- Under which of the following conditions would a client/patient be dismissed by your center or
asked to leave the program before completing the treatment course? (CHECK ALL THAT
APPLY)
31.3 Client/patient using drugs or alcohol
75.9 Client/patient bringing drugs or alcohol onto the facility premises
12.0 Client/patient being unable to pay for treatment (e.g., private sources of payment run out;
insurance stops covering costs)
69.9 Other* (PLEASE SPECIFY)- The high number of responses in the “Other” option are quite varied and therefore, not
specified here. Other responses include aggressive and violent behaviors, non-compliance,
smoking, and legal issues.
- The high number of responses in the “Other” option are quite varied and therefore, not
- What are the top two sources from which clients/patients are referred to your facility for
treatment? (CHECK UP TO TWO)
27.7 Individual/self-referrals
6.0 Family
1.2 Private physician
22.9 Alcohol or other drug counselors (e.g., CASACs)
2.4 Other health care professionals (e.g., physicians, nurses)
3.6 Schools/educational organizations
3.6 Employers/employee assistance programs
18.1 Other community organizations
42.2 Criminal justice/court/drug court (exclusive of DUI/OWI)
45.8 Criminal justice/court/drug court referrals(DUI/OWI)
22.9 Other sources - How would you describe the attitude of the surrounding community toward having a treatment
facility in the neighborhood? (CHECK THE ONE THAT BEST APPLIES)
2.4 Generally hostile
43.4 Neither hostile nor supportive
48.2 Generally supportive
6.0 Not applicable - If your facility does any advertising or outreach to attract patients/clients, which two of the
following methods does it use most often? (CHECK UP TO TWO)
12.0 This facility does not do any advertising or outreach
23.5 Local print/fliers
4.8 Television
27.7 Internet
10.8 Hospitals/doctors’ offices
21.7 Community centers
48.2 Other
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