Form Product Feedback S Product Feedback S Product Feedback Survey

Voluntary Customer Satisfaction Surveys to Implement Executive Order 12862 in the Substance Abuse and Mental Health Services Administration (SAMHSA)

Revised Attachment 2 - KAP CIS 8-23-17 092117cb

Knowledge Application Program (KAP)

OMB: 0930-0197

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KAP Customer Information Survey September 2017

KAP Customer Information Survey

Distributed via Survey Monkey


Introduction Page:


The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Knowledge Application Program (KAP) develops information resources to translate data to practice on the treatment of substance use disorders.


We need your help!

To ensure that KAP products continue to meet the needs of professionals like you, please complete this brief survey. Your responses will help us enhance the development, dissemination, and use of KAP products. We do not collect or retain any personally identifying information, including your email address, without your permission. All responses are combined for reporting purposes.

Thank you for taking the time to complete this survey.

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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 6 minutes per respondent, per year, including the time for reviewing instructions and reviewing sample products. 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, 5600 Fishers Lane, Rockville, MD 20857.




Personal Background

Learning about our users helps us tailor our products to be most useful.

  1. What is your area of specialization? (Please select all that apply.)

  • Addiction treatment

  • Substance use prevention/education services

  • Primary care/nursing/other health care

  • Behavioral health services

  • Criminal justice/courts

  • Employee assistance services

  • Recovery support

  • Tribal leadership

  • Other (Please specify:_________)

  1. How many years have you worked in your specialty? Total number of years: ___

  2. What best describes your current position at work? (Please select all that apply.)

  • Counselor/therapist

  • Peer counselor/SUD program volunteer

  • Primary care practitioner

  • Clinical supervisor

  • Program manager

  • Administrator

  • Case manager

  • Intake counselor, assessor, or evaluator

  • Policymaker

  • Outreach worker

  • Analyst

  • Trainer/educator

  • Employee assistance provider

  • Law enforcement officer

  • Behavioral health services provider

  • Other (Please specify:_________)

  1. What client/patient population(s) do you serve? (Please select all that apply.)

  • Women

  • Men

  • Families

  • Rural/remote populations

  • Urban populations

  • Adolescents (ages 12–17)

  • Young adults (ages 18–24)

  • Specific cultural groups (Please specify:__________)

  • Individuals in the criminal justice system

  • Patients in primary care

  • People with or in recovery from substance use disorders

  • People with or in recovery from mental disorders

  • People with medical/physical health issues

  • I do not work directly with clients/patients or in an agency that provides client/patient services

  • Other (Please specify:_________)

  1. In which state are you employed? ____

  2. In which region(s) do you or your agency provide services? (Please select all that apply)

  • Northeast (CT, ME, MA, NH, NJ, NY, PA, RI, VT)

  • South (AL, AR, DE, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, WV)

  • Midwest (IL,IN, IA, KS, MI, MN, NE, ND, OH, SD, WI)

  • West (AK, AZ, CA, CO, HI, ID, NM, MT, NV, OR, UT, WA, WY)

  • Puerto Rico, Guam, or other U.S. Territories

N/A - I do not work directly with clients/patients or in an agency that provides client/patient services

  1. Would you consider the area(s) where you or your agency provide services to be:

    • Rural

    • Urban

    • Suburban

    • Reservation or tribal lands

    N/A - I do not work directly with clients/patients or in an agency that provides client/patient services

  2. Do you hold a degree, license, or certification in addiction treatment or a related area (e.g., licensed professional counselor or social worker, Ph.D. psychologist, M.D. psychiatrist/general practitioner)?

  • Yes (Please specify:_____________)

  • No


Information Needs

To understand how we can best meet your information needs, the next few questions focus on the types of information resources you use and how you gather new information.

  1. What sources do you rely on to learn about new developments in your field? (Please select your top 3 sources.)

  • SAMHSA

  • Other government agency (Please specify:________________)

  • Professional organization (Please specify:________________)

  • Consumer advocacy or recovery group (Please specify:________________)

  • Google or other online search engine

  • Colleague or clinical supervisor

  • Academic or scientific institution (Please specify:_____________)

  • Trade or commercial news source (Please specify:__________)

  • Other: (Please specify:________________)

  1. In what ways are you most likely to hear about new information and resources related to your field? (Please select the top 3.)

  • Email notification

  • Text message

  • Blog post

  • Social media (e.g., Twitter, Facebook, LinkedIn)

  • Podcast

  • Video

  • Word-of-mouth

  • Mentioned/cited in a journal, book, newsletter, or other professional publication

  • Mentioned/cited in a webinar or e-learning course

  • Mentioned at an in-person conference, training, or workshop

  • Mentioned in an academic course

  • Direct search link (i.e., you searched for material on a topic and this product appeared among your search results)

  • Other (Please specify:__________)

  1. Which elements contribute to a resource’s authoritativeness? (Please select the top 3 elements.)

  • Inclusion of current information

  • Source of information

  • Date of publication or latest update

  • Author/sponsor of publication

  • Comprehensiveness of information included

  • Clarity of information presented

  • Appropriateness for diverse audiences

  • Other (Please specify:__________)

  1. Which types of resources are you most likely to need or use? (Please select all that apply.)

  • Resources my clients/patients/families can use themselves (Please specify: ________)

  • Psycoeducational materials I can use with clients

  • Talking points I can use when sharing information with other professionals (e.g., at conferences, during presentations)

  • Guidance on useful resources (e.g., a guide that lists relevant resources, describes the purpose and utility of each, and gives links)

  • Guidelines that inform me of best practices for screening, assessment, and treatment

  • Materials I can use in training/workforce development efforts

  • Materials to support clinical supervision and consultation

  • Materials I can use for program development (e.g., sample policies and procedures, administrative guidelines, community partnership-building)

  • Materials in languages other than English (Please specify languages:___________)



  1. In which formats would you prefer to receive new information and resources related to your field? (please select all that apply)

  • Printed materials

  • Online resources (e.g., web pages, E-Learning modules, downloadable PDF files)

  • Mobile resources (e.g., apps, eBooks)

  • Podcasts or other audio materials

  • Videos

  • Webinars or e-learning courses

  • In-person conferences or trainings

  • Other (Please specify: __________


Thank you for completing this survey. To help us further understand how we can meet the needs of professionals like you, we invite you to participate in future discussions about KAP’s product topics and formats, promotional efforts, and audience engagement initiatives. If you are interested in joining the conversation, please send your name and contact information to [INSERT SAMHSA EMAIL ADDRESS]. Your responses on this survey will remain anonymous and your contact information will not be shared with anyone other than KAP staff members running the sessions.

Thank you!

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