SurveyMonkey Powered Online Survey

As someone who has called our Talkline, your thoughts and experiences are very important to us. Your honest responses in this survey will help improve Backline services and advocacy to support people in their decisions and experiences with pregnancy, parenting, abortion and adoption.

This survey is ANONYMOUS. Responses will be compiled and may be quoted anonymously, but never in a way that could identify individual callers. If you have any questions, suggestions or concerns, please contact us at info@yourbackline.org or 503-287-4344.

Thank you again for your participation in this survey.

1. How did you first contact the Talk Line?

How did you first contact the Talk Line? A peer counselor answered when I called.

A peer counselor did not answer when I called. I left a voicemail.

A peer counselor did not answer when I called. I did not leave a voicemail.

Comments

2. If someone did not answer on your first call, did you eventually talk to a Backline peer counselor?

If someone did not answer on your first call, did you eventually talk to a Backline peer counselor? Yes

Comments

3. Was this your first call to Backline?

Was this your first call to Backline? Yes

4. If you've called the Talk Line before, how many times have you talked to someone?

If you've called the Talk Line before, how many times have you talked to someone? None, this was my first call

1 time

2-5 times

6-10 times

>11 times

5. How did you hear about Backline? (select more than one option if applicable):

How did you hear about Backline? (select more than one option if applicable): Internet Search (Google, Yahoo, etc) Web Link from Another Organization Outreach Materials (brochure, card)	Provider/Clinic Referral Friend/Loved One Unknown
If Website Link or Clinic Referral, please tell us which one.

6. When you called, who were you seeking support for? (select more than one answer if applicable):

When you called, who were you seeking support for? (select more than one answer if applicable): Myself Partner/Significant Other Daughter/Son/Dependent	Other Relative Friend Client/Patient/Student
Other (please specify)

7. What is your gender identity? Check all that apply.

What is your gender identity? Check all that apply. Female

Male

Transgender

Genderqueer

Other (please specify)

8. Please indicate your personal experience(s) with pregnancy, parenting, abortion and adoption (check all that apply).

Please indicate your personal experience(s) with pregnancy, parenting, abortion and adoption (check all that apply). I have been pregnant I have had an abortion I have placed a child for adoption I have experienced pregnancy or infant loss	I am or have been a parent to one or more children I have adopted a child I am an adoptee None of the above
Other (please specify)

9. We know that your reasons for calling the Talk Line may include many complex issues. Please check any of the following issues or situations that prompted you to call Backline.

We know that your reasons for calling the Talk Line may include many complex issues. Please check any of the following issues or situations that prompted you to call Backline. Pregnancy Options Counseling

Abortion Support or Counseling

Abortion Funding

Abortion Referral

Past Abortion experience

Parenting Support or Counseling

Parenting Resources or Referrals

Past Birth experience

Adoption Support or Counseling

Adoption Resources or Referrals

Past Adoption experience

Past Pregnancy experience

Miscarriage or Stillbirth

Fetal Diagnosis or Anomaly

Infertility

General Pregnancy Support or Counseling

Sexual or Reproductive Health Questions

Other (please specify)

10. If you had to pick the ONE main reason that you called the Talk Line, what would it be?

If you had to pick the ONE main reason that you called the Talk Line, what would it be? Pregnancy Options Counseling Abortion Support or Counseling Abortion Funding Abortion Referral Past Abortion experience Parenting Support or Counseling Parenting Resources or Referrals Past Birth experience Adoption Support or Counseling	Adoption Resources or Referrals Past Adoption experience Past Pregnancy experience Miscarriage or Stillbirth Fetal Diagnosis or Anomaly Infertility General Pregnancy Support or Counseling Sexual or Reproductive Health Questions
Other (please specify)

11. Please tell us how you would rank your overall experience calling Backline.

Awful	Bad	OK	Good	Wonderful
*Please tell us how you would rank your overall experience calling Backline. Awful	Bad	OK	Good	Wonderful

12. Please tell us how you would rank other aspects of your call to Backline.

	Awful	Bad	OK	Good	Wonderful	Don't Know or Doesn't Apply
hours the Talk Line is open	*Please tell us how you would rank other aspects of your call to Backline. hours the Talk Line is open Awful	hours the Talk Line is open Bad	hours the Talk Line is open OK	hours the Talk Line is open Good	hours the Talk Line is open Wonderful	hours the Talk Line is open Don't Know or Doesn't Apply
ability to reach a counselor	ability to reach a counselor Awful	ability to reach a counselor Bad	ability to reach a counselor OK	ability to reach a counselor Good	ability to reach a counselor Wonderful	ability to reach a counselor Don't Know or Doesn't Apply
counselor's listening skills	counselor's listening skills Awful	counselor's listening skills Bad	counselor's listening skills OK	counselor's listening skills Good	counselor's listening skills Wonderful	counselor's listening skills Don't Know or Doesn't Apply
counselor's ability to be open & nonjudgmental	counselor's ability to be open & nonjudgmental Awful	counselor's ability to be open & nonjudgmental Bad	counselor's ability to be open & nonjudgmental OK	counselor's ability to be open & nonjudgmental Good	counselor's ability to be open & nonjudgmental Wonderful	counselor's ability to be open & nonjudgmental Don't Know or Doesn't Apply
length of time allowed for your call	length of time allowed for your call Awful	length of time allowed for your call Bad	length of time allowed for your call OK	length of time allowed for your call Good	length of time allowed for your call Wonderful	length of time allowed for your call Don't Know or Doesn't Apply
helpfulness of ideas, information or referrals offered to you	helpfulness of ideas, information or referrals offered to you Awful	helpfulness of ideas, information or referrals offered to you Bad	helpfulness of ideas, information or referrals offered to you OK	helpfulness of ideas, information or referrals offered to you Good	helpfulness of ideas, information or referrals offered to you Wonderful	helpfulness of ideas, information or referrals offered to you Don't Know or Doesn't Apply

13. Please tell us more about your experience calling Backline. Was there anything specific that you found helpful? Is there anything that could be improved?

Please tell us more about your experience calling Backline. Was there anything specific that you found helpful? Is there anything that could be improved?

14. We recognize that many issues and factors may impact a person's experience with pregnancy, parenting, abortion, and/or adoption. For you, which of the following have been a source of SUPPORT or HELP?

We recognize that many issues and factors may impact a person's experience with pregnancy, parenting, abortion, and/or adoption. For you, which of the following have been a source of SUPPORT or HELP? Partner or Significant Other

Family

Friends

Community

Culture

Immigration status

Language access

Keeping things to myself/secret

Social attitudes or stigma

Faith, religion or spirituality

Emotions or feelings about your situation

Your physical health

Your mental health

Ability to support existing children/family

Ability to support future/potential child

Money/financial resources

Health insurance

Access to health care services

Referrals you were given

Clinics or providers you visited

Information you were given

Counseling or support you received (other than Backline)

Other or comments

15. For you, which of the following have been a source of DISTRESS or PROBLEM?

For you, which of the following have been a source of DISTRESS or PROBLEM? Partner or Significant Other Family Friends Community Culture Immigration status Language access Keeping things to myself/secret Social attitudes or stigma Faith, religion or spirituality Emotions or feelings about your situation	Your physical health Your mental health Ability to support existing children/family Ability to support future/potential child Money/financial resources Health insurance Access to health care services Referrals you were given Clinics or providers you visited Information you were given Counseling or support you received (other than Backline)
Other or comments

16. In a perfect world, what might have helped or provided more support for you in your situation or decision?

In a perfect world, what might have helped or provided more support for you in your situation or decision?

17. We welcome any other comments or concerns you would like to share about your experience using our Talk Line.

We welcome any other comments or concerns you would like to share about your experience using our Talk Line.

18. Thank you for taking the time to answer these questions and share your ideas with us!

Sometimes we have questions or want to follow up with someone about their suggestions for Backline. If you feel comfortable, please provide your name and information so that we can contact you if needed.

If you prefer to remain anonymous that is fine too!

Thank you for taking the time to answer these questions and share your ideas with us! Sometimes we have questions or want to follow up with someone about their suggestions for Backline. If you feel comfortable, please provide your name and information so that we can contact you if needed. If you prefer to remain anonymous that is fine too! Name:
Email Address:
Phone Number:

Backline Caller Feedback Survey