VA Questionnaire
RequiredRequired Question(s)
Please respond to the 13-item questionnaire fully and candidly. Your responses will be kept confidential and will help us to know more about your practice, and to represent your interests as major changes are made to the VA in compliance with new federal law. 

You can take the first step by consistently using (and requesting that others use) your legal professional title, which is Clinical Social Worker.

Note: You may exit and return at any point in the questionnaire. 
 
Required 1.

Approximately how many clinical social workers are employed at your site?
< 25
25-50
50-75
75-100
100+
Required 2.

I work in the following programs (check all that apply):
Mental Health
PTSD-Outpatient
Homeless Outreach
Suicide Prevention
Home-based Primary Care
Poly Trauma/TBI Program
Integrated Dual Diagnosis Program
Caregiver Support--Geriatrics & Extended Care
Other  
Required 3.
My responsibilities can be expressed as percentages in the following areas (total 100%): 
 None <10% 10-20% 20-30% 30-40% 40-50% 50-60% 60-70% 70-80% 80-90% 90-100% 
Psychotherapy
Clinical Care Management
Homeless Outreach
Suicide Prevention
Administrative (non-clinical management)
Clinical-Centered Supervision
PTSD Outpatient
Other (please specify in the comment section below)
  • Comment:

  • 500 characters left.
Required 4.

Please list the most important ways that good behavioral healthcare services are provided at your site (e.g. peer review, pilot program, etc): 
 

350 characters left.
Required 5.

My site's social work chief has provided me with formal communications from the national VHA Chief of Social Work, including information about clinical practice and pay advancement. 
Yes
No, I have received no such communications.
Required 6.
My site makes significant use of of clinical social workers in the following sectors (check all that apply):
PTSD
Mental Health
Suicide Prevention
Homeless Outreach
Substance Use
HUD-VASH
Other  
Required 7.
What is the profession of the person in charge of Mental Health services at your site?
Clinical Social Worker
Psychiatrist
Psychologist
Nurse
Other  
Required 8.

I can point to specific instances in which our labor union effectively advocated for clinical social workers and those in need of behavioral healthcare. 
Yes
No
  • Comment:

  • 500 characters left.
Required 9.

I could do my job better if allowed to do the following (e.g. have guaranteed access to Vtel, more psychotherapy hours, develop programming, etc.): 
 

350 characters left.
Required 10.

I can describe the process for Special Advancement for Achievement based on having received full and accurate information about my rights to apply for SAA and other forms of career advancement. 
Yes
No
Required 11.

Behavioral healthcare at this site could be better provided in the following ways: 
 

350 characters left.
Required 12.
Please provide the name and address of your VA site. All of your information will remain entirely confidential. 
 

350 characters left.
13.
Please fill out the following information to receive regular VA updates. Again, all of your information will remain entirely confidential. Please provide your phone number if you wish to participate in a follow-up phone call. 

First Name:
Last Name:
Work Phone:
Email Address:
emailaddress@xyz.com