Client Interview Script

Attachment 5: Client Interview Script

OMB No. 0930-0320

Expiration Date 03/31/2014

Substance Abuse and Mental Health Services Administration (SAMHSA)

Evaluation of SAMHSA Homeless Programs

Model Client Interview Script

(For the Supplemental Client Interview to the GPRA/NOMs Interview)

Following Introduction to GPRA/NOMs

I also have a short survey that asks about your experience and satisfaction with the [Grantee’s GBHI/SSH Program Name]. I will tell you more about this survey later.

GPRA/NOMs Interviewer Survey Transition

Now I have a short survey that asks you about your background and experience and satisfaction with the [Grantee’s GBHI/SSH Program Name]. Can I tell you more about this survey?

The questions in this survey are asked as part of a national study of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Homeless Programs. The survey is meant to help us learn how the program is doing. This national study will also help find ways to make the program better.

Introduction and Verbal Informed Consent

READ CLIENT CONSENT FORM

• Do you have any questions for me?

(Answer questions.)

• Do you wish to complete this survey?

If no, thank client for their time and end session per normally used GPRA/NOMs baseline and follow-up procedures.

If yes [Please check to see if GPRA/NOMs client/consumer ID, date, Grantee site number and interviewer site number are printed on the cover page and fill in as needed]:

• Thank you for agreeing to take part in this survey. The survey has two parts. For the first part of the survey, I will read you the questions. You will complete the second part of the survey, which asks about your satisfaction with the program, on your own. I will give you a separate sheet and envelope to fill out the questions about your satisfaction with the program so that I will not see your responses. We will discuss this in more detail after we finish the first part of the survey.

• You will receive a written copy of the information we have just talked about. It provides two toll-free numbers to call RTI International if you have questions or concerns about the survey. You will also receive a frequently asked questions form that may help answer any questions you have.

ADMINISTER SURVEY PART 1

GPRA interviewer Transition to Part 2, satisfaction survey:

• Thank you for answering the questions from the first part of the survey. The second part of this survey includes questions about your satisfaction with the program. It will take you about [At baseline: 3 to 5 minutes] [At 6-month follow-up: 5 to 7 minutes] to answer.

• As with all other questions, this is also voluntary and you can choose to not answer these [At baseline: 16 questions] [At 6-month follow-up: 23 questions] or skip any.

• Please do not write your name on the survey.

• Now I am going to give you a sheet with [At baseline: 16 questions] [At 6-month follow-up: 23 questions] about your experience with this program.

• Please answer these questions on your own. Please fill in the circle completely to mark your response. There is an example of how to fill in the circles on the front of the survey.

• Note to interviewer: If you suspect a problem with literacy, you may provide assistance. You may explain how to answer yes/no questions or Likert scale questions by pointing out what those answers look like or explain which directions imply “better” or “worse”. Also, you can read the questions aloud to the client using a blank copy of the instrument and allow the client to mark the answers themselves. Please sit in a location that prevents you from seeing the client’s answers to support the client being able to provide their answers confidentially.

• When you are done, please place the sheet with your answers in this envelope and seal it.

• Please return the sealed envelope containing the survey to me. I will not see your responses. I will mail the envelope to RTI International who is evaluating this program for SAMHSA.

Provide client with the incentive when he or she completes the interview and satisfaction survey (even if incomplete).