Attachment 4 - Pro Attachment 4 - Provider Survey

Attachment 4:
Provider Survey

OMB NO. 0930-XXXX

Exp. Date XX/XX/XX

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Today’s Date: |___|___||___|___||___|___|

MO DAY YR

Provider Organization Identification Number |___|___|___|___|

Public Burden Statement: 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.  Public reporting burden for this collection of information is estimated to average .5 hours per client per year, 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 7-1044, Rockville, Maryland, 20857.

Please begin survey on the next page 

Access to Recovery (ATR) Provider Survey

INTRODUCTION

You or your organization was identified as either an Access to Recovery (ATR) service provider belonging to the [Grantee’s ATR Program]’s provider network or as an ATR case management/care coordination organization or individual.

To improve upon and better understand the ATR program we would like you to answer the following survey questions. This survey is part of a larger evaluation being conducted by RTI International, an independent research organization funded by the Center for Substance Abuse Treatment (CSAT) to conduct a national evaluation of the ATR Program.

We strongly recommend that an individual most familiar with your organization and its role within the ATR program complete this survey. These questions ask about the services your organization provides and its experience participating in the ATR program.

IMPORTANT: For the purposes of this survey, ATR clients and ATR-funded clients refer to individuals who received services that were reimbursed through the [Grantee’s ATR Program]’s voucher payment system.

If you have any questions about this study, you may contact Cassie Williams at RTI

(1-800-334-8571 (ext. 23749). She can also be reached via email at [email protected].

Section A — Organizational Characteristics

In this section, we are gathering background information about you, your organization, and the ATR-funded services your organization offers.

1. How long have you worked for this organization?

0–5 months

6–11 months

1 to 2 years

3 to 4 years

5 or more years

2. Which of the following best describes your position in this organization?

Organization director or senior manager

Case manager/care coordinator

Clinical services director

Tribal leader

Pastor/clergy

Other (please specify): __________________________

3. Which of the following best describes your organization?

Community organization

Faith-based, affiliated directly with a religious institution or congregation (e.g., church, mosque, temple)

Independent faith-based without administrative affiliation with a religious institution or congregation (e.g., the Salvation Army)

Secular organization

Traditional healer (e.g., tribal cultural/religious practices, homoeopathic medicine)

Tribal agency

Indian Health Service provider

Case manager/care coordinator employed by the [Grantee’s ATR Program]

Other (please specify): __________________________

4. How would you classify the ownership structure of your organization?

Private, for profit

Private, nonprofit

Public

Other (please specify): _______________________________

5. Did your organization receive federal, state or tribal funding prior to participating in the ATR program?

Yes

No

Don’t Know

6. Is your organization still actively involved with the [Grantee’s ATR Program] (e.g., current member of provider network)?

Yes

No

Don’t Know

If no, why is your organization no longer actively involved with the ATR program? (Please check all that apply.)

No or insufficient number of ATR clients

Difficulty meeting Grantee’s provider requirements

Lack of organizational support for ATR program

Other (please specify): _______________________________

7. For how many months has/had your organization been involved with the [Grantee’s ATR Program]?

Months (If less than 1 month, enter “01”; if 2 years, enter “24.”)

8. Please indicate the client population groups your organization serves/served through the ATR program. (Please check all that apply.)

Adolescents

Any adult clients

Criminal justice/probation clients

Opioid replacement clients

Methamphetamine clients

American Indian/Alaska Native clients

Pregnant women or women with children

Other (please specify): _____________________________

9. Which of the following modalities is offered by your organization? (Please check all that apply)

Day treatment

Inpatient/hospital (other than detox)

Outpatient, nonmethadone

Outreach

Intensive outpatient

Methadone

Residential/rehabilitation

Detoxification

After care

Recovery support services

Other (please specify): ____________________________

Not Applicable

10. Please indicate from the list below which specific clinical treatment and/or medical services your organization provides as part of the ATR program. (Please check all that apply.)

	We do not provide clinical treatment or medical services.		Co-occurring Treatment Services
	Brief intervention		Pharmacological interventions
	Brief treatment		HIV/AIDS counseling
	Referral to treatment		Family/marriage counseling
	Assessment		Medical care
	Treatment/ recovery planning		Alcohol/drug testing
	Individual counseling		HIV/AIDS medical support & testing
	Group counseling
	Other Clinical Treatment and/or Medical Services, please specify: ______________________________________________________
	______________________________________________________
	______________________________________________________
	______________________________________________________
	______________________________________________________

11. Please indicate from the list below which recovery support services your organization provides as part of the ATR Program. (Please check all that apply.)

	We do not provide recovery support services		Sweat lodges
	Case management/care coordination		Traditional ceremonies
	Family services (including marriage education, parenting and child development services)		Talking circles
	Child care		Indigenous language recovery
	Pre-employment services		Continuing care
	Employment coaching		Relapse prevention
	Individual services coordination		Recovery coaching
	Transportation		Self-help and support groups
	HIV/AIDS services (e.g., education, medical support, testing, counseling)		Education services (e.g., substance abuse, HIV/AIDS)
	Transitional housing services		Peer coaching or mentoring
	Housing support		Alcohol- and drug-free social activities
	Pastoral counseling		Information and referral
	Spiritual Support
	Other Recovery Support Services, please specify: ______________________________________________________
	______________________________________________________
	______________________________________________________
	______________________________________________________
	______________________________________________________

12. Do the services offered by your organization to ATR-funded clients differ from those services offered to clients not funded through the ATR program?

Yes

No

Don’t Know

If yes, please describe how service offerings differ between ATR-funded clients and clients not funded through the ATR program.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Section B—ATR Program Satisfaction

13. How satisfied is your organization with the voucher redemption system established by the [Grantee’s ATR Program]?

Very satisfied

Satisfied

Unsure

Dissatisfied

Very dissatisfied

No experience

14. How satisfied is your organization with the reimbursement rates for ATR services?

Very satisfied

Satisfied

Unsure

Dissatisfied

Very dissatisfied

No experience

15. Which statement best describes your organization’s experience with ATR regulations and policies?

Our organization has been able to maintain its mission and character (including any religious or faith beliefs, if applicable)

Our organization has had to alter the way it presents its mission and character (including any religious or faith beliefs, if applicable)

I have no opinion

16. Overall, how satisfied is your organization with the [Grantee’s ATR Program]?

Very satisfied

Satisfied

Unsure

Dissatisfied

Very dissatisfied

No experience

Section C—ATR Program Preparation Activities

In this section, we are gathering information about your organization’s experience in preparing for the ATR program.

17. Prior to enrolling in the ATR program, did a representative from your organization attend any meetings held by the [Grantee’s ATR Program] to discuss organization requirements of participation in the ATR program?

Yes

No

Don’t Know

18. In preparation for participation in the ATR program, did your organization offer staff training related to the ATR program?

Yes

No

Don’t Know

If yes, please indicate the type of training offered. (Please check all that apply.)

ATR screening and/or assessment

ATR service provision

Voucher management

Cultural training (e.g., competence, awareness, sensitivity)

Data collection/data management (e.g., GPRA)

Other (please specify): ___________________________

19. In preparation for participation in the ATR program, did your organization request any type of technical assistance from the [Grantee’s ATR Program]?

Yes

No

Don’t Know

If yes, please indicate the type of technical assistance requested. (Please check all that apply.)

	Assistance with applying to the ATR network
	Assistance with voucher management and data collection systems
	Assistance with attracting (marketing to) ATR clients
	Cultural competency training
	Assistance with capacity or sustainability
	Assistance in identifying which services are reimbursable from the program
	Other (please specify): _________________________________________

20. Did your organization change its administrative policies to accommodate participation in the ATR program?

Yes

No

Don’t Know

If yes, what type of administrative policies has your organization changed?

Electronic reporting and voucher tracking

Screening policies

Billing procedures

Contracting procedures

Data collection for quality assurance

Other (please specify):______________________________

Section D—Client Characteristics

In this section, we are gathering information about your organization’s experience serving
ATR-funded clients.

For the purposes of these questions, an ATR client or ATR-funded client is any client who has at least one service funded through the ATR program. A non-ATR client is any client who does not have any services funded through the ATR program.

21. Has your organization served any ATR clients?

Yes

No → Go to Question 29

Don’t Know

22. Approximately what percentage of your organization’s clients is ATR-funded?

%

23. Of these ATR-funded clients, what percentage received services from your organization prior to being enrolled in the ATR program?

%

24. Approximately what percentage of your ATR clients also receive services from your organization that are not funded through the ATR program (e.g., funded from other sources such as block grant, Medicaid)?

%

25. In an average week, how many active ATR clients (unduplicated count of individuals) does your organization serve?

    Number of ATR clients

26. In an average week, how many active non-ATR clients (unduplicated count of individuals) does your organization serve?

    Number of Non-ATR clients

27. In an average week, what percentage of your organization’s clients receives clinical treatment and/or medical services in your organization? (If your organization does not provide clinical treatment services, then please indicate 0%)

    ATR clients	%
    Non-ATR clients	%

28. In an average week, what percentage of your organization’s clients receives recovery support services in your organization? (If your organization does not provide recovery support services, then please indicate 0%)

ATR clients	%
Non-ATR clients	%

29. Which one statement best describes your experience with the number of ATR clients you have served?

We have served fewer ATR clients than we had expected.

We have served about the number of ATR clients we expected.

We have served more ATR clients that we had expected.

30. Which situation(s) describes any barriers your organization has had in recruiting/enrolling ATR clients? (Please check all that apply.)

No barriers in recruiting clients

Inadequate outreach

Staff not trained in ATR procedures

Lack of marketing resources

Program not easily accessible to ATR clients (e.g., no public transportation)

Institutional barriers

Cultural barriers (e.g., language barriers, not enough staff trained to work with clients with minority clients)

Inadequate support at the grantee level (e.g., lack of training)

Inadequate funding

Wrong client mix

Other (please specify): _________________

31. Which situation(s) describes any facilitators that have aided your organization in recruiting/enrolling ATR clients? (Please check all that apply.)

No facilitators in recruiting clients

Available resources for staff training on the ATR program and its procedures

Availability of ATR technical assistance

Improved marketing and outreach resources

Management support of the ATR program within our organization

Change in organization procedures (e.g., hours of operation) to better accommodate client needs

Establishment of satellite office near the screening and/or assessing agency

Addition of new services to meet ATR client needs

Other (please specify): _________________

Section E—Ongoing Delivery of the ATR Program

This section of the questionnaire gathers information on the day-to-day delivery of the ATR program in your organization.

32. Who is responsible for entering ATR clients’ GPRA data into the system? (Please check all that apply.)

A clinical practitioner or recovery support service staff within our organization

A case manager or case coordinator within our organization

A medical records technician within our organization

Staff at an umbrella organization that oversees the operations of our organization

Staff outside our organization designated by grantee’s ATR program

Other (please specify): ________________________________

33. How does your organization bill for ATR-funded services?

Electronic voucher management system

Paper invoice

Third party handles billing

Other (please specify):_________________________________________

34. How does your organization track of the number of ATR clients it serves? (Please check all that apply.)

Do not track

Maintain a list of clients in organization’s own MIS system

Enter and view client data in a centralized grantee-hosted ATR database

Other (please specify): ______________________________________

35. How does your organization track the client’s use of his/her voucher? (Please check all that apply.)

Do not track

View voucher expenditures online in organization’s own MIS system

Maintain a list of clients and client data within our organization

View voucher expenditures on centralized grantee-hosted ATR Web site

Contact case manager/case coordinator or agency that issued voucher

Other (please specify): _____________________________________

36. If an ATR client’s voucher does not include services that your organization thinks they need or the client’s voucher has expired, what are your organization’s procedures for obtaining these services for this client? (Please check all that apply.)

Contact the assessing agency

Contact the ATR grantee

Find a way to provide the services through other funding mechanisms

Provide the client with a list of possible providers outside of the ATR network

Other (please specify): ___________________________________

37. Does a representative from your organization usually attend organization meetings (e.g., annually, biannually) held by the [Grantee’s ATR Program] to discuss the ATR program?

Yes

No

Don’t Know

38. Does your organization offer ongoing staff training related to the ATR program?

Yes

No

Don’t Know

If yes, please indicate the type of training that is typically offered. (Please check all that apply.)

ATR screening and assessment

ATR service provision

Voucher management

Cultural training (e.g., competence, awareness, sensitivity)

Data collection/data management (e.g., GPRA)

Other (please specify): ___________________________

39. Has your organization requested any type of technical assistance from the [Grantee’s ATR Program]?

Yes

No

Don’t Know

If yes, please indicate the type of technical assistance requested. (Please check all that apply.)

Assistance with voucher management and data collection systems

Assistance with attracting (marketing to) ATR clients

Cultural competency training

Assistance with capacity or sustainability

Assistance in identifying which services are reimbursable from the program

Other (please specify): _________________________________________

40. To what extent are/were the following factors barriers to delivering the ATR program in your organization? Please read each statement and choose the response that best describes your situation.

	To a very little extent		To some extent		To a very great extent
Staff turnover	1	2	3	4	5
Competing priorities at this organization	1	2	3	4	5
Lack of available treatment or recovery support service slots for referrals	1	2	3	4	5
Staff’s lack of time	1	2	3	4	5
Inadequate training and TA resources	1	2	3	4	5
Inadequate resources for ATR client outreach and marketing	1	2	3	4	5
Lack of participation, enthusiasm, and/or commitment from organization’s leaders	1	2	3	4	5

41. To what extent do/did the following factors facilitate the delivery of the ATR program in your organization? Please read each statement and choose the statement that best describes your situation.

	To a very little extent		To some extent		To a very great extent
Your organization’s ATR coordinator	1	2	3	4	5
Involving treatment/recovery support services staff in the initial decision to participate in the program	1	2	3	4	5
A champion within your organization	1	2	3	4	5
Making organizational changes within the organization to facilitate increased ATR activities	1	2	3	4	5
Having training and technical assistance available from ATR grantee	1	2	3	4	5
Participation, enthusiasm, and/or commitment from organization’s leaders	1	2	3	4	5

42. If you have suggestions or comments you’d like to share regarding the [Grantee’s ATR Program], please write them below.

Thank you for completing this survey! Your input will help us to gain a better understanding of how the ATR Program is performing.

If you have any questions regarding this survey, please call Cassie Williams at 1-800-###-###, ext. 2---- or e-mail her at [email protected].

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