Please fill out the follow responses about needs in the community and Family Pride services.

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* 1. What type of organization are you employed with?

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* 2. Our mission is "to engage children and families with our innovative and professional clinical services in the home and community."  Is our mission accurately coinciding with the needs of our community?

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* 3. Have you referred clients and/or families to Family Pride or been involved with client input regarding services?

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* 4. In the past year, have there been any changes in the composition of people your organization serves (i.e. increase/decrease in financial concerns, mental health needs, skills based needs)? If yes, please explain.

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* 5. Has any of these changes created a gap in services for the community?  If so, please describe the gap.

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* 6. Do you have any suggestions of other programming that you would like to see Family Pride providing in the future?

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* 7. What would you see as the most significant mental health needs not being addressed in the community and what services or activities would fill those needs?

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* 8. Please mark the most accurate response to the items listed below.

  Strongly Agree Agree Neutral Disagree Strongly Disagree N/A
I am aware of Family Pride's treatment model and programs.
I am/have been satisfied with the ease of Family Pride's referral process.
Family Pride team members effectively participate in team meetings on behalf of clients and families.
Will you continue to refer clients as deemed appropriate?
Do you feel there is sufficient communication between your organization and Family Pride staff?

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* 9. How would you rate your overall satisfaction with quality of service?

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* 10. How would you rate your overall satisfaction with effectiveness of the programs?

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* 11. Would you recommend referring individuals and families to Family Pride?

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* 12. Would you like a copy of the final report or response to any of the feedback you have provided? If so, please provide your contact information below.

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