Form SBIRT Organization SBIRT Organization SBIRT Organizational Readiness and Satisfaction Survey

SBIRT Organizational Readiness and Satisfaction Survey

Funding for data collection supported by the

Center for Substance Abuse Treatment (CSAT)

Substance Abuse and Mental Health Services Administration (SAMHSA)

U.S. Department of Health and Human Services (HHS)

OMB No. 0930-0197

Expiration Date: 01/31/17

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 9 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.

SBIRT Organizational Readiness and Satisfaction Survey		1= Disagree 2= Somewhat Disagree 3= Neither Agree nor Disagree 4= Somewhat Agree 5= Agree
		1	2	3	4	5
	I am involved in the implementation of the SBIRT Program in this organization
	This organization has received useful SAMHSA technical assistance to develop protocols and procedures for SBIRT implementation
	This organization has a clear plan for implementing SBIRT
	The SBIRT program is well integrated into patient care in this organization
	Staff in this organization are encouraged to recommend ways to improve SBIRT implementation
	I feel confident that leadership here will support SBIRT staff as they adjust to change in their workplace.
	The leadership here trusts staff’s professional judgment to implement SBIRT
	Staff in this organization are committed to implementing SBIRT
	It is difficult to change procedures in this organization to meet new conditions
	Staff in this organization can manage the processes for implementing SBIRT
	Staff in this organization can handle the challenges that might arise in implementing SBIRT
	Staff in this organization coordinate tasks so that SBIRT implementation goes smoothly
Screening
	This organization has received useful SAMHSA technical assistance for conducting SBIRT screening.
	Staff are generally satisfied with the technical assistance they have received for conducting SBIRT screening.
	Staff in this organization are expected to screen patients for substance use
	Staff providing SBIRT services have the necessary skill-level/proficiency to implement screenings effectively
	Staff providing SBIRT services have received the necessary training to implement screenings effectively
	Staff providing SBIRT services have the necessary knowledge to implement screenings effectively
	Staff providing SBIRT services have the necessary time to implement screenings effectively
	Staff get the leadership support they need to conduct screenings.
	Staff providing SBIRT services have all of the resources necessary to implement screenings effectively
	Sufficient staff are available to make the implementation of screening work
Brief Intervention
	This organization has received useful SAMHSA technical assistance on conducting brief interventions
	Staff are generally satisfied with the technical assistance they have received for conducting brief interventions.
	Staff in this organization are expected to conduct brief intervention sessions with eligible clients
	Staff providing SBIRT services have the necessary skill-level/proficiency to implement brief interventions effectively
	Staff providing SBIRT services have received the necessary training to implement brief interventions effectively
	Staff providing SBIRT services have gained the necessary knowledge to implement brief interventions effectively
	Staff providing SBIRT services have the necessary time to implement brief interventions effectively
	Staff get the leadership support they need to conduct brief interventions with eligible clients.				DK==d
	Staff providing SBIRT services have all of the resources necessary to implement brief interventions effectively
	Sufficient staff are available to make the implementation of brief interventions work
Brief Treatment
	This organization has received useful SAMHSA technical assistance on conducting brief treatment sessions
	Staff are generally satisfied with the technical assistance they have received for conducting brief treatment sessions
	Staff in this organization are expected to conduct brief treatment sessions with eligible clients
	Staff providing SBIRT services have the necessary skill-level/proficiency to implement brief treatment sessions effectively
	Staff providing SBIRT services have received the necessary training to implement brief treatment sessions effectively
	Staff providing SBIRT services have gained the necessary knowledge to implement brief treatment sessions effectively
	Staff providing SBIRT services have the necessary time to implement brief treatment sessions effectively
	Staff get the leadership support they need to conduct brief treatment sessions for eligible clients.
	Staff providing SBIRT services have all of the resources necessary to implement brief treatment sessions effectively
	Sufficient staff are available to make the implementation of brief treatment sessions work

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