1.

* 1. Setting in which you work, Please Check all that apply

* 2. I work primarily with ages (under 17), (18-24), (25-35), (36 – 60), (60 and above)

* 3. In your role, on a scale of 1-5, how problematic do you find.....(5 being strongly agree and 1 being strongly disagree)

5 Timely access to crisis intervention services (Mass Health Product or no insurance) - Inpatient
i We adjusted the number you entered based on the slider’s scale.

* 4. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Timely access to crisis intervention services (Mass Health Product or no insurace) -Outpatient
i We adjusted the number you entered based on the slider’s scale.

* 5. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Timely access to crisis intervention services (Private or commercial insurance) -Inpatient
i We adjusted the number you entered based on the slider’s scale.

* 6. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Timely access to crisis intervention services (Private or commercial insurance) -Outpatient
i We adjusted the number you entered based on the slider’s scale.

* 7. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Timely access for bed in detox
i We adjusted the number you entered based on the slider’s scale.

* 8. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Timely access for mental health services
i We adjusted the number you entered based on the slider’s scale.

* 9. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Timely access for Co-morbid conditions (mental health and substance use) services
i We adjusted the number you entered based on the slider’s scale.

* 10. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Timely access for Tri-morbid conditions (substance use/mental health and medical conditions)
i We adjusted the number you entered based on the slider’s scale.

* 11. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Timely access for co-morbid Cognitive Impairment/Developmental Disability and Mental Health Conditions
i We adjusted the number you entered based on the slider’s scale.

* 12. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Child or Adolescent CBAT or Inpatient Bed
i We adjusted the number you entered based on the slider’s scale.

* 13. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Section 35 Process
i We adjusted the number you entered based on the slider’s scale.

* 14. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Over-utilization of ER
i We adjusted the number you entered based on the slider’s scale.

* 15. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Lack of psychopharmacology services
i We adjusted the number you entered based on the slider’s scale.

* 16. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Different provider options (inter agency) when attempting to coordinate services for a client
i We adjusted the number you entered based on the slider’s scale.

* 17. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Partial Hospitalization Services
i We adjusted the number you entered based on the slider’s scale.

* 18. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Specialized, evidenced based practices:  Dialectical Behavior Therapy (DBT)
i We adjusted the number you entered based on the slider’s scale.

* 19. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Specialized, evidenced based practices:  Substance abuse treatment for adolescents
i We adjusted the number you entered based on the slider’s scale.

* 20. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Specialized, evidenced based practices:  Treatment for sexual offenders
i We adjusted the number you entered based on the slider’s scale.

* 21. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Specialized, evidenced based practices:  Treatment for people who hoard
i We adjusted the number you entered based on the slider’s scale.

* 22. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Specialized, evidenced based practices:  Treatment for Post-traumatic Stress Disorder (PTSD)
i We adjusted the number you entered based on the slider’s scale.

* 23. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Specialized, evidenced based practices: Other____________________________
i We adjusted the number you entered based on the slider’s scale.

* 24. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Specialized, evidenced based practices: Coordinating services with schools
i We adjusted the number you entered based on the slider’s scale.

* 25. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Specialized, evidenced based practices: Coordinating services with the court system
i We adjusted the number you entered based on the slider’s scale.

* 26. In your role, on a scale of 1-5, how problematic do you find... (5 being strongly agree and 1 being strongly disagree)

5 Section 12 Process
i We adjusted the number you entered based on the slider’s scale.

* 27. What else impedes the delivery of behavioral health services on Cape Cod?

* 28. Have insurance policies/practices impeded your ability to provide appropriate services to your clients? If so, how?

* 29. Please identify the areas of strategic focus you would like to see the Behavioral Health Coalition focus on:

* 30. Would you be interested in getting more involved with the Behavioral Health Coalition in any of the following way:

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