CATI Questionnaire

Attachment A.5 (N-MHSS 2017 CATI questionnaire)
FORM APPROVED: OMB No. xxxx-xxxx
APPROVAL EXPIRES: xx/xx/xxxx
See OMB burden statement on last page

NATIONAL MENTAL HEALTH SERVICES SURVEY
2017 N-MHSS
Hello

Hello, my name is [fill interviewer name] and I am calling
concerning the Federal Government's annual survey of mental
health treatment providers called N-MHSS or the National
Mental Health Services Survey. The N-MHSS survey is sponsored
by SAMHSA, the Substance Abuse and Mental Health Services
Administration.

GetDir

May I speak with [fill director name] regarding this
facility’s 2017 N-MHSS survey?
<1>
<2>
<3>
<4>

Hello2

SPEAKING WITH FACILITY DIRECTOR/APPROPRIATE PERSON
[goto Intro]
CONNECTED TO FACILITY DIRECTOR/APPROPRIATE PERSON
[goto Hello2]
FACILITY DIRECTOR NOT AVAILABLE [goto Callback]
ANSWERING MACHINE [goto Message_Q]

Hello, my name is [fill interviewer name] and I am calling
concerning the Federal Government's annual survey of mental
health treatment providers called N-MHSS or the National
Mental Health Services Survey. The N-MHSS survey is sponsored
by SAMHSA, the Substance Abuse and Mental Health Services
Administration.
[goto Intro]

Intro

Recently you were mailed a letter from J. Neil Russell at
SAMHSA along with a letter from your State or Federal Agency
Mental Health Director. Both letters requested the
participation of your facility in the 2017 N-MHSS. We are
calling at this time to complete the survey. Is this a good
time?
<1>
<2>
<3>
<4>
<5>
<6>
<7>
<8>
<9>
<10>
<11>
<12>

YES, CONTINUE [goto BeginSurvey]
SCHEDULE CALLBACK AT CONVENIENT TIME [goto Callback]
COMPLETING ON THE WEB [Thanks]
NO LONGER PROVIDES MENTAL HEALTH TREATMENT [goto
BeginSurvey]
NEVER PROVIDED MENTAL HEALTH SERVICES [goto
BeginSurvey]
DUPLICATE FACILITY [goto Duplicate]
MERGED WITH ANOTHER FACILITY [goto Merged]
FACILITY CLOSED/NO LONGER EXISTS [goto Thanks2]
SATELLITE FACILITY [goto Satellite]
WRONG NUMBER [goto Sorry]
COMPLETING BY MAIL [goto Thanks]
FACILITY IS A JAIL/PRISON [goto vJail]

BeginSurvey

NOTE: SINCE 2014, THE CATI INSTRUMENT ENDS AT THIS POINT.
INTERVIEWERS FOLLOW THE INSTRUCTIONS DETAILED BELOW, TO LAUNCH
THE WEB UTILITY. USING A UNIQUE INTERVIEWER URL FOR TRACKING
PURPOSES, THE TELEPHONE SURVEY IS COMPLETED WITH THE
RESPONDENT USING THE ONLINE INSTRUMENT.
Click on the three dots to connect to the Web Browser.
DO NOT CLICK THE THREE DOTS MORE THAN ONCE. IF NECESSARY, EXIT
BLAISE AND RE-OPEN THE CASE TO RECONNECT TO THE BROWSER.
YOU SHOULD HAVE ONLY ONE BROWSER WINDOW OPEN WHILE ACCESSING
THE WEB INSTRUMENT.
IF YOUR BROWSER DOES NOT APPEAR TO OPEN, CONFIRM IF THERE IS A
BROWSER WINDOW MINIMIZED AT THE BOTTOM OF YOUR SCREEN. IF
THERE IS, CLOSE IT.
WHILE IN THE WEB INSTRUMENT, DO NOT CLOSE YOUR BROWSER WINDOW
UNTIL THE CASE IS COMPLETE OR AFTER A BREAK OFF.
IF YOU ARE UNABLE TO ACCESS THE WEB INSTRUMENT, OR HAVE ANY
PROBLEMS OR QUESTIONS, CONTACT THE FLOOR SUPERVISOR
IMMEDIATELY.

Duplicate

Which facility is a duplicate of this one?
PRESS ENTER TO CHOOSE FROM LIST OR TO ENTER FACILITY INFO
[choose from list of facilities or goto MainFacility]

Merged

Which facility was this one merged with?
PRESS ENTER TO CHOOSE FROM LIST OR TO ENTER FACILITY INFO
[choose from list of facilities or goto MainFacility]

Satellite

Which facility is this one associated with?
For the purpose of this survey a satellite facility is one that
does not have permanent staff on location. Often times staff
will travel from another location to provide treatment on a
limited schedule.
PRESS ENTER TO CHOOSE FROM LIST OR TO ENTER FACILITY INFO
[choose from list of facilities or goto MainFacility]

Sorry

I'm sorry. Thank you for your time.
[goto Thanks2]

vJail

Just to confirm, this facility provides mental health
treatment services only to incarcerated persons or juvenile
detainees. Is that correct?
<1>
<0>

MainFacility

May I have the name, address and phone number of the facility?
<1>

Message_Q

YES, THAT IS CORRECT [goto Thanks2]
NO, THAT IS NOT CORRECT [goto Intro]

CONTINUE

*** Survey CALL MESSAGE ***
DID YOU LEAVE THE MESSAGE?
<1>
<2>

Yes
No

[goto Thanks]
Thanks

Thank you so much for your time. Your responses are very
important to the study and we look forward to receiving your
completed questionnaire.

Thanks2

Thank you for your time.

Callback

USE THE ‘APPOINTMENT’ TAB ABOVE TO MAKE AN APPOINTMENT.

BeginSurvey

NOTE: SINCE 2014, THE CATI INSTRUMENT ENDS AT THIS POINT.
INTERVIEWERS FOLLOW THE INSTRUCTIONS DETAILED BELOW, TO LAUNCH
THE WEB UTILITY. USING A UNIQUE INTERVIEWER URL FOR TRACKING
PURPOSES, THE TELEPHONE SURVEY IS COMPLETED WITH THE
RESPONDENT USING THE ONLINE INSTRUMENT.
Click on the three dots to connect to the Web Browser.
DO NOT CLICK THE THREE DOTS MORE THAN ONCE. IF NECESSARY, EXIT
BLAISE AND RE-OPEN THE CASE TO RECONNECT TO THE BROWSER.
YOU SHOULD HAVE ONLY ONE BROWSER WINDOW OPEN WHILE ACCESSING
THE WEB INSTRUMENT.
IF YOUR BROWSER DOES NOT APPEAR TO OPEN, CONFIRM IF THERE IS A
BROWSER WINDOW MINIMIZED AT THE BOTTOM OF YOUR SCREEN. IF
THERE IS, CLOSE IT.
WHILE IN THE WEB INSTRUMENT, DO NOT CLOSE YOUR BROWSER WINDOW
UNTIL THE CASE IS COMPLETE OR AFTER A BREAK OFF.
IF YOU ARE UNABLE TO ACCESS THE WEB INSTRUMENT, OR HAVE ANY
PROBLEMS OR QUESTIONS, CONTACT THE FLOOR SUPERVISOR
IMMEDIATELY.

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 xxxx-xxxx. Public reporting burden for this collection of information is
estimated to average 25 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, 5600 Fishers Lane, Room 15E57-B, Rockville, Maryland 20857.

PLEDGE TO RESPONDENTS: The information you provide will be protected to the fullest extent
allowable under Section 501(n) of the Public Health Service Act (42 USC 290aa(n)). This law permits
the public release of identifiable information about an establishment only with the consent of that
establishment and limits the use of the information to the purposes for which it was supplied. With the
explicit consent of eligible treatment facilities, information provided in response to survey questions
marked with an asterisk may be published in SAMHSA’s online Behavioral Health Treatment Services
Locator, the National Directory of Mental Health Treatment Facilities, and other publically available
listings. Responses to non-asterisked questions will be published with no direct link to individual
treatment facilities.