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Copy of Anonymous Outcomes Survey - First Step Services, LLC
1.
Which type of treatment did you receive at First Step?
Assessment Only
Substance Use
Mental Health
ADETS/Prime for Life
Assessment Only
Substance Use
Mental Health
ADETS/Prime for Life
2.
Since completing treatment at First Step, how would you rate your overall quality of life?
Very Bad
1 star
Bad
2 stars
It's OK
3 stars
Good
4 stars
Very Good
5 stars
Other (please specify)
3.
How would you best describe your current employment status?
Full Time
Part Time
Student
Laid Off
Unemployed
Full Time
Part Time
Student
Laid Off
Unemployed
Other (please specify)
4.
Since completing treatment at First Step, how often have you participated in a community mutual-help group such as AA, NA, Smart Recovery, etc?
Never
Daily
Weekly
Monthly
Occasionally
Never
Daily
Weekly
Monthly
Occasionally
5.
Do you consider yourself to be in recovery?
Yes
No
Yes
No
6.
Since completing treatment at First Step, how many times have you experienced the following due to substance use?
None
1 Time
2 Times
3 Times
Inpatient Admission
None
1 Time
2 Times
3 Times
ER/Hospital Admission
None
1 Time
2 Times
3 Times
Accidents
None
1 Time
2 Times
3 Times
Arrests/Incarcerations
None
1 Time
2 Times
3 Times
7.
Please indicate in the blanks how often in the past 3 months you have used any of the following substances:
No Use
1 - 3 x Monthly
1 - 2 x Weekly
3 - 6 x Weekly
Daily
Tobacco
No Use
1 - 3 x Monthly
1 - 2 x Weekly
3 - 6 x Weekly
Daily
Alcohol
No Use
1 - 3 x Monthly
1 - 2 x Weekly
3 - 6 x Weekly
Daily
Marijuana or Hash
No Use
1 - 3 x Monthly
1 - 2 x Weekly
3 - 6 x Weekly
Daily
Cocaine or Crack
No Use
1 - 3 x Monthly
1 - 2 x Weekly
3 - 6 x Weekly
Daily
Heroin
No Use
1 - 3 x Monthly
1 - 2 x Weekly
3 - 6 x Weekly
Daily
Hallucinogens
No Use
1 - 3 x Monthly
1 - 2 x Weekly
3 - 6 x Weekly
Daily
Benzodiazepines (non-prescribed) (Le. Valium, Xanax, Klonopin)
No Use
1 - 3 x Monthly
1 - 2 x Weekly
3 - 6 x Weekly
Daily
Opioids (non-prescribed) (i.e. Oxycodone, Hydrocodone)
No Use
1 - 3 x Monthly
1 - 2 x Weekly
3 - 6 x Weekly
Daily
Stimulants (non-prescribed) (Le. Ritalin, Adderall)
No Use
1 - 3 x Monthly
1 - 2 x Weekly
3 - 6 x Weekly
Daily
Inhalants
No Use
1 - 3 x Monthly
1 - 2 x Weekly
3 - 6 x Weekly
Daily
Methamphetamine
No Use
1 - 3 x Monthly
1 - 2 x Weekly
3 - 6 x Weekly
Daily
Kratom
No Use
1 - 3 x Monthly
1 - 2 x Weekly
3 - 6 x Weekly
Daily
Other (please specify)
8.
Which best describes your current living situation?
Independent (own home/apartment/dorm)
Living with relatives/parents
Sober living home
Residential Facility (half-way house/group home/therapeutic community)
Homeless (shelter/vehicle/place-to-place)
Hospital
Correctional Facility
Other (please specify)
9.
Overall, how helpful was the treatment experience at First Step?
Not Helpful At All
1 thumb
Not Helpful
2 thumbs
Neither Helpful or Unhelpful
3 thumbs
Helpful
4 thumbs
Very Helpful
5 thumbs
Other (please specify)
10.
Please tell us how First Step can improve its services, or if you have any additional comments that would help us to better serve.