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Consumer/Stakeholder Survey NEW

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* 1. Region you received support from?

Jacksonville

Wilmington

Elizabeth City

Goldsboro

Smithfield

Wilson

Greenville

Kinston

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* 2. Are you?

Adult Consumer

Child/Adolescent Consumer

Parent Family Member

External Stakeholder/Provider/Other Paid support

Other (please specify)

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* 3. What Pride In North Carolina Services did you ( or your family member) receive?

Child Residential

Child/Adolescent Day Treatment

Case Management

Outpatient Therapy

Intensive In Home services

Community Support Team

Medication Management-Psychiatric services

PSR

B-3 Peer Supports/Respite

School Based Therapy

Other

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* 4. Overall I am satisfied with the quality of services provided by Pride in North Carolina, LLC.

Yes

I have been satisfied and dissatisfied

Unsure

Other (please specify)

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* 5. I have been given the option to have services via telehealth (ie: computer or phone etc.) in response to COVID-19.

Yes

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* 6. I feel Pride in North Carolina has made health and safety a priority during COVID-19.

Strongly Agree

Agree

Disagree

Strongly Disagree

Unknown

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* 7. Based on my experience, Pride in North Carolina, LLC.

	Yes	No	Unknown (n/a)
Was effective at serving me in a timely manner upon admission.	Was effective at serving me in a timely manner upon admission. Yes	Was effective at serving me in a timely manner upon admission. No	Was effective at serving me in a timely manner upon admission. Unknown (n/a)
Utilizes and encourages a Child and Family approach to children's services.	Utilizes and encourages a Child and Family approach to children's services. Yes	Utilizes and encourages a Child and Family approach to children's services. No	Utilizes and encourages a Child and Family approach to children's services. Unknown (n/a)
Is effective at responding to and de-escalating crisis situations.	Is effective at responding to and de-escalating crisis situations. Yes	Is effective at responding to and de-escalating crisis situations. No	Is effective at responding to and de-escalating crisis situations. Unknown (n/a)
I felt my interaction with staff met my needs.	I felt my interaction with staff met my needs. Yes	I felt my interaction with staff met my needs. No	I felt my interaction with staff met my needs. Unknown (n/a)
I am involved in the planning of my treatment.	I am involved in the planning of my treatment. Yes	I am involved in the planning of my treatment. No	I am involved in the planning of my treatment. Unknown (n/a)
I am treated with respect and courtesy.	I am treated with respect and courtesy. Yes	I am treated with respect and courtesy. No	I am treated with respect and courtesy. Unknown (n/a)

Other (please specify)

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* 8. Pride in North Carolina, LLC. staff treated me with respect and honored any cultural needs or preferences I requested.

Yes

Unknown

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* 9. What specifically are some cultural needs or preferences? ( check all that apply)

Materials/Handouts in other languages

Time off sessions during a specific holiday/time of the year

Preference for staff of a certain gender or race

Addition of faith based supports/people included in treatment

None of the above

Other (please specify)

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* 1. Region you received support from?

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* 2. Are you?

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* 3. What Pride In North Carolina Services did you ( or your family member) receive?

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* 4. Overall I am satisfied with the quality of services provided by Pride in North Carolina, LLC.

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* 5. I have been given the option to have services via telehealth (ie: computer or phone etc.) in response to COVID-19.

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* 6. I feel Pride in North Carolina has made health and safety a priority during COVID-19.

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* 7. Based on my experience, Pride in North Carolina, LLC.

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* 8. Pride in North Carolina, LLC. staff treated me with respect and honored any cultural needs or preferences I requested.

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* 9. What specifically are some cultural needs or preferences? ( check all that apply)

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* 10. Please add any comments, concerns or feedback that would assist us in program improvement or service delivery.