OMB No. 0930-0XXX
Expiration Date xx/xx/xxxx
Substance Abuse and Mental Health Services Administration (SAMHSA)
National Evaluation of SAMHSA’s PATH Program
PATH Telephone Interview Guide
[PREFILL]
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RESPONDENT ID NUMBER: |
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DATE OF INTERVIEW: |
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SAMHSA TI OR SM NUMBER: |
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Respondent Type:
State PATH Contact or other relevant staff
Intermediary Representative
PATH Provider, Director or other relevant staff
____________________________________________________________________________
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 program 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.
[READ VERBAL CONSENT FORM SCRIPT]
Introduction
Hello, my name is ______________ and I work with the National Evaluation of SAMHSA’s PATH Program. HSRI though a subcontract from RTI International is conducting the evaluation. I would like to talk to you about participating in the evaluation study.
About the Study
This interview is part of the data collection for a national evaluation effort to ensure that the grantee and local PATH programs are consistent with legislative requirements and to recommend changes to the program design and operation.
We are contacting SPCs and staff from Intermediaries and PATH provider organizations to get their perspectives on their PATH programs. You are one of 28 SPCs, 14 Intermediary staff, and 60 PATH provider staff project who may participate in telephone interviews. We are conducting telephone interviews with a sample of SPCs as well as with Intermediary and PATH provider staff, to explore facilitators and barriers encounter related to specific areas (i.e., outreaching and enrolling consumers and veterans into PATH, use of data, setting annual targets, collaboration with CoCs and other community resources, implementing SOAR, making and persons attaining service referrals). The information gather from the telephone interview will be helpful in making recommendations to program design and operation. These questions were approved by the Department of Health and Human Services, SAMHSA, CMHS.
Voluntary Participation and Privacy
Your participation in this interview is completely voluntary. You may refuse to answer any question in the interview and you may stop participating at any time.
All the information you provide in this interview 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. The interviewer will be entering your responses directly into a computer that will be password protected to prevent any unauthorized access. You will be assigned a participant ID number, and your name will not appear on this form; 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 telephone interview poses little risk to you. As is 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 SPCs, Intermediary and PATH Provider staff project like you will be aggregated and the results will help stakeholders, practitioners, policy makers, researchers, and funders learn more about the efforts of SAMHSA PATH Programs and factors contributing to their success. Results will help inform SAMHSA and future programs about what works.
Duration
This interview will take about 1 hour of your time, including the time for reviewing the consent form and instructions and completing the interview.
Questions
You are welcome to contact our office any time if you have questions about the interview or evaluation.
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.
Participant Agreement
By verbally agreeing to participate in this evaluation, you are not giving up any of your legal rights. Verbally agreeing to participate indicates that you have been read the information provided above, have received answers to your questions, and have freely decided to participate. Do you give your verbal consent to participate in this evaluation?
Did the respondent provide verbal consent to participate in the interview?
Yes
No
Consent to Audiotaping
With your permission, we would like to audiotape the interview to be used solely for ensuring that notes from the interviews are accurate, which will facilitate accurate data collection and analysis. Following the interview, we will review our notes and, if needed, reference the audiotape to be sure that we have accurately captured your responses. Once we have ensured the accuracy of your responses, the audio will be erased. Do you consent to the audiotaping of this interview?
Did the respondent provide consent to record the interview for note-taking purposes?
Yes
No
INTRODUCTION
[INTINTRO]
Thank you for taking the time to speak with me today for the National Evaluation of SAMHSA’s PATH Program State PATH Telephone Interview. The questions in this interview are about your knowledge of and experience with [NAME OF GRANTEE ORGANIZATION]’s PATH Program, part of the PATH SAMHSA Homeless Program.
Based on our review of other data available for your PATH program, we have selected specific modules for which to focus our discussion on. Those modules are:
[INTERVIEWER PREFILL MODULES TO BE DISCUSSED]
MODULE A: OUTREACH/CONTACTS BARRIERS AND LESSONS LEARNED
MODULE B: ELIGIBILITY BARRIERS AND LESSONS LEARNED
MODULE C: ENROLLMENT BARRIERS AND LESSONS LEARNED
MODULE D: OUTREACHING VETERANS BARRIERS AND LESSONS LEARNED
MODULE E: ENROLLING VETERANS BARRIERS AND LESSONS LEARNED
MODULE F: SOAR IMPLEMENTATION BARRIERS AND LESSONS LEARNED
MODULE G: SETTING ANNUAL TARGETS BARRIERS AND LESSONS LEARNED
MODULE H: COLLABORATION BARRIERS AND LESSONS LEARNED
MODULE I: DATA BARRIERS AND LESSONS LEARNED
MODULE J: MAKING SERVICE REFERRALS BARRIERS AND LESSONS LEARNED
MODULE K: PERSONS ATTAINING REFERRALS BARRIERS AND LESSONS LEARNED
MODULE A: OUTREACH/CONTACTS BARRIERS AND LESSONS LEARNED
MODULE B: ELIGIBILITY BARRIERS AND LESSONS LEARNED
MODULE C: ENROLLMENT BARRIERS AND LESSONS LEARNED
MODULE D: OUTREACHING VETERANS BARRIERS AND LESSONS LEARNED
MODULE E: ENROLLING VETERANS BARRIERS AND LESSONS LEARNED
MODULE F: SOAR IMPLEMENTATION BARRIERS AND LESSONS LEARNED
MODULE G: SETTING ANNUAL TARGETS BARRIERS AND LESSONS LEARNED
MODULE H: COLLABORATION BARRIERS AND LESSONS LEARNED
MODULE I: DATA BARRIERS AND LESSONS LEARNED
MODULE J: MAKING SERVICE REFERRALS BARRIERS AND LESSONS LEARNED
MODULE K: PERSONS ATTAINING REFERRALS BARRIERS AND LESSONS LEARNED
[READ CLOSING/THANK YOU SCRIPT]
If you have any questions or need to speak with someone about this National Evaluation of SAMHSA’s PATH Program or the PATH Telephone Interview, please contact Terry Camacho-Gonsalves, the Project Manager for the PATH evaluation at 1-617-844-2504 or by email at [email protected].
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | vmulkern |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |