1. American Indian Veterans Survey
Today’s Date: _________________________
Tribal Affiliation:________________________ Age:______________
Era Served in the Military:__________________ Marital Status: _______________
Branch of Military: ________________________ Children: Yes____ No_____
Combat Veteran: Yes____ No____
To help us better understand the mental health needs of American Indian Veterans and
their families in this area (Pawnee Service Area) please respond to the following
questions using a scale from 1 – 10, with 1 being “Not Likely” and 10 being “Very
Likely”. Please circle the number that best corresponds to your answer.
1. How likely are American Indian people in this area aware of mental health
services available to American Indian Veterans and their families?
1 2 3 4 5 6 7 8 9 10
Not Somewhat Very
Likely Likely Likely
2. How likely are American Indian people in this area willing to utilize the mental
health services available to American Indian Veterans and their families?
1 2 3 4 5 6 7 8 9 10
Not Somewhat Very
Likely Likely Likely
3. How likely is it that the mental health services currently available to American
Indian Veterans and their families in this area are not being utilized due to
inaccessibility?
_____________________________________________________________________
1 2 3 4 5 6 7 8 9 10
Not Somewhat Very
Likely Likely Likely
2. 4. How likely is it that the community’s attitude (both local and extended) about
supporting efforts to address the mental health needs of American Indian Veterans
hinders the pursuit of the efforts to address their mental health needs?
1 2 3 4 5 6 7 8 9
10
Not Somewhat Very
Likely Likely Likely
5. How likely is it that people in the community are knowledgeable about specific
mental health issues that American Indian Veterans face such as Post-Traumatic
Stress Disorder (PTSD) or Traumatic Brain Injury (TBI) ?
____________________________________________________________________
1 2 3 4 5 6 7 8 9
10
Not Somewhat Very
Likely Likely Likely
6. How likely is it that the level of expertise and training among those working on the
issue of mental health needs of American Indian Veterans in this area is Very
High?
____________________________________________________________________
1 2 3 4 5 6 7 8 9
10
Not Somewhat Very
Likely Likely Likely
7. How likely is it that the level of expertise and training among those working on
the issue of mental health needs of American Indian Veterans in this area is Very
Low?
1 2 3 4 5 6 7 8 9
10
Not Somewhat Very
Likely Likely Likely
8, How likely is it that complementary and/or alternative medicine/therapies would
be helpful in treating the mental health needs of American Indian Veterans in
this area?
1 2 3 4 5 6 7 8 9
10
Not Somewhat Very
