Lewis and Clark Public Health QPR Pre-training Survey

Please fill this survey out BEFORE the training begins. The information you provide helps us get a sense of your suicide prevention knoweldge coming into the training.

QPR training date

Date

Creating your anonymous participant ID

Below are questions that will generate an anonymous "ID" associated with your responses. The same questions will asked again in the post survey.

The ID allows us to evaluate how effective the training was by linking everyone's "pre" and "post" responses, while making sure all responses are kept anonymous and confidential.

First Letter of your First Name

If your first name is "John," enter the letter "J"

First letter of the city/town you were born in

If you were born in Grand Rapids, enter the letter "G"

First letter of the street you currently live on

If you live on "Main St.", enter the letter "M"

Day of birth

If your birthday is on the 10th of the month, enter the number "10"

Last Digit of the Year you were Born

If you were born in 1984, enter the number "4"

3. Age

4. In what county do you currently live?

5. In what county do you currently work?

6. Gender

7. Ethnicity

8. Have you or a family member ever served in the military?

9. Are you attending this training for your role as a:

Other

10. How would you rate your knowledge of suicide in the following areas?

Rows	Low	Medium	High
Facts concerning suicide prevention
Warning signs of suicide
How to ask someone about suicide
Persuading someone to get help
How to get help for someone
Information about local resources for help with suicide

How would you rate your knowledge of suicide in the following areas?

Rows	Low	Medium	High
The Warning signs of suicide
What language to use and what language to avoid when asking someone if they are thinking about suicide
Local and national resources available to help somone who is thinking about suicide

How comfortable do you feel doing the following?

Rows	Not at all comfortable	Somewhat comfortable	Comfortable
Asking someone directly if they are thinking about suicide
Persuading someone who is thinking about suicide to get help from crisis lines, mental health agencies, and other resources
Reaching out to the trusted friends, family members, or other supporters of someone who is thinking about suicide to get help

11. If you ask someone about suicide, you will plant the idea in their mind. They will then attempt to take their lives.

12. People who die from suicide are weak and cowardly.

13. If a person attempted suicide, survived and then received help, they are unlikely to die by suicide later.

14. People who talk about suicide won’t do it. They’re just seeking attention.

15. If a suicidal person plans to attempt suicide with a firearm but can’t get to one, they will just find some other way to die.

16. Do you feel that asking someone about suicide is appropriate?

17. Do you feel likely to ask someone if they are thinking of suicide?

18. Before you take today's training, how would you rate your confidence in the following areas?

Rows	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I feel confident in my level of understanding about suicide, suicide prevention and mental health.
I can recognize the signs a person may be dealing with a mental health problem, or suicidal crisis.
I feel prepared to help a person at-risk of suicide.
I can help a person who may be dealing with a mental health problem, or suicidal crisis by connecting them with resources.
I feel confident in my ability to recognize and correct mistaken beliefs about mental health, suicide, and mental illness as I come across them.

12. Since 2018, how many of the following training programs have you taken in Lewis and Clark County that are included in the following list: QPR (Question, Persuade, Refer); Youth Mental Health First Aid; Mental Health First Aid; Applied Suicide Intervention Skills Training (ASIST).

13. May we contact you in six months to inquire how the training has impacted you? The information you provide will help inform the future of this project.

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.