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        DELTA

Recovery Oriented System Indicators (ROSI) Consumer Survey

To provide the best possible mental health services, we want to know what things helped or hindered your progress during the past six (6) months. We will not ask for any information that would identify you.  These survey questions are about your experience with services from a Community Services Board (CSB) or other mental health provider. 

Please read the directions carefully and complete all  sections on this page before submitting your responses.  When you finish the survey, please click on the "Submit" button at the bottom of the page to send your responses or click on "Reset" if you choose to cancel the survey.

Choose a Community Services Board here if your responses are about a CSB. Otherwise, enter the Other Provider's Name here if your responses are not about a CSB.

Section One Directions: Please read each statement and then click on the response that best represents your situation during the past six months.  If the statement is about something you did not experience, click on "Does Not Apply".

   

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Does Not
Apply       
1 There is at least one person who believes in me.

2 I have a place to live that feels like a comfortable home to me.

3 I am encouraged to use consumer-run programs (for example, support groups, drop-in centers, etc.).

4 I do not have the support I need to function in the roles I want in my community.

5  I do not have enough good service options to choose from.

6 Mental health services helped me get housing in a place I feel safe.

7 Staff do not understand my experience as a person with mental health problems.

8 The mental health staff ignore my physical health.

   

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Does Not
Apply       
9 Staff respect me as a whole person.

10 Mental health services have caused me emotional or physical harm.

11  I cannot get the services I need when I need them.

12 Mental health services helped me get medical benefits that meet my needs.

13 Mental health services led me to be more dependent, not independent.

14 I lack the information or resources I need to uphold my client rights and basic human rights.

15 I have enough income to live on.

16 Services help me develop the skills I need.

 

Section Two Directions:  Please read each statement and then click on the response that best represents your situation during the past six months. The responses range from “Never/Rarely” to “Almost Always/Always.” If the statement was about something you did not experience, click on the last response, “Does Not Apply.”

   

Never/Rarely

Sometimes

Often

Almost Always/
Always
Does Not
Apply     
17 I have housing that I can afford.

18 I have a chance to advance my education if I want to.

19 I have reliable transportation to get where I need to go.

20 Mental health services helped me get or keep employment.

21 Staff see me as an equal partner in my treatment program.

22 Mental health staff support my self-care or wellness.

23 I have a say in what happens to me when I am in crisis.

24 Staff believe that I can grow, change and recover.

25 Staff use pressure, threats, or force in my treatment.

   

Never/Rarely

Sometimes

Often

Almost Always/
Always
Does Not
Apply     
26 There was a consumer peer advocate to turn to when I needed one

27 There are consumers working as paid employees in the mental health agency where I receive services.

28 Staff give me complete information in words I understand before I consent to treatment or medication.

29 Staff encourage me to do things that are meaningful to me.

30 Staff stood up for me to get the services and resources I needed.

31 Staff treat me with respect regarding my cultural background (think of race, ethnicity, religion, language, age, sexual orientation, etc).

32 Staff listen carefully to what I say.

33 Staff lack up-to-date knowledge on the most effective treatments.

   

Never/Rarely

Sometimes

Often

Almost Always/
Always
Does Not
Apply     
34 Mental health staff interfere with my personal relationships.

35 Mental health staff help me build on my strengths.

36 My right to refuse treatment is respected.

37 My treatment plan goals are stated in my own words.

38 The doctor worked with me to get on medications that were most helpful for me.

39 I am treated as a psychiatric label rather than as a person.

40 I can see a therapist when I need to.

41 My family gets the education or supports they need to be helpful to me.

42 I have information or guidance to get the services and supports I need, both inside and outside my mental health agency.


Section Three Directions: Are there other issues related to how services help or hinder your recovery? Please explain in the following text box.

Section Four Directions: We are asking you to provide the following information in order for us to be able to have a general description of participants taking this survey.  Please click on the answer that best fits your response to the question or write in the answer in the box provided.  Only answer those items you wish to answer.  Please do not write your name or address on this survey.  This keeps your identity confidential.

1. What is your gender? Female Male

2. What is your age?                                            

3. What is your racial or ethnic background? (Check the one that applies best.)

  1. American Indian/ Alaska Native
  2. Asian
  3. Black or African American
  4. Native Hawaiian/ Other Pacific Islander
  5. White/Caucasian
  6. More than one race
  7. Other:

    Do you consider yourself Hispanic or Latino/Latina?  a. Yes   b. No

4. Your level of education is: (Check the highest level you reached.)

  1. Less than High School
  2. High School/GED
  3. College/Technical Training
  4. Graduate School
  5. Other:

5. How long have your been receiving mental health services?

  1. Less than 1 year
  2. 1 to 2 years
  3. 3 to 5 year
  4. More than 5 years

6. What services have you used in the past six months? (Check all that apply.)

Counseling/Psychotherapy Assertive Community Treatment (ACT) Case Management
Housing/Residential Services Psychosocial Rehabilitation Clubhouse
Medication Management Employment/Vocational Services Other:
Self-help/Consumer Run Service Alcohol/ Drug Abuse Treatment    

7. The town, city or community where you live can be described as:

  1. Urban
  2. Suburban
  3. Rural
  4. Remote/Frontier

8. What is your living arrangement?

  1. My own home or apartment
  2. Supervised/supported apartment
  3. Residential facility
  4. Boarding house
  5. Homeless or homeless shelter
  6. Other:

9. Are you a person who currently has both mental health and substance abuse (alcohol, drug addiction) problems?

Yes    No

Please Click on the Submit button below before leaving this page.  Click the Reset button if you want to clear all of your answers and not send in your survey.  Thank you. 



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