PEF Self-Study: Requirements for Clinical Record-Keeping: From the Basic to the Complicated Survey

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* 1. Please provide us with the following information:

Last Name, First Name *

Company

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country

Email Address *

Phone Number *

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* 2. NASW Member #

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* 3. License #

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* 4. If you attended by phone, please indicate the phone number you used.

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* 5. Profession

Social Worker (MSW, LMSW, LCSW, LCSW-R, etc.)

Social Work Student

Licensed Mental Health Counselor

Licensed Marriage and Family Therapist

Licensed Psychologist

Other (please specify)

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* 6. How many years have you worked in the field?

0-5

6-10

11-15

16-20

20+

Your Opportunity to Provide Feedback: Thank you for taking the time to provide us with your reflections on the training workshop you have just completed. Your feedback will be used to inform future training initiatives.

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* 7. Workshop Objectives

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Overall, the workshop was high quality.	Overall, the workshop was high quality. Strongly Disagree	Overall, the workshop was high quality. Disagree	Overall, the workshop was high quality. Neutral	Overall, the workshop was high quality. Agree	Overall, the workshop was high quality. Strongly Agree
I am now able to Describe the ethical responsibility of mental and behavioral health professionals to maintain client records.	I am now able to Describe the ethical responsibility of mental and behavioral health professionals to maintain client records. Strongly Disagree	I am now able to Describe the ethical responsibility of mental and behavioral health professionals to maintain client records. Disagree	I am now able to Describe the ethical responsibility of mental and behavioral health professionals to maintain client records. Neutral	I am now able to Describe the ethical responsibility of mental and behavioral health professionals to maintain client records. Agree	I am now able to Describe the ethical responsibility of mental and behavioral health professionals to maintain client records. Strongly Agree
I am now able to Distinguish the ethical responsibility of mental and behavioral health professionals to maintain client records from related legal requirements.	I am now able to Distinguish the ethical responsibility of mental and behavioral health professionals to maintain client records from related legal requirements. Strongly Disagree	I am now able to Distinguish the ethical responsibility of mental and behavioral health professionals to maintain client records from related legal requirements. Disagree	I am now able to Distinguish the ethical responsibility of mental and behavioral health professionals to maintain client records from related legal requirements. Neutral	I am now able to Distinguish the ethical responsibility of mental and behavioral health professionals to maintain client records from related legal requirements. Agree	I am now able to Distinguish the ethical responsibility of mental and behavioral health professionals to maintain client records from related legal requirements. Strongly Agree
I am now able to Explain how they protect client confidentiality through their record keeping practices.	I am now able to Explain how they protect client confidentiality through their record keeping practices. Strongly Disagree	I am now able to Explain how they protect client confidentiality through their record keeping practices. Disagree	I am now able to Explain how they protect client confidentiality through their record keeping practices. Neutral	I am now able to Explain how they protect client confidentiality through their record keeping practices. Agree	I am now able to Explain how they protect client confidentiality through their record keeping practices. Strongly Agree

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* 8. Workshop Content

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Organization of materials was effective.	Organization of materials was effective. Strongly Disagree	Organization of materials was effective. Disagree	Organization of materials was effective. Neutral	Organization of materials was effective. Agree	Organization of materials was effective. Strongly Agree
Presentation of materials was clear.	Presentation of materials was clear. Strongly Disagree	Presentation of materials was clear. Disagree	Presentation of materials was clear. Neutral	Presentation of materials was clear. Agree	Presentation of materials was clear. Strongly Agree
I gained new knowledge, skills, or strategies that I will use in my practice.	I gained new knowledge, skills, or strategies that I will use in my practice. Strongly Disagree	I gained new knowledge, skills, or strategies that I will use in my practice. Disagree	I gained new knowledge, skills, or strategies that I will use in my practice. Neutral	I gained new knowledge, skills, or strategies that I will use in my practice. Agree	I gained new knowledge, skills, or strategies that I will use in my practice. Strongly Agree

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* 9. Feedback on Presenter(s):Kathryn Krase, Ph.D., J.D., M.S.W.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Demonstrated expertise on the topic.	Demonstrated expertise on the topic. Strongly Disagree	Demonstrated expertise on the topic. Disagree	Demonstrated expertise on the topic. Neutral	Demonstrated expertise on the topic. Agree	Demonstrated expertise on the topic. Strongly Agree
Effectively responded to questions.	Effectively responded to questions. Strongly Disagree	Effectively responded to questions. Disagree	Effectively responded to questions. Neutral	Effectively responded to questions. Agree	Effectively responded to questions. Strongly Agree
Solicited audience participation.	Solicited audience participation. Strongly Disagree	Solicited audience participation. Disagree	Solicited audience participation. Neutral	Solicited audience participation. Agree	Solicited audience participation. Strongly Agree
Teaching methods were effective.	Teaching methods were effective. Strongly Disagree	Teaching methods were effective. Disagree	Teaching methods were effective. Neutral	Teaching methods were effective. Agree	Teaching methods were effective. Strongly Agree
I would recommend NASW-NYS to hold additional workshops by this presenter.	I would recommend NASW-NYS to hold additional workshops by this presenter. Strongly Disagree	I would recommend NASW-NYS to hold additional workshops by this presenter. Disagree	I would recommend NASW-NYS to hold additional workshops by this presenter. Neutral	I would recommend NASW-NYS to hold additional workshops by this presenter. Agree	I would recommend NASW-NYS to hold additional workshops by this presenter. Strongly Agree

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* 10. What did you learn in today's workshop that you anticipate using in your work with your clients?

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* 11. What suggestions would you make to improve this workshop?

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* 12. Please provide recommendations for additional programming content you would like NASW-NYS to provide through its professional development/continuing education services.