OPOC for Caregivers

Ontario Perception of Care Tool
For Mental Health and Addictions (OPOC-MHA) –
Caregiver Version

This questionnaire asks about your perceptions of care, and that which your loved one received. This information is being collected to help agencies and programs identify areas of strengths on which to build, and areas for improvement. Your feedback is important and will ultimately help to enhance the overall mental health and substance use system in Ontario.

Question Title

* Did your loved one give consent for you to be involved in their care?

Consent, in this case, is defined as express permission given by a patient or client for their physician or treatment provider to be involved in their care, including sharing information to the extent possible within privacy legislation

Yes

Sometimes

Not Sure

Question Title

* If you did not feel involved in your loved one’s care team, what were the reasons? Please choose the option that best represents your experience.

I did not want to be involved

My loved one did not want me to be involved

Staff did not invite me to be a part of the care team

Staff said the Privacy Act prevents them from including me

N/A, I felt involved

Other (please specify)

Question Title

* Caregiver Involvement and Engagement

These questions are designed to allow you to provide feedback on your experience interacting with staff as part of the care team of your loved one.

	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
1) I was involved in the process of getting my loved one’s consent to be involved in their care.	1) I was involved in the process of getting my loved one’s consent to be involved in their care. Strongly Disagree	1) I was involved in the process of getting my loved one’s consent to be involved in their care. Disagree	1) I was involved in the process of getting my loved one’s consent to be involved in their care. Agree	1) I was involved in the process of getting my loved one’s consent to be involved in their care. Strongly Agree	1) I was involved in the process of getting my loved one’s consent to be involved in their care. N/A
2) I felt welcome from the start.	2) I felt welcome from the start. Strongly Disagree	2) I felt welcome from the start. Disagree	2) I felt welcome from the start. Agree	2) I felt welcome from the start. Strongly Agree	2) I felt welcome from the start. N/A
3) I felt that I was a valued member of the care team for my loved one.	3) I felt that I was a valued member of the care team for my loved one. Strongly Disagree	3) I felt that I was a valued member of the care team for my loved one. Disagree	3) I felt that I was a valued member of the care team for my loved one. Agree	3) I felt that I was a valued member of the care team for my loved one. Strongly Agree	3) I felt that I was a valued member of the care team for my loved one. N/A
4) I was included in decisions made about my loved one's treatment.	4) I was included in decisions made about my loved one's treatment. Strongly Disagree	4) I was included in decisions made about my loved one's treatment. Disagree	4) I was included in decisions made about my loved one's treatment. Agree	4) I was included in decisions made about my loved one's treatment. Strongly Agree	4) I was included in decisions made about my loved one's treatment. N/A
5) Staff kept me up to date on my loved one's progress.	5) Staff kept me up to date on my loved one's progress. Strongly Disagree	5) Staff kept me up to date on my loved one's progress. Disagree	5) Staff kept me up to date on my loved one's progress. Agree	5) Staff kept me up to date on my loved one's progress. Strongly Agree	5) Staff kept me up to date on my loved one's progress. N/A
6) Services were provided at a time that was convenient for me.	6) Services were provided at a time that was convenient for me. Strongly Disagree	6) Services were provided at a time that was convenient for me. Disagree	6) Services were provided at a time that was convenient for me. Agree	6) Services were provided at a time that was convenient for me. Strongly Agree	6) Services were provided at a time that was convenient for me. N/A
7) Staff understood and responded to my needs and concerns.	7) Staff understood and responded to my needs and concerns. Strongly Disagree	7) Staff understood and responded to my needs and concerns. Disagree	7) Staff understood and responded to my needs and concerns. Agree	7) Staff understood and responded to my needs and concerns. Strongly Agree	7) Staff understood and responded to my needs and concerns. N/A
8) If I had a serious concern, I would know how to make a formal complaint to the organization.	8) If I had a serious concern, I would know how to make a formal complaint to the organization. Strongly Disagree	8) If I had a serious concern, I would know how to make a formal complaint to the organization. Disagree	8) If I had a serious concern, I would know how to make a formal complaint to the organization. Agree	8) If I had a serious concern, I would know how to make a formal complaint to the organization. Strongly Agree	8) If I had a serious concern, I would know how to make a formal complaint to the organization. N/A
9) My input was welcomed when staff made referrals for my loved one, including alternative approaches (e.g., exercise, meditation, nutrition, culturally appropriate approaches).	9) My input was welcomed when staff made referrals for my loved one, including alternative approaches (e.g., exercise, meditation, nutrition, culturally appropriate approaches). Strongly Disagree	9) My input was welcomed when staff made referrals for my loved one, including alternative approaches (e.g., exercise, meditation, nutrition, culturally appropriate approaches). Disagree	9) My input was welcomed when staff made referrals for my loved one, including alternative approaches (e.g., exercise, meditation, nutrition, culturally appropriate approaches). Agree	9) My input was welcomed when staff made referrals for my loved one, including alternative approaches (e.g., exercise, meditation, nutrition, culturally appropriate approaches). Strongly Agree	9) My input was welcomed when staff made referrals for my loved one, including alternative approaches (e.g., exercise, meditation, nutrition, culturally appropriate approaches). N/A
10) I was included in decisions about my loved one's discharge from treatment.	10) I was included in decisions about my loved one's discharge from treatment. Strongly Disagree	10) I was included in decisions about my loved one's discharge from treatment. Disagree	10) I was included in decisions about my loved one's discharge from treatment. Agree	10) I was included in decisions about my loved one's discharge from treatment. Strongly Agree	10) I was included in decisions about my loved one's discharge from treatment. N/A
11) The discharge planning process took into account my safety.	11) The discharge planning process took into account my safety. Strongly Disagree	11) The discharge planning process took into account my safety. Disagree	11) The discharge planning process took into account my safety. Agree	11) The discharge planning process took into account my safety. Strongly Agree	11) The discharge planning process took into account my safety. N/A

As a caregiver, do you have any comments about caregiver involvement and engagement?

Question Title

* Caregiver Education and Support

These questions are intended to allow you to provide feedback around the education and support you received in understanding your loved one’s challenges and providing support to your loved one.

	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
12) Staff provided me with adequate, easily understandable information (i.e. diagnosis, prognosis, symptoms, health status, progress, treatment plan, medication) about my loved one’s challenges	12) Staff provided me with adequate, easily understandable information (i.e. diagnosis, prognosis, symptoms, health status, progress, treatment plan, medication) about my loved one’s challenges Strongly Disagree	12) Staff provided me with adequate, easily understandable information (i.e. diagnosis, prognosis, symptoms, health status, progress, treatment plan, medication) about my loved one’s challenges Disagree	12) Staff provided me with adequate, easily understandable information (i.e. diagnosis, prognosis, symptoms, health status, progress, treatment plan, medication) about my loved one’s challenges Agree	12) Staff provided me with adequate, easily understandable information (i.e. diagnosis, prognosis, symptoms, health status, progress, treatment plan, medication) about my loved one’s challenges Strongly Agree	12) Staff provided me with adequate, easily understandable information (i.e. diagnosis, prognosis, symptoms, health status, progress, treatment plan, medication) about my loved one’s challenges N/A
13) Staff provided me with adequate information about resources and support programs available to my loved one.	13) Staff provided me with adequate information about resources and support programs available to my loved one. Strongly Disagree	13) Staff provided me with adequate information about resources and support programs available to my loved one. Disagree	13) Staff provided me with adequate information about resources and support programs available to my loved one. Agree	13) Staff provided me with adequate information about resources and support programs available to my loved one. Strongly Agree	13) Staff provided me with adequate information about resources and support programs available to my loved one. N/A
14) Staff provided me with adequate information about what to do in case my loved one has a relapse or crisis.	14) Staff provided me with adequate information about what to do in case my loved one has a relapse or crisis. Strongly Disagree	14) Staff provided me with adequate information about what to do in case my loved one has a relapse or crisis. Disagree	14) Staff provided me with adequate information about what to do in case my loved one has a relapse or crisis. Agree	14) Staff provided me with adequate information about what to do in case my loved one has a relapse or crisis. Strongly Agree	14) Staff provided me with adequate information about what to do in case my loved one has a relapse or crisis. N/A

As a caregiver, do you have any comments about caregiver education and support?

Question Title

* Caregiver Personal Support

These questions are designed to allow you to provide feedback around the supports that were available to you as a caregiver for your own personal needs.

	Strongly Disagree	Disagree	Agree	Strongly Agree	I don't know	N/A
15) I received adequate information about the programs and services available to me as a caregiver.	15) I received adequate information about the programs and services available to me as a caregiver. Strongly Disagree	15) I received adequate information about the programs and services available to me as a caregiver. Disagree	15) I received adequate information about the programs and services available to me as a caregiver. Agree	15) I received adequate information about the programs and services available to me as a caregiver. Strongly Agree	15) I received adequate information about the programs and services available to me as a caregiver. I don't know	15) I received adequate information about the programs and services available to me as a caregiver. N/A
16) Staff encouraged me to feel hopeful about my loved one’s recovery.	16) Staff encouraged me to feel hopeful about my loved one’s recovery. Strongly Disagree	16) Staff encouraged me to feel hopeful about my loved one’s recovery. Disagree	16) Staff encouraged me to feel hopeful about my loved one’s recovery. Agree	16) Staff encouraged me to feel hopeful about my loved one’s recovery. Strongly Agree	16) Staff encouraged me to feel hopeful about my loved one’s recovery. I don't know	16) Staff encouraged me to feel hopeful about my loved one’s recovery. N/A
17) I was able to access adequate resources and supports for my own well-being.	17) I was able to access adequate resources and supports for my own well-being. Strongly Disagree	17) I was able to access adequate resources and supports for my own well-being. Disagree	17) I was able to access adequate resources and supports for my own well-being. Agree	17) I was able to access adequate resources and supports for my own well-being. Strongly Agree	17) I was able to access adequate resources and supports for my own well-being. I don't know	17) I was able to access adequate resources and supports for my own well-being. N/A
18) Responses to my crises or urgent needs were provided when needed.	18) Responses to my crises or urgent needs were provided when needed. Strongly Disagree	18) Responses to my crises or urgent needs were provided when needed. Disagree	18) Responses to my crises or urgent needs were provided when needed. Agree	18) Responses to my crises or urgent needs were provided when needed. Strongly Agree	18) Responses to my crises or urgent needs were provided when needed. I don't know	18) Responses to my crises or urgent needs were provided when needed. N/A

As a caregiver, do you have any comments about caregiver personal support?

Question Title

* Environment

These questions are designed to allow you to provide feedback on the physical space in which your loved one received treatment.

	Strongly Disagree	Disagree	Agree	Strongly Disagree	I don't know	N/A
19) Overall, I found the program space clean and well maintained (e.g., meeting space, bathroom).	19) Overall, I found the program space clean and well maintained (e.g., meeting space, bathroom). Strongly Disagree	19) Overall, I found the program space clean and well maintained (e.g., meeting space, bathroom). Disagree	19) Overall, I found the program space clean and well maintained (e.g., meeting space, bathroom). Agree	19) Overall, I found the program space clean and well maintained (e.g., meeting space, bathroom). Strongly Disagree	19) Overall, I found the program space clean and well maintained (e.g., meeting space, bathroom). I don't know	19) Overall, I found the program space clean and well maintained (e.g., meeting space, bathroom). N/A
20) I felt the facility was safe.	20) I felt the facility was safe. Strongly Disagree	20) I felt the facility was safe. Disagree	20) I felt the facility was safe. Agree	20) I felt the facility was safe. Strongly Disagree	20) I felt the facility was safe. I don't know	20) I felt the facility was safe. N/A

As a caregiver, do you have any comments about the environment?

Question Title

* Perception of My Loved One’s Care

These questions are designed to allow you to provide general feedback on the care your loved one received from this service provider.

	Strongly Disagree	Disagree	Agree	Strongly Agree	I don't know	N/A
21) The wait time for services was reasonable for my loved one.	21) The wait time for services was reasonable for my loved one. Strongly Disagree	21) The wait time for services was reasonable for my loved one. Disagree	21) The wait time for services was reasonable for my loved one. Agree	21) The wait time for services was reasonable for my loved one. Strongly Agree	21) The wait time for services was reasonable for my loved one. I don't know	21) The wait time for services was reasonable for my loved one. N/A
22) When my loved one first began receiving treatment, they were encouraged by staff to give consent for me to be involved in their care.	22) When my loved one first began receiving treatment, they were encouraged by staff to give consent for me to be involved in their care. Strongly Disagree	22) When my loved one first began receiving treatment, they were encouraged by staff to give consent for me to be involved in their care. Disagree	22) When my loved one first began receiving treatment, they were encouraged by staff to give consent for me to be involved in their care. Agree	22) When my loved one first began receiving treatment, they were encouraged by staff to give consent for me to be involved in their care. Strongly Agree	22) When my loved one first began receiving treatment, they were encouraged by staff to give consent for me to be involved in their care. I don't know	22) When my loved one first began receiving treatment, they were encouraged by staff to give consent for me to be involved in their care. N/A
23) My loved one received adequate services to learn to cope with their mental illness and/or addiction.	23) My loved one received adequate services to learn to cope with their mental illness and/or addiction. Strongly Disagree	23) My loved one received adequate services to learn to cope with their mental illness and/or addiction. Disagree	23) My loved one received adequate services to learn to cope with their mental illness and/or addiction. Agree	23) My loved one received adequate services to learn to cope with their mental illness and/or addiction. Strongly Agree	23) My loved one received adequate services to learn to cope with their mental illness and/or addiction. I don't know	23) My loved one received adequate services to learn to cope with their mental illness and/or addiction. N/A
24) Staff provided my loved one with a sense of hope.	24) Staff provided my loved one with a sense of hope. Strongly Disagree	24) Staff provided my loved one with a sense of hope. Disagree	24) Staff provided my loved one with a sense of hope. Agree	24) Staff provided my loved one with a sense of hope. Strongly Agree	24) Staff provided my loved one with a sense of hope. I don't know	24) Staff provided my loved one with a sense of hope. N/A
25) Staff treated my loved one with respect.	25) Staff treated my loved one with respect. Strongly Disagree	25) Staff treated my loved one with respect. Disagree	25) Staff treated my loved one with respect. Agree	25) Staff treated my loved one with respect. Strongly Agree	25) Staff treated my loved one with respect. I don't know	25) Staff treated my loved one with respect. N/A
26) Staff provided my loved one treatment and support specific to their strengths and needs.	26) Staff provided my loved one treatment and support specific to their strengths and needs. Strongly Disagree	26) Staff provided my loved one treatment and support specific to their strengths and needs. Disagree	26) Staff provided my loved one treatment and support specific to their strengths and needs. Agree	26) Staff provided my loved one treatment and support specific to their strengths and needs. Strongly Agree	26) Staff provided my loved one treatment and support specific to their strengths and needs. I don't know	26) Staff provided my loved one treatment and support specific to their strengths and needs. N/A
27) Staff were sensitive to my loved one’s cultural needs (e.g., religion, language, ethnic background, race).	27) Staff were sensitive to my loved one’s cultural needs (e.g., religion, language, ethnic background, race). Strongly Disagree	27) Staff were sensitive to my loved one’s cultural needs (e.g., religion, language, ethnic background, race). Disagree	27) Staff were sensitive to my loved one’s cultural needs (e.g., religion, language, ethnic background, race). Agree	27) Staff were sensitive to my loved one’s cultural needs (e.g., religion, language, ethnic background, race). Strongly Agree	27) Staff were sensitive to my loved one’s cultural needs (e.g., religion, language, ethnic background, race). I don't know	27) Staff were sensitive to my loved one’s cultural needs (e.g., religion, language, ethnic background, race). N/A
28) The layout of the facility met my loved one’s needs.	28) The layout of the facility met my loved one’s needs. Strongly Disagree	28) The layout of the facility met my loved one’s needs. Disagree	28) The layout of the facility met my loved one’s needs. Agree	28) The layout of the facility met my loved one’s needs. Strongly Agree	28) The layout of the facility met my loved one’s needs. I don't know	28) The layout of the facility met my loved one’s needs. N/A
29) The discharge planning process took into account the safety of my loved one.	29) The discharge planning process took into account the safety of my loved one. Strongly Disagree	29) The discharge planning process took into account the safety of my loved one. Disagree	29) The discharge planning process took into account the safety of my loved one. Agree	29) The discharge planning process took into account the safety of my loved one. Strongly Agree	29) The discharge planning process took into account the safety of my loved one. I don't know	29) The discharge planning process took into account the safety of my loved one. N/A
30) The services and supports my loved one received helped them deal more effectively with the challenges in their life.	30) The services and supports my loved one received helped them deal more effectively with the challenges in their life. Strongly Disagree	30) The services and supports my loved one received helped them deal more effectively with the challenges in their life. Disagree	30) The services and supports my loved one received helped them deal more effectively with the challenges in their life. Agree	30) The services and supports my loved one received helped them deal more effectively with the challenges in their life. Strongly Agree	30) The services and supports my loved one received helped them deal more effectively with the challenges in their life. I don't know	30) The services and supports my loved one received helped them deal more effectively with the challenges in their life. N/A

As a caregiver, do you have any comments about the care your loved one received?

Question Title

* Overall Experience

These questions are designed to allow you to provide feedback on your overall experience with this service provider.

	Strongly Disagree	Disagree	Agree	Strongly Agree	I don't know	N/A
31) I think the services or supports provided here are of high quality.	31) I think the services or supports provided here are of high quality. Strongly Disagree	31) I think the services or supports provided here are of high quality. Disagree	31) I think the services or supports provided here are of high quality. Agree	31) I think the services or supports provided here are of high quality. Strongly Agree	31) I think the services or supports provided here are of high quality. I don't know	31) I think the services or supports provided here are of high quality. N/A
32) If a friend were in need of similar services or supports, I would recommend this service.	32) If a friend were in need of similar services or supports, I would recommend this service. Strongly Disagree	32) If a friend were in need of similar services or supports, I would recommend this service. Disagree	32) If a friend were in need of similar services or supports, I would recommend this service. Agree	32) If a friend were in need of similar services or supports, I would recommend this service. Strongly Agree	32) If a friend were in need of similar services or supports, I would recommend this service. I don't know	32) If a friend were in need of similar services or supports, I would recommend this service. N/A
33) The services and supports I have received have helped me deal more effectively with the challenges experienced by my loved one	33) The services and supports I have received have helped me deal more effectively with the challenges experienced by my loved one Strongly Disagree	33) The services and supports I have received have helped me deal more effectively with the challenges experienced by my loved one Disagree	33) The services and supports I have received have helped me deal more effectively with the challenges experienced by my loved one Agree	33) The services and supports I have received have helped me deal more effectively with the challenges experienced by my loved one Strongly Agree	33) The services and supports I have received have helped me deal more effectively with the challenges experienced by my loved one I don't know	33) The services and supports I have received have helped me deal more effectively with the challenges experienced by my loved one N/A

As a caregiver, do you have any comments about the overall experience?

Question Title

* Please complete this section only if your loved one is/was receiving services in a residential or inpatient program.

	Strongly Disagree	Disagree	Agree	Strongly Agree	I don't know	N/A
34) There were enough activities of interest to my loved one during free time.	34) There were enough activities of interest to my loved one during free time. Strongly Disagree	34) There were enough activities of interest to my loved one during free time. Disagree	34) There were enough activities of interest to my loved one during free time. Agree	34) There were enough activities of interest to my loved one during free time. Strongly Agree	34) There were enough activities of interest to my loved one during free time. I don't know	34) There were enough activities of interest to my loved one during free time. N/A
35) Rules or guidelines concerning my contact with my loved one were appropriate to my needs.	35) Rules or guidelines concerning my contact with my loved one were appropriate to my needs. Strongly Disagree	35) Rules or guidelines concerning my contact with my loved one were appropriate to my needs. Disagree	35) Rules or guidelines concerning my contact with my loved one were appropriate to my needs. Agree	35) Rules or guidelines concerning my contact with my loved one were appropriate to my needs. Strongly Agree	35) Rules or guidelines concerning my contact with my loved one were appropriate to my needs. I don't know	35) Rules or guidelines concerning my contact with my loved one were appropriate to my needs. N/A
36) The layout of the facility was suitable for visits with family and friends (e.g., privacy, comfort level).	36) The layout of the facility was suitable for visits with family and friends (e.g., privacy, comfort level). Strongly Disagree	36) The layout of the facility was suitable for visits with family and friends (e.g., privacy, comfort level). Disagree	36) The layout of the facility was suitable for visits with family and friends (e.g., privacy, comfort level). Agree	36) The layout of the facility was suitable for visits with family and friends (e.g., privacy, comfort level). Strongly Agree	36) The layout of the facility was suitable for visits with family and friends (e.g., privacy, comfort level). I don't know	36) The layout of the facility was suitable for visits with family and friends (e.g., privacy, comfort level). N/A
37) The area in and around my loved one’s room was comfortable for sleeping (e.g., noise level, lighting).	37) The area in and around my loved one’s room was comfortable for sleeping (e.g., noise level, lighting). Strongly Disagree	37) The area in and around my loved one’s room was comfortable for sleeping (e.g., noise level, lighting). Disagree	37) The area in and around my loved one’s room was comfortable for sleeping (e.g., noise level, lighting). Agree	37) The area in and around my loved one’s room was comfortable for sleeping (e.g., noise level, lighting). Strongly Agree	37) The area in and around my loved one’s room was comfortable for sleeping (e.g., noise level, lighting). I don't know	37) The area in and around my loved one’s room was comfortable for sleeping (e.g., noise level, lighting). N/A
38) My loved one’s special dietary needs were met (e.g., diabetic, halal, vegetarian, kosher).	38) My loved one’s special dietary needs were met (e.g., diabetic, halal, vegetarian, kosher). Strongly Disagree	38) My loved one’s special dietary needs were met (e.g., diabetic, halal, vegetarian, kosher). Disagree	38) My loved one’s special dietary needs were met (e.g., diabetic, halal, vegetarian, kosher). Agree	38) My loved one’s special dietary needs were met (e.g., diabetic, halal, vegetarian, kosher). Strongly Agree	38) My loved one’s special dietary needs were met (e.g., diabetic, halal, vegetarian, kosher). I don't know	38) My loved one’s special dietary needs were met (e.g., diabetic, halal, vegetarian, kosher). N/A
39) The facility kept track of my loved one’s personal belongings.	39) The facility kept track of my loved one’s personal belongings. Strongly Disagree	39) The facility kept track of my loved one’s personal belongings. Disagree	39) The facility kept track of my loved one’s personal belongings. Agree	39) The facility kept track of my loved one’s personal belongings. Strongly Agree	39) The facility kept track of my loved one’s personal belongings. I don't know	39) The facility kept track of my loved one’s personal belongings. N/A

As a caregiver, do you have any comments about the residential or inpatient program?

Question Title

* Please complete this question only if your loved one is/was receiving services in a residential or inpatient program.

40 a) Please comment on aspects of your experience with this treatment/support service that were particularly helpful to you.

Question Title

* 40 b) Please comment on aspects of your experience with this treatment/support service that you feel could be improved.

Question Title

* The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

1) What is your age?

12 and under

13-18 years

19-25 years

26-34 years

35-44 years

45-54 years

55-64 years

65+ years

Prefer not to answer

Question Title

* The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

2) Were you born in Canada?

Yes

Do not know

Prefer not to answer

Question Title

* The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

3) What language would you feel most comfortable speaking in with your health care provider?

Question Title

* The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

4) Which of the following best describes your racial or ethnic group?

Question Title

* The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

5) What is your gender?

Female

Intersex

Male

Trans-Female to Male

Trans-Male to Female

Two-Spirit (a term used by some Indigenous people)

Do not know

Prefer not to answer

Other (please specify)

Question Title

* The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

6) What is your sexual orientation?

Bisexual

Gay

Heterosexual

Lesbian

Queer (a term used by people who do not follow common sexual orientations)

Two-Spirit (a term used by Indigenous people)

Do not know

Prefer not to answer

Other (please specify)

Question Title

* The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

7) What was your total family income before taxes last year?

Question Title

* The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

8) How many people does this income support?

Other (please specify the number):

Question Title

* The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

9) Does your loved one live with you?

Yes

Sometimes

Question Title

* The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

10) I am my loved one's:

Parent

Spouse/Partner/Significant Other

Service Provider/Peer Helper

Brother/Sister

Daughter/Son

Extended Family

Friend

Do not know

Prefer not to answer

Other (please specify)

Question Title

* The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

11) How old is your loved one?

12 and under

13-18 years

19-25 years

26-34 years

35-44 years

45-54 years

55-64 years

65+ years

Prefer not to answer

Question Title

* The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

12) How far along is your loved one in the treatment services and support process?

Just getting started

Treatment services/support is in progress

Completed or almost completed

Completed but still receiving some services

Left early

Do not know

Prefer not to answer

Other (please specify)

Question Title

* The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

13) How many times has your loved one been hospitalized as an inpatient for mental illness?

Never

1 time

2-5 times

6-10 times

More than 10 times

Do not know

Prefer not to answer

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* The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

15) Did you receive help completing this questionnaire?

Yes

If Yes, please comment on support needed:

OPOC for Caregivers

Ontario Perception of Care ToolFor Mental Health and Addictions (OPOC-MHA) –Caregiver Version

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* If you did not feel involved in your loved one’s care team, what were the reasons? Please choose the option that best represents your experience.

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* Caregiver Involvement and EngagementThese questions are designed to allow you to provide feedback on your experience interacting with staff as part of the care team of your loved one.

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* Caregiver Education and SupportThese questions are intended to allow you to provide feedback around the education and support you received in understanding your loved one’s challenges and providing support to your loved one.

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* Caregiver Personal SupportThese questions are designed to allow you to provide feedback around the supports that were available to you as a caregiver for your own personal needs.

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* EnvironmentThese questions are designed to allow you to provide feedback on the physical space in which your loved one received treatment.

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* Perception of My Loved One’s CareThese questions are designed to allow you to provide general feedback on the care your loved one received from this service provider.

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* Overall ExperienceThese questions are designed to allow you to provide feedback on your overall experience with this service provider.

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* Please complete this section only if your loved one is/was receiving services in a residential or inpatient program.

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* Please complete this question only if your loved one is/was receiving services in a residential or inpatient program.40 a) Please comment on aspects of your experience with this treatment/support service that were particularly helpful to you.

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* 40 b) Please comment on aspects of your experience with this treatment/support service that you feel could be improved.

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Ontario Perception of Care Tool
For Mental Health and Addictions (OPOC-MHA) –
Caregiver Version

* Caregiver Involvement and Engagement

These questions are designed to allow you to provide feedback on your experience interacting with staff as part of the care team of your loved one.

* Caregiver Education and Support

These questions are intended to allow you to provide feedback around the education and support you received in understanding your loved one’s challenges and providing support to your loved one.

* Caregiver Personal Support

These questions are designed to allow you to provide feedback around the supports that were available to you as a caregiver for your own personal needs.

* Environment

These questions are designed to allow you to provide feedback on the physical space in which your loved one received treatment.

* Perception of My Loved One’s Care

These questions are designed to allow you to provide general feedback on the care your loved one received from this service provider.

* Overall Experience

These questions are designed to allow you to provide feedback on your overall experience with this service provider.

* Please complete this question only if your loved one is/was receiving services in a residential or inpatient program.

40 a) Please comment on aspects of your experience with this treatment/support service that were particularly helpful to you.