MHAT Pre-Survey

Pre-Survey

Please complete the following questions PRIOR to the start of the training. Your information will be utilized to evaluate the course as an evidence-based intervention in Rhode Island.

Question Title

* Please enter the first letter of your first name.
For example, if your first name is John, you would enter J:

Question Title

* Please enter the first letter of your last name.
For example, if your last name is Doe, you would enter D:

Question Title

* Please enter the last letter of your first name.
For example, if your first name is John, you would enter N:

Question Title

* Please enter the last letter of your last name.
For example, if your last name is Doe, you would enter E:

Question Title

* Please enter the two-digit day of your birth date (01-31).
For example, if your date of birth is December 18, you would enter 18 or if your date of birth is December 2, you would enter 02:

Question Title

* What is your age?

Under 18

18-24

25-34

35-44

45-54

55+

Question Title

* What is your gender?

Female

Male

Transgender

Non-Binary

Prefer not to answer

Other (please specify)

Question Title

* What is your race? (Check as many as apply)

White

Black or African American

American Indian or Alaska Native

Asian

Native Hawaiian or other Pacific Islander

Prefer not to answer

Other (please specify)

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* Are you Hispanic or Latino?

Yes

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* Are you of Portuguese ancestry?

Yes

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* What is your sexual identity/identity status?

Heterosexual

Lesbian

Gay

Bisexual

Prefer not to answer

Other (please specify)

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* Do you provide care or services for someone over 55?

Yes

Question Title

* Do you identify as a person with lived experience(mental health or substance use challenges), serious mental illness, or in long-term recovery?

Yes

Question Title

* Do you support a family member with lived experience (mental health or substance use challenges), serious mental illness, or in long-term recovery?

Yes

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* Are you a veteran or someone caring for a veteran?

Yes

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* Are you an employee of a municipal government in Barrington, Bristol, East Providence, or Warren?

Yes

Question Title

* Are you a caregiver of a child with special needs (ie. IEP, 504 plan, learning differences, etc.)?

Yes

Question Title

* Where do you live?

Barrington

Bristol

Warren

East Providence

In Rhode Island, outside of Barrington, Bristol, Warren & East Providence

Out of State

Question Title

* Where is the organization or job that you work for located?

Barrington

Bristol

Warren

East Providence

In Rhode Island, outside of Barrington, Bristol, Warren & East Providence

Out of State

Not Applicable

Question Title

* Which of the following mental health or related workforce category BEST describes you?

Mental Health Professionals (e.g., Licensed social worker or counselor, guidance counselor, school psychologist, behavioral health support, etc.)

Health Professionals (e.g., Occupational or physical therapist, school nurse, speech pathologist, primary care provider, etc.)

Family/Student Support (e.g., Case worker or manager, community outreach worker, pupil personnel worker, crisis care worker, etc.)

Tribal (e.g., Healer, elder, elected tribal official)

Law Enforcement (e.g., Probation officer, police officer, SRO)

First Responders (e.g., Firefighters, EMS)

Educator (e.g., School admin, teacher/professor, librarian, paraeducator, early intervention specialist, student, etc.)

Support Staff (e.g., Custodian, cafeteria attendant, bus driver, before and/or after care staff, volunteer, monitor, etc.)

Administrative & Clerical (e.g., Administrative assistant, secretary, registrar, evaluator, etc.)

Other, please specify:

Question Title

* Where do you anticipate using the content from this workshop most directly? (Check all that apply)

Family

Work with colleagues/employees

Work with clients/patients/customers

School - as a peer

School - as an instructor/administrator/staff member

Community groups

Other, please specify:

Question Title

* Are you attending this program as part of a specific grant or program (i.e., MHAT, FRSAN, SOR)?

Yes

MHAT Pre-Survey

Pre-Survey

Question Title

* Please enter the first letter of your first name.For example, if your first name is John, you would enter J:

Question Title

* Please enter the first letter of your last name.For example, if your last name is Doe, you would enter D:

Question Title

* Please enter the last letter of your first name.For example, if your first name is John, you would enter N:

Question Title

* Please enter the last letter of your last name.For example, if your last name is Doe, you would enter E:

Question Title

* Please enter the two-digit day of your birth date (01-31).For example, if your date of birth is December 18, you would enter 18 or if your date of birth is December 2, you would enter 02:

Question Title

* What is your age?

Question Title

* What is your gender?

Question Title

* What is your race? (Check as many as apply)

Question Title

* Are you Hispanic or Latino?

Question Title

* Are you of Portuguese ancestry?

Question Title

* What is your sexual identity/identity status?

Question Title

* Do you provide care or services for someone over 55?

Question Title

* Do you identify as a person with lived experience(mental health or substance use challenges), serious mental illness, or in long-term recovery?

Question Title

* Do you support a family member with lived experience (mental health or substance use challenges), serious mental illness, or in long-term recovery?

Question Title

* Are you a veteran or someone caring for a veteran?

Question Title

* Are you an employee of a municipal government in Barrington, Bristol, East Providence, or Warren?

Question Title

* Are you a caregiver of a child with special needs (ie. IEP, 504 plan, learning differences, etc.)?

Question Title

* Where do you live?

Question Title

* Where is the organization or job that you work for located?

Question Title

* Which of the following mental health or related workforce category BEST describes you?

Question Title

* Where do you anticipate using the content from this workshop most directly? (Check all that apply)

Question Title

* Are you attending this program as part of a specific grant or program (i.e., MHAT, FRSAN, SOR)?

* Please enter the first letter of your first name.
For example, if your first name is John, you would enter J:

* Please enter the first letter of your last name.
For example, if your last name is Doe, you would enter D:

* Please enter the last letter of your first name.
For example, if your first name is John, you would enter N:

* Please enter the last letter of your last name.
For example, if your last name is Doe, you would enter E:

* Please enter the two-digit day of your birth date (01-31).
For example, if your date of birth is December 18, you would enter 18 or if your date of birth is December 2, you would enter 02: