2015 Alliance Community Needs Assessment (Provider Survey)

1. Survey of Alliance Providers

Alliance Behavioral Healthcare is committed to the continuous improvement of the services offered to our residents with mental health, developmental disabilities, and substance use needs. We are conducting a needs assessment to understand service needs and gaps.

Please take a few minutes to complete this brief survey. Your responses are very important to help us understand the service needs in our community. The information that we receive through this process will inform our service planning and development efforts for the next year and will help us better serve adults, children, and families in our communities.

Please complete the survey by Friday, January 30.

Thank you!

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* 1. Please tell us which of the following describes you best:

Solo Practitioner

Group Practice

Agency

Hospital

Other (please specify)

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* 2. What is your role within your organization?

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* 3. Please let us know the populations that you or your agency serves (select all that apply):

Child/Adolescent Mental Health

Child/Adolescent Developmental Disabilities

Child/Adolescent Substance Abuse

Adult Mental Health

Adult Developmental Disabilities

Adult Substance Abuse

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* 4. In which of the Alliance catchment area counties do you provide services (select all that apply)?

Cumberland

Durham

Johnston

Wake

Other (please specify)

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* 5. Which of the following do you or your agency offer to improve service accessibility (select all that apply)?

Bilingual/bicultural services (Spanish)

Bilingual/bicultural services (Other--please elaborate below)

Integrated medical/behavioral health services

Services for veterans/active military/military families

Open Access (including same-day access to psychiatry)

Same day appointments

Weekend appointments

Evening appointments

Telepsychiatry

Services provided in the home

Assistance with transportation

(Optional) Please provide additional information including your agency name. location, and further details about above responses.

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* 6. Describe your capacity to provide disaster/emergency response services (select all that apply)

Disaster plan is in place to ensure responsiveness to current consumers

Some staff have been trained through NC Disaster Response Network

Staff available to assist at shelters or other community sites

Specialized training in disaster response (provide details in next question)

Other (provide details)

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* 1. Please tell us which of the following describes you best:

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* 2. What is your role within your organization?

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* 3. Please let us know the populations that you or your agency serves (select all that apply):

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* 4. In which of the Alliance catchment area counties do you provide services (select all that apply)?

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* 5. Which of the following do you or your agency offer to improve service accessibility (select all that apply)?

Question Title

* 6. Describe your capacity to provide disaster/emergency response services (select all that apply)

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* 7. If staff have received specialized training in disaster response, please provide additional details about the training