2 Alternative Full page Coversheet w/ Questionnaire (begin

Generic Clearance for Questionnaire Pretesting Research

NSP-1_110618_v2

National Survey of Psychiatrists Cognitive Testing

OMB: 0607-0725

Document [pdf]
Download: pdf | pdf
2019 NATIONAL
SURVEY OF PSYCHIATRISTS

The 2019 National Survey of Psychiatrists (NSP) is being conducted by
the United States Census Bureau on behalf of the Substance Abuse and
Mental Health Services Administration of the U.S. Department of Health
and Human Services.
We appreciate your help with this important survey. If you need help or
have questions about completing this form, please call 1-888-369-3615 or
email us at [email protected].

NSP-1
(11/14/2018)

27039015

§<${0¤

Start Here

A5.

Have you EVER provided direct clinical care
as a psychiatrist?
Yes ➔ SKIP to Question A7

Respond online today at:

No

https://respond.census.gov/nsp
A6.

OR
Complete this form and mail it back
as soon as possible.

Why have you never provided direct clinical
care as a psychiatrist? Mark all that apply.
Did not enjoy clinical care
Wanted to pursue alternate career

Section A.
Eligibility
A1.

A2.

Clinical care did not pay well enough
Other

Are you currently licensed to practice medicine
in the U.S.?

A7.

Yes

Employed ➔ SKIP to Section D on page 11

No ➔ If No, you do not need to complete
the rest of this questionnaire. Please mark
“No” and return this questionnaire in the
envelope provided so we know you are not
eligible.

Looking for work
Retired
Other

Did you complete your residency in psychiatry?

A8.

Yes

A4.

Do you think you will provide direct clinical
care as a psychiatrist in the future?
Yes

No ➔ If No, you do not need to complete
the rest of this questionnaire. Please mark
“No” and return this questionnaire in the
envelope provided so we know you are not
eligible.
A3.

What is your current employment status?
Mark one box only.

No ➔ SKIP to Section E on page 12
Don’t know ➔ SKIP to Section E on page 12

Are you currently providing direct clinical care
as a psychiatrist?

A9.

When do you think you will provide direct
clinical care as a psychiatrist in the future?

Yes ➔ SKIP to Section B on page 3

In less than a year

No

1 to 2 years
In more than two years

Have you provided direct clinical care as a
psychiatrist within the PAST TWO YEARS?

Don’t know

Yes ➔ SKIP to Section C on page 7

SKIP to Section E on page 12

No

2

27039023

§<${8¤

Section B.
Current Employment in
Direct Clinical Care
B1.

B3.

What setting(s) do you provide direct clinical
care within? Mark all that apply.
Community Mental Health Center (CMHC)
Criminal justice setting

Which area(s) of clinical care do you specialize
in? Mark all that apply.

Federally Qualified Health Center (FQHC)

Addiction Psychiatry

Health Maintenance Organization (HMO)

Administrative Psychiatry

Hospital - General

Child and Adolescent Psychiatry

Hospital - Private psychiatric

Community Psychiatry

Hospital - State psychiatric

Consultation-Liaison Psychiatry

Long term care

Emergency Psychiatry

Primary care office or clinic

Forensic Psychiatry

Private practice (solo or group)

Gender Identity Issues

Residential setting - Mental Health (MH)
or Substance Use Disorder (SUD)

General Psychiatry
VA or military medical center
Geriatric Psychiatry
Other
Intellectual Disability Psychiatry
B4.

Military Psychiatry
Psychiatric Research

a. Direct patient care
Include all time spent
directly interacting with
patients, in-person or
by telehealth, and
collaborative care

Psychiatric Informatics
Psychoanalysis
Sexual Orientation Issues
Other

B2.

What percentage of time do you spend on each
of the following types of work activities during
a typical week? Do not use decimals.

During a typical week, how many different
employment settings do you work in?
Settings

b. Documentation and
follow-up related to
patient care

%

c. Programs/services
leadership

%

d. Teaching

%

e. Research

%

f. Other

%

Total

3

%

100%

27039031

§<${@¤

B5.

During a typical week, what percentage of time
do you spend providing services to clients in
each of the following age groups? Do not use
decimals.

B9.

Yes

%

a. Children aged 17 or younger

Are you currently able to provide psychiatric
services to patients in a language other than
English USING an interpreter or translator?

No ➔ SKIP to Question B11
b. Adults aged 18 to 64

%
B10.

c. Adults aged 65 and older

Total
B6.

%

100%

In which language(s) other than English are
you able to provide psychiatric services to
patients USING an interpreter or translator?
Mark all that apply.
Spanish

During a typical week, what percentage of time
do you spend providing services to clients of the
following sexes? Do not use decimals.

Chinese (including Mandarin and
Cantonese)

a. Male

%

Vietnamese

b. Female

%

Tagolog (including Filipino)

Arabic
French

Total
B7.

100%

American Sign Language

Are you currently able to provide psychiatric
services to patients in a language other than
English WITHOUT using an interpreter or
translator?

Other
B11.

Yes

During a typical week, do you personally use
telehealth in your workplace(s)?
Yes

No ➔ SKIP to Question B9

No
B8.

In which language(s) other than English are
you able to provide psychiatric services to
patients WITHOUT using an interpreter or
translator? Mark all that apply.

B12.

Do you have any patients in your current
caseload for whom you are providing specific
services related to gender identity?

Spanish

Yes

Chinese (including Mandarin and
Cantonese)

No

Tagolog (including Filipino)

B13.

Vietnamese

Do you have any patients in your current
caseload for whom you are providing specific
services related to sexual orientation?

Arabic

Yes

French

No

American Sign Language

B14a.

Other

Are you currently treating any patients with
Clozapine?
Yes
No ➔ SKIP to Question B15a

4

27039049

§<${R¤


File Typeapplication/pdf
File Modified2018-11-14
File Created2018-11-06

© 2024 OMB.report | Privacy Policy