Form Interviews and sur Interviews and sur Interviews and survey-instruments

ATTACHMENT A
DISCUSSION GUIDES FOR STAKEHOLDER INTERVIEWS

1

OMB NO. 0930-XXXX
Expiration Date XX/XX/XXXX

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 60 minutes per
respondent 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.

INSTRUCTIONS TO INTERVIEWERS:
This document is intended to guide on-site interviews, but each topic may not be appropriate to
cover with each respondent. Interviewers should exercise judgment in pursuing topics more deeply
or not at all, depending on the role and level of knowledge of each respondent and the site context.
Before beginning each interview, interviewers should:
Thank respondents for participating and discuss the voluntary nature of their
participation
Introduce self and role (and provide business card with contact information) and
provide a brief overview of the evaluation
Notify respondents that no comments will be linked with respondent names in any
public documents, that responses will be kept confidential except as required by law
Notify respondents that the interview will last approximately 60 minutes
Notify respondents that they should be able to provide responses “off the top of their
heads” but in the event they cannot, we will simply move on to another topic and they
may call the interviewer after the site visit to provide additional responses if they are
willing and able.

1.

Applying for SOAR
Decision to apply
Participants in the application process
How state formulated approach described in the application
Leading agencies or individuals and how they became leaders

Financial considerations
-

Financial motivations to apply, if any

-

Plans to dedicate existing or new resources to SOAR

Process for identifying pilot site(s)
2.

Relevant previous initiatives in pilot site(s), if any

Strategic planning forum
Strategic planning in advance of forum, if any
Recruitment process and role of PRA in recruitment
Forum participants
Missing agencies or individuals (e.g. medical providers)
-

Factors preventing their involvement

-

Later involvement, if any

Discussions of what participants’ responsibilities to SOAR would be
Resulting action plan and person(s) responsible for implementing different components
-

Changed views of SSI/SSDI application process Changed perspective on the
components and complexity of this process

-

Changed opinion on the importance of obtaining SSI/SSDI for clients

Stakeholders’ levels of commitment to SOAR before and after the forum
Stakeholders’ perceptions of their SOAR-related responsibilities before and after the
forum
Perceptions of the strengths and weaknesses of the forum
3.

Ongoing strategic planning
Formal or informal strategic planning sessions after the forum
Strategies, if any, for implementing portions of the strategic plan
Recruiting additional partners
New actions resulting from SOAR (e.g., assignment of a specific DDS office or staff
person to SOAR)
New relationships resulting from SOAR (e.g., linkages with hospitals or treatment
facilities)
Process for deciding whether to expand SOAR after pilot rollout

1.

-

Process for identifying expansion sites

-

Previous initiatives in expansion sites, if any

-

Expansion process

-

Expansion results

-

Extent to which pilot experience informed expansion strategy

Respondent’s participation in SOAR
Respondent’s role in the SOAR initiative
-

Facilitate communication

-

Troubleshoot problems

-

Indentify potential resources

How respondent’s actual role compares to his or her initial expectations
Percentage of time respondent spends on SOAR
Degree to which respondent’s supervisor and other agency leaders support his or her
participation in SOAR
-

Percentage of time respondent’s supervisor expects him or her to spent on
SOAR

Extent to which respondent’s organization commits resources (e.g., other staff members’
time) to SOAR
2.

Current Stakeholders
Agencies involved in SOAR
-

SSA Offices (state/local)

-

DDS Offices (state/local)

-

Local lead(s)

-

Housing and other public assistance agencies (state/local)

-

Public and private health systems (state/local)

-

Homeless service providers

-

Community mental health providers

-

State mental health agency

-

Correctional agencies/facilities (state/local)

-

Collaborations established with Continuum of Care, PATH, Health Care for the
Homeless programs, HOPE and Department of Veterans’ Affairs

Role of each agency in implementing SOAR
Other partners that provide official or unofficial leadership
Factors that facilitate or impede implementation
-

Extent to which each agency’s leaders support SOAR

-

Extent to which SOAR responsibilities are congruent with existing staff
responsibilities

-

Organizations that have refined organizational priorities and/or job descriptions
because of SOAR, if any

-

Effect of turnover on agencies’ participation in SOAR

Reasons agencies remain involved in SOAR
Reasons some agencies have stopped contributing to SOAR or reduced the extent
their involvement
3.

of

State Lead’s Communication with Stakeholders
Frequency (contact with each agency before and after SOAR began)
Method of communication (email, in-person meetings, telephone)
-

Group meetings after the strategic planning forum, if any

Purpose of communication/ topics discussed
Changes in communication over time
Opinion about how productive the entity’s communication is with each of the other
agencies in achieving partnership goals and activities
Extent to which SOAR has increased or improved communication between stakeholders

1.

Identifying Trainers
Number of trainers, reasons for changes in number of trainers over time
Process for selecting trainers
-

Discussions with trainers about time commitment and responsibilities

-

Discussions with
responsibilities

trainers’

supervisors

about

time

commitment

and

Background of trainers
-

Experience with SSI/SSDI applications

-

Experience with homeless clients

-

Experience conducting trainings

Turnover among trainers
Process for selecting replacement trainers, if any
2.

Ongoing Trainer Involvement
Nature of communication between state lead and trainers
Trainer availability to conduct trainings
Other areas of ongoing trainer involvement (e.g. providing TA to case managers)
Factors facilitating ongoing trainer involvement
Factors impeding ongoing trainer involvement
Extent to which trainers’ supervisors support them spending time conducting trainings
Extent to which trainers’ supervisors support them spending time providing TA to case
managers

D. IN-STATE TRAININGS ON STEPPING STONES TO RECOVERY FOR CASE
MANAGERS
1.

Recruiting Trainees
Strategies and process
Barriers faced
Supervisory support/ buy-in
Discussions, if any, of case managers’ responsibilities after receiving training
Demand for training

2.

In-State Training Coordination
Process
Barriers faced
Rationale for pace and location of rollout
Extent to which stakeholders communicate about timing, frequency, size and location of
trainings

3.

Trainee Participation
Number, timing and locations of in-state trainings
Total number of staff trained
Types of staff trained (agencies, roles)
Participation of SSA and DDS
Participation of case managers’ supervisors
Refresher trainings, if any
Untrained staff who should be trained
Barriers to participation

4.

Effects of Trainings on Case Managers
Growth, if any, in the number of organizations with case managers who submit
SSI/SSDI applications for homeless clients
Growth, if any, in the number of case managers who submit applications
Implementation of SOAR critical components
-

Flagging applications as SOAR

-

Obtaining prior treatment records

-

Writing medical summary reports co-signed by physician or psychologist (and
report quality)

-

Review of applications for completeness and accuracy

-

Electronic submission of applications to SSA

-

Case managers becoming authorized representative

-

Case managers becoming representative payees

Other perception of changes in application quality
Ongoing communication between case managers and other stakeholders
-

State and local leads

-

SSA and DDS

-

Trainers

-

Peers

Types of TA requested, if any

Types of TA received, if any
Extent to which TA provider initiated contact with state lead or other stakeholders;
nature of these conversations
Changes to practices/procedures in response to TA
Feedback on TA
Unmet TA needs
F. DATA COLLECTION SYSTEMS AND PRACTICES
1.

Data Collection Procedures
Data system(s) stakeholders use to track application outcomes
-

Use of PRA web tracking system within and across participating agencies

-

Feedback on PRA web tracking system

Successes and challenges of tracking
-

Strategies for motivating participants to enter data

-

Data reliability

Role and responsibilities of data liaison
2.

State Use of Outcomes Data
Extent to which respondent and other participants review data from PRA web tracking
system
Extent to which respondent and other participants review data from other tracking
systems
Use(s) of outcomes data

1.

SSI/SSDI Benefits
Number of SOAR applications submitted
Approval rates and timing compared to non-homeless applications

2.

Other Benefits
Other benefits to clients that resulted from SOAR
-

Medicaid enrollment

1.

-

Housing changes

-

Enrollment in treatment programs

Cost Recovery
Entities recovering health care expenses after applicants enroll in Medicaid and
amount recovered
Reimbursement of General Assistance by SSA
Process for tracking and calculating cost recovery
Extent to which the prospect of cost recovery sparked stakeholder support for the
initiative
Extent to which the prospect of cost recovery influenced SOAR strategic plans

2.

Savings
Savings due to shelter stays and entities realizing savings
Entities realizing other savings and amount

1.

Future plans for SOAR
Plans to continue or expand SOAR
Plans for tracking outcomes in the future
Plans to tap new or existing resources to sustain or expand SOAR
Factors facilitating or impeding SOAR’s continuation and expansion

2.

Success-related factors
Factors facilitating strategic plan implementation and ongoing communication
-

Methods of communication that seemed to work best

-

New DUAs or MOUs that were needed

Factors impeding strategic plan implementation and ongoing communication
-

Strategies for overcoming barriers

-

What should have been done but was not

-

What was done that in retrospect should not have been

Localities more and less successful with respect to implementation and individual
outcomes
-

Factors accounting for the difference

Perception of state’s success in SOAR implementation
Perception of changes to client outcomes attributable to SOAR

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 60 minutes per
respondent 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.

INSTRUCTIONS TO INTERVIEWERS:
This document is intended to guide on-site interviews, but each topic may not be appropriate to
cover with each respondent. Interviewers should exercise judgment in pursuing topics more deeply
or not at all, depending on the role and level of knowledge of each respondent and the site context.
Before beginning each interview, interviewers should:
Thank respondents for participating and discuss the voluntary nature of their
participation
Introduce self and role (and provide business card with contact information) and
provide a brief overview of the evaluation
Notify respondents that no comments will be linked with respondent names in any
public documents, that responses will be kept confidential except as required by law
Notify respondents that the interview will last approximately 60 minutes
Notify respondents that they should be able to provide responses “off the top of their
heads” but in the event they cannot, we will simply move on to another topic and they
may call the interviewer after the site visit to provide additional responses if they are
willing and able.

1.

Background
Agency
Role at agency
Agency’s experience with the SSI/SSDI application process prior to SOAR
Respondent’s experience with the SSI/SSDI application process prior to SOAR
Respondent’s prior experience with data system and data management
Agency’s role in SOAR
Respondent’s other SOAR responsibilities, if any

11

SOAR

2.

Data Liaison Interview Guide

Becoming Involved
How respondent first learned about SOAR
How respondent became the data liaison
-

Recruiter

-

Reasons for becoming the data liaison
 Role of financial incentive

-

Involvement of respondent’s supervisor

Respondent’s level of interest in the position
3.

Strategic Planning Forum and In-State Trainings
Participation in the forum
Strengths and weaknesses of the forum
Discussion of PRA web data system during forum, if any, and messages given to
participants
Participation in in-state trainings, if any
Strengths and weaknesses of in-state trainings
Discussion of PRA web data system during trainings, if any, and messages given to
participants

1.

Data Liaison Responsibilities
Describe responsibilities as data liaison
How role compares to initial expectations
How role has changed over time
Percentage of time respondent spends on data liaison responsibilities
More or less than respondent expected
Factors facilitating respondent’s involvement
Barriers to involvement
Degree to which respondent’s supervisor and other agency leaders support respondent
spending time on SOAR

SOAR

2.

Data Liaison Interview Guide

PRA Web Tracking System
TA case managers received regarding data system, if any
Ongoing communication with case management agencies
-

Frequency (contact with each agency)

-

Prior relationships with these agencies, if any

-

Who initiates contact

-

Method of communication (email, in-person meetings, telephone)

-

Purpose of communication/ topics discussed

-

Relationships and communication with case managers’ supervisors

-

Opinion about how productive the entity’s communication is with each of the
other agencies in improving data quality

Strategies for encouraging use
Strategies for improving data quality
Methods of monitoring system use and data quality
Motivations for case managers to enter data
Process of obtaining data and submitting data to Mathematica

3.

-

Challenges

-

Strategies to overcome challenges

DDS Data
Process of initiating a SOAR tracking system
Ongoing communication with DDS staff
-

Frequency

-

Prior relationships with this agency, if any

-

Who initiates contact

-

Method of communication (email, in-person meetings, telephone)

-

Purpose of communication/ topics discussed

Strategies for encouraging use
Strategies for improving data quality
Methods of monitoring system use and data quality

SOAR

Data Liaison Interview Guide

Relationships with DDS supervisors
Motivations for DDS staff to enter data
Process of obtaining data and submitting data to Mathematica

4.

-

Challenges

-

Strategies to overcome challenges

Contact with TA Provider and TA Provider’s Contractors
Frequency
Who initiates contact
Topics discussed
Perspective on usefulness of Mathematica site visit to establish data system
Perspective on usefulness of Mathematica’s remote support
How PRA and Mathematica could better support data liaison

4.

SOAR Leadership
Communication with state/local lead
-

Frequency (contact with before and after SOAR began)

-

Method of communication (email, in-person meetings, telephone)

-

Purpose of communication/ topics discussed

-

Changes in communication over time

-

Opinion about how productive communication is in improving SOAR
applications

Role of state lead in encouraging case managers to use the web tracking system and
troubleshooting related problems
Role of other leaders in encouraging case managers to use the web tracking system and
troubleshooting related problems
State lead’s role in encouraging stakeholders to dedicate resources to SOAR
Other leaders’ role in encouraging stakeholders to dedicate resources to SOAR

1.

Web Tracking System
Extent to which case managers use the web tracking system and for what purposes

SOAR

Data Liaison Interview Guide

-

Proportion of SOAR cases for which case managers enters initial application
information

-

Proportion of SOAR cases for which case managers enter information on
application outcomes

-

Reasons case managers do not enter data

-

Changes over time in use of system

Differences, if any, between cases case managers enter and cases they do not enter
Differences between case managers that use the system and those that do not
Role of supervisors in encouraging/requiring case mangers to use the system
-

Practices for monitoring use

Extent to which case managers or other in-state stakeholders look at resultant data
Extent to which data from the system informs decision making
Positive and negative aspects of the system
-

Questions case managers finds confusing

-

Technical issues with the system, if any

Ways system could be improved; Inherent challenges, if any
2.

DDS Data
Perceived quality of DDS data
-

Proportion of SOAR cases for which DDS staff enter initial application
information

-

Proportion of SOAR cases for which DDS staff enter information on
application outcomes

-

Reasons staff do not enter data

-

Changes over time in use of system

Extent to which data from the system informs decision making
Positive and negative aspects of the system
-

Questions case managers finds confusing

-

Technical issues with the system, if any

Ways system could be improved; Inherent challenges, if any

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 60 minutes per
respondent 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.

INSTRUCTIONS TO INTERVIEWERS:
This document is intended to guide on-site interviews, but each topic may not be appropriate to
cover with each respondent. Interviewers should exercise judgment in pursuing topics more deeply
or not at all, depending on the role and level of knowledge of each respondent and the site context.
Before beginning each interview, interviewers should:
Thank respondents for participating and discuss the voluntary nature of their
participation
Introduce self and role (and provide business card with contact information) and
provide a brief overview of the evaluation
Notify respondents that no comments will be linked with respondent names in any
public documents, that responses will be kept confidential except as required by law
Notify respondents that the interview will last approximately 60 minutes
Notify respondents that they should be able to provide responses “off the top of their
heads” but in the event they cannot, we will simply move on to another topic and they
may call the interviewer after the site visit to provide additional responses if they are
willing and able.

1.

Background Question
Overview of respondent’s role at SSA/DDS
Overview of organizational structure
-

Division of responsibilities between regional and local offices

-

Number of local offices

-

Local office structure (e.g. divisions that handle different types of applications)

-

Procedures for identifying and processing homeless applications before SOAR

16

SOAR

2.

DDS and SSA Staff Interview Guide

Applying for SOAR
Relevant previous initiatives in this locality, if any
How respondent first learned about SOAR
Participation in the application process, if any

3.

Strategic Planning Forum
Involvement in early statewide or local strategic planning, if any
Participation in the forum
-

How recruited

-

Decision to participate or not to participate

Leading agencies or individuals and how they became leaders
Resulting action plan and person(s) responsible for implementing different components
Discussions of what participants’ responsibilities to SOAR would be
Stakeholders’ perceptions of their SOAR-related responsibilities before and after the
forum
Stakeholders’ levels of commitment to SOAR before and after the forum
Respondent’s perceptions of the strengths and weaknesses of the forum
-

Expectations of forum

-

Extent to which forum met expectations

-

Most and least useful aspects

B. SOAR Activities
1.

Overview of SSA/DDS Participation in SOAR
SSA/DDS role in the SOAR initiative
How agency’s role compares to early expectations
How agency’s role has changed over time
Role of any existing pre-release agreements between SSA/DDS and local entities
New SSA/DDS activities/structure attributable to SOAR
-

Redefined staff roles
 Determining whether or not set aside staff time for SOAR
 Other responsibilities of these staff, if any

SOAR

DDS and SSA Staff Interview Guide

 Selecting and training staff
 Selecting and training replacement staff after turnover, if applicable
2.

Processing SOAR and Other Homeless Applications
Identifying homeless and SOAR applications
-

Definitions of “homeless” and “SOAR”
 Differences, if any, between SSA/DDS definition of homelessness and case
managers’ definitions of homelessness

-

Determining whether an applicant is homeless and/or is a SOAR applicant

Flagging applications
-

Flagged applications as homeless before SOAR

-

Currently flag applications as homeless

-

Currently flag applications as SOAR

Differences between processing a homeless individual’s application and all other
applications
-

Expedite applications

-

Processed by different staff

Special procedures for processing SOAR applications
-

Expedite applications

-

Processed by different staff

Key differences between a SOAR and non-SOAR application
-

Quantity of information

-

Quality of application

-

Ability to contact applicant

Ways SOAR applications could be improved
3.

In-State Trainings on Stepping Stones to Recovery for Case Managers
Agency involvement in in-state trainings
-

Frequency of participation

-

Who participates

SOAR

DDS and SSA Staff Interview Guide

-

Communication with trainers or other SOAR leaders about timing and location
of training

-

Nature of participation

-

Discussion, if any, of communication between SSA/DDS and case managers

-

Strengthens of training
 Benefits to case managers

-

Weaknesses of training
 Areas for improvement

Impact of training
-

Perceptions of training’s effect on the number of homeless applications

-

Perception of trainings effect on the quality of homeless applications

-

Implementation of SOAR critical components
 Flagging applications as SOAR
 Inclusion of prior treatment records
 Electronic submission of applications to SSA
 Case managers becoming authorized representatives
 Case managers becoming representative payees
 Writing medical summary reports co-signed by physician or psychologist
 Report quality
 Extent to which reports are useful

4.

Agency support for SOAR
Factors influencing agency’s participation in SOAR
Extent to which engaging in activities to support SOAR was congruent with existing
staff responsibilities
-

Participating in trainings

-

Providing feedback on applications

Extent to which SOAR was congruent with existing agency priorities (e.g. a larger
initiative relating to homeless)
Degree to which agency leaders are aware of SOAR
Level of agency’s leaders support for SOAR

SOAR

1.

DDS and SSA Staff Interview Guide

Ongoing Communication
Partners
-

SOAR leaders

-

Housing and other public assistance agencies (state/local)

-

Public and private health systems (state/local)

-

Homeless service providers

-

Community mental health providers

-

State mental health agency

-

Correctional agencies/facilities (state/local)

-

Other stakeholders

Frequency (contact with before and after SOAR began)
Method of communication (email, in-person meetings, telephone)
Purpose of communication/ topics discussed
Changes in communication over time
Opinion about how productive communication is in improving SOAR applications
Extent to which SOAR has increased or improved communication between stakeholders
2.

Ongoing Strategic Planning
Nature and strength of SOAR leadership
-

Extent to which state lead or other leaders facilitates ongoing communication
between stakeholders

-

Leader’s roles in troubleshooting problems

-

Leader’s roles in encouraging stakeholders to dedicate resources to SOAR

Involvement in ongoing statewide strategic planning, if any
-

Strategic planning sessions after the forums

-

Discussions with the state lead or other stakeholders

Struggles implementing portions of the strategic plan
Factors facilitating strategic plan implementation and ongoing communication
-

New DUA or MOUs

SOAR

DDS and SSA Staff Interview Guide

Factors impeding strategic plan implementation and ongoing communication

1.

-

Strategies for overcoming barriers

-

What should have been done but was not

-

What was done that in retrospect should not have been

Tracking Procedures
Tracking systems and procedures
Outcomes tracked
Differences between tracking homeless and non-homeless SSI/SSDI applications
Differences between tracking SOAR and non-SOAR SSI/SSDI applications
Efforts, if any, to compare application outcomes for homeless applications to outcomes
for all applicants
-

Reasons for these efforts

-

Successes and challenges of these efforts

Efforts, if any, to compare application outcomes for SOAR applicants to outcomes for
all applicants or for other homeless applicants

2.

-

Reasons for these efforts

-

Successes and challenges of these efforts

Application Outcomes
Number of SOAR applications submitted
Percent approved on first application
Percent approved overall
Percent of approvals made without an authorized representative
Average time between application submission and approval
Percent of SOAR applicants needing a consultative examination
Percent of applicants ultimately denied for benefits
SOAR application approval rates and time frames compared to those for non-homeless
individuals
Homeless application approval rates and time frames compared to those for nonhomeless individuals

SOAR

1.

DDS and SSA Staff Interview Guide

Future SSA/DDS plans
Plans to continue or expand agency’s SOAR participation
Factors facilitating or impeding SOAR’s continuation and expansion in this agency

2.

Overall Assessment of SOAR
Overall assessment of SOAR’s success in this locality
Challenges SOAR faced in this locality
Lessons for this or other communities regarding SOAR

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 60 minutes per
respondent 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.

INSTRUCTIONS TO INTERVIEWERS:
This document is intended to guide on-site interviews, but each topic may not be appropriate to
cover with each respondent. Interviewers should exercise judgment in pursuing topics more deeply
or not at all, depending on the role and level of knowledge of each respondent and the site context.
Before beginning each interview, interviewers should:
Thank respondents for participating and discuss the voluntary nature of their
participation
Introduce self and role (and provide business card with contact information) and
provide a brief overview of the evaluation
Notify respondents that no comments will be linked with respondent names in any
public documents, that responses will be kept confidential except as required by law
Notify respondents that the interview will last approximately 60 minutes
Notify respondents that they should be able to provide responses “off the top of their
heads” but in the event they cannot, we will simply move on to another topic and they
may call the interviewer after the site visit to provide additional responses if they are
willing and able.

1.

Background
Agency
Role at agency
Agency experience with SSI/SSDI application process prior to SOAR

2.

Becoming involved
How respondent’s agency first learned about SOAR
Participation in SOAR application process
How respondent’s agency decided to participate
23

SOAR

3.

Other State and Local Partners Guide

-

Impact of previous partnerships with SOAR leaders or other SOAR participants

-

Who made the decision

-

Plans to finance SOAR efforts

-

Financial motives, if any

SOAR Responsibilities
Agency’s role in SOAR
-

How agency’s involvement compares to initial expectations

-

How agency’s involvement has changed over time

Respondent’s role in SOAR
-

Percentage of time respondent spends on SOAR

-

How respondent’s actual role compares to his or her initial expectations

Congruence of SOAR with organizational mission and previous activities
Degree to which SOAR caused agency to redefine staff responsibilities
Factors facilitating involvement
-

Financial motivations, if any

Barriers to involvement
Degree to which respondent’s supervisor and other agency leaders support staff
spending time on SOAR
4.

Strategic Planning Forum
Involvement in early statewide or local strategic planning, if any
Participation in the forum
-

How recruited

-

Decision to participate or not to participate

Leading agencies or individuals and how they became leaders
Missing agencies or individuals (e.g. medical providers) and factors preventing their
involvement
Resulting action plan and person(s) responsible for implementing different components
Discussions of what participants’ responsibilities to SOAR would be
Stakeholders’ perceptions of their SOAR-related responsibilities before and after the
forum

SOAR

Other State and Local Partners Guide

Stakeholders’ levels of commitment to SOAR before and after the forum
Respondent’s perceptions of the strengths and weaknesses of the forum
-

Expectations of forum

-

Extent to which forum met expectations

-

Most and least useful aspects

Previous similar initiatives in this locality, if any

[Ask if agency supplies case managers]
1.

Participation
Process for learning about training
Staff that participated, if any
Number of case managers that participated
Process for determining which staff would participate
Barriers to participation
Discussions before training of how case managers would implement SOAR

2.

Training Feedback
Perceptions of training (most and least useful aspects)
Participation of SSA and DDS
-

Nature of participation

-

Value of participation

-

Identification of a SSA and/or DDS staff member to contact

Discussion during training of PRA web tracking system
Discussion during training of case managers’ future responsibilities to SOAR
Difference in case managers’ knowledge of the SSI/SSDI application process before and
after training
3.

Case Manager’s Participation in SOAR
Percentage of time case managers are expected to spend on SOAR
Percentage of time case managers actually spend on SOAR

SOAR

Other State and Local Partners Guide

Extent to which SOAR is congruent with case manager’s core responsibilities
Time required to complete a benefit application
4.

Implementing Training Components
Extent to which respondent is aware of the details of preparing SOAR applications
Perceived impact of SOAR on application quality
Frequency before/since SOAR training of submitting SSI/SSDI applications (generally
and for homeless individuals)
Frequency of using information from SOAR training in work with clients
Extent and methods of outreach to homeless clients and changes over time
Frequency before/since SOAR training of
-

Obtaining prior treatment records

-

Writing medical summary reports co-signed by physician or psychologist (and
report quality)

-

Review of applications for completeness and accuracy

-

Electronic submission of applications to SSA

-

Case managers becoming authorized representative

-

Case managers becoming representative payees

Barriers to completing above steps
Practices for quality control

1.

Ongoing Communication
Partners
-

SOAR leaders

-

Housing and other public assistance agencies (state/local)

-

Public and private health systems (state/local)

-

Homeless service providers

-

Community mental health providers

-

State mental health agency

-

Correctional agencies/facilities (state/local)

-

Other stakeholders

SOAR

Other State and Local Partners Guide

Frequency (contact with before and after SOAR began)
Method of communication (email, in-person meetings, telephone)
Purpose of communication/ topics discussed
Changes in communication over time
Opinion about how productive communication is in improving SOAR applications
Extent to which SOAR has increased or improved communication between stakeholders
2.

Ongoing Strategic Planning
Nature and strength of SOAR leadership
-

Extent to which state lead or other leaders facilitates ongoing communication
between stakeholders

-

Leader’s roles in troubleshooting problems

-

Leader’s roles in encouraging stakeholders to dedicate resources to SOAR

Involvement in ongoing statewide strategic planning, if any
-

Strategic planning sessions or other group meetings after the forums

-

Discussions with the state lead or other stakeholders

Struggles implementing portions of the strategic plan
Factors facilitating strategic plan implementation and ongoing communication
-

New DUAs or MOUs

Factors impeding strategic plan implementation and ongoing communication

1.

-

Strategies for overcoming barriers

-

What should have been done but was not

-

What was done that in retrospect should not have been

General Case Management Tracking Procedures
Process and systems used for maintaining case management records
Special processes for SOAR cases, if any
Process for and timing of follow-up on submitted applications
Procedures that are mandatory v. voluntary

SOAR

2.

Other State and Local Partners Guide

Successes and Challenges of Tracking Outcomes
Perception of personal success at tracking SOAR outcomes
Challenges of tracking
Factors contributing to successes and challenges

[if agency houses case managers]
1.

Early Experiences
How learned about the system
Deciding whether or not case manager should use the system
-

Reasons

Training case managers received, if any

1.

Early Experiences with the System
How learned about the system
Deciding whether or not case manager should use the system
-

Reasons

Training case managers received, if any
2.

Use of the Current System
Extent to which respondent or other agency leaders encourage/require case managers to
use the system
-

Reasons for requiring or not requiring use

-

Practices for monitoring use

-

Extent to which respondent is familiar with the system

Extent to which case managers use the system and for what purposes
-

Proportion of SOAR cases for which case managers enters initial application
information

-

Proportion of SOAR cases for which respondent case managers enter
information on application outcomes

SOAR

Other State and Local Partners Guide

-

Reasons case managers enter data

-

Reasons case managers do not enter data

-

Changes over time in use of system

-

Differences, if any, between cases case managers enter and cases they do not
enter

-

Extent to which case managers at this organization differ in their level of use

Extent to which respondent, case managers or other agency staff look at resultant data
Extent to which data from the system informs decision-making
Positive and negative aspects of the system
-

Questions case managers finds confusing

-

Technical issues with the system, if any

Ways system could be improved
3.

Inherent challenges, if any

Interactions with Data Liaison
Interactions with data liaison before SOAR
Initial interaction with data liaison regarding SOAR web tracking system
Frequency of interactions with the data liaison regarding SOAR web tracking system
Topics discussed with data liaison
Changes over time
Interactions with other SOAR stakeholders regarding SOAR web tracking system

1.

SSI/SSDI Benefits
Number of SOAR applications submitted
Number of SOAR applications approved
Average time between application submission and approval
Factors contributing to application approvals and denials

2.

Other Benefits
Other benefits to clients that resulted from SOAR

SOAR

3.

Other State and Local Partners Guide

-

Medicaid enrollment

-

Housing changes

-

Enrollment in treatment programs

-

Effect of SOAR on case managers’ non-SOAR work

Cost Recovery
Entities recovering health care expenses after applicants enroll in Medicaid and amount
recovered
Reimbursement of General Assistance by SSA
Savings due to shelter stays and entities realizing savings
Entities realizing other savings and amount

1.

Successful Aspects of Training and SOAR

2.

Challenges or Areas Needing Improvement

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 60 minutes per
respondent 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.

INSTRUCTIONS TO INTERVIEWERS:
This document is intended to guide on-site interviews, but each topic may not be appropriate to
cover with each respondent. Interviewers should exercise judgment in pursuing topics more deeply
or not at all, depending on the role and level of knowledge of each respondent and the site context.
Before beginning each interview, interviewers should:
Thank respondents for participating and discuss the voluntary nature of their
participation
Introduce self and role (and provide business card with contact information) and
provide a brief overview of the evaluation
Notify respondents that no comments will be linked with respondent names in any
public documents, that responses will be kept confidential except as required by law
Notify respondents that the interview will last approximately 60 minutes
Notify respondents that they should be able to provide responses “off the top of their
heads” but in the event they cannot, we will simply move on to another topic and they
may call the interviewer after the site visit to provide additional responses if they are
willing and able.

1.

Background Questions
Agency
Role at agency
Previous experience
-

Experience with SSI/SSDI applications

-

Experience with homeless clients

-

Experience conducting trainings

31

SOAR

2.

State Trainers Interview Guide

Becoming a Trainer
How respondent first learned about SOAR
How respondent became a trainer
-

Recruiter

-

Reasons for becoming a trainer

-

Discussions with recruiter about time commitment and responsibilities

-

Discussions with respodent’s supervisors about time commitment and
responsibilities

Other trainers
-

Number of other trainers

-

How other trainers were selected

-

Background of other trainers
 Experience with SSI/SSDI applications
 Experience with homeless clients
 Experience conducting trainings
 Level of commitment among other trainers

-

Turnover among trainers, if any
 Process for selecting replacement trainers

3.

Extent of other trainers’ participation

SOAR Responsibilities
Agency’s role in SOAR
-

How agency’s involvement compares to initial expectations

-

How agency’s involvement has changed over time

Respondent’s role in SOAR
-

Percentage of time respondent spends on SOAR

-

How respondent’s actual role compares to his or her initial expectations

-

How role has changed over time

Congruence of SOAR with organizational mission and previous activities
Barriers to involvement

SOAR

State Trainers Interview Guide

Degree to which respondent’s supervisor and other agency leaders support staff
spending time on SOAR
4.

Early SOAR involvement and Strategic Planning Forum
Involvement in application process or early strategic planning, if any
Selected as trainer before or after strategic planning forum
Participation in the forum
-

How recruited

-

Decision to participate or not to participate

Leading agencies or individuals and how they became leaders
Missing agencies or individuals (e.g. medical providers) and factors preventing their
involvement
Resulting action plan and person(s) responsible for implementing different components
Discussions of what participants’ responsibilities to SOAR would be
Stakeholders’ perceptions of their SOAR-related responsibilities before and after the
forum
Stakeholders’ levels of commitment to SOAR before and after the forum
Respondent’s perceptions of the strengths and weaknesses of the forum
-

Expectations of forum

-

Extent to which forum met expectations

-

Most and least useful aspects

Previous similar initiatives in this locality, if any

Feedback on TTT session
Advantages of TTT model
Disadvantages of TTT model

1.

Recruiting Trainees
Recruiter

SOAR

State Trainers Interview Guide

Strategies
Barriers faced
Supervisory support/ buy-in
Discussions, if any, of trainees’ responsibilities after receiving training
Demand for training
2.

In-State Training Coordination
Coordinators
-

Role of state/local lead

-

Role of trainers

Barriers faced
Rationale for pace and location of rollout
Extent to which stakeholders communicate about timing, frequency, size and location of
trainings
3.

Participation
Number, timing and locations of in-state trainings
Total number of staff trained
Types of staff trained (agencies, roles)
Participation of SSA and DDS
-

Recruitment of SSA/DDS

-

Nature of SSA/DDS participation

Participation of case managers’ supervisors
Untrained staff who should be trained
Barriers to participation
Refresher trainings, if any
Case manager satisfaction with in-state trainings
4.

Training Feedback
Modifications respondent made to Stepping Stones to Recovery curriculum
o Reasons for modifications
o Portions of curriculum not taught and reason

SOAR

State Trainers Interview Guide

o Extent to which in-state trainings covered Medicaid enrollment and
eligibility
o Extent to which in-state trainings covered online submission of
applications
Easiest parts of curriculum to teach and reason
Most difficult parts of curriculum to teach and reason
Challenges of conducting in-state trainings
Trainee perceptions
Difference in trainees’ knowledge of the SSI/SSDI application process due to training
Perceived level and type of support from state lead or other SOAR leaders
Needs filled by training
Unmet SOAR training needs
5.

Follow-up Contact with Case Managers
Providing formal or informal TA
Other follow-up contact between training participants and trainers
Number of participants trainer(s) had follow up contact with
Frequency of contact
Differences between case mangers with whom respondent had follow-up contact and
case managers with whom respondents did not have contact
-

Previous relationship

-

Organizational affiliation

Who initiated contact
Topics discussed
Opinion on productivity of follow-up contact
6.

Effects of Trainings on Case Managers
Growth, if any, in the number of organizations with case managers who submit
SSI/SSDI applications for homeless clients
Growth, if any, in the number of case managers who submit applications
Implementation of SOAR critical components
-

Flagging applications as SOAR

SOAR

State Trainers Interview Guide

-

Obtaining prior treatment records

-

Writing medical summary reports co-signed by physician or psychologist (and
report quality)

-

Review of applications for completeness and accuracy

-

Electronic submission of applications to SSA

-

Case managers becoming authorized representative

-

Case managers becoming representative payees

Other perception of changes in application quality
Changes in nature or frequency of communication between case managers and other
stakeholders

1.

-

State and local leads

-

SSA and DDS

-

Trainers

-

Peers

In-State Training Observations
Usefulness of TA contractor observing the first in-state training
Changes in response to TA contractor feedback, if any

2.

Additional Training
Types of additional training requested, if any
Perceived responsiveness of TA contractor to requests for additional training
Nature and quality of training received
Coordinating these requests with state lead
Unmet needs for additional training, if any

1.

Ongoing Communication
Partners
-

SOAR leaders

-

SSA/DDS

SOAR

State Trainers Interview Guide

-

Housing and other public assistance agencies (state/local)

-

Public and private health systems (state/local)

-

Homeless service providers

-

Community mental health providers

-

State mental health agency

-

Correctional agencies/facilities (state/local)

-

Other stakeholders

Frequency (contact with before and after SOAR began)
Method of communication (email, in-person meetings, telephone)
Purpose of communication/ topics discussed
Changes in communication over time
Opinion about how productive communication is in improving SOAR applications
Extent to which SOAR has increased or improved communication between stakeholders
2.

Ongoing Strategic Planning
Nature and strength of SOAR leadership
-

Extent to which state lead or other leaders facilitates ongoing communication
between stakeholders

-

Leader’s roles in troubleshooting problems

-

Leader’s roles in encouraging stakeholders to dedicate resources to SOAR

Involvement in ongoing statewide strategic planning, if any
-

Strategic planning sessions or other group meetings after the forums

-

Discussions with the state lead or other stakeholders

Struggles implementing portions of the strategic plan
Factors facilitating strategic plan implementation and ongoing communication
-

New DUAs or MOUs

Factors impeding strategic plan implementation and ongoing communication
-

Strategies for overcoming barriers

-

What should have been done but was not

-

What was done that in retrospect should not have been

SOAR

1.

State Trainers Interview Guide

Future Plans for Participation
Plans to continue or expand SOAR participation

2.

Overall Assessment of SOAR
Overall assessment of SOAR’s success in this locality
Challenges SOAR faced in this locality
Factors facilitating or impeding SOAR’s continuation and expansion in this community
Lessons for this or other communities regarding SOAR

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 60 minutes per
respondent 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.

INSTRUCTIONS TO INTERVIEWERS:
This document is intended to guide on-site interviews, but each topic may not be appropriate to
cover with each respondent. Interviewers should exercise judgment in pursuing topics more deeply
or not at all, depending on the role and level of knowledge of each respondent and the site context.
Before beginning each interview, interviewers should:
Thank respondents for participating and discuss the voluntary nature of their
participation
Introduce self and role (and provide business card with contact information) and
provide a brief overview of the evaluation
Notify respondents that no comments will be linked with respondent names in any
public documents, that responses will be kept confidential except as required by law
Notify respondents that the interview will last approximately 60 minutes
Notify respondents that they should be able to provide responses “off the top of their
heads” but in the event they cannot, we will simply move on to another topic and they
may call the interviewer after the site visit to provide additional responses if they are
willing and able.

1.

Background
Agency
Role at agency
Experience with SSI/SSDI applications prior to SOAR training
Case managers’ experiences with SSI/SSDI applications prior to SOAR training

2.

Becoming Involved
How respondent’s agency first learned about SOAR
Participation in SOAR application process

39

SOAR

Case Manager Supervisor/Local Agency Director Interview Guide

How respondent’s agency decided to participate

3.

-

Impact of previous partnerships with SOAR leaders or other SOAR participants

-

Who made the decision

-

Plans to finance SOAR efforts

-

Financial motives, if any

Strategic Planning Forum
Involvement in early strategic planning, if any
Participation in the forum
-

How recruited

-

Decision to participate or not to participate

Leading agencies or individuals and how they became leaders
Missing agencies or individuals (e.g. medical providers) and factors preventing their
involvement
Resulting action plan and person(s) responsible for implementing different components
Discussions of what participants’ responsibilities to SOAR would be
Stakeholders’ perceptions of their SOAR-related responsibilities before and after the
forum
Stakeholders’ levels of commitment to SOAR before and after the forum
Respondent’s perceptions of the strengths and weaknesses of the forum
-

Expectations of forum

-

Extent to which forum met expections

-

Most and least useful aspects

Previous similar initiatives in this locality, if any
4.

SOAR Responsibilities
Agency’s role in SOAR
-

How agency’s involvement compares to initial expectations

-

How agency’s involvement has changed over time

-

Case managers’ roles in SOAR

Respondent’s role in SOAR
-

Percentage of time respondent spends on SOAR

-

How respondent’s actual role compares to his or her initial expectations

SOAR

Case Manager Supervisor/Local Agency Director Interview Guide

Congruence of SOAR with organizational mission and previous activities
Degree to which SOAR caused agency to redefine staff responsibilities
Factors facilitating involvement
-

Financial motivations, if any

Barriers to involvement
Degree to which respondent’s supervisor and other agency leaders support staff
spending time on SOAR
How agency’s involvement has changed over time
How agency’s involvement compares to initial expectations

1.

Recruiting Trainees
Process for learning about training
Number of case managers that participated
Whether respondent or any other staff apart from case managers participated
Process for determining which staff would participate
Barriers to participation
Discussions before training of how case managers would implement SOAR
Refresher trainings, if any
Ongoing contact or TA from trainers, if any

2.

Training Feedback
Perceptions of training (most and least useful aspects)
Difference in case managers’ knowledge of the SSI/SSDI application process before and
after training
Participation of SSA and DDS
-

Nature of participation

-

Value of participation

-

Identification of a SSA and/or DDS staff member to contact

Discussion during training of case managers’ future responsibilities to SOAR
Discussion during training of PRA web tracking system

SOAR

3.

Case Manager Supervisor/Local Agency Director Interview Guide

Case Manager’s Participation in SOAR
Percentage of time case managers are expected to spend on SOAR
Percentage of time case managers actually spend on SOAR
Extent to which SOAR is congruent with case manager’s core responsibilities

4.

Implementing Training Components
Extent to which respondent is involved with/aware of the details of preparing SOAR
applications
Frequency before/since SOAR training of submitting SSI/SSDI applications (generally
and for homeless individuals)
Perceived impact of SOAR on application quality
Frequency of using information from SOAR training in work with clients
Extent and methods of outreach to homeless clients and changes over time
Frequency before/since SOAR training of
-

Obtaining prior treatment records

-

Writing medical summary reports co-signed by physician or psychologist (and
report quality)

-

Review of applications for completeness and accuracy

-

Electronic submission of applications to SSA

-

Case managers becoming authorized representative

-

Case managers becoming representative payees

Barriers to completing above steps
Practices for quality control
Feedback from SSA/DDS regarding application quality, if any
5.

Ongoing communication
Partners
-

SOAR leaders

-

SSA/DDS

-

Trainers

-

Housing and other public assistance agencies (state/local)

-

Public and private health systems (state/local)

-

Homeless service providers

-

Community mental health providers

SOAR

Case Manager Supervisor/Local Agency Director Interview Guide

-

State mental health agency

-

Correctional agencies/facilities (state/local)

-

Other stakeholders

Frequency (contact with before and after SOAR began)
Method of communication (email, in-person meetings, telephone)
Purpose of communication/ topics discussed
Changes in communication over time
Opinion about how productive communication is in improving SOAR applications
Extent to which SOAR has increased or improved communication between stakeholders
6.

Ongoing Strategic Planning
Nature and strength of SOAR leadership
-

Extent to which state lead or other leaders facilitates ongoing communication
between stakeholders

-

Leader’s roles in troubleshooting problems

-

Leader’s roles in encouraging stakeholders to dedicate resources to SOAR

Involvement in ongoing statewide strategic planning, if any
-

Strategic planning sessions or other group meetings after the forums

-

Discussions with the state lead or other stakeholders

Struggles implementing portions of the strategic plan
Factors facilitating strategic plan implementation and ongoing communication
-

New DUAs or MOUs

Factors impeding strategic plan implementation and ongoing communication

1.

-

Strategies for overcoming barriers

-

What should have been done but was not

-

What was done that in retrospect should not have been

General Case Management Tracking Procedures
Process and systems used for maintaining case management records\
Special processes for SOAR cases, if any
Process for and timing of follow-up on submitted applications
Procedures that are mandatory v. voluntary

SOAR

2.

Case Manager Supervisor/Local Agency Director Interview Guide

Successes and Challenges of Tracking Outcomes
Perception of personal success at tracking SOAR outcomes
Challenges of tracking
Factors contributing to successes and challenges

1.

Early Experiences with the System
How learned about the system
Deciding whether or not case manager should use the system
-

Reasons

Training case managers received, if any
2.

Use of the Current System
Extent to which respondent or other agency leaders encourage/require case managers to
use the system
-

Reasons for requiring or not requiring use

-

Practices for monitoring use

-

Extent to which respondent is familiar with the system

Extent to which case managers use the system and for what purposes
-

Proportion of SOAR cases for which case managers enters initial application
information

-

Proportion of SOAR cases for which respondent case managers enter
information on application outcomes

-

Reasons case managers enter data

-

Reasons case managers do not enter data

-

Changes over time in use of system

-

Differences, if any, between cases case managers enter and cases they do not
enter

-

Extent to which case managers at this organization differ in their level of use

Extent to which respondent, case managers or other agency staff look at resultant data
Extent to which data from the system informs decision-making
Positive and negative aspects of the system
-

Questions case managers finds confusing

-

Technical issues with the system, if any

SOAR

Case Manager Supervisor/Local Agency Director Interview Guide

Ways system could be improved
3.

Inherent challenges, if any

Interactions with Data Liaison
Interactions with data liaison before SOAR
Initial interaction with data liaison regarding SOAR web tracking system
Frequency of interactions with the data liaison regarding SOAR web tracking system
Topics discussed with data liaison
Changes over time
Interactions with other SOAR stakeholders regarding SOAR web tracking system

1.

SSI/SSDI Benefits
Number of SOAR applications submitted
Number of SOAR applications approved
Average time between application submission and approval
Factors contributing to application approvals and denials

2.

Other Benefits
Other benefits to clients that resulted from SOAR
-

Medicaid enrollment

-

Housing changes

-

Enrollment in treatment programs

-

Effect of SOAR on case managers’ non-SOAR work

1.

Successful Aspects of Training and SOAR

2.

Challenges or Areas Needing Improvement
Challenges or areas needing improvement

ATTACHMENT B
SOCIAL NETWORK SURVEY

OMB No. 0930-XXXX
Expiration Date XX/XX/XXXX

SOCIAL NETWORK SURVEY

This brief survey is designed to help us understand the types of contacts you had
or currently have with people in other organizations that also are participants in
the SOAR initiative.
The names of these other organizations have been prefilled in the survey.
However, if there are other organization that you believe are members of the
SOAR initiative that are not included, please add them in the boxes marked,
“Other, please specify.”
Completion of the survey should take no more than 10 minutes. Your name and
responses will be kept private to the extent of the law. Findings from the survey
will be reported in aggregate form only so that no person can be identified.
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 10 minutes per respondent 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 71044, Rockville, Maryland, 20857. As noted previously, all aspects of your participation in this
survey are voluntary; you will not be penalized in any way by refusing to complete any portion of
the survey.

B-2

For each row, please place a check mark in the column that best answers the question.

QUESTION 1

QUESTION 2

PRIOR to the start of your
participation in SOAR, how
frequently did you have contact with
anyone in the following
organizations for any reason?
a

b

c

d

never

once
or
twice
a year

every
month
or two

every
week
or two

e
more
than
once
a
week

QUESTION 3

PRIOR to the start of your
participation in SOAR, how
frequently did you have contact with
anyone in the following
organizations about the SSI/SSDI
application process specifically?
a

b

c

d

never

once
or
twice
a year

every
month
or two

every
week
or two

SSA office (state/local)
[will be prefilled]
DDS office (state/local)
[will be prefilled]
Housing and public assistance
agencies
[will be prefilled]
Public and private health systems
(state/local)
[will be prefilled]
Homeless service providers
[will be prefilled]
Community MH providers
[will be prefilled]
Correctional agencies/facilities
(state/local)
[will be prefilled]
State/local lead
[will be prefilled]
Other [please specify]
Other [please specify]

B-3

e
more
than
once
a
week

NOW how frequently do you have
contact with anyone in the following
organizations about the SSI/SSDI
application process?

a

b

c

d

never

once
or
twice
a year

every
month
or two

every
week
or two

e
more
than
once
a
week

For each row, please place a check mark in the column that best answers the question.

QUESTION 4
To what extent has each of the following organizations
followed through on its responsibilities and
commitments to SOAR?
a

b

c

Not at all

To some extent

To a considerable
extent

SSA office (state/local)
[will be prefilled]
DDS office (state/local)
[will be prefilled]
Housing and public assistance
agencies
[will be prefilled]
Public and private health systems
(state/local)
[will be prefilled]
Homeless service providers
[will be prefilled]
Community MH providers
[will be prefilled]
Correctional agencies/facilities
(state/local)
[will be prefilled]
State/local lead
[will be prefilled]
Other [please specify]
Other [please specify]

B-4

For each row, please place a check mark in the column that best answers the question.

QUESTION 5
Since the start of SOAR in your community, to what
extent has your relationship with each of the following
organizations helped you carry out your role in
assisting individuals who are homeless access SSI/SSDI
benefits?
SSA office (state/local)
[will be prefilled]
DDS office (state/local)
[will be prefilled]
Housing and public assistance
agencies
[will be prefilled]

a

b

c

Not at all

To some extent

To a considerable
extent

Public and private health systems
(state/local)
[will be prefilled]
Homeless service providers
[will be prefilled]
Community MH providers
[will be prefilled]
Correctional agencies/facilities
(state/local)
[will be prefilled]
State/local lead
[will be prefilled]
Other [please specify]
Other [please specify]

B-5