Confidentiality Disclosure:

This survey is designed to collect anonymous data for mental health support services needs only. Your participation is entirely voluntary, and your responses will remain confidential. We assure you that no personally identifiable information will be shared or distributed. Your anonymity and privacy are of utmost importance to us. By proceeding with this survey, you acknowledge that your responses will be used solely for the intended mental health support needs assessment. Thank you for your input.

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1. Are you currently employed?

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2. Are you a student?

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3. What is your age range?

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4. Please select your zip code

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5. What is your Ethnicity

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6. Please indicate your preferred language

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7. What type of medical insurance to you have?

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8. Do you know how to access your mental health/substance use (behavioral health) benefits?

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9. Do you have personal transportation? (i.e. a personal vehicle or regular access to a shared vehicle).

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10. Do you have internet access at home or where you currently reside?

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11. Do you feel you have access to mental health resources?

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12. How do you get your information about mental health services?

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13. Have you ever received any type of behavioral health counseling services (including substance use/misuse)?

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14. Have you ever been diagnosed with a mental health condition?

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15. Do you family or loved ones openly discuss supports that may be needed to help with mental health, including but not limited to mindful practices?

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16. Do your family or loved ones openly discuss mental health topics around stress, anxiety, and/or depression?

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17. How important is your mental health to your overall wellness/wellbeing?

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18. How important are behavioral health (mental health/substance use) services to your wellness/wellbeing?

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19. How important is having a therapist/counselor focus on your culturally specific needs as part of your care/treatment?

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20. How important is it for the staff supporting your counselor/therapist to also be same ethnicity as yourself (i.e., the case managers, navigators, peer support, office staff, etc.)?

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21. Rank the following by most important to you, to address the mental health of Asian American/Pacific Islander residents in Placer County.

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22. What are some issues or barriers that may prevent you or your loved ones from seeking mental health services in Placer County? Please check all that apply

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23. Please indicate your gender assigned at birth

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24. Please indicate your current gender identity

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25. Please indicate your sexual orientation

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26. Where did you hear about this survey?

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