Attachments

2008 NSMHTF - Attachments.pdf

2008 National Survey of Mental Health Treatment Facilities (NSMHTF)

Attachments

OMB: 0930-0119

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Attachment 1.0
CMHS Cover Letter

[SAMHSA Letterhead]
January 11, 2008
[Salutation] [First & Last Name]
[Title]
[Organization Name
[Organization Address]
[City, [State] [Zipcode]

Org ID: xxxxxx Facility ID: xx

Dear [Salutation] [Last Name]:
I am asking for your help in completing the 2008 National Survey of Mental Health Treatment
Facilities (NSMHTF). This is a recurrent nationwide survey conducted by the Center for Mental
Health Services (CMHS). We have enclosed a questionnaire, information sheets, and a postagepaid return envelope. For your convenience, several options are available for responding: (1)
Internet, (2) Mail, or (3) Fax. Please use only one method of response.
The purpose of the survey is to continue the biennial survey of key characteristics of services provided
by mental health facilities (including general hospitals with separate psychiatric living units). The
survey examines type of services provided, facility accreditation, and current caseload.
The information you provide will be used to update the National Mental Health Information
Center’s Mental Health Services Locator (http://mentalhealth.samhsa.gov/databases/). This
online Directory is used extensively by mental health professionals, as well as consumers, to locate
mental health facilities across the country. Not responding to this Inventory may result in your
facility (or facilities) being listed incorrectly in this online Directory.
Please take the time to complete the questionnaire by Friday, February 15, 2008. If you have any
questions, please call our Survey Help Line from 8:00 a.m. to 5:00 p.m. Eastern Time.
Best regards,
Daniel Foley
Project Officer, Survey, Analysis, and Financing Branch
Division of State and Community Systems Development
Center for Mental Health Services
Enclosures

Attachment 1.1
Criteria Used to Determine Facility Eligibility

2008 National Survey of Mental Health Treatment Facilities
Criteria Used to Determine Facility Eligibility
A mental health facility must have each of the following five characteristics:
1. Formal establishment by law, regulation, charter, license, or agreement;
2. An established organizational structure, including a staffing structure;
3. A primary goal for all or part of the facility of improving the mental health of its clientele;
4. A clientele with psychiatric, psychological, or associated social adjustment impairments;
5. Provision of mental health services.
If you have comments or questions regarding the criteria for being considered a mental health facility,
please contact the help line at 1 (800) 722-6194.

Attachment 1.2
Service Descriptions

2008 National Survey of Mental Health Treatment Facilities
QUESTION 6 – MENTAL HEALTH SERVICES DEFINITIONS
Intake services – Services designed to briefly assess the type and degree of a client/patient's
mental health condition to determine whether services are needed and to link him/her to the
most appropriate and available service.
Diagnostic Evaluation – The aims of a general psychiatric evaluation are 1) to establish a
psychiatric diagnosis, 2) to collect data sufficient to permit a case formulation, and 3) to develop
an initial treatment plan, with particular consideration of any immediate interventions that may
be needed to ensure the patient's safety, or, if the evaluation is a reassessment of a patient in
long-term treatment, to revise the plan of treatment in accord with new perspectives gained from
the evaluation. Services may include interviews, psychological testing, physical examinations
including speech/hearing, and laboratory studies.
Information and Referral Services – Information services are those designed to impart
information on the availability of clinical resources and how to access them. Referral services
are those that direct, guide, or link a client/patient with appropriate services provided outside of
the facility.
Psychiatric Emergency Walk-in Services – These provide psychiatric care in emergency
situations and are staffed by workers specifically trained for this purpose. They include crisis
intervention, which enables the individual, family members and friends to cope with the
emergency while maintaining the individual's status as a functioning community member to the
greatest extent possible, and a facility which is open for a patient to walk in.
Suicide Prevention – Suicide prevention encompasses identification of risk factors; staff
education on identifying the distinguishing attributes of suicidal behavior and using methods of
risk detection; assessment, intervention, and management of suicidal patients. It may feature a
variety of therapeutic approaches, treatment of underlying mental disorders and/or substance
abuse treatment, pharmacotherapy when indicated, supportive services, and education of the
consumer and family members. Hotlines help individuals in suicidal crisis to contact the nearest
suicide prevention and mental health service provider.
Case Management – This service helps people arrange for appropriate services and supports.
A case manager coordinates mental health, social work, educational, health, vocational,
transportation, advocacy, respite care, and recreational services, as needed. The case manager
makes sure that the changing needs of the client/patient and family are met.
Psychosocial Rehabilitation Services – These are therapeutic activities or interventions
provided individually or in groups that may include development and maintenance of daily and
community-living skills, self-care, skills training includes grooming, bodily care, feeding, social
skills training, and development of basic language skills.
Vocational Rehabilitation Services – These are services that include job finding/development;
assessment and enhancement of work-related skills – such as writing a resume or taking part in
an interview -- attitudes, and behaviors; as well as provision of job experience to
clients/patients. It also includes transitional employment.
(Continued on other side)

Legal Advocacy – Legal services are provided to ensure the protection and maintenance of a
client/patient's legal rights.
Education Services – Locating or providing a full range of educational services from basic
literacy through the General Equivalency Diploma and college courses. These include special
education at the pre-primary, primary, secondary, and adult levels.
Housing Services – Housing services are designed to assist individuals in finding and
maintaining appropriate housing arrangements.
Consumer-Run Services – These are mental health treatment or support services that are
provided by mental health consumers. They include social clubs, peer-support groups, and
other peer-organized or consumer-run activities such as evaluations of consumer satisfaction of
mental health treatment.
Chronic Disease/Illness Management – Chronic Disease Management (CDM) is a systematic
approach to improving health care for people with chronic disease. Central to most CDM
approaches are patient self-management, physician education, and organizational support.
Among the variety of strategies employed are case management, continuous quality
improvement, disease management (DM) and the chronic care model (CCM).
Disease Management (DM) programs identify appropriate candidates for Chronic Disease
Management (CMD), develop a long-term care strategy using evidence-based medicine
guidelines, provide patient education to bring about behavior change, apply appropriate medical
services to support the physician’s treatment plan, and collect, evaluate and disseminate
information on outcomes to physicians and other providers of care.
The Chronic Care Model (CCM) is a strategy for adapting medical practice to better meet the
needs of the management of chronic disease. It identifies the essential elements of a heath care
system that encourages high-quality chronic disease care as the following:
1. Community: Connect medical practices with community health resources.
2. Health System: Adjust the goals, policies, and financial incentives of health care
organizations to the management of chronic disease as a priority.
3. Self-management Report: Assist patients to become effective self-managers of their
chronic disease.
4. Delivery System Design: Structure the delivery system to enhance team management.
5. Decision Support: Integrate evidence-based guidelines into daily practice decisionmaking.
6. Clinical Information Systems: Institute clinical information systems that provide
physician reminders for noncompliance with guidelines, feedback to physicians on
compliance with chronic disease performance measures, and patient registries for
population-based care.

Attachment 1.3
Mental Health Therapeutic Approaches

2008 National Survey of Mental Health Treatment Facilities
QUESTION 7 - MENTAL HEALTH TREATMENT APPROACHES
Interpersonal Psychotherapy – Through one-on-one conversations, this approach focuses on
the patient's current life and relationships within the family, social, and work environments. The
goal is to identify and resolve problems with insight, as well as build on strengths.
Group Therapy – This form of therapy involves groups of usually 4 to 12 people who have
similar problems and who meet regularly with a therapist. The therapist uses the emotional
interactions of the group's members to (1) help them get relief from distress and (2) possibly
modify their behavior.
Couples Counseling/Family Therapy – These two similar approaches to therapy involve
discussions and problem-solving sessions facilitated by a therapist; sometimes with the couple
or entire family group; sometimes with individuals. Such therapy can help couples and family
members improve their understanding of, and the way they respond to, one another. This type
of therapy can resolve patterns of behavior that might lead to more severe mental illness.
Family therapy can help educate the individuals about the nature of mental disorders and teach
them skills to cope better with the effects of having a family member with a mental illness, such
as how to deal with feelings of anger or guilt.
Behavior Modification – This approach applies learning and conditioning principles to modify
overt behaviors, which are those behaviors obvious to everyone, including, the client.
Cognitive/Behavioral Therapy – A combination of cognitive and behavioral therapies, this
approach helps people change negative thought patterns, beliefs, and behaviors so they can
manage symptoms and enjoy more productive, less stressful lives.
Activity Therapy – This approach includes art, dance, music, recreational and occupational
therapies, and psychodrama.
Electroconvulsive Therapy – Also known as ECT, this technique uses low voltage electrical
stimulation of the brain to treat some forms of major depression, acute mania, and some forms
of schizophrenia. This potentially life-saving technique is considered only when other therapies
have failed, when a person is seriously medically ill and/or unable to take medication, or when a
person is very likely to commit suicide. Substantial improvements in the equipment, dosing
guidelines, and anesthesia have significantly reduced the side effects.
Psychotropic Medication Therapy – This approach encompasses the prescription and
administration of psychotropic medications; assessment of drug effectiveness, efficacy, and
risks versus benefits; as well as monitoring and treating side effects.

Attachment 1.4
Supportive Services

2008 National Survey of Mental Health Treatment Facilities

Question 8 – SUPPORTIVE PRACTICES

Supported Housing – Supported housing is independent normal housing with flexible,
individualized supportive services to allow client/patients to maintain as much independence as
possible.

Supported Employment – These supportive services include assisting individuals in finding
work; assessing individuals' skills, attitudes, behaviors, and interest relevant to work; providing
vocational rehabilitation and/or other training; and providing work opportunities.

Assertive Community Treatment – This multi-disciplinary clinical team approach provides 24hour intensive community services in the individual's natural setting that help those with serious
mental illness live in the community.

Family Psychoeducation – Family psychoeducation involves a partnership among consumers,
families and supporters, and practitioners. Through relationship building, education,
collaboration, and problem solving, family psychoeducation helps consumers and their families
and supporters to:
•
•
•
•
•
•

Learn about mental illness
Master new ways of managing their mental illness
Reduce tension and stress within the family
Provide social support and encouragement to each other
Focus on the future
Find ways for families and supporters to help consumers in their recovery

Integrated Dual Disorders Treatment – This treatment occurs when a person receives
combined treatment for mental illness and substance abuse from the same clinician or
treatment team. Effective integrated treatment programs view recovery as a long-term,
community-based process. The approach includes:
•
•
•
•
•
•
•
•

Individualized treatment, based on a person’s current stage of recovery
Education about the combined illnesses
Assertive outreach to client/patients
Intensive case management
Help with housing and supported employment among other services
Money management
Relationships and social support
Counseling designed especially for those with co-occurring disorders

(Continued on other side)

Illness Management and Recovery – IMR is a standardized individual or group format
program based on five evidence-based practices.
•
•
•
•
•

Psychoeducation teaches about mental illness and its treatment, which improves
consumers’ understanding of their disorder and their capacity for informed treatment
decision-making.
Behavioral tailoring helps consumers fit taking medication into daily routines by building
in natural reminders (such as putting one’s toothbrush by one’s medication dispenser),
which improves medication adherence and can prevent relapses and re-hospitalizations.
Relapse prevention training teaches consumers how to recognize situations that trigger
relapses and the early warning signs of a relapse and develops a plan for responding to
those signs in order to stop them before they worsen and interfere with functioning.
Coping skills training bolsters consumers’ ability to deal with persistent symptoms by
helping them identify and practice coping strategies, which can decrease distress and
the severity of symptoms.
Social skills training helps consumers strengthen their social supports and bonds with
others by practicing interpersonal skills in role plays and real life situations, resulting in
more rewarding relationships and better illness management.

FOR CHILDREN
Therapeutic Foster Care – A service which provides treatment for troubled children within
private homes of trained families. The approach combines the normalizing influence of familybased care with specialized treatment interventions, thereby creating a therapeutic environment
in the context of a nurturing family home.
Multisystemic Therapy – MST addresses the multidimensional nature of behavior problems in
troubled youth. Treatment focuses on those factors in each youth's social network that are
contributing to his or her antisocial behavior. The primary goals of MST programs are to
decrease rates of antisocial behavior and other clinical problems, improve functioning (e.g.,
family relations, school performance), and achieve these outcomes at a cost savings by
reducing the use of out-of-home placements such as incarceration, residential treatment, and
hospitalization. The ultimate goal of MST is to empower families to build a healthier environment
through the mobilization of existing child, family, and community resources. MST is delivered in
the natural environment (in the home, school, or community). The typical duration of homebased MST services is approximately 4 months, with multiple therapist-family contacts occurring
weekly. MST addresses risk factors in an individualized, comprehensive, and integrated fashion,
allowing families to enhance protective factors. Specific treatment techniques used to facilitate
these gains are based on empirically supported therapies, including behavioral, cognitive
behavioral, and pragmatic family therapies.
Functional Family Therapy – Functional Family Therapy is a family intervention program for
dysfunctional youth, including those with problems such as conduct disorder, violent acting-out,
and substance abuse. It is conducted both in clinic settings as an outpatient therapy and as a
home-based model. This therapeutic model identifies specific phases of treatment, which
organize intervention in a coherent manner, thereby allowing clinicians to maintain focus in the
context of considerable family and individual disruption. Each phase includes specific goals,
assessment foci, specific techniques of intervention, and therapist skills necessary for success.

Attachment 1.5
Seclusion and Restraint Definitions

2008 National Survey of Mental Health Treatment Facilities

Question 16 – Seclusion and Restraint Definitions

Seclusion - The involuntary confinement of a client/patient alone in a room or area from which the
client/patient is physically prevented from leaving.

Restraint - Any manual method or physical or mechanical device, material or equipment, that
immobilizes or reduces the ability of a client/patient to move his or her arms, legs, body or head
freely, attached or adjacent to the client/patient’s body, that he or she cannot easily remove that
restricts freedom of movement or normal access to one’s body. Also a restraint is a drug or
medication when it is used as a restriction to manage the client/patient’s behavior or restrict the
client/patient’s freedom of movement and is not a standard treatment or dosage for the client/patient’s
condition.

Attachment 1.6
Mental Health Facilities Type Definitions

2008 National Survey of Mental Health Treatment Facilities
Question 18 - MENTAL HEALTH FACILITY TYPE DEFINITIONS
Psychiatric Hospital - A facility operated as a hospital by the State (e.g. State mental hospital) or
licensed as a hospital by the State (e.g. private psychiatric hospital), whose primary purpose is to
provide inpatient care to patients with mental illness or emotional disturbance.
Residential Treatment Center for Severely Emotionally Disturbed Children - A facility not
licensed as a psychiatric hospital, whose primary purpose is to provide individually planned programs
of mental health treatment services in a residential care setting for children and youth younger than
18. This type of facility must have a clinical program that is directed by a psychiatrist, psychologist,
social worker, or psychiatric nurse who has a master’s or a doctoral degree. The primary reason for
admission of more than half of the clients is mental illness that can be classified by DSM-IV, DSMIII/DSM-IIIR/ICD-9-CM/ICD-10-CM codes, other than the codes for mental retardation, developmental
disorders, and substance-related disorders, such as drug abuse and alcoholism.
Residential Treatment Center for Adults – A facility not licensed as a psychiatric hospital, whose
primary purpose is to provide individually planned programs of mental health treatment services in a
residential care setting for adults.
Separate Psychiatric Living Unit of a General Hospital - A general hospital (public or private) that
provides inpatient mental health services in at least one separate psychiatric living unit. This unit
must have specifically allocated staff and space for the treatment of persons with mental illness. The
unit may be located in the hospital itself or in a separate building, either adjacent or more remote, that
is owned by the general hospital.
Outpatient/Partial Care Mental Health Facility - A facility that provides only outpatient mental
health services to ambulatory clients/patients for less than 3 hours at a single visit, on an individual,
group or family basis, usually in a clinic or similar facility. A psychiatrist generally assumes the
medical responsibility for all clients/patients or direction of the mental health treatment. Also can be a
facility that provides only partial care mental health services to ambulatory clients/patients in sessions
of 3 or more hours on a regular schedule.
Multi-setting (non-hospital) Mental Health Facility - A facility that provides mental health services
in two service settings (residential and outpatient setting) and is not classified as a psychiatric or
general hospital or as a residential treatment center for emotionally disturbed children. (The
classification of psychiatric hospital, general hospital, or residential treatment center for emotionally
disturbed children takes precedence over a multi-setting classification, even if two settings are
offered.)
Other - Any other type of facility or hospital not defined in the categories above. Please choose this
category ONLY if you are sure that you cannot use one of the above categories.

Attachment 1.7
Service Settings

2008 National Survey of Mental Health Treatment Facilities

Service Settings: What do they mean?
There are three service settings used in this Survey:

Inpatient (IP) – 24-hour inpatient psychiatric care in a
hospital setting
Residential Care (RC) – 24-hour or overnight psychiatric
care in a residential, non-inpatient, setting
Outpatient or Partial Care (OP/PC) – less than 24-hour, not
overnight, psychiatric care, such as ambulatory outpatient
counseling or partial day care
Examples of facilities that have IP service settings include psychiatric
hospitals or general hospitals with separate psychiatric inpatient units. IP
service settings are typically licensed by the State and provide both
medical and psychiatric treatment on a 24-hour basis.
Examples of facilities that have RC service settings include residential
treatment centers for children or adults, residential supportive centers, and
multi-service community mental health centers. These facilities do NOT
provide traditional hospital care for their clients.
Examples of facilities that have OP/PC service settings include the
traditional mental health outpatient clinic, the multi-service community
mental health center, and the partial day care center.
When responding to this Survey, please combine all of your service
programs by setting (e.g., multiple OP/PC programs).
Please keep these points in mind when responding to the Survey. If you
have any questions about how to classify your service programs into
service settings, please call the Survey Hotline and we will assist you.
(See other side for response mode information)

Attachment 1.8
Response Modes

2008 National Survey of Mental Health Treatment Facilities

THREE WAYS TO RESPOND
(1)

(2)

(3)

Questionnaire Internet Submission
•

Point your web browser to http://mhsurvey.s-3.com

•

Enter your ID and password (found on the pink information sheet).

•

Enter your data, then check your data and fix it if necessary.

•

When your data are correct, click on Done

•

Make corrections on your Mental Health Service Location
Verification Form and mail it using the enclosed postage-paid
envelope.

Questionnaire Fax Submission
•

Complete the paper questionnaire using black ink.

•

Fax the questionnaire to 301-628-XXXX or 301-628-XXXX- Attn:
2008 NSMHTF.

•

Make corrections on your Mental Health Service Location
Verification Form and mail it using the enclosed postage-paid
envelope.

All Mail Submission
•

Complete both the questionnaire and the Mental Health Service
Location Verification Form by hand.

•

Mail the completed documents in the enclosed postage-paid
envelope.

Please choose only 1 method of response
(See other side for Service Setting information)

Attachment 1.9
Questionnaire

US Department of Health and Human Services

FORM NOT YET APPROVED
OMB. No. 0930-XXXX
APPROVAL EXPIRES: XX/XX/XXXX
See OMB burden statement on last page

Version 12/19/07

2008 National Survey of Mental Health
Treatment Facilities
Substance Abuse and Mental Health Services Administration
PLEASE REVIEW THE INFORMATION PRINTED BELOW IN THE LEFT COLUMN.
PLEASE MAKE ANY CORRECTIONS USING THE RIGHT COLUMN BELOW.
Current Information

FACILITY INFORMATION BOX

Corrections

Facility Name (Line 1)

Facility Name (Line 2)

Street Address

Mailing Address (if different)

City

State

Zip Code

Phone Number

(

)

ZipFour

City

Extension

Phone Number

(

Fax Number

State

Zip Code

ZipFour

Extension

)

Fax Number

(

)

(

Facility Director

Current Web Site Address -- If the web address in the box below is correct, please check here:

Corrected Web Site Address -- If the box above is blank or the web address is incorrect, enter the correct address below.

A. Is this the Main Administrative Facility? Yes

B. Are mental health services provided at this facility? Yes

(Go to the next page and continue with the questionnaire)
No
(Go to Question C)
C. Which of the following statements best describes this facility? <
CHECK ONE ONLY

It is an administrative facility only

It performs some other service. Please specify:

It provides substance abuse services
It provides developmental disability services
CMHS FACILITY ID

Draft

Please complete the contact information in Section E
(page 12) and return the questionnaire.
1

PLEASE READ THIS ENTIRE PAGE BEFORE
COMPLETING THE QUESTIONNAIRE

INSTRUCTIONS
Most of the questions in this questionnaire ask about this facility. By this facility we mean the specific treatment facility
whose name and location are printed in the Facility Information Box on the front cover. If you have any questions
about how the phrase this facility applies to your facility, please call the survey helpline at 1-800-722-6194.
[NOTE: If you have corrected the address, please consider the facility at the corrected address.]
Answer ONLY for the specific facility whose name and location are printed on the front cover, unless otherwise
specified in the questionnaire.
Return the completed questionnaire in the envelope provided. Please keep a copy for your records.
If you have any further questions or need additional blank forms, contact the survey helpline at:
1-800-722-6194
[email protected]
Or write to:
Social & Scientific Systems, Inc.
PO Box 8548
Silver Spring, MD 20907-9907

Would You Rather Complete the Questionnaire Online?
You can choose to respond to this questionnaire using the Internet at http://mhsurvey.s-3.com/. See the pink
information sheet enclosed in your questionnaire packet for your unique user ID and password. If this information
has been misplaced, please contact the survey helpline at 1-800-722-6194.

IMPORTANT INFORMATION
Information from asterisked (*) questions will be published in SAMHSA's online Mental Health Services Locator
and will be available online at http://mentalhealth.samhsa.gov/databases/.
Note that complete and accurate name and address information is needed for SAMHSA's online Mental Health
Services Locator so it can correctly map the facility's location.
Only facilities designated as eligible by SAMHSA will be listed in SAMHSA's online Mental Health Services
Locator. The orange information sheet included in your packet describes the criteria used to determine eligibility.
If you have any further concerns or questions regarding eligibilty, please contact the survey helpline
at 1-800-722-6194.

Draft

CMHS FACILITY ID
2

Questions? Call 1-800-722-6194

ANSWER ALL REMAINING QUESTIONS
FOR MENTAL HEALTH SERVICES ONLY.
(EXCLUDE ALL NON-MENTAL HEALTH
SERVICES FROM YOUR RESPONSES.)

SECTION A:
SERVICE CHARACTERISTICS
Section A asks about this facility's client/patients and
services. Remember: This questionnaire asks about this
facility only, the facility at the location listed in the Facility
Information Box on the front cover.

What telephone number(s) should a potential
client/patient call to schedule a mental health intake
appointment at this facility?

*4.

INTAKE TELEPHONE NUMBER(S)

In which of following settings are mental health
services provided at this facility?

(

) -

Extension

CHECK ALL SETTINGS THAT APPLY

24-hour hospital inpatient care
2.

(

) -

24-hour residential care

Extension

Less than 24-hour outpatient/partial care
*2.

4a. What are the hours of operation for the intake
telephone number(s)?

Are substance abuse services also provided at this
facility (the facility listed in the Facility Information Box
on the front cover of the questionnaire)?
Yes

CONTINUE WITH QUESTION 2a

SKIP TO QUESTION 3

From

Days of the Week:

*2a. In which of the following settings are
substance abuse services provided
at this facility?

This facility does not accept telephone calls for
mental health intake appointments.
*5.

(CHECK ALL SETTINGS THAT APPLY)

24-hour hospital inpatient care
24-hour residential care

Does this facility operate a 24/7 hotline that
responds to persons experiencing acute mental
health problems?
A hotline is a telephone service, available and staffed
24 hours a day, 7 days a week, that provides
information, referral, and immediate counseling to the
client/patient in a crisis situation.

Less than 24-hour outpatient/partial care
*3.

What is the primary service focus at this facility?

DO NOT consider 911, or the local police number, a
hotline for the purpose of this survey.

CHECK ONE ONLY

Mental health services
Substance abuse services
Mix of mental health and substance abuse services
(neither is primary)

Yes

CONTINUE WITH QUESTION 5a

SKIP TO QUESTION 6

General health care (neither mental health nor
substance abuse services is primary)

*5a. Enter the hotline telephone number(s) below.

Other service focus; please specify:

HOTLINE TELEPHONE NUMBER(S):

(

) -

Extension

(

) -

Extension

Draft

CMHS FACILITY ID
3

Questions? Call 1-800-722-6194

*6.

Which of the following mental health services are
provided at this facility? For definitions of mental health
services, please see the blue information sheet.

CHECK ALL THAT APPLY

Intake services

Diagnostic evaluation

Information and referral services

Many people in recovery benefit from a number of
supportive practices. Which of the following are
provided by this facility? For definitions of the supportive
practices listed, please see the green information sheet.
CHECK ALL THAT APPLY

ADULTS
a.

Supported housing

Psychiatric emergency walk-in services

Supported employment

Suicide prevention services

Case management

Assertive community treatment
Family psychoeducation

Psychosocial rehabilitation services

Integrated dual disorders treatment

Illness management and recovery (IMR)

Vocational rehabilitation services

Legal advocacy

CHILDREN/ADOLESCENTS

Education services

Housing services

Consumer-run services

Chronic disease/illness management

Other; please specify:

Therapeutic foster care
Multisystemic therapy
Functional family therapy

Does an acute care crisis intervention treatment team
operate from this facility?
Yes, within facility only
Yes, off site only
Yes, within facility and off site

*7.

Which of the following mental health treatment
approaches are provided at this facility? For definitions
of mental health treatment approaches, please see the
purple information sheet.

*10.

Please identify the following functions at your facility
that are accomplished using computerized systems:
a.

Computerized results reporting (e.g., laboratory results,
psychological testing)

Computerized Physician Order Entry (CPOE) or
outpatient prescriptions/directions

c.
d.

Sending to and receiving clinical data from other
providers
Creating and transmitting referrals to other providers or
services (e.g., employment placement, housing
assistance, vocational training)

Treatment plan creation and maintenance

CHECK ALL THAT APPLY

Interpersonal psychotherapy

Group therapy

Couples counseling/family therapy

Behavior modification

Cognitive/Behavioral therapy

Activity therapy

Electroconvulsive therapy

Psychotropic medication therapy

Other; please specify:

Functional family therapy

Problem list creation and maintenance
Medication interaction checking

Billing/claims preparation and submission

i.
j.

Patient scheduling
Process note-taking

Other; please specify:

Draft

CMHS FACILITY ID
i.

Questions? Call 1-800-722-6194
*11.

Indicate which age/gender categories of client/patients
are accepted for treatment at this facility?

15.
.

Indicate whether the following quality assurance
practices are in place at this facility?

CHECK YES OR NO FOR EACH CATEGORY
CHECK YES OR NO FOR EACH PRACTICE

YES

a. Children/adolescents

YES

(17 or younger)
b. Adult women (18-64)

a. Required continuing education

for staff

c. Adult men (18-64)
b. Regularly scheduled case review

d. Seniors (65 or Older)

*12.

with a supervisor
c. Regularly scheduled case review by

Indicate whether the specially designed service
programs listed below are provided at this facility.

an appointed quality review committee
d. Client/patient outcome follow-up

CHECK YES OR NO FOR EACH SPECIAL PROGRAM TYPE

YES

after discharge

a. Specially designed program to

e. Periodic utilization review

treat children who are severely
emotionally disturbed (SED)
b. Specially designed program to
treat adults with severe and
persistent mental illness (SPMI)
c. Specially designed program to
treat seniors with Alzheimer's/
dementia
d. Specially designed program to
treat persons with co-occurring
mental illness and substance
abuse disorders

f. Periodic client/patient

satisfaction surveys
16.
.

b. Has training been provided to staff at

this facility on alternatives to seclusion
and restraint practices?

e. Specially designed program to

treat forensic (referred from your
State's judicial system)
client/patients
f. Specially designed programs to
treat post-traumatic stress disorder

SECTION B: GENERAL
FACILITY CHARACTERISTICS

g. Other special program; please specify:

17.
*13.

Does this facility provide mental health services for the
hearing-impaired?
Yes
No

*14.
.

Publish
Do not publish; please explain:

CHECK ALL THAT APPLY

English

Spanish

Other; please specify:

Sometimes there is a reason (e.g., the facility is
primarily a residence) when a mental health facility
would not want to be listed in a public directory.
Indicate below whether this facility (the facility listed in
the Facility Information Box on the front cover of the
questionnaire) should, or should not, be published in
SAMHSA's online Mental Health Services Locator?
CHECK ONE ONLY

In what languages does staff provide mental health
services at this facility?

In the 12-month period beginning January 1, 2007, and
ending December 31, 2007:
YES
NO
a. Has staff at this facility used seclusion
or restraint practices with clients?

Draft

CMHS FACILITY ID
5

Questions? Call 1-800-722-6194
*18.

23.

Check one box below that best describes this type of
facility (the facility listed in the Facility Information Box
on the front cover of the questionnaire). Use the yellow
information sheet, Mental Health Facilities Type
Definitions, to classify this facility correctly.

Does this facility offer treatment at no charge to
client/patients who cannot afford to pay? Note that the
answer to this question will not be published in SAMHSA's
online Mental Health Services Locator.
Yes

CHECK ONE ONLY

Psychiatric hospital
24.

Residential treatment center for emotionally disturbed
children
Residential treatment center for adults

Separate psychiatric unit of a general hospital

CHECK ALL THAT APPLY

Medicaid

Medicare

State mental health agency (or equivalent) funds

Other state government funds; specify:

A private partnership
A private corporation

Local government funds

State mental health agency (SMHA)

Other public funds; specify:

Outpatient/partial care mental health facility
Multi-setting (non-hospital) mental health facility
Other; please specify:

*19.

Which of the following types of client/patient payments
(direct or indirect) or insurance are accepted by this
facility for mental health services?

This facility is owned by:
CHECK ONE ONLY

State government (e.g., Department of Health)
other than the SMHA
Regional/district (e.g., hospital district authority)
County government
City or municipal government
Other; please describe:

20.

Community Service Block Grants

Community Mental Health Block Grants

Other Federal block grants; specify:

Client/patient fees

Private Insurance

Other private funds; specify:

Is this facility part of a for-profit or part of a non-profit
organization?
CHECK ONE ONLY

For-profit
Non-profit (includes not-for-profit)
*21.

Is this facility affiliated with a religious organization?

Yes; please specify:

No
22.
.

Does this facility use a sliding fee scale? Note that the
answer to this question will not be published in SAMHSA's
online Mental Health Services Locator.
Yes
No

Draft

CMHS FACILITY ID
No

Questions? Call 1-800-722-6194
25.
.

27.

Does this facility provide mental health treatment
services through any managed care organizations
(MCOs)?

If available, enter the National Provider Identifier (NPI)
for this facility.
NPI

Managed care plans have arrangements with certain
health care providers who give services to plan
members, usually at discounted rates. Examples
include managed behavioral healthcare organizations
(MBHOs), health maintenance organizations (HMOs),
and preferred provider organizations (PPOs).

SECTION C: CLIENT/PATIENT
COUNTS
IMPORTANT: Questions in this section ask for counts at
different time periods, e.g., the single day of
December 31, 2007, the month of December 2007, the last 90
days before December 31, 2007, and the full 12-month period
ending on December 31, 2007. Please pay close attention to
the time period specified in each question. If the counts are not
available for December 31, 2007, use the last day of the most
recent month for which data are available.

Yes - Continue with Q25a
No - Skip to Q26
*25a. What is the main MCO through which
your facility provides mental health
treatment services? Please specify:

Include in your counts all client/patients receiving mental health
treatment, even if mental health is their secondary diagnosis or
if a mental illness has not yet been formally determined.
*26.
.

Does this facility have licensing, certification, or
accreditation from any of the following organizations?

28.
.

Include only licensing, accreditation, etc., related to the
provision of behavioral health services.
Do not include general business licenses, fire marshal
approvals, personal-level credentials, food service
licenses, etc.

For the client/patient counts requested in this section,
indicate below the number of facilities that are
included in your counts. Although counts for this
facility only are preferred, it may be that you are unable
to break your data down into separate facilities.
Only this facility
This facility plus others

CHECK YES OR NO FOR EACH CATEGORY

YES

This Facility

a. State mental health agency

+ Additional Facilities
b. State substance abuse agency

= Total Facilities
c. State department of health

When we receive your questionnaire, we will contact you for
a list of the other facilities included in your client counts.

d. Hospital licensing authority
e. JCAHO (Joint Commission on

Accreditation of Healthcare
Organizations)

IMPORTANT: The questions in this section ask for counts
or percents based on the service settings you checked in
question 1 at the beginning of the questionnaire.

f. CARF (Commission on Accreditation

of Rehabilitation Facilities)

If you checked 24-Hour Hospital Inpatient Setting,
complete Section C1.

g. NCQA (National Committee for

If you checked 24-Hour Residential Care Setting,
complete Section C2.

Quality Assurrance)
h. COA (Council on Accreditation for

If you checked Less than 24-Hour Outpatient/Partial
Care Setting, complete Section C3.

Children & Family Services)
i. Another state or local agency or

other organization; please specify:

Section C4 (and the remainder of the questionnaire)
should be completed by all mental health providers.

Draft

CMHS FACILITY ID
7

Questions? Call 1-800-722-6194
29b. For each category below enter either the number
.
or the percent of client/patients from the HOSPITAL
INPATIENT TOTAL BOX in Question 29a.

SECTION C1: 24-HOUR HOSPITAL
INPATIENT CARE SETTING
29.
.

Using the total number of client/patients specified in
Question 29a, please give a breakdown of the client/patient
population for each category below. You may use numbers
(#) OR percents (%). Numbers in each box should add to
the total in Question 29a. Percents should add to 100%.

On December 31, 2007, did any client/patients receive
mental health services in a 24-hour hospital inpatient
care setting at this facility (the facility listed in the
Facility Information Box on the front cover of the
questionnaire)?

USE NUMBERS (#) OR PERCENTS (%)
SEX

Yes

ANSWER QUESTIONS 29a, 29b, AND 29c

SKIP TO QUESTION 30

29a.
.

TOTAL= Q29a

100%

TOTAL= Q29a

100%

TOTAL= Q29a

100%

TOTAL= Q29a

100%

TOTAL= Q29a

100%

Male
Female

On December 31, 2007, how many
client/patients received mental health
services in a 24-hour hospital inpatient care
setting at this facility?

AGE
0-17

DO NOT count family members, friends, or
other non-treatment client/patients

18-64
65 & up

HOSPITAL INPATIENT
TOTAL BOX
ETHNICITY
Hispanic
Non-Hispanic

RACE
White
Black
American Indian
or Alaskan Native
Asian or Pacific Islander
Mixed Race

LEGAL STATUS
Voluntary
Involuntary, non-forensic
Involuntary, forensic

Draft

CMHS FACILITY ID
8

Questions? Call 1-800-722-6194

29c.
.

30b. For each category below enter either the number
.
or the percent of client/patients from the RESIDENTIAL
TOTAL BOX in Question 30a.

On December 31, 2007, how many hospital
inpatient beds at this facility were set up and
staffed for the provision of mental health
services?

Using the total number of client/patients specified in
Question 30a, please give a breakdown of the client/patient
population for each category below. You may use numbers
(#) OR percents (%). Numbers in each box should add to
the total in Question 30a. Percents should add to 100%.

ENTER A NUMBER
(IF NONE WERE SET UP
ON DECEMBER 31, ENTER "0")

USE NUMBERS (#) OR PERCENTS (%)
Number of beds

SEX

TOTAL= Q30a

100%

TOTAL= Q30a

100%

TOTAL= Q30a

100%

TOTAL= Q30a

100%

TOTAL= Q30a

100%

Female

AGE
.

Male

SECTION C2: 24-HOUR RESIDENTIAL
CARE SETTING

30.

On December 31, 2007, did any client/patients receive
mental health services in a 24-hour residential care
setting at this facility (the facility listed in the Facility
Information Box on the front cover of the
questionnaire)?

0-17
18-64
65 & up

Yes

ANSWER QUESTIONS 30a, 30b, AND 30c

SKIP TO QUESTION 31

30a.
.

ETHNICITY

On December 31, 2007, how many
client/patients received mental health
services in a 24-hour residential care
setting at this facility?

Hispanic
Non-Hispanic

DO NOT count family members, friends, or
other non-treatment client/patients

RACE
White

RESIDENTIAL

Black

TOTAL BOX

American Indian
or Alaskan Native
Asian or Pacific Islander
Mixed Race

LEGAL STATUS
Voluntary
Involuntary, non-forensic
Involuntary, forensic

Draft

CMHS FACILITY ID
9

Questions? Call 1-800-722-6194
31b.

30c. On December 31, 2007, how many residential
.
beds at this facility were set up and staffed
for the provision of mental health services?

For each category below enter either the number
or the percent of client/patients from the OUTPATIENT
TOTAL BOX in Question 31a.
Using the total number of client/patients specified in
Question 31a, please give a breakdown of the client/patient
population for each category below. You may use numbers
(#) OR percents (%). Numbers in each box should add to
the total in Question 31a. Percents should add to 100%.

ENTER A NUMBER
(IF NONE WERE SET UP
ON DECEMBER 31, ENTER "0")

USE NUMBERS (#) OR PERCENTS (%)

Number of beds
SEX

SECTION C3: LESS THAN 24-HOUR
OUTPATIENT/PARTIAL
CARE SETTING

TOTAL= Q31a

100%

TOTAL= Q31a

100%

TOTAL= Q31a

100%

TOTAL= Q31a

100%

Male
Female

AGE
31.

During the month of December 2007, did any
client/patients receive mental health services in an
outpatient care setting at this facility (the facility listed
in the Facility Information Box on the front cover of
the questionnaire)?

0-17
18-64
65 & up

Yes

ANSWER QUESTIONS 31a AND 31b

SKIP TO QUESTION 32

31a.
.

ETHNICITY
Hispanic

As of December 31, 2007, how many active
client/patients were enrolled for services in
an outpatient care setting at this facility?

Non-Hispanic

An active outpatient client/patient is someone
who: (1) was seen at this facility at least once
during the 90 days before December 31, 2007;
AND
(2) was still enrolled in treatment on
December 31, 2007.

RACE
White
Black

DO NOT count family members, friends, or
other non-treatment client/patients

American Indian
or Alaskan Native

OUTPATIENT

Asian or Pacific Islander

TOTAL BOX

Mixed Race

LEGAL STATUS
Voluntary
Involuntary, non-forensic
Involuntary, forensic

TOTAL= Q31a

100%
Draft

CMHS FACILITY ID
10

Questions? Call 1-800-722-6194

SECTION C4: ALL MENTAL HEALTH
CARE SETTINGS
32.
.

Please use the box below to elaborate on any of the
information requested or provided in this questionnaire.
Use additional sheets of paper if more space is needed.
If applicable, indicate the number of the question to
which your comments refer.

Approximately what percent of the mental health
treatment client/patients enrolled on
December 31, 2007, at the facility listed in the Facility
Information Box on the front cover of the
questionnaire, had a diagnosed co-occurring mental
health and substance abuse disorder?
%

PERCENT OF CLIENT/PATIENTS
(IF NONE, ENTER "0")
33.

SECTION D: COMMENTS

In the 12-month period beginning January 1, 2007, and
ending December 31, 2007, what was the total number
of admissions, readmissions, and transfers to this
facility that received mental health treatment? Count
every admission and re-admission in this 12-month period.
If a person was admitted 3 times, count this as
3 admissions. Exclude returns from unauthorized absence
(escape, AWOL, elopement).
FOR OUTPATIENT CLIENT/PATIENTS,
consider an admission to be the initiation of a course
of treatment. Count admissions into treatment, not
individual treatment visits.
IF DATA FOR THIS TIME PERIOD are not available,
use the most recent 12-month period for which data are
available.
Count all admissions in which client/patients received
mental health treatment, even if mental health was their
secondary diagnosis.
NUMBER OF MENTAL
HEALTH ADMISSIONS
IN 12-MONTH PERIOD

34.
.

Of the total number of admissions listed in the box
above, what proportion were military veterans?
Please give your best estimate

Data collected but not available
Data not collected

Draft

CMHS FACILITY ID
11

Questions? Call 1-800-722-6194

SECTION E: CONTACT INFORMATION
Person Responsible for Completing This Survey

CHECK ONE ONLY

Ms.

Miss

Mrs.

Mr.

Dr.

Other; please specify:

First Name

Last Name

Title

Email Address

Phone Number

(

Extension

) -

Fax Number

(

Thank you for your participation. Please return this questionnaire in the

envelope provided. If you no longer have the envelope, please mail this
questionnaire to:
Social & Scientific Systems, Inc.
P.O. Box 8548
Silver Spring, MD 20907-9907

Public burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA
Reports Clearance Officer, Room 7-1044, 1 Choke Cherry Road, Rockville, Maryland 20857. An agency may not conduct or sponsor, and a person
is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this
project is 0930-XXXX.

Draft

CMHS FACILITY ID
12

Attachment 2.0
Current List of Publications

2008 National Survey of Mental Health Treatment Services

Current List of Publications

1. Center for Mental Health Services, Mental Health, United States, 2004.
Manderscheid, R.W., and Berry, J.T., eds. DHHS Pub No. (SMA)-06-4195. Rockville,
MD: Substance Abuse and Mental Health Services Administration, 2006.
2. National Center for Health Statistics, Health, United States, 2006. DHHS Pub. No.
2006-1232, Hyattsville, Maryland: Centers for Disease Control, 2006.
3. U.S. Census Bureau, Statistical Abstract of the United States: 2006 (125th Edition.)
Washington, D.C., 2005.
4. New Freedom Commission on Mental Health. Subcommittee on Acute Care:
Background Paper. DHHS Pub. No. SMA-04-3876. Rockville, MD: 2004.
5. Center for Mental Health Services, Mental Health Directory, 2000, compiled by
Manderscheid, R.W.; Atay, J.E.; Brown, D.; and Henderson, M.J. DHHS, Pub. No.
(SMA) 01-3503. Washington, DC: Supt. of Docs, U.S. Gov. Print. Office, 2001.
6. Manderscheid RW, Henderson MJ, Witkin MJ, Atay JE. Contemporary Mental Health
Systems and Managed Care. in Horwitz, Allan V. and Scheid, Teresa L. (Eds), A
Handbook for the study of Mental Health Systems, Cambridge University Press, 1999.
7. Manderscheid RW, Henderson MJ, Witkin MJ, Atay JE. Contemporary Mental Health
Systems and Managed Care, International Journal of Mental Health Systems, Vol. 27,
No.4, Winter 1998-1999, pp.5-25.
8. Manderscheid RW, Henderson MJ, Witkin MJ, Atay JE. The U.S. mental health
system of the 1990s, the challenges of managed care, International Journal of Law and
Psychiatry, Vol. 23, No. 3-4, pp.245-259.
9. Office of Applied Studies, Substance Abuse and Mental Health Statistics Source
Book, 1998, Rouse, Beatrice A. (Ed), DHHS, Pub. No. (SMA) 98-3170. 1998.

Attachment 3.0
Solicitation Letter for Outside Reviewers

[SAMHSA Letterhead]
August 29, 2007
[Salutation] [First & Last Name] [Title]
[Organization Name]
[Organization Address]
[City, [State] [Zipcode]
Dear [Salutation] [Last Name]:
In the first quarter of 2008, the federal Center for Mental Health Services (CMHS),
within the Substance Abuse and Mental Health Services Administration, will field the 2008
National Survey of Mental Health Treatment Facilities (NSMHTF). In preparation for
submitting our supporting statement to the federal Office of Management and Budget
(OMB), who justifies the need for the survey and the estimated public response burden, we
are asking you or a member of your staff to review and critique the document and give us
your comments. Specifically, the OMB seeks views from outside the agency on “the
availability of data, frequency of collection, the clarity of instructions and recordkeeping,
disclosure, or reporting format (if any), and on the data elements to be recorded, disclosed,
or reported.”
We have included copies of information sheets and the questionnaire that will be
mailed to the respondents and ask that you critique them as well, including the clarity,
relevance, and unambiguous use of terminology. Also, please review the reasonableness
of the Notification of Burden statement on the form (last page of questionnaire) and the
reasonableness of the $40 hourly rate (including fringe) used to estimate the cost of
completing the questionnaire. Please markup the documents and return them using the
enclosed Federal Express envelope. We will formally respond to all of your comments.
If you have any questions that you would like to ask, please feel free to contact us
at (240) 381-5022 (Jim Maedke, email: [email protected]) or (240) 276-1766 (Daniel
Foley, email: [email protected]). Your help in making this data collection a
success is greatly appreciated. Please send your comments by September 21, 2007.
Sincerely,

James Maedke
Project Manager

Daniel Foley
Project Officer, Survey, Analysis and Financing Branch
Division of State and Community Systems Development
Center for Mental Health Services
Enclosures

Attachment 3.1
Summary of Outside Reviewers’ Comments

Summary of Comments from Outside Reviewers

For this Supporting Statement, we were pleased to receive detailed comments
from four of the nine solicited reviewers. One reviewer was from the National Center for
Health Statistics, two were from State Mental Health Agency offices, and one was from
the Department of Veterans Affairs. All respondents were thanked for their time and
effort on the review of the Statement.
There was an overwhelming positive response to the Supporting Statement by
the reviewers. This included not only the protocol for collecting the data as outlined in
the Statement itself, but also for the new questionnaire, instructions, and inserts that
substantially reduce respondent burden. The reviewers were especially pleased with
the reduction in complexity of the questions. The format of the questions and response
categories in the questionnaire were endorsed as clear and unambiguous. In addition,
all reviewers felt that providing three modes for responding (mail, fax, & Internet), and,
involving the State Mental Health Agency in fielding the survey, would help with
improving the response rate. Finally, the reviewers agreed that the deployment of a
formal Computer Assisted Telephone Interview for non-responders would significantly
improve the response rate and the quality of follow-up data collection efforts.
In addition to the positive comments, the reviewers also recommended
substantive changes for the questionnaire and in particular for the associated inserts.
One area that was significantly changed was the definition inserts. From the definition
of outpatient to the exclusion of psychometric testing as a therapeutic approach,
clarifications were made to all the Supporting Statement attachments that described and
defined mental health service related concepts.
Another area that was improved was the description of service settings. For the
purposes of the Survey, we traditionally break up services into one of three main
categories: (1) Inpatient care, defined as 24-hour psychiatric hospital care; (2)
Residential care, defined as 24-hour care in a non-psychiatric hospital setting; and (3)
Outpatient care, defined as less than 24-hour care in either an ambulatory setting or a
partial day setting. The reviewers directed us to consider certain exceptions to these
three settings including inpatient care provided in the community but not at the level of a
psychiatric hospital and residential care that was only custodial in nature. These
comments were used to update our inserts.
The reviewers in general found fault with the Therapeutic Approaches question.
Their comments resulted in us dropping certain approaches, adding new ones, and rewriting some of them to use more common terminology. This question on therapeutic
approaches was completely re-written based on their comments and further review on
our part. In addition, several reviewer comments regarding the need to ascertain
evidence-based performance measures and quality assurance monitors, resulted in a
two new questions.

A number of reviewers also felt that a centralized response burden for a mental
health organization that had up to around five service locations was reasonable but that
mental health organizations with more than five locations may require more
consideration of a coordinated approach for the collection of facility-level data among
these large organizations. Ideally, each service location will complete their own
questionnaire; however, in some organizations, there may be only one respondent that
will complete questionnaires for all sites. Although the reviewers noted a decrease in
the amount of time necessary to complete one questionnaire after multiple
administrations, the response burden for large organizations may be proportionately
larger if the questionnaires are completed centrally. The reviewers’ comments have
resulted in the creation of coordinated data collection plans and procedures for
organizations that choose to complete all questionnaires at their headquarters and have
more than five service locations.
Finally, regarding the estimation of the cost of response burden, the reviewers
agreed that $40 per hour was a reasonable estimate of the typical labor cost for
completing the questionnaire.

Attachment 4.0
Sample Mental Health US Table

Table 1. Number of mental health organizations, by type of organization:
United States, selected years, 1970-20041
Type of organization

1970

1976

1980

1986

1990

1992

1994

3,005

3,480

3,727

4,747

5,284

5,498

5,392

State and county mental hospitals

310

303

280

285

273

Private psychiatric hospitals

150

182

184

314

462

Non-Federal general hospitals with
separate psychiatric services

797

870

923

1,351

VA medical centers2

115

126

136

Federally funded community mental
health centers

196

517

Residential treatment centers for
emotionally disturbed children

261
1,176

1998

2000

2002

2004

5,722

4,541

4,301

4,159

256

229

223

222

237

475

430

348

269

253

264

1,674

1,616

1,612

1,707

1,373

1,285

1,290

139

141

162

161

145

142

140

—

691

—

331

368

437

501

497

459

461

475

508

458

1,151

1,145

2,221

2,233

2,475

2,474

2,832

2,059

1,893

1,910

Number of mental health organizations
All organizations

All other mental health organizations3

Number with 24-hour hospital or residential treatment care
All organizations

1,734

2,273

2,526

3,039

3,430

3,415

3,827

3,729

3,199

3,032

2,891

State and county mental hospitals

310

303

280

285

273

256

229

223

222

237

Private psychiatric hospitals

150

182

184

314

462

475

430

348

269

253

264

Non-Federal general hospitals with
separate psychiatric services

664

791

843

1,287

1,571

1,517

1,531

1,593

1,325

1,232

1,230

VA medical centers2

110

112

121

124

130

133

135

123

133

131

—

Federally funded community mental
health centers

196

517

691

—

Residential treatment centers for
emotionally disturbed children

261

331

368

437

501

497

459

461

475

508

458

All other mental health organizations3

592

493

520

1,016

975

774

686

702

Number with less than 24-hour care
All organizations

2,156

2,318

2,431

2,946

3,189

3,390

4,087

4,386

3,536

3,367

3,219

State and county mental hospitals

195

147

100

Private psychiatric hospitals

100

114

176

198

347

263

235

213

216

Non-Federal general hospitals with
separate psychiatric services

376

303

299

497

633

618

875

965

815

784

796

VA medical centers2

100

113

127

137

141

161

148

128

115

116

—

Federally funded community mental
health centers

196

517

691

200

—

Residential treatment centers for
emotionally disturbed children

163

167

227

210

285

312

249

1,141

1,121

1,092

2,016

1,992

2,171

2,420

2,760

2,025

1,881

1,891

All other mental health organizations3

Sources: Published and unpublished inventory data from the Survey and Analysis Branch, Division of State and Community Systems Development, Center for Mental
Health Services. VA Medical Centers were not surveyed in 2004. Also, the 2004 organization counts INCLUDE territories.
1
Some organizations were reclassified as a result of changes in reporting procedures and definitions. For 1979-80, comparable data were not available for certain
organization types and data for either an earlier or a later period were substituted. These factors influence the comparability of 1980-98 data with those of earlier
years. VA Medical Centers were not surveyed in 2004. The organization counts for 2004 includes territories.
2
Includes Department of Veterans Affairs (formerly Veterans Administration) (VA) neuropsychiatric hospitals, VA general hospital psychiatric services, and VA
psychiatric outpatient clinics.
3
Includes freestanding psychiatric outpatient clinics, partial care organizations, and multiservice mental health organizations. Multiservice mental health
organizations were redefined in 1984.
4
The survey format was changed in 1994 and partial care is now included with outpatient, and together are called "less than 24-hour care".

Attachment 5.0
Sample State Table

2004 STATE TABLES
Table 8a. Patient Census in 24-hr Hospital or Residential Care Settings
By State, According to Patient Census Indicators: 2004 IMHO
State

Number of
Organizations

First Day
Census

Additions

Episodes1

Last Day Beds

United States ...............................................

2,891

180,466

2,712,700

2,893,167

212,231

Excluding Territories ..................................

2,879

179,386

2,697,221

2,876,607

210,990

Alabama .......................................................
Alaska ...........................................................
Arizona .........................................................
Arkansas .......................................................
California ......................................................
Colorado .......................................................
Connecticut ...................................................
Delaware ......................................................
D.C. ..............................................................
Florida ...........................................................
Georgia .........................................................
Hawaii ...........................................................
Idaho .............................................................
Illinois ............................................................
Indiana ..........................................................
Iowa ..............................................................
Kansas ..........................................................
Kentucky .......................................................
Louisiana ......................................................
Maine ............................................................
Maryland .......................................................
Massachusetts ..............................................
Michigan .......................................................
Minnesota .....................................................
Mississippi ....................................................
Missouri ........................................................
Montana ........................................................
Nebraska ......................................................
Nevada .........................................................
New Hampshire ............................................
New Jersey ...................................................
New Mexico ..................................................
New York ......................................................

51
20
33
39
197
40
61
13
13
121
61
11
12
150
82
43
23
51
49
27
67
122
89
58
54
71
11
24
11
25
85
25
192

4,442
474
1,631
1,555
18,208
2,384
2,828
686
1,138
8,392
5,093
380
513
7,056
4,271
1,701
979
2,407
1,863
1,746
4,004
8,787
5,235
3,304
3,188
3,661
601
1,249
499
969
6,581
1,124
19,908

36,228
8,852
29,489
33,564
228,291
28,815
44,574
6,238
13,126
150,154
89,368
4,798
8,963
131,006
53,399
30,191
22,281
51,691
47,707
20,062
54,967
120,244
69,747
55,677
46,676
69,174
8,682
12,529
12,822
11,693
73,606
12,551
216,099

40,670
9,326
31,119
35,119
246,499
31,199
47,402
6,924
14,264
158,545
94,462
5,178
9,476
138,062
57,670
31,892
23,260
54,098
49,570
21,808
58,971
129,031
74,982
58,981
49,864
72,835
9,283
13,778
13,321
12,662
80,187
13,675
236,007

4,806
570
1,960
1,950
21,042
2,861
3,351
824
1,359
9,901
6,080
446
647
8,414
5,261
1,943
1,313
3,027
2,403
2,234
4,595
10,002
5,879
3,982
4,026
4,427
666
1,408
647
1,103
7,515
1,268
21,812

1 First Day Census + Additions

Created on 2/9/07 10:40:58 AM

Page 1 of 2

Data -> Inv_Imp_2004_v1

2004 STATE TABLES
Table 8a. Patient Census in 24-hr Hospital or Residential Care Settings
By State, According to Patient Census Indicators: 2004 IMHO
State

North Carolina ..............................................
North Dakota ................................................
Ohio ..............................................................
Oklahoma .....................................................
Oregon ..........................................................
Pennsylvania ................................................
Rhode Island ................................................
South Carolina ..............................................
South Dakota ................................................
Tennessee ....................................................
Texas ............................................................
Utah ..............................................................
Vermont ........................................................
Virginia ..........................................................
Washington ...................................................
West Virginia ................................................
Wisconsin .....................................................
Wyoming .......................................................
American Samoa ..........................................
Guam ............................................................
Puerto Rico ...................................................
Virgin Islands ................................................

Number of
Organizations

First Day
Census

69
17
131
39
36
176
18
29
13
55
104
25
18
76
44
25
61
12
0
1
9
2

3,435
553
5,493
1,649
2,176
11,563
865
1,390
670
3,359
5,709
2,016
918
6,048
2,378
1,080
2,793
436
0
252
747
82

Additions

88,199
9,319
109,992
44,445
17,391
168,992
15,855
29,830
7,155
70,691
132,145
11,588
8,194
66,758
32,182
20,614
55,507
5,099
0
1,899
13,295
285

Episodes1

91,634
9,872
115,485
46,094
19,567
180,555
16,720
31,220
7,825
74,050
137,854
13,605
9,112
72,807
34,560
21,694
58,300
5,535
0
2,151
14,042
367

Last Day Beds

4,446
645
6,695
2,112
2,412
13,765
1,008
1,740
797
4,146
7,504
2,246
644
6,994
2,679
1,408
3,428
594
0
273
882
85

1 First Day Census + Additions

Created on 2/9/07 10:40:58 AM

Page 2 of 2

Data -> Inv_Imp_2004_v1

Attachment 6.0
Pilot Design

2008 National Survey of Mental Health Treatment Facilities

Pilot Design

Overview
The 2008 National Survey of Mental Health Treatment Facilities (NSMHTF), a
national survey sponsored by the Center for Mental Health Services (CMHS), surveys all
mental health facilities in the 50 States, District of Columbia, and eight Territories. The
NSMHTF surveys facilities, or points-of-service, as opposed to organizations. All
previous surveys, known collectively as the Inventory of Mental Health Organizations
(IMHO), have surveyed mental health organizations. This meant that responses were
aggregated across different treatment locations. Roughly 45% of the mental health
organizations in the nation have more than one service location. Since the content of the
questionnaire for the 2008 NSMHTF is completely different from previous cycles, and
since the observation level has changed to the facility, it’s important to test how well the
new “instrument” will do at measuring mental health services.
The questionnaire is very similar to the 2007 National Survey Substance Abuse
Treatment Services (N-SSATS). Although the questionnaire for the N-SSATS has been
successfully fielded for the last decade, this will be the first time an N-SSATS-like
questionnaire will be fielded to mental health facilities.

Survey Goal and Objectives
Goal: To collect service data from all mental health facilities in the nation.
Objective 1: Collect information relevant to consumers and make that information
available to the public via the National Mental Health Center’s web site.
Objective 2: Collect information at the point-of-service level to make this survey
comparable to the National Survey of Substance Abuse Treatment Services conducted by
SAMHSA’s Office of Applied Studies conducted on an annual basis.
Objective 3: Retain the organization structure (i.e., identify the headquarters
facility and the organization director) of each mental health provider.
Objective 4: For numerical questions, enable the quantitative answers from each
facility to be summed to the organization level. This is needed to continue the
longitudinal analyses conducted across survey cycles.

Pilot Goal and Objectives
Goal: To evaluate the efficacy and response burden of the 2008 NSMHTF
questionnaire
Objective 1: To determine the relevance of the questionnaire mailing packet
inserts.
Objective 2: To determine a realistic response burden (elapsed minutes).
Objective 3: To complete the Pilot Questionnaire and, in general, provide
feedback about the experience completing the Survey questionnaire.
Objective 4: To identify problems with the questionnaire including (a) unclear
phrasing, (b) inclusion of superfluous questions, and (c) absence of key questions.

OMB Considerations
OMB requires Federal agencies to obtain their approval before conducting a
survey with more than nine respondents. For this pilot, we will be counting respondents
as mental health organization directors. This will result in nine respondents which meets
the OMB requirement.

Timeline
Currently, the OMB Package for the 2008 NSMHTF is scheduled to be sent to
OMB by mid-September; therefore, all Pilot activities will conclude by Friday,
September 14th, 2007. The findings of the Pilot will be added to the final OMB
Submission.
To meet this deadline, it will be necessary to send the Pilot packages by Friday,
August 10, 2007. The Pilot members will then have three weeks to complete the Pilot
materials and return them to SSS. The deadline for return of the Pilot materials will be
Friday, August 31, 2007. This will give us two weeks to summarize the findings and
modify the OMB Package.

Selection of Pilot Members
Historically, there have been six organization types used in the analysis of the
IMHO. They are:

1. Public Psychiatric Hospital;
2. Private Psychiatric Hospital;
3. Residential Treatment Center for Children with Severe Emotional
Disturbance;
4. General Hospital with a Separate Psychiatric Unit;
5. Outpatient Mental Health Clinic;
6. Multi-Service mental health organization that provides both outpatient and
residential services.
We will choose one organization for each of these types. To get to the nine OMB
limit, we will select another Residential Treatment Center, another Outpatient Clinic, and
another Multi-Service organization. This will result in nine respondents.
We will restrict our universe to the neighboring States of Delaware, Maryland,
Pennsylvania, West Virginia, and Virginia. Respondents will be drawn at random within
the six organization types. Attachment 1 shows a list of the Pilot respondents.
To extent possible, given the short timeline for the Pilot, refusals will be replaced
to maintain the nine respondent sample size. Late refusals will probably not be replaced
because the feedback from the Pilot participants needs to be added to the final OMB
Package.

Pilot Materials
The following three documents will be included in the mailing packet:
1. A cover letter;
2. A Questionnaire;
3. Feedback Form
The cover letter will introduce the survey, request their help in conducting the
Pilot, set August 31st as the deadline, and provide cursory instructions. The cover letter
will be signed by Jeff Buck of the CMHS. The cover letter will also include an
exemption for the Pilot participants from the main survey in early 2008. See Attachment
2 for the cover letter.
The survey packet will include a cover letter, inserts, and a questionnaire. To
maximize the usefulness of the Pilot, the Survey Packet will appear very similar to the
actual packet to be mailed to all organizations in early 2008. To this end, the Survey
Questionnaire along with the supporting documents will be included. Additionally, the
questionnaire to be included will be the latest Teleform version. Attachment 2.8 of the
OMB Supporting Statement contains the questionnaire.

The Feedback Form (see Attachment 3) will ask straight-forward questions about
the questionnaire response experience. This will include the appropriateness of the cover
letter, all inserts, and the questionnaire itself. The questionnaire will include questions
related to response burden and the time needed to study the survey packet materials,
complete the questionnaire, and return the completed questionnaire. The Feedback Form
will also contain a section for general comments. The findings from the Feedback Form
will be summarized in the OMB submission. Suggested changes to the questionnaire will
be reviewed and implemented if found to be appropriate.

Pilot Procedures
The Pilot packets will be mailed to the respondents via Federal Express. It is
hoped that this will raise the ‘visibility’ of the Pilot materials and subsequently increase
the likelihood of participation. A pre-paid Federal Express envelope will be included in
the packet for the respondents to return the materials.
The nine Pilot participants will not be required to complete the survey again at the
beginning of 2008. Because of this, the Pilot respondents will have a special version of
the questionnaire containing the appropriate dates. The questionnaire asks for the
number of services at the end of a particular date. Those dates will be modified to fit a
valid response from the Pilot members.
On the day following the Federal Express mailing of the packet, an SSS staff
member will contact the recipient as a means of introduction, to explain the purpose of
the pilot, solicit participation, and answer any questions. This staff member will also be
available to answer any questions or comments during the three week waiting period.
Finally, a staff member will also contact the Pilot respondent the Monday of the last week
in August if the packet has not yet been received. This contact will be to encourage the
participant to return the materials and to answer any further questions.
To test the Teleform processing, the twelve questionnaires will be scanned into
Teleform, read by Teleform, verified by an SSS employee, and stored in a SQL database.
This will constitute the first test of the data capture technology.
The responses of the Pilot participants will be reviewed and all comments
documented for the OMB submission. Each comment will have a response which will
discuss the reason why the comment is not being implemented or how the survey has
been modified as directed by the respondent.

Summary

The questionnaire for the 2008 NSMHTF is completely different from
questionnaires in earlier IMHO surveys. Although the questionnaire is very similar the
N-SSATS, and therefore has been tested with SA providers, the questionnaire has never
been fielded with the mental health service sector. This Pilot attempts to gather
information from nine mental health providers in an effort to determine if the fielding of
the new form will be successful.

Attachment 1

List of Pilot Participants (see Supporting Statement)

Attachment 2

Pilot Cover Letter (see Supporting Statement)

Attachment 3

Feedback Form (see Supporting Statement)

Attachment 6.1
Pilot Cover Letter

[SAMHSA Letterhead]
August 10, 2007
[Salutation] [First & Last Name] [Title]
[Organization Name]
[Organization Address]
[City, [State] [Zipcode]
Dear [Salutation] [Last Name]:
I am asking for your help in evaluating an important new questionnaire. As you may know, every
two years, the federal Center for Mental Health Services (CMHS) within the Substance Abuse and
Mental Health Services Administration has conducted the Inventory of Mental Health
Organizations (IMHO). The purpose of this survey was to collect information about the services
offered, number of clients served, staffing, and expenditures from all mental health organizations in
the country.
However, after an extensive period of evaluation and re-design, we have reconfigured this data
collection effort to obtain information at the point-of-service level (i.e., the facility level). We
believe that this change re-focuses our efforts on collecting information that will be more helpful to
consumers. Further, the data that we collect will be more comparable to data that SAMHSA
collects for substance abuse facilities. We also hope that you will find that the information we are
seeking is more readily accessible to you and therefore easier to report. We are calling the facilitybased study the National Survey of Mental Health Treatment Facilities (NSMHTF), and it will be a
recurrent nationwide survey that will replace the IMHO. Information from the NSMHTF will be
used to update the National Mental Health Information Center’s Mental Health Services Locator.
This online directory, http://mentalhealth.samhsa.gov/databases/ , is used extensively by
consumers and mental health professionals to locate mental health services across the country. In
early 2008, CMHS will initiate the first wave of this new effort, the 2008 NSMHTF, by sending
questionnaires to approximately 12,000 mental health facilities across the nation.
To prepare for this new study, we have randomly sampled your facility to complete the pilot
questionnaire for the 2008 NSMHTF survey in advance of the main effort. Your feedback will be
invaluable in helping us identify improvements that we can make to the survey prior to the national
mailing in early 2008. All the feedback you provide will be included in our official request to the
federal Office of Management and Budget (OMB) that we will submit in September requesting
authorization to conduct the full survey. This is why your participation is so important. Also, your
response to the pilot study will be counted as a response to the 2008 NSMHTF survey and we will
not be contacting you again in January.
The enclosed packet contains the following materials:
1. The NSMHTF questionnaire
2. Support documents
3. A Feedback Form to obtain your reactions to the questionnaire

The survey packet contains all the materials that will be sent out for the full survey. Although
respondents for the main survey will be able to use the mail, fax, or Web to respond, we can offer
this pilot study only as a mail questionnaire. As you complete the NSMHTF questionnaire, please
also complete the enclosed Feedback Form and note how long the questionnaire took to complete,
items that you had difficulty with, or any comment that you think will be helpful to us as we
finalize the questionnaire design.
Shortly after you receive this packet, a staff member from the office of our contractor, Social &
Scientific Systems Inc. (SSS), will contact you to discuss the pilot study and your participation and
to answer any questions you might have. It is vitally important for us to receive your feedback on
the new questionnaire by Friday, August 31, 2007. We have enclosed a pre-paid and preaddressed Fed Ex envelope in order for you to return the completed NSMHTF questionnaire and the
Feedback Form.
On behalf of all the staff at CMHS working on this effort, I would like to thank you in advance for
helping us create a better survey that we believe will greatly enhance the information that we can
make available to mental health professionals and the general public. If you would like to speak to
someone immediately about our pilot study, please contact Susan Forrester of SSS
at 1 (800) 722-6194.

Sincerely,

Jeffrey A. Buck, PhD
Chief, Survey, Analysis, and Financing Branch
Division of State and Community Systems Development
Center for Mental Health Services
Enclosures

Attachment 6.2
Pilot Feedback Form

Study ID____________

Feedback Form for the Pilot Survey
National Survey of Mental Health Treatment Facilities (NSMHTF) Questionnaire
Thank you for completing the pilot survey! Please take a few minutes to record answers to the questions below
in order that we can further improve the questionnaire. When you are finished, please return it, along with the
completed NSMHTF questionnaire(s), in the pre-paid Fed Ex envelope. If you have questions, please contact:
Susan Forrester at 1 (800) 722-6194.
1.

How long did it take you to complete the
questionnaire:
________________ (# of minutes)
_______ ________________ (# of minutes)

First Questionnaire
Second Questionnaire (if completed)
2.

Which ones?

Were there any questions that you
thought were unclear or poorly
phrased?

Question #

Comments

Yes

______

________________________________________________

______

________________________________________________

______

________________________________________________

______

________________________________________________

______

________________________________________________

Were there any questions that you
thought were not appropriate or relevant
for your facility?

Which ones?
Question #

Comments

Yes

______

________________________________________________

______

________________________________________________

______

________________________________________________

______

________________________________________________

______

________________________________________________

______

________________________________________________

Were there topics that were not
addressed that you would like to have
seen included?

What are they?

Yes
No

___________________________________________________________

___________________________________________________________
___________________________________________________________

Were the format of the questionnaire
and the “skip” instructions easy to
follow?

___________________________________________________________

Yes
No

___________________________________________________________

Comments:
___________________________________________________________

___________________________________________________________
___________________________________________________________
___________________________________________________________

Page 1

Study ID____________
6.

Did you find the supporting documents
helpful in completing the questionnaire?
Yes
No

Comments:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

Were the questionnaire instructions
clear?
Yes
No

Do you think the questions were
appropriate for the facility, or point-ofservice, level?

Comments:
___________________________________________________________
___________________________________________________________
___________________________________________________________

Yes
No

___________________________________________________________
___________________________________________________________
___________________________________________________________

Do you think that you would have any
difficulty answering questionnaire
Sections A and B as part of a telephone
interview?
Yes
No

10. Please share with us any other comments you have about the questionnaire.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Page 2

Attachment 6.3
Summary of Pilot Results

Summary of Pilot Results

We received responses from nine facility directors for the Pilot Study. Eight of the nine sent
both the questionnaire and the feedback form. The following is a summary of the questions on
the feedback form:
•
•

•
•
•
•
•
•
•

The length of time to complete the questionnaire averaged 50 minutes; however, most of
the responses were 30 minutes or less; therefore, the estimate burden of one hour is
reasonable;
One respondent thought the grammar for Question 10 was poor—this question has been
modified. Another respondent was not sure whether to respond to section C since the
questionnaire incorrectly used the term “hospital residential”—this error has been
corrected. Therefore, six of the eight respondents did not think that any questions were
unclear or poorly phrased;
One respondent stated that they did not collect race or ethnicity information. Therefore,
seven of the eight respondents thought all of the questions were relevant;
No one thought there were important topics that were not addressed in the
questionnaire;
The sample all agreed that the skip instructions were easy to follow;
All respondents found the supporting documents to be useful;
Everyone thought that the instructions were clear;
All stated that the questions were appropriate for the facility level;
Everyone thought that the questions in Sections A and B were general enough to be
answered over the telephone.

Comments on the questionnaire centered on two items: therapeutic approaches and use of
languages other then English. Since the Pilot, we have completely re-written the therapeutic
approaches question. In addition, many of the comments from the reviewers of the Supporting
Statement were added to this question.
In summary, the respondents to the Pilot helped us to (a) find some errors in the
questionnaire, (b) make modifications some of the questions, and (c) confirmed that the
questionnaire, as a whole, was acceptable.

File Type	application/pdf
File Title	Microsoft Word - 2008 NSMHTF OMB Supporting Statement - Attachments.doc
Author	jmaedke
File Modified	2007-12-24
File Created	2007-12-24