Spirituality Pilot SLP Professional

Thank you for taking time to complete this survey. It has 4 sections and most questions require a simple checked response. Please answer the questions the best you can, as they relate to you.

Spiritual Involvement and Beliefs Scale - Part 1

Please indicate how strongly you agree with the following statements.

Strongly Disagree

Disagree

Mildly Disagree

Neutral

Mildly Agree

Agree

Strongly Agree

I set aside time for meditation and/or self-reflection.

I can find meaning in times of hardship.

A person can be fulfilled without pursuing an active spiritual life.

I find serenity by accepting things as they are.

I have a relationship with someone I can turn to for spiritual guidance.

Prayer does not really change what happens.

In times of despair, I can find little reason to hope.

I have a personal relationship with a power greater than myself.

I have had a spiritual experience that greatly changed my life.

When I help others, I expect nothing in return.

I don't take time to appreciate nature.

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Spiritual Involvement and Beliefs Scale - Part 2

Please indicate how strongly you agree with the following statements.

Strongly Disagree

Disagree

Mildly Disagree

Neutral

Mildly Agree

Agree

Strongly Agree

I have joy in my life because of my spirituality.

My relationship with a higher power helps me love others more completely.

Spiritual writings enrich my life.

I have experienced healing after prayer.

My spiritual understanding continues to grow.

I focus on what needs to be changed in me, not on what needs to be changed in others.

In difficult times, I am still grateful.

I have been through a time of suffering that led to spiritual growth.

I solve my problems without using spiritual resources.

I examine my actions to see if they reflect my values.

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Spiritual Background - Part 3

Please respond to each question as best you can. Some questions require a checked response and ask for additional comments or explanation.

What is your spiritual or religious affiliation? (Please check all that apply)

	(Select all that apply.)
	Agnostic
	Atheist
	Baha'i
	Buddhist
	Christian Scientist
	Eastern Orthodox
	Hindu
	Jehovah's Witness
	Jewish
	Mormon
	Muslim
	Native American
	Pagan
	Protestant
	Roman Catholic
	Seventh Day Adventist
	Wiccan
	None
	Other

How knowledgeable do you consider yourself to be about your own faith tradition?

	1 Not at all
	2
	3
	4
	5
	6
	7 Very

During the past MONTH how many times did you participate in a formal religious experience, ceremony, or service?

	0 times
	1-3 times
	4-6 times
	7-9 times
	10 or more times

During the past WEEK how many times did you pray?

	0 times
	1-3 times
	4-6 times
	7-9 times
	10 or more times

During the past WEEK how many times did you meditate?

	0 times
	1-3 times
	4-6 times
	7-9 times
	10 or more times

What does spirituality mean to you?

To what extent do you consider yourself to be a spiritual person?

	1 Not at all
	2
	3
	4
	5
	6
	7 Very

To what extent do you see your own spirituality playing a part in your work? (Please choose 1 number on the 7 point scale and provide comments.)

	(Select all that apply.)
	1 Not at all
	2
	3
	4
	5
	6
	7 Very
	Please explain:

Do you think it is appropriate (i.e. within scope of practice; ethical) for speech-language pathologists to talk with clients about their (the clients') spiritual needs related to the communication disorder?

	(Select all that apply.)
	Yes
	No
	Please explain:

Who do you think should address a client's spiritual needs related to the communication disorder? (Please check all that apply)

	(Select all that apply.)
	Chaplain
	Clergy person
	Nurse
	Physician
	Shaman
	Social worker
	Speech pathologist
	Other:

How comfortable would you feel in addressing the spiritual needs of clients as they relate to the communication disorder? (Please choose 1 number on the 7 point scale and provide comments.)

	(Select all that apply.)
	1 Not at all
	2
	3
	4
	5
	6
	7 Very
	Comments:

How comfortable would you feel providing therapy services to clients with different beliefs and values from your own? (Please choose 1 number from the 7 point scale and provide comments.)

	(Select all that apply.)
	1 Not at all
	2
	3
	4
	5
	6
	7 Very
	Comments:

Have you had any training/education in providing spiritual care to others?

	(Select all that apply.)
	Yes
	No
	If yes, please describe:

Would you be interested in learning about the spiritual needs of people with communication disorders and learning how to provide spiritual care to them? (Please choose 1 number on the 7 point scale and provide comments.)

	(Select all that apply.)
	1 Not at all
	2
	3
	4
	5
	6
	7 Very
	Comments:

How might a speech -language pathologist address the spiritual needs of clients?

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Demographics - Part 4

What is your age?

	16-20
	21-25
	26-30
	31-35
	36-40
	41-45
	46-50
	51-55
	55-60
	Over 60

What is your gender?

	Male
	Female

In which state(s) are you licensed to practice?

	(Select all that apply.)
	MN
	WI
	Other:

Total number of years practicing in the profession?

	1-5
	6-10
	11-15
	16-20
	21-25
	26-30
	31-35
	36-40
	Over 40

Number of years at your current facility?

	1-5
	6-10
	11-15
	16-20
	21-25
	26-30
	31-35
	36-40
	Over 40

Type of setting in which you work?

	(Select all that apply.)
	Community clinic
	Hospital inpatient
	Hospital outpatient
	Long-term care facility
	Short-term care facility
	Public school
	Private school
	Other:

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Thank you for taking the time to respond to these questions. We appreciate your interest in this topic and your help in this project. When you click on the submit button, your responses will automatically be forwarded to a secure web site for later analysis.

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