Opioid Treatment Program Participant Satisfaction Survey

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Opioid Treatment

Program Participant Satisfaction Survey

Please complete the following information prior to completing the survey.

Gender:



Male



Female



Transgender

Race:



African American



Caucasian



Hispanic



Asian



Native American



Indian



Arabic



Other: ___________________

Age:



11 and under:



12-17



18-21



22-29



30-39



40-49



50-59



60+

Time In Program:



Less than 3 months



3,4,5 months



6,7,8 months



9,10,11 months



1 year to 2 years



Greater than 2 years:

Survey Was Completed With

Help From:



Help from No One



Help from staff member



Help with friend



Help from Family Member

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Opioid Treatment

Program Participant Satisfaction Survey

Please circle the number under each item that represents your opinion

Access/Admission/Orientation

1. I got into the program quickly.

1 2 3 4 5

Strongly Disagree Disagree Agree Strongly Agree Don’t Know

Does Not Apply

2. Getting into the program was easy.

1 2 3 4 5

Does Not Apply

3. The people who helped me get into the program were nice.

1 2 3 4 5

Does Not Apply

4. I understand the program rules and what happens if I don’t follow them.

1 2 3 4 5

Does Not Apply

5. I understand how the program works.

1 2 3 4 5

Does Not Apply

Input

1. People who work here care about what I think.

1 2 3 4 5

Does Not Apply

2. I am encouraged to give my opinion about my treatment and this program.

1 2 3 4 5

Does Not Apply

3. There are several ways for me to give my opinion about the program.

1 2 3 4 5

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4. My counselor is interested in what I think about the program.

1 2 3 4 5

Does Not Apply

.

5. I know how my opinion is used to improve the program and services.

1 2 3 4 5

Does Not Apply

Rights

1. I am treated with dignity and respect.

1 2 3 4 5

Does Not Apply

2. My rights were clearly explained to me.

1 2 3 4 5

Does Not Apply

3. If something happens that I don’t like, I know how to file a complaint.

1 2 3 4 5

Does Not Apply

4. I have never felt threatened or have been mistreated.

1 2 3 4 5

Does Not Apply

5. My privacy is respected by all program staff.

1 2 3 4 5

Does Not Apply

Medical Services

1. The doctor provides good care.

1 2 3 4 5

Does Not Apply

2. The nurses provide good care.

1 2 3 4 5

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3. My physical health needs are addressed.

1 2 3 4 5

Does Not Apply

4. I am receiving an adequate dose of medication.

1 2 3 4 5

Does Not Apply

5. The dosing system/window works well.

1 2 3 4 5

Does Not Apply

Assessment

1. My problems and needs are understood.

1 2 3 4 5

Does Not Apply

2. When I disclose my problems, I feel safe.

1 2 3 4 5

Does Not Apply

3. If I have a new problem or need, the staff knows about it.

1 2 3 4 5

Does Not Apply

4. I understand why I am asked questions about my problems.

1 2 3 4 5

Does Not Apply

5. When people ask me about my life and my problems, I feel respected.

1 2 3 4 5

Does Not Apply

Treatment Plan

1. I know the goals on my treatment plan.

1 2 3 4 5

(5)

2. I helped create the goals on my treatment plan.

1 2 3 4 5

Does Not Apply

3. My treatment plan is based on my needs.

1 2 3 4 5

Does Not Apply

4. I review my treatment plan on a regular basis.

1 2 3 4 5

Does Not Apply

5. My treatment plan is changed when things change in my life.

1 2 3 4 5

Does Not Apply

Quality of Care

1. I would recommend this program to my family and friends.

1 2 3 4 5

Does Not Apply

2. My counselor cares about me.

1 2 3 4 5

Does Not Apply

3. My counselor understands my problems, my needs, and my goals.

1 2 3 4 5

Does Not Apply

4. Everybody who works here cares about me.

1 2 3 4 5

Does Not Apply

5. I am encouraged to get my family involved in treatment.

1 2 3 4 5

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Quality of Life

1. My life has improved since entering this program.

1 2 3 4 5

Does Not Apply

2. I am doing better in school, work, or my daily living activities.

1 2 3 4 5

Does Not Apply

3. My family situation has improved.

1 2 3 4 5

Does Not Apply

4. I am involved in social situations that support my recovery.

1 2 3 4 5

Does Not Apply

5. I am better at handling stress.

1 2 3 4 5

Does Not Apply

Cultural Competency

1. My religious and spiritual beliefs/practices are respected.

1 2 3 4 5

Does Not Apply

2. The staff has a good understanding of my social and family background.

1 2 3 4 5

Does Not Apply

3. I easily understand people speaking to me.

1 2 3 4 5

Does Not Apply

4. My beliefs about life and treatment are understood.

1 2 3 4 5

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5. The program is sensitive to people’s beliefs and differences.

1 2 3 4 5

Does Not Apply

Accessibility

1. The program’s building is nice and is easy to use.

1 2 3 4 5

Does Not Apply

2. The program hours fit my schedule.

1 2 3 4 5

Does Not Apply

3. The program location is easy to get to.

1 2 3 4 5

Does Not Apply

4. Transportation to and from the program is available and meets my needs.

1 2 3 4 5

Does Not Apply

5.

The program treats all people equally

.

1 2 3 4 5

Does Not Apply

Client Safety

1. The organization provides services in a safe setting.

1 2 3 4 5

Does Not Apply

2. I am never approached at the clinic by people trying to sell drugs to me or asking

me to sell drugs to them.

1 2 3 4 5

Does Not Apply

3. I feel safe in the neighborhood and parking areas around the clinic.

1 2 3 4 5

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4. I have never felt threatened by other patients while receiving treatment.

1 2 3 4 5 Strongly Disagree Disagree Agree Strongly Agree Don’t Know

Does Not Apply

5. If the clinic had to be evacuated while I was receiving services, I would know

where to exit.

1 2 3 4 5

Does Not Apply