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Client/Stakeholder Satisfaction Survey
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1.
Region you received support from?
(Required.)
Raleigh
Fayetteville
Jacksonville
Wilmington
Elizabeth City
Smithfield
Wilson
Greenville
Kinston
Goldsboro
Rocky Mount
Other (please specify)
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2.
Are you?
(Required.)
Adult Client
Child/Adolescent Client
Parent/Guardian/Family Member
External Stakeholder/Provider/Other Paid support
Other (please specify)
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3.
What Pride in North Carolina Services did you ( or your family member) receive?
(Required.)
Outpatient Therapy
Intensive in Home services (IIH)
Community Support Team
Medication Management-Psychiatric services
PSR
School Based Therapy
High Fidelity Wraparound
Intensive Home Therapy Services (IHTS)
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4.
Overall I am satisfied with the quality of services provided by Pride in North Carolina.
(Required.)
Yes
No
I have been satisfied and dissatisfied
Unsure
Other (please specify)
5.
Overall I feel my/ my child/family member's quality of life has improved or changed for the better since receiving services and supports from Pride in North Carolina.
Yes
No
Unknown
Other (please specify)
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6.
I/My family member is/am better able to handle problems since receiving services from Pride in North Carolina.
(Required.)
Yes
No
Unknown
Other (please specify)
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7.
Pride in North Carolina staff treated me with respect and honored any cultural needs or preferences I requested.
(Required.)
Yes
No
Unknown
Other (please specify)
8.
What specifically were some of the cultural needs/preferences you requested or expressed?
Materials/handouts in other languages
Time off of services/sessions during a specific holiday/time of year
Preference for staff of a certain gender or race
Needs related to medication (taking or not taking medications)
Addition of faith based supports/people included on Treatment teams
Addition of cultural needs/preferences on the PCP or crisis plan
Other (please specify)
9.
Based on my experience please rate the following: 1 means you were not satisfied at all and 5 means you were highly satisfied.
1
2
3
4
5
Unknown/prefer not to answer
Pride was effective at serving me in a timely manner upon admission.
1
2
3
4
5
Unknown/prefer not to answer
I felt I had say in my treatment goals.
1
2
3
4
5
Unknown/prefer not to answer
Pride is effective at responding to and de-escalating crisis situations.
1
2
3
4
5
Unknown/prefer not to answer
I felt my/my family's interaction with staff met my/my family's needs.
1
2
3
4
5
Unknown/prefer not to answer
The schedule of services was based on my input/needs rather than the staff's.
1
2
3
4
5
Unknown/prefer not to answer
Pride staff understood my needs.
1
2
3
4
5
Unknown/prefer not to answer
Other (please specify)
10.
Please answer the following if you receive(d) services via Tele-Health.
Great
Good
Average
Poor
Connectivity/quality of picture and audio.
Great
Good
Average
Poor
Convenience of days and times of service being available.
Great
Good
Average
Poor
Comfort level of the service provided over tele compared to face to face.
Great
Good
Average
Poor
Met my needs.
Great
Good
Average
Poor
Other (please specify)
11.
Please add any comments, concerns or feedback that would assist us in program improvement or service delivery.
