Form DTAC Feedback Surv DTAC Feedback Surv DTAC Feedback Survey

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

SAMHSA DTAC CFS _OMB Attachment A-10.3.19

DTAC

OMB: 0930-0197

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Attachment A: SAMHSA DTAC Customer Feedback Survey

Take this survey on your smartphone or tablet!


Welcome to the Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Technical Assistance Center (DTAC) Customer Feedback Survey.


What is the goal of this survey? We are gathering information on your satisfaction with the quality and relevance of SAMHSA DTAC’s products, the quality of SAMHSA DTAC’s service, and in general how well SAMHSA DTAC is meeting your disaster behavioral health (mental health and substance use-related) needs.


Why have I been selected for this survey? We are asking you to complete this survey because you have interacted with SAMHSA DTAC in the past in some capacity or you have been referred by a colleague as someone who may have a need for disaster behavioral health information and resources.


Your participation. Your participation is completely voluntary. You can choose whether or not to take the survey. You can skip any question or stop without finishing the survey. Whether or not you complete the survey will not affect any services you receive from SAMHSA DTAC.


Who will view my results? Any information you provide will be treated as confidential to the extent provided by law. We have no way of connecting your survey responses to you. All information collected will be reported in summary form. Only project staff will review the results of this survey.


Questions? If you have any technical difficulties or questions about the survey, please call the toll-free survey helpline at 1–800–305–3515 or send an email to [email protected].


If you click on “Start survey now,” you are voluntarily agreeing to take part in this survey. Click one of the options below.


_____ Start survey now / I voluntarily agree to participate in this survey. [Go to Question G1]

_____ Exit survey / I do not want to participate in this survey.

Please explain why you do not want to participate in this survey: [open-ended text box] _________________________________________________

_________________________________________________

Thank you.

[TERMINATE SURVEY]


OMB No. 0930-0325

Expiration Date: 01/31/2020

Burden Statement: This information is being collected to assist the Substance Abuse and Mental Health Services Administration (SAMHSA) for the purpose of program monitoring of the DTAC. This voluntary information collected will be used at an aggregate level to determine the reach, consistency, and quality of the DTAC Program. Under the Privacy Act of 1974 any personally identifying information obtained will be kept private to the extent of the law. 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 Office of Management and Budget (OMB) control number. The OMB control number for this project is 0930-0325. Public reporting burden for this collection of information is estimated to average 18 minutes per encounter, 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, 5600 Fishers Ln, Room 15E57B, Rockville, MD 20857.



G1: In the past 12 months, which SAMHSA DTAC services and/or resources have you used? (Select all that apply.)


  1. Subscribed to the monthly SAMHSA DTAC Bulletin GO TO S1

  2. Subscribed to the quarterly SAMHSA DTAC newsletter, The Dialogue GO TO S2

  3. Called or emailed SAMHSA DTAC for training or technical assistance and resources GO TO S3

  4. Visited the website < https://www.samhsa.gov/dtac> GO TO S4

  5. Downloaded, ordered, or accessed tip sheets, online training, or other resource materials GO TO N1

  6. I don’t know GO TO D1

  7. None of these GO TO G2


G2: What information sources do you primarily use to get information on disaster behavioral health planning, preparedness, response, and/or recovery? Please select the three sources you are most likely to use and order them from one to three with one being most likely to use. (Require participants to select three options.)


  1. Search engine (e.g., Google, Bing, Yahoo, etc.)

  2. Centers for Disease Control and Prevention (CDC)

  3. Federal Emergency Management Agency (FEMA)

  4. American Red Cross (ARC)

  5. U.S. Department of Health and Human Services (e.g., Assistant Secretary for Preparedness and Response)

  6. National Child Traumatic Stress Network

  7. National Center for Posttraumatic Stress Disorder

  8. National Association of State Mental Health Program Directors (NASMHPD) Multi-State Behavioral Health Consortium

  9. International Society for Traumatic Stress Studies

  10. Professional association (e.g., American Psychiatric Association, American Psychological Association, National Association of Social Workers, American Medical Association, American Nurses Association); please specify: ________ [open-ended text box]

  11. SAMHSA (e.g., DTAC, Technology Transfer Centers)

  12. State or local emergency management agency or organization (National Association of County and City Health Officials, Association of State and Territorial Health Officials)

  13. Library or professional journal; please specify: ________ [open-ended text box]

  14. Other; please specify: ________ [open-ended text box]


SAMHSA DTAC Bulletin


You indicated that you subscribe to the SAMHSA DTAC Bulletin <https://www.samhsa.gov/dtac/disaster-behavioral-health-resources#dtacbulletin>.


S1. [For SAMHSA DTAC Bulletin subscribers] How often do you read the SAMHSA DTAC Bulletin?


  1. Every time I receive it

  2. Every now and then

  3. Never


S1a. [For SAMHSA DTAC Bulletin subscribers] Do you feel that you receive the SAMHSA DTAC Bulletin…


  1. Often enough

  2. Too frequently

  3. Too rarely


S1b. [For SAMHSA DTAC Bulletin subscribers] Please rate your level of satisfaction with each of the following as it relates to your experiences with the SAMHSA DTAC Bulletin. (Scale for each response category below: 1 = Not at all satisfied, 2 = Satisfied, 3 = Very satisfied)


  1. The usefulness of the information you receive from the SAMHSA DTAC Bulletin

  2. The completeness of the information included in the SAMHSA DTAC Bulletin

  3. The relevance of the topics included in the SAMHSA DTAC Bulletin (Disaster Behavioral Health Preparedness and Response, Disaster-Specific Resources)

  4. The overall quality of the SAMHSA DTAC Bulletin


S1c. [For SAMHSA DTAC Bulletin subscribers] SAMHSA DTAC also sends the SAMHSA DTAC Supplemental Research Bulletin twice a year to SAMHSA DTAC Bulletin subscribers. Please rate your level of satisfaction with each of the following as it relates to your experiences with the SAMHSA DTAC Supplemental Research Bulletin. (Scale for each response category below: 1 = Not at all satisfied, 2 = Satisfied, 3 = Very satisfied)


  1. The usefulness of the information you receive from the SAMHSA DTAC Supplemental Research Bulletin

  2. The completeness of the information included in the SAMHSA DTAC Supplemental Research Bulletin

  3. The relevance of the topics included in the SAMHSA DTAC Supplemental Research Bulletin (The Effects of Disaster on Children, First Responder Mental Health, Serving People with Serious Mental Illness in Disaster)

  4. The overall quality of the SAMHSA DTAC Supplemental Research Bulletin


S1d. Have you ever visited the SAMHSA DTAC website <https://www.samhsa.gov/dtac> because of what you read either in the SAMHSA DTAC Bulletin or the SAMHSA DTAC Supplemental Research Bulletin?


  1. Yes

  2. No


S1e. [If no for S1d] Why not? ___________ [open-ended text box]


SAMHSA DTAC’S The Dialogue


You indicated that you subscribe to The Dialogue <https://www.samhsa.gov/dtac/disaster-behavioral-health-resources/dialogue>.


S2. [For subscribers of The Dialogue] How often do you read The Dialogue?


  1. Every time I receive it

  2. Every now and then

  3. Never


S2a. [For subscribers of The Dialogue] Do you feel that you receive The Dialogue…


  1. Often enough

  2. Too frequently

  3. Too rarely


S2b. [For subscribers of The Dialogue] Please rate your level of satisfaction with each of the following as it relates to your experiences with The Dialogue. (Scale for each response category below: 1 = Not at all satisfied, 2 = Satisfied, 3 = Very satisfied)


  1. The usefulness of the information you receive from The Dialogue

  2. The completeness of the information included in The Dialogue

  3. The relevance of the topics included in The Dialogue (Disaster Response Apps and Resources, Mass Violence, First Responder Mental Health, Serving People with Serious Mental Illness in Disaster)

  4. The overall quality of The Dialogue


S2c. Have you ever visited the SAMHSA DTAC website <https://www.samhsa.gov/dtac> because of what you read in The Dialogue?


  1. Yes

  2. No


S2d. [If no to S2c] Why not? ___________ [open-ended text box]

Telephone or Email Assistance


S3. What was the reason for your most recent call or email to SAMHSA DTAC for technical assistance? (Select all that apply.)


  1. Crisis Counseling Assistance and Training (CCP) toolkit (online resources pertaining to CCP)

  2. Aid in applying for the CCP

  3. Questions about other disaster, emergency, or crisis grant funding sources

  4. Phone consultation on disaster behavioral health topics

  5. Tip sheets concerning disaster behavioral health topics

  6. Help with finding disaster behavioral health research or other resources

  7. To request a consultant with experience in: _________________ [open-ended text box]

  8. Other; please specify: ___________________________ [open-ended text box]


S3a. Considering your MOST RECENT interaction with SAMHSA DTAC, how satisfied were you with the following? (Scale for each response category below: 1 = Not at all satisfied, 2 = Satisfied, 3 = Very satisfied, 4 = Not applicable [e.g., I have not received the information requested])


  1. Friendliness of SAMHSA DTAC staff

  2. Timeliness of the initial response to your request

  3. Timeliness of providing the information or support you requested

  4. Accuracy of the information you received

  5. Relevance of the information you received

  6. Overall quality of the training or technical assistance that SAMHSA DTAC provided to you


S3b. Overall, how well would you rate SAMHSA DTAC training or technical assistance in meeting your needs?


  1. Extremely well

  2. Very well

  3. Somewhat well

  4. Not well at all

  5. Not applicable


SAMHSA DTAC Website


S4. How many times in the past 12 months have you visited the SAMHSA DTAC website <https://www.samhsa.gov/dtac>? (Your best estimate is fine.)


  1. 1 time

  2. 2–5 times

  3. 6–10 times

  4. More than 10 times

  5. None; why not? _________________ [open-ended text box]


S4a. Considering your visit(s) to the SAMHSA DTAC website over the past 12 months, how satisfied were you with the following? (Scale for each response category below: 1 = Not at all satisfied, 2 = Satisfied, 3 = Very satisfied, 4 = Not applicable)


  1. Ease of navigating through the website

  2. Usefulness of the information on the website

  3. Ability to easily find what you need on the website

  4. How quickly the web pages load

  5. The website search function

  6. Overall quality of the website

  7. Ability to easily find contact information to submit an inquiry (in general or for a specific branch)


S4b. How likely are you to refer someone to the SAMHSA DTAC website <https://www.samhsa.gov/dtac> for information about disaster behavioral health?


  1. Very likely

  2. Likely

  3. Somewhat likely

  4. Not at all likely


Disaster Behavioral Health Information Needs


SAMHSA is committed to expanding access to quality disaster behavioral health services, including in times of disaster. The following questions are intended to help us understand your needs for disaster behavioral health information. These questions are organized around the following disaster phases: planning, preparedness, response, and recovery.


N1. For the disaster behavioral health PLANNING topics below, please rate your NEED for training and technical assistance. (Scale for each response category below: 1 = Not important/needed, 2 = Somewhat important, 3 = Very important, 4 = Not applicable)


  1. Writing and/or updating an all-hazards disaster behavioral health preparedness plan

  2. Developing interagency partnerships to support all-hazards planning

  3. Identifying funding for all-hazards planning activities

  4. Incorporating substance use treatment into planning activities

  5. Hazard or risk assessment tools

  6. Resource assessment tools

  7. Evacuation planning

  8. Identifying vulnerable populations, such as people experiencing homelessness, children, refugees, people with serious mental illness or substance use disorders, etc.

  9. Conducting needs assessments

  10. Incorporating cultural competency


N1a. (If a, d, h, or j selected) Have you used any of the following SAMHSA DTAC products related to disaster behavioral health PLANNING? (Check all that apply.) For the products that you have used, please rate your level of satisfaction with each of them.


For “Relevance,” “Length,” and “Quality of information,” use:

1 = Not at all satisfied, 2 = Satisfied, 3 = Very satisfied, 4 = Not applicable





  • Psychosocial Issues for Older Adults in Disasters [LINK PENDING]

    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource




N1b. (If none are checked in N1a) Why have you not used any of these materials?

  • I did not know about these materials.

  • I could not find these materials.

  • I could not download these materials.

  • These materials were out of stock.

  • I did not need these materials.

  • Other; please specify: ____________________


N2. For the disaster behavioral health PREPAREDNESS topics below, please rate your NEED for training and technical assistance. (Scale for each response category below: 1 = Not important/needed, 2 = Somewhat important, 3 = Very important, 4 = Not applicable)


    1. Increasing awareness of disaster behavioral health among disaster behavioral health professionals

    2. Evaluating your disaster behavioral health plan

    3. Training disaster behavioral health workers

    4. Managing disaster behavioral health workers

    5. Building resilient communities


N2a. (If c, d, or e are selected) Have you used any of the following SAMHSA DTAC products related to disaster behavioral health PREPAREDNESS? (Check all that apply.) For the products that you have used, please rate your level of satisfaction with each of them.


For “Relevance,” “Length,” and “Quality of information,” use:

1 = Not at all satisfied, 2 = Satisfied, 3 = Very satisfied, 4 = Not applicable






N2b. (If none are checked in N2a) Why have you not used any of these materials?

  • I did not know about these materials.

  • I could not find these materials.

  • I could not download these materials.

  • These materials were out of stock.

  • I did not need these materials.

  • Other; please specify: ____________________


Disaster behavioral health response comprises the coordination and management of resources (including personnel, equipment, and supplies) using the Incident Command System in an all-hazards approach, as well as measures taken for life, property, and environmental safety. The response phase is a reaction to the occurrence of a catastrophic disaster or emergency.


N3. For the disaster behavioral health RESPONSE topics below, please rate your NEED for training and technical assistance. (Scale for each response category below: 1 = Not important/needed, 2 = Somewhat important, 3 = Very important, 4 = Not applicable)


  1. Working within Incident Command System or Unified Command structures

  2. Finding and applying for disaster/emergency response grants

  3. Helping individuals cope with disaster stress

  4. Understanding disaster behavioral health interventions

  5. Managing stress in disaster responders

  6. Training disaster behavioral health workers

  7. Cultural competence in disaster response


N3a. (If b, c, e, f, and g are selected) Have you used any of the following SAMHSA DTAC products related to disaster behavioral health RESPONSE? (Check all that apply.) For the products that you have used, please rate your level of satisfaction with each of them.


For “Relevance,” “Length,” and “Quality of information,” use:

1 = Not at all satisfied, 2 = Satisfied, 3 = Very satisfied, 4 = Not applicable


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource




  • First Responder Online Training Course: Fatal Frontlines [LINK PENDING]

    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


N3b. (If none are checked in N3a) Why have you not used any of these materials?

  • I did not know about these materials.

  • I could not find these materials.

  • I could not download these materials.

  • These materials were out of stock.

  • I did not need these materials.

  • Other; please specify: ____________________


Disaster behavioral health recovery consists of those activities that continue beyond the emergency period to restore critical community functions and begin to manage stabilization efforts. The recovery phase begins immediately after the threat to human life has subsided. The goal of the recovery phase is to bring the affected area back to some degree of normalcy.


N4. For the disaster behavioral health RECOVERY topics below, please rate your NEED for training and technical assistance. (Scale for each response category below: 1 = Not important/needed, 2 = Somewhat important, 3 = Very important, 4 = Not applicable)


  1. Tip sheets on disaster behavioral health topics (e.g., coping with stress/grief, talking with children)

  2. Continued technical assistance for Crisis Counseling Assistance and Training Program (CCP) grants

  3. Preparing for conclusion of response work

  4. Planning for disaster anniversary

  5. Other; please list: ____________________ [open-ended text box]


N4a. (If any of above is selected) Have you used any of the following SAMHSA DTAC products related to disaster behavioral health RECOVERY? (Check all that apply.) For the products that you have used, please rate your level of satisfaction with each of them.


For “Relevance,” “Length,” and “Quality of information,” use:

1 = Not at all satisfied, 2 = Satisfied, 3 = Very satisfied, 4 = Not applicable)


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


  • Coping with Anger After a Disaster or Traumatic Event [LINK PENDING]

    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


    • The relevance of this resource

    • The length of this resource

    • The quality of information in this resource


N4b. (If none are checked in N4a) Why have you not used any of these materials?

  • I did not know about these materials.

  • I could not find these materials.

  • I could not download these materials.

  • These materials were out of stock.

  • I did not need these materials.

  • Other; please specify: ____________________


Disaster Behavioral Health Information Channels


N5. Please indicate which of the following ways you would like to interact with SAMHSA DTAC. (Select all that apply.)


  1. In-person regional or national conference or meeting

  2. One-on-one, in-person consultation at your work site

  3. Virtual or web-based meetings

  4. Phone consultation

  5. Email consultation

  6. Other; please specify: _____________________ [open-ended text box]


N6. Please indicate which of the following TRAINING delivery methods would be useful to your organization. (Select all that apply.)


  1. In-person or classroom-based curriculum

  2. Online training module

  3. Webinar (i.e., live online presentation with audience)

  4. YouTube/webcast (i.e., recorded audio and visual presentation)

  5. Podcast (i.e., recorded audio presentation)

  6. Mobile application (i.e., apps for mobile phone or tablet)

  7. Other; please specify: _____________________ [open-ended text box]


N7. How important to you is the possibility of obtaining continuing education credits upon completion of a training?


  1. Extremely important

  2. Very important

  3. Somewhat important

  4. Not at all important


N8. How important is it to you to be able to receive SAMHSA DTAC resources digitally (electronically)?


  1. Extremely important

  2. Very important

  3. Somewhat important

  4. Not at all important


N9. How important is it to you to be able to receive paper-based SAMHSA DTAC resources?


  1. Extremely important

  2. Very important

  3. Somewhat important

  4. Not at all important


N10. Would you refer your colleagues or professional peers to SAMHSA DTAC for disaster behavioral health information?


_____ Yes

_____ No; why not? ________________________ [open-ended text box]


N11. How likely are you to contact SAMHSA DTAC in the future for your disaster behavioral health information needs?


  1. Very likely

  2. Likely

  3. Somewhat likely

  4. Not at all likely


DEMOGRAPHICS


D1. What is your gender? (Select one.)


  1. Male

  2. Female

  3. Transgender

  4. None of these


D2. Are you Hispanic or Latino? (Select one.)


  1. Yes

  2. No


D3. What race do you consider yourself? (Select all that apply.)


  1. American Indian or Alaska Native

  2. Asian

  3. Black or African American

  4. Native Hawaiian or Other Pacific Islander

  5. White


D4. What is your year of birth?


Year: ___ ___ ___ ___ [open-ended text box]


D5. What is the highest level of education you have finished, whether or not you received a degree?


  1. Less than 12th grade

  2. 12th grade/high school diploma/equivalent (GED)

  3. Vocational/technical diploma

  4. Some college or university

  5. Bachelor’s degree (B.A., B.S.)

  6. Graduate work/graduate degree

  7. I don’t know


D6. Are you a/an…? (Select one.)


  1. Administrator

  2. Advocate

  3. Consultant

  4. Counselor

  5. Direct service provider

  6. Disaster behavioral health professional

    1. How long have you worked in the disaster behavioral health field? _____ years

    2. What percentage of your job do you spend on

              1. Disaster behavior health planning: _____ percent

              2. Disaster behavior health preparedness: _____ percent

              3. Disaster behavior health response: _____ percent

              4. Any disaster behavioral health activity other than the above: _____ percent

              5. Any activity other than disaster behavioral health _____ percent

The above should total 100 percent.

  1. Disaster survivor

  2. Emergency management professional

  3. First responder

  4. Librarian

  5. Manager

  6. Nurse

  7. Psychiatrist or other medication-prescribing clinical professional

  8. Psychologist or other therapeutic mental health professional

  9. Public health professional

  10. Researcher/evaluator

  11. Retiree

  12. Social Worker

  13. Student/faculty member

  14. Substance use prevention or treatment professional

  15. Trainer

  16. Volunteer

  17. Other; please specify: _____________________ [open-ended text box]


D7. For which type of organization do you primarily work? (Select one.)


  1. Academic organization

  2. Consultant

  3. Federal government

  4. For-profit organization

  5. Local government

  6. Nonprofit organization

  7. Professional association

  8. Retiree

  9. State or territory government

  10. Student

  11. Tribal government

  12. Other type of organization; please specify: ___________________________ [open-ended text box]


D8. In which state or territory do you work? [Drop-down menu of all states and territories including Puerto Rico, U.S. Virgin Islands, Guam, Commonwealth of Northern Mariana Islands, Republic of the Marshall Islands, Federated States of Micronesia, American Samoa, and Other; please specify: _________] GO TO G3


Overall Satisfaction and Comments


G3. Overall, how do you rate your experience with SAMHSA DTAC staff, products, and service? (1 = Not at all satisfied, 2 = Somewhat satisfied, 3 = Satisfied, 4 = Extremely satisfied)


G4. Please use the space below to share your thoughts and suggestions on how SAMHSA DTAC can best serve your needs both now and where you see your agency and needs developing in the future.


For example:

  • What SAMHSA DTAC training or technical assistance topics are you most interested in?

  • What topics would you like to see in SAMHSA DTAC webcasts, podcasts, or web-based trainings?

  • What suggestions do you have for improving the SAMHSA DTAC website?

  • In what ways did SAMHSA DTAC not provide you with the information or support you needed?

  • In what ways can SAMHSA DTAC improve the SAMHSA DTAC Bulletin, SAMHSA DTAC Supplemental Research Bulletin, and/or The Dialogue?

  • What are the greatest needs facing your agency that SAMHSA can assist you with?

  • What is one item that you would like to see SAMHSA offer in the future that is currently not offered?


We very much appreciate any comments that you have, as this is an important way for us to know and provide you what you need.


[Open-ended text box]

___________________________________

___________________________________

___________________________________

___________________________________


Thank you for completing this survey!

[SUBMIT BUTTON; END OF SURVEY]

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