Attach L__devnssats2011.mathematica.net_ALL

Attach L__devnssats2011.mathematica.net_ALL.PDF

2011 Opioid Treatment Program (OTP) Survey

Attach L__devnssats2011.mathematica.net_ALL

OMB: 0930-0319

Document [pdf]

Download: pdf | pdf

NSSATS/OTP 2011 Web Survey

Page 1 of 1

U.S. Department of Health and Human Services

FORM APPROVED:
OMB No. XXXX-XXXX
APPROVAL EXPIRES: Date

Welcome to the

NATIONAL SURVEY OF
SUBSTANCE ABUSE TREATMENT SERVICES
(N-SSATS)
This is also the log in site for the new 2011 OPIOID
TREATMENT PROGRAM (OTP) SUPPLEMENTAL WEB
QUESTIONNAIRE
March 31, 2011
Sponsored by:
Substance Abuse and Mental Health Services
Administration (SAMHSA)

User Name

THIS IS A SECURE
SITE

Conducted by:
Mathematica Policy Research, Inc.

Password

/RJ,Q

If you do not know your User ID and Password, please refer to the pink flyer in the
N-SSATS packet or the green flyer included in your OTP packet. You can also call our
toll free number to obtain the information: 1-888-324-8337.

Public burden for this collection of N-SSATS information is estimated to average 40 minutes 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.
For the OTP supplement, the public burden is estimated to average 50 minutes per response.
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, Room 7-1044, 1 Choke Cherry
Road, Rockville, MD 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 number for
this project is XXXX-XXXX.

Pledge to respondents
The information you provide will be protected to the fullest extent allowable under the Public Health Service
Act, 42 USC Sec 501(n). This law permits the public release of identifiable information about an
establishment only with the consent of that establishment and limits the use of the information to the
purposes for which it was supplied. With the explicit consent of eligible treatment facilities, information
provided in response to survey questions marked with an asterisk will be published in SAMHSA's National
Directory of Drug and Alcohol Abuse Treatment Programs and the Substance Abuse Treatment Facility
Locator. Facility data will be de-identified such that identifying individual treatment facilities from the
published data will not be possible.

http://localhost/otpweb/otplogin.htm

2/10/2011

OTP Web Survey

Page 1 of 1

Welcome to the 2011 Opioid Treatment Program (OTP) Supplemental Questionnaire on the
Internet.
3/($6(5($'7+,6(17,5(3$*(%()25(&203/(7,1*7+(
48(67,211$,5(

,16758&7,216
Ŷ Many of the questions in this survey ask about “this Opioid Treatment Program (OTP).” By “this OTP” we mean (INSERT FILL). If
this OTP is part of a larger facility, report only about the services and activities at this OTP. If you have any questions about how
"this OTP" applies to your facility, please call 1-888-324-8337.
Ŷ Please answer ONLY for (INSERT FILL).
Ŷ Please keep a copy of your completed Web questionnaire for your records. You will be given the opportunity to review and print
your responses at the end of the questionnaire.
Ŷ For additional information about this survey and definitions of some of the terms used, please visit our website at
http://info.nssats.com/.

Ŷ For "Helpful Hints" on completing this questionnaire on the Web: Click Here.
Ŷ To preview the questionnaire: Click Here.
Ŷ When you are ready to begin, click on the BEGIN QUESTIONNAIRE button below.

%(*,148(67,211$,5(

4XLW
If you have immediate problems or questions, you can reach our helpline at 1-888-324-8337. The helpline is staffed Monday-Friday, 8am to 8pm
(Eastern Time). You can leave a message 24 hours a day when staff is not available,
OR
you can send an e-mail to the help desk by clicking on this link [email protected].

http://localhost/otpweb/otpinstruction.htm

2/10/2011

Helpful

Page 1 of 1

1DWLRQDO6XUYH\RI6XEVWDQFH$EXVH7UHDWPHQW6HUYLFHV166$76
DQG2SLRLG7UHDWPHQW3URJUDP2736XSSOHPHQWDO4XHVWLRQQDLUH
Substance Abuse and Mental Health Services Administration (SAMHSA)

+HUHDUHDIHZWLSVWRKHOS\RXFRPSOHWHWKLVTXHVWLRQQDLUHTXLFNO\DQGHDVLO\
Ŷ To VIEW or move down entire pages -- USE the scroll bar along the right side of your computer screen. Some screens
contain more than one question on a page. By using the scroll bar, you will be able to view all of the questions on a page.
Ŷ To VIEW a question on a previous screen or to CHANGE your answer to an earlier question, use the BACK button on your
browser.
Ŷ To SAVE responses and temporarily leave the questionnaire -- click on the QUIT button at the bottom of any screen. When
you return to the questionnaire and login again, previous answers will have been saved and you will continue from the point
where you left off.
Ŷ Do NOT use the ENTER key to complete your answers -- USE your mouse to navigate between questions. Although using
the enter key is a natural reaction, this will cause you to skip any remaining questions on that page.
Ŷ To CONTINUE to the next page -- click on the Submit button at the bottom of any screen.
Ŷ To RESET the answers on the page you are viewing, if you have made an error in entering data -- click on the START PAGE
OVER button at the bottom of any screen. You can then correct your mistake and click the Submit button to submit and
continue.
To preview the questionnaire: Click Here
To return to the main introduction: Click Here

%(*,148(67,211$,5(

4XLW

http://localhost/otpweb/otphelpful.htm

2/14/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
Who will be primarily responsible for completing this questionnaire?
Middle

Name: First

Last

Title:
Telephone number:
)

(

Ext

Fax number:
(

)

Email Address:

Quit for now

Review my answers

Back

If you have immediate problems or questions, you can reach our helpline at 1-888-324-8337. The helpline is staffed Monday-Friday, 8am to 8pm
(Eastern Time). You can leave a message 24 hours a day when staff is not available,
OR
you can send an e-mail to the help desk by clicking on this link [email protected].

http://devnssats2011.mathematica.net/default.aspx?page=149

2/14/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
1.

Is this OTP, at this location, normally scheduled to be open 365 days a year?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=150

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
2.

Does this OTP have a plan or an agreement with another provider to provide continuity of care for patients during service
disruptions, whether due to a major disaster or a more routine event, such as a snowstorm?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?Page=151

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
2a.

With which of the following providers does this OTP have such a plan or agreement?
SELECT "Yes" or "No" for each
YES

1. A hospital
2. Another OTP
3. A pharmacy
4. Other (Specify:
)

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?Page=152

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
3.

Does this OTP have a formal agreement for medical referral purposes with...
SELECT "Yes" OR "No" FOR EACH
Yes

1. A Federally Qualified Health Center (FQHC)
2. A hospital
3. A medical clinic
4. Other (Specify:
)

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?Page=153

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
4.

Does this OTP have a written agreement (as provided in 42 CFR Part 2) that permits other health service providers to
receive, process, store, or otherwise manage patient records?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=154

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
5.

For each day of the week, record this OTP's number of scheduled daily hours...
Column A - For dispensing methadone, buprenorphine (Subutex® or generic) or
buprenorphine/naloxone (Suboxone®).
Column B - For counseling.
If not scheduled on a given day, record "0" hours for that activity on that day.
Column A
Total Number
of Scheduled
Hours for
Dispensing
Medication

Column B
Total Number of
Scheduled
Hours for
Counseling

a. Monday
b. Tuesday
c. Wednesday
d. Thursday
e. Friday
f. Saturday
g. Sunday

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=155

2/10/2011

NSSATS Web Survey

Page 1 of 1

D. OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
6.

Does the OTP, at this location, provide vaccinations for...
SELECT "Yes" OR "No" FOR EACH
Yes No
1. Hepatitis B
2. Influenza

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=156

2/9/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7a1. Consider all screening performed at intake, assessment or admission. Does this OTP routinely screen for diabetes?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=157

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7b1. Consider all testing performed as medically appropriate. Does this OTP perform diagnostic tests for diabetes?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=158

2/14/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7a2. Consider all screening performed at intake, assessment or admission. Does this OTP routinely screen for hepatitis C?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=159

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7b2. Consider all testing performed as medically appropriate. Does this OTP perform diagnostic tests for hepatitis C?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=160

2/14/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7a3. Consider all screening performed at intake, assessment or admission. Does this OTP routinely screen for HIV/AIDS?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=161

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7b3. Consider all testing performed as medically appropriate. Does this OTP perform diagnostic tests for HIV/AIDS?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=162

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7a4. Consider all screening performed at intake, assessment or admission. Does this OTP routinely screen for hypertension
(high blood pressure)?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=163

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7b4. Consider all testing performed as medically appropriate. Does this OTP perform diagnostic tests for hypertension (high
blood pressure)?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=164

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7a5. Consider all screening performed at intake, assessment or admission. Does this OTP routinely screen for pregnancy?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=165

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7b5. Consider all testing performed as medically appropriate. Does this OTP perform diagnostic tests for pregnancy?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=166

2/14/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7a6. Consider all screening performed at intake, assessment or admission. Does this OTP routinely screen for heartbeat
abnormalities?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=167

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7b6. Consider all testing performed as medically appropriate. Does this OTP perform diagnostic tests for heartbeat
abnormalities?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=168

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7a7. Consider all screening performed at intake, assessment or admission. Does this OTP routinely screen for sexually
transmitted infections (STIs, including gonorrhea, syphilis)?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=169

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7b7. Consider all testing performed as medically appropriate. Does this OTP perform diagnostic tests for sexually transmitted
infections (STIs, including gonorrhea, syphilis)?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=170

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7a8. Consider all screening performed at intake, assessment or admission. Does this OTP routinely screen for sleep apnea?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=171

2/14/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7b8. Consider all testing performed as medically appropriate. Does this OTP perform diagnostic tests for sleep apnea?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=172

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7a9. Consider all screening performed at intake, assessment or admission. Does this OTP routinely screen for alcohol use?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=173

2/14/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7b9. Consider all testing performed as medically appropriate. Does this OTP perform diagnostic tests for alcohol use?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=174

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7a10. Consider all screening performed at intake, assessment or admission. Does this OTP routinely screen for tobacco use?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=175

2/14/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
7b10. Consider all testing performed as medically appropriate. Does this OTP perform diagnostic tests for tobacco use?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=176

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
8.

Does this OTP routinely test for any of the following drugs at admission?
SELECT "YES" OR "NO" FOR EACH
Yes

1. Marijuana
2. Cocaine
3. Benzodiazepines
4. Heroin
5. Prescription opioids
6. Methamphetamines
7. Other stimulants (Please specify:
)

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=177

2/14/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9a1. Does this OTP routinely screen for the psychiatric condition of anxiety/panic disorder?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=178

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9b1. Does this OTP provide treatment involving medication for the psychiatric condition of anxiety/panic disorder?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=179

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9c1. Does this OTP provide treatment involving counseling therapy for the psychiatric condition of anxiety/panic disorder?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=180

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9a2. Does this OTP routinely screen for the psychiatric condition of bipolar disorder?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=181

2/14/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9b2. Does this OTP provide treatment involving medication for the psychiatric condition of bipolar disorder?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=182

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9c2. Does this OTP provide treatment involving counseling therapy for the psychiatric condition of bipolar disorder?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=183

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9a3. Does this OTP routinely screen for the psychiatric condition of depression?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=184

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9b3. Does this OTP provide treatment involving medication for the psychiatric condition of depression?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=185

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9c3. Does this OTP provide treatment involving counseling therapy for the psychiatric condition of depression?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=186

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9a4. Does this OTP routinely screen for the psychiatric condition of post traumatic stress disorder?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=187

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9b4. Does this OTP provide treatment involving medication for the psychiatric condition of post traumatic stress disorder?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=188

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9c4. Does this OTP provide treatment involving counseling therapy for the psychiatric condition of post traumatic stress
disorder?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=189

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9a5. Does this OTP routinely screen for the psychiatric condition of schizophrenia?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=190

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9b5. Does this OTP provide treatment involving medication for the psychiatric condition of schizophrenia?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=191

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9c5. Does this OTP provide treatment involving counseling therapy for the psychiatric condition of schizophrenia?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=192

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9a6. Does this OTP routinely screen for any other psychiatric conditions?
Yes No
Please Specify

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=193

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9b6. Does this OTP provide treatment involving medication for any other condition?
Yes No
Please Specify

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=194

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
9c6. Does this OTP provide treatment involving counseling therapy for any other condition?
Yes No
Please Specify

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=195

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
10.

This question concerns the clinical staff providing patient services at this OTP in a typical week.
Please count a staff member in one category only.
Column A - Please record total number employed at this OTP.
Column B - Please record the sum total hours worked for all staff listed in Column A in a typical week.
Column A
Total Number
Employed at this OTP
(IF NONE, ENTER "0")

Column B
Sum Total Number of Hours
Worked in a Typical Week

1. Physician (MD, DO, Psychiatrist,
etc.)
2. Registered Nurse (RN)
3. Licensed Practical
Nurse (LPN)
4. Mid-level medical
personnel (Nurse
Practitioner, PA, APRN,
etc.)
5. Pharmacist
6. Doctoral level counselor
(Psychologist, etc.)
7. Masters level counselor
(MSW, etc.)
8. Other degreed
counselor (BA, BS)
9. Associate degree or non
degreed counselor

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=196

2/14/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
11.

For clinical management, does this OTP...
SELECT "YES" OR "NO" FOR EACH
Yes

1. Use in-house or proprietary software
(software that was created for, or modified
specifically for, this OTP or facility)?
2. Use commercially-available
software that has not been modified
specifically for this OTP or facility?
3. Use a paper system only
(no computer/electronic clinical management)?

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=197

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
12.

For each of the following activities, please indicate if staff members routinely use computer or electronic resources,
paper only, or a combination of both to accomplish their work...
SELECT ONE METHOD FOR EACH ACTIVITY
Work Activity
Computer/
Electronic
Only
1

Paper
Only
2

Both
Electronic
and Paper
3

1. Intake
2. Assessment
3. Treatment plan
4. Discharge
5. Referrals
6. Issue/Receive
lab results
7. Billing
8. Outcomes
management
9. Medication
dispensing

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=198

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
13.

Do computers at this OTP have the capability to access the Internet?
Yes
No
Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=199

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
13a. Does this OTP primarily access the Internet using...
SELECT ONE ONLY
1. A regular "dial-up" telephone line
2. DSL, cable modem, fiber optics, satellite,
wireless (such as Wi-Fi) or some other
broadband Internet connection?
3. Something else? (Specify:

Quit for now

)

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=200

2/10/2011

OTP Web Survey

Page 1 of 1

OPIOID TREATMENT PROGRAM SERVICES AND CHARACTERISTICS
14.

Do any outpatients travel an hour or more, each way to be treated at this OTP?
Yes
No
Not applicable, no outpatient OTP patients

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=201

2/10/2011

OTP Web Survey

Page 1 of 1

OTP PATIENT CHARACTERISTICS
1.

During the 2010 calendar year, how many new
patients were admitted to this OTP?
ENTER A NUMBER
(IF NONE ENTER "0")
2010 Calendar Year Total Box

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=202

2/14/2011

OTP Web Survey

Page 1 of 1

OTP PATIENT CHARACTERISTICS
2.

On March 31, 2011, how many patients were
in treatment at this OTP?
ENTER A
NUMBER
(IF NONE,
ENTER "0")
MARCH 31, 2011
TOTAL BOX

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=203

2/10/2011

OTP Web Survey

Page 1 of 1

OTP PATIENT CHARACTERISTICS
3.

On March 31, 2011, how many of these OTP patients were...

Each category total should equal the number
reported in the TOTAL BOX in B2.
ENTER THE NUMBER OF PATIENTS IN EACH CATEGORY
(IF NONE, ENTER"0")
GENDER

Male
Female
Other, unknown or not collected

AGE

Under 18
18-34
35-54
55 and over
Unknown or not collected

RACE & ETHNICITY

White
Black
Hispanic
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Two or more races
Unknown or not collected

VETERAN STATUS

Veteran
Non Veteran
Unknown or not collected

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=204

2/10/2011

OTP Web Survey

Page 1 of 1

OTP PATIENT CHARACTERISTICS
4.

Of the patients in treatment on March 31, 2011, how many had been in treatment continuously at this OTP for...
ENTER THE NUMBER OF PATIENTS
(IF NONE, ENTER "0")
0-90 days
91-180 days
181-365 days
More than 1 year to less than
2 years
2 years or longer

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=205

2/10/2011

OTP Web Survey

Page 1 of 1

OTP PATIENT CHARACTERISTICS
5.

How many of the patients in treatment on March 31, 2011, were dispensed methadone?
ENTER A NUMBER (IF NONE, ENTER "0")
Number
Dispensed
Methadone

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=207

2/14/2011

OTP Web Survey

Page 1 of 1

OTP PATIENT CHARACTERISTICS
5a.

Of these patients, how many were receiving methadone for...
ENTER THE NUMBER OF PATIENTS
(IF NONE, ENTER "0")
Maintenance
Detoxification

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=208

2/14/2011

OTP Web Survey

Page 1 of 1

OTP PATIENT CHARACTERISTICS
5b.

How many methadone maintenance patients in B5a were receiving methadone doses of...
ENTER THE NUMBER OF PATIENTS
(IF NONE, ENTER "0")
Less than 40 mg.
40 to 79 mg.
80 to 119 mg.
120 mg. or above

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=209

2/14/2011

OTP Web Survey

Page 1 of 1

OTP PATIENT CHARACTERISTICS
5c.

How many of the patients in B5 had been receiving methadone for 2 years or more?
ENTER A NUMBER
(IF NONE, ENTER "0")
Number Receiving
Methadone For
2 Years Or More

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=210

2/14/2011

OTP Web Survey

Page 1 of 1

OTP PATIENT CHARACTERISTICS
5d.

Of the patients in B5c, how many were receiving take-home doses for the following number of days...
NUMBER OF DAYS

ENTER THE NUMBER OF PATIENTS (IF NONE, ENTER "0")

0 days (did not receive take-home
doses)
1-7 days
8-14 days
15-30 days

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=211

2/14/2011

OTP Web Survey

Page 1 of 1

OTP PATIENT CHARACTERISTICS
6.

How many of the patients in treatment on March 31, 2011 were receiving
buprenorphine (Subutex® or generic) or buprenorphine/naloxone
(Suboxone®)?
ENTER A NUMBER (IF NONE, ENTER "0")
Number dispensed
Buprenorphine or
Buprenorphine/Naloxone

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=213

2/14/2011

OTP Web Survey

Page 1 of 1

OTP PATIENT CHARACTERISTICS
6a.

Of these patients, how many were receiving buprenorphine for...
ENTER THE NUMBER OF PATIENTS
(IF NONE, ENTER "0")
Maintenance
Detoxification
Total Receiving Buprenorphine

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=214

2/14/2011

OTP Web Survey

Page 1 of 1

OTP PATIENT CHARACTERISTICS
6b.

How many buprenorphine maintenance patients in B6a were receiving buprenorphine doses of...
ENTER THE NUMBER OF PATIENTS
(IF NONE, ENTER "0")
Buprenorphine
Buprenorphine or Naloxon
(Subutex® or Generic)
(Suboxone®)
Dosage
Less than 8 mg
8 to 16 mg
17 to 24 mg
25 to 32 mg
More than 32 mg

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=215

2/14/2011

OTP Web Survey

Page 1 of 1

OTP PATIENT CHARACTERISTICS
7.

Please indicate any comments.

Quit for now

Review my answers

Back

http://devnssats2011.mathematica.net/default.aspx?page=216

2/14/2011

File Type	application/pdf
File Title	\376\377\000o\000t\000p\000l\000o\000g\000i\000n\000.\000p\000d\000f
Author	rcallahan
File Modified	2011-02-14
File Created	2011-02-14