Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. – Step 1 of 4 Community Care of West Virginia, in conjunction with Orion Strategies, is conducting a survey of residents of four Ohio/West Virginia border counties (Belmont and Monroe in Ohio and Marshall and Wetzel in West Virginia) to assess attitudes and opinions around healthcare in your region. The survey aims to identify barriers to and opportunities for improving healthcare outcomes, including mental and behavioral health (such as substance use treatment and recovery). The survey should take approximately 5 (five) minutes to complete. At the end, participants will have an optional/voluntary opportunity to indicate interest in participating in a potential future focus group. Focus group participants would be compensated for their time. In which of the following counties do you live? *Belmont County (Ohio)Marshall County (West Virginia)Monroe County (Ohio)Wetzel County (West Virginia)None of the aboveWhich of the following describes your sex? *FemaleMaleOtherWhich of the following describes your current age? *17 or under18 to 24 years25 to 34 years35 to 44 years45 to 54 years55 to 64 years65 years or olderIf any of the following roles are applicable to you, select all that apply: *Healthcare providerFirst responderEducatorNone of the aboveNextThis section will ask your opinion on the availability of certain healthcare services in your county. Please indicate how much you agree or disagree with the following statements. Youth mental health is a crisis in my county *Strongly agreeSomewhat agreeSomewhat disagreeStrongly disagreeUnsureAdult mental health is a crisis in my county *Strongly agreeSomewhat agreeSomewhat disagreeStrongly disagreeUnsureHow would you rate access to mental health services in your county? *GoodFairMediocrePoorUnsureYouth substance use/abuse is a crisis in my county *Strongly agreeSomewhat agreeSomewhat disagreeStrongly disagreeUnsureAdult substance use/abuse is a crisis in my county *Strongly agreeSomewhat agreeSomewhat disagreeStrongly disagreeUnsureHow would you rate access to behavioral health services (such as substance use treatment and addiction recovery resources) in your county? *GoodFairMediocrePoorUnsureHomelessness is an issue in my county *Strongly agreeSomewhat agreeSomewhat disagreeStrongly disagreeUnsureSubstance abuse is more prevalent among the homeless population in my county *Strongly agreeSomewhat agreeSomewhat disagreeStrongly disagreeUnsureNextOf the following options, which two do you see as the biggest barriers in your county preventing people from accessing behavioral and/or mental health care? (PLEASE SELECT TWO) *Lack of knowledge about where to receive mental/behavioral health careLack of mental/behavioral health care providers in the areaUnable to get a timely appointmentLong office wait timeTransportation (none or unreliable)StigmaHigh costLack of/insufficient insurance coverageOther(please select two)If other, please specify: *How would you rate access to primary care providers (family doctors, nurse practitioners, internal medicine specialists) in your county? *GoodFairMediocrePoorUnsureDo you currently have a primary care provider (either a doctor, nurse practitioner, or physicians’ assistant)? Yes, and they are in my countyYes, but they are outside of my countyNoIn which county and state is your primary care provider located? county? clinic) live? What would you say are the two biggest reasons you travel outside of your county to access primary care?No available providers locallyLong wait times (in-office)Difficulty getting appointments in my areaPrefer a specific providerPrefer a specific practicePrevious bad experienceInsurance issuesOtherIf other, please specify:How long do you typically wait for a routine appointment with your primary care provider (such as a check-up, chronic condition follow-up, etc.)? *Less than 1 week1-2 weeks3-4 weeksMore than 1 monthI cannot get an appointmentIn the last year, have you had to visit a walk-in urgent care clinic? *YesNoIn the last year, have you had to visit the hospital emergency room because access to another form of care (either primary care physician or an urgent care clinic) was not available? *YesNoHave you experienced any of the following issues in the past year? *Delayed care because no appointments were availableAppointment cancelled or rescheduled by the provider/officePrimary care provider leaving the area/provider turnoverLack of follow-up on test results or referralsDifficulty obtaining prescription refillsNone of the above(Select all that apply)NextMy county needs more primary care providers (such as doctors, physicians’ assistants, and nurse practitioners) *Strongly agreeSomewhat agreeSomewhat disagreeStrongly disagreeUnsureMy county needs more women’s health services *Strongly agreeSomewhat agreeSomewhat disagreeStrongly disagreeUnsureMy county needs more walk-in or same-day appointments *Strongly agreeSomewhat agreeSomewhat disagreeStrongly disagreeUnsureMy county needs more pediatric care *Strongly agreeSomewhat agreeSomewhat disagreeStrongly disagreeUnsureMy county needs more available transportation to appointments *Strongly agreeSomewhat agreeSomewhat disagreeStrongly disagreeUnsureMy county needs better availability of mental and behavioral health services (including substance use/recovery/treatment services) *Strongly agreeSomewhat agreeSomewhat disagreeStrongly disagreeUnsureWould you be willing to participate in a possible future focus group to gather more information about your local healthcare experiences? Focus group participants would be compensated for their time. *YesNoNote: Community Care of West Virginia and Orion Strategies are only collecting the following information to identify potential future focus group participants. We will not distribute, share, or sell your personal information for any reason. Additionally, none of the personal information shared below will be connected or attributed to your earlier survey responses. All survey responses will be anonymized for the purposes of reporting and all results will be presented in aggregate. Upon completion of this survey project and the potential future focus group project, your personal information will not be retained in any form or used in any future way by either Community Care of West Virginia or Orion Strategies. Name *FirstLastPhoneEmailAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeThank you for sharing your insights with Community Care of West Virginia! We appreciate your time! Submit
