Exit Women’s Recovery Network Outreach Survey Write a description of your survey here. Select any question below to change it. Then add questions as needed. Question Title * 1. What is your current age? 18-29 30-39 40-49 50-59 60+ Question Title * 2. What is your ethnicity? White Black or African American Hispanic or Latino Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Other (please specify) Question Title * 3. What is your drug of choice? Alcohol Opiates (Heroin, Fentanyl, Oxycodone) Benzodiazepines (Ativan, Valium, Xanax) Stimulants (Cocaine, Methamphetamines, Adderall) Marijuana Other (please specify) Question Title * 4. At what facility did you last receive treatment? Gosnold Behavioral Health Recovering Champions Foundations Group Recovery Center Duffy Health Center I have never been to an inpatient treatment center Other (please specify) Question Title * 5. Are you currently in a 12 step program (AA/NA)? Yes No Question Title * 6. In what area of Cape Cod do you reside? Upper Cape (Bourne, Falmouth, Mashpee, Sandwich) Mid Cape (Barnstable, Brewster, Dennis, Harwich, Hyannis, Yarmouth) Lower Cape (Chatham, Eastham, Orleans, Provincetown, Wellfleet) Other (please specify) Question Title * 7. What is your current housing situation? Sober Living Year Round Rental Seasonal Rental Own Home Live with family or friends Homeless Other (please specify) Question Title * 8. What is your current employment situation? Part time Full time Part time (seasonal) Full time (seasonal) Unemployed/looking for work Unemployed/ disability Question Title * 9. Is transportation an issue for you receiving help? Yes No Question Title * 10. What type of insurance do you have? Federal Medicare/Medicaid Private insurance I don’t know I don’t have insurance Question Title * 11. Do you have a Primary Care Physician on Cape Cod? Yes No No, but looking for a PCP Question Title * 12. Do you have a mental or behavioral therapist on Cape Cod? Yes No No, but looking to establish with a therapist Question Title * 13. If you answered “yes” to Question 12, how often do you see your therapist? Weekly Bi-Weekly Monthly I don’t have a therapist Other (please specify) Question Title * 14. Do you suffer from any of the following mental health issues? (Check all that apply) Anxiety Depression PTSD Bipolar Disorder Social Isolation Eating Disorders Suicidal thoughts or behaviors None of the above Question Title * 15. Have you experienced sexual assault or related trauma? Yes No Question Title * 16. Have you experienced physical or emotional abuse? Yes No Question Title * 17. Would you be interested in all women’s group therapy sessions? Yes No Question Title * 18. In the last year, have you used the ER for an anxiety or depression related issue? Yes No Question Title * 19. Have any of the following issues interfered with you receiving healthcare over the last year? (Check all that apply) Childcare Transportation Lack of information or resources Insurance coverage Cost of care/ services Access to primary care physician Lack of weekend or weeknight hours Other (please specify) None of the above Question Title * 20. Has RWW holistic healing practices(acupuncture, meditation, yoga, breath work etc) worked to support your physical and mental health? Yes No No, but interested in accessing information and resources about these practices through an all women’s recovery network Question Title * 21. Which areas would you like to have more assistance with? (Check all that apply) Employment Housing Child Care Legal Issues DCF, custody issues, or child support assistance Continuing Education Establishing Healthcare Trauma Related Therapy Other (please specify) Question Title * 22. Are you a MEMBER of the following places? (Check all that apply) Recovery Without Walls Pier Recovery Hyannis Falmouth Recovery Center The Pause - Brewster Planet Fitness Wellstrong Duffy Health Center Parents Supporting Parents WIC WE CAN B free First Steps Together Calmer Choice The Baby Center None of the above Done