Thank you for taking the time to complete this survey. We are looking to our neighbors to see what is needed in our community. Your anonymity is important to us - there are no ways to identify your answers. Please answer as best you can and tell us about your own experience.

To ensure we have a strong voice behind our findings, we welcome you to forward this on to family, friends or anyone in your network.

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* 1. What neighborhood do you live in?

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* 2. What County do you live in?

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* 3. How would you describe yourself? (please check all that apply)

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* 4. What is your gender?

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* 5. What is your age?

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* 6. Which of the following are you experiencing (or did you experience) during COVID-19 (coronavirus)? (check all that apply)

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* 7. In the past 30 days, how personally impacted were you by the following:

  To a Great Extent Somewhat Very Little Not at All
Coronavirus (Covid-19)
Protests
Riots
Vandalism
Looting
Racism/Racial Injustice
Policing
Curfews
Gun Violence
Opioid Epidemic
School Closures
Gang Activity
Altered or limited access to support systems (family, friends, places of worship, etc.)
Altered or limited ability to mark life events (weddings, graduations, births, funerals, etc.)
Altered or limited routine care (medical, dental, childcare, etc.)
Paying bills (rent, mortgage, utilities, etc.)
Employment status
Drug or alcohol misuse
Altered or limited access to basic daily necessities (food, household essentials, baby supplies, etc.)

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* 8. In the past 30 days, how do you feel your community has coped or dealt with the following:

  Very Good Good Acceptable Poor Very Poor
Coronavirus (Covid-19)
Protests
Riots
Vandalism
Looting
Racism/Racial Injustice
Policing
Curfews
Gun Violence
Opioid Epidemic
School Closures
Gang Activity
Altered or limited access to support systems (family, friends, places of worship, etc.)
Altered or limited ability to mark life events (weddings, graduations, births, funerals, etc.)
Altered or limited routine care (medical, dental, childcare, etc.)
Paying bills (rent, mortgage, utilities, etc.)
Employment status
Drug or alcohol misuse
Altered or limited access to basic daily necessities (food, household essentials, baby supplies, etc.)

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* 9. Do you feel you feel you have an adequate understanding of trauma?

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* 10. What services or programs do you need? (check all that apply)

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* 11. Are you an essential worker?      
Essential workers are exempt from stay at home and shelter in place orders, and must report to their place of work. Essential workers include but are not limited to those working in public health/health care, law enforcement, public safety, first responders, food and agriculture, energy and electricity, petroleum, water and wastewater, transportation, public works, communications and IT, and others.

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* 12. What are you doing/did you do during the COVID-19 pandemic? (Check all that apply)

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* 13. How much is/did the COVID-19 pandemic impact your day-to-day life?

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* 14. Which of the following has had the biggest impact on your access to food in the past month?

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* 15. In the past month, because of the COVID-19 pandemic, I have:
(Check all that apply)

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* 16. Have you been tested for COVID-19?  Check all that apply.

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* 17. Over the last 2 weeks, how often have you been bothered by the following problems?

  Not at All Several Days Over Half the Days Nearly All the Days
Feeling nervous, anxious, or on edge 
Not being able to stop or control worrying 
Worrying too much about different things 
Trouble relaxing 
Being so restless that it's hard to sit still 
Being easily annoyed or irritable 
Feeling afraid as if something awful might happen

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* 18. Please indicate the extent to which you agree with each of the following statements.

  Strongly Disagree Disagree Neutral Agree Strongly Agree
I tend to bounce back quickly after hard times 
I have a hard time making it through stressful events 
It does not take me long to recover from a stressful event 
It is hard for me to snap back when something bad happens 
I usually come through difficult times with little trouble 
I tend to take a long time to get over set-backs in my life 

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* 19. How much has the COVID-19 pandemic interrupted the care you receive from others (e.g., counselor, therapist, support groups) for mental health?

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* 20. When was your most recent visit to a doctor, nurse, or other health care provider? Includes telemedicine and remote visits.

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* 21. Are you currently receiving treatment for substance use, including alcohol?

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* 22. Are you currently participating in a 12-step program like AA, NA, CA?

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* 23. Has your program had any cancellations of meetings or service due to the COVID-19 pandemic in the past month?

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* 24. Did your program offer you any alternatives to meetings like phone calls or internet support in the past month? (For example, Zoom calls)

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* 25. Are you on methadone or other medications for treatment of opioid use disorder (heroin, fentanyl, etc)?

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* 26. Has the clinic or service-provider from which you receive your methadone or other opioid use disorder medication had an interruption of services in the past month due to the COVID-19 pandemic?

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* 27. Are you currently receiving telemedicine visits from your methodone/suboxone/buprenorphine provider?

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* 28. In the past month, how much has the COVID-19 pandemic interrupted the care you receive from others (e.g., counselor, therapist, support groups) for substance use addiction (e.g., alcohol, tobacco, cocaine)?

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