1	If given the opportunity to send front-line social workers at your site to the 6 hour CE course on Palliative Social Work—and in doing so, cover the time away from work—would you do this? 2	If given the opportunity to send front-line social workers at your site to the 6 hour CE course on Palliative Social Work—and in doing so, cover the time away from work—would you do this? 3	If given the opportunity to send front-line social workers at your site to the 6 hour CE course on Palliative Social Work—and in doing so, cover the time away from work—would you do this? 4	If given the opportunity to send front-line social workers at your site to the 6 hour CE course on Palliative Social Work—and in doing so, cover the time away from work—would you do this? 5 (Extremely likely)

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* 3. Please tell us about yourself:

Job title:

Setting:

Zip code:

Question Title

* 4. The number of social work staff in your department?

1-10

11-20

21-30

31-40

More than 40

Don't know

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* 5. Does your organization have a palliative care team?

Yes

Don't know

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* 6. Does your organization have a palliative care social worker?

Yes

Don't know

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* 7. Do you belong to any of the following professional associations? (Please check all that apply)

SSWLHC

AOSW

NASW

SWHPN

ACMA

AVASW

Other (please specify)

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* 8. What is your highest professional degree?

BSW

MSW

DSW

PhD

EdD

Other (please specify)

Thank you for participating in the survey. Your responses will be very helpful in guiding the next steps for this important initiative.