Online Survey Software | Qualtrics Survey Solutions

Hello!

We are asking you to complete this survey because we want your ideas and opinions. Your answers will be anonymous and confidential. That means your name will not be attached to this survey.

Your answers will help us do a better job helping children and youth who feel stressed, sad, angry, or have other feelings they don't know what to do with. We want to make sure children and youth can be successful with friends, family members and school. That way, they can reach their full potential.

We know life is different now with COVID-19. Please answer the questions thinking about the future. Let us know how we can do a better job helping you and your child when things are back to normal.

If you have more than one child, focus your answers on your children who have the most trouble with their emotions or with the use of alcohol and drugs.

After completing this survey, you can enter a drawing to win a $50 VISA gift card.

Tell us about your child. (select all that apply)

My child has a known mental health issue
I am worried about my child's mental health
I am not concerned about my child's mental health
My child has a known issue with alcohol or drug use
I am worried about my child's drug or alcohol use
I am not concerned about my child's drug or alcohol use

How likely is it that you would turn to these people or resources for help if your child had a mental health issue or problems with drugs or alcohol?

How likely is it that you would turn to these people or resources for help if your child had a mental health issue or problems with drugs or alcohol?
	Very likely	Likely	Not Sure	Unlikely	Very Unlikely
Friends	Very likely	Likely	Not Sure	Unlikely	Very Unlikely
A family member	Very likely	Likely	Not Sure	Unlikely	Very Unlikely
Someone at my place of worship	Very likely	Likely	Not Sure	Unlikely	Very Unlikely
Teacher, counselor or another adult at school	Very likely	Likely	Not Sure	Unlikely	Very Unlikely
My doctor or healthcare provider	Very likely	Likely	Not Sure	Unlikely	Very Unlikely
Internet or social media	Very likely	Likely	Not Sure	Unlikely	Very Unlikely
Helpline	Very likely	Likely	Not Sure	Unlikely	Very Unlikely
Textline	Very likely	Likely	Not Sure	Unlikely	Very Unlikely

Have you gotten mental health or drug and alcohol help for your child? This could be calling a helpline, seeing a counselor, or getting family or group counseling.

Yes
No

Let us know how helpful each of these would be if you wanted to get services for your child.

Let us know how helpful each of these would be if you wanted to get services for your child.
	Very helpful	Helpful	Maybe helpful	Not helpful
Free or low cost services	Very helpful	Helpful	Maybe helpful	Not helpful
Evening or weekend appointments	Very helpful	Helpful	Maybe helpful	Not helpful
Telehealth services on a phone or computer	Very helpful	Helpful	Maybe helpful	Not helpful
Services in my child's school	Very helpful	Helpful	Maybe helpful	Not helpful
Services with my child's health care provider	Very helpful	Helpful	Maybe helpful	Not helpful
Services that are closer to where we live	Very helpful	Helpful	Maybe helpful	Not helpful
Services that are provided in our home	Very helpful	Helpful	Maybe helpful	Not helpful
Services that are provided in my child's primary language	Very helpful	Helpful	Maybe helpful	Not helpful
Services that are provided by someone who understands our family's cultural background	Very helpful	Helpful	Maybe helpful	Not helpful
Knowing that our family's privacy will be protected	Very helpful	Helpful	Maybe helpful	Not helpful
Other (50 word limit)	Very helpful	Helpful	Maybe helpful	Not helpful

What is your zip code?

What type of insurance does your child have?

Does your child's insurance cover the cost of mental health services and medications?

Yes, it covers the cost
It covers part of the cost
It probably does not cover the cost
No, it does not cover these services
I am not sure

If you or a family member have a crisis or you want help for mental health or drugs and alcohol:

Call (512)-472-HELP (4357)--- anytime day or night!

Click here for more resources.