Opioid Treatment Program Participant Satisfaction Survey

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1 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: 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

2 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. 2. Getting into the program was easy. 3. The people who helped me get into the program were nice. 4. I understand the program rules and what happens if I don t follow them. 5. I understand how the program works. Input 1. People who work here care about what I think. 2. I am encouraged to give my opinion about my treatment and this program. 3. There are several ways for me to give my opinion about the program.

3 4. My counselor is interested in what I think about the program.. 5. I know how my opinion is used to improve the program and services. Rights 1. I am treated with dignity and respect. 2. My rights were clearly explained to me. 3. If something happens that I don t like, I know how to file a complaint. 4. I have never felt threatened or have been mistreated. 5. My privacy is respected by all program staff. Medical Services 1. The doctor provides good care. 2. The nurses provide good care.

4 3. My physical health needs are addressed. 4. I am receiving an adequate dose of medication. 5. The dosing system/window works well. Assessment 1. My problems and needs are understood. 2. When I disclose my problems, I feel safe. 3. If I have a new problem or need, the staff knows about it. 4. I understand why I am asked questions about my problems. 5. When people ask me about my life and my problems, I feel respected. Treatment Plan 1. I know the goals on my treatment plan.

5 2. I helped create the goals on my treatment plan. 3. My treatment plan is based on my needs. 4. I review my treatment plan on a regular basis. 5. My treatment plan is changed when things change in my life. Quality of Care 1. I would recommend this program to my family and friends. 2. My counselor cares about me. 3. My counselor understands my problems, my needs, and my goals. 4. Everybody who works here cares about me. 5. I am encouraged to get my family involved in treatment.

6 Quality of Life 1. My life has improved since entering this program. 2. I am doing better in school, work, or my daily living activities. 3. My family situation has improved. 4. I am involved in social situations that support my recovery. 5. I am better at handling stress. Cultural Competency 1. My religious and spiritual beliefs/practices are respected. 2. The staff has a good understanding of my social and family background. 3. I easily understand people speaking to me. 4. My beliefs about life and treatment are understood.

7 5. The program is sensitive to people s beliefs and differences. Accessibility 1. The program s building is nice and is easy to use. 2. The program hours fit my schedule. 3. The program location is easy to get to. 4. Transportation to and from the program is available and meets my needs. 5. The program treats all people equally. Client Safety 1. The organization provides services in a safe setting. 2. I am never approached at the clinic by people trying to sell drugs to me or asking me to sell drugs to them. 3. I feel safe in the neighborhood and parking areas around the clinic.

8 4. I have never felt threatened by other patients while receiving treatment. 5. If the clinic had to be evacuated while I was receiving services, I would know where to exit. Please provide us with comments and feedback about this program. What do we do best? What is the one area we could most improve? Additional comments:

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