Pawnee Nation Prevention and Recovery Services Rural Opioid Response Planning

The purpose of this survey is to gather a better understanding of the communities needs and barriers surrounding the issues of substance misuse, behavioral, and mental health so that we may outline, design and implement resources to overcome them.
This [project/publication/program/website] [is/was] supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $XX with xx percentage financed with nongovernmental sources.  The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.

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* 1. If a treatment facility for substance abuse/mental health were developed locally or nearby, what would you like to see (select all that apply)?

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* 2. What concerns would you have if a substance abuse/ mental health facility were built locally or nearby?

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* 3. How knowledgeable are you about mental health-related issues?

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* 4. How knowledgeable are you about the opioid epidemic?

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* 5. Have you ever used drugs?

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* 6. If you answered “yes” please answer the following, I have used drugs for?

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* 7. Have you or anyone close to you received treatment for substance abuse or mental health?

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* 8. If so, where was treatment received?

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* 9. Was treatment received in-patient or out-patient services?

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* 10. If you or anyone close to you wanted to or needed to attend a treatment facility but have been unable to do so; what has been the barrier(s)?

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* 11. Which of these factors do you believe lead towards legal/illegal drug misuse (select all that apply)?

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* 12. What is your age?

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* 13. What is your gender?

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* 14. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 15. Please describe your race/ethnicity.

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* 17. Contact Information

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