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Rural Response Network: Access to Services Questionnaire

Thank you for completing this brief (5 minutes or less) questionnaire!

This questionnaire asks for your opinion about how alcohol, substance (drug) abuse and mental health disorders have impacted your community and the barriers people might face in knowing if, how, and where to get help.

It is intended for people ages 18 or older who live and/or work in Oberlin, Wellington, Grafton, Lagrange, Eaton Township and surrounding rural communities in Lorain County. Participation is voluntary and anonymous. All results will be added together and summarized.

This information will be used by the Rural Response Network consortium to help direct prevention/education, outreach, linkage, treatment, and recovery support efforts.
1.Do you think that drug use is a concern in your community?
2.I can recognize the signs of alcohol or drug misuse/ abuse (substance use disorder).
3.Problems with alcohol and/or drugs is something my family and I can talk openly about.
4.My family and I can talk openly about mental health issues.
5.I know where to find help and resources if someone I know needs help with drug addiction.
6.I know where to find help and resources if someone I know needs help with a mental health problem.
7.If I or someone close to me had a problem with alcohol or drugs I would turn to the following people for help or support (check all that apply):
8.What do you think would stop you or someone you know from getting help for a drug or alcohol problem? Check the top three things.
9.Substance Misuse/Addiction (alcohol and/or drugs) Services and Resources: Rank the level of need in your community
High
Medium
Low
No Need
Community-based prevention programs
Increased knowledge about substance use disorders
Easier access to treatment
Programs to decrease stigma
Availability of more family support groups
Overdose Prevention (ex. Narcan, test strips)
Help with linking to services
Access/maintenance with Medication Assisted Treatment (i.e. Suboxone)
10.Stress: What is a source of stress in your daily life?
High
Medium
Low
No Need
Relationships
Fear of domestic violence
Health problems
Alcohol and drug abuse
Mental Health
Access to health care services
Not enough food
Unreliable or no transportation
Access to safe, affordable housing
Access to education
Lack of job/stable employment
Community violence
11.Do you live and/or work in Grafton, Lagrange, Oberlin or Wellington?
12.How old are you?
13.What is your gender?
14.Which race/ethnicity describes you?
15.What is your household income?