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Local Planning & Network Development
Local Stakeholder Survey

1. Please indicate which best describes your relationship with Helen Farabee Regional MHMR Centers.
Government Official: Please Specify
Interested Citizen
Local Provider
School Official
 Law Enforcement/ Judicial System: Please Specify 
Other: Please Specify 

2. In which county do you live?

3. Are you aware that all Centers are now required by state law to explore contracting services they currently provide to interested third parties?
Yes    No

4. The following is a list of services provided by your local community mental health center that may be contracted out.  Please check the 3 you think are most important for citizens in your community:

Routine Services  

Intake (Screening & Assessment)

 Intensive/Assertive Community Treatment
 Adult Rehabilitation Services Counseling for Adults
Supported Employment Consumer Peer Support
Respite Services Flexible Community Support
Nursing Services Parent/Family Support Activities
Pharmacological Management (physician services) Counseling for Children & Adolescents
Rehabilitation Services for Children & Adolescents Intensive Multi-Systemic Therapy for children & Adolescents
Supported Housing Residential Treatment
Crisis & Other Discrete Services  
Crisis Hotline Mobile Outreach
23-Hour Observation Day Program for Acute Needs
Crisis Stabilization Unit Inpatient Services
Intensive Crisis  Residential Laboratory Services
Safety Monitoring Crisis Transportation

5. If you had to choose 2 services listed which the Center should contract with outside Providers, which 2 services would it be?
a.  
b.  

6. Why did you choose the 2 services indicated in question #5?


7. On the list below, please identify the three most important factors you think the center should consider when contracting for a provider for services:
Convenient Locations Pharmacy on Site
Transportation available Length of time for appointment
Clean Environment Wait time to see the doctor
Cost of services Bilingual Services and materials
Religious and spiritual values Cultural/Ethnic Sensitivity & Knowledge
Reputation of Provider All services at the same location
Other

8. In our current service delivery system, what gaps in services do you identify?


9. Please make any additional comments including significant issues or concerns you have regarding the Center, contracting services, and/or the current service delivery system.


For more information please contact us at:
 Connie Johnston (940) 397-3370
johnstonc@helenfarabee.org
or visit our website at www.helenfarabee.org

THANK YOU FOR YOUR HELP WITH THIS SURVEY- YOUR OPINION COUNTS!