age
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What is your age?, type: esriFieldTypeString
, Coded Values:
[0-15: 0-15 years old]
, [16-25: 16-25 years old]
, [26-59: 26-59 years old]
, ...2 more...
)
sex_assigned_at_birth
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What sex were you assigned at birth?, type: esriFieldTypeString
, Coded Values:
[Female: Female]
, [Male: Male]
, [prefer_not_to_answer2: Prefer not to answer]
)
consumer_mh
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Are you a consumer of mental health services?, type: esriFieldTypeString
, Coded Values:
[Yes (Currently): Yes (Currently)]
, [Yes (Previously): Yes (Previously)]
, [No: No]
, ...1 more...
)
consumer_ads
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Are you a consumer of alcohol and/or drug services?, type: esriFieldTypeString
, Coded Values:
[Yes (Currently): Yes (Currently)]
, [Yes (Previously): Yes (Previously)]
, [No: No]
, ...1 more...
)
friend_consumer
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Are you a friend, family member, or loved one of a consumer of mental health services and/or alcohol and drug services?, type: esriFieldTypeString
, Coded Values:
[Yes: Yes]
, [No: No]
, [prefer_not_to_answer7: Prefer not to answer]
)
job_field
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Are you connected to any of the following stakeholder groups (Employed, Affiliated, Represent, Lived Experience)? (Check all that apply), type: esriFieldTypeString
)
stakeholder_org
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Optional: Please provide specific stakeholder organization name(s) (please DO NOT include names of individuals):, type: esriFieldTypeString
)
disability
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you have a disability or other impairment that is expected to last longer than 6 months and substantially limits a major life activity, which is not the result of a severe mental illness?, type: esriFieldTypeString
, Coded Values:
[Yes: Yes]
, [No: No]
, [prefer_not_to_answer7: Prefer not to answer]
)
sb_living
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you live or work in San Bernardino County?, type: esriFieldTypeString
, Coded Values:
[sb_yes: Yes]
, [sb_no: No, I live and work in a neighboring California County]
, [prefer10: Prefer not to anwer]
)
sbco_cities
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you live in one of the following cities?, type: esriFieldTypeString
, Coded Values:
[san_bernardino_city: San Bernardino]
, [fontana_city: Fontana]
, [ontario_city: Ontario]
, ...4 more...
)
city_name
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: City of residence:, type: esriFieldTypeString
)
future_updates
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: In the future how would you like to receive updates? (check all that apply), type: esriFieldTypeString
)
app_helpfulness
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you think a free app that teens can contact for help with mental health, food, housing, or other support would be helpful for teens in your community?, type: esriFieldTypeString
, Coded Values:
[yes: Yes, very helpful]
, [somewhat_helpful: Somewhat helpful]
, [not_helpful: Not helpful]
, ...1 more...
)
app_recommendation
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: If the app were available, how likely would you be to use it or recommend it to a friend who needed help?, type: esriFieldTypeString
, Coded Values:
[not_likely: Not likely]
, [not_sure: Not sure]
, [somewhat_likely: Somewhat likely]
, ...1 more...
)
app_easier_help
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Would having a private confidential, teen-friendly app make it easier for you to ask for help when you need it?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [maybe: Maybe]
, [no: No]
)
app_comments
(
nullable: true, editable: true, defaultValue: null, length: 9999, alias: Any other comments or feedback on the app?, type: esriFieldTypeString
)
end_message
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Thank you again for taking the time to review and provide feedback., type: esriFieldTypeString
)