| RPT |
_|MHRRTP Veteran Satisfaction Survey||Date Given: <.Date_Given.>|Clinician: <.Staff_Ordered_By.>|Location: <.Location.>||Veteran: <.Patient_Name_Last_First.>|SSN: <.Patient_SSN.>|DOB:
<*Answer_5255*>|15. Veterans' activities are carefully planned.| <*Answer_5256*>|16. If a veteran breaks a rule, s/he knows what the consequences will be.| <*Answer_5257*>|17. Once a schedule
is arranged for a veteran, the veteran must follow it.| <*Answer_5258*>|18. This is a lively place.| <*Answer_5259*>|19. Staff have relatively little time to encourage veterans.|
<*Answer_5260*>|20. Veterans say anything they want to the staff.| <*Answer_5261*>|21. Veterans can leave here anytime without saying where they are going.| <*Answer_5262*>|22. There is
relatively little emphasis on teaching veterans solutions to practical problems.| <*Answer_5263*>|23. Personal problems are openly talked about.| <*Answer_5264*>|24. This is a very well
organized program.| <*Answer_5265*>|25. If a veteran's program is changed, staff always tell him/her why.| <*Answer_5266*>|26. The staff very rarely punish veterans by taking away their
privileges.| <*Answer_5267*>|27. The veterans are proud of this program.| <*Answer_5268*>|28. Veterans seldom help each other.| <*Answer_5269*>|29. It is hard to tell how veterans are
feeling here.| <*Answer_5270*>|30. Veterans are expected to take leadership here.| <*Answer_5271*>|31. Veterans are expected to make detailed, specific plans for the future.|
<*Answer_5272*>|32. Veterans are rarely asked personal questions by the staff.| <*Answer_5273*>|33. The staff make sure that this place is always neat.| <*Answer_5274*>|34. Staff rarely give
veterans a detailed explanation of what the program is about.| <*Answer_5275*>|35. Veterans who break the rules are penalized for it.| <*Answer_5276*>|36. There is very little group spirit in
this program.| <*Answer_5277*>|37. Staff are very interested in following up with veterans once they leave the program.| <*Answer_5278*>|38. Veterans are careful about what they say when staff
<.Patient_Date_Of_Birth.> (<.Patient_Age.>)|Gender: <.Patient_Gender.>||||A. Date of admission to this MHRRTP (mm/dd/yyyy):| <*Answer_5474*>|B. MHRRTP Type:| <*Answer_5350*>|1. What race do you
are around.| <*Answer_5279*>|39. The staff tend to discourage criticism from veterans.| <*Answer_5280*>|40. There is relatively little discussion about exactly what veterans will be doing after
they leave the program.| <*Answer_5281*>|41. Veterans are expected to share their personal problems with each other.| <*Answer_5282*>|42. This place usually looks a little messy.|
<*Answer_5283*>|43. The program rules are clearly understood by the veterans.| <*Answer_5284*>|44. If a veteran fights with another veteran, s/he will get into real trouble with the staff.|
<*Answer_5285*>|45. Staff welcome me and help me feel comfortable in this program.| <*Answer_5286*>|46. The physical space of this program (for example, the lobby and/or waiting rooms) feels
inviting and dignified.| <*Answer_5287*>|47. Staff regularly asks me about my interests and the things I would like to do in the community.| <*Answer_5288*>|48. I can easily access my treatment
records if I want to.| <*Answer_5289*>|49. Staff introduces me to veterans in recovery who can serve as role models or mentors.| <*Answer_5290*>|50. I am/can be involved with staff trainings
and education programs at this VA.| <*Answer_5291*>|51. Staff helps me to develop and plan for life goals beyond managing symptoms or staying stable (for example, employment, education, physical
fitness, connecting with family and friends, hobbies).| <*Answer_5292*>|52. This program offers specific services that fit my unique culture and life experiences.| <*Answer_5293*>|53. Staff
listens to me and respects my decisions about my treatment and care.| <*Answer_5294*>|54. Staff offers to help me connect with self-help, peer support, or consumer advocacy groups and programs.|
<*Answer_5295*>|55. I am encouraged to attend VA advisory boards and/or management meetings if I want.| <*Answer_5296*>|56. Staff helps me to find jobs.| <*Answer_5297*>|57. Staff listens, and
consider yourself?| <*Answer_5404*>|1-A. Are you Hispanic, Spanish or Latino?| <*Answer_5405*>|2. How many years of education have you completed?| <*Answer_5402*>|3. Have you ever been
responds, to my cultural experiences, interests, and concerns| <*Answer_5298*>|58. Staff does not use threats, bribes, or other forms of pressure to get me to do what they want.|
<*Answer_5299*>|59. Staff talks with me about what it would take to complete or exit this program.| <*Answer_5300*>|60. I am encouraged to help staff with the development of new groups, programs,
or services.| <*Answer_5301*>|61. Staff works hard to help me fulfill my personal goals.| <*Answer_5302*>|62. In the last MONTH, how often did you participate in an activity where you felt
completely involved in what you were doing, so much so that you lost track of time?| <*Answer_5303*>|63. In the last MONTH, how often did you participate in an activity where you felt you learned
something important about yourself?| <*Answer_5304*>|64. In the last MONTH, how often did you participate in an activity where you had a sense of accomplishment or felt proud of what you had
done?| <*Answer_5305*>|65. In the last MONTH, how often did you participate in an activity where you felt that your life has purpose or meaning?| <*Answer_5306*>|66. In the last MONTH, how
often did you participate in an activity where you experienced yourself growing as a person?| <*Answer_5307*>|67-A. I find strength and comfort in my spirituality.| <*Answer_5308*>|67-B. I feel
deep inner peace or harmony.| <*Answer_5309*>|67-C. I feel a spiritual presence.| <*Answer_5310*>|68. How do you feel about your life as a whole?| <*Answer_5311*>|69. Thinking ahead to
twelve months from today, do you expect your mental health will be:| <*Answer_5312*>|70. How much do you feel you know about your mental health problems, including symptoms and types of treatment,
such as medication, and rehabilitation?| <*Answer_5313*>|71. How much input do you have into your treatment and/or rehabilitation plan?| <*Answer_5314*>|72. Overall, how would you rate the
homeless since leaving military service?| <*Answer_5477*>|4. Were you homeless when you last lived in the community (before this current VA admission)?| <*Answer_5476*>|5. Did you transfer to
quality of care you receive in this program?| <*Answer_5315*>|73. Overall, how satisfied are you with the care you receive in this program?| <*Answer_5316*>|74. Would you recommend this program
to other veterans if they needed care?| <*Answer_5317*>|75. If you could have free care outside of the VA, would you choose to come to this program again?| <*Answer_5318*>|76-A. Alcoholics
Anonymous (AA)?| <*Answer_5478*>|76-B. Narcotics Anonymous (NA)?| <*Answer_5479*>|76-C. Al-Anon?| <*Answer_5480*>|76-D. Peer support-groups for veterans (for example, Vet-to-Vet)?|
<*Answer_5481*>| $~
this program from another VA inpatient unit or VA residential program?| <*Answer_5475*>|6. In general, at the present time would you say your physical health is:| <*Answer_5243*>|7. In general,
at the present time would you say your mental health is:| <*Answer_5244*>|8. Do you take any prescription medications on a regular basis?| <*Answer_5245*>|8-A. Do you receive any of your
medications from a nurse?| <*Answer_5247*>|8-B. Do you receive any of your medications from the VA pharmacy?| <*Answer_5248*>|9. Veterans put a lot of energy into what they do around here.|
<*Answer_5250*>|10. The healthier veterans here take care of the less healthy ones.| <*Answer_5251*>|11. Veterans tend to hide their feelings from one another.| <*Answer_5252*>|12. There is no
veteran leadership in this program.| <*Answer_5253*>|13. This program emphasizes training for new kinds of jobs.| <*Answer_5254*>|14. Veterans hardly ever discuss their sexual lives.|
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