Care Partner RAP Survey

We appreciate and value your constructive feedback and will use this information to help shape future care and programing at our facility. Thank you—your opinions are welcome and important to our team. Not all questions may be specific to your experience.

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* 1. Name

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* 2. If open to us contacting you for further feedback please enter a phone number.

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* 3. Today's Date

Date

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* 4. Did staff provide you with a Care Partner Recovery Action Plan book?

Yes

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* 5. Would you be interested in attending education classes and/or care partner support group?

Yes

If YES, what days and specific times would be most convenient for you to attend?

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* 6. Were your questions concerning treatment options or follow-up care addressed?

Yes

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* 7. How helpful or useful was information about the following:

	Not Very Helpful	Poor	Fair	Good	Very Helpful
Overview of inpatient hospitalization and outpatient programs	Overview of inpatient hospitalization and outpatient programs Not Very Helpful	Overview of inpatient hospitalization and outpatient programs Poor	Overview of inpatient hospitalization and outpatient programs Fair	Overview of inpatient hospitalization and outpatient programs Good	Overview of inpatient hospitalization and outpatient programs Very Helpful
Confidentiality and limits to disclosing information	Confidentiality and limits to disclosing information Not Very Helpful	Confidentiality and limits to disclosing information Poor	Confidentiality and limits to disclosing information Fair	Confidentiality and limits to disclosing information Good	Confidentiality and limits to disclosing information Very Helpful
Sharing useful information about your loved one	Sharing useful information about your loved one Not Very Helpful	Sharing useful information about your loved one Poor	Sharing useful information about your loved one Fair	Sharing useful information about your loved one Good	Sharing useful information about your loved one Very Helpful
Learning about communication strategies	Learning about communication strategies Not Very Helpful	Learning about communication strategies Poor	Learning about communication strategies Fair	Learning about communication strategies Good	Learning about communication strategies Very Helpful
Recognizing the signs of a crisis	Recognizing the signs of a crisis Not Very Helpful	Recognizing the signs of a crisis Poor	Recognizing the signs of a crisis Fair	Recognizing the signs of a crisis Good	Recognizing the signs of a crisis Very Helpful
Being informed of your loved one’s recovery action plan	Being informed of your loved one’s recovery action plan Not Very Helpful	Being informed of your loved one’s recovery action plan Poor	Being informed of your loved one’s recovery action plan Fair	Being informed of your loved one’s recovery action plan Good	Being informed of your loved one’s recovery action plan Very Helpful
5 steps to help in a crisis	5 steps to help in a crisis Not Very Helpful	5 steps to help in a crisis Poor	5 steps to help in a crisis Fair	5 steps to help in a crisis Good	5 steps to help in a crisis Very Helpful
How to communicate with first responders	How to communicate with first responders Not Very Helpful	How to communicate with first responders Poor	How to communicate with first responders Fair	How to communicate with first responders Good	How to communicate with first responders Very Helpful
Tips for managing medications	Tips for managing medications Not Very Helpful	Tips for managing medications Poor	Tips for managing medications Fair	Tips for managing medications Good	Tips for managing medications Very Helpful
Discussing and documenting follow up care	Discussing and documenting follow up care Not Very Helpful	Discussing and documenting follow up care Poor	Discussing and documenting follow up care Fair	Discussing and documenting follow up care Good	Discussing and documenting follow up care Very Helpful
Self-care strategies for yourself	Self-care strategies for yourself Not Very Helpful	Self-care strategies for yourself Poor	Self-care strategies for yourself Fair	Self-care strategies for yourself Good	Self-care strategies for yourself Very Helpful
Financial resources	Financial resources Not Very Helpful	Financial resources Poor	Financial resources Fair	Financial resources Good	Financial resources Very Helpful
Community and support resources	Community and support resources Not Very Helpful	Community and support resources Poor	Community and support resources Fair	Community and support resources Good	Community and support resources Very Helpful

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* 8. Were you involved with any treatment, activities or discharge planning?

Yes

Comments:

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* 9. Do you feel the CP RAP helped you feel more aware and ready for your loved one’s follow up care plan?

Yes

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* 10. How aware are you of your loved one’s follow up care plan?

not at all aware

slightly aware

somewhat aware

very aware

completely aware

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* 11. Do you feel you have a better understanding of the importance of follow up care including therapy, support groups, and other recommended supports?

Yes

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* 12. Do you feel you have a better understanding of the importance of your loved one adhering to medications?

Yes

N/A

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* 13. Do you feel the Care Partner RAP book was easy to understand?

Yes

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* 14. How helpful was the Care Partner RAP in providing a better understanding of your loved one’s mental health challenges and needs?

Extremely helpful

Very helpful

Somewhat helpful

Not so helpful

Not at all helpful

Care Partner RAP Survey

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* 1. Name

Question Title

* 2. If open to us contacting you for further feedback please enter a phone number.

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* 3. Today's Date

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* 4. Did staff provide you with a Care Partner Recovery Action Plan book?

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* 5. Would you be interested in attending education classes and/or care partner support group?

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* 6. Were your questions concerning treatment options or follow-up care addressed?

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* 7. How helpful or useful was information about the following:

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* 8. Were you involved with any treatment, activities or discharge planning?

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* 9. Do you feel the CP RAP helped you feel more aware and ready for your loved one’s follow up care plan?

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* 10. How aware are you of your loved one’s follow up care plan?

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* 11. Do you feel you have a better understanding of the importance of follow up care including therapy, support groups, and other recommended supports?

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* 12. Do you feel you have a better understanding of the importance of your loved one adhering to medications?

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* 13. Do you feel the Care Partner RAP book was easy to understand?

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* 14. How helpful was the Care Partner RAP in providing a better understanding of your loved one’s mental health challenges and needs?

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* 15. What suggestions or resources were most helpful in the section on Self-Care?

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* 16. Any further comments or suggestions regarding the Care Partner RAP?