COMET Use Survey

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Required format:

As someone who attended a COMET Community Training, you can help us understand how COMET is being used. If you have used the COMET questions in a conversation, please tell us about that experience. If you have not used COMET, we appreciate learning more about that, too.

Acknowledge someone is "not yourself." ("You don't seem yourself lately.")
Ask "How are you?" ("How are you? No, really. How are you?")
Share observation of mood or behavior. ("I've noticed you haven't... [been at coffee, at the football games, at the club"]. OR "I've noticed you seem... [stressed, sad, distracted] lately.")
Ask about family or social life. ("How are things at home/work/school/with your friends?")
Offer an invitation to further engage. ("Can we get coffee sometime soon and talk? Can I call you sometime?")
Optional - Self-disclosure. ("You know, ____ happened to me a few years ago. I hear you. For me, it was ____.")
Ask how to help more OR exit the conversation supportively. ("How can I help you? I think we should call ____ for help, OK?")

Please take 5 minutes to complete this short survey. The information you provide will help improve the program.

Your answers will be kept confidential. Survey results will be reviewed in group format only.

If you have questions, please contact us at COMET@cuanschutz.edu. Thank you!

Is this the first time you have filled out this survey?

Yes

Not sure!

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Did you attend a COMET Community Training (which lasts 1.5-2 hours)?

Yes

Not sure!

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Have you used the COMET questions or statements in any way?

Yes

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Please indicate why you have not used the COMET questions / statements. Select all that apply.

Opportunity has not come up

I forgot the questions/statements

I do not feel confident about using the COMET questions/statements

I was not interested in the training when I attended it

I do not know of resources that the person might need, so I do not want to start a conversation

Other

Please tell us about yourself. All answers are confidential and we will use this information only in group form to describe the people taking this survey.

How would you describe your gender?

Man

Woman

Non-binary

Prefer to self-describe

Prefer not to answer

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How would you describe your race? (check all that apply)

American Indian or Alaska Native

Asian

Black or African American

Pacific Islander

White

Other

Prefer not to answer

Are you Hispanic or Latino/a?

Yes

Prefer not to answer

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What is your age range?

18-24 years

25-36 years

37-50 years

51-64 years

65+ years

Prefer not to answer

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What is your zip code?

Please pick the best option for your occupation category (select one):

Farmer/Rancher

Agriculture-Related Business or Services Manager/Owner/Retail Worker/Skilled Worker

Non-Agriculture-Related Business Owner/Manager/Retail Worker/Skilled Worker

Educator/Teacher/Mentor

Extension Agent

Finance/Banker/Insurance/Accountant

Office Manager/Office Staff/Human Resources/Receptionist

Mental-Behavioral Health Provider/Counselor

Primary Care Clinician or specialist/Nurse/Medical Assistant/Care Coordinator

Social Worker/Case Manager/Social Services

Non-Profit Organization or Program Management/Staff

Pastor/Religious Services

Public Service Professional (police, sheriff, EMT, firefighter)

Government Professional (elected or appointed official)

Other

Retired

Student

Not Applicable

Prefer not to answer

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Thank you for completing this survey! If you use COMET in the future, please use this survey again to tell us about your experiences. You can also email us at COMET@cuanschutz.edu if you have any additional questions or comments.

Date you used COMET (estimate OK):

M-D-Y

How did the person you spoke with respond when you used the COMET questions/statements?

Did not engage in a conversation and responded "No, thanks. I'm fine." (no follow up)

Engaged in conversation and we ended it with no plans to talk further.

Engaged in a conversation and we agreed to meet and talk further, or meet at a social activity.

Engaged in a conversation and the other person agreed to meet with someone/an organization that I suggested.

Engaged in a conversation and we reached out to a local organization for support during our conversation.

Other: describe

Don't know.

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On a scale of 1 - 5, what was your comfort level using COMET in this interaction?

1 (not comfortable at all)

5 (very comfortable)

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How much do you agree or disagree with this statement: COMET helped me have this conversation.

Strongly disagree

Disagree

Neither

Agree

Strongly Agree

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Describe the setting where COMET was used:

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Other comments:

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How would you describe the gender of this person that you had a conversation with using COMET?

Man

Woman

Non-binary

Prefer to self-describe

Don't know

Prefer not to answer

How would you describe the race of this person? (check all that apply)

American Indian or Alaska Native

Asian

Black or African American

Pacific Islander

White

Other

Don't know

Prefer not to answer

Would you describe the person you had this conversation with as Hispanic or Latino/a?

Yes

Don't know

Prefer not to answer

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To the best of your ability, how would you describe the age of the person you had this conversation with?

18-24 years

25-36 years

37-50 years

51-64 years

65+ years

Don't know

Prefer not to answer

reset

How would you describe your gender?

Man

Woman

Non-binary

Prefer to self-describe

Prefer not to answer

reset

How would you describe your race? (check all that apply)

American Indian or Alaska Native

Asian

Black or African American

Pacific Islander

White

Other

Prefer not to answer

Are you Hispanic or Latino/a?

Yes

Prefer not to answer

reset

What is your age range?

18-24 years

25-36 years

37-50 years

51-64 years

65+ years

Prefer not to answer

reset

What is your zip code?

Please pick the best option for your occupation category (select one):

Farmer/Rancher

Agriculture-Related Business or Services Manager/Owner/Retail Worker/Skilled Worker

Non-Agriculture-Related Business Owner/Manager/Retail Worker/Skilled Worker

Educator/Teacher/Mentor

Extension Agent

Finance/Banker/Insurance/Accountant

Office Manager/Office Staff/Human Resources/Receptionist

Mental-Behavioral Health Provider/Counselor

Primary Care Clinician or specialist/Nurse/Medical Assistant/Care Coordinator

Social Worker/Case Manager/Social Services

Non-Profit Organization or Program Management/Staff

Pastor/Religious Services

Public Service Professional (police, sheriff, EMT, firefighter)

Government Professional (elected or appointed official)

Other

Retired

Student

Not Applicable

Prefer not to answer

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Please indicate if you give the COMET Team permission to use quotes from your open-ended responses. Your name will not be listed with the quote. Quotes may be used in presentations, evaluation reports, and grant applications.

Yes

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Do you have more to share about this interaction or more opinions about COMET?

You can receive a $30 gift card for a 15-20 minute conversation about your experiences using COMET. Can we contact you to ask you a few more questions?

Yes

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Do you have more to share about this interaction or more opinions about COMET?

You can receive a $30 gift card for a 15-20 minute conversation about your experiences using COMET. If interested, please provide your first name and contact information (email or phone number). A member of our team will contact you. Thank you!

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How would you like us to contact you? It is OK to select multiple methods.

Email (please provide email address)

Phone call (please provide phone number)

Text message (please provide number to text)

Thank you for completing this survey! If you use the COMET questions/statements again, please continue to use this survey link to tell us about your experiences. You can also email us at COMET@cuanschutz.edu if you have any additional questions or comments.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.