Youth survey

MACMH is collaborating with NAMI Minnesota to get input on the children's mental health system from families and youth. This information will be used to improve the children's mental health system through things like legislative change and service development.
NOTE: The information will be presented as group data to protect any identifying information you might include in this survey.

* 1. What is your age?

* 2. What county do you live in?

* 3. Please specify your race (you may select more than one)

* 4. Please indicate your specific ethnicity and/or tribal affiliation (ex. Somali, Hmong, Chinese, etc.)

* 5. How long have you been receiving mental health services or treatment?

* 6. What is your diagnosis? (select all that apply)

* 7. What type of classroom/school are you in?

* 8. Indicate which special services you receive at school:

* 9. What has made it difficult for you to get help? (Select all that apply)

* 10. Please provide feedback about your experiences with the below services:

  I HAVE received this service I have NOT needed this service I needed this service and COULDN'T get it I am not aware of this service
Individual therapy (weekly, bi-weekly, or monthly appointment with a therapist)
School-linked mental health services (therapy at school with a licensed therapist, NOT the school counselor)
Psychiatry/medication management 
Behavioral health home (specific service provided by an agency that communicates/coordinates with your providers)
In-home therapy/skills building (CTSS)
Personal Care Assistance (PCA)
Respite care 
Mental health case management
Mobile crisis/stabilization
Intensive outpatient services (therapy multiple times/week, individually or in a group 1-2 hours/session)
Day treatment (group setting, 2-3 hours/session, 2-5 days/week)
CADI waiver (Community Access for Disability Inclusion, financial support through the county)
DD waiver (Developmental Disabilities waiver, financial support through the county)
Youth ACT
Hospital in-reach service coordination (specific service provided by hospitals after discharge)
Partial hospitalization (full day services everyday)
Residential treatment
Therapeutic foster care
PRTF (Psychiatric Residential Treatment Facility)
Inpatient hospitalization

* 11. If you could create a new service what would it look like?

* 12. Describe 1-3 changes you would like to see in the children's mental health system

* 14. Please complete the table below based on the service you selected in question 13:

  Strongly agree Somewhat agree Disagree Strongly disagree
My treatment was individualized for my needs
My treatment was provided in a setting in which I was comfortable
My provider involved me in creating my treatment plan
My provider asked me about my treatment goals
My provider asked about my family’s culture
My treatment was in line with my culture and beliefs
My provider used language that I understood
My provider communicated/worked with the other provider’s on my team
My provider talked about wellness during my treatment/services (i.e. physical activity, meditation, healthy food, etc.)
My provider talked about/included my natural supports (friends, parents, community members, etc.)

* 15. Are you willing to talk with us further? If so, please enter your information below

* 16. Is there anything you would like to add?