12 Week Program Survey Question Title * 1. Are you a potential applicant or referral worker? (Select One) Potential Applicant Referral Worker OK Question Title * 2. Do you feel that a 12 week program would be beneficial? Yes No OK Question Title * 3. What do you feel is the increased benefit in having a 12 week program? Comment below. OK Question Title * 4. Is there a time of year that would be most convenient for a 12 week program? Spring Summer Fall Winter No preference OK Question Title * 5. What would pose the most difficulty for potential applicants to attend a 12 week program? (Please rate in order of greatest difficulty to least difficult - 1 being greatest and 5 being least) 1 2 3 4 5 Childcare and/or child/parent separation 1 2 3 4 5 Extended leave from work 1 2 3 4 5 Personal financial challenges and home responsibilities 1 2 3 4 5 Medical concerns 1 2 3 4 5 Physical, emotional, spiritual, and mental stamina to complete 12 weeks OK Question Title * 6. Please list any reasons (other than those listed above) that would make it difficult to attend a 12 week program: OK Question Title * 7. What components of the program do you feel would benefit from an increased focus? From the list below, rank the following in order from 1 to 13 (where 1 is the most important to you and 13 is the least important to you). 1 2 3 4 5 6 7 8 9 10 11 12 13 Cultural Teachings (dress, drum, rattle, ceremony, and sweats) 1 2 3 4 5 6 7 8 9 10 11 12 13 Sexual Abuse 1 2 3 4 5 6 7 8 9 10 11 12 13 Lateral Violence 1 2 3 4 5 6 7 8 9 10 11 12 13 More Group Work 1 2 3 4 5 6 7 8 9 10 11 12 13 Separate Men's and Women's Groups 1 2 3 4 5 6 7 8 9 10 11 12 13 Anger 1 2 3 4 5 6 7 8 9 10 11 12 13 Shame 1 2 3 4 5 6 7 8 9 10 11 12 13 Aftercare Planning - Transitioning back to community 1 2 3 4 5 6 7 8 9 10 11 12 13 Sexual Health 1 2 3 4 5 6 7 8 9 10 11 12 13 Preparation For Going Home - Family dynamics 1 2 3 4 5 6 7 8 9 10 11 12 13 Grief and Loss 1 2 3 4 5 6 7 8 9 10 11 12 13 Relationships - Coupleships 1 2 3 4 5 6 7 8 9 10 11 12 13 Relapse Prevention - Reducing potential risk for relapse OK DONE