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Fields marked with * are required.
Section I:
Contact Information
Submitter Information:
Are you open to communicating your center's ideas and experiences with HCC? *
Yes No
Contact Information:
Please provide point-of-contact information if communications should be directed to someone other than the person submitting this form.
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School Demographics
Institutional Category - A:
-- Select One -- Public Private
Institutional Category - B:
-- Select One -- 2-year College 4-year College
Institutional Size (# of credit students):
-- Select One -- Under 2500 Between 2500 - 7500 Between 7500 - 15,000 Over 15,000
Institutional Type:
-- Select One -- Mostly Residential Mostly Commuter All Residential All Commuter Other (provide details)
If "Other" was chosen as type of institution, provide details here:
Does your institution provide personal counseling services?:
Yes No Not Sure
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Section II:
Counseling Center Operations
NOTE: When selecting multiple items, press the CTRL key until all desired items have been chosen by clicking on them using the mouse.
If you are housed with other services, what other services are provided?:
-- Select all that apply -- Advising Academic Support Career Disability Support Health/Wellness Trio Not Housed with Other Services Other (provide details)
If "Other" was chosen, please provide details here:
Are weekend hours offered?:
Yes No Not Sure
"Walk-in" Hours
Walk-in Hours Offered?:
Yes No Not Sure
Evening Hours
Evening Hours Offered?:
Yes No Not Sure
Number of days per week that evening hours are offered:
-- Select One -- 0 1 2 3 4 5 Greater than 5
Time when evening hours end:
-- Select One -- 6:00 PM 7:00 PM 8:00 PM 9:00 PM After 9:00 PM Other (please specify) N/A
If "Other" was chosen, please provide details here:
24-Hour Crisis/Emergency Coverage
24-Hour Crisis/Emergency Coverage Available?:
Yes No Not Sure
If No, please describe your procedures for handling after-hours emergencies:
Psychiatric Services
Is there a consulting psychiatrist on staff?:
Yes No Not Sure
Are clients required to be seeing a therapist in your center in order to receive psychiatric services?:
Yes No Not Sure
Revenue
Is revenue brought into your center?:
Yes No Not Sure
If Yes, please describe how it is accomplished:
Section III:
Clinical Services
Please indicate whether or not your institution offers the services listed below and also rate their level of importance to the mission of your center. Please use the following scale: 5=Very Important; 4=Important; 3=Neither Important nor Unimportant; 2=Somewhat Important; 1=Not Important
1. Career Counseling
2. Career Assessments
3. Formal Clinical Assessments (e.g. depression, anxiety, eating disorders)
4. Formal Diagnosis (using DSM-IV)
5. Personality Assessments
6. Learning Disability Assessments
7. Substance Abuse Assessments
8. Counseling for Students Receiving Campus Disciplinary Action
9. Court-mandated Counseling
10. Faith-based Counseling
11. Phone or Telecounseling
12. Web-based Counseling
If Yes, please describe how this is accomplished (e.g. technologies, policies, procedures, etc.):
13. Web Q&A (column, "Dear Abby," style)
14. Psychiatric Services/Medication Provider
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Section IV:
Training for Center Staff
Are your staff members trained in threat assessment?:
Yes No Not Sure
If Yes, please indicate who performed the training:
Is your staff trained in ASSIST or any other type of formalized suicide assessment?:
Yes No Not Sure
Is your staff trained in Critical Incident Stress Debriefing or something similar?:
Yes No Not Sure
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Section V:
Outreach
Faculty Workshops
If you provide faculty workshops, please describe the topics you offer and how often they are offered:
On-Campus Housing
Do you have a staff person who acts as a liaison to Housing?:
Yes No N/A Not Sure
If applicable, please describe the type of training provided for Housing staff and how often it is provided:
Campus Security
Training/outreach offered to campus security staff?:
Yes No Not Sure
If offered, please describe the training/outreach that is provided:
Groups
What types of groups are, typically, most successful?:
What percentage of individual clients are also in some type of group?:
-- Select One -- Fewer than 10% 10% - 20% 20% - 30% 30% - 40% 40% - 50% 50% - 60% 60% - 70% Higher than 70%
Marketing
Please describe any innovative and effective marketing strategies that you utilize:
NOTE: When selecting multiple items, press the CTRL key until all desired items have been chosen by clicking on them using the mouse.
If applicable, please choose the social networking website(s) used to advertise services or to assist students:
-- Select all that apply -- Facebook MySpace Classmates.com hi5 Student.com tribe.net Advogato deviantArt Jaiku LiveJournal MocoSpace Searchles Sconex Tagged.com Vox Windows Live Spaces (MSN Spaces) Xanga Yahoo! 360 Other
If "Other" was chosen, please list the name(s) of the site(s) you use:
If applicable, please describe how online social networking is being used:
Mental Health
Do you utilize any web-based prevention programs?:
Yes No Not Sure
If Yes, please describe the program(s) you utilize and also please include the web address(es):
Does your center provide any targeted outreach to parents regarding mental health?:
Yes No Not Sure
If Yes, please describe the targeted outreach that is offered:
Please describe the follow-up procedures that are conducted by the counseling center if a faculty member, parent, or friend expresses concern about a student:
When, if at all, would you contact a student if someone expresses concern to you about him or her?:
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Section VI:
Disruptive Students
What role does your institution's counseling center play in working with disruptive students?:
Please describe what your institution and counseling center are doing differently since the Virginia Tech incident:
Are there currently campus protocols in place which address suicidal/dangerous clients; pre/post hospitilazation; arrest?:
Yes No Not Sure
If you have protocols in place, and you are willing to share specifics, please describe them. (HCC is developing similar protocols and would appreciate any information you are able to provide):
Does your institution have an involuntary leave policy for students?:
Yes No Not Sure
Is the counseling center staff involved in determining a student's need for involuntary leave?:
Yes No N/A Not Sure
Is the counseling center staff involved in determining the return of a student placed on involuntary leave?:
Yes No N/A Not Sure
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Section VII:
Best Practices
Please describe how you evaluate the impact of your services on student academic success:
Please describe how you evaluate the impact of your services on student psychological well-being:
Please describe what you feel is/are the most innovative service(s) or feature(s) of your center:
Please describe what improvements are most needed in your center:
Please describe what improvements have already been made to your center that are most notable to you:
Please describe the services and features that you hope to provide within the next five years, which are not currently provided:
If money weren't an issue, and based upon the needs of your clients, what would you do differently?:
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Section VIII:
Additional Questions
Do you have an extern training program?:
Yes No Not Sure
Are your externs compensated?:
Yes No N/A Not Sure
If applicable, please explain how externs are compensated:
If phone or web counseling is offered, how does your institution manage informed consent and threats to safety?:
Please describe the measures in place for referring students off-campus (i.e. staff designated to facilitate referrals? Referral book?):
Do you have a formal policies/procedures manual for your center?:
Yes No Not Sure
HCC is compiling its own policy/procedures manual. Would you be willing to share information and ideas, related to your policies/procedures manual, with HCC?:
Yes No
If Yes, please provide information for contacting you; or, fill out the contact information that appears at the beginning of the survey:
