Form Stakeholder Survey Stakeholder Survey Stakeholder Survey

Attachment 3: Stakeholder Survey

OMB No. 0930-0320

Expiration Date 03/31/2014

Substance Abuse and Mental Health Services Administration (SAMHSA)

Evaluation of SAMHSA Homeless Programs

Stakeholder Survey

Today’s Date: |___|___||___|___||___|___|
MO DAY YR

SAMHSA GBHI/SSH Site Number |___|___|___|___|___|

Stakeholder Organization Identification Number |___|___|___|___| [Pre-filled]

___________________________________________________

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 0930-0320.  Public reporting burden for this collection of information is estimated to average 17 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 7-1044, Rockville, Maryland, 20857.

Welcome—and thank you for taking this survey!

1. First we would like to ask about your personal involvement with the local SAMHSA GBHI/SSH project. For each of the following statements please indicate whether it describes your involvement.

a. I helped plan for or prepare our initial SAMHSA GBHI/SSH grant application ___Yes ___No

b. I have been involved with the SAMHSA GBHI/SSH project since it was funded ___Yes ___No

c. I regularly attend stakeholder meetings ___Yes ___No

d. I am directly involved with the SAMHSA GBHI/SSH project ___Yes ___No

2. Has Federal funding for your local SAMHSA GBHI/SSH project ended? ___Yes ___No

[If Yes, Q21 will be asked; If No it will be skipped.]

About your Agency

3. The next questions are about your agency

a. Which of the following types best describes your agency or organization? (check all that apply)	___Social services ___Substance abuse treatment ___Mental health treatment ___Hospital ___Housing ___Shelter ___Drop-in center ___Employment or job skills ___Education ___Veterans ___Criminal justice ___Case management ___Not a service provider (e.g., state/city government) ___Other, specify:
b. Is your agency or organization: (check one)	___State or local government agency ___For-profit company ___Non-profit organization ___Faith-based organization ___University ___Other, specify:
c. What types of staff expertise does your agency or organization make available to SAMHSA GBHI/SSH project clients? (check all that apply)	___Licensed Psychiatrist ___Licensed Psychologist ___Licensed Social Worker ___Licensed Registered Nurse ___Certified/licensed substance abuse counselor ___Vocational specialist ___Housing specialist ___Case manager ___Peer advocate ___Other (please specify)_______________
d. What percentage of your agency or organization clients receives SSI/SSD for a psychiatric or medical disability? (check one)	___ None ___1% to 25% ___26% to 50% ___51% to 75% ___76% to 100% ___Don’t Know
e. For what percentage of your clients does your agency or organization serve as a representative payee for SSI/SSD?	___ None ___1% to 25% ___26% to 50% ___51% to 75% ___76% to 100% ___Don’t Know ___Not applicable

Services Provided

4. The following questions address the types of services provided by your agency or organization. Please indicate whether each service is provided by your agency or organization staff and/or through referrals or linkages. For each service that is directly provided by your agency, please indicate whether the client pays a fee or a co-pay whether “out of pocket”, through insurance or government subsidy for housing, etc.

Service	Provided by
	Program Staff in my Agency	Referrals/ linkages	If Yes provided by Your Agency: Client pays fee
a. Substance abuse treatment	Yes No	Yes No	Yes No
b. Mental health treatment	Yes No	Yes No	Yes No
c. Integrated mental health and substance abuse treatment	Yes No	Yes No	Yes No
d. Case management	Yes No	Yes No	Yes No
e. Substance abuse and mental health screening/assessment	Yes No	Yes No	Yes No
f. Detoxification services	Yes No	Yes No	Yes No
g. Medication/med. management	Yes No	Yes No	Yes No
h. Drug testing	Yes No	Yes No	Yes No
i. Discharge planning	Yes No	Yes No	Yes No
j. Aftercare	Yes No	Yes No	Yes No
k. Crisis care (e.g., 24 hour crisis response service)	Yes No	Yes No	Yes No
l. Self help groups/peer support	Yes No	Yes No	Yes No
m. General medical treatment	Yes No	Yes No	Yes No
n. Specialized medical care for women	Yes No	Yes No	Yes No
o. HIV/AIDS testing	Yes No	Yes No	Yes No
p. HIV/AIDS/STD medical treatment	Yes No	Yes No	Yes No
q. HIV/AIDS/STD prevention education	Yes No	Yes No	Yes No
r. Vocational training	Yes No	Yes No	Yes No
s. Job placement/Employment	Yes No	Yes No	Yes No
t. Education/GED program	Yes No	Yes No	Yes No
u. Housing	Yes No	Yes No	Yes No
v. Housing assistance	Yes No	Yes No	Yes No
w. Housing readiness training	Yes No	Yes No	Yes No
x. Family counseling/services	Yes No	Yes No	Yes No
y. Money management	Yes No	Yes No	Yes No
z. Benefits application (e.g., SSI/SSD, food stamps)	Yes No	Yes No	Yes No
aa. Medical insurance applications (including Medicaid/Medicare)	Yes No	Yes No	Yes No
bb. Transportation	Yes No	Yes No	Yes No
cc. Assistance getting identification	Yes No	Yes No	Yes No
dd. Legal assistance	Yes No	Yes No	Yes No
ee. Parenting skills/education	Yes No	Yes No	Yes No
ff. Childcare	Yes No	Yes No	Yes No
gg. Other, specify: __________________________	Yes No	Yes No	Yes No

5. Has your participation as a partner in the SAMHSA GBHI/SSH project changed the services your agency provides? ___Yes ___No [Skip to Q7]

6. If Yes, please indicate whether each of the services offered by your agency listed below has not changed, been expanded, or been added as a result of your participation as a partner in the SAMHSA GBHI/SSH project. (Check one box for each service.) [Note: Only items endorsed “Yes” as provided in Q4 will be displayed in Q6]

Service	Not changed	Expanded service	Added new service
a. Substance abuse treatment
b. Mental health treatment
c. Integrated mental health and substance abuse treatment
d. Case management
e. Substance abuse and mental health screening/assessment
f. Detoxification services
g. Medication/med. management
h. Drug testing
i. Discharge planning
j. Aftercare
k. Crisis care (e.g., 24 hour crisis response service)
l. Self help groups/peer support
m. General medical treatment
n. Specialized medical care for women
o. HIV/AIDS testing
p. HIV/AIDS/STD medical treatment
q. HIV/AIDS/STD prevention education
r. Vocational training
s. Job placement/Employment
t. Education/GED program
u. Housing
v. Housing assistance
w. Housing readiness training
x. Family counseling/services
y. Money management
z. Benefits application (e.g., SSI/SSD, food stamps)
aa. Medical insurance applications (including Medicaid/Medicare)
bb. Transportation
cc. Assistance getting identification
dd. Legal assistance
ee. Parenting skills/education
ff. Childcare
gg. Other, specify:__________________

[On web survey, for questions 7-9: Only ask 7 IF Q4a = YES, If No, skip to Q8; Only ask 8 if Q4b is = Yes, If no, skip to Q9, Only ask Q9 if Q4c =Yes. If Q4a, Q4b, and Q4c =No, Skip to Q10.]

7. [If yes, to Q4a]. You answered that your agency staff directly provides substance abuse treatment. Approximately what percentage of your agency’s clients receive each of the following type(s) of substance abuse treatment services?

   Substance Abuse Treatment Services	None	1%–25%	26%–50%	51%–75%	76%–100%
   7a. ANY substance abuse treatment
   7b. Group outpatient counseling
   7c. Individual outpatient counseling
   7d. Pharmacotherapy (e.g., methadone, buprenorphine, etc)
   7e. Residential treatment (group and individual counseling)
   7f. AA/NA or other 12-step peer support
   7g. Other, specify:

8. [If yes to Q4b] You answered that your agency staff directly provides mental health treatment. Approximately, what percentage of your agency’s clients receive each of the following type(s) of mental health treatment services?

   Mental Health Treatment Services	None	1%–25%	26%–50%	51%–75%	76%–100%
   8a. ANY mental health treatment services
   8b. Group outpatient counseling
   8c. Individual outpatient counseling
   8d. Residential treatment (group and individual counseling)
   8e. Trauma/PTSD treatment/services
   8f. Prescribed psychotropic medication
   8g. Peer to peer mental health counseling/support
   8h. Other, specify:

9. [If YES to Q4c]. You answered that your agency directly provides integrated mental health and substance abuse treatment to GBHI/SSH participants. Please tell us about the integrated mental health and substance abuse treatment you provide to GBHI/SSH clients.

   a. Clients are screened for both mental health and substance use problems	Yes No
   b. Clients are assessed for both mental health diagnosis and substance use diagnosis with a licensed professional and accompanying treatment needs	Yes No
   c. Clients receive mental health services on-site and are referred to substance abuse treatment services off-site	Yes No
   d. Clients receive substance abuse treatment services on-site and are referred for mental health services, including medication management, off-site	Yes No
   e. Clients receive mental health and substance abuse treatment at the same site	Yes No
   f. Clients receive on-site group sessions specifically designed to address both mental health and substance use problems (e.g., dual diagnosis groups)	Yes No
   g. Staff include mental health professionals who provide mental health treatment and substance abuse professionals who provide substance abuse treatment	Yes No
   h. Staff are cross-trained in substance abuse and mental health treatment	Yes No
   i. Clients must be in recovery prior to beginning mental health treatment	Yes No
   j. Mental health and substance abuse treatment staff serve on the same team and collaborate on treatment plan	Yes No
   k. Clients must be stable mentally before beginning substance abuse treatment	Yes No

10. Please indicate whether each Evidence Based Practice (EBP) is being or was implemented by your agency or organization GBHI/SSH initiative BEFORE, DURING, or AFTER the local GBHI/SSH project was funded.

    EBP	Has your agency ever implemented this EBP?	Before GBHI/SSH Project	During GBHI/SSH Project	After Cessation of GBHI/SSH Project Funding
    a. 12-Step	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    b. Assertive Community Treatment (ACT)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    c. Adolescent Community Reinforcement Approach (ACRA)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    d. Case management (other than ACT, SBCM)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    e. Cognitive Behavioral Therapy (CBT)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    f. Contingency Management	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    g. Critical Time Intervention (CTI)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    h. Dialectical Behavior Therapy (DBT)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    i. Double Trouble	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    j. Family Education (e.g., Family Psychoeducation)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    k. Family treatment (e.g., Multi-Systemic Treatment (MST))	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    l. Housing First	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    m. Integrated Dual Disorders Treatment (IDDT)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    n. Illness Management and Recovery (IMR)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    o. Matrix Model	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    p. Medication management (e.g., Medication Algorithms Practices)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    q. Motivational Enhancement Therapy (MET)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    r. Motivational Interviewing (MI)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    s. Service Outreach and Recovery (SOAR)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    t. Stages of Change	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    u. Strengths-Based Case Management (SBCM)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    v. Substance abuse counseling	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    w. Supportive Employment	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    x. Therapeutic Community (TC)/Modified Therapeutic Community (MTC)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    y. Trauma EBP (e.g., Seeking Safety, Trauma Recovery and Empowerment Model (TREM), Sanctuary model)	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    z. Treatment Improvement Protocol (TIP) Series Specify: TIP #_________	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No
    aa. Other, specify: ___________________	Yes No [if No, skip to next question]	Yes No	Yes No	Yes No

11. Can you please tell us about the role of client choice in treatment

In which ways does your agency accommodate client choice with regard to treatment? (check all that apply)	___ Type of treatment (e.g., substance abuse, trauma, integrated treatment, etc.) ___Types of medication prescribed ___ Modality of treatment (e.g., group vs. individual) ___ Treatment setting (e.g., residential, outpatient, continuing day treatment, at housing) ___Length of treatment ___ Other, specify ________________
Treatment assignments are determined by (check all that apply)	___ Client Choice ___ The treatment program ___ Criminal justice record ___ Probation/parole considerations ___ Being clean and sober ___ Reached a certain phase of treatment ___ Stability of mental health symptoms ___ Stage of change ___ Other clinical determinations, specify ___ Psychiatric advanced directive ___ other, specify: ______________

12. Does your agency provide housing? ___Yes ___No [Skip to Q17]

Housing
Which type(s) of housing does your agency use? (check all that apply)	___ Emergency Housing (short-term, e.g. emergency shelter, crisis housing, safe haven) ___ Time-limited Housing (e.g. transitional, halfway house) ___ Permanent Housing (e.g. tenant holds lease) ___ Public Housing ___ Other subsidized housing (e.g. affordable housing for seniors or persons with disabilities) ___ Vouchers for Housing: Shelter Plus ___ Vouchers for Housing: Shelter Plus care ___ Vouchers for Housing: Section 8 ___ Scatter-site apartments ___ Single-site apartments (e.g. 2 or more apartments set aside for target population) ___ Congregate Housing (e.g. SRO, rooms with shared common areas) ___ Housing through Residential Treatment ___ Permanent On-site support services with no time limit ___ Permanent Off-site support services with no time limit ___ Time-limited support services (1 year or less) ___ Housing First ___ Other, specify:
Which other housing-related services does your agency provide participants? (check all that apply)	___ Housing readiness ___ Daily skills (food shopping, cleaning, etc.) ___ Time planning ___ Cooking ___ Money management ___ Furniture ___ Other, specify ___ None of these
In which ways does your agency accommodate client choice with regard to housing? (check all that apply)	___ Housing location ___ Type of housing in terms of whether treatment (substance abuse or mental health) is required ___ Type of housing in terms of permanence/transitional/crisis ___ Other, specify ___ Not able to accommodate client choice
Housing assignments are determined by: (check all that apply)	___ Client choice ___ The treatment program ___ Criminal justice record ___ Probation/parole considerations ___ Being clean and sober ___ Reached a certain phase of treatment ___ Stability of mental health symptoms ___ Other clinical determinations, specify ___ Other, specify:

Implementation of Local SAMHSA GBHI/SSH Initiative

17. The following statements refer to your agency or organization’s staff experience with cultural competence, gender services and trauma. The statements are worded for grantees that are currently operating. If your local SAMHSA GBHI/SSH grant has ended, please think about the situation just prior to the grant ending. Please indicate the extent to which you agree or disagree.

Please indicate the extent to which you agree or disagree with the following statements about the services provided by your agency or organization:	strongly agree (SA), agree (A), neither agree nor disagree (N), disagree (D), or strongly disagree (SD)
	SA	A	N	D	SD
a. Our staff has experience serving the target population (e.g., homeless youth, adults or families with substance use and/or co-occurring mental disorders)
b. Our staffing has diversity reflecting the target population
c. We have specific plans to overcome language barriers (bilingual staff, instruments in various languages)
d. We have had training(s) on cultural sensitivity
e. We assess the client’s trauma history
f. We offer trauma-specific treatment or other services
g. We have had training(s) on trauma-informed treatment or services
h. We offer gender-specific treatment or services options
i. We have had training(s) on gender-specific treatment or other services
j. Our clients have choice in selecting treatment or other services in which to participate
k. Our clients have choice in selecting type of housing
l. We conduct client satisfaction surveys
m. Clients/consumers serve as paid staff members

18. The following statements refer to the implementation and operation of the local SAMHSA GBHI/SSH project. The statements are worded for grantees that are currently operating. If your local SAMHSA GBHI/SSH grant has ended, please think about the situation just prior to the grant ending. Please indicate the extent to which you agree or disagree.

Please indicate the extent to which you agree or disagree with the following statements about the implementation and operation of your SAMHSA GBHI/SSH project:	strongly agree (SA), agree (A), neither agree nor disagree (N), disagree (D), or strongly disagree (SD)
	SA	A	N	D	SD
a. Information sharing about specific clients among partners has improved as a result of SAMHSA GBHI/SSH
b. Communication among partnering organizations has improved as a result of SAMHSA GBHI/SSH
c. SAMHSA GBHI/SSH partners have created common goals as a result of the SAMHSA GBHI/SSH project
d. Support for the SAMHSA GBHI/SSH project from grantee agency line staff has been strong
e. Support for the SAMHSA GBHI/SSH project from housing partner(s) line staff has been strong
f. Support for the SAMHSA GBHI/SSH project from substance abuse partner(s) line staff has been strong
g. Support for the SAMHSA GBHI/SSH project from mental health treatment partner(s) line staff has been strong
h. Support for the SAMHSA GBHI/SSH project from housing partner(s) administration has been strong
i. Support for the SAMHSA GBHI/SSH project from substance abuse partner(s) administration has been strong
j. Support for the SAMHSA GBHI/SSH project from mental health treatment partner(s) administration has been strong
k. SAMHSA GBHI/SSH has increased clients’ willingness to access available services
l. SAMHSA GBHI/SSH has increased my agency or organization’s capabilities to provide clients effective and appropriate services
m. The SAMHSA GBHI/SSH project has tapped into other federal, state or local government funding to enhance its activities during SAMHSA GBHI/SSH funding
n. The SAMHSA GBHI/SSH project has tapped into federal, state or local government funding to sustain its activities after SAMHSA GBHI/SSH funding ends
o. My agency has been involved in sustainability planning to help the SAMHSA GBHI/SSH project continue after SAMHSA GBHI/SSH funding ends
p. The SAMHSA GBHI/SSH project has implemented targeted approaches and strategies as planned
q. The SAMHSA GBHI/SSH project has effectively overcome obstacles or setbacks
r. SAMHSA GBHI/SSH has improved integration of services for target clients in our community
s. SAMHSA GBHI/SSH has fostered coordination between different types of service providers
t. SAMHSA GBHI/SSH includes members from all necessary or relevant agencies or organizations
u. Our SAMHSA GBHI/SSH project has clear criteria on how resources are allocated
v. SAMHSA GBHI/SSH goals and strategies are well-focused
w. SAMHSA GBHI/SSH has effectively utilized pre-existing community capabilities and assets
x. SAMHSA GBHI/SSH efforts have been undercut by turf battles or in-fighting
y. SAMHSA GBHI/SSH has had insufficient involvement from agency leaders
z. SAMHSA GBHI/SSH has used too much of a “top down” approach
aa. SAMHSA GBHI/SSH has used too much of a “bottom up” approach
bb. Staff turnover has limited effectiveness of SAMHSA GBHI/SSH activities
cc. SAMHSA GBHI/SSH has placed too much emphasis on substance abuse treatment, at the expense of housing
dd. SAMHSA GBHI/SSH has placed too much emphasis on housing, at the expense of substance abuse treatment
ee. Formal interagency agreements (e.g., MOUs) have facilitated SAMHSA GBHI/SSH efforts
ff. SAMHSA GBHI/SSH has fostered development of uniform application, eligibility criteria, or intake assessments
gg. SAMHSA GBHI/SSH efforts have been supported by co-location of services
hh. SAMHSA GBHI/SSH has increased use of interagency MIS or client tracking systems
ii. The SAMHSA GBHI/SSH project has focused on the wrong clients
jj. SAMHSA GBHI/SSH has had little effect on how my agency or organization serves clients
kk. SAMHSA GBHI/SSH will have little lasting impact on the treatment system in our community
ll. TA provided under SAMHSA GBHI/SSH has helped my agency or organization contribute to SAMHSA GBHI/SSH objectives

The next questions ask about your collaboration with other agencies or organizations now involved with the local SAMHSA GBHI/SSH project.

19. Prior to your local SAMHSA GBHI/SSH project, how often did you collaborate with agencies or organizations in each of the following areas?

    Collaborations with…	Frequency of collaboration prior to SAMHSA GBHI/SSH
    	Never	Rarely	Occasionally	Frequently	Don’t know
    Social services (including benefits)
    Substance abuse treatment
    Mental health treatment
    Hospital
    Housing
    Shelters
    Drop-in center
    Medical
    Education
    Employment or job training
    Veterans agency
    Criminal justice
    Peer-Consumer/Family advocacy
    Policy-makers/legislators
    Research/evaluation

20. Since the start of your local SAMHSA GBHI/SSH project how often have you collaborated with agencies or organizations in each of the following areas?

Collaborations with…	Frequency of collaboration since SAMHSA GBHI/SSH started
	Never	Rarely	Occasionally	Frequently	Don’t know
Social services (including benefits)
Substance abuse treatment
Mental health treatment
Hospital
Housing
Shelters
Drop-in centers
Medical
Education
Employment or job training
Veterans agency
Criminal justice
Peer-Consumer/Family advocacy
Policy-makers/legislators
Research/evaluation

[IF Q2 = YES, GO TO Q21; IF Q2 = NO, SKIP to Q22]

21. Since Federal funding of your local SAMHSA GBHI/SSH project stopped, how often have you collaborated with agencies or organizations in each of the following areas?

    Collaborations with…	Frequency of collaboration since SAMHSA GBHI/SSH funding stopped
    	Never	Rarely	Occasionally	Frequently	Don’t know
    Social services (including benefits)
    Substance abuse treatment
    Mental health treatment
    Hospital
    Housing
    Shelters
    Drop-in centers
    Medical
    Education
    Employment or job training
    Veterans agency
    Criminal justice
    Peer-Consumer/Family advocacy
    Policy-makers/legislators
    Research/evaluation

22. Since the start of your local SAMHSA GBHI/SSH project, how effective have your collaborations been with agencies or organizations in each of the following areas? That is, how effective have your collaborations been in helping your local SAMHSA GBHI/SSH project achieve its intended outcomes?

Collaborations with…	Effectiveness of collaboration in helping achieve outcomes
	Not effective	Somewhat effective	Very effective	Don’t know
Social services (including benefits)
Substance abuse treatment
Mental health treatment
Hospital
Housing
Shelters
Drop-in centers
Medical
Education
Employment or job training
Veterans agency
Criminal justice
Peer-Consumer/Family advocacy
Policy-makers/legislators
Research/evaluation

THANK YOU VERY MUCH for participating in the survey!

The information you provided will be valuable in helping to improve the SAMHSA GBHI/SSH programs.

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