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  5. Culural Competence Self Assessment Questionnaire
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Exit Survey
 
 
Hello:
You are invited to participate in our Cultural Competence Self-Assessment Questionnaire. In this survey, all of the personnel in the San Diego Field Office will complete a survey that asks questions about cultural competence. The purpose of this survey is to assess the cultural competence needs of the office and address cross-cultural weaknesses and build upon cross-cultural strengths of the staff generally and organization specifically . It will take approximately 20-30 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. Your opinions are very important as they will help develop the cultural competence of the office as a whole which will allow us to better serve our clients.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
 
Sex:
 
Male
 
Female
 
 
 
Race (select all that apply)
 
1. Asian/Pacific Islander
 
2. Black/African American
 
3. Hispanic- or Latino-American
 
4. Native American / Indian American
 
5. Caucasian
 
6. Other (please specify)

 
 
 
How well are you able to describe the communities of color in your service area?
 
NOT AT ALL
 
BARELY
 
FAIRLY WELL
 
VERY WELL
 
 
 
How well are you able to describe differences within cultural groups?
 
NOT AT ALL
 
BARELY
 
FAIRLY WELL
 
VERY WELL
 
 
 
How well are you able to describe the strengths of the groups of color in your service area?
 
NOT AT ALL
 
BARELY
 
FAIRLY WELL
 
VERY WELL
 
 
 
How well are you able to describe the social problems of the groups of color in your service area?
 
NOT AT ALL
 
BARELY
 
FAIRLY WELL
 
VERY WELL
 
 
To what extent do you know the following demographics within communities of color in your service area?
NOT AT ALL BARELY FAIRLY WELL VERY WELL
Unemployment rates
Geographic locations
Income differentials
Educational attainment
Birth/death rates
Crime rates
Homicide rates
 
 
To what extent do you know the following people of color in your service area?
NOT AT ALL BARELY FAIRLY WELL VERY WELL
Social historians
Informal supports and natural helpers
Formal social service agencies
Formal leaders
Informal leaders
Business people
Advocates
Clergy or spiritualists
 
 
 
Do you know the prevailing beliefs, customs, norms and values of the groups of color in your service area?
 
NOT AT ALL
 
BARELY
 
FAIRLY WELL
 
VERY WELL