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Ski Cross Canada: Mental Health Check-In

1.Contact Info(Required.)
Given a year full of changes to our daily routine, constant need to adapt, and uncertainty about the future, it would be normal if you have experienced a fluctuation in your mental health from thriving, to just okay, to struggling at times.  To ensure there is a broad understanding of the needs and adequate supports are in place, please fill out this Mental Health Check-In Survey.  The aim of this questionnaire is to better understand your mental health needs and work towards having appropriate supports and resources in place for those who require additional assistance in lead up to and during this season.  


The following outlines the parameters of your consent to participate in this Mental Health Check-In Survey:

Participation - Participation will involve completing the 17 question Check-In Survey, which will take about 5 minutes to fill out. Participation is entirely voluntary, and you may withdraw at any time without prejudice or aversive consequence. You can withdraw by not completing the survey.

Risks/Benefits - There are minimal risks associated with participation in this check-in survey. It is possible that the questionnaire may be triggering to some.  If this occurs, you can contact Dr. Karen MacNeill or support from your personal network. Understanding current mental health needs could connect you with the appropriate supports, so you can be well and excel in the lead up to and during your upcoming season

Confidentiality – The information obtained in this Mental Health Check-In will be viewed and processed privately and professionally by Dr. Karen MacNeill and Alex Hodgins.  At times, it would be helpful to share information with the team physician (Dr. Karin Kausky) to ensure appropriate supports are in place.  The results from this survey may be summarized and presented to staff, but no individual identifying information will be disclosued without consent 

Limits to Confidentiality - There are limits to confidentiality guided by the law, and the Canadian Psychological Association Code of Ethics.  There are specific situations in which confidentiality cannot be assumed.  Confidentiality will be maintained unless a participant is at risk to self or others.  If a participant is actively suicidal, homicidal and/or cannot keep themselves or others safe, all steps will be taken to ensure psychological and physical safety.  


If you have any questions, please do not hesitate to contact Dr. Karen MacNeill- karen@macneillperformance.com.
2.

I UNDERSTAND THE PRESENTED INFORMATION WITH REGARDS TO THE MH CHECK-IN SURVEY AND AGREE TO PARTICPATE


(Required.)
3.Sport(Required.)
4.Over the past 3 months, on average how would you rate your mental health on the following continuum?(Required.)
5.Given the current pandemic and other sport related demands, where would you rate your current stress level?(Required.)
6.Have you ever been diagnosed, treated or experienced symptoms of a mental health condition such as depression, anxiety, suicidal ideation, obsessive compulsive disorder, eating disorder, PTSD, personality disorder?(Required.)
7.How much do you agree/disagree with this statement; “I have the emotional and psychological tools to manage my stress and am able to cope with my current circumstances”.(Required.)
8.How have you been feeling in the past month? Pick your Top 3 predominant emotions.(Required.)
The following questions concern how you have been feeling over the past 30 days. Please check the answer that best represents how you have been:
9.It was difficult to be around teammates/ my team(Required.)
10.I found it difficult to do what I needed to(Required.)
11.I was less motivated(Required.)
12.I was irritable, angry or aggressive(Required.)
13.I could not stop worrying about injury or my performance(Required.)
14.I found training more stressful(Required.)
15.I found it hard to cope with selection pressures(Required.)
16.I worried about life after sport(Required.)
17.I needed alcohol or other substances to relax(Required.)
18.I took unusual risks off-field of play(Required.)
19.Do you feel you have the appropriate supports in place to take care of your mental health needs?(Required.)
20.Is there anything else you would like Karen or Alex to know about your mental health or supports that would be of benefit to you at this time?
Thank You.