Recovery Support Centers Evaluation Survey
Version 2 – January 2019

Instructions:
We value your participation and feedback. This survey is voluntary and confidential. You may decline to participate; this will not affect your membership at the center. Your feedback is valuable and important for center evaluation and planning.   If you are uncomfortable answering a question, we have provided a choice, “Don’t Know, Not Sure, Prefer Not to Answerer”, for your convenience. The questions mostly refer to your experiences when you visited the Center during the last six months, including today. Some questions require just one answer, while others allow for more than one. Select the choice or choices that are closest to your answer, even if the fit is not exact. Please follow instructions within the questions, and ask staff for help if you have difficulty with a question.

1.	Date Survey Completed: ______________________________(mm/dd/yyyy)

2.	Please check if this questionnaire is being answered in English or in Spanish. 
  English              Spanish

3.	Please identify if any of the items below have been issues for you within the past six months. For each item, please check whether it has been a primary, secondary, or not relevant issue for you in the past six months. (Check one answer for each row)

	
Primary	
Secondary	
Not Relevant	
Don’t Know, Not Sure,
Prefer Not to Answer	

A. Substance Use 	

	

B. Mental Health 	

	

C. Gambling 	

	

D. Tobacco	

	
	
E. Other issues 
   Specify:					

4.	How long have you been coming to the Center? (Check one)
  Just started (Less than one month)   	  More than 1 year
  1 to 6 months                                         	  More than 3 years
  7 to 12 months			 	  Don’t know, not sure, or prefer not to answer

5.	In the last six months, how often did you come to the Center? (Check one)
  Daily or nearly every day		   Less than once a month
  1 to 5 times a week		  1 to 3 times a month
  1 time ever (just started) 		  Don’t know, not sure, or prefer not to answer

6.	This question is about what members may achieve when visiting the Center. Please check an achievement if you made progress in realizing it in the past six months. (Check ALL  that apply)

Achievements When Visiting Recovery Support Center	
Made Progress	

A.  Got support for your recovery and efforts to overcome obstacles to recovery	

B.  Developed safe relationships that supported your recovery	

C.  Spent time in a safe place free of violence, abuse, stress, and drugs/alcohol	

D.  Participated in meetings, groups, or drug-free or gambling-free activities	

E.  Learned more about recovery, how to cope with threats to recovery	

F.  Mentored or helped others with their recoveries; gave back to the recovery  community	

G.  Volunteered at the Center; participated in planning and running Center  activities	

H.  Talked to other members or staff about your needs, problems, and other issues	

I.  Got information about or referrals for services such as treatment, housing,  employment, health
    insurance, food stamps, VA benefits, and social security 	

J.  Got help developing new skills, such as with a computer or becoming a group facilitator or peer
     leader	

K.  Learned about upcoming events at the Center and in the broader recovery community 	

L.  Got information about recovery for a friend or family member	 	

M. Participated in wellness activities, such yoga, meditation, acupuncture, and other healthy 
     practices	

N.  Got help dealing with CORI when looking for work	

O.  Got help with family issues	

P.  Obtained HIV testing	

Q.  Obtained hepatitis C testing	

R.  Obtained Narcan training	

7.	In the past six months, which of the following activities did you participate at the Center? (Check All that apply)
 New member orientation
 The Center’s community meetings
 Helped plan an event or activity
 Helped facilitate a group meeting
 Participated in center governance, such as advisory board meetings
 Attended an event or activity
 Other
 None
 Don’t know, not sure, or prefer not to answer

8.	As a result of participating in the Center during the past six months have you felt more connected to any of the following? (Check ALL that apply)
 Other Center members or participants
 Center staff
 Friends or associates outside of the Center
 Members of 12-step fellowships
 Your family (parents, siblings, children, other relatives)
 Members of social, recreational, or civic groups, or community organizations
 Members of faith-based communities
 Members of other support groups
 The recovery community in general
 Other
 Have not felt more connected to anyone
 Don’t know, not sure, or prefer not to answer

9.	How much has your recovery benefitted from coming to the Center during the past six months?  (Check one)
 Very much		 Not at all
 Somewhat		 Don’t know, not sure, or prefer not to answer
 A little			 Not applicable

10.	Overall, how satisfied were you with your experiences when coming to the Center in the past six months? (Check one)
 Very			 Not at all
 Somewhat		 Don’t know, not sure, or prefer not to answer
 A little

11.	During the past six months how much would you or did you recommend the Center to a friend, associate, or family member who needed support for his or her recovery?  (Check one)
 Very			 Not at all
 Somewhat		 Don’t know, not sure, or prefer not to answer
 A little

12.	What other supports do you currently need or wish that the Center could provide? (Check all that apply)
 Help with employment
 Support with CORI issues
 Training for computer skills or other skills
 Additional recreational activities, wellness activities
 Information or a referral for housing assistance
 Additional groups and meetings
 Help connecting to outside groups
 Information about or a referral to substance abuse treatment
 Information or referrals for other services, such as medical care, health insurance, etc.
 Information or a referral for the hepatitis C medical treatment
 Open more or other hours on weekdays 
 Open more or other hours during the weekend
 Training to become a group facilitator or peer leader
 More participation in leadership and governance of the Center
 More involvement in the broader recovery community
 Legal assistance
 Tobacco cessation
 None, just fine the way it is
 Other (specify)________________________________________________________
  Don’t know, not sure, or prefer not to answer

13.	Please check all items below for which you needed or wanted information or a referral during the past six months? (Check ALL  that apply)
  Long-term or recurring pain (such as headaches, lower back pain, sickle cell disease, 
       etc.)
  Recurring relapses
  Overdoses on drugs or alcohol
  Depression, suicidal thoughts or an attempt
  Diseases due to injection drug use
  Anxiety, panic attacks, PTSD, obsessive-compulsive disorder, or insomnia
  Alcohol-related liver diseases, such as alcoholic fatty liver, hepatitis, or cirrhosis
  Attention deficit hyperactivity disorder (AD/HD or A. D. D.)
  Problems with my gambling
  Don’t know, not sure, or prefer not to answer

14.	 In the past six months did a doctor give you a prescription for antidepressants for anxiety or depression, sedatives for insomnia, tranquilizers for anxiety or insomnia, or stimulants for ADHD? (Check one)
  Yes
  No
  Don’t know, not sure, or prefer not to answer

15.	In the past six months did a doctor give you an opioid prescription for pain? (Check one)
  Yes
  No
  Don’t know, not sure, or prefer not to answer

16.	 Have you been issued a medical Marijuana card within the past six months? (Check one)
  Yes
  No
  Don’t know, not sure, or prefer not to answer

17.	Please indicate,  in your lifetime or in the past six months,   if any of the following items have been issues for you.  Indicate Yes or No for each substance.  

Substance	
Ever in your life (lifetime)	
Past Six Months	
Prefer Not to Answer	
	
Yes	
No	
Yes	
No		

A. Alcohol	

	

B. Marijuana	

	

C. Heroin	

	

D. Non-medical use of prescription opioids	

	

E. Other Drugs including: crack/ cocaine,  other
    stimulants (e.g. methamphetamine),  tranquilizers, 
    sedatives, or others not mentioned.	

	

18.	When were you last treated in a substance abuse program? (Check one)
 I am currently in treatment
 In the past three months
 In the past six months
 More than six months ago
 More than a year ago
 Never treated in a program (skip to question 19)
 Not applicable, never had an addictive disorder (skip to question 23)
 Don’t know, not sure, or prefer not to answer (skip to question 19)

19.	What type of treatment? Check the answer that best describes your most recent treatment.  (Check one)
 Detox
 Step down treatment (CSS: clinical stabilization services or TSS: transitional support services)
 Residential
 Outpatient drug-free counseling, day treatment, intensive outpatient
 Medication assisted treatment (Methadone, Buprenorphine [Suboxone], or Naltrexone [Vivitrol])    
  Supportive case management, community-based case management     
 Emergency room
 Other
 Don’t know, not sure, or prefer not to answer
 Never treated or never addicted

20.	 Which of the following choices best describes your current recovery status? (Check one)
 I am not in recovery (skip to question 23)
 Less than 1 month of recovery
 1 to 6 months of recovery
 7 to 12 months of recovery
 More than one year of recovery
 More than three years of recovery
 More than five years of recovery
 Don’t know, not sure, or prefer not to answer
 Not applicable, never addicted (skip to question 23)

21.	Please indicate how long you have not been using alcohol, drugs, tobacco and/or not involved with gambling? (Check one box for each column)

	
Alcohol	
Drugs	
Gambling	
Tobacco	

Less than 1 month	

	

1 to 6 months	

	

7 to 12 months	

	

More than 1 year	

	

More than 3 years	

	

More than 5 years	

	

Don’t know, not sure, or prefer not to answer	

	
	
Not applicable, never used it or engaged in it					

I am currently using or engaging in	

	

22.	How supportive of your recovery have the following people been in the past six months?  (Check only one box per row)

	How supportive of your recovery?	
	
Very	
Somewhat	
 A Little	
Not at  All 	
Don’t Know, Not Sure, or Refused	Not Applicable	

A. Your immediate family  (partner, 
     parents, siblings, children)	

	

	

B. Your extended family (cousins, 
     aunts, etc.)	

	

	

C. Other people you live with	

	

	

D. Friends, associates	

	

	

E. People at work or at school	

	

	

F.  Sponsor	

	

	

G. Center members	

	

	

H. Center staff	

	

	

I.  Self-help groups held  outside of
    the Center	

	

	

J. Parole or probation officer;  drug 
    court judge and/ or team	

	

	

K. Counselor	

	

	

L. Recovery coach	

	

	

23.	Have you done the following things as part of your recovery in the past six months?  (Check ALL that apply)
 Went to meetings or attended recovery groups outside of the Center
 Attended 12-step conventions 
 Got a sponsor or served as a sponsor for someone else
 Changed your living situation to be more recovery oriented
 Stopped hanging out with other drug or alcohol users
 Developed a healthy lifestyle
 Increased your spirituality
 Got a job
 Other ____________________________________
 Not applicable
 None of the above
 Don’t know, not sure, or prefer not to answer

24.	What is your current job status? (Check most important one)
 Employed (working full time or part time)
 Unemployed		
 Retired, disabled, or caretaker 
 Student (GED program, skills training or certificate program, college)	
 Other
 Don’t know, not sure, or prefer not to answer

25.	Which best describes your current housing? (Check one)
 Renting a room, apartment (private or public housing), or house
 Living with family or friends
 Homeless: shelter, couch to couch, on street
 Sober home/group home
 Short or long-term housing program
 Own condo or house
 Other
 Don’t know, not sure, or prefer not to answer

Thank you for taking the time to answer the above questions and helping us to better understand the effectiveness of the Centers. The Massachusetts Department of Public Health, Bureau of Substance Abuse Services and the Recovery Support Centers appreciate your contribution.