20987 ID_Supplemental Document-Consumer Background-ATTACHMENT 8

ATTACHMENT 8
Consumer Background and Voluntary Participation Information Sheet

Pre-Test of Instruments of Psychosocial Care for the Treatment of Adults with PTSD:

What is this about?:

• The National Institute of Mental Health (NIMH) and the Assistant Secretary for Planning and Evaluation (ASPE) are seeking consumer participants interested in completing a survey that measures the quality of therapy provided to adults with post-traumatic stress disorder (PTSD).

Background about the project:

• Improving the quality of behavioral healthcare is a national priority.

• In September 2011, ASPE, with support from NIMH, contracted with Mathematica Policy Research to develop a way to measure the quality of care for adults with PTSD.

• Mathematica is developing three brief surveys, one to be completed by therapists, one to be completed by therapist supervisors, and one to be completed by consumers that assess therapists’ use of strategies that are consistent with evidence-based psychotherapy for PTSD.

• The surveys are designed to take 5 to 10 minutes to complete.

About your participation:

• Mathematica is seeking consumer participants who are interested in completing a quality improvement survey following a therapy session.

• The goal of the survey is to improve the quality of care provided by therapists for people with PTSD.

• The survey will ask about things a therapist did during a therapy session (e.g., Did your therapist assign homework?).

• The survey will not ask for any personal information about what you might have said during a therapy session.

• Consumer participants will receive a $20 gift card as compensation for their time.

• Participation in the survey is voluntary. Participants will not be penalized if they refuse to participate or decide to stop.

• Participant information and responses will be kept confidential. Individual responses will not be shared with a participant’s therapist or the facility where he/she received treatment. Mathematica may share a summary of findings (containing no names or identifying information) with ASPE, NIMH, or other research organizations to improve the survey and the quality of care for patients with PTSD. Participant information will only be used for this survey.

• As part of the survey, participants will have a chance to review the project background information for the survey and formally give their consent to participate.

• To mail the gift card, Mathematica will need to collect the participant’s address after he/she completes the survey. Participant addresses will not be used for any other purposes and will not be shared with any other organization.

Link to Survey: [insert link]

Participant Requirements:

• To be eligible for the survey, participants must be age 18 or older and currently receiving treatment for their diagnosis of PTSD.

• Participants must be available to complete a survey for 5-10 minutes shortly after a therapy session.

Additional Information:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Assistant Secretary of Planning and Evaluation,, Room 415F, US Department of Health and Human Services, 200 Independence Ave. SW, Washington, DC 20201. Do not return the completed form to this address.

• For additional information, please contact Melissa Azur, the project director, at [email protected] or (202) 250-3518 or Kirsten Beronio, the Contract Officer Representative, at [email protected].