Survey to Providers on Peer Roles

The Basics

This survey is intended for people who are working in provider roles in traditional organizations and who are working toward implementing or supporting the ongoing existence of peer roles. Answers to this survey will be used to support the development of a handbook for both people working in peer roles and providers implementing/supporting peer roles. Your responses may be used in this book and/or on a corresponding website dedicated to this same issue.

If you attempt to take this survey and you are working in a peer role, receiving services, working in a peer-to-peer organization, or don't otherwise fit any of these categories, it will take you to a 'disqualification' page.

However:

If you work in a peer role, please take our survey for people working in peer roles available at: www.surveymonkey.com/s/pr_peerrole

If you receive services from a traditional provider, please take our survey at: www.surveymonkey.com/s/pr_services

If you work in a peer-to-peer organization or don't otherwise fit any of these categories, but want to share your thoughts and ideas with us, please e-mail us directly at info@westernmassrlc.org.

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* 1. Are you currently (or have you recently been) working in a provider (non-peer) role in a traditional organization?

Yes, I am CURRENTLY working in a provider (non-peer) role in a traditional organization.

Yes, I have RECENTLY (within the last two years) worked in a provider (non-peer) role in a traditional organization.

No, I work in a peer role in a traditional organization.

No, I work in a peer role in a peer-to-peer organization.

No, I receive services from a traditional organization.

No, I don't fit any of these categories.

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* 2. In what state or U.S. territory do you live?


State	State menu

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* 3. Please briefly describe the types of services your organization offers.

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* 4. What is your job title?

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* 5. Please briefly describe your job responsibilities.

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* 6. How long have you worked for this organization?

Less than 1 year

1 to 3 years

4 to 6 years

7 to 9 years

10 or more years

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* 7. Do peer roles currently exist in your organization?

Yes. They have existed for five or more years.

Yes. They have existed for two to four years.

Yes. They have existed for over a year.

Yes. But we just got started (less than a year)

No. But we're in the later stages of implementation (hiring, etc.)

No. But we're in the early stages of planning (developing job descriptions, etc.)

No. We haven't started the planning process yet.

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* 8. OPTIONAL: Include your Name, e-mail and/or phone number if you'd like us to be able to contact you with possible additional questions or information.

Name:

Company:

Address 1:

Address 2:

City/Town:

State/Province:

ZIP/Postal Code:

Country:

Email Address:

Phone Number:

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* 9. If a quote from one of my responses is used in the handbook and/or on the website, I would like to be recognized in the following way:

I would like to remain anonymous.

I would like to remain anonymous, but you can include my general location (State/Country)

You can use my FIRST NAME AND STATE only.

You can use my full name and state, but NOT my organization name/title.

You can use my full name, organization, title and state.