Kansas Tobacco Guideline for Behavioral Health Survey

Question Title

* 1. Is the Guideline useful?

Yes

Undecided

Comment:

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* 2. Please answer these questions:

What do you like about the Guideline?

What do you not like about the Guideline?

What change or changes would you recommend making to the Guideline?

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* 3. If you are suggesting changes, you can use this space to tell us more about why the changes would be helpful.

Question Title

* 4. Are you interested in having your organization or practice adopt and implement the Tobacco Guideline for Behavioral Health?

Yes

Need more information

Question Title

* 5. If additional information is needed, please specify what information you would need in order to more seriously consider agreeing to adopt and implement the Guideline.

	1- Very likely to adopt	2	3	4 - Unlikely to adopt
Supporting tobacco prevention efforts	Supporting tobacco prevention efforts 1- Very likely to adopt	Supporting tobacco prevention efforts 2	Supporting tobacco prevention efforts 3	Supporting tobacco prevention efforts 4 - Unlikely to adopt
Promoting wellness by integrating evidence-based tobacco treatment into routine clinical practice.	Promoting wellness by integrating evidence-based tobacco treatment into routine clinical practice. 1- Very likely to adopt	Promoting wellness by integrating evidence-based tobacco treatment into routine clinical practice. 2	Promoting wellness by integrating evidence-based tobacco treatment into routine clinical practice. 3	Promoting wellness by integrating evidence-based tobacco treatment into routine clinical practice. 4 - Unlikely to adopt
Building staff capacity to provide care.	Building staff capacity to provide care. 1- Very likely to adopt	Building staff capacity to provide care. 2	Building staff capacity to provide care. 3	Building staff capacity to provide care. 4 - Unlikely to adopt
Adopting a tobacco-free environment.	Adopting a tobacco-free environment. 1- Very likely to adopt	Adopting a tobacco-free environment. 2	Adopting a tobacco-free environment. 3	Adopting a tobacco-free environment. 4 - Unlikely to adopt

1- Very likely to adopt

4 - Unlikely to adopt

Supporting tobacco prevention efforts

Supporting tobacco prevention efforts 1- Very likely to adopt

Supporting tobacco prevention efforts 2

Supporting tobacco prevention efforts 3

Supporting tobacco prevention efforts 4 - Unlikely to adopt

Promoting wellness by integrating evidence-based tobacco treatment into routine clinical practice.

Promoting wellness by integrating evidence-based tobacco treatment into routine clinical practice. 1- Very likely to adopt

Promoting wellness by integrating evidence-based tobacco treatment into routine clinical practice. 2

Promoting wellness by integrating evidence-based tobacco treatment into routine clinical practice. 3

Promoting wellness by integrating evidence-based tobacco treatment into routine clinical practice. 4 - Unlikely to adopt

Building staff capacity to provide care.

Building staff capacity to provide care. 1- Very likely to adopt

Building staff capacity to provide care. 2

Building staff capacity to provide care. 3

Building staff capacity to provide care. 4 - Unlikely to adopt

Adopting a tobacco-free environment.

Adopting a tobacco-free environment. 1- Very likely to adopt

Adopting a tobacco-free environment. 2

Adopting a tobacco-free environment. 3

Adopting a tobacco-free environment. 4 - Unlikely to adopt

	Yes	No	Uncertain
Supporting tobacco prevention efforts	Supporting tobacco prevention efforts Yes	Supporting tobacco prevention efforts No	Supporting tobacco prevention efforts Uncertain
Promoting wellness by integrating evidence-based tobacco treatment into clinical practice	Promoting wellness by integrating evidence-based tobacco treatment into clinical practice Yes	Promoting wellness by integrating evidence-based tobacco treatment into clinical practice No	Promoting wellness by integrating evidence-based tobacco treatment into clinical practice Uncertain
Building staff capacity to provide care	Building staff capacity to provide care Yes	Building staff capacity to provide care No	Building staff capacity to provide care Uncertain
Adopting a tobacco-free environment	Adopting a tobacco-free environment Yes	Adopting a tobacco-free environment No	Adopting a tobacco-free environment Uncertain

Yes

Uncertain

Supporting tobacco prevention efforts

Supporting tobacco prevention efforts Yes

Supporting tobacco prevention efforts No

Supporting tobacco prevention efforts Uncertain

Promoting wellness by integrating evidence-based tobacco treatment into clinical practice

Promoting wellness by integrating evidence-based tobacco treatment into clinical practice Yes

Promoting wellness by integrating evidence-based tobacco treatment into clinical practice No

Promoting wellness by integrating evidence-based tobacco treatment into clinical practice Uncertain

Building staff capacity to provide care

Building staff capacity to provide care Yes

Building staff capacity to provide care No

Building staff capacity to provide care Uncertain

Adopting a tobacco-free environment

Adopting a tobacco-free environment Yes

Adopting a tobacco-free environment No

Adopting a tobacco-free environment Uncertain

Kansas Tobacco Guideline for Behavioral Health

Question Title

* 1. Is the Guideline useful?

Question Title

* 2. Please answer these questions:

Question Title

* 3. If you are suggesting changes, you can use this space to tell us more about why the changes would be helpful.

Question Title

* 4. Are you interested in having your organization or practice adopt and implement the Tobacco Guideline for Behavioral Health?

Question Title

* 5. If additional information is needed, please specify what information you would need in order to more seriously consider agreeing to adopt and implement the Guideline.

Question Title

* 6. Please rate each of the four main categories which make up the voluntary Guideline, where 1 represents a strong likelihood that it could be adopted in your practice and 4 represents a poor likelihood for adoption.

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* 7. [Indicate if any of the sections of the voluntary Guideline present significant challenges for you to implement.] THIS QUESTION IS SLATED TO BE ELIMINATED.