Name
              
                * 
              
             
          
                
                
                  
                    First Name 
                   
                
                
                  
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
            
              
                
            
              Email
              
                * 
              
             
          
                
                
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Please indicate if this is your Pre or Post CRAFT Connect study survey.
              
             
          
                
                
                
                  
                    Pre study 
                  
                    Post study 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              If this is your Post study, how many sessions did you participate in?
              
             
          
                
                
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Please list any programs or organizations that have referred and/or encouraged you to participate in CRAFT Connect Family Support.
              
             
          
                
                
                
                  
                    USARA 
                  
                    New Roads Behavioral Health 
                  
                    Foundation for Reovery 
                  
                    Other 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              If other:
              
             
          
                
                
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
              
                
            
              Please enter your zip code.
              
             
          
                
                
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Emotional/mental well-being?
              
             
          
                
                
                
                  
                    Good 
                  
                    Fair 
                  
                    Poor 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Physical well-being?
              
             
          
                
                
                
                  
                    Good 
                  
                    Fair 
                  
                    Poor 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Relationship well-being?
              
             
          
                
                
                
                  
                    Good 
                  
                    Fair 
                  
                    Poor 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Emotional/mental well-being?
              
             
          
                
                
                
                  
                    Good 
                  
                    Fair 
                  
                    Poor 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Physical well-being?
              
             
          
                
                
                
                  
                    Good 
                  
                    Fair 
                  
                    Poor 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Relationship well-being?
              
             
          
                
                
                
                  
                    Good 
                  
                    Fair 
                  
                    Poor 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              I know how to improve my family's well-being.
              
             
          
                
                
                
                  
                    Strongly disagree 
                  
                    Disagree 
                  
                    Neutral 
                  
                    Agree 
                  
                    Strongly Agree 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              I have the skills needed to improve my family's well-being.
              
             
          
                
                
                
                  
                    Strongly disagree 
                  
                    Disagree 
                  
                    Neutral 
                  
                    Agree 
                  
                    Strongly Agree 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              I am confident I can improve my family's well-being.
              
             
          
                
                
                
                  
                    Strongly disagree 
                  
                    Disagree 
                  
                    Neutral 
                  
                    Agree 
                  
                    Strongly Agree 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              I often think I can't do anything to improve my family's well-being.
              
             
          
                
                
                
                  
                    Strongly disagree 
                  
                    Disagree 
                  
                    Neutral 
                  
                    Agree 
                  
                    Strongly Agree 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              My sleep is disturbed
              
             
          
                
                
                
                  
                    Yes, regular basis 
                  
                    Yes, sometimes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Caregiving is inconvenient
              
             
          
                
                
                
                  
                    Yes, regular basis 
                  
                    Yes, sometimes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Caregiving is a physical strain
              
             
          
                
                
                
                  
                    Yes, regular basis 
                  
                    Yes, sometimes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Caregiving is confining
              
             
          
                
                
                
                  
                    Yes, regular basis 
                  
                    Yes, sometimes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              There have been family adjustments
              
             
          
                
                
                
                  
                    Yes, regular basis 
                  
                    Yes, sometimes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              There have been changes in personal plans
              
             
          
                
                
                
                  
                    Yes, regular basis 
                  
                    Yes, sometimes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              There have been other demands on my time
              
             
          
                
                
                
                  
                    Yes, regular basis 
                  
                    Yes, sometimes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              There have been emotional adjustments
              
             
          
                
                
                
                  
                    Yes, regular basis 
                  
                    Yes, sometimes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Some behavior is upsetting
              
             
          
                
                
                
                  
                    Yes, regular basis 
                  
                    Yes, sometimes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              It is upsetting to find the person I care for has changed so much from his/her former self
              
             
          
                
                
                
                  
                    Yes, regular basis 
                  
                    Yes, sometimes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              There have been work adjustments
              
             
          
                
                
                
                  
                    Yes, regular basis 
                  
                    Yes, sometimes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Caregiving is a financial strain
              
             
          
                
                
                
                  
                    Yes, regular basis 
                  
                    Yes, sometimes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              I feel completely overwhelmed
              
             
          
                
                
                
                  
                    Yes, regular basis 
                  
                    Yes, sometimes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
              
                
            
              Total your responses. "Yes, regular basis" equals 2 points. "Yes, sometimes" equals 1 point. Scoring ranges from 0 to 26, with 0 indicating no caregiver strain and 26 indicating extreme strain.