Spirituality and Religion in Psychiatric Practice Survey

Please answer each of the following questions regarding your personal educational needs.

Are you a member of CCPS?: *

Yes

If so, in what chapter?: *

In what city do you live?: *

In what city do you practice? : *

Are you employed faculty of a university?: *

Yes

If so, which university?:

Are you volunteer clinical faculty of a university?: *

Yes

If so, which university?:

How many years have you been practicing psychiatry (including residency) ?: *

Specialty:

What percentage of your working hours is spent among the following tasks?

(percentages should add up to 100%)

Patient care: medication management: %

Patient care: psychotherapy : %

Administration: %

Research : %

Supervision/teaching medical students or residents : %

Supervision/teaching of other healthcare professionals: %

Please rate how strongly you agree or disagree with the following statements regarding religion and spiritual aspects of assessment and psychiatric care:

NOTE: “Assessment” pertains to the diagnostic interview, or other form of information-gathering, for the purposes of making psychiatirc diagnosis. “Treatment” may be considered medication management or any form of psychotherapy. Answer the following questions on a scale of 1 to 7: 1 if you strongly disagree, up to 7 if you strongly agree, 4 if you have no opinion.

Please rate from 1 to 7 using the method shown above.:

	1	2	3	4	5	6	7
I feel very comfortable performing spiritual assessments of my patients.
I almost always include a spiritual assessment in evaluating my patients.
I feel very comfortable addressing the spritual needs of my patients.
Religion and/or spirituality are important components of psychatric assessment.
Religion and/or spirituality are important components of psychatric treatment.
Religion and/or spirituality are frequently cited by patients as related to a cause of their psychological distress.
Religion and/or spirituality are frequently cited by patients as related to their ability to cope with psychological distress.
Religious and/or spiritual issues frequently present themselves in the course of treament of my patients.
I have at least once advised or referred a patient to see a chaplain or spritual minister (e.g. priest, pastor, spiritual leader, et.al.).
I consider myself to have some expertise in the area of religious and spiritual aspects of psychiatric assessment and care.
I often teach other healthcare professionals (e.g. medical students, psychiatric residents, non-psychiatric healthcare providers, etc.) about religious and spiritual aspects of psychiatric assessment and care.
I would be willing to teach other healthcare professionals about religious and spiritual aspects of psychiatric assessment and care.
I am comfortable integrating religious or spiritual components into my patient's psychiatric care, if they so desire.
I would like to learn more about religious and spiritual aspects of psychiatric assessment and care.

How often do you perform a spiritual assessment? (percentage, 0 - 100): %

How often do religious/spiritual issues present as an important component of the assessment and/or treatment of your patients? (percentage, 0 - 100): %

Any Particular faith, religion, or worldview you are most comfortable? :

Any Particular faith, religion, or worldview you are least comfortable?:

Have we forgotten anything? We welcome your comments and suggestions:

May we contact you with more questions (e.g. future surveys, focus groups, etc.)?

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Spirituality and Religion in Psychiatric Practice Survey