CCBHC Consumer Satisfaction Surveys-Adult-Youth-Parent-Child-English-Spanish.pdf
PDF 2 MB Posted
- Solicitation number
- 40DHHS-S3183
- Issued by
- Nevada
About this file
The document is a collection of bilingual (English and Spanish) consumer satisfaction surveys for Certified Community Behavioral Health Clinics (CCBHCs), designed to gather feedback from adult, youth, and parent/child service recipients. The surveys are comprehensive, multi-page documents that capture detailed demographic information and solicit responses about service quality, treatment experiences, personal progress, and overall satisfaction across various dimensions including staff interactions, treatment effectiveness, personal growth, family relationships, and community engagement.
These surveys are structured to collect qualitative and quantitative data across multiple rating scales, allowing respondents to provide nuanced feedback on their experiences with CCBHC services. The surveys include sections for demographic information such as age, gender, race, ethnicity, and sexual orientation, followed by a series of statements rated from "Strongly Agree" to "Strongly Disagree". The questions cover topics like service accessibility, staff responsiveness, treatment goal selection, personal development, medication management, and overall service satisfaction. The multilingual format suggests an intentional approach to accessibility and inclusive data collection, potentially aimed at understanding service experiences across diverse population groups.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 40DHHS-S3183-Insurance-Schedule.docx | DOCX document | |
| Quote Instructions.pdf | ||
| 3183-Business Associate Addendum.docx | DOCX document | |
| 40DHHS-S3183-reference-questionnaire-2025-04-02.pdf | ||
| 3183-Certification-regarding-lobbying.pdf | ||
| Service Performance Standards.docx | DOCX document | |
| CCBHC Measures Technical Manual-2019.pdf | ||
| Terms-and-conditions-for-services.pdf | ||
| 40DHHS-S3183 - Q_and_A Final 2025-05-08.pdf | ||
| DHCFP-3183 Business Continuity Agreement_v2.docx | DOCX document | |
| Standard Form Contract .pdf | ||
| 40DHHS-S3183-Attachment-Scope-of-Work.xlsx | XLSX spreadsheet | |
| 40DHHS-S3183 -CCBHC QIP -request-for-proposals-2025-04-07.docx | DOCX document | |
| Cost Schedule CCBHC QIP.xlsx | XLSX spreadsheet | |
| 3183-Requirements Matrix.xlsx | XLSX spreadsheet |
Show all 15
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
American Indian or Native American or Alaskan Native Asian Black/African American Middle Eastern and North African Native Hawaiian/Pacific Islander White/Caucasian Other Prefer not to answer
6. Please select your race (Select ALL that apply): 5. Are you Hispanic/Latino/Latinx?
No Prefer not to answer
I am happy with the friendships I have.
I have people with whom I can do enjoyable things.
I feel I belong in my community.
In a crisis, I would have the support I need from family or friends.
The location of services was convenient (parking, distance, etc.).
Staff was willing to see me as often as I felt it was necessary.
Staff returned my call in 24 hours.
Services were available at times that were good for me.
I was able to get all of the services I thought I needed.
This is an anonymous survey for services provided at:
CCBHC Name
CCBHC Location Address
Today's Date:
Please complete the following information about yourself:
1. Age:
o 18-24 o 25-34 o 35-54 o 55-64 o 65 or older
2. Sex assigned at birth:
o Male o Female o Intersex o Prefer not to answer
3. How do you describe yourself?
o Male o Female o Transgender Man o Transgender Woman o GenderqueerIGender non-forming o Other/Different Identity o Prefer not to answer
4. Sexual orientation identity:
o Straight/Heterosexual o Gay o Lesbian o Bisexual o Other/Not listed o Prefer not to answer
Please complete the following questions and leave blank if not applicable:
Strongly Agree
Neither
Agree nor Strongly Agree Disagree Disagree Disagree
16. I was able to see a psychiatrist when I wanted to.
Public Health Supportive Services 32 1--001E PLEASE CONTINUE ON BACK ---+
CONSUMER SATISFACTION SURVEY -ADULT
Agree nor Disagree
Disagree
17. I do things that are more meaningful to me.
18. I am better able to take care of my needs.
19. I am better able to handle things when they go wrong.
20. I am better able to do things that I want to do.
21. I like the services that I received here.
22. If I had other choices, I would still get services from this agency.
23. I would recommend this agency to a friend or family member.
24. I felt comfortable asking questions about my treatment and medication.
25. I, not staff, decided my treatment goals.
26. Staff here believes that I can grow, change, and recover.
27. I felt free to complain.
28. I was given information about my rights.
29. Staff told me what medication side effects to watch out for.
30. Staff respected my wishes about who is and is not to be given information about my treatment.
31. Staff were sensitive to my cultural background, race, religion, language, etc.
32. Staff helped me obtain the information I needed so that I could take charge of managing illness.
33. I was encouraged to use consumer-run programs (support groups, drop-in centers, crisis phone line, etc.).
34. Staff encouraged me to take responsibility for how I live my life.
35. I deal more effectively with daily problems.
36. I am better able to control my life.
37. I am better able to deal with crisis.
38. I am getting along better with my family.
39. I do better in social situations.
40. I do better in school and/or work.
41. My housing situation has improved.
42. My symptoms are not bothering me as much.
43. What would make services here better? Additional Comments:
Indio Americano o Nativo de Alaska Asiatico Negro/Afromericano Medio oriental y Norteafricano Nativo Hawaiano/lsleiio Pacifico Blanco/Caucasico Otra Prefiero no responder
6. Por favor seleccione su raza (Seleccione TODO lo que corresponda): 5. lEres de origen hispano/latino?
Si No Prefiero no responder
Estoy contento con las amistades que tengo.
Tengo gente con la que puedo hacer cosas agradables.
Siento que pertenezco a mi comunidad.
En una crisis, tendria el apoyo que necesito de mi familia o amigos.
La localizaci6n de los servicios era conveniente (estacionamiento, distancia, etc.).
El personal estaba dispuesto a verme tan a menudo como me pareci6 que era necesario.
El personal me devolvi6 la llamada en 24 horas.
Los servicios estaban disponibles en momentos que eran buenos para mi.
Pude obtener todos los servicios que pense que necesitaba.
Esta es una encuesta an6nima para los servicios prestados en:
Nombre de CCBHC
Dirección de ubicación de CCBHC
Fecha de Hoy:
Por favor complete lo siguiente informaci6n personel:
1. Edad:
o 18-24 o 25-34 o 35-54 o 55-64 o 65 o mayor
2. Sexo se le asign6 al nacer:
o Masculino o Femenino o lntersexual o Prefiero no responder
3. lC6mo se describe a si mismo?
o Masculino o Femenino o Hombre transgenero o Mujer transgenero o Genero queer/ Genero no conforme o Otra/ldentidad Diferente o Prefiero no responder
4. ldentidad de orientaci6n sexual:
o Heterosexual o Homosexual o Lesbiana o Bisexual o Otra/No listado o Prefiero no responder
Por favor complete las siguientes preguntas y dejelas en blanco si no corresponde:
No Estoy
Totalmente Estoy en Acuerdo Estoy Totalmente en
Acuerdo en ni en en en
Acuerdo Desacuerdo Desacuerdo Desacuerdo
16. Pude ver a un psiquiatra cuando quise.
Public Health Supportive Services 32-1-0015 POR FAVOR CONTINUA EN LA PARTE DE ATRAS
ESTUDIO DE SATISFACCION DEL CONSUMIDOR -ADULTO
Totalmente en Acuerdo
Estoy en
Acuerdo
No Estoy en Acuerdo nien Desacuerdo
Estoy en
Desacuerdo
Totalmente en
Desacuerdo
17. Hago cosas que son mas significativas para mi. 0 0 0 0 0
18. Soy mas capaz de cuidar de mis necesidades. 0 0 0 0 0
19. Soy mas capaz de manejar las cosas cuando se equivocan. 0 0 0 0 0
20. Soy mas capaz de hacer las cosas que quiero hacer. 0 0 0 0 0
21. Me gustan los servicios que recibi aqui. 0 0 0 0 0
22. Si tuviera otras opciones, seguiria recibiendo servicios de esta agencia.
23. Yo recomendaria esta agencia a un amigo o miembro de la familia.
los medicamentos que debia mantener en cuenta.
debe recibir informaci6n sobre mi tratamiento.
religion, idioma, etc.
enfermedad.
telef6nica de crisis, etc.)
vivo mi vida.
0 0 0 0 0 0 0 0 0 0
24. Me sentia c6modo haciendo preguntas acerca de mi tratamiento y medicaci6n. 0 0 0 0 0
25. Yo, no el personal, decidi mis metas de tratamiento. 0 0 0 0 0
26. El personal aqui cree que puedo crecer, cambiar y recuperar. 0 0 0 0 0
27. Me senti libre para quejarme. 0 0 0 0 0
28. Me dieron informaci6n sobre mis derechos. 0 0 0 0 0
29. El personal me dijo cuales son los efectos secundarios de 0 0 0 0 0
30. El personal respet6 mis deseos sobre quien si y quien no 0 0 0 0 0
31. El personal era sensible sobre mi transfondo cultural, raza, 0 0 0 0 0
32. El personal me ayud6 a obtener la informaci6n que necesitaba para poder encargarme de manejar mi 0 0 0 0 0
33. Me animaron a utilzar los programas dirigidos por los consumidores (grupos de apoyo, centros de acogida, linea 0 0 0 0 0
34. El personal me animo a sumir la responsabilidad de como 0 0 0 0 0
35. Trato los problemas diarios mas eficazmente. 0 0 0 0 0
36. Soy mas capaz de controlar mi vida. 0 0 0 0 0
37. Soy mas capaz de lidiar con crisis. 0 0 0 0 0
38. Me estoy llevando mejor con mi familia. 0 0 0 0 0
39. Me siento mejor en situaciones sociales. 0 0 0 0 0
40. Me siento mejor en la escuela y/o trabajo. 0 0 0 0 0
41. Mi situaci6n de alojamiento ha mejorado. 0 0 0 0 0
42. Mis sintomas ya no me molestan tanto. 0 0 0 0 0
43. lQue mejoraria de los servicios aqui? Comentarios Adicionales:
Today's Date:
Please complete the following information:
1. Child's Age:
O Less than 1 0 7 0 1 0 8 0 2 0 9 0 3 0 10 0 4 0 11 0 5 0 12 0 6
2. Age of Parent
[I]
3. Gender of Parent?
0 Male 0 Female 0 Transgender 0 Other/Different Identity 0 Prefer not to answer
4. Are you Hispanic/Latino/Latinx?
o Yes 0 No 0 Prefer not to answer
5. Please select your (parent) race (Select ALL that apply):
□ American Indian or Native American or
Alaskan Native
□ Asian
□ Black/African American
□ Middle Eastern and North African
□ Native Hawaiian/Pacific Islander
□ White/Caucasian
□ Other
□ Prefer not to answer
6. What is the child's gender?
o Male 0 Female O Transgender 0 Other/Different Identity 0 Prefer not to answer
7. Is the child, or either parent, Hispanic/ Latino/Latinx?
o Yes 0 No 0 Prefer not to answer
8. Please select the child's race (Select ALL that apply):
□ American Indian or Native American or Alaskan Native
□ Asian
□ Black/African American
□ Middle Eastern and North African
□ Native Hawaiian/Pacific Islander
□ White/Caucasian
Agree Agree Disagree Disagree Disagree
9. I have people with whom I can do enjoyable things.
10. I have people that I am comfortable talking with about my child's problems.
11. I know people who will listen and understand me when I need to talk.
12. In a crisis, I would have the support I need from family or friends.
13. The location of the services was convenient for us.
14. Services were available at times that were good for us.
15. I helped to choose my child's services.
16. I helped to choose my child's treatment goals.
17. The people helping my child stuck with us no matter what.
18. Staff spoke with me in a way I understood.
Public Health Supportive Services 32-3-001E PLEASE CONTINUE ON BACK
CONSUMER SATISFACTION SURVEY - PARENT /CHILD
Disagree
19. I participated in my child's treatment. 0 0 0 0 0
20. I felt my child had someone to talk to when he/she was troubled. 0 0 0 0 0
21. My family got the help we wanted for our child. 0 0 0 0 0
22. My family got as much help as we needed for our child. 0 0 0 0 0
23. Staff treated me with respect. 0 0 0 0 0
24. Staff respected my family's religious/spiritual beliefs. 0 0 0 0 0
25. Staff was sensitive to my cultural/ethnic background. 0 0 0 0 0
26. My child is better able to cope when things go wrong. 0 0 0 0 0
27. My child is better at handling daily life. 0 0 0 0 0
28. My child is better able to do things he/she want to do. 0 0 0 0 0
29. I am satisfied with my family life right now. 0 0 0 0 0
30. If my child took medication for his/her problems, staff told us what medication side effects to watch out for. 0 0 0 0 0
31. I felt free to complain. 0 0 0 0 0
32. My child gets along better with family members. 0 0 0 0 0
33. My child gets along better with friends and other people. 0 0 0 0 0
34. My child is doing better in school. 0 0 0 0 0
35. What would make services here better? Additional Comments:
Fecha de Hoy:
Por favor complete lo siguiente informaci6n:
1. Edad del nino/a:
0 Menos de 1 0 7 0 1 0 8 O 2 o 9 o 3 o 10 0 4 0 11 0 5 0 12 0 6
2. Edad del Padre:
[I]
3. Genero del Padre?
0 Masculino 0 Femenino o Transgenero o Otra/ldentidad Diferente 0 Prefiero no responder
4. tEres de origen hispano/latino?
O Si 0 No 0 Prefiero no responder
5. Por favor seleccione su (padre) raza (Seleccione TODO lo que corresponda):
□ Indio Americano o Nativo de Alaska
□ Asiatico
□ Negro/Afromericano
□ Medio oriental y Norteafricano
□ Nativo Hawaiano/lsleiio Pacifico
□ Blanco/Caucasico
□ Otra
□ Prefiero no responder
6. tCual es el genero del nino/a?
0 Masculino 0 Femenino 0 Transgenero 0 Otra/ldentidad Diferente 0 Prefiero no responder
7. tEs el nino/a, o uno de los padres, de origen hispano/latino?
O Si 0 No 0 Prefiero no responder
8. Por favor seleccione su raza del nino/a (Seleccione TODO lo que corresponda):
□ Indio Americano o Nativo de Alaska
□ Asiatico
□ Negro/Afromericano
□ Medio oriental y Norteafricano
□ Nativo Hawaiano/lsleiio Pacifico
□ Blanco/Caucasico
Por favor complete las siguientes preguntas y dejelas en blanco si no corresponde:
en Acuerdo
18. El personal habl6 conmigo de una manera que entendi.
Public Health Supportive Services 32-3--001s POR FAVOR CONTINUA EN LA PARTE DE ATRAS---+
ESTUDIO DE SATISFACCION DEL CONSUMIDOR - PADRES/HIJOS
Totalmente
Estoy en Acuerdo Estoy Totalmente en Acuerdo
32. Mi hijo/a se lleva mejor con la familia.
33. Mi hijo/a se lleva mejor con amigos y con otras personas.
34. Mi hijo/a esta haciendo mejor en la escuela.
CONSUMER SATISFACTION SURVEY - YOUTH
Today's Date: _
Please complete the following information about yourself:
1. Age:
0 13 0 14 0 15 0 16 0 17
2. Gender:
o Male 0 Female o Transgender 0 Other/Different Identity 0 Prefer not to answer
3. Are you Hispanic/ Latino/Latinx?
o Yes 0 No O Prefer not to answer
4. Please select your race (Select ALL that apply):
□ American Indian or Native American or Alaskan Native
□ Asian
□ Black/African American
□ Middle Eastern and North African
□ Native Hawaiian/Pacific Islander
□ White/Caucasian
Agree Agree Disagree Disagree Disagree
5. I have people with whom I can do enjoyable things. 0 0 0 0 0
6. I have people that I am comfortable talking with about my problems.
7. I know people who will listen and understand me when I need to talk. 0 0 0 0 0
8. In a crisis, I would have the support I need from family or friends. 0 0 0 0 0
9. The location of the services was convenient. 0 0 0 0 0
10. Services were available at times that were good for me. 0 0 0 0 0
11. I helped to choose my services. 0 0 0 0 0
12. I helped to choose my treatment goals. 0 0 0 0 0
13. The people helping me stuck with me no matter what. 0 0 0 0 0
14. Staff spoke with me in a way I understood. 0 0 0 0 0
15. I participated in my own treatment. 0 0 0 0 0
16. I felt I had someone to talk to when I was troubled. 0 0 0 0 0
17. I got the help I wanted. 0 0 0 0 0 Public Health Supportive Services 32-2-001E PLEASE CONTINUE ON BACK
0 0 0 0 0
Disagree
18. I got as much help as I needed. 0 0 0 0 0
19. Staff treated me with respect. 0 0 0 0 0
20. Staff respected my family's religious/spiritual beliefs. 0 0 0 0 0
21. Staff was sensitive to my cultural/ethnic background. 0 0 0 0 0
22. I am better able to cope when things go wrong. 0 0 0 0 0
23. I am better at handling daily life. 0 0 0 0 0
24. I am better able to do things I want to do. 0 0 0 0 0
25. I am satisfied with my family life right now. 0 0 0 0 0
26. If I took medication for my problems, staff told me what medication side effects to watch out for. 0 0 0 0 0
27. I felt free to complain. 0 0 0 0 0
28. I am getting along better with my family. 0 0 0 0 0
29. I get along better with friends and other people. 0 0 0 0 0
30. I am doing better in school and/or work. 0 0 0 0 0
31. What would make services here better? Additional Comments:
ESTUDIO DE SATISFACCION DEL CONSUMIDOR - JUVENTUD
Fecha de Hoy: _
Por favor complete lo siguiente informaci6n personel:
1. Edad:
0 13 0 14 0 15 0 16 0 17
2. Genero:
O Masculino 0 Femenino 0 Transgenero 0 Otra/ldentidad Diferente 0 Prefiero no responder
3. lEres de origen hispano/latino?
0 Si 0 No 0 Prefiero no responder
4. Por favor seleccione su raza (Seleccione TOCO lo que corresponda):
□ Indio Americano o Nativo de Alaska
□ Asiatico
□ Negro/Afromericano
□ Medio oriental y Norteafricano
□ Nativo Hawaiano/lsleiio Pacifico
□ Blanco/Caucasico
Por favor complete las siquientes preguntas y_ dejelas en blanco si no corresponde:
Totalmente Estoy en Acuerdo Estoy Totalmente en en nien en en
Acuerdo Acuerdo Desacuerdo Desacuerdo Desacuerdo
5. Tengo gente con la que puedo hacer cosas agradables.
6. Tengo gente con la que me siento c6modo hablando de mis problemas.
7. Conozco gente que me escuchara y me entendera cuando necesite hablar.
8. En una crisis, tendria el apoyo que necesito de mi familia o amigos.
buenos para mi.
12. Ayude a elegir las metas de mi tratamiento. 0 0 0 0 0
13. La gente que me ayudo se qued6 conmigo y no importo que. 0 0 0 0 0
14. El personal habl6 conmigo de una manera que entendi. 0 0 0 0 0
15. Yo participe en mi propio tratamiento. 0 0 0 0 0
16. Senti que tenia a alguien con quien hablar cuando estaba preocupado.
17. Consegui la ayuda que queria. 0 0 0 0 0
Public Health Supportive Services 32-2-001S POR FAVOR CONTINUA EN LA PARTE DE ATRAS
0 0 0 0 0
0 0 0 0 0
9. La localizaci6n de los servicios era conveniente. 0 0 0 0 0
10. Los servicios estaban disponibles en momentos que eran 0 0 0 0 0
11. Ayude a elegir mis servicios. 0 0 0 0 0 en en nien en en
Acuerdo Acuerdo Desacuerdo Desacuerdo Desacuerdo
18. Consegui toda la ayuda que necesitaba. 0 0 0 0 0
19. El personal me trat6 con respeto. 0 0 0 0 0
20. El personal respet6 las creencias religiosas/espirituales de mi familia. 0 0 0 0 0
21. El personal era sensible a mi cultura/origen etnico. 0 0 0 0 0
22. Soy mas capaz de hacer frente cuando las cosas van mal. 0 0 0 0 0
23. Soy mejor manejando la vida diaria. 0 0 0 0 0
24. Soy mas capaz de hacer las cosas que quiero hacer. 0 0 0 0 0
25. Estoy satisfecho con mi vida familiar ahora mismo. 0 0 0 0 0
26. Si tomaba medicamentos para mis problemas, el personal me aviso a que efectos secundarios de la medicaci6n necesitaba prestarle atenci6n.
0 0 0 0 0
27. Me senti libre para quejarme. 0 0 0 0 0
28. Me estoy llevando mejor con mi familia. 0 0 0 0 0
29. Me llevo mejor con amigos y con otras personas. 0 0 0 0 0
30. Estoy haciendo mejor en la escuela y/o trabajo. 0 0 0 0 0
| CONSUMER SATISFACTION SURVEY - YOUTH |
| ESTUDIO DE SATISFACCION DEL CONSUMIDOR - JUVENTUD |
File details come from the government source that posted it. Updated .