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The goal of the Community Health Worker project is to implement an evidence-based, rural-specific program designed to serve individuals suffering from mental illness and substance abuse by integrating research and considerations for prevention, intervention, and follow-up treatment.  In an effort to meet these considerations, please help us in gathering information by completing the following short survey.  Please put an X in the box, under the rating that best describes your perspective.

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* 1. Name: (optional)

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* 2. Please enter today's date.

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* 3. Please mark which role best describes you.

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* 4. Community members and students feel accepted in seeking local mental health services.

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* 5. Community members and students feel accepted in seeking local addiction counseling.

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* 6. Abundant local mental health services are available to community members and students.

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* 7. Abundant local addiction counseling services are available to community members and students.

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* 8. Local mental health services are easily accessible.

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* 9. Local addiction counseling services are easily accessible.

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* 10. Community members and students can receive local mental health services quickly.

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* 11. Community members and students can receive local addiction counseling services quickly.

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* 12. I have sufficient awareness about local mental health and addiction counseling supports and needs.

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* 13. I am supportive of improving the acceptability, accessibility, availability, and affordability of local mental health and addiction counseling services.

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* 14. I would like to help improve the acceptability, accessibility, availability, and affordability of local mental health and addiction counseling services.

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* 15. I understand how I can help improve the acceptability, accessibility, availability, and affordability of local mental health and addiction counseling services.

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* 16. I am very satisfied with communication between relevant, local organizations in meeting mental health needs of community members and students.

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* 17. For health providers, law enforcement, court system employees, mental health providers, and educators:  I feel confident and effective in treating or helping individuals who have more complex or multiple mental health concerns.

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* 18. For health providers, law enforcement, court system employees, mental health providers, and educators:  I have substantial support in identifying individuals who are high-risk for depression or suicide.

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* 19. For health providers, law enforcement, court system employees, mental health providers, and educators:  I have substantial support in providing follow-up care for individuals who are high-risk for depression or suicide.

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* 20. INSTRUCTIONS: For the purposes of this survey, “mental health professionals” include psychologists, psychiatrists, clinical social workers, and counselors. Likewise, “mental health concerns” include issues ranging from personal difficulties (e.g., loss of a loved one) to mental illness (e.g., anxiety, depression). Please mark the circle in each row that best represents your opinion.
If I had a mental health concern, seeking help from a mental health professional would be...

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* 21. If I had a mental health concern, seeking help from a mental health professional would be...

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* 22. If I had a mental health concern, seeking help from a mental health professional would be...

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* 23. If I had a mental health concern, seeking help from a mental health professional would be...

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* 24. If I had a mental health concern, seeking help from a mental health professional would be...

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* 25. If I had a mental health concern, seeking help from a mental health professional would be...

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* 26. If I had a mental health concern, seeking help from a mental health professional would be...

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* 27. If I had a mental health concern, seeking help from a mental health professional would be...

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* 28. If I had a mental health concern, seeking help from a mental health professional would be...

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