Fall 2016

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Dear Faith-Leader or Designee;

Thank you for your participation in our Congregational Needs Assessment. This survey is designed to help assess the needs of the faith-based community and help Allegany County's new Health Ministries Network start to connect programs and resources to those who could benefit from them.

As the Network's convening organization, Ardent Solutions is familiar with resources in our community and is able to respond to the needs and concerns that most affect our populations. Connecting with faith-based leaders across Allegany County and our neighboring communities in Cattaraugus and Steuben Counties, we hope to support you in your work through the Health Ministries Network.

Ardent recognizes the positive link between faith-based groups and our community and wants to build on the strengths of both.  With a focus on disease prevention, wellness, and health promotion our hope is to encourage beneficial partnerships, strengthen relationships and aid the community in healing the body, mind, and spirit.

Please take a few moments to help us understand what your needs might be.  This survey should take no more than 10 minutes of your time.  Thank you!

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* 1. Thinking about those in your congregation, please indicate the top five (5) health priorities that are a concern or problem for the people that you serve.

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* 2. Thinking about your congregation, please prioritize the top five (5) concerns or barriers that individuals and families face in relation to their personal health and wellness.

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* 3. In your ministry, do you talk about any of the following from a faith-based perspective? Please check all that apply.

  Bible Study Class Sunday School Vacation Bible School Sermons or Worship Service Church Newsletter/Bulletin Youth Club Outreach and Recreational Events
Physical Health
Emotional /Mental health
Social / Recreational Health
Medical Care Issues

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* 4. Within your ministry, would there be interest in learning more and taking some active steps to improve health at the following levels?  Please check all that apply.

  Very interested Somewhat interested Not interested
Individual Health Issues (one-on-one or small group programs based on a specific health issue)
Family Health issues (services for families to be safe, healthier and stronger)
Congregational/Ministry Health (general services that can positively impact all members of the congregation)

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* 5. What are health related activities that you feel would benefit your congregation?  Would there be interest in any of these activities?

  Interested Now Interested for the Future Currently have Program within Ministry Would Like Further Information
Physical Activity Program(s)
Smoking Cessation Program
Stress Management Workshop(s)
National Diabetes Prevention Program
Addiction Services
Health Information Fair
Preventative Health Screening Services (Blood Pressure, Diabetes, etc.)
Financial Wellness Workshops
First Aid/CPR/AED Certification Training
Access to Food Program(s)
Chronic Disease Self-Management Program
Chronic Pain Self-Management Program
Diabetes Self-Management Program
Walk with Ease Arthritis Program
A Matter of Balance: Managing Concerns About Falls
Growing Stronger Strength Training Program for Older Adults
SafeTalk Suicide Awareness Training
Eat Healthy, Be Active Program
Child Passenger Safety Seat Event
CarFit Educational Event
Letting Go! Older Adult Depression Program
Powerful Tools for Caregivers Program

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* 6. If you indicated that you currently have a health related activity within your ministry, would you please indicate what that is and provide a brief overview of what it entails?

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* 7. Are there health related supports that you feel would benefit your congregation?

  Interested now Interested for the future Currently have program Interested in Learning More
Alcohol / Substance Abuse Support Group
Support for Persons with Mental Illness
Health Education Services (one-on-one, small group, or large group)
Pregnancy Counseling and Supports
Depression / Anxiety Support Group
Volunteer Transportation Services
Caregiver Support
Family/Individual Trauma Support
Adult Literacy/GED Services
Alzheimer's and Dementia Support
End-of-Life Decision Making Supports
Early Childhood Development Support
Child Passenger Safety Seat Distribution Program
"Cribs for Kids" Safe Sleep Environment Distribution Program
Nutrition Counseling
Healthy Food Distribution Program
Suicide Prevention and Suicide Loss Support
Health Insurance Facilitated Enrollment Support

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* 8. If you indicated that you currently have a health related support(s) within your ministry, would you please indicate what that is and provide a brief overview of what it entails?

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* 9. Do you have any additional areas of concern or interest? (Please explain)

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* 10. Please indicate the population(s) you primarily work with (please check all that apply):

  Never Occasionally Frequently Most of the time
Children
Teens
Families
Older Adults
Single Adults
Couples

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* 11. What time(s) work well for activities / programs (please check all that apply):

  Morning Afternoon Evening
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday

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* 12. Is there a preferred time of year for programs?

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* 13. Please indicate your church's availability to host health ministry related functions and events.

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* 14. Please indicate educational topics and training that would benefit local faith-leaders in their roles and responsibilities.

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* 15. Please indicate your level of interest in participating in the Allegany County Health Ministries Network.

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* 16. Faith-Leader Contact Information (Required)

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* 17. Health Ministries Network Designee Information (a member of the congregation assigned to work with the Health Ministries Network if Faith-Leader so chooses)

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