Practitioners Survey Step 1 of 13 7% Practitioner ID* Client ID* What is the gender of the young person?*MaleFemaleOtherWhat is the age of the young person?* What is their BME (black and minority ethnic group) status? (refer to Census categories)* Which parent has the substance misuse problem?* What is the primary substance of misuse? (write n/a if no substance misuse present)* Approximately how many months or years has the young person been living with (or affected by) the substance misuse?* Which parent has mental health problems?* What is the primary mental health problem? (write n/a if no mental health problems present)* Approximately how many months or years has the young person been living with (or affected by) the mental health problems?* How did you meet this young person? (e.g. did you already know them, were they referred or were they a self-referral)* If they were referred, where did the referral come from? (write n/a if they were not referred from elsewhere)* Approximately how long have you known this young person? (write first appointment if they were not previously known toyou)* Before Intervention QuestionsPlease fill in the date of the Before Questions and continue.Date The date the survey was completed before intervention. Personal Competence Questions*Please think about how the last month has been, your thoughts and how you have felt about yourself and important people in your life.Totally DisagreeDisagreeAverageAgreeTotally AgreeI reach my goals if I work hardI am satisfied with my life up until nowI know how to reach my goalsWhen it is impossible for me to change certain things I stop worrying about themI feel competentWhen I have to choose between several options I almost always know what will be right for meMy belief in myself gets me through difficult timesWhen things go badly I have a tendency to find something good that can come out of it Social Competence Questions*Please think about how the last month has been, your thoughts and how you have felt about yourself and important people in your life.Totally DisagreeDisagreeAverageAgreeTotally AgreeI easily make others feel comfortable around meI easily find new friendsI am good at talking to new peopleI always find something fun to talk aboutI always find something comforting to say to others when they are sad Structured Style Questions*Please think about how the last month has been, your thoughts and how you have felt about yourself and important people in your life.Totally DisagreeDisagreeAverageAgreeTotally AgreeI am at my best when I have clear aims and objectivesI always make a plan before I start something newI am good at organising my timeIn my family we have rules that simplify everyday life Social Resources Questions*Please think about how the last month has been, your thoughts and how you have felt about yourself and important people in your life.Totally DisagreeDisagreeAverageAgreeTotally AgreeI have some friends/family members that usually encourage meMy friends always stick togetherI have some close friends/family members that really care about meI always have someone that can help me when I need itI have some close friends/family members that value my qualities Family Cohesion Questions*Please think about how the last month has been, your thoughts and how you have felt about yourself and important people in your life.Totally DisagreeDisagreeAverageAgreeTotally AgreeIn my family we share views of what is important in lifeI feel comfortable with my familyIn my family we agree on most thingsMy family view the future as positive, even when very sad things happenIn my family we support each otherIn my family we like to do things together After Intervention QuestionsPlease continue and fill in the After intervention survey. Please also enter the date the After section was completed.Date Please enter the date the After intervention questions were completed. (After) Personal Competence Questions*Please think about how the last month has been, your thoughts and how you have felt about yourself and important people in your life.Totally DisagreeDisagreeAverageAgreeTotally AgreeI reach my goals if I work hardI am satisfied with my life up until nowI know how to reach my goalsWhen it is impossible for me to change certain things I stop worrying about themI feel competentWhen I have to choose between several options I almost always know what will be right for meMy belief in myself gets me through difficult timesWhen things go badly I have a tendency to find something good that can come out of it (After) Social Competence Questions*Please think about how the last month has been, your thoughts and how you have felt about yourself and important people in your life.Totally DisagreeDisagreeAverageAgreeTotally AgreeI easily make others feel comfortable around meI easily find new friendsI am good at talking to new peopleI always find something fun to talk aboutI always find something comforting to say to others when they are sad (After) Structured Style Questions*Please think about how the last month has been, your thoughts and how you have felt about yourself and important people in your life.Totally DisagreeDisagreeAverageAgreeTotally AgreeI am at my best when I have clear aims and objectivesI always make a plan before I start something newI am good at organising my timeIn my family we have rules that simplify everyday life (After) Social Resources Questions*Please think about how the last month has been, your thoughts and how you have felt about yourself and important people in your life.Totally DisagreeDisagreeAverageAgreeTotally AgreeI have some friends/family members that usually encourage meMy friends always stick togetherI have some close friends/family members that really care about meI always have someone that can help me when I need itI have some close friends/family members that value my qualities (After) Family Cohesion Questions*Please think about how the last month has been, your thoughts and how you have felt about yourself and important people in your life.Totally DisagreeDisagreeAverageAgreeTotally AgreeIn my family we share views of what is important in lifeI feel comfortable with my familyIn my family we agree on most thingsMy family view the future as positive, even when very sad things happenIn my family we support each otherIn my family we like to do things together
