St. Louis Mental Health Training Cooperative

Local Congregation Survey and Self-Assessment

The St. Louis Mental Health Training Cooperative (MHTC) is interested in understanding the mental health and substance abuse issues that you face in your congregation, as well as any desires for training you might have. This survey should take about 10-15 minutes to complete. We appreciate your time. Thank you.

Name of Congregation: ______

Address of Congregation: ______

Name(s) of Person(s) Completing Survey: ______

Position(s) of Person Completing Survey: □Clergy □Other Congregation Staff □ Lay Person

□Other: ______

Please identify the mental health and substance abuse issues in your congregation:

Substance Abuse or Mental Health Issue / How often this issue is present / How big a concern for you
Alcoholism/excessive drinking / □rarely □sometimes □often / □none □minor □major
Drug use/substance abuse / □rarely □sometimes □often / □none □minor □major
Anxiety / □rarely □sometimes □often / □none □minor □major
Post-Trauma or Abuse issues / □rarely □sometimes □often / □none □minor □major
Severe personality problems / □rarely □sometimes □often / □none □minor □major
Depression / □rarely □sometimes □often / □none □minor □major
Severe mental illness - bipolar disorder, schizophrenia / □rarely □sometimes □often / □none □minor □major
Children’s behavior problems / □rarely □sometimes □often / □none □minor □major
Runaway or homeless youth / □rarely □sometimes □often / □none □minor □major
Military veterans with mental health issues / □rarely □sometimes □often / □none □minor □major
Distinguishing sin or willful behavior from mental illness / □rarely □sometimes □often / □none □minor □major
Uncertain how to support families with mental illness / □rarely □sometimes □often / □none □minor □major
Not sure when and where to refer someone for treatment / □rarely □sometimes □often / □none □minor □major
Unavailability of housing / □rarely □sometimes □often / □none □minor □major
Other: ______/ □rarely □sometimes □often / □none □minor □major

Please describe the most pressing mental health- and substance abuse-related challenges about which you would like more information or resources:

______

______

______

Please indicate which of the following trainings would be useful for your congregation:

Substance Abuse or Mental Health Training / Interested in this training for your congregation? / (If interested) who would participate in the training?
Mental Health 101 – a 1-2 hour introduction to mental health / □no □somewhat □very / □Clergy □Lay Persons □Other
Mental Health First Aid – a thorough 12-hour training on how to respond to mental illness / □no □somewhat □very / □Clergy □Lay Persons □Other
Children’s Mental Health(1.5 hrs) / □no □somewhat □very / □Clergy □Lay Persons □Other
Children’s Mental Health – comprehensive (7 sessions) / □no □somewhat □very / □Clergy □Lay Persons □Other
Education for families coping with mental illness (2-6 hours) / □no □somewhat □very / □Clergy □Lay Persons □Other
Firsthand accounts - People present their experience with mental illness (1-2 hours) / □no □somewhat □very / □Clergy □Lay Persons □Other
Clergy – Mental Health Clinician Consultations (1 hour) / □no □somewhat □very / □Clergy □Lay Persons □Other
Companionship Training – a team approach to helping people with mental illness (4 hours) / □no □somewhat □very / □Clergy □Lay Persons □Other
Addictions 101 (1-4 hours) / □no □somewhat □very / □Clergy □Lay Persons □Other
Substance Abuse and Dependence – 1 to 1.5 day workshop / □no □somewhat □very / □Clergy □Lay Persons □Other
Setting up a substance abuse ministry (2 hours) / □no □somewhat □very / □Clergy □Lay Persons □Other
Helping children living with addicted individuals (1-4 hours) / □no □somewhat □very / □Clergy □Lay Persons □Other
Response to Trauma (1-2 hours) / □no □somewhat □very / □Clergy □Lay Persons □Other
Other: ______/ □no □somewhat □very / □Clergy □Lay Persons □Other
Other: ______/ □no □somewhat □very / □Clergy □Lay Persons □Other

May we contact you with information on available trainings?

□email: ______□phone: ______

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Congregational Needs Assessment/Self-Assessment

Local Congregation Self-Assessment

This Self-Assessment is designed to help identify your congregation’s strengths and areas for growth, with respect to mental health and substance abuse issues, in four areas:

1) Knowledge of symptoms, causes and treatments;

2) Ministries for supporting people and their families;

3) Relationships with treatment providers;

4) Outreach and advocacy for people with mental health and substance use issues

For each o f the items below, please indicate your congregation’s status by checking the small box next to the description that is most like your congregation.

1. Knowledge of Mental Health and Substance Abuse Issues

1a. Knowledge of Mental Illness – symptoms, causes, and treatments (Adults)

□No Knowledge - Unengaged
We have not provided educational opportunities in our congregation concerning symptoms, causes, and treatments; our congregation is not knowledgeable / □Limited Knowledge - Unengaged
We have not provided educational opportunities in our congregation concerning symptoms, causes, and treatments; some people in our congregation are knowledgeable / □ Some Knowledge – Limited Engagement
We have rarely provided educational opportunities in our congregation concerning symptoms, causes, and treatments; some people in our congregation are knowledgeable / □Some Knowledge –Engagement
We have provided several educational opportunities in our congregation concerning symptoms, causes, and treatments; some people in our congregation are knowledgeable / □Knowledgeable and Engaged
We have provided several educational opportunities in our congregation concerning symptoms, causes, and treatments; many or most people in our congregation are knowledgeable

Comments: ______

______

1b. Knowledge of Mental Illness – symptoms, causes, and treatments (Children)

□No Knowledge - Unengaged
We have not provided educational opportunities in our congregation concerning symptoms, causes, and treatmentsin children; our congregation is not knowledgeable / □Limited Knowledge - Unengaged
We have not provided educational opportunities in our congregation concerning symptoms, causes, and treatmentsin children; some people in our congregation are knowledgeable / □ Some Knowledge – Limited Engagement
We have rarely provided educational opportunities in our congregation concerning symptoms, causes, and treatmentsin children; some people in our congregation are knowledgeable / □Some Knowledge –Engagement
We have provided several educational opportunities in our congregation concerning symptoms, causes, and treatmentsin children; some people in our congregation are knowledgeable / □Knowledgeable and Engaged
We have provided several educational opportunities in our congregation concerning symptoms, causes, and treatmentsin children; many or most people in our congregation are knowledgeable

Comments: ______

______

1c. Knowledge of Substance Abuse – symptoms, causes, and treatments

□No Knowledge - Unengaged
We have not provided educational opportunities in our congregation concerning symptoms, causes, and treatments; our congregation is not knowledgeable / □Limited Knowledge - Unengaged
We have not provided educational opportunities in our congregation concerning symptoms, causes, and treatments; some people in our congregation are knowledgeable / □ Some Knowledge – Limited Engagement
We have rarely provided educational opportunities in our congregation concerning symptoms, causes, and treatments; some people in our congregation are knowledgeable / □Some Knowledge –Engagement
We have provided several educational opportunities in our congregation concerning symptoms, causes, and treatments; some people in our congregation are knowledgeable / □Knowledgeable and Engaged
We have provided several educational opportunities in our congregation concerning symptoms, causes, and treatments; many or most people in our congregation are knowledgeable

Comments: ______

2. Ministries of Support for People and Their Families

Note: Ministries of support can include either formal or informal supports. For example, if clergy or lay persons are involved in visiting people in the hospital or providing spiritual direction, that is ministry. Please answer based on the knowledge you have. For example, if you do not know of lay persons providing support to people with mental health problems, respond as if they are not providing such support.

2a. Ministries of Support to People withMental Health Issues and Their Families

□No Ministries - Unengaged
Neither clergy nor lay persons provide support to people with Mental Health issues or their families; we are not currently receiving or seeking information or training / □Unintentional Ministry - Unengaged
Clergy or lay persons (but not both) provide unplanned support to people with Mental Health issues and/or their families; we are not currently receiving or seeking information or training / □ Unintentional Ministry - Limited Engagement
Clergy or lay persons (but not both) provide unplanned support to people with Mental Health issues and/or their families; we plan to receive training / □Intentional Ministry - Engagement
Clergy and/or lay persons intentionally seek opportunities to support people with Mental Health issues and/or their families; we currently are receiving (or very recently received) information or training / □Ongoing Ministry –Engaged
Both clergy and lay persons regularly provide support to people with Mental Health issues and their families; many (or an identifiable group of people) have been trained in this type of ministry

Comments: ______

______

2a. Ministries of Support to People withSubstance Abuse Issues and Their Families

□No Ministries - Unengaged
Neither clergy nor lay persons provide support to people with Substance Abuse issues or their families; we are not currently receiving or seeking information or training / □Unintentional Ministry - Unengaged
Clergy or lay persons (but not both) provide unplanned support to people with Substance Abuse issues and/or their families; we are not currently receiving or seeking information or training / □ Unintentional Ministry - Limited Engagement
Clergy or lay persons (but not both) provide unplanned support to people with Substance Abuse issues and/or their families; we plan to receive training / □Intentional Ministry - Engagement
Clergy and/or lay persons intentionally seek opportunities to support people with Substance Abuse issues and/or their families; we currently are receiving (or received recently) information or training / □Ongoing Ministry –Engaged
Both clergy and lay persons regularly provide support to people with Substance Abuse issues and their families; many (or an identifiable group of people) have been trained in this type of ministry

Comments: ______

______

3. Relationships with Treatment Providers

3a. Relationships with Mental Health Treatment Providers in the community.

□Unaware
Our congregation is not aware of the Mental Health Treatment Providers in our community. (We do not know who they are or where they are located.) / □Limited Awareness – No Relationship
Our congregation is aware of one or two Mental Health Treatment Providers in the community, but we do not have any relationships with those providers, and we do not refer people to them. / □ Limited Awareness – Limited Relationship
Our congregation is aware of one or more Mental Health Treatment Providers in the community, and we sometimes refer people to those providers. / □Good Awareness – Limited Relationships
Our congregation is aware of most or all of the Mental Health Treatment Providers in the community, and we sometimes refer people to those providers. / □Good Awareness – Strong Relationships
Our congregation is aware of most or all of the Mental Health Treatment Providers in the community, and our relationships with some of them involve more than just referring people to them. (For example, they refer to us, or we do joint trainings or advocacy work)

Comments: ______

______

3b. Relationships with Substance Abuse Treatment Providers in the community.

□Unaware
Our congregation is not aware of the Substance Abuse Treatment Providers in our community. (We do not know who they are or where they are located.) / □Limited Awareness – No Relationship
Our congregation is aware of one or two Substance Abuse Treatment Providers in the community, but we do not have any relationships with those providers, and we do not refer people to them. / □ Limited Awareness – Limited Relationship
Our congregation is aware of one or more Substance Abuse Treatment Providers in the community, and we sometimes refer people to those providers. / □Good Awareness – Limited Relationships
Our congregation is aware of most or all of the Substance Abuse Treatment Providers in the community, and we sometimes refer people to those providers. / □Good Awareness – Strong Relationships
Our congregation is aware of most or all of the Substance Abuse Treatment Providers in the community, and our relationships with some of them involve more than just referring people to them. (For example, they refer to us, or we do joint trainings or advocacy work)

Comments: ______

______

4. Outreach and Advocacy for People with Mental Health and Substance Abuse Issues

4a. Mental Health-related Outreach and Advocacy

□Inactive
Our congregation does not make attempts to initiate contact with people who have Mental Health issues, or to advocate for them. / □Limited, Minor Involvement
Our congregation has some minor involvement either in trying to initiate contact with people who have Mental Health issues, or in advocating for them in the community. / □ Minor Involvement in Both Areas
Our congregation has some minor involvement both in trying to initiate contact with people who have Mental Health issues, and in advocating for them in the community. / □Extensive Involvement in One Area
Our congregation is extensively involved either in trying to initiate contact with people who have Mental Health issues or in advocating for them in the community / □Extensive Involvement in Both Areas
Our congregation is extensively involved both in trying to initiate contact with people who have Mental Health issues and in advocating for them in the community

Comments: ______

______

4b. Substance Abuse-related Outreach and Advocacy

□Inactive
Our congregation does not make attempts to initiate contact with people who have Substance Abuse issues, or to advocate for them. / □Limited, Minor Involvement
Our congregation has some minor involvement either in trying to initiate contact with people who have Substance Abuse issues, or in advocating for them in the community. / □ Minor Involvement in Both Areas
Our congregation has some minor involvement both in trying to initiate contact with people who have Substance Abuse issues, and in advocating for them in the community. / □Extensive Involvement in One Area
Our congregation is extensively involved either in trying to initiate contact with people who have Substance Abuse issues or in advocating for them in the community / □Extensive Involvement in Both Areas
Our congregation is extensively involved both in trying to initiate contact with people who have Substance Abuse issues and in advocating for them in the community

Comments: ______

______

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Congregational Needs Assessment/Self-Assessment

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Congregational Needs Assessment/Self-Assessment