DMHA CLC Webinar 3 Survey

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* 1. Please enter your information

First Name

Last Name

Email Address

Organization

Job Title

County

Part 1: Evaluation survey

Please rate your level of agreement with each statement.

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* 2. Overall this video was a good use of my time.

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* 3. I can define historical trauma.

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* 4. I can define intergenerational trauma.

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* 5. I understand that cultures who have experienced historical trauma will continue to experience intergenerational trauma 2-3 generations later due to the prolonged stages of grief and developing detrimental coping skills and defense mechanisms that are passed down through direct parent-child interactions.

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* 6. I would recommend this webinar to my colleagues.

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* 7. Please choose the group you represent:

Community Mental Health Center

System of Care

Treatment Provider

Recovery Community

Indiana State Agency

Other

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* 8. In the group selected above, I have_____years of experience in my current or multiple roles.

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* 9. Does your patient population include Indigenous people?

Yes

I don't know

N/A, my organization does not provide clinical services or direct community services.

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* 10. What Indiana county(ies) do you represent?

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* 11. Additional Comments/Feedback/Questions:

Part 2: Additional Learning Opportunities

The following survey seeks your feedback on additional learning opportunities through the Indiana facilitation of Wellbriety in two upcoming virtual training opportunities and the final book selection and logistics for Book Club.

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* 12. As discussed in the video, Executive Director Carolina Castoreno of the American Indian Center is offering two upcoming training opportunities on components of the Wellbriety model in December and January. These opportunities are funded through support from DMHA.

One of these trainings is the Warrior Down/Recovery Coach, on Dec 8-11 from 9-4pm EST; this program provides a relapse prevention and recovery support program to Native Americans who are completing treatment, returning to the community from incarceration, or who have been working on their recovery journey using traditional method of 12 Step and who wish to provide support to others experiencing the same issues.

In consideration of the Warrior Down/Recovery Coach training option, please select the statement that best fits you.

Please provide an additional comments or contact information for recommended training participants.

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* 13. As discussed in the video, Executive Director Carolina Castoreno of the American Indian Center is offering two upcoming training opportunities on components of the Wellbriety model in December and January. These opportunities are funded through support from DMHA.

The second of these trainings is the Medicine Wheel & 12 Steps for Men & Women on January 12-15 from 9-4pm EST; this program trains facilitators to implement this video based curriculum in their communities. The Medicine Wheel & 12 Steps program was developed to provide a culturally appropriate 12 Step program for Native American People. This Program was developed by White Bison, Inc. based on the teachings of Medicine Wheel, Cycle of Life and the Four Laws of Change.

In consideration of the Medicine Wheel & 12 Steps for Men & Women training option, please select the statement that best fits you.

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* 14. The results of the Oct 15th survey for book club:
1. Chosen Book: White Fragility: Why It's So Hard for White People to Talk About Racism, by Robin DiAngelo
2. Chosen Format: three 1-hour virtual sessions in Jan, Feb and March
3. Chosen content delivery: we will offer all three options - ebook license, paperback book pick-up at DMHA office, and shipped to address of reader's choice with reader paying for shipment.

Please officially sign-up for the book club by identifying your chosen content delivery method below.

As an e-book - DMHA purchases the e-book license and emails to me.

As a paper back book - DMHA purchases the book and I pick-up at DMHA offices. Dates and times will be shared with those that select this option via email.

As a paper back book - DMHA purchases the book and I pay for shipment to an address of my choice. Shipping cost payment link and shipping tracking information will be shared with those that select this option via email.

I am not participating in book club.

If selecting "paperback shipped to address of your choice", please provide your full mailing address. You will receive an email confirmation when shipped.