Form PATH Provider Web PATH Provider Web PATH Provider Web Survey

Attachment 3: PATH Provider Web Survey

Evaluation of the Projects for Assistance in Transition from Homelessness (PATH) Program

PATH Evaluation_Attachment3_2017_May1

PATH Provider Web Survey

OMB: 0930-0381

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0930-0381 can be found here:

2023-03-21 - Reinstatement with change of a previously approved collection

Document [docx]

Download: docx | pdf

Strongly Disagree [1]

Disagree [2]

Neither Agree nor Disagree [3]

Agree [4]

Strongly Agree [5]

Don’t know [8]

State/territory organization [IMPL2_1]

Housing partner(s) [IMPL2_2]

Substance abuse treatment partner(s) [IMPL2_3]

Mental health treatment partner(s) [IMPL2_4]

Healthcare partner(s) [IMPL2_5]

OMB No. 0930-0xxx

Expiration Date xx/xx/xxxx

Welcome to the

National Evaluation of SAMHSA’s Project for Assistance in Transition from Homelessness (PATH)

PATH Provider

Web Survey

Thank you for taking time to complete the National Evaluation of SAMHSA’s Project for Assistance in Transition from Homelessness PATH Provider – Web Survey. the questions in this survey are about your knowledge of and experience with [Name of Grantee Organization]’s PATH program.

Please click the “Continue” button below to proceed of you are affiliated with [Name of Grantee Organization]’s PATH program. Please click here if you are not affiliated with this program [link to terminate].

CONTINUE button

_______________________________________________________________________

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 0930-0XXX. Public reporting burden for this collection of information is estimated to average 1 hour per respondent, 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.

OMB No. 0930-0xxx

Expiration Date xx/xx/xxxx

Consent to Participate in the National Evaluation of

Substance Abuse and Mental Health Services Administration (SAMHSA)

Project for Assistance in Transition from Homelessness (PATH)

PATH Provider

Web Survey

About the Study

This interview is part of the data collection for a national evaluation of SAMHSA’s Center for Mental Health Services (CMHS) Project for Assistance in Transition from Homelessness (PATH) program, to ensure that the grantee and local programs are consistent with legislative requirements and to recommend changes to the program design and operation. HSRI though a subcontract from RTI International is conducting the evaluation. These questions were approved by the Department of Health and Human Services, SAMHSA, CMHS.

We are contacting the Project Director or comparable staff of the state and territories PATH programs to get their perspectives on their PATH project to help SAMHSA improve PATH program and the supports they offer to clients and grantees. You are one of close to 500 provides who may participate in this study. The following questions ask about your agency’s PATH program.

The PATH Provider web survey covers background information about your agency; the services provided by your PATH program; the target population of clients/consumers of focus for your program and your experience implementing your program.

Voluntary Participation and Privacy

Your participation in this survey is completely voluntary. You may refuse to answer any question in the survey and you may stop participating at any time.

All the information you provide in this web survey will be kept private and will not be shared with anyone from your agency or directly with SAMHSA. We will not divulge your individual responses to your employer or anyone else outside of the research team. You will be assigned a participant ID number and your name will not appear on the web survey; the information linking your name and agency ID will be kept—separately from this consent and your responses—in a password-protected folder accessible only to the evaluation team.

Risks and Benefits of the Study

Participation in this interview poses little risk to you. In addition to the privacy protections described above, we will reduce the risk of inadvertent disclosure by associating your responses with a unique identifier and not your name.

There are no immediate benefits of participation. No incentive for participation is provided. Information from project directors and other key staff like you will be aggregated, and the results will help stakeholders, practitioners, policy makers, researchers, and funders learn more about the efforts of the SAMHSA CMHS PATH program and factors contributing to their success. Results will help inform SAMHSA and future programs about what works.

Duration

This survey will take about 1 hour of your time. This includes the time for reviewing instructions, searching existing data sources, gathering the data needed, and completing the interview.

Questions

You are welcome to contact our office any time if you have any questions. Please call Terry Camacho-Gonsalves, the Project Manager for the PATH evaluation at 1-617-844-2504 or by email at [email protected]. If you have any questions about your rights as a study participant, you may call the Human Services Research Institute (HSRI) Office of Institutional Review Board at 1-617-844-2501; or you may write to them at HSRI Office of Institutional Review Board, 2236 Massachusetts Avenue, Cambridge MA 02140.

By clicking on “Consent” below, you agree to participate in the study. Please select “Consent” only if:

✔ You understand the information about the study in this consent form, and

✔ You are willing to continue to participate in the study.

 Consent  Do not consent

Substance Abuse and Mental Health Services Administration (SAMHSA)

Project for Assistance in Transition from Homelessness (PATH)

PATH Provider

Web Survey

Module A: Provider Background

Please review and verify the pre-populated information about the grantee’s PATH program for which your organization is an intermediary for.

[PREFILL GRANTEE1 – GRANTEE2]

[GRANTEE1]

Provider Organization Name: [ALLOW 200]

[GRANTEE2]

Provider Location – City: [ALLOW 50] State: |___|___|

[ORG1]

What types of organization is your organization? Check all that apply

Community mental health center [1]
Consumer-run mental health agency [2]
Other mental health agency [3]
Social service agency [4]
Shelter or other temporary housing resource [5]
Other housing agency [6]
Health Care for Homeless/other health agency [7]
Substance use treatment agency [8]
Other (Specify): [8]
Don’t know [98]

Next we would like to ask you some questions about yourself.

[ROLE1]

Are you the Project Director or in a comparable role for this agency’s PATH program?

Yes [1]
No [2]
Don’t know [98]

[ROLE2]

How long have you been in this position for this agency’s PATH program?

_____ Years ____ Months ___Don’t Know

[ROLE3]

On a typical week, what percentage of your time is spent on PATH-related activities?
%

[ROLE4]

In addition to your responsibilities with this agency’s PATH program, please describe your other responsibilities within your organization. For example, supervision of other clinical programs, management of other agency programs, non-PATH training or technical assistance, direct service provision etc.

MODULE B: PATH PROGRAM ADMINISTRATION

The next questions are about the administration of this agency’s PATH program.

First we want to know if there are specific target populations that have been designated as high priority populations to be served by your agency’s PATH program.

[POP1]

Which of the following populations have been designated as high priority populations to be served by your agency’s PATH program? Check all that apply.

Persons with serious mental illness (SMI) [1]
Persons with co-occurring SMI and substance use disorders [2]
People who are homeless [3]
People who are literally homeless [4]
People who are chronically homeless [5]
Veterans [6]
Persons with criminal justice backgrounds (e.g., previously incarcerated, reentry/diversion, or on probation/adjudication [7]
People from racial and ethnic minority groups [8]
Youth [9]
People who are Lesbian, gay, bisexual, or transgender individuals, questioning and allies (LGBT/LGBTQA) [10]
Families [11]
Other (Specify): [12]
Other (Specify): [13]
Other (Specify): [14]
No priority populations have been designated by your agency [15]
Don’t Know [98]

[SERVICES]

The next questions are in regards to the PATH services provided by your agency’s PATH program and any of your agency’s PATH subcontractors. For each PATH allowable/eligible service, we would like to know a) whether you provide the allowable/eligible service; and b) whether the service is a priority service within your agency’s PATH program. By priority service, we mean a service that is emphasized within your agency’s PATH program or that is a focus of your agency’s PATH program.

[SERV1A]

Does your agency’s PATH program provide outreach services?

Yes [1]
No [2] [Go to SERV2A]
Don’t know [98] [Go to SERV2A]

[SERV1B]

Are outreach services priority services in your agency’s PATH program?

Yes [1]
No [2]
Don’t know [98]

[SERV1C]

Does your agency’s PATH program conduct street outreach?

Yes [1]
No [2]
Don’t know [98]

[SERV1D]

Does your agency’s PATH program conduct in-reach?

Yes [1]
No [2]
Don’t know [98]

[SERV2A]

Does your agency’s PATH program provide screening and diagnostic treatment services?

Yes [1]

No [2] [Go to SERV3A]
Don’t know [98] [Go to SERV3A]

[SERV2B]

Are screening and diagnostic treatment services priority services in your agency’s PATH program?

Yes [1]
No [2]
Don’t know [98]

[SERV3A]

Does your agency’s PATH program provide habilitation and rehabilitation services?

Yes [1]
No [2] [Go to SERV4A]
Don’t know [98] [Go to SERV4A]

[SERV3B]

Are habilitation and rehabilitation services priority services in your agency’s PATH program?

Yes [1]
No [2]
Don’t know [98]

[SERV4A]

Does your agency’s PATH program provide community mental health services?

Yes [1]
No [2] [Go to SERV5A]
Don’t know [98] [Go to SERV5A]

[SERV4B]

Are community mental health services priority services in your agency’s PATH program?

Yes [1]
No [2]
Don’t know [98]

[SERV5A]

Does your agency’s PATH program provide alcohol or drug treatment services?

Yes [1]

No [2] [Go to SERV6A]
Don’t know [98] [Go to SERV6A]

[SERV5B]

Are alcohol or drug treatment services priority services in your agency’s PATH program?

Yes [1]
No [2]
Don’t know [98]

[SERV6A]

Does your agency’s PATH program provide staff training? Staff training includes the training of individuals who work in shelters, mental health clinics, substance abuse programs and other sites where People who are homeless require services or training in program areas such as outreach or engagement.

Yes [1]
No [2] [Go to SERV7A]
Don’t know [98] [Go to SERV7A]

[SERV6B]

Is staff training a priority service in your agency’s PATH program?

Yes [1]
No [2]
Don’t know [98]

[SERV7A]

Does your agency’s PATH program provide case management services?

Yes [1]
No [2] [Go to SERV8A]
Don’t know [98] [Go to SERV8A]

[SERV7B]

Are case management services priority services in your agency’s PATH program?

Yes [1]
No [2]
Don’t know [98]

[SERV8A]

Does your agency’s PATH program provide supportive and supervisory services in residential settings?

Yes [1]
No [2] [Go to SERV9A]
Don’t know [98] [Go to SERV9A]

[SERV8B]

Are supportive and supervisory services in residential settings priority services in your agency’s PATH program?

Yes [1]
No [2]
Don’t know [98]

[SERV9A]

Does your agency’s PATH program make referrals for other services (e.g., primary healthcare, job training, educational services and housing)?

Yes [1]
No [2] [Go to SERV10A]
Don’t know [98] [Go to SERV10A]

[SERV9B]

Are making referrals for other services (e.g., primary healthcare, job training, educational services and housing) a priority service in your agency’s PATH program?

Yes [1]
No [2]
Don’t know [98]

[SERV9C]

Which services does PATH program make referrals for? Check all that apply

Primary healthcare [1]
Job training [2]
Educational services [3]
Housing [4]
Other (Specify): [5]
Other (Specify): [6]
Other (Specify): [7]
Don’t know [98]

[SERV10A]

Does your agency’s PATH program provide the PATH allowable housing assistance services?

Yes [1]
No [2] [Go to EBP1]
Don’t know [98] [Go to EBP1]

[SERV10B]

Is providing the PATH allowable housing assistance services a priority service in your agency’s PATH program?

Yes [1]
No [2]
Don’t know [98]

[SERV10C]

Which PATH allowable housing assistance services are provided by your agency’s PATH program? Check all that apply.

Minor renovation, expansion, and repair of housing [1]
Planning of housing [2]
Technical assistance in applying for housing assistance [3]
Improving the coordination of housing services [4]
Security deposits [4]
Costs associated with matching eligible homeless individuals with appropriate housing situations [5]
One-time rental payments to prevent eviction [6]
Other (Specify): [7]
Other (Specify): []
Other (Specify): [9]
Don’t know [98]

[HOUSE1]

Does your agency’s PATH program provide housing to PATH consumers?

Yes [1] [Go to HOUSE1]
No [2] [Go to MATCH1]
Don’t know [98]

[HOUSE2]

What type(s) of housing does your agency’s PATH program provide to PATH consumers?

Permanent public housing [1]
Permanent, privately owned housing [2]
Transitional housing [3]
Emergency shelter [4]
Other (Specify): [5]
Other (Specify): [6]
Other (Specify): [7]
Don’t know [98]

Next we want to ask you some questions regarding the sources of match funds.

[MATCH1]

Does your agency’s PATH program provide match funds?

Yes [1]
No [2]
Don’t know [98]

MODULE C: TECHNICAL ASSISTANCE AND TRAINING

The next few questions are about the technical assistance and training that your agency’s PATH program may have received during the past year?

[TTA1]

Has your agency’s PATH program received technical assistance in the past year?

Yes [1] [Go to TTA2]
No [2] [Go to TTA4]
Don’t know [98]

[TTA2]

Did your agency’s PATH program request the technical assistance in the past year?

Yes [1]
No [2]
Don’t know [98]

[TTA3]

Who provided technical assistance to your agency’s PATH program in the past year? Check all that apply.

PATH State/Territory [1]
Another State/Territory agency [2]
SAMHSA [3]
SAMHSA PATH Technical Assistance contractor [4]
Another SAMHSA funded contract or contractor [5]
Own agency [6]
Other (Specify): [7]
Other (Specify): [8]
Other (Specify): [9]

Don’t know [98]

[TTA4]

Has your agency’s PATH program received trainings in the past year?

Yes [1] [Go to TTA5]
No [2] [Go to HMIS1]
Don’t know [98]

[TTA5]

Did your agency’s PATH program request the training in the past year?

Yes [1]
No [2]
Don’t know [98]

[TTA6]

Who provided training to your agency’s PATH program in the past year? Check all that apply.

PATH State/Territory [1]
Another State/Territory agency [2]
SAMHSA [3]
SAMHSA PATH Technical Assistance contractor [4]
Another SAMHSA funded contract or contractor [5]
Own agency [6]
Other (Specify): [7]
Other (Specify): [8]
Other (Specify): [9]

Don’t know [98]

[PROGRAMMER NOTE: If TTA1 =1 OR TTA4 = 1, GET TTA7; ELSE SKIP TO MODULE D]

[TTA7]

In which topics areas has your agency’s PATH program received technical assistance or training in the past year? Check all that apply.

Development of Intended Use Plans [TTA5_1]
Determining client eligibility for PATH services [TTA5_2]
Enrolling clients for PATH services [TTA5_3]
PATH-eligible services: (Check all that apply) [TTA5_4]

Outreach services [TTA5_4_1]
Screening and diagnostic treatment services [TTA5_4_2]
Habilitation and rehabilitation services [TTA5_4_3]
Community mental health services [TTA5_4_4]
Alcohol or drug treatment services [TTA5_4_5]
Staff training [TTA5_4_6]
Case management services [TTA5_4_7]
Supportive and supervisory services in residential services [TTA5_4_8]
Referral for primary health services, job training, educational services and relevant housing services [TTA5_4_9]
Allowable housing services (e.g., planning of housing, technical assistance in applying for housing assistance, security deposits, etc.) [TTA5_4_10]

Evidence-Based Practices (EBPs) (general trainings or trainings on specific EBPs) Check all that apply. [TTA5_5]

Assertive Community Treatment (ACT) [TTA5_5_1]
Cognitive Behavioral Therapy (CBT) [TTA5_5_2]
Critical Time Intervention (CTI) [TTA5_5_3]
Double Trouble in Recovery (DTR) [TTA5_5_4]
Eye Movement Desensitization and Reprocessing (EMDR) [TTA5_5_5]
Housing First Model [TTA5_5_6]
Illness Management and Recovery (IMR) [TTA5_5_7]
Integrated Dual Disorder Treatment (IDDT) [TTA5_5_8]
Intensive Case Management (ICM) [TTA5_5_9]
Matrix Model [TTA5_5_10]
MISSION [TTA5_5_11]
Motivational Interviewing [TTA5_5_12]
Motivational Enhancement Therapy (MET) [TTA5_5_13]
Permanent Supportive Housing [TTA5_5_14]
Screening and Brief Intervention (SBI) [TTA5_5_15]
Seeking Safety [TTA5_5_16]
SSI/SSDI Outreach, Access, and Recovery (SOAR) [TTA5_5_17]
Trauma Recovery and Empowerment Model (TREM) [TTA5_5_18]
Trauma-informed care [TTA5_5_19]
Wellness Recovery Action Plan (WRAP) [TTA5_5_20]
Other (Specify): [TTA5_5_21]
Other (Specify): [TTA5_5_21]
Other (Specify): [TTA5_5_23]
Don’t know [98]

Data Collection [TTA5_6]
Data Reporting [TTA5_7]
Annual Survey Report [TTA5_8]
Homeless Management Information Systems (HMIS) [TTA5_9)
Transitioning clients out of PATH services [TTA5_10]
Other (Specify): [TTA5_11]
Other (Specify): [TTA5_12]
Other (Specify): [TTA5_13]

Don’t Know [98]

MODULE D: HOMELESS MANAGEMENT INFORMATION SYSTEM

[HMIS1]

What is the status of your agency’s PATH program ’s transition to the use of HUD’s Homeless Management Information System (HMIS) for the PATH Program?

Have not started using HMIS for the PATH program [1]
The use of HMIS for the PATH program is in process [2] [Go to HMIS2]
Using HMIS for the PATH program [3] [Go to HMIS3]
Other (Specify): [4]

Don’t know [98]

[HMIS2]

Is your agency’s PATH program collecting PATH client data through another system approved by SAMHSA that supports interoperability with the local HMIS?

Yes [1]
No [2]
Don’t know [98]

[HMIS3]

Have staff working in your agency’s PATH program been trained in the use of HMIS?

Yes [1]
No [2]
Don’t know [98]

[PROGRAMMER NOTE: If HMIS1 = 2, 3, or 4, or HMIS2 =1, GET HMIS4; ELSE SKIP TO MODULE E]

[HMIS4]

How are HMIS data being used by your agency’s PATH program? Check all that apply.

Not yet being used [1]
To plan PATH services or activities [2]
To monitor PATH consumer participation in services or housing [3]
To monitor PATH consumer outcomes [4]
To report Annual Survey/PATH Data [5]
To report to other State or Federal agencies [6]
Other (Specify): [7]
Other (Specify): [8]
Other (Specify): [9]

Don’t Know [98]

MODULE E: CONTINUUM OF CARE

The next few questions are about involvement with the HUD Continuum of Care (CoC) program.

[COC1]

Does your agency participate in the HUD Continuum of Care (CoC) program?

Yes [1]
No [2]
Don’t know [98]

[COC2]

Does your agency’s PATH program participate in the HUD Continuum of Care (CoC) program?

Yes [1]
No [2]
Don’t know [98]

[COC3]

Does your agency’s PATH program work with the CoCs to facilitate use of HMIS for PATH data collection?

Yes [1]
No [2]
Don’t know [98]

[COC4]

Does your agency’s PATH program work with the CoCs to facilitate timely service coordination?

Yes [1]
No [2]
Don’t know [98]

[COC5]

Is your agency’s PATH program required to collaborate with or work with your CoC?

Yes [1]
No [2]
Don’t know [98]

[COC6]

Does your agency’s PATH program participate in other local planning activities and program coordination initiatives, such as coordinated entry and coordinated assessments activities?

Yes [1] [Go to COC6]
No [2] [Go to COLLAB1]
Don’t know [98]

[COC7]

Is your agency’s PATH program required to participate in other local planning activities and program coordination initiatives, such as coordinated entry and coordinated assessments activities?

Yes [1]
No [2]
Don’t know [98]

MODULE F: COLLABORATION WITH OTHER ORGANIZATIONS

The next sets of questions ask about your organization’s collaboration with other local organizations that have been involved with the SAMHSA PATH program.

[COLLAB1]

Related to the SAMHSA PATH program, how often has your organization collaborated with other local organizations in each of the following areas?

	Never [1]	Rarely [2]	Sometimes [3]	Often [4]	Don’t know [8]
Social services providers [COLLAB1_1]	○	○	○	○	○
Drop-in centers [COLLAB1_2]	○	○	○	○	○
Medical (primary/specialized) care providers [COLLAB1_3]	○	○	○	○	○
Peers/consumers [COLLAB1_4]	○	○	○	○	○

[COLLAB2]

Related to the SAMHSA PATH program, how often has your organization collaborated with other local organizations in each of the following areas?

	Never [1]	Rarely [2]	Sometimes [3]	Often [4]	Don’t know [8]
Substance abuse treatment providers [COLLAB2_1]	○	○	○	○	○
State substance abuse authority [COLLAB2_2]	○	○	○	○	○
Mental health treatment providers [COLLAB2_3]	○	○	○	○	○
State mental health authority [COLLAB2_4]	○	○	○	○	○

[COLLAB3]

Related to the SAMHSA PATH program, how often has your organization collaborated with other local organizations in each of the following areas?

	Never [1]	Rarely [2]	Sometimes [3]	Often [4]	Don’t know [8]
Housing providers [COLLAB3_1]	○	○	○	○	○
State or local housing authority [COLLAB3_2]	○	○	○	○	○
Local continuum of care [COLLAB3_3]	○	○	○	○	○
Shelters [COLLAB3_4]	○	○	○	○	○

[COLLAB4]

Related to the SAMHSA PATH program, how often has your organization collaborated with other local organizations in each of the following areas?

	Never [1]	Rarely [2]	Sometimes [3]	Often [4]	Don’t know [8]
Education providers [COLLAB4_1]	○	○	○	○	○
Employment or job training providers [COLLAB4_2]	○	○	○	○	○
Veterans agencies [COLLAB4_3]	○	○	○	○	○
Criminal justice agencies [COLLAB4_4]	○	○	○	○	○
State Medicaid office [COLLAB4_5]	○	○	○	○	○
Family advocacy groups [COLLAB4_6]	○	○	○	○	○
Policy-makers/legislators [COLLAB4_7]	○	○	○	○	○
Research/evaluation [COLLAB4_8]	○	○	○	○	○

[PROGRAMMER NOTE: IF COLLAB1_1=3 OR 4, GET COLLAB5_1; IF COLLAB1_2=3 OR 4, GET COLLAB5_2; IF COLLAB1_3=3 OR 4, GET COLLAB5_3; IF COLLAB1_4=3 OR 4, GET COLLAB5_4; ELSE SKIP TO COLLAB6]

[COLLABINTRO5]

The next questions refer to the effectiveness of your organization’s collaboration with other local organizations.

[COLLAB5]

Related to the SAMHSA PATH program, how effective have your organization’s collaborations with the following local groups been in helping the SAMHSA PATH program achieve its intended outcomes?

	Not at all effective [1]	Slightly effective [2]	Moderately effective [3]	Very effective [4]	Don’t know [8]
Social services providers [COLLAB5_1]	○	○	○	○	○
Drop-in centers [COLLAB5_2]	○	○	○	○	○
Medical (primary/specialized) care providers [COLLAB5_3]	○	○	○	○	○
Peers/consumers [COLLAB5_4]	○	○	○	○	○

[PROGRAMMER NOTE: IF COLLAB2_1=3 OR 4, GET COLLAB6_1; IF COLLAB2_2=3 OR 4, GET COLLAB6_2; IF COLLAB2=3 OR 4, GET COLLAB6_3; IF COLLAB2_4=3 OR 4, GET COLLAB6_4; ELSE SKIP TO COLLAB7]

[COLLAB6]

Related to the SAMHSA PATH program, how effective have your organization’s collaborations with the following local groups been in helping the SAMHSA PATH program achieve its intended outcomes?

	Not at all effective [1]		Slightly effective [2]		Moderately effective [3]	Very effective [4]	Don’t know [8]
Substance abuse treatment providers [COLLAB6_1]		○		○	○	○	○
State substance abuse authority [COLLAB6_2]		○		○	○	○	○
Mental health treatment providers [COLLAB6_3]		○		○	○	○	○
State mental health authority [COLLAB6_4]		○		○	○	○	○

[PROGRAMMER NOTE: IF COLLAB3_1=3 OR 4, GET COLLAB7_1; IF COLLAB3_2=3 OR 4, GET COLLAB7_2; IF COLLAB3_3=3 OR 4, GET COLLAB7_3; IF COLLAB3_4=3 OR 4, GET COLLAB7_4; ELSE SKIP TO COLLAB8]

[COLLAB7]

Related to the SAMHSA PATH program, how effective have your organization’s collaborations with the following local groups been in helping the SAMHSA PATH program achieve its intended outcomes?

	Not at all effective [1]		Slightly effective [2]		Moderately effective [3]		Very effective [4]	Don’t know [8]
Housing providers [COLLAB7_1]		○		○		○	○	○
State or local housing authority [COLLAB7_2]		○		○		○	○	○
Local continuum of care [COLLAB7_3]		○		○		○	○	○
Shelters [COLLAB7_4]		○		○		○	○	○

[PROGRAMMER NOTE: IF COLLAB4_1=3 OR 4, GET COLLAB8_1; IF COLLAB4_2=3 OR 4, GET COLLAB8_2; IF COLLAB4_3=3 OR 4, GET COLLAB8_3; IF COLLAB4_4=3 OR 4, GET COLLAB8_4; IF COLLAB4_1=3 OR 4, GET COLLAB8_1; IF COLLAB4_2=3 OR 4, GET COLLAB8_2; IF COLLAB4_3=3 OR 4, GET COLLAB8_3; IF COLLAB4_4=3 OR 4, GET COLLAB8_4; ELSE SKIP TO COLLAB9]

[COLLAB8]

Related to the SAMHSA PATH program, how effective have your organization’s collaborations with the following local groups been in helping the SAMHSA PATH program achieve its intended outcomes?

	Not at all effective [1]		Slightly effective [2]		Moderately effective [3]		Very effective [4]	Don’t know [8]
Education providers [COLLAB8_1]		○		○		○	○	○
Employment or job training providers [COLLAB8_2]		○		○		○	○	○
Veterans agencies [COLLAB14_3]		○		○		○	○	○
Criminal justice agencies [COLLAB8_4]		○		○		○	○	○
State Medicaid office [COLLAB8_5]		○		○		○	○	○
Family advocacy groups [COLLAB8_6]		○		○		○	○	○
Policy-makers/legislators [COLLAB8_7]		○		○		○	○	○
Research/evaluation [COLLAB8_8]		○		○		○	○	○

The next set of questions asks about different types of collaboration with SAMHSA grant partners in 4 categories: (1) substance abuse or mental health treatment providers, (2) healthcare providers or agencies, (3) public housing authorities and/or housing providers, and (4) other types of organizations, for example criminal justice agencies, veterans affairs, or the local HUD Continuum of Care.

Please include collaboration with partners in your organization ONLY IF the partner works in a category different from your own; do not include collaboration with partners in your organization who work in your category. Include collaboration with partners from other organizations whether they work in your category or a different category.

[COLLAB9]

How often do you collaborate with one or more local substance abuse or mental health treatment provider partners to:

	Never [1]		Rarely [2]		Sometimes [3]		Often [4]	Don’t know [8]
Work with the partner to identify, recruit, and/or screen clients [COLLAB9_1]		○		○		○	○	○
Make referrals to the partner [COLLAB9_2]		○		○		○	○	○
Receive referrals from the partner [COLLAB9_3]		○		○		○	○	○
Exchange information on specific clients [COLLAB9_4]		○		○		○	○	○
Work together to implement HIT solutions to support effective coordination of care for the population(s) of focus [COLLAB9_5]		○		○		○	○	○
Collaborate on services for one or more individual clients [COLLAB9_6]		○		○		○	○	○
Plan coordinated approaches to serving the population(s) of focus [COLLAB9_7]		○		○		○	○	○
Plan coordinated approaches to funding current services for clients [COLLAB9_8]		○		○		○	○	○
Plan coordinated approaches to sustaining services for the population(s) of focus [COLLAB9_9]		○		○		○	○	○

[COLLAB10]

How often do you collaborate with one or more local healthcare provider partners to:

	Never [1]		Rarely [2]		Sometimes [3]		Often [4]	Don’t know [8]
Work with the partner to identify, recruit, and/or screen clients [COLLAB10_1]		○		○		○	○	○
Make referrals to the partner [COLLAB10_2]		○		○		○	○	○
Receive referrals from the partner [COLLAB10_3]		○		○		○	○	○
Exchange information on specific clients [COLLAB10_4]		○		○		○	○	○
Work together to implement HIT solutions to support effective coordination of care for the population(s) of focus [COLLAB10_5]		○		○		○	○	○
Collaborate on services for one or more individual clients [COLLAB10_6]		○		○		○	○	○
Plan coordinated approaches to serving the population(s) of focus [COLLAB10_7]		○		○		○	○	○
Plan coordinated approaches to funding current services for clients [COLLAB10_8]		○		○		○	○	○
Plan coordinated approaches to sustaining services for the population(s) of focus [COLLAB10_9]		○		○		○	○	○

[COLLAB11]

How often do you collaborate with one or more local public housing authority and/or housing provider partners to:

	Never [1]		Rarely [2]		Sometimes [3]		Often [4]	Don’t know [8]
Work with the partner to identify, recruit, and/or screen clients [COLLAB11_1]		○		○		○	○	○
Make referrals to the partner[COLLAB11_2]		○		○		○	○	○
Receive referrals from the partner [COLLAB11_3]		○		○		○	○	○
Exchange information on specific clients [COLLAB11_4]		○		○		○	○	○
Work together to implement HIT solutions to support effective coordination of care for the population(s) of focus [COLLAB11_5]		○		○		○	○	○
Collaborate on services for one or more individual clients [COLLAB11_6]		○		○		○	○	○
Plan coordinated approaches to serving the population(s) of focus [COLLAB11_7]		○		○		○	○	○
Plan coordinated approaches to funding current services for clients [COLLAB11_8]		○		○		○	○	○
Plan coordinated approaches to sustaining services for the population(s) of focus [COLLAB11_9]		○		○		○	○	○

[COLLAB12]

How often do you collaborate with one or more local [SELECTED OTHER] agencies or organizational partners to:

[PROGRAMMING NOTE: SELECT THE HIGHEST RATING AMONG COLLAB1_1, COLLAB1_2, COLLAB1_4, COLLAB4_1, COLLAB4_2, COLLAB4_3, COLLAB4_4, COLLAB4_5, COLLAB4_6, COLLAB4_7, AND COLLAB4_8; USE THAT LABEL IN “SELECTED OTHER” IMMEDIATELY ABOVE. IF TWO OR MORE RATINGS ARE TIED, RANDOMLY SAMPLE ONE OF THOSE WITH THE HIGHEST RATINGS.]

	Never [1]		Rarely [2]		Sometimes [3]		Often [4]	Don’t know [8]
Work with the partner to identify, recruit, and/or screen clients [COLLAB12_1]		○		○		○	○	○
Make referrals to the partner [COLLAB12_2]		○		○		○	○	○
Receive referrals from the partner [COLLAB12_3]		○		○		○	○	○
Exchange information on specific clients [COLLAB12_4]		○		○		○	○	○
Work together to implement HIT solutions to support effective coordination of care for the population(s) of focus [COLLAB12_5]		○		○		○	○	○
Collaborate on services for one or more individual clients [COLLAB12_6]		○		○		○	○	○
Plan coordinated approaches to serving the population(s) of focus [COLLAB12_7]		○		○		○	○	○
Plan coordinated approaches to funding current services for clients [COLLAB12_8]		○		○		○	○	○
Plan coordinated approaches to sustaining services for the population(s) of focus [COLLAB12_9]		○		○		○	○	○

The next set of questions asks about your perceptions of how your SAMHSA PATH team worked together.

[COLLAB13]

Please rate the frequency of each of the following.

	Never [1]		Rarely [2]		Sometimes [3]		Often [4]	Always [5]	Don’t know [8]
Team members discuss strategies to improve their working relationships. [COLLAB13_1]		○		○		○	○	○	○
The team works together to resolve problems among members. [COLLAB13_2]		○		○		○	○	○	○
The team incorporates feedback about its process to strengthen its effectiveness. [COLLAB13_3]		○		○		○	○	○	○
The team informally and/or formally evaluates how they work together. [COLLAB13_4]		○		○		○	○	○	○
Team members talk about similarities and differences among their professional roles in working with the grant population(s) of focus. [COLLAB13_5]		○		○		○	○	○	○
Members of the team address conflicts with each other directly. [COLLAB13_6]		○		○		○	○	○	○
The team discusses the degree to which each professional should be involved with particular clients. [COLLAB13_7]		○		○		○	○	○	○
Team members talk about ways to involve additional professionals with various expertise in the team. [COLLAB13_8]		○		○		○	○	○	○
There are ‘‘turf’’ issues among members of the team. [COLLAB13_9]		○		○		○	○	○	○

[COLLAB14]

Please rate the frequency of each of the following, using the scale: 1= never, 2 = rarely, 3 = sometimes, 4 = often and 5= always.

	Never [1]		Rarely [2]		Sometimes [3]		Often [4]		Always [5]		Don’t know [8]
The team does not welcome new ideas about how to help clients. [COLLAB14_1]		○		○		○		○		○	○
Team members respect one another even when they have different ideas about how to help clients. [COLLAB14_2]		○		○		○		○		○	○
The team has appropriate expectations of the roles of members in supporting clients. [COLLAB14_3]		○		○		○		○		○	○
The team respects the opinion and input of each member. [COLLAB14_4]		○		○		○		○		○	○
There is open communication among team members. [COLLAB14_5]		○		○		○		○		○	○
Team members focus on understanding the perspectives of others rather than defending their own specific opinions. [COLLAB14_6]		○		○		○		○		○	○
The team supports each member in his or her work with clients. [COLLAB14_7]		○		○		○		○		○	○
There is freedom to be different and disagree within the team. [COLLAB14_8]		○		○		○		○		○	○
New practices related to working with clients occur as a result of the diversity of ideas among team members. [COLLAB14_9]		○		○		○		○		○	○

[COLLAB15]

Please rate the frequency of each of the following, using the scale: 1= never, 2 = rarely, 3 = sometimes, 4 = often and 5= always.

	Never [1]		Rarely [2]		Sometimes [3]		Often [4]		Always [5]		Don’t know [8]
Working with team members who have multiple perspectives results in new programs available to help clients. [COLLAB15_1]		○		○		○		○		○	○
The roles and/or responsibilities of team members change as a result of teamwork. [COLLAB15_2]		○		○		○		○		○	○
As a result of working as a team, services/supports for clients are delivered in new ways. [COLLAB15_3]		○		○		○		○		○	○
Team members take on tasks outside their role when necessary. [COLLAB15_4]		○		○		○		○		○	○
The team depends on members with varying roles (e.g., mental health professional, case manager, housing specialist, etc.) to implement specific activities. [COLLAB15_5]		○		○		○		○		○	○
The team relies on members with varying roles (e.g., mental health professional, case manager, housing specialist, etc.) to accomplish its goals. [COLLAB15_6]		○		○		○		○		○	○
The team makes distinctions among the roles and responsibilities of each member. [COLLAB15_7]		○		○		○		○		○	○
The team consults with members who have a variety of perspectives about how to address the needs of clients. [COLLAB15_8]		○		○		○		○		○	○

MODULE G: IMPLEMENTATION OF THE SAMHSA PATH PROGRAM

The next questions are about local implementation of the SAMHSA PATH program.

[IMPL1]

Please indicate the extent to which you agree or disagree with the following statement about support for the SAMHSA PATH program from front line staff of partners in each of the following categories.

Support has been strong for the SAMHSA PATH program from front line staff at…

	Strongly Disagree [1]	Disagree [2]	Neither Agree nor Disagree [3]	Agree [4]	Strongly Agree [5]	Don’t know [8]
State/territory organization [IMPL1_1]
Housing partner(s) [IMPL1_2]
Substance abuse treatment partner(s) [IMPL1_3]
Mental health treatment partner(s) [IMPL1_4]
Healthcare partner(s) [IMPL1_5]

[IMPL2]

Please indicate the extent to which you agree or disagree with the following about support for the SAMHSA PATH program from the administration and management of partners in each of the following categories.

Support has been strong for the SAMHSA PATH program from the administration and management at …

[IMPL3]

Please indicate the extent to which you agree or disagree with the following statements about your organization's implementation of the SAMHSA PATH program.

The following statements refer to the implementation and operation of the SAMHSA PATH program.

[IMPL4]