RTI International is currently conducting a cross-site evaluation of the Screening, Brief Intervention and Referral and Treatment (SBIRT) program implemented across multiple health care settings and states. This survey is sponsored by the Department of Health and Human Services and is conducted in collaboration with this health care facility. The objective of the survey is to generate knowledge about the implementation of SBIRT. We are asking you as a staff member of this facility to participate in this important confidential survey. Completing the survey will take only about 13 minutes
You will be asked questions about your background and your experiences with the SBIRT program. The information you provide in this survey will be kept strictly private by the evaluation team and will not be shared with anyone from this facility. Your name or any other identifying information will not be connected to your survey responses. If the results of this study are presented at scientific meetings or published in scientific journals, no information will be included that could identify you or your answers.
Your decision to take part in this evaluation study is completely voluntary. You can refuse to answer any question or stop participating at any time.
If you have any questions about the study, please call Jesse Hinde at 919-541-1209.
Completion of the survey implies your consent to participate in this research. Please keep this form for your records.
| File Type | application/msword |
| File Title | APPENDIX 7: |
| Author | proth |
| Last Modified By | Mallonee, Erin |
| File Modified | 2015-10-02 |
| File Created | 2015-09-17 |