Group Services Client Feedback

Name (optional, but if we have your name we can follow up on specific group requests)

First NameLast Name

Phone Number (so we can follow up!)

Area CodePhone Number

Evidence shows that receiving mental health services in a group setting alongside peers is an effective treatment method. Help us figure out what groups and how best to deliver them at Alaska Behavioral Health!

As a client or parent/guardian of a child, what do you hope to get out of group services?

Right now, group offerings are limited due to the Coronavirus pandemic. Please check all that apply. I am likely to attend:

Groups outside while weather allowsNew groups via Zoom (telehealth)A new or on-going group via Zoom only if I know the participants or have a chance to meet them in person firstI'll wait until we can meet in personNone of the above.Other

Comments?

The following groups are of interest to me(check all that apply):

	via Zoom	Only in person	Outside while weather allows	I'm not Interested
Distress Tolerance (DBT inspired group)
Groups to address insomnia & sleep issues
Groups to address depression
Parenting groups (such as ARC reflections)
Family therapy groups (such as Parenting with Love & Limits
Self-identity/awareness groups
Social skills through gaming
Art Groups

Comments/Suggestions

Resources available for services:

	Yes	No
I have access to a good internet connection
I have access to a device with a camera for video-conferencing
I know how to join Zoom meetings
I have a safe, private place to participate in sessions

Comments:

Please list ages of any participants you have in mind while answering this survey.

Any last comments/suggestions?