ECHO - Student Survey: Selective Prevention

ECHO
(Education and Counseling for High School Opportunities)
Student Survey: Selective Prevention
CDAC Behavioral Healthcare, Inc.
Counselor*
Name of counselor
Name*

First NameLast Name
School*
Name of school
Date*

MonthDayYear
Date of completion
Type of Survey:*

Pre SurveyPost Survey
Main area in which you are experiencing difficulties:*

AcademiaFamilyPeersRelationshipsAngerStressGrief
For the statements below, select the answer that best describes your attitude and feelings at this time related to the problem selected above.
I would describe my stress level related to my problem as:*

LowMedium lowMediumMedium highHigh
I know and use positive coping skills to handle my problem.*

Strongly agreeAgreeNeutralDisagreeStrongly Disagree
I have confidence that my problem(s) can be resolved.*

Strongly agreeAgreeNeutralDisagreeStrongly Disagree
I have reached out to positive friends/peers who can support me with my problem.*

Strongly agreeAgreeNeutralDisagreeStrongly Disagree
I have access to positive adults who encourage, support and help me when I need it.*

Strongly agreeAgreeNeutralDisagreeStrongly Disagree
I have a strong commitment to school.*

Strongly agreeAgreeNeutralDisagreeStrongly Disagree
Should be Empty: