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Parent and Community Member Needs Assessment Survey
Para cambiar el idioma de la encuesta al español, seleccione Español en la esquina superior derecha.
Thank you for taking the time to complete this survey!
The purpose of this survey is to better understand your community's needs. The survey will take about 5 minutes. Please only take this survey one time. Your participation is greatly appreciated.
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1.
Are you a parent or caregiver to a child under the age of 18?
(Required.)
Yes
No
Prefer not to answer
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2.
What is your zip code?
(Required.)
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3.
From your perspective, what are the biggest issues impacting your community in general?
Select top 3
(Required.)
Limited educational opportunities (e.g., lack of quality schools, vocational training, or adult education)
Lack of economic opportunities and jobs (including livable wages and career advancement)
Limited access to physical health care (such as doctors, specialists, and preventative care)
Limited access to mental health services (including treatment for anxiety, depression, and other conditions)
Untreated substance use disorder (due to lack of treatment resources or prevention efforts)
Limited access to basic necessities (e.g., food, clean water, electricity, and affordable utilities)
Inadequate public transportation options (such as limited bus routes, unreliable service, or lack of infrastructure)
Lack of affordable and high-quality housing (including options for low-income families and individuals)
Insufficient safe and accessible recreational spaces (such as parks, playgrounds, and community centers)
Deteriorating infrastructure (e.g., poor-quality roads, bridges, and sidewalks)
Abandoned housing or underutilized commercial buildings
Rising crime and public safety concerns (including violent crime, property crime, or gang activity)
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4.
Which factors do you believe most contribute to substance use and behavioral health challenges in our community?
Select up to 3
(Required.)
Adverse Childhood Experiences (e.g., abuse, neglect, household substance use)
Family conflict or lack of parental involvement
Economic hardship and poverty
Lack of access to mental health care and support services
Peer pressure and social norms around substance use
Community violence or unsafe environments
Limited access to positive youth activities and mentorship
Social media and media influences
Lack of education and awareness about substance use risks
Other (please specify)