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.)

American Indian/ Alaska Native
Asian
Black or African American
Native Hawaiian/ Other Pacific Islander
White/Caucasian
More than one race
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.)

Less than High School
High School/GED
College/Technical Training
Graduate School
Other:

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

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

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

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

Urban
Suburban
Rural
Remote/Frontier

8. What is your living arrangement?

My own home or apartment
Supervised/supported apartment
Residential facility
Boarding house
Homeless or homeless shelter
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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***Please Note: The department name has changed to the Department of Behavioral Health and Developmental Services on July 1, 2009 (from the Department of Mental Health, Mental Retardation and Substance Abuse Services). The department’s new Web site address is www.dbhds.virginia.gov. The previous Web site address will continue to work for up to a year after July 1, 2009.***

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

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