Form BRSS TACS TA Surve BRSS TACS TA Surve BRSS TACS TA Survey

OMB No. 0930-0197

Expiration Date: XX/XX/XXXX

Survey of Satisfaction with

Substance Abuse and Mental Health Services’ (SAMHSA’s)

Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS)

Training and Technical Assistance (TTA) Events

This survey is intended to assess your satisfaction with the [add name of BRSS TACS TTA event here]. Individual responses will not be released to federal staff or individual TA providers. The results of the survey will only be presented in aggregate form so that individual responses cannot be identified.

The survey will require no more than six minutes to complete. Participation in the survey is entirely voluntary.

For questions regarding this survey, please contact the BRSS TACS TTA Evaluator, Dr. Bethany Marcogliese, by telephone at 781-247-1747 or by email at bmarcogliese@center4si.com.

For further information regarding BRSS TACS TTA activities, please go to: www.samhsa.gov/brss-tacs

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0197. Public reporting burden for this collection of information is estimated to average 6 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E57B, Rockville, Maryland, 20857.

Section A

A1. Please print the [title/name] of the BRSS TACS TTA event you participated in: [This section will be completed by project staff prior to administration whenever possible.]

A2. Which of the following best describes this BRSS TACS TTA event? [This section will be completed by project staff prior to administration whenever possible.]

Online training, webinar, or other online event

Site visit or other on-site technical assistance

Long-term telephone/email consultation

In-person conference presentation or workshop

Annual or semi-annual Grantee Meeting presentation or workshop

Other  Please specify:

A3. Please select the response that best indicates your opinion about the BRSS TACS TTA event.

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree	Don’t know/ not applicable
a. The event was well organized
b. I learned something valuable from participating in this event
c. I expect to use the information I learned in this event
d. The presenters and/or technical staff for this event were knowledgeable about the content area
e. The information provided was based on current research, best practices, and resources

Section B

The next questions ask about your overall opinion about the BRSS TACS TTA event.

B1. Please select the response that best indicates your opinion about participating in the BRSS TACS TTA event.

	Very satisfied	Satisfied	Neither satisfied nor dissatisfied	Dissatisfied	Very dissatisfied	Don’t know/ not applicable
a. How satisfied are you with the quality of the information/instruction/ assistance you received during this event?
b. How satisfied are you with the quality of the products you received as part of this event (e.g. slide presentation, worksheets, resource list, or other tools)?..................................
c. Overall, how satisfied are you with the BRSS TACS TTA event?

B2. Optional: Please provide any additional comments or recommendations for future BRSS TACS training or technical assistance events.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Section C

The next few questions ask about your background and experience with SAMHSA.

C1. Which of the following categories best describes your role?

Mark all that apply.

Provider

SAMHSA grantee

Consumer-Operated Services Providers

Certified Peer Specialist

Recovery Coach

Other Peer Provider

State or Territory Administrator

Native American Tribe

Other  Please specify:

C1a. Optional: Please indicate which grant program(s) you oversee or are part of:

Thank you for participating in our survey!
We look forward to serving you at future BRSS TACS TTA events.