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RISE 2022- Recovery Indicators and Service Effectiveness

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* 1. Name (optional)

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* 2. Date

Date

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* 3. Date of birth

Date

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* 4. Sex (Check One)

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* 5. Nationality/Ethnicity (Check all that apply):

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* 6. I feel welcomed when I walk in the door at this agency or organization.

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* 7. I feel like staff members treat me with respect and view me as their equal.

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* 8. Staff members work hard to connect to the important people in my life.

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* 9. Staff members help me feel safe, because they understand the things that have happened to me in the past.

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* 10. Staff members have good relationships with physical health care providers (e.g., doctors, nurses) to help me get needed healthcare.

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* 11. I am encouraged to take an active role in my treatment and recovery.

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* 12. Staff members are interested in my culture and how we deal with life's challenges.

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* 13. Staff members are in regular communication with the other health care and social service providers involved in my care.

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* 14. Staff members try to accommodate my own scheduling needs.

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* 15. Staff members recognize and celebrate the progress I am making in my recovery.

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* 16. Staff members help me to identify people, places, and programs in the community that I can rely on for continued support after I am discharged.

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* 17. Staff members help me get and stay well. (Overcome trauma triggers and/or other obstacles).

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* 18. Staff members seem to know about activities and events going on in the community.

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* 19. Staff actively participates in community activities and events that support my recovery and resilience.

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* 20. Persons receiving services participate in community activities and events.

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* 21. Staff members have offered to help me find my way in the community (e.g., to go to school, to get a job, to join a faith community, etc.)

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* 22. I would recommend this program to my family and/or friends.

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* 23. Comments

0 of 23 answered
 

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