CHNA 2021

Help us build a healthier Community by taking our Community Needs Assessment Survey. This information will help to provide much needed outreach and wellness programs in the area, keeping you and your family as healthy as possible. The results from this survey are confidential.

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* 1. What is your zip code?

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* 2. Gender

Male

Female

Prefer not to answer

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* 3. Age range

Under 18 years

19-24 years

25-30 years

31-40 years

41-50 years

51-60 years

61-65 years

older than 65 years

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* 4. Highest level of education

Some high school

High school diploma or GED

Some college

Associates degree

Bachelor degree

Graduate Degree

Post graduate

Prefer not to answer

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* 5. Household Income (per year)

Less than $10,000

$10,000 to $29,000

$30,000 to $49,000

$50,000 to $99,000

$100,000 or above

Prefer not to answer

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* 6. What is your race/ethnicity?

African American

American Indian or Alaskan Native

Asian/Pacific Islander

Caucasian

Hispanic or Latino

Native Hawaiian or other Pacific Islander

Prefer not to answer

Other (please specify)

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* 7. What do you believe is the biggest health problem in your community? (Check all that you think apply)

Heart disease

Cancer

Diabetes/sugar

Asthma/lung disease

Smoking, drug or alcohol use

Mental Health Issues (Depression, Anxiety)

Dental health

Infectious disease

High blood pressure/stroke

Injuries

Overweight/obesity

Access to healthcare/no insurance

HIV

Sexually transmitted diseases

Other (please tell us what you think)

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* 8. What do you think are the problems that keep you or other community members from getting healthcare they need? (Check all that you think apply)

No health insurance

Too expensive/cannot afford

Couldn't get an appointment with my doctor

Doctor is too far away from my home

No transportation

Service is not available in our community

Local doctors are not on my insurance plan

Other (please tell us what you think)

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* 9. Do you have any ideas or recommendations to help decrease the health problems in the community or to solve the problems with access to health services?

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* 10. What are the greatest strengths of your community? (Check all that apply)

Education

Employment/job skills

Healthcare treatment

Healthy eating

Parks/green space

Community safety

Affordable housing options

Community activities

Police

Personal space

Insurance

Transportation

Workplace safety

Language

Family

Mental health access

Substance abuse access

Other (please specify)

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* 11. What are the greatest weaknesses of your community? (Check all that apply)

Education

Job skills

Employment

Substance abuse

Mental health

Lack of community activities

Police

Lack of personal space

Lack of affordable housing

Legal issues

Insurance

Limited transportation

Workplace safety

Language skills

Family

Lack of healthy food

Community safety

Poor access to healthcare

Minimal recreation/green space access

Other (please specify)

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* 12. What is the level of healthcare need in the following areas as they exist within your community? (Please select a response of High, Low, No need, or Don't know for each type of health concern.)

	High	Low	No need	Don't know
Primary care	Primary care High	Primary care Low	Primary care No need	Primary care Don't know
Specialty care	Specialty care High	Specialty care Low	Specialty care No need	Specialty care Don't know
Dental care	Dental care High	Dental care Low	Dental care No need	Dental care Don't know
Eye care	Eye care High	Eye care Low	Eye care No need	Eye care Don't know
Substance abuse	Substance abuse High	Substance abuse Low	Substance abuse No need	Substance abuse Don't know
Mental health	Mental health High	Mental health Low	Mental health No need	Mental health Don't know
Transportation to healthcare appointments	Transportation to healthcare appointments High	Transportation to healthcare appointments Low	Transportation to healthcare appointments No need	Transportation to healthcare appointments Don't know

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* 13. What is the level of nutritional need in the following areas as they exist within your community? (Please select a response of High, Low, No need, or Don't know for each.)

	High	Low	No need	Don't know
Access to affordable healthy foods	Access to affordable healthy foods High	Access to affordable healthy foods Low	Access to affordable healthy foods No need	Access to affordable healthy foods Don't know
Access to healthy food in schools	Access to healthy food in schools High	Access to healthy food in schools Low	Access to healthy food in schools No need	Access to healthy food in schools Don't know
Access to healthy food in stores	Access to healthy food in stores High	Access to healthy food in stores Low	Access to healthy food in stores No need	Access to healthy food in stores Don't know

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* 14. What is a source of stress in your daily life? (Please select a response of High, Low, None, or Don't know for each.)

	High	Low	None	Don't know
Relationships	Relationships High	Relationships Low	Relationships None	Relationships Don't know
Fear of domestic violence	Fear of domestic violence High	Fear of domestic violence Low	Fear of domestic violence None	Fear of domestic violence Don't know
Access to health care services	Access to health care services High	Access to health care services Low	Access to health care services None	Access to health care services Don't know
Access to food	Access to food High	Access to food Low	Access to food None	Access to food Don't know
Access to transportation	Access to transportation High	Access to transportation Low	Access to transportation None	Access to transportation Don't know
Access to safe housing	Access to safe housing High	Access to safe housing Low	Access to safe housing None	Access to safe housing Don't know
Access to education	Access to education High	Access to education Low	Access to education None	Access to education Don't know
Community violence	Community violence High	Community violence Low	Community violence None	Community violence Don't know

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* 15. What is the greatest transportation need as it exists in your community? (Please select a response of High, Low, No need, or Don't know for each.)

	High	Low	No need	Don't know
Transportation to health care	Transportation to health care High	Transportation to health care Low	Transportation to health care No need	Transportation to health care Don't know
Transportation to work	Transportation to work High	Transportation to work Low	Transportation to work No need	Transportation to work Don't know
Transportation to grocery stores	Transportation to grocery stores High	Transportation to grocery stores Low	Transportation to grocery stores No need	Transportation to grocery stores Don't know
Reliable, scheduled transportation	Reliable, scheduled transportation High	Reliable, scheduled transportation Low	Reliable, scheduled transportation No need	Reliable, scheduled transportation Don't know
Affordable transportation	Affordable transportation High	Affordable transportation Low	Affordable transportation No need	Affordable transportation Don't know
Transportation to community activities	Transportation to community activities High	Transportation to community activities Low	Transportation to community activities No need	Transportation to community activities Don't know

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* 16. What is the level of language barrier you experience in your community? (Please select a response of High, Low, None or Don't know for each.)

	High	Low	None	Don't know
Access to multi-lingual services	Access to multi-lingual services High	Access to multi-lingual services Low	Access to multi-lingual services None	Access to multi-lingual services Don't know
Access to language skill education	Access to language skill education High	Access to language skill education Low	Access to language skill education None	Access to language skill education Don't know
Access to employment in your first language	Access to employment in your first language High	Access to employment in your first language Low	Access to employment in your first language None	Access to employment in your first language Don't know

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* 17. What is the greatest substance abuse need in the following areas? (Please select a response of High, Low, No need, or Don't know for each).

	High	Low	No need	Don't know
Prevention programs	Prevention programs High	Prevention programs Low	Prevention programs No need	Prevention programs Don't know
Reduction of drug use	Reduction of drug use High	Reduction of drug use Low	Reduction of drug use No need	Reduction of drug use Don't know
Reduction of prescription drug use	Reduction of prescription drug use High	Reduction of prescription drug use Low	Reduction of prescription drug use No need	Reduction of prescription drug use Don't know
Access to treatment - outpatient	Access to treatment - outpatient High	Access to treatment - outpatient Low	Access to treatment - outpatient No need	Access to treatment - outpatient Don't know
Access to treatment - residential	Access to treatment - residential High	Access to treatment - residential Low	Access to treatment - residential No need	Access to treatment - residential Don't know
Reduction of alcohol abuse	Reduction of alcohol abuse High	Reduction of alcohol abuse Low	Reduction of alcohol abuse No need	Reduction of alcohol abuse Don't know
Drug specific treatment: ___________________________	Drug specific treatment: ___________________________ High	Drug specific treatment: ___________________________ Low	Drug specific treatment: ___________________________ No need	Drug specific treatment: ___________________________ Don't know

What drug?

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* 18. What is the greatest mental health need for the following areas as they exist in your community? (Please select a response of High, Low, No need, or Don't know for each)

	High	Low	Ne need	Don't know
Residential mental health treatment	Residential mental health treatment High	Residential mental health treatment Low	Residential mental health treatment Ne need	Residential mental health treatment Don't know
Mental health professionals	Mental health professionals High	Mental health professionals Low	Mental health professionals Ne need	Mental health professionals Don't know
Prevention	Prevention High	Prevention Low	Prevention Ne need	Prevention Don't know
Access to treatment	Access to treatment High	Access to treatment Low	Access to treatment Ne need	Access to treatment Don't know

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* 19. What is the greatest housing need as it exists within your community? (Please select a response of High, Low, No need, or Don't know for each.)

	High	Low	No need	Don't know
Resident advocacy	Resident advocacy High	Resident advocacy Low	Resident advocacy No need	Resident advocacy Don't know
Senior housing	Senior housing High	Senior housing Low	Senior housing No need	Senior housing Don't know
Affordable housing	Affordable housing High	Affordable housing Low	Affordable housing No need	Affordable housing Don't know
Access to loans	Access to loans High	Access to loans Low	Access to loans No need	Access to loans Don't know
Financial literacy	Financial literacy High	Financial literacy Low	Financial literacy No need	Financial literacy Don't know

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* 20. What is the greatest employment need as it exists within your community? (Please select a response of High, Low, No need, or Don't know for each.)

	High	Low	No need	Don't know
Job search and placement assistance	Job search and placement assistance High	Job search and placement assistance Low	Job search and placement assistance No need	Job search and placement assistance Don't know
Incoming generating skills	Incoming generating skills High	Incoming generating skills Low	Incoming generating skills No need	Incoming generating skills Don't know
Internships, paid, leadership, or volunteer work opportunities	Internships, paid, leadership, or volunteer work opportunities High	Internships, paid, leadership, or volunteer work opportunities Low	Internships, paid, leadership, or volunteer work opportunities No need	Internships, paid, leadership, or volunteer work opportunities Don't know

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* 21. What would improve the quality of life for you within your community? Please rank the level of need in the following areas. (Please select a response of High, Low, No need, or Don't know for each.)

	High	Low	No need	Don't know
Educational opportunities	Educational opportunities High	Educational opportunities Low	Educational opportunities No need	Educational opportunities Don't know
Housing	Housing High	Housing Low	Housing No need	Housing Don't know
Recreational opportunities	Recreational opportunities High	Recreational opportunities Low	Recreational opportunities No need	Recreational opportunities Don't know
Community safety	Community safety High	Community safety Low	Community safety No need	Community safety Don't know
Healthcare access	Healthcare access High	Healthcare access Low	Healthcare access No need	Healthcare access Don't know
Dental care access	Dental care access High	Dental care access Low	Dental care access No need	Dental care access Don't know
Public transportation	Public transportation High	Public transportation Low	Public transportation No need	Public transportation Don't know
Substance abuse support	Substance abuse support High	Substance abuse support Low	Substance abuse support No need	Substance abuse support Don't know
Mental health services	Mental health services High	Mental health services Low	Mental health services No need	Mental health services Don't know
Employment opportunities	Employment opportunities High	Employment opportunities Low	Employment opportunities No need	Employment opportunities Don't know
Community activities	Community activities High	Community activities Low	Community activities No need	Community activities Don't know
After school programs	After school programs High	After school programs Low	After school programs No need	After school programs Don't know
Partnership with local police department	Partnership with local police department High	Partnership with local police department Low	Partnership with local police department No need	Partnership with local police department Don't know
Connections to resources/community agencies	Connections to resources/community agencies High	Connections to resources/community agencies Low	Connections to resources/community agencies No need	Connections to resources/community agencies Don't know
Access to local parks and community classes	Access to local parks and community classes High	Access to local parks and community classes Low	Access to local parks and community classes No need	Access to local parks and community classes Don't know
Trails and paths	Trails and paths High	Trails and paths Low	Trails and paths No need	Trails and paths Don't know

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* 22. What is the greatest education need? (Please select a response of High, Low, No need, or Don't know for each.)

	High	Low	No need	Don't know
Childhood development	Childhood development High	Childhood development Low	Childhood development No need	Childhood development Don't know
Youth development	Youth development High	Youth development Low	Youth development No need	Youth development Don't know
Access to the ourdoors	Access to the ourdoors High	Access to the ourdoors Low	Access to the ourdoors No need	Access to the ourdoors Don't know
Nutrition and physical exercise	Nutrition and physical exercise High	Nutrition and physical exercise Low	Nutrition and physical exercise No need	Nutrition and physical exercise Don't know
Life skills trainings	Life skills trainings High	Life skills trainings Low	Life skills trainings No need	Life skills trainings Don't know
Parenting classes	Parenting classes High	Parenting classes Low	Parenting classes No need	Parenting classes Don't know
Health education	Health education High	Health education Low	Health education No need	Health education Don't know
Adult education	Adult education High	Adult education Low	Adult education No need	Adult education Don't know
Day care	Day care High	Day care Low	Day care No need	Day care Don't know
Quality of available education	Quality of available education High	Quality of available education Low	Quality of available education No need	Quality of available education Don't know