DMHA CLC Webinar 1 Survey

Question Title

* 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.

Question Title

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

Question Title

* 3. I understand definitions on race & racism.

Question Title

* 4. I understand definitions on class & classism.

Question Title

* 5. I understand the impact of internalization.

Question Title

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

Question Title

* 7. Please choose the group you represent:

Community Mental Health Center

System of Care

Recovery Provider

Other

Question Title

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

Question Title

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

Question Title

* 10. Additional Comments/Feedback/Questions:

Part 2: Personal bias assessment

Please rate your level of agreement with each statement.

Question Title

* 11. I respect other cultures that differ from my own.

Question Title

* 12. I impose my personal beliefs on other people.

Question Title

* 13. I respect non-traditional family structures (e.g., divorced parents, same-gender parents, foster/adoptive parents, extended family, and grandparents as caregivers).

Question Title

* 14. I accept people who are LGBTQ.

Question Title

* 15. I say something when someone makes harmful or insensitive comments about other people.

Question Title

* 16. I make insensitive comments or engage in insensitive behaviors.

Question Title

* 17. I am willing to listen and grow if and when my attitudes or behaviors may--intentionally or not--cause harm to or disrespect others' identities, cultures, or beliefs.

Question Title

* 18. I respect a person’s decision to assimilate (or not assimilate) to the predominant culture of the U.S.

Question Title

* 19. Speaking languages other than English in the U.S. is acceptable.

Question Title

* 20. Roles of family members may differ within or across cultures or families.

Question Title

* 21. A person’s family members and other designees can be decision makers for services and support.

Question Title

* 22. I understand the distinction between a communication disability and a communication difference.

Question Title

* 23. There are several American English dialects and all English speakers use a dialect of English.

Question Title

* 24. Inequalities are largely systemic in origin, rather than the result of cultural flaws or differences.

Question Title

* 25. The use of a foreign accent or limited English skill is not a reflection of reduced intellectual capacity.

Question Title

* 26. The use of a foreign accent or limited English skill is not a reflection of the ability to communicate clearly and effectively in a native language.

Question Title

* 27. I understand that culture impacts the way that different people raise their children

DMHA CLC Webinar 1 Survey

Question Title

* 1. Please enter your information

Question Title

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

Question Title

* 3. I understand definitions on race & racism.

Question Title

* 4. I understand definitions on class & classism.

Question Title

* 5. I understand the impact of internalization.

Question Title

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

Question Title

* 7. Please choose the group you represent:

Question Title

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

Question Title

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

Question Title

* 10. Additional Comments/Feedback/Questions:

Question Title

* 11. I respect other cultures that differ from my own.

Question Title

* 12. I impose my personal beliefs on other people.

Question Title

* 13. I respect non-traditional family structures (e.g., divorced parents, same-gender parents, foster/adoptive parents, extended family, and grandparents as caregivers).

Question Title

* 14. I accept people who are LGBTQ.

Question Title

* 15. I say something when someone makes harmful or insensitive comments about other people.

Question Title

* 16. I make insensitive comments or engage in insensitive behaviors.

Question Title

* 17. I am willing to listen and grow if and when my attitudes or behaviors may--intentionally or not--cause harm to or disrespect others' identities, cultures, or beliefs.

Question Title

* 18. I respect a person’s decision to assimilate (or not assimilate) to the predominant culture of the U.S.

Question Title

* 19. Speaking languages other than English in the U.S. is acceptable.

Question Title

* 20. Roles of family members may differ within or across cultures or families.

Question Title

* 21. A person’s family members and other designees can be decision makers for services and support.

Question Title

* 22. I understand the distinction between a communication disability and a communication difference.

Question Title

* 23. There are several American English dialects and all English speakers use a dialect of English.

Question Title

* 24. Inequalities are largely systemic in origin, rather than the result of cultural flaws or differences.

Question Title

* 25. The use of a foreign accent or limited English skill is not a reflection of reduced intellectual capacity.

Question Title

* 26. The use of a foreign accent or limited English skill is not a reflection of the ability to communicate clearly and effectively in a native language.

Question Title

* 27. I understand that culture impacts the way that different people raise their children

Question Title

* 28. Cultural competency impacts education.

Question Title

* 29. Cultural norms impact familial roles.

Question Title

* 30. Cultural norms impact gender roles.

Question Title

* 31. Cultural competency impacts employment.

Question Title

* 32. Cultural norms impact views on wellness.

Question Title

* 33. Cultural norms impact views on disability.

Question Title

* 34. Cultural norms impact views on addiction.

Question Title

* 35. Cultural norms impact views on treatment.