GPRA Post-Event Survey Presented by Opioid Response Network Step 1 of 4 25% Training and Technical Assistance (TTA) GPRA Post-Event Form (GPRA-PEF) Public reporting burden for this collection of information is estimated to average 10 minutes to complete this questionnaire. Send comments regarding this burden estimate or any other aspect of this collection of information to the Substance Abuse and Mental Health Services Administration (SAMHSA) Reports Clearance Officer, Room 15E57A, 5600 Fishers Lane, Rockville, MD 20857. 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 Office of Management and Budget (OMB) control number. The control number for this project is 0930-0389. This questionnaire aims to gather your feedback regarding the quality and usefulness of this event. The information you provide will be used to enhance and improve future training events. Your answers will not be released to anyone and will remain anonymous. Your name will not be written on the questionnaire or be kept in any other records. All responses you provide for this study will remain confidential. When the results of the questionnaire are reported, you will not be identified by name or any other information that could be used to infer your identity. Only SAMHSA and its grantee will have access to view any data collected. Your participation is voluntary, and you may withdraw from completing this questionnaire at any time you wish or skip any question you don’t feel like answering. Your refusal to participate will not result in any penalty or loss of benefits to which you are otherwise entitled. The following questions are designed to assess the quality of today’s event.I attended(Required)Recovery Support in Opioid Abatement Efforts1. How satisfied were you with the overall quality of this event? Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied 2. I expect this event to benefit me and/or my community. Strongly Agree Agree Neutral Disagree Strongly Disagree 3. I expect this event will improve my ability to work effectively. Strongly Agree Agree Neutral Disagree Strongly Disagree 4. I would recommend this event to a friend/colleague. Yes No 5. What about the event was most useful to you?6. How could this event be improved? DemographicsIn order for SAMHSA to continuously improve its training programs, it is important that we know a bit about those we are currently serving. Your reply to these demographic questions will help SAMHSA to improve its technical assistance programs. Please note that your responses will be reported in aggregate.8. Are you Hispanic, Latino/a, or Spanish origin? Yes No Prefer not to answer [IF YES] What ethnic group do you consider yourself? You may indicate more than one. Central American Cuban Dominican Mexican Puerto Rican South American Prefer not to answer Select AllEthnicity Other (please specify)9. What is your race? You may indicate more than one. Black or African American White American Indian Alaska Native Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander Prefer not to answer Race Other (please specify) 11. Please select the best category that describes your community (Select one or more): Metropolitan or Suburban Community (communities located in a city or town) Tribal Community (any American Indian or Alaska Native tribe, band, nation, pueblo, village, or community) Rural or Frontier Community (sparsely populated areas that are geographically isolated from population centers and services, usually has few homes or other buildings, and not very many people) Unknown Community Other (please specify)12. What is the highest degree you have received? (Select one): Less than 12th Grade 12th Grade/High School Diploma/Equivalent Vocational/Technical (Voc/Tech) Diploma Some College or University Bachelor’s Degree (For example: BA, BS) Graduate Work/Graduate Degree Prefer not to answer Other 13. What is your primary occupation/profession? (Select one): Addictions Professional Psychiatrist Psychologist Counselor/therapist (all types) Social Worker Recovery coach Peer recovery specialist Prevention specialist Case manager/care coordinator Clinical supervisor Faith leader Community Health Worker/Educator/Health Educator Criminal Justice/Law Enforcement Professional Public or Business Administrator Researcher Physician Physician Assistant Pharmacist Nurse/Nurse Practitioner Advance Practice Registered Nurse Midwife Teacher/educator Dentist Student – Full-time Student – Part-time (not working) Student – Part-time (working) Business owner Rural worker or Farmer Family member/caregiver Retired Other 14. If you are a Student, what is your primary field of study? (If Not a Student SKIP this question) Not Applicable – not a student Addiction Medicine Counseling Criminal Justice/Law Enforcement Medicine (general or residency) Nursing (general or registered nurse) Nursing Practitioner Peer or Recovery Specialist Pharmacy Physician Assistant Prevention science Psychiatry Psychology Public Health (Master’s or PhD) Recovery Coach Social Work Certification program Other 15. Which of the following best describes your principal employment setting? (Select one): Not Applicable – not employed State/county/jurisdiction/territorial/tribal government Substance use disorder treatment program Substance use prevention program Community recovery support program Group home Transitional/supported living facility Mental health clinic or treatment program (Community mental health program) Community health/Community health coalition Community coalition Primary care Federally Qualified Health Centers (FQHC) Hospital State or private psychiatric hospital Aging Services Network Skilled nursing facility Criminal justice/corrections (court, prison, jail, prison/probation, TASC) Military/VA Higher education setting Elementary or secondary education setting Community-based organization (including faith-based organizations) Self-employed (any type of business) Farm or rural establishment Family-run or consumer-run organization Homecare Shelter Government Other 16. What is the ZIP Code of your principal employment setting or school (if you are a student)?17. What is your sex? [OPTIONAL] Male Female