2018 Community Health Needs Assessment

Parent Survey

Before starting the survey, please note that we are asking for responses from parents or caregivers of children ages 0-17 who live in their home in Adams, Arapahoe, Denver, or Douglas counties only. Thank you!

Please answer questions 1-14 about yourself and the children living in your home.

Question Title

* 1. What county do you live in?

Adams

Arapahoe

Denver

Douglas

Other (please specify)

Question Title

* 2. What zip code do you live in?

Question Title

* 3. How many children age 0 to 17 currently live in your home?

Question Title

* 4. How old is/are the child/children in your home? Mark all that apply

Under 1 year

1 to 2 years

3 to 5 years

6 to 11 years

12 to 14 years

15 to 17 years

Question Title

* 5. Is/are your child/children Hispanic, Latino/a or Spanish origin?

Yes - Some or all of my children are of Hispanic, Latino/a, or Spanish origin

No - None of my children are of Hispanic, Latino/a, or Spanish origin

Question Title

* 6. What are the race(s) of the child/children living in your home. Mark all that apply.

White

Black or African American

American Indian or Alaska Native

Asian

Pacific Islander

More than one race

Other (please specify)

Question Title

* 7. What kind of health insurance does/do your child/children have? Mark all that apply.

Medicaid

CHP+

Private or commercial insurance

Medicare

Tricare

My child does not have health insurance

Other (please specify)

Question Title

* 8. What is your household income? Mark ONE response.

$0 to $24,999

$25,000 to $49,999

$50,000 to $74,999

$75,000 to $99,000

$100,000 or more

Don't know/prefer not to answer

Question Title

* 9. During the past 12 months, where did you usually take your child/children for routine medical care such as check-ups? Mark one response.

Doctor's office

A hospital emergency room

An emergency room not in a hospital

Urgent care clinic

Retail clinic like Walgreens or King Soopers

School-based health center

My child/children does/do not have a usual place for medical care

My child/children did not need medical care in the last 12 months

Other (please specify)

Question Title

* 10. During the past 12 months, where did you usually take your child/children for immediate medical care for issues such as high fever, vomiting, or injury? Mark one response.

Doctor's office

A hospital emergency room

An emergency room not in a hospital

Urgent care clinic

Retail clinic like Walgreens or King Soopers

School-based health center

My child/children did not need immediate care in the last year

Other (please specify)

Question Title

* 11. What are some reasons that my prevent or delay you from getting medical care for your child/children? Mark up to 3 responses.

Am not sure how to find a doctor

Unable to afford to pay for care

Unable to schedule an appointment when needed

Unable to find a doctor who knows or understands my culture or religious beliefs

Unable to find a doctor who takes my insurance

Do not have insurance to cover medical care

Challenges getting to the doctor's office

Doctor's office does not have convenient hours

Do not need to see a doctor

Other (please specify)

Question Title

* 12. During the past 12 months, have you or any of family members you live with been unable to get any of the following when it was really needed? Check all that apply.
If you were able to get all of the following resources when you needed them, please mark, "NONE - we were able to get all these things when they were needed."

Food

Housing

Utilities (electricity, gas, etc.)

Transportation

Clothing

Child care

Medicine or health care

Phone

NONE - we were able to get all of these things when they were needed

Other (please specify)

Question Title

* 13. During the past 12 months, has a doctor, nurse, or other health care worker talked with you about your ability to get or pay for any of the following? Check all that apply.

Food

Housing

Utilities (electricity, gas, etc.)

Transportation

Clothing

Child care

Medicine or health care

Phone

None of these things were discussed

Other (please specify)

Question Title

* 14. During the past 12 months, what community resources have you used? Mark all that apply.

Child protective services

Mental health programs or services

Health and human services

Public health department

Domestic violence services

Employment or unemployment services

Food or nutrition programs

Housing or shelter services

Immigration services

Law/legal services

Recreation centers

Public libraries

Senior services

NONE

Other (please specify)

The goal of the next question (Question 15) is to understand what you think are the most critical health needs for children in your community. Please answer the next question about children who live in your community, not just your children.

Question Title

* 15. When you think about the most critical health needs for children in your community, please rank each health need below on a scale of 1 to 3, with 1 being less critical and 3 being very critical. If you think of a health concern that is not listed here, please write it in under “other” and provide your ranking.

	1 - Less critical	2 - Somewhat critical	3 - Very critical	Not sure
Accidents and injuries	Accidents and injuries 1 - Less critical	Accidents and injuries 2 - Somewhat critical	Accidents and injuries 3 - Very critical	Accidents and injuries Not sure
Asthma	Asthma 1 - Less critical	Asthma 2 - Somewhat critical	Asthma 3 - Very critical	Asthma Not sure
Care for children with special needs (physical, emotional, developmental or behavioral)	Care for children with special needs (physical, emotional, developmental or behavioral) 1 - Less critical	Care for children with special needs (physical, emotional, developmental or behavioral) 2 - Somewhat critical	Care for children with special needs (physical, emotional, developmental or behavioral) 3 - Very critical	Care for children with special needs (physical, emotional, developmental or behavioral) Not sure
Dental care	Dental care 1 - Less critical	Dental care 2 - Somewhat critical	Dental care 3 - Very critical	Dental care Not sure
Diabetes	Diabetes 1 - Less critical	Diabetes 2 - Somewhat critical	Diabetes 3 - Very critical	Diabetes Not sure
Early child care and education	Early child care and education 1 - Less critical	Early child care and education 2 - Somewhat critical	Early child care and education 3 - Very critical	Early child care and education Not sure
Healthy pregnancies and childbirth (not teen pregnancy)	Healthy pregnancies and childbirth (not teen pregnancy) 1 - Less critical	Healthy pregnancies and childbirth (not teen pregnancy) 2 - Somewhat critical	Healthy pregnancies and childbirth (not teen pregnancy) 3 - Very critical	Healthy pregnancies and childbirth (not teen pregnancy) Not sure
Immunizations (vaccines) and infectious diseases	Immunizations (vaccines) and infectious diseases 1 - Less critical	Immunizations (vaccines) and infectious diseases 2 - Somewhat critical	Immunizations (vaccines) and infectious diseases 3 - Very critical	Immunizations (vaccines) and infectious diseases Not sure
Mental or behavioral health	Mental or behavioral health 1 - Less critical	Mental or behavioral health 2 - Somewhat critical	Mental or behavioral health 3 - Very critical	Mental or behavioral health Not sure
Nutrition	Nutrition 1 - Less critical	Nutrition 2 - Somewhat critical	Nutrition 3 - Very critical	Nutrition Not sure
Obesity	Obesity 1 - Less critical	Obesity 2 - Somewhat critical	Obesity 3 - Very critical	Obesity Not sure
Physical activity	Physical activity 1 - Less critical	Physical activity 2 - Somewhat critical	Physical activity 3 - Very critical	Physical activity Not sure
Respiratory health other than asthma (COPD, cystic fibrosis)	Respiratory health other than asthma (COPD, cystic fibrosis) 1 - Less critical	Respiratory health other than asthma (COPD, cystic fibrosis) 2 - Somewhat critical	Respiratory health other than asthma (COPD, cystic fibrosis) 3 - Very critical	Respiratory health other than asthma (COPD, cystic fibrosis) Not sure
Sexual health	Sexual health 1 - Less critical	Sexual health 2 - Somewhat critical	Sexual health 3 - Very critical	Sexual health Not sure
Suicide prevention	Suicide prevention 1 - Less critical	Suicide prevention 2 - Somewhat critical	Suicide prevention 3 - Very critical	Suicide prevention Not sure
Teen pregnancy	Teen pregnancy 1 - Less critical	Teen pregnancy 2 - Somewhat critical	Teen pregnancy 3 - Very critical	Teen pregnancy Not sure

Other (please specify health need and your ranking)

The goal of the next question (Question 16) is to understand what you think are other critical needs or concerns that affect child health in your community. Please answer the next question about children who live in your community, not just your children.

Question Title

* 16. When you think about other critical needs or concerns that affect child health in your community, please rank each community concerns below on a scale of 1 to 3, with 1 being less critical and 3 being very critical. If you think of a concern that is not listed here, please write it under “other” and provide your ranking.

	1 - Less critical	2 - Somewhat critical	3 - Very critical	Not Sure
Access to benefits (Medicaid, WIC, food stamps)	Access to benefits (Medicaid, WIC, food stamps) 1 - Less critical	Access to benefits (Medicaid, WIC, food stamps) 2 - Somewhat critical	Access to benefits (Medicaid, WIC, food stamps) 3 - Very critical	Access to benefits (Medicaid, WIC, food stamps) Not Sure
Access to or cost of child care	Access to or cost of child care 1 - Less critical	Access to or cost of child care 2 - Somewhat critical	Access to or cost of child care 3 - Very critical	Access to or cost of child care Not Sure
Bullying and other stressors in school	Bullying and other stressors in school 1 - Less critical	Bullying and other stressors in school 2 - Somewhat critical	Bullying and other stressors in school 3 - Very critical	Bullying and other stressors in school Not Sure
Child abuse and neglect	Child abuse and neglect 1 - Less critical	Child abuse and neglect 2 - Somewhat critical	Child abuse and neglect 3 - Very critical	Child abuse and neglect Not Sure
Crime and community violence	Crime and community violence 1 - Less critical	Crime and community violence 2 - Somewhat critical	Crime and community violence 3 - Very critical	Crime and community violence Not Sure
Domestic violence	Domestic violence 1 - Less critical	Domestic violence 2 - Somewhat critical	Domestic violence 3 - Very critical	Domestic violence Not Sure
Educational needs	Educational needs 1 - Less critical	Educational needs 2 - Somewhat critical	Educational needs 3 - Very critical	Educational needs Not Sure
Family member alcohol or drug use	Family member alcohol or drug use 1 - Less critical	Family member alcohol or drug use 2 - Somewhat critical	Family member alcohol or drug use 3 - Very critical	Family member alcohol or drug use Not Sure
Housing	Housing 1 - Less critical	Housing 2 - Somewhat critical	Housing 3 - Very critical	Housing Not Sure
Hunger or access to healthy food	Hunger or access to healthy food 1 - Less critical	Hunger or access to healthy food 2 - Somewhat critical	Hunger or access to healthy food 3 - Very critical	Hunger or access to healthy food Not Sure
Lack of employment opportunities	Lack of employment opportunities 1 - Less critical	Lack of employment opportunities 2 - Somewhat critical	Lack of employment opportunities 3 - Very critical	Lack of employment opportunities Not Sure
Legal problems	Legal problems 1 - Less critical	Legal problems 2 - Somewhat critical	Legal problems 3 - Very critical	Legal problems Not Sure
Parenting education (parenting skills for child development)	Parenting education (parenting skills for child development) 1 - Less critical	Parenting education (parenting skills for child development) 2 - Somewhat critical	Parenting education (parenting skills for child development) 3 - Very critical	Parenting education (parenting skills for child development) Not Sure
Safe neighborhoods and places for children to play	Safe neighborhoods and places for children to play 1 - Less critical	Safe neighborhoods and places for children to play 2 - Somewhat critical	Safe neighborhoods and places for children to play 3 - Very critical	Safe neighborhoods and places for children to play Not Sure
Social Media	Social Media 1 - Less critical	Social Media 2 - Somewhat critical	Social Media 3 - Very critical	Social Media Not Sure
Traffic safety	Traffic safety 1 - Less critical	Traffic safety 2 - Somewhat critical	Traffic safety 3 - Very critical	Traffic safety Not Sure
Transportation challenges	Transportation challenges 1 - Less critical	Transportation challenges 2 - Somewhat critical	Transportation challenges 3 - Very critical	Transportation challenges Not Sure

Other (please specify concern and your ranking)

Thank you for your input!