Survey for Mental Health Providers
** This is a confidential survey developed to track services related to the Cold Springs Fire. The intention is aimed at helping program managers better understand services, possible gaps in services, and will be used solely in the refinement of future services. Your help in answering these questions will greatly inform how we are able to address support in the future.
All information contained in this document is protected under HIPPA and will remain confidential.
Please identify the type of work you do:
Please indicate all affiliations that apply:
What gender do you identify with?
Age:
What race or ethnicity do you identify with?
For what race or ethnicity did you most frequently provide services? (Mark all that apply)
Were you made aware of the Mental Health Voucher program?
What percentage of your clients working with residual effects from the Cold Springs Fire utilized the Mental Health Voucher program?
What were common presenting symptoms for your clients? (Please check all that apply)
Were there any additional services you would have liked to offer to your clients but were not able to provide? If so, what would they be?
Your answer
Did you perceive any differences in working with multicultural clients? If so, explain.
Your answer
Any other information you feel would be helpful for us to know?
Your answer
May we contact you for an individual interview? If so, please provide your preferred means of contact.
Your answer
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