• Peer Run Organization Point In Time Survey

  • Thank you for taking this survey! Our goal is to understand more about your recovery/wellness journey and your relationship with your peer-run organization. 

    A Peer Run Organization (PRO) in Ohio is a behavioral health nonprofit planned, operated, and governed by individuals with direct, lived experience of mental health or substance use disorders (Ohio Department of Behavioral Health). Your peer run organization is the organization that shared this survey with you.

    It is available from June 15th - June 29th. If you need assistance with filling out the survey, please reach out to your peer-run organization (who shared this survey with you).

    Please only take this survey once this year.

    Please read each question carefully. 

    All questions are required, but 'Prefer Not to Answer' is always an accepted answer. Please check the help text for how to indicate you prefer not to answer a question. 

    This survey can be taken on a computer, phone, or tablet. On a phone, we'd recommend turning it horizontal for the best view of all questions.

  • Demographics

  • As a participant at Courage to Caregivers, we know you are on a family recovery journey. This survey is about you and your recovery/wellness journey, so please fill out the demographics and following questions for yourself and your experiences. 

  • For the following question, if you are multiracial - please select all races that are applicable to you. 

  • 5. Which racial/ethnic category best describes you (select all that apply)?*
  • 6. Primary Language*
  • 7. Which culture(s) do you feel most shaped your values, traditions, and ways of navigating daily life? This may or may not match where you were born or what passport you hold. (Select all that apply.)*
  • 8. Sex at Birth*
  • 9. Do you identify as trans or have a trans history?*
  • 10. Gender Identity (select all that apply)*

  • Sexual Orientation:
    Sexual orientation is a person’s emotional, romantic, and/or sexual attractions to another person There are many ways a person can describe their sexual orientation and many labels a person can use. (The Trevor Project, 2023)

  • 11. Sexual Orientation (select all that apply)*
  • 13. Employment (select all that apply)*
  • 14. Highest Level of Education
  • 15. Have you ever served in the US military or are you currently serving?*
  • 15b. In which branch of the military have you served or are you currently serving? (select all that apply)*
  • 16. Do you identify as a disabled person or as someone with a disability, chronic illness, neurodivergence, or other condition that affects how you navigate the world?*
  • 16a. If you would like, please describe the nature of your disability, chronic illness, or access needs (you may use your own words or select from the list below). (select all that apply)*
  • 17. Insurance/Payer (select all that apply)*
  • 18. Over the past 90 days, what has been your primary housing status?*
  • 19. What was your primary housing for the past 90 days?*

  • Mental Health

  • 21. Have you ever been diagnosed with a mental health condition?*
  • 21a. What mental health conditions have you been diagnosed with (select all that apply)?*
  • 22. If you have experienced violence or trauma, please select the category(ies) that best describes your experiences(s). If you have not experienced violence or trauma, please select 'none of the above.*

  • Substance Use

  • For the purposes of this survey, we are gathering information about substances to understand the diverse recovery journeys of participants.

    We'd like to know more about your history, if any, with illegal substances and/or substance misuse or abuse.

    Substance misuse means use in any way not directed by a doctor, including use without a prescription of one's own; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor (SAMHSA NSDUH).

    Abuse is defined the use of prescribed or "over-the-counter" drugs in excess of the directions and any non-medical use of drugs (DAST).

  • 23. Do you have a history of using illegal substances or substance misuse or abuse?*
  • Rows
  • 23b. Have you ever used illegal substances or misused substances by injection?*
  • 23d. How did you obtain syringes for your substance use (select all that apply)?*
  • 23f. In the last 90 days have you had a drug overdose?*
  • 23h. As a result of the overdose(s)...(select all that apply)*
  • 23j. Who provided the Narcan (select all that apply)?*

  • Justice Involvement

  • 24. Have you been arrested in the last 90 days?*
  • 25. Are you currently on...(select all that apply)*
  • 26. Do you currently have any active court cases?*
  • 26a. What type of court case(s) (select all that apply)?*

  • Emergency Room and Hospital Use

  • 27. In the last 90 days, have you gone to the emergency room or department?*
  • 27b. For what reason(s) did you go to the emergency room or department (select all that apply)?*
  • 27d. Were you required to go to the emergency room or department by law enforcement?*
  • 28. Have you had any inpatient hospital stays that were 2 or more nights in the past 90 days?*
  • 28b. Why did you spend the night in the hospital (select all that apply)?*

  • Program Participation

  • Services and Supports Utilized

  • We would like to hear more about the supports and activities you participate in at your peer run organization. We are asking about the supports and activities at the peer run organization who shared this survey with you and that you named in question 1. 

  • 31. What mental health-related activities or services do you participate in or utilize (select all that apply)?*
  • 32. What substance use-related activities or services do you participate in or utilize (select all that apply)?*
  • 33. What family support-related services or supports do you participate in (select all that apply)?*
  • 34. What basic needs-related services or supports do you participate in (select all that apply)?*
  • 35. What health and wellness-related services or supports do you participate in (select all that apply)?*
  • 36. What legal-related services and supports do you participate in (select all that apply)?*
  • 37. What social/community-related services and supports do you participate in (select all that apply)?*
  • 38. What education/employment services or supports do you participate in (select all that apply)?*
  • 39. Are there any other supports/services not listed above that you participate in?*
  • 40. Did attending this organization help you obtain employment or improve your employment?*
  • 40a. How has attending this organization helped you obtain or improve your employment? (select all that apply)*

  • Brief Assessment of Recovery Capital - 10

  • The BARC-10 (Brief Assessment of Recovery Capital) is a 10-item questionnaire developed by Dr. John F. Kelly and colleagues at the Recovery Research Institute.

    The BARC-10 is strength-based. It measures "recovery capital"—the psychological, physical, social, and environmental assets a person can draw upon to maintain recovery and improve their quality of life.

  • Rows

  • MHSIP

  • Rows

  • In Your Words

  • 43. How has the support from your peer run organization helped in your recovery/wellness journey?*

  • Thank you for your participation in this survey! We appreciate your willingness to share your experiences with us.

    If you'd like to talk more about your experiences or process your responses to any of the questions - feel free to reach out to a trusted staff member at your peer run organization.

    You may also reach out to the research team who created this survey, call Erin at 317-353-7108.

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