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OTP State Profiles Report:
Customer Feedback Survey
OMB No. 0930-0197
Expiration Date: 03/31/2014
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
0930-0197. Public reporting burden for this collection of information is
estimated to average 10 minutes per respondent, per year, including the time for
reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden,
to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 2-1057,
Rockville, Maryland, 20857.
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OTP State Profiles Report: Customer Feedback Survey
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OTP State Profiles Report:
Customer Feedback Survey
OTP State Profiles Report: Customer Feedback Survey
The Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance
Abuse Treatment (CSAT) currently publishes a “State Profiles” report on medication-assisted
treatment for opioid addiction. You have been identified as a possible user of this report. We are
interested in knowing what aspects of the report you find most useful as well as which new data
elements you’d like to see in future reports.
Your feedback is very important to us. Please mark the response that best describes your opinion.
When you have finished, click the "Submit" button at the end of the survey. The responses you
provide will remain confidential. All results will be presented in aggregate form only.
If you'd like to refer to the most recent "State Profiles" report as you answer our questions, please
click on the following link:
http://dpt.samhsa.gov/pdf/MedicationAssistedTreatmentForOpioidAddiction_2010StateProfiles03.
pdf
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OTP State Profiles Report: Customer Feedback Survey
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OTP State Profiles Report:
Customer Feedback Survey
Before being contacted about this survey, did you know
about the existence of the SAMHSA "State Profiles" report?
Yes
No
Do you use the "State Profiles" Report?
Yes
No
How have you (or your orgnization) used the report?
Please check all that apply.
To secure support for funding
To write legislation
To inform policy-making at the state/local levels
To see how my clinic compares on key characteristics
To update myself on current issues in the field
Other:
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OTP State Profiles Report:
Customer Feedback Survey
What is your position in your organization?
What type of organization do you work for?
Non-profit provider of medication-assisted treatment (opioid treatment program, or OTP)
For-profit provider of medication-assisted treatment (OTP)
Other substance abuse treatment provider
State / Local Government
Advocacy / Policy
Academic / Library
Law enforcement / Justice
Community Organization (non-Governmental)
Federal Government
Military / VA
Other:
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OTP State Profiles Report:
Customer Feedback Survey
Usefulness of Current Report
The "State Profiles" Report currently contains the following data elements for each State and selected
Territories.
Please share your level of agreement with the following
statements about the usefulness of various sections of the
"State Profiles" report to your organization.
Neutral
Somewhat
unuseful
Extremely
unuseful
Don't
Know /
Not
Applicable
Summary data
highlighting State population
Summary data
highlighting Number of
patients in
substance abuse
treatment
Summary data
highlighting Number of
Extremely
useful
Somewhat
useful
Map of individual
states showing Opiod Treatment
Program (OTP)
locations.
Map of individual
states showing Drug Addiction
Treatment Act
(DATA) - certified
physicians'
locations
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OTP State Profiles Report: Customer Feedback Survey
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Neutral
Somewhat
unuseful
Extremely
unuseful
Don't
Know /
Not
Applicable
State/National
comparisons Number of
patients: total,
methadone,
buprenorphine
State/National
comparisons Type of payment
accepted: cash,
PHI, Medicare,
Medicaid, state,
military, sliding
scale, no charge
State/National
comparisons Type of OTP
operation: PNP,
PFP,
local/state/federal
government,
tribal
State/National
comparisons Cumulative
distribution of
buprenorphine
per 100K
population by
grams weight
compared to the
national
distribution
Extremely
useful
Somewhat
useful
Summary data
highlighting State Opiod
Treatment
Authority (SOTA)
contact
information
State/National
comparisons Type of
treatment:
maintenance only,
detox only or both
substance abuse
facilities
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OTP State Profiles Report: Customer Feedback Survey
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OTP State Profiles Report:
Customer Feedback Survey
Formatting
Future reports will be published electronically (as PDFs available online) rather than in print. Please
indicate if the following would be useful to your organization. Electronic publication will also allow us
to provide some interactive data tools. These will allow you to conduct simple analysis right at your
computer.
[If you do not have the software to view PDFs, free software is available at the following site:
http://get.adobe.com/reader/]
Extremely
Useful
Somewhat
Useful
Neutral
Somewhat
Useful
Extremely
Unuseful
Don't
Know / Not
Applicable
PDF for each
state profile
PDF of the
national
summary
PDFs for each
region
PDF of the entire
report
Interactive DATA
TOOLS (for
example, to let
you check how
your State
compares to
another)
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OTP State Profiles Report:
Customer Feedback Survey
Potential new measures
SAMHSA staff identified other pieces of State (or Territory)-level information that may be helpful to
readers of future State Profiles reports. Following are examples of new items that may be included in
future "State Profiles" reports. For each item, please think about how useful it might be for your
organization and indicate whether data should be included for this item in future reports.
Include in future reports?
If so, with national
comparison?
Summary data highlighting OTPs in the state that are open
365 days/year
Summary data highlighting OTPs with plan to address
service discontinuity, disaster,
etc.
Summary data highlighting OTPs that conduct screening,
diagnostic tests for certain
medical conditions [list]
Summary data highlighting OTPs that test for certain drugs
at admission [list]
Summary data highlighting OTPs that test, screen for
certain psychiatric conditions
[listing them], treat with
medications, provide
counseling
Summary data highlighting types and #s of FTEs for
various staff categories
Summary data highlighting OTPs in State indicating staff
use electronic/paper/both for
various types of work
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OTP State Profiles Report: Customer Feedback Survey
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Include in future reports?
If so, with national
comparison?
Summary data highlighting OTPs in State with patients
who must travel more than an
hour each way
Summary data highlighting OTP patient demographics
Summary data highlighting OTPs with # patients in
treatment for X days at that
OTP
Summary data highlighting OTPs with # patients treated
with methadone, for
detox/maint
- at what dose (for above)
Summary data highlighting - #
of patients on methadone for
2+ years
Summary data highlighting - #
of patients in treatment for X
days at this OTP
Summary data highlighting - #
receiving take-homes and for
what # days
Summary data highlighting OTPs with # patients treated
with buprenorphine, for
detox/maint
- at what dose (for above)
Summary data highlighting - #
of patients on buprenorphine
for 2+ years
Summary data highlighting - #
of patients in treatment for X
days at this OTP
Summary data highlighting - #
receiving take-homes and for
what # days
Summary data highlighting - #
of OTPs that offer amenities
such as child care,
transportation [list]
https://docs.google.com/forms/d/1vlDP4tWQirYuD61qNvfc1R3JvqVDluhvre1hdwBggJ0/... 6/13/2013
OTP State Profiles Report: Customer Feedback Survey
Summary data highlighting ED visits for ODs due to
prescription drugs, last 3-5
years
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Include in future reports?
If so, with national
comparison?
What other item(s) would you like to see included in future
"State Profiles" reports? Please list them below, and describe
your rationale for adding them.
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We would also like your feedback on the "National Section"
that will introduce this report. Are there current 'hot" topics
that you would like to see addressed in the national
summary?
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Thanks!
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your feedback with us!
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| File Type | application/pdf |
| Author | David.Dean |
| File Modified | 2013-06-13 |
| File Created | 2013-06-13 |