Community Readiness Assessment Survey
A: Existing Community Efforts
 
1.
On a scale from 1 to 10, how much of a concern is suicide in our community? (With 1 being "not at all" and 10 being "a great concern"). Please explain your rating.?
Not at all         A great concern  
 
  • Comment:

  • 500 characters left.
2.
What suicide prevention programs or services are available in your community?
 

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3.

How long have these programs or services been available?

 

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4.

What mental health treatment efforts or services are available in your community?


What mental health treatment efforts or services are being planned for your community?

 

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5.
Can you describe efforts to involve the community, including youth and elders, in the planning of prevention programs or mental health services?
 

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B. Community Knowledge About Prevention
 
6.

Based on your knowledge, what does the community know about efforts for suicide prevention and the treatment of mental illness?


Include information such as the name of programs, the services provided, how to access services, who they serve (such as youth, adults, males, females), whether they treat both mental health problems and alcoholism, etc.

 

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7.

On a scale from 1 to 10, how aware is the general community of these prevention and treatment efforts? (With 1 being "not at all" and 10 being "a great deal"). Please explain your rating.

Not at all         A great deal  
 
  • Comment:

  • 500 characters left.
C. Leadership
 
8.

On a scale from 1 to 10, how concerned are your elected leaders with providing suicide prevention and mental health services for community members? (With 1 being "not at all" and 10 being "a great concern"). Please explain your rating.


On a scale from 1 to 10, how concerned are your informal or influential leaders with providing suicide prevention and mental health services for community members? (With 1 being "not at all" and 10 being "a great concern"). Please explain your rating.

 Not at all         A great concern 
Elected Leaders
Informal/Influential Leaders
  • Comment:

  • 500 characters left.
9.

Would the leadership (elected or informal) support additional efforts to address suicide prevention planning in our community? Please explain.

 

350 characters left.
D. Community Climate
 
10.

What are the community's feelings about suicide prevention?

 

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11.

What are the primary obstacles to obtaining or adding more suicide prevention programs or mental health treatment services in our community?

 

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E. Knowledge About the Problem
 
12.

How knowledgeable are community members about the issue of suicide? Please explain.

 

350 characters left.
13.

In your community, what types of information are available about suicide prevention?

 

350 characters left.
F. Resources for Prevention Efforts
 
14.

Who would a person turn to first for help if he or she was thinking about suicide?

 

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15.

What are the community's feelings about getting involved in suicide prevention efforts (e.g., talking to a person thinking about suicide, volunteering time, financial donations, providing space)?

 

1000 characters left.
16.

Please describe any prevention plans or grants to address the issue of suicide in your community.

 

350 characters left.
17.

These are all of the questions we have for you today. Do you have anything else to add?

 

350 characters left.