HB-1032 SurveyHB-1032 Survey

1. Please indicate your affiliation and geographic location

Please indicate your affiliation and geographic location Consumer

Mental Health Professional

Medical Professional

Elected Official

Drug and Alcohol Treatment Provider

Government Employee

Prevention Provider

What county(ies) do your services cover?

2. What crisis response services are currently available in your community? (please mark all that apply and feel free to write in additional information)

What crisis response services are currently available in your community? (please mark all that apply and feel free to write in additional information) Daytime comprehensive crisis outpatient services (counseling, medication stabilization, community crisis intervention, continuity of care, case management)

24-hour comprehensive crisis outpatient services (counseling, medication stabilization, community crisis intervention, continuity of care, case management)

24-hour crisis hotline

Crisis inpatient services

Crisis intervention teams

Mobile crisis teams

Extended observation ("23 hour" services)

24-hour psychiatric emergency services

Detox Services (Social Model)

Other (please specify)

3. How would you rate the following services for your community?

	Exceptional	More Than Adequate	Adequate	Inadequate	Nonexistent	N/A
Availability of crisis services (business hours and after hours)	*How would you rate the following services for your community? Availability of crisis services (business hours and after hours) Exceptional	Availability of crisis services (business hours and after hours) More Than Adequate	Availability of crisis services (business hours and after hours) Adequate	Availability of crisis services (business hours and after hours) Inadequate	Availability of crisis services (business hours and after hours) Nonexistent	Availability of crisis services (business hours and after hours) N/A
Response time to initial crisis	Response time to initial crisis Exceptional	Response time to initial crisis More Than Adequate	Response time to initial crisis Adequate	Response time to initial crisis Inadequate	Response time to initial crisis Nonexistent	Response time to initial crisis N/A
Timely access to follow up services	Timely access to follow up services Exceptional	Timely access to follow up services More Than Adequate	Timely access to follow up services Adequate	Timely access to follow up services Inadequate	Timely access to follow up services Nonexistent	Timely access to follow up services N/A
Detox services (Social model)	Detox services (Social model) Exceptional	Detox services (Social model) More Than Adequate	Detox services (Social model) Adequate	Detox services (Social model) Inadequate	Detox services (Social model) Nonexistent	Detox services (Social model) N/A
Overall continuum of care	Overall continuum of care Exceptional	Overall continuum of care More Than Adequate	Overall continuum of care Adequate	Overall continuum of care Inadequate	Overall continuum of care Nonexistent	Overall continuum of care N/A

4. How is the crisis response system working with citizens and other agencies in your community? Please rate the following:

	High	Above Average	Average	Below Average	Poor	N/A
Community knowledge of available services	*How is the crisis response system working with citizens and other agencies in your community? Please rate the following: Community knowledge of available services High	Community knowledge of available services Above Average	Community knowledge of available services Average	Community knowledge of available services Below Average	Community knowledge of available services Poor	Community knowledge of available services N/A
Collaboration between crisis response entities and other agencies	Collaboration between crisis response entities and other agencies High	Collaboration between crisis response entities and other agencies Above Average	Collaboration between crisis response entities and other agencies Average	Collaboration between crisis response entities and other agencies Below Average	Collaboration between crisis response entities and other agencies Poor	Collaboration between crisis response entities and other agencies N/A
Outreach and communication with grassroots groups and individuals	Outreach and communication with grassroots groups and individuals High	Outreach and communication with grassroots groups and individuals Above Average	Outreach and communication with grassroots groups and individuals Average	Outreach and communication with grassroots groups and individuals Below Average	Outreach and communication with grassroots groups and individuals Poor	Outreach and communication with grassroots groups and individuals N/A
Consumer satisfaction	Consumer satisfaction High	Consumer satisfaction Above Average	Consumer satisfaction Average	Consumer satisfaction Below Average	Consumer satisfaction Poor	Consumer satisfaction N/A

Comments:

5. Please rate how well the current crisis response system is working in your community?

Please rate how well the current crisis response system is working in your community? Our services FULLY meet our crisis needs

Our services MOSTLY meet the crisis needs

Our services SOMETIMES meet our crisis needs

Our services are inadequate and RARELY meet our crisis needs

I am not sure/do not know

Comments:

6. What are three positive outcomes you have seen from the current crisis response system in your community?

What are three positive outcomes you have seen from the current crisis response system in your community? one
Two
Three

7. What are three services that are missing in your community's crisis response system?

What are three services that are missing in your community's crisis response system? One
Two
Three

8. If resources and funding were unlimited, what would your "ideal" crisis response system look like?

If resources and funding were unlimited, what would your "ideal" crisis response system look like?

9. Given existing funding and resources, what would be the best response system for your community?

Given existing funding and resources, what would be the best response system for your community?

10. Would you prefer to a statewide or a local crisis response system?

Would you prefer to a statewide or a local crisis response system? Statewide

Local

Combination of statewide and local

No preference

11. What is most important to you when receiving support/services during a crisis

What is most important to you when receiving support/services during a crisis

12. What recovery and wellness components are the most important to you in relation to crisis services?

What recovery and wellness components are the most important to you in relation to crisis services?

HB-1032 Survey
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1. HB-1032 Crisis Response Survey

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1. HB-1032 Crisis Response Survey

HB-1032 Survey
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