Residential Treatment Survey

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* 1. Who paid for your child's residential treatment? Check all that apply.

Medicaid/Medical Assistance

MinnesotaCare

Private insurance

County funds

Other (please specify)

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* 2. Did you need to go through the county for residential treatment?

Yes

Don't remember/Don't know

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* 3. Did you have to go through a county screening team to obtain residential services for your child?

Yes

Other (please specify)

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* 4. If you went through a screening team, please share your experiences.

	Strongly agree	Agree	Neither agree or disagree	Disagree	Strongly disagree
I was invited to attend the screening team meetings	I was invited to attend the screening team meetings Strongly agree	I was invited to attend the screening team meetings Agree	I was invited to attend the screening team meetings Neither agree or disagree	I was invited to attend the screening team meetings Disagree	I was invited to attend the screening team meetings Strongly disagree
The right people were a part of the screening team	The right people were a part of the screening team Strongly agree	The right people were a part of the screening team Agree	The right people were a part of the screening team Neither agree or disagree	The right people were a part of the screening team Disagree	The right people were a part of the screening team Strongly disagree
The right number of people were a part of the screening team	The right number of people were a part of the screening team Strongly agree	The right number of people were a part of the screening team Agree	The right number of people were a part of the screening team Neither agree or disagree	The right number of people were a part of the screening team Disagree	The right number of people were a part of the screening team Strongly disagree
My concerns were heard by the screening team, my views were respected	My concerns were heard by the screening team, my views were respected Strongly agree	My concerns were heard by the screening team, my views were respected Agree	My concerns were heard by the screening team, my views were respected Neither agree or disagree	My concerns were heard by the screening team, my views were respected Disagree	My concerns were heard by the screening team, my views were respected Strongly disagree
The screening team was a useful process	The screening team was a useful process Strongly agree	The screening team was a useful process Agree	The screening team was a useful process Neither agree or disagree	The screening team was a useful process Disagree	The screening team was a useful process Strongly disagree
I agreed with the decision of the screening team	I agreed with the decision of the screening team Strongly agree	I agreed with the decision of the screening team Agree	I agreed with the decision of the screening team Neither agree or disagree	I agreed with the decision of the screening team Disagree	I agreed with the decision of the screening team Strongly disagree

Other (please specify)

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* 5. If you went through a screening team, about how long did it take between the time you asked the county for residential treatment until the time your child was placed?

One week

Two weeks

Three weeks

A month

More than a month

Other (please specify)

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* 6. Did any part of the screening process (including a relative search if one was done) identify people and resources in your community to help your child and family?

Yes

Other (please specify)

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* 7. Please provide any other comments about your experience with the county screening teams.

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* 8. Do you think there should be a county screening team to decide if a child needs residential treatment or should this be decided by the treating mental health professional?

Yes there should be a screening team

No there should not be a screening team, it should be decided by the treating mental health professional

Other (please specify)

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* 9. If there has to be a screening team, do you think you should have final say in who is invited to the screening team?

Yes

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* 10. The proposed law would require the county to reach out to your relatives to see if they could care for your child instead of sending them to residential treatment. How would you feel about that?

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* 11. Please share any other thoughts you have on the process of obtaining residential treatment for your child.

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* 12. If you are willing to talk more about your experience with NAMI please provide your contact information. Thank you!

Name

Address

Address 2

City/Town

ZIP/Postal Code

Email Address

Phone Number