Client/Stakeholder Satisfaction Survey

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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?

Outpatient Therapy

Intensive in Home services (IIH)

Community Support Team

Medication Management-Psychiatric services

PSR

School Based Therapy

High Fidelity Wraparound

Intensive Home Therapy Services (IHTS)

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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. Overall I feel my/ my child/family member's quality of life has improved or changed for the better since receiving services and supports from Pride in North Carolina, LLC.

Yes

Not sure at this time

Other (please specify)

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* 6. I/My family member is/am better able to handle problems since receiving services from Pride in North Carolina, LLC.

Yes

Unknown

Other (please specify)

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* 7. 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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* 8. What specifically were some of the cultural needs/preferences you requested or expressed?

Materials/handouts in other languages

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

Preference for staff of a certain gender or race

Needs related to medication (taking or not taking medications)

Addition of faith based supports/people included on Treatment teams

Addition of cultural needs/preferences on the PCP or crisis plan

Other (please specify)

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* 9. 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)
I felt I had say in my treatment goals.	I felt I had say in my treatment goals. Yes	I felt I had say in my treatment goals. No	I felt I had say in my treatment goals. 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/my family's interaction with staff met my/my family's needs.	I felt my/my family's interaction with staff met my/my family's needs. Yes	I felt my/my family's interaction with staff met my/my family's needs. No	I felt my/my family's interaction with staff met my/my family's needs. Unknown (n/a)
The schedule of serivces was based on my input/needs rather than the staff's.	The schedule of serivces was based on my input/needs rather than the staff's. Yes	The schedule of serivces was based on my input/needs rather than the staff's. No	The schedule of serivces was based on my input/needs rather than the staff's. Unknown (n/a)

Other (please specify)

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* 10. Please answer the following if you receive(d) services via Tele-Health.

	Great	Good	Average	Poor
Connectivity/quality of picture and audio.	Connectivity/quality of picture and audio. Great	Connectivity/quality of picture and audio. Good	Connectivity/quality of picture and audio. Average	Connectivity/quality of picture and audio. Poor
Convenience of days and times of service being available.	Convenience of days and times of service being available. Great	Convenience of days and times of service being available. Good	Convenience of days and times of service being available. Average	Convenience of days and times of service being available. Poor
Comfort level of the service provided over tele compared to face to face.	Comfort level of the service provided over tele compared to face to face. Great	Comfort level of the service provided over tele compared to face to face. Good	Comfort level of the service provided over tele compared to face to face. Average	Comfort level of the service provided over tele compared to face to face. Poor
Met my needs.	Met my needs. Great	Met my needs. Good	Met my needs. Average	Met my needs. Poor

Other (please specify)

Client/Stakeholder Satisfaction Survey

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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. Overall I feel my/ my child/family member's quality of life has improved or changed for the better since receiving services and supports from Pride in North Carolina, LLC.

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* 6. I/My family member is/am better able to handle problems since receiving services from Pride in North Carolina, LLC.

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

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* 8. What specifically were some of the cultural needs/preferences you requested or expressed?

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

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* 10. Please answer the following if you receive(d) services via Tele-Health.

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