City of New Britain Opioid Use Disorder Prevention, Treatment and Recovery Needs Assessment

City of New Britain Opioid Stakeholder Assessment

Actionable data and community-centric services representing prevention, treatment and recovery programming are key components of reducing opioid overdose and mortality. Please answer the following ten survey questions to help New Britain Recovers identify stakeholder collaboration, data collection and direct service needs.

Question Title

* 1. Contact Information

Respondent First and Last Name

Respondent Title

Organization Name

Organization Address

Organization City/Town

Organization ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Please select the descriptions that represent your day to day work. (Please select all that apply.)

Clinician specializing in behavioral health

Clinician specializing in primary care

Clinician specializing in other specialty

First Responder - police, sheriff, fire, EMS, etc.

Local government - health department, mayor's office, etc.

Corrections - jail, community corrections, probation, etc.

Judiciary - courts, judges, prosecutor's office, etc.

Policy - legislator, policy maker, etc.

Peer Support/Advocacy Organization

Person in Recovery

Social determinants of health provider - housing, transportation, etc.

Faith-based community

Business community

Environmental Health

COVID-19 Essential Worker

Other (please specify)

Question Title

* 3. How long have you been in this position?

0-5 years

6-10 years

11-15 years

over 15 years