Center for Life Resources Needs Assessment for Individuals Receiving Services
We want to hear from you.
*
1.
In what county do you current live?
(Required.)
Brown
Coleman
Comanche
Eastland
Gillespie
Kendal
Kerr
Kimble
Mason
McCulloch
Menard
Mills
San Saba
2.
What is your age?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
3.
What is your birth gender?
Female
Male
4.
What is the highest level of school that you completed or highest degree received?
No schooling completed
Grade K-4
Grade 5-8
Grade 9-12 no diploma
High School Diploma
GED
Trade school
Associate's degree
Bachelor's Degree
Master's Degree
Doctorate's Degree
5.
If you are age 16 and over, what is your current employment situation?
Self-Employed
Employed Full-time
Employed Part-time
Stay at home spouse/parent
Disabled and not able to work
Retired
6.
Are you presently or have you been in the US Armed Forces?
Yes
No, skip to question 9
7.
Select your current status.
Active
Reserve
National Guard
Honorable Discharge
Discharge or release under conditions other than dishonorable
Dishonorable Discharge
8.
In which branch of the US Armed Forces did or are you servicing?
Army
Marine Corp
Navy
Airforce
Space Force
Coast Guard
9.
How did you hear about the services offered by Center for Life Resources (CFLR)?
Family/Friend
Community Event
Radio
Church
Primary Care Provider
Law Enforcement
Judicial System
School
FaceBook
Instagram
cflr.us website
10.
Please select all the services you receive from Center for Life Resources.
Autism Services
Early Childhood Intervention Services (case management, PT/OT/SLT)
Case Management/Service Coordination
Skills Training/psychosocial rehab
Counseling
Outpatient Substance Use Treatment
Crisis Services
Crisis Respite Services
ICF
Texas Home Living or HCS services
Psychiatric Medications and Monitoring
Supported Employment
Supported Housing
Assertive Community Treatment
Family Partner/Peer Services
Veterans Services
JCI Services ( Apprenticeship, ISS, etc.)
11.
How do you most often receive these services?
Face to Face in person
Video appointment
Phone appointment ( audio only no video)
12.
Please rate your satisfaction with the services you receive.
Not Satisfied
Sometimes Satisfied
Mostly Satisfied
Satisfied
Not Satisfied
Sometimes Satisfied
Mostly Satisfied
Satisfied
13.
To what extend would you agree with the following statements?
Yes
No
Sometimes
I was involved in planning my care.
Yes
No
Sometimes
Staff spent enough time with me.
Yes
No
Sometimes
What I had to say was respected.
Yes
No
Sometimes
I was listened to carefully.
Yes
No
Sometimes
Things were explained to me in a way that i could understand.
Yes
No
Sometimes
14.
Overall, were the services you received convenient and accessible for you?
Yes
No
15.
Please identify the main 3 reasons the services were not convenient or accessible for you.
I didn't have tranportation.
Service not offered at a good time for me.
Service not offered on a good day for me.
I can't afford internet service for telehealth service.
My internet service is too slow for telehealth service.
My cell phone service is poor and spotty.
I didn't have any cell phone minutes.
I didn't receive appointment reminders
I am homeless.
16.
Would you recommend service at CFLR to a family or friend
Yes
No
Please add any comments.
17.
How could CFLR more effectively serve you?
Send me appointment reminders.
Increase staffing so that I have the time I need.
Increasing counseling staff so that I can receive that service.
Help me get set up int the patient portal for reminders.
Make appointments available before 8 am and after 5 pm.
Other (please specify)
18.
Which language do prefer to speak and for services to be provided?
English
Spanish
German
Korean
French
Vietnamese
Chinese
Tagalog
Hindu
Arabic
Russian//Polish/ or other Slavic language
Other Indo-European language
Other Asian and Pacific Island language
Other (please specify)
19.
Were the service provided in the language you prefer?
Yes
No
20.
Do you know how to file a complaint if you are not satisfied with services?
Yes
No
21.
How did you learn how to file a complaint? Select all that apply
My Rights Handbook.
Center staff told me.
I saw it on the bulletin board.
I saw it on the CFLR website.
22.
If you wish to be in a drawing for a backpack style cooler, please leave your full name and a working phone number so that if you are randomly selected we can contact you when our survey closes in March of 2025.
