School-Based Health Center - School District Employees Survey
We are planning to open a school-based health center in the new Cañon City Middle School. Your responses to this survey will help the planning team understand what kinds of student health services are needed, such as medical care, counseling services, dental care, etc.

As a staff member of Cañon City School District your opinion about needed health services is very important.

Cañon City School District, Solvista Health, and Valley-Wide Health Systems are part of the planning team for the school-based health center at the new Cañon City Middle School. Students with a signed parental consent and district employees will be eligible to receive services at the School Based Health Center.

An SBHC brings the healthcare provider into a school so students and staff can avoid health related absences and receive the support they need to succeed in the classroom. SBHCs are staffed by a multi-disciplinary team of qualified medical and mental health professionals.

Services provided may include: physical exams, including sports physicals; immunizations; care for acute, minor injury and illness; management of chronic conditions such as asthma, allergies, and diabetes; counseling services; routine lab tests and throat cultures; prescriptions and medications; health wellness education; referral to community providers and agencies; and assistance to families with enrollment into Medicaid and CHP+.

We are in the process of conducting a needs assessment to determine the specific health needs of students and district staff. In order to help us plan for the School-Based Health Center, we would like to ask you a few questions about what you see as the health needs of district staff and students in the district. This information will help us decide where the greatest need is and what types of services and programs to offer at the center. Your answers are completely confidential. You do not need to put your name anywhere on this form. Thank you for your help.
1. What do you like best about the district? *
Required
2. On a scale of 1-5 (1 being major, 5 being minor) rate each of the physical health complaints and chronic conditions listed below for youth in the district. *
1
2
3
4
5
ADD/ADHD
Asthma
Coughing, breathing issues
Diabetes
Headaches
Injuries or accidents
Overweight/Obesity
Sore throat, colds/fever, earaches
Stomach aches
Skin problems or rashes
Seizures
Toothaches or dental problems
2.1 On a scale of 1-5 (1 being major, 5 being minor) rate each of the physical health complaints and chronic conditions listed below for district employees *
1
2
3
4
5
ADD/ADHD
Asthma
Coughing, breathing issues
Diabetes
Headaches
Injuries or accidents
Overweight/Obesity
Sore throat, colds/fever, earaches
Stomach aches
Skin problems or rashes
Seizures
Toothaches or dental problems
3. We would like your perception on other issues. Please rate each of the problems listed below on a scale of 1-5 (1 being major, 5 being minor) for youth in the district. *
1
2
3
4
5
Academic problems
Alcohol use
Depression/anxiety and other mental health issues
Drug use
Pregnancy, sexually transmitted infections
Problems at home
Tobacco use
Violence, bullying, and other behavior problems
3.1 We would like your perception on other issues. Please rate each of the problems listed below on a scale of 1-5 (1 being major, 5 being minor) for district employees. *
1
2
3
4
5
Academic problems
Alcohol use
Depression/anxiety and other mental health issues
Drug use
Pregnancy, sexually transmitted infections
Problems at home
Tobacco use
Violence, bullying, and other behavior problems
4. What are the most pressing problems district employees face? (Check all that apply.) *
Required
4.1 What are the most pressing problems children and youth in our community face? (Check all that apply.) *
Required
5. For students who might use the center, what hours would be best? (Check all that apply.) *
Required
5.1 For district employees who might use the center, what hours would be best? (Check all that apply.) *
Required
6. What school-based services do you think are needed for students and district employees? (Check all that apply.) *
Required
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