Attachment A - MH Questions

Attachment A – OMB Executive Summary of Youth MH Service Utilization Cognitive Interviews

2009 NSDUH Youth Mental Health Services Utilization Module Question Changes

The NSDUH Youth Mental Health Services Utilization module, asked of all youth aged 12 to 17, currently includes 10 service categories from the Services Assessment for Children and Adolescents (SACA).  Currently, NSDUH defines adolescent mental health treatment/counseling for emotional or behavioral problems as receipt of services from any of the 10 service categories.  In February, 2008, SAMHSA began updating this approach by organizing the 10 service categories under the sectors of care often reported in child mental health services literature (i.e. specialty mental health; education; general medical; juvenile justice)  to more specifically depict the types of providers and service delivery sites for youth mental health services.  SAMHSA began investigating options for adding to and improving the 2009 NSDUH Youth Mental Health Services Utilization module. SAMHSA made final decisions on modifications for the 2009 Youth Mental Health Services Utilization module on April 23, 2008, and cognitive interviewing of these questions began. 

The purpose of the cognitive interviewing task was to evaluate the proposed new Youth Mental Health Services Utilization questions prior to fielding the 2009 survey. The testing also examined the level of difficulty potential NSDUH respondents may have in answering questions regarding their past use of services.

A total of 33 cognitive interviews over two rounds were conducted in July and August of 2008, with subjects aged 12 to 17 in Chicago, IL, Rockville, MD, Washington, DC and Research Triangle Park, NC. Approximately half of the respondents were recruited from traditional schools, and the other half recruited from alternative schools It was anticipated that alternative school students would have a higher likelihood of having encountered the additional services covered in the newly proposed questions.

Each participant completed a shortened electronic version of the NSDUH interview, consisting of the Youth Mental Health Service Utilization module. Respondents were asked the new questions at the end of the module. The module was administered to the respondents via Computer-Assisted Self-Interviewing (CASI). When the respondent received these new questions, the CASI program instructed them to stop answering the questions themselves and alert the interviewer. The interviewer then asked the respondents first to read the question aloud, then to rephrase each question in their own words and describe the cognitive strategies they used to answer the questions. They were also asked to rate the level of difficulty they had answering each question and define terms that may be unfamiliar.

Results from the first round were used to inform changes to the proposed questions for the second round. Highlights on the findings resulting from this aspect of the cognitive interviews are presented in the bullets below,

• Overall, respondents who received treatment or counseling through educational services or the justice system had a difficult time coming up with the number of times they received these services in the past 12 months. Half of these respondents estimated (mostly those who received services many times in the past 12 months) their answers, while the other half (who may have received treatment or counseling once a month), physically counted. When asked, those that did not receive treatment or counseling in the past 12 months said they thought it would be hard to answer this type of question.

• Findings from these cognitive interviews suggest that respondents of this age may have a hard time with the word “psychologist”, and primarily consider “psychologists”, “social workers” and “counselors” as the same thing. Moreover, the majority of respondents considered their school guidance counselor as a “school counselor”.

• Over half the respondents thought of a “special school” as a school for children with learning disabilities, or a school for the gifted, and included these in their answer. Half also thought a “special classroom” included detention, remedial classes, special ed., or other classes designed for kids with learning disabilities. Most respondents considered a “special classroom aide” as a teacher’s aid – one who helps the teacher in class, or runs errands. Respondents included tutoring or more attention from the teacher in their answer regarding “Special help in a regular classroom”.

• The question regarding special schools and special help in a classroom in a regular school had to be read twice to a few respondents. This one question included two concepts that were cognitively difficult for the 12-17 year olds to parse out in some instances.

• Only one out of the 33 respondents included school treatment or counseling in their answer to the pre-existing YMHSU module question regarding private therapists and counselors.

• Most respondents referred to a juvenile justice facility as a prison, jail, “juvie” or detention center. Respondents who had not been through the justice system found this question easy to answer, but difficult to read and process due to unfamiliar terms. A list of additional terms for juvenile justice facilities was added to this question in Round 2, but none of the respondents had heard of them.

• The question in Round 1 regarding receiving treatment from a probation officer or juvenile corrections officer or court counselor proved difficult for most of the respondents, even if they had not been through the court system. They interpreted these terms as “police officers”.

Using the findings from this cognitive interviewing task, final questions were developed. The recommended questions for the 2009 NSDUH questionnaire are detailed in Attachment 1.

Attachment 1

New Questions for the 2009 NSDUH Youth Mental Health Services Utilization Module

YSU30 [IF CURNTAGE = 12 – 17 and YE09=1] Sometimes students get treatment or counseling through the school system. This counseling is often provided by school social workers, school psychologists or school counselors.

During the past 12 months, that is, since [DATEFILL], did you receive any treatment or counseling from a school social worker, a school psychologist, or a school counselor for emotional or behavioral problems that were not caused by alcohol or drugs?

1 Yes

2 No

DK/REF

YSU31 [IF YSU30 = 1] Think about the last time you talked with a school social worker, school psychologist, or school counselor about emotional or behavioral problems that were not caused by alcohol or drugs. What was the reason for your talk?

To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.

1 You thought about killing yourself or tried to kill yourself.

2 You felt depressed

3 You felt very afraid and tense

4 You were breaking rules and “acting out”

5 You had eating problems

6 Some other reason

DK/REF

YSU31a [IF ANY ENTRY IN YSU31 = 6] What was the other reason for your last talk with a school social worker, school psychologist or school counselor?

To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.

1 You had trouble controlling your anger

2 You had gotten into physical fights

3 You had problems at home or in your family

4 You had problems with your friends

5 You had problems with people other than your friends or family

6 You had problems at school

7 Some other reason

DK/REF

YSU31SP [IF ANY ENTRY IN YSU31a=7] Please type in the most important other reason for your last talk with a school social worker, school psychologist or school counselor. You do not need to give a detailed description — just a few words will be okay. When you have finished typing your answer, press the [ENTER] key to go to the next question.

_____________

DK/REF

YSU32 [IF CURNTAGE = 12 – 17] At any time during the past 12 months, that is since [DATEFILL], did you attend a school for students with emotional or behavioral problems?

1 Yes

2 No

DK/REF

YSU33 [IF CURNTAGE = 12 – 17 and YSU32=2 or DK/ref] Regular schools sometimes provide programs to help students with emotional or behavioral problems.

At any time during the past 12 months, did you participate in a school program that was just for students with emotional or behavioral problems?

1 Yes

2 No

DK/REF

YSU34 These next questions are about experiences with the justice system.

During the past 12 months, that is, since [DATEFILL], did you stay overnight or longer in any type of juvenile detention center, sometimes called “juvie”, prison, or jail?

1 Yes

2 No

DK/REF

YSU35 [IF YSU34=1] During the past 12 months, how many nights altogether did you stay in any type of juvenile detention center, prison or jail?

# OF NIGHTS: [RANGE: 1 - 366]

DK/REF

YSU36 [IF YSU34 = 1] Sometimes, the court system provides treatment or counseling in juvenile detention centers, prisons or jails. These services are often provided by psychiatrists, psychologists, social workers or counselors who work for the court system.

While you were in a juvenile detention center, prison or jail during the past 12 months, did you receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs?

1 Yes

2 No

DK/REF

6