Erie County Mental Health
Customer Satisfaction Reply 2006-07

Adult

Please complete the following questions regarding the services identified. The information gathered from these surveys may impact your survices and how they are delivered. All responses are kept confidential. Thank you for your time.

Providers List:

Achievement Center: Outpatient
Achievement Center: Family Based Mental Health
Case Management Support Services: Forensics
Case Management Support Services: Administrative Case Management(Intake) Services
Case Management Support Services: Resource Coordinator
Case Management Support Services: Intensive Case Management
Case Management Support Services: Representative Payee
Community of Caring
Community Country Day School
Counselling Services Center Inc
Crime Victims Center
Erie School District: Stars/ASSP
Erie School District: Student Assist Program
Independence Court
Lakeshore Community Services: ICM
Lakeshore Community Services: Independent Living
Mental Health Association of Northwestern Pa: Center Services
National Alliance of Mentally Ill of Erie County
Safe Harbor: Outpatient
Safe Harbor: Crisis Services
Sarah Reed Children's Center: Outpatient
Sarah Reed Children's Center: Partial Hospitalization Program
Stairways: Outpatient
Stairways: Crisis Residential Unit
Stairways: Independent Living Services
Stairways: Personal Care Home
Stairways: Community Rehabilitation Residences
Stairways: Community Living Services

Submitter E:mail Address (required):

1. Has this service provider helped you in your recovery (mental well-being)?

Yes Sometimes No N/A
Comments/Examples

2. Have your relationships with people (family/friends) improved since using this service provider?

Yes Sometimes No N/A Comments/Examples

3. Does this provider inform you of other services available in the community?

Yes Sometimes No N/A Comments/Examples

4. Are you able to speak openly and ask questions with the staff at this service provider?

Yes Sometimes No N/A
Comments/Examples

5. Are this provider's services available as needed?

Yes Sometimes No N/A
Comments/Examples

6. Does the staff at this service provider treat you with courtesy and respect?

Yes Sometimes No N/A
Comments/Examples

7. As far as you know, is your confidentiality respected at this service provider?

Yes Sometimes No N/A
Comments/Examples

8. Overall, how satisfied are you with this service provider?

Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied

9. Overall: What are you most satisfied with?

10. Overall: What are you least satisfied with and how can it be improved?

11. Do you fear losing this service?

Yes No
If yes, could you please give a reason?

12. Do you know who to go to if you have a problem with this service provider?

Yes No

13. Please indicate any of the following factors that have had an impact with this provider's services.

Location Positive Negative N/A Comments/Examples

Hours of Operation Positive Negative N/A Comments/Examples

Parking Positive Negative N/A Comments/Examples

Transportation Positive Negative N/A Comments/Examples

Waiting Area Comfort Positive Negative N/A Comments/Examples

Time Spent Waiting Positive Negative N/A Comments/Examples

Handicap Accessibility Positive Negative N/A Comments/Examples

Getting an Appointment Positive Negative N/A Comments/Examples

Phone Calls Returned Positive Negative N/A Comments/Examples

Staff Positive Negative N/A Comments/Examples

Other Positive Negative N/A Comments/Examples

The following three questions may or may not apply to this service:

Treatment Decisions

14. Are you given the chance to make treatment decisions?

Yes, always Sometimes No, never

Quality of Life

15. What effect has the treatment you received had on the quality of your life?

The quality of my life is:

Much Better Better Same Worse Much-worse

Help in the last twelve months

16. Are you given the chance to make treatment decisions?

Yes, always Sometimes No, never