Mental Health and Addictions Program Client Experience Survey 2018-2019

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* 1. Please tell us who is completing this survey by choosing one of the following options.

Client

Parent/Guardian

Caregiver

Spouse/Partner

Escort

Other (please specify)

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* 2. How long did it take you to get an appointment with the program?

Less than a day

1 - 7 days

1 - 2 weeks

More than 2 weeks

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* 3. How long have you been receiving care with this program?

Less than 1 week

1 - 4 weeks

1 - 3 months

4 - 12 months

1 - 5 years

Over 5 years

I don't know

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* 4. Please identify which of the following community services you are aware of (check all that apply).

Mental Health and Addictions Program hours of operation

Emergency Department

24 Hour Crisis Response

Kids Help Phone

Prenatal Program

Wellness and Recovery Centre

Northwestern Health Unit Needle Exchange

Out of the Cold Shelter

Nursing Station services in your home community

Other (please specify)

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* 5. What supports do you have in your community (check all that apply)?

Parents/children/siblngs

Spouse/romantic partner

Friends

Social workers/other social service workers

None

I don't know

Other (please specify)

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* 6. The following questions are about your experiences around the program or service:

	Always	Usually	Sometimes	Never
Are you kept waiting a long time when you have appointments?	Are you kept waiting a long time when you have appointments? Always	Are you kept waiting a long time when you have appointments? Usually	Are you kept waiting a long time when you have appointments? Sometimes	Are you kept waiting a long time when you have appointments? Never
How often is the area where you receive services clean?	How often is the area where you receive services clean? Always	How often is the area where you receive services clean? Usually	How often is the area where you receive services clean? Sometimes	How often is the area where you receive services clean? Never
How often are the common areas (hallway, lobby, etc.) clean?	How often are the common areas (hallway, lobby, etc.) clean? Always	How often are the common areas (hallway, lobby, etc.) clean? Usually	How often are the common areas (hallway, lobby, etc.) clean? Sometimes	How often are the common areas (hallway, lobby, etc.) clean? Never
Do you feel safe when you are here?	Do you feel safe when you are here? Always	Do you feel safe when you are here? Usually	Do you feel safe when you are here? Sometimes	Do you feel safe when you are here? Never
Are you given enough privacy when discussing your issues or treatment with staff?	Are you given enough privacy when discussing your issues or treatment with staff? Always	Are you given enough privacy when discussing your issues or treatment with staff? Usually	Are you given enough privacy when discussing your issues or treatment with staff? Sometimes	Are you given enough privacy when discussing your issues or treatment with staff? Never

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* 7. Do you feel that you have been treated unfairly for any of the following reasons?

Age

Sex/gender

Race/ethic background

Spiritual/religious beliefs

Sexual orientation

Language

Financial situation

A disability you have

I was not treated unfairly

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* 8. Apart from talking to your nurse, doctor or treatment team, do you know how to make a complaint at this hospital?

Yes

If yes, to whom would you make a complaint?

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* 9. Please answer the following questions about your experience with the Mental Health and Addictions Program staff:

	Always	Usually	Sometimes	Never
Do staff return your phone calls within a reasonable amount of time?	Do staff return your phone calls within a reasonable amount of time? Always	Do staff return your phone calls within a reasonable amount of time? Usually	Do staff return your phone calls within a reasonable amount of time? Sometimes	Do staff return your phone calls within a reasonable amount of time? Never
Did the staff introduce themselves to you?	Did the staff introduce themselves to you? Always	Did the staff introduce themselves to you? Usually	Did the staff introduce themselves to you? Sometimes	Did the staff introduce themselves to you? Never
Did the staff explain their role before they offered care?	Did the staff explain their role before they offered care? Always	Did the staff explain their role before they offered care? Usually	Did the staff explain their role before they offered care? Sometimes	Did the staff explain their role before they offered care? Never
Are you involved as much as you want in decisions about your treatment?	Are you involved as much as you want in decisions about your treatment? Always	Are you involved as much as you want in decisions about your treatment? Usually	Are you involved as much as you want in decisions about your treatment? Sometimes	Are you involved as much as you want in decisions about your treatment? Never
Were your individual needs, preferences, and cultural values respected in your treatment?	Were your individual needs, preferences, and cultural values respected in your treatment? Always	Were your individual needs, preferences, and cultural values respected in your treatment? Usually	Were your individual needs, preferences, and cultural values respected in your treatment? Sometimes	Were your individual needs, preferences, and cultural values respected in your treatment? Never
Do you feel that you are treated with courtesy and respect by Mental Health and Addictions staff?	Do you feel that you are treated with courtesy and respect by Mental Health and Addictions staff? Always	Do you feel that you are treated with courtesy and respect by Mental Health and Addictions staff? Usually	Do you feel that you are treated with courtesy and respect by Mental Health and Addictions staff? Sometimes	Do you feel that you are treated with courtesy and respect by Mental Health and Addictions staff? Never
Do you feel that staff support your improvement and recovery?	Do you feel that staff support your improvement and recovery? Always	Do you feel that staff support your improvement and recovery? Usually	Do you feel that staff support your improvement and recovery? Sometimes	Do you feel that staff support your improvement and recovery? Never
Do staff tell you about other services and supports available in the community?	Do staff tell you about other services and supports available in the community? Always	Do staff tell you about other services and supports available in the community? Usually	Do staff tell you about other services and supports available in the community? Sometimes	Do staff tell you about other services and supports available in the community? Never
Do you feel that enough care is taken of any physical health problems you have (diabetes, weight gain, heart disease)?	Do you feel that enough care is taken of any physical health problems you have (diabetes, weight gain, heart disease)? Always	Do you feel that enough care is taken of any physical health problems you have (diabetes, weight gain, heart disease)? Usually	Do you feel that enough care is taken of any physical health problems you have (diabetes, weight gain, heart disease)? Sometimes	Do you feel that enough care is taken of any physical health problems you have (diabetes, weight gain, heart disease)? Never

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* 10. Please answer the following questions about your experience with the Mental Health and Addictions Program:

	Definitely	For the most part	Somewhat	Not at all	I don't know/Not applicable
Do you understand your care plan?	Do you understand your care plan? Definitely	Do you understand your care plan? For the most part	Do you understand your care plan? Somewhat	Do you understand your care plan? Not at all	Do you understand your care plan? I don't know/Not applicable
Do staff clearly explain the purpose of medication?	Do staff clearly explain the purpose of medication? Definitely	Do staff clearly explain the purpose of medication? For the most part	Do staff clearly explain the purpose of medication? Somewhat	Do staff clearly explain the purpose of medication? Not at all	Do staff clearly explain the purpose of medication? I don't know/Not applicable
Do staff clearly explain possible medication side effects?	Do staff clearly explain possible medication side effects? Definitely	Do staff clearly explain possible medication side effects? For the most part	Do staff clearly explain possible medication side effects? Somewhat	Do staff clearly explain possible medication side effects? Not at all	Do staff clearly explain possible medication side effects? I don't know/Not applicable
Do you feel that you can refuse treatment (for example, medications)?	Do you feel that you can refuse treatment (for example, medications)? Definitely	Do you feel that you can refuse treatment (for example, medications)? For the most part	Do you feel that you can refuse treatment (for example, medications)? Somewhat	Do you feel that you can refuse treatment (for example, medications)? Not at all	Do you feel that you can refuse treatment (for example, medications)? I don't know/Not applicable
As a result of your care with this program, do you feel better prepared to deal with daily problems?	As a result of your care with this program, do you feel better prepared to deal with daily problems? Definitely	As a result of your care with this program, do you feel better prepared to deal with daily problems? For the most part	As a result of your care with this program, do you feel better prepared to deal with daily problems? Somewhat	As a result of your care with this program, do you feel better prepared to deal with daily problems? Not at all	As a result of your care with this program, do you feel better prepared to deal with daily problems? I don't know/Not applicable
As a result of your care with this program or service, do you feel more ready to accomplish the things you want to do?	As a result of your care with this program or service, do you feel more ready to accomplish the things you want to do? Definitely	As a result of your care with this program or service, do you feel more ready to accomplish the things you want to do? For the most part	As a result of your care with this program or service, do you feel more ready to accomplish the things you want to do? Somewhat	As a result of your care with this program or service, do you feel more ready to accomplish the things you want to do? Not at all	As a result of your care with this program or service, do you feel more ready to accomplish the things you want to do? I don't know/Not applicable
Overall, are you being helped by your care with this program or service?	Overall, are you being helped by your care with this program or service? Definitely	Overall, are you being helped by your care with this program or service? For the most part	Overall, are you being helped by your care with this program or service? Somewhat	Overall, are you being helped by your care with this program or service? Not at all	Overall, are you being helped by your care with this program or service? I don't know/Not applicable

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* 11. What is your sex/gender?

Male

Female

Transsexual/Transgender

I identify as

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* 12. What is your age?

0 - 11 Years

12 - 18 years

19 - 24 years

25 - 44 years

45 to 64 years

65 years or older

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* 13. If you needed treatment again, would you choose to come back to this program or service?

Definitely

Probably

Maybe

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* 14. Would you recommend the Mental Health and Addictions Program of the Sioux Lookout Meno Ya Win Health Centre to friends and family?

Definitely Yes

Probably Yes

Probably No

Definitely No

Unsure

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* 15. Using any number from 1 - 10, where 1 is the WORST health centre possible, and 10 is the BEST health centre possible, how would you rate the program?

1 - WORST

10- BEST

1 - WORST

10- BEST

Mental Health and Addictions Program Client Experience Survey 2018-2019

Question Title

* 1. Please tell us who is completing this survey by choosing one of the following options.

Question Title

* 2. How long did it take you to get an appointment with the program?

Question Title

* 3. How long have you been receiving care with this program?

Question Title

* 4. Please identify which of the following community services you are aware of (check all that apply).

Question Title

* 5. What supports do you have in your community (check all that apply)?

Question Title

* 6. The following questions are about your experiences around the program or service:

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* 7. Do you feel that you have been treated unfairly for any of the following reasons?

Question Title

* 8. Apart from talking to your nurse, doctor or treatment team, do you know how to make a complaint at this hospital?

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* 9. Please answer the following questions about your experience with the Mental Health and Addictions Program staff:

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* 10. Please answer the following questions about your experience with the Mental Health and Addictions Program:

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* 11. What is your sex/gender?

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* 12. What is your age?

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* 13. If you needed treatment again, would you choose to come back to this program or service?

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* 14. Would you recommend the Mental Health and Addictions Program of the Sioux Lookout Meno Ya Win Health Centre to friends and family?

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* 15. Using any number from 1 - 10, where 1 is the WORST health centre possible, and 10 is the BEST health centre possible, how would you rate the program?

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* 16. What would have made your experience with this program or service better?

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* 17. What has been a positive part of your experience with this program or service?