Evaluation of Veterans Health Administration Mental Health Services

August 2008 Version with Changes from December 2007 Version Marked

(Note: Minor formatting changes (bolding, capitalization, updated skip patterns, etc.) are not marked.)

VA SMI CLIENT SURVEY

DEMOGRAPHICS

First, I want to ask you some background questions.

DEMO1

I need to ask about your racial/ethnic background. Are you of Hispanic or Latino origin or descent?

0 NO

1 YES

DEMO2

What is your race? Please select one or more. [Interviewer Note: Ask “Anything else?” as needed.]

1 White

2 Black or African American

3 Asian

3 Native Hawaiian or Other Pacific Islander 4 American Indian or Alaskan Native

DEMO3

What is the last year of school you have completed?

1. DID NOT COMPLETE HIGH SCHOOL

2. HIGH SCHOOL GRADUATE OR GED

3. SOME COLLEGE

4. COLLEGE GRADUATE OR BEYOND

DEMO4

What is your current marital status?

1. Married

2. Living as married

3. Separated

4. Divorced

5. Widowed

6. Never married

DEMO5

What category describes your total household income, that is income from all sources, during the past 12 months?

1. $15,000 or less

2. $15,001 - $30,000

3. $30,001 - $60,000

4. $60,001 or more

DEMO6

In addition to coverage you receive through the VA, are you currently covered by any other individual or group health plan?

0 NO

1 YES

HOUSING ASSISTANCE

Next, I want to ask you some questions about your housing over the last 12 months.

HOUSE1

Did you need help to find a place to live in the past 12 months?

0. NO  SKIP TO EMPLYINTRO (NEXT SECTION)

1. YES

HOUSE2

Did you receive help from the VA to find a place to live in the past 12 months?

0. NO  SKIP TO EMPLYINTRO (NEXT SECTION)

1. YES

HOUSE3

Did you receive as much help as you needed from the VA?

0. NO

1. YES

EMPLOYMENT ASSISTANCE

EMPLYINTRO

Now I’d like to ask you some questions about your employment over the last 12 months.

Interviewer Notes: Use only one code per respondent. If respondent gives more than one answer (e.g., self-employed and homemaker) code them as the response with the highest value (in this case, self-employed or “7”)

If respondent gives a response not on the list, ask them to pick the response from the list that best describes their situation.

EMPLY1

What is your current work status? Are you currently…?

(INTERVIEWER: CODE HIGHEST CATEGORY.)

8 Employed for wages

7 Self-employed

6 Unable to work/ disabled

5 Looking for work and unemployed for less than 1 year

4 Looking for work and unemployed for more than 1 year

3 Homemaker

2 Student

1 Retired

0 Unemployed and not looking for work

EMPLY2

Did you need help to find a job in the past 12 months?

0. NO  SKIP TO PNFSINTRO (NEXT SECTION)

1. YES

EMPLY3

Did you receive help from the VA to find a job in the past 12 months?

0. NO  SKIP TO PNFSINTRO (NEXT SECTION)

1. YES

EMPLY4

Did you receive as much help as you needed from the VA?

0. NO

1. YES

PERCEIVED NEED FOR SERVICES

PNFSINTRO

The rest of the questions in this survey will ask about counseling or treatment in the last 12 months. Please listen to what we mean by counseling or treatment:

People can get counseling, treatment or medicine for many different reasons, such as:

• for feeling depressed, anxious, or "stressed out";

• for personal problems (like when a loved one dies or when there are problems at work);

• for family problems (like marriage problems or when parents and children have trouble getting along);

• for needing help with drug or alcohol use;

• and/or for mental or emotional illness such as depression, bipolar disorder, post-traumatic stress disorder or PTSD, or schizophrenia.

[PROGRAMMING NOTE: Help screen will include reasons for later reference.]

Please do not include any physical health care.

With that definition in mind…

PNFS1

Within the last 12 months since [FILL MONTH/YEAR], was there ever a time when you felt that you might need counseling or treatment for any of those reasons? [Interviewer Note: Repeat reasons as needed.]

0. NO

1. YES

MENTAL HEALTH SERVICE USE/ VA USER STATUS

MHSU1

In the last 12 months, did you get counseling or treatment for any of those reasons?

0. NO  SKIP TO FUNCTINTRO (NEXT TO LAST SECTION).

1. YES

MHSU2INTRO

Next, I will be asking you about the counseling or treatment you received in the last 12 months from the VA. Please do not include physical health care.

MHSU2

In the last 12 months, how many outpatient visits for counseling or treatment did you have at the VA? Please also include visits elsewhere that were paid for by the VA.

# OF OUTPATIENT VISITS – VA:

MHSU3

In the last 12 months, how many nights did you stay at a VA psychiatric hospital or in a psychiatric ward or unit for counseling or treatment? Please also include visits elsewhere that were paid for by the VA.

# OF NIGHTS – VA:

MHSU4 INTRO

Next I will be asking you about the counseling or treatment you received in the last 12 months from non-VA sources. Please do not include physical health care.

MHSU4

In the last 12 months, how many outpatient visits for counseling or treatment did you have at any non-VA facility or doctor's office? Please do not count visits that were paid for by the VA.

# OF OUTPATIENT VISITS – NON-VA:

MHSU5

In the last 12 months, how many nights did you stay at any non-VA psychiatric hospital or in a psychiatric ward or unit for counseling or treatment? Please do not count any stays paid for by the VA.

# OF NIGHTS – NON-VA:

T he following will be programmed to guide the interviewer through the remaining items:

IF ITEM MHSU1 IS “0” THIS RESPONDENT IS A NON-USER.

PLEASE MARK A “1” IN THIS BOX:

NON-USER:

IF ITEMS MHSU2 IS “000” AND MHSU3 IS “NO” THIS RESPONDENT IS A NON-VA USER. PLEASE MARK A “1” IN THIS BOX:

NON-VA USER ONLY:

IF MHSU4 IS “000” AND MHSU5 IS “000” THIS RESPONDENT IS A VA-ONLY USER.

PLEASE MARK A “1” IN THIS BOX:

VA USER ONLY:

IF MHSU2 OR MHSU3 IS NOT “000” AND MHSU4 OR MHSU5 IS NOT “000” THIS RESPONDENT IS A DUAL USER.

PLEASE MARK A “1” IN THIS BOX:

DUAL USER:

EXPERIENCE OF CARE: TIMELINESS

TIMLINTRO

The next questions ask about your counseling or treatment.

[IF DUAL USER:]

Please respond to the following items based ONLY on the counseling or treatment you received at the VA.

[TO ALL:] Do not include physical health care. Do not include counseling or treatment during an overnight stay or from a self-help group like AA/NA.

TIML1

In the last 12 months, did you need counseling or treatment right away?

0. NO  SKIP TO TIML3

1. YES

TIML2

In the last 12 months, when you needed counseling or treatment right away, how often did you see someone as soon as you wanted? Your choices are never, sometimes, usually, or always.

0. Never

1. Sometimes

2. Usually

3. Always

TIML3

In the last 12 months, not counting times you needed counseling or treatment right away, did you make any appointments for counseling or treatment?

0. NO SKIP TO RECOVINTRO (NEXT SECTION)

1. YES

TIML4

In the last 12 months, not counting times you needed counseling or treatment right away, how often did you get an appointment for counseling or treatment as soon as you wanted? Your choices are never, sometimes, usually, or always.

1. Never

2. Sometimes

3. Usually

4. Always

EXPERIENCE OF CARE: RECOVERY

RECOVINTRO

Please tell me how accurately the following statements describe the activities, values, and practices of the program where you received counseling or treatment.

[IF DUAL USER:]

Please respond to the following items based ONLY on the counseling or treatment you received at the VA.

[TO ALL:] Please tell me whether you strongly agree, agree, disagree, or strongly disagree.

RECOV1

Staff encourage me to have hope and high expectations for myself and my recovery.

Do you ‘agree’ or ‘disagree’? ‘Strongly agree/disagree’ or ‘Agree/Disagree’?

1. Strongly agree

2. Agree

3. Disagree

4. Strongly disagree

RECOV2

Staff believe that I can make my own life choices regarding things such as where to live, when to work, whom to be friends with.

Do you ‘agree’ or ‘disagree’? ‘Strongly agree/disagree’ or ‘Agree/Disagree’?

1. Strongly agree

2. Agree

3. Disagree

4. Strongly disagree

RECOV3

Staff listen to me and respect my decisions about my treatment and care.

Do you ‘agree’ or ‘disagree’? ‘Strongly agree/disagree’ or ‘Agree/Disagree’?

1. Strongly agree

2. Agree

3. Disagree

4. Strongly disagree

RECOV4

Staff regularly ask me about my interests and the things I would like to do in the community.

Do you ‘agree’ or ‘disagree’? ‘Strongly agree/disagree’ or ‘Agree/Disagree’?

1. Strongly agree

2. Agree

3. Disagree

4. Strongly disagree

RECOV5

Staff help me to develop and plan for life goals beyond managing symptoms or staying stable (for example, employment, education, physical fitness, connecting with family and friends, hobbies).

Do you ‘agree’ or ‘disagree’? ‘Strongly agree/disagree’ or ‘Agree/Disagree’?

1. Strongly agree

2. Agree

3. Disagree

4. Strongly disagree

RECOV6

Staff help me to include people who are important to me in my recovery/treatment planning such as family, friends, clergy, or an employer.

Do you ‘agree’ or ‘disagree’? ‘Strongly agree/disagree’ or ‘Agree/Disagree’?

1. Strongly agree

2. Agree

3. Disagree

4. Strongly disagree

RECOV7

Staff introduce me to people in recovery who can serve as role models or mentors.

Do you ‘agree’ or ‘disagree’? ‘Strongly agree/disagree’ or ‘Agree/Disagree’?

1. Strongly agree

2. Agree

3. Disagree

4. Strongly disagree

EXPERIENCE OF CARE: SATISFACTION WITH CARE

[IF NON-VA ONLY USER]:  SKIP TO SATIS2INTRO

[IF VA-ONLY USER OR DUAL USER]:

The next questions are about all the counseling or treatment you got in the last 12 months at the VA or paid for by the VA during office, clinic, or overnight visits as well as over the phone. Please do the best you can to include all the different people you went to for counseling or treatment in your answers.

Do not include physical health care.

SATISF1

Using any number from 0 to 10, where 0 is the worst counseling or treatment possible and 10 is the best counseling or treatment possible, what number would you use to rate all of your counseling or treatment in the last 12 months? IF DUAL USER, ADD: at VA or paid for by the VA.

RATING OF ALL COUNSELING/TREATMENT:

[IF VA ONLY USER]:  SKIP TO SATIS3

SATIS2INTRO

[IF NON-VA ONLY USER]:

The next question is about all the counseling or treatment you got in the last 12 months from non-VA providers during office, clinic, or overnight visits as well as over the phone. Please do the best you can to include all the different people you went to for counseling or treatment in your answers.

[IF DUAL USER:]

Now please consider all the counseling or treatment you got in the last 12 months from non-VA providers during office, clinic, or overnight visits as well as over the phone.

SATISF2

Using any number from 0 to 10, where 0 is the worst counseling or treatment possible and 10 is the best counseling or treatment possible, what number would you use to rate all of your counseling or treatment in the last 12 months from non-VA providers? [Interviewer Note: Include residential and DOM stays.]

RATING OF ALL COUNSELING/TREATMENT:

SATSIF3

If you could have free counseling or treatment outside the VA, would you choose to receive counseling or treatment in the VA or outside the VA? Would you say…

1. Definitely in the VA

2. Probably in the VA

3. Probably outside the VA

4. Definitely outside the VA

[IF NON-VA ONLY USER]:  SKIP TO DECIS5

[IF VA ONLY USER or DUAL USER]: CONTINUE TO DECIS1

DECISION TO USE VA MENTAL HEALTH SERVICES

DECISINTRO

I am going to read a list of reasons why you might have chosen to use the VA for counseling or treatment in the past 12 months. Please tell me whether you strongly agree, somewhat agree, somewhat disagree, or strongly disagree. Do not include physical health care.

DECIS1

You chose to use the VA for counseling or treatment because…VA care costs less than other care available to you.

Do you ‘agree’ or ‘disagree’? ‘Strongly’ or ‘somewhat’?

4. Strongly agree

3 Somewhat agree

2 Somewhat disagree

1 Strongly disagree

DECIS2

You chose to use the VA for counseling or treatment because…The VA's location is convenient.

Do you ‘agree’ or ‘disagree’? ‘Strongly’ or ‘somewhat’?

4. Strongly agree

3 Somewhat agree

2 Somewhat disagree

1 Strongly disagree

DECIS3

You chose to use the VA for counseling or treatment because……The VA provides a higher quality of care.

Do you ‘agree’ or ‘disagree’? ‘Strongly’ or ‘somewhat’?

4. Strongly agree

3 Somewhat agree

2 Somewhat disagree

1 Strongly disagree

DECIS4

You chose to use the VA for counseling or treatment because……The VA provides prescription benefits.

Do you ‘agree’ or ‘disagree’? ‘Strongly’ or ‘somewhat’?

4. Strongly agree

3 Somewhat agree

2 Somewhat disagree

1 Strongly disagree

[IF VA ONLY USER]:  SKIP TO FUNCT1 (NEXT SECTION)

[IF NON-VA ONLY USER or DUAL USER]: CONTINUE TO DECIS5

DECISINTRO

I am going to read a list of reasons why you might have chosen to use services outside of the VA for counseling or treatment during the past 12 months. Please tell me whether you strongly agree, somewhat agree, somewhat disagree, or strongly disagree. Do not include physical health care.

DECIS5

You chose to use services outside the VA for counseling or treatment because…The location of other sources of counseling or treatment are more convenient than the VA.

Do you ‘agree’ or ‘disagree’? ‘Strongly’ or ‘somewhat’?

4 Strongly agree

3 Somewhat agree

2 Somewhat disagree

1 Strongly disagree

DECIS6

You chose to use services outside the VA for counseling or treatment because…Your out-of-pocket costs for counseling or treatment outside the VA are lower.

Do you ‘agree’ or ‘disagree’? ‘Strongly’ or ‘somewhat’?

4 Strongly agree

3 Somewhat agree

2 Somewhat disagree

1 Strongly disagree

DECIS7

You chose to use services outside the VA for counseling or treatment because…The quality of care outside the VA is higher.

Do you ‘agree’ or ‘disagree’? ‘Strongly’ or ‘somewhat’?

4 Strongly agree

3 Somewhat agree

2 Somewhat disagree

1 Strongly disagree

DECIS8

You chose to use services outside the VA for counseling or treatment because……You use the VA only for prescriptions.

Do you ‘agree’ or ‘disagree’? ‘Strongly’ or ‘somewhat’?

4 Strongly agree

3 Somewhat agree

2 Somewhat disagree

1 Strongly disagree

FUNCTIONING

FUNCTINTRO

The following questions ask for your views about your health. The first question is about your health now.

FUNCT1

In general, would you say your health is…?

5 Excellent

4 Very Good

3 Good

2 Fair

1 Poor

Now I am going to read a list of activities you might do during a typical day. As I read each item, please tell me if you health now limits you a lot, limits you a little, or does not limit you at all in these activities.

FUNCT2

...moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf. Does your health now limit you a lot, limit you a little, or not limit you at all?

1. YES, LIMITED A LOT

2. YES, LIMITED A LITTLE

3. NO, NOT LIMITED AT ALL

FUNCT3

...climbing several flights of stairs. Does your health now limit you a lot, limit you a little, or not limit you at all?

1 YES, LIMITED A LOT

2 YES, LIMITED A LITTLE

3 NO, NOT LIMITED AT ALL

The next set of questions will ask about the past 4 weeks. The following two questions ask about your physical health and your daily activities.

FUNCT4

During the past 4 weeks, have you accomplished less than you would like as a result of your physical health?

1 No, none of the time

2 Yes, a little of the time

3 Yes, some of the time

4 Yes, most of the time

5 Yes, all the time

FUNCT5

During the past 4 weeks, were you limited in the kind of work or other regular daily activities you do as a result of your physical health?

1 No, none of the time

2 Yes, a little of the time

3 Yes, some of the time

4 Yes, most of the time

5 Yes, all of the time

The following two questions ask about your emotions and your daily activities.

FUNCT6

During the past 4 weeks, have you accomplished less than you would like as a result of any emotional problems, such as feeling depressed or anxious?

1 No, none of the time

2 Yes, a little of the time

3 Yes, some of the time

4 Yes, most of the time

5 Yes, all of the time

FUNCT7

During the past 4 weeks, did you not do work or other regular daily activities as carefully as usual as a result of any emotional problems, such as feeling depressed or anxious?

1. No, none of the time

2. Yes, a little of the time

3. Yes, some of the time

4. Yes, most of the time

5. Yes, all of the time

The next question is about your pain and daily activities.

FUNCT8

During the past 4 weeks, how much did pain interfere with your normal work, including both work outside the home and housework? Did it interfere…

1 Not at all

2 A little bit

3 Moderately

4 Quite a bit

5 Extremely

The next question is about your health and social activities.

FUNCT9

During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities like visiting with friends, relatives, etc.)? Has it interfered…

1 All of the time

2 Most of the time

3 Some of the time

4 A little of the time

5 None of the time

The next questions are about how you feel and how things have been with you during the past 4 weeks.

As I read each statement, please give me the one answer that comes closest to the way you have been feeling; is it all of the time, most of the time, a good bit of the time, some of the time, a little of the time, or none of the time?

FUNCT10

How much of the time during the past 4 weeks…have you felt calm and peaceful?

1 All of the time

2 Most of the time

3 A good bit of the time

4 Some of the time

5 A little of the time

6 None of the time

FUNCT11

How much of the time during the past 4 weeks…did you have a lot of energy?

1 All of the time

2 Most of the time

3 A good bit of the time

4 Some of the time

5 A little of the time

6 None of the time

FUNCT12

How much of the time during the past 4 weeks…have you felt downhearted and blue?

1 All of the time

2 Most of the time

3 A good bit of the time

4 Some of the time

5 A little of the time

6 None of the time

The next set of questions will ask about the past 12 months.

FUNCT13

Compared to one year ago, how would you rate your emotional problems (such as feeling anxious, depressed, or irritable) now?

5 Much better

4 Somewhat better

3 About the same

2 Somewhat worse

1 Much worse

PERCEIVED IMPROVEMENT/HELPFULNESS OF TREATMENT

IMPROV1

Compared to 12 months ago, how would you rate your ability to deal with daily problems now?

5 Much better

4 A little better

3 About the same

2 A little worse

1 Much worse

IMPROV2

Compared to 12 months ago, how would you rate your ability to deal with social situations now?

5 Much better

4 A little better

3 About the same

2 A little worse

1 Much worse

IMPROV3

Compared to 12 months ago, how would you rate your ability to accomplish the things you want to do now?

5 Much better

4 A little better

3 About the same

2 A little worse

1 Much worse

IMPROV4

Compared to 12 months ago, how would you rate your problems or symptoms now?

5 Much better

4 A little better

3 About the same

2 A little worse

1 Much worse

[IF NON USER]: SKIP TO END

[IF VA ONLY USER, NON-VA ONLY USER, or DUAL USER]: CONTINUE TO IMPROV5

IMPROV5

In the last 12 months, how much were you helped by the counseling or treatment that you got?

0. Not at all

1. A little

2. Somewhat

3. A lot

END

These are all the questions I have. Thank you very much for your participation in this project.

[END INTERVIEW]

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