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

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

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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) 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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) 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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) 1
i We adjusted the number you entered based on the slider’s scale.

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* 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____________________________ 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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* 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 1
i We adjusted the number you entered based on the slider’s scale.

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

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

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

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

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