Public reporting burden for this collection of information is estimated to average 12 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Rockville, MD 20857. An agency may not conduct nor sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The control number for this project is 0930-0197.

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* 1. Answer the following questions about the technical assistance (TA) that SAMHSA's GAINS Center for Behavioral Health and Justice Transformation conducted with your agency by selecting the appropriate response.

  Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied
How satisfied were you with the TA you received?
How satisfied were you with the TA process?

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* 2. Indicate how strongly you agree or disagree with the following statements.

  Strongly Agree Agree Disagree Strongly Disagree N/A
The TA achieved its stated goals and objectives.
The TA significantly increased your knowledge in areas relevant to your work.
The TA request process was easy for your agency to use.
The TA planning process helped identify the critical TA need(s) of your agency.
The TA accurately targeted your need(s) and included sufficient action steps to address those need(s).

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* 3. Indicate how strongly you agree or disagree with the following statements.

  Strongly Agree Agree Disagree Strongly Disagree N/A
Facilitators and support staff satisfactorily planned and organized the TA.
Facilitators and support staff were responsive to your needs throughout the TA experience.
The TA was provided in a timely manner.

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* 4. Indicate how strongly you agree or disagree with the following statements.

  Strongly Agree Agree Disagree Strongly Disagree N/A
Facilitators and support staff were prepared for the TA.
Facilitators and support staff were knowledgeable, skilled, and qualified to deliver the TA.
Facilitators and support staff weres effective in delivering the TA.
You would use these facilitators again.
You would recommend these facilitators to others.

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* 5. Answer the following questions about the TA that SAMHSA's GAINS Center conducted with your agency.

  A Great Deal Somewhat Not Very Much Not at All N/A
To what extent has the TA you received improved your agency's capacity to provide effective behavioral health treatment services?
To what extent will you make changes to your work or your staff's work as a result of the TA?
To what extent will the TA strengthen your behavioral health treatment system?

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* 6. How has the TA strengthened your agency's behavioral health treatment system?

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* 7. What barriers do you anticipate might delay or impede the application of the TA?

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* 8. What recommendations do you have to improve the SAMHSA GAINS Center's TA services?

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* 9. Do you anticipate needing follow up TA related to this event?

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* 10. Please explain.

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* 11. Do you think this or similar TA would be beneficial to other agencies? Please explain.

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* 12. Any other comments or suggestions?

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