Respect and Social Inclusion Data Collection
Napa County Public Health created the Respect and Social Inclusion framework pictured below based on interview data collected from Napa County community members from 2019-2022. Community partners are now collecting responses in order to measure Respect and Social Inclusion in Napa County. Participants may select the multiple choice response that best fits their own experience, or fill out this form as part of a client interview.
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Respect and Social Inclusion Domain Framework
Are you responding for yourself or filling out responses for a client?
Clear selection
If responding on behalf of a client, what is your organization's name?
Which race/ethnicity that best describes you? *
What is your gender?
Clear selection
What is your age? *
What is your primary language? *
Do you identify as part of the LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning) community?
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I feel like my community is committed to including me and my opinions.
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I have opportunities to provide my input to improve the health and well-being of my community.
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I trust that organizations in my community interact with me in a way that is ethical, accountable, and honest.
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I trust the information I get from my community is accurate and timely.
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I see my culture or identity represented in my community.
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I am involved in decision-making processes in my community.
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When I provide input, my opinions are valued.
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I see my input reflected in community events, systems, and outcomes.
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I am aware of opportunities to share about my culture and learn about other cultures.
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I see images and language that reflect my identity throughout my community.
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I feel safe and welcome sharing my identity in my community.
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I can receive services in my preferred language.
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When I ask for assistance in accessing services, I receive the help I need.
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During an emergency, I am connected to a support system that I trust (such as family, neighbors, a community organization).
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I know how to access support services during an emergency (such as free food, financial support, shelter).
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