Attachment B4:
Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program Practice-Level Survey
HRSA Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access and Screening and Treatment for Maternal Depression and Related Behavioral Disorders Programs Project
December 2019
Public Burden Statement: This data collection will provide the Health Resources and Services Administration with information to guide future program and policy decisions regarding increasing health care providers’ (i.e., physicians, nurse practitioners, physician assistants, nurse midwives, and other health care professionals) capacity to address patients’ behavioral health and access to behavioral health services. 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 information collection is 0906-XXXX and it is valid until XX/XX/202X. This information collection is voluntary. The current project will fully comply with the Privacy Act of 1974 (5 U.S.C. Section 552a, 1998; https://www.justice.gov/opcl/privacy-act-1974). The Privacy Act may apply to some data collection activities (e.g., the study will collect email addresses from some respondents). Public reporting burden for this collection of information is estimated to average xx hours per response, including the time for reviewing instructions, searching existing data sources, 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 HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or [email protected].
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HRSA Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access and Screening and Treatment for Maternal Depression and Related Behavioral Disorders Programs Project
Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program Practice-Level Survey
Funding for data collection supported by the Maternal and Child Health Bureau (MCHB) Health Resources and Services Administration (HRSA) U.S. Department of Health and Human Services |
HRSA funded [insert name of state] to implement a Screening and Treatment for Maternal Depression and Related Behavioral Disorders (MDRBD) program, [insert program name]. HRSA also funded JBS International, Inc. (JBS) to conduct an outcome and impact evaluation of the Maternal and Child Health Bureau (MCHB) MDRBD program (hereafter referred to as the HRSA MCHB evaluation). JBS is an independent evaluator of the program and is not part of HRSA or any other federal agency.
Survey Purpose: As part of the HRSA MCHB evaluation, we are conducting a survey of practices that have providers who are participating in [insert name of state]’s HRSA MDRBD program. The survey is designed to collect information on your practice’s experiences with the MDRBD program (e.g., assessing and treating behavioral health conditions, accessing behavioral health care services for your practice’s patients, and capacity to address behavioral health conditions) and assist HRSA in future program implementation.
Survey Instructions: This online survey should take less than fifteen (15) minutes for you to complete. Please answer based on your current practice and understanding, unless otherwise indicated. There are no right or wrong answers to the survey questions. Please note that your responses will remain private and are voluntary. Survey results will be reported to HRSA in the aggregate and no identifying information will appear in the evaluation reports without your prior approval. No identifiable data will be provided to HRSA.
About Your State’s Program and Helpful Terminology: Each state’s MDRBD program includes creating a clinical behavioral health consultation service; enrolling health care providers and practices into the program; and providing training on how to consult with the clinical behavioral health consultation service in your state and/or to provide behavioral health care in your practice. For the purposes of this survey, behavioral health encompasses both mental health and associated disorders as well as substance use disorders and staff refers to all staff in your practice – not just physicians. In addition, health care provider refers to primary care providers, not behavioral health providers.
Please create a Unique Identifier for your survey to maintain the privacy of your responses and allow us to match your future survey responses.
How to create your practice’s Unique Identifier: Use your state abbreviation, last three digits of your practice’s ZIP code, and first two letters of your practice name. For example, for the Good Health practice located in Ohio in the ZIP code 44101, the Unique Identifier would be OH101GO.
Does your practice screen for behavioral health conditions among pregnant and postpartum patients?
Yes (if yes, go to question 1a)
No (if no, go to question 4)
Question 1a: If yes, when does your practice screen for behavioral health conditions? Select all that apply.
First trimester
Second trimester
Third trimester
Postpartum
Provider discretion
Patient complaint
Other (specify)
What behavioral health screening tool(s) are used in your practice? Select all that apply.
4 Ps/4 Ps Plus/5 Ps
ASSIST/Modified ASSIST
AUDIT
DAST
EPDS
GAD-7
OFWBA
PASS-3
PHQ-2
PHQ-9
T-ACE
TWEAK
Other (specify)
Which staff administer behavioral health screening tools in your practice? Select all that apply.
Obstetricians/Gynecologists
Pediatricians
Family physicians
Nurse midwives/Advanced practice nurses/Nurse practitioners
Physician assistants
Registered nurses
Licensed practical nurses
Medical assistants
Not applicable – self-administered by patient
Other (specify)
In the last 12 months, what changes has your practice made as a result of participating in the MDRBD program? Select all that apply.
Screen more patients
Adopt screening instrument(s)
Refer more patients to specialty behavioral health treatment
Provide behavioral health treatment (e.g., counseling, medication) in your practice
Coordinate care with behavioral health clinicians
Build professional relationship(s) with community-based service providers
Refer more patients to community-based service providers
In the last 12 months, as a result of the MDRBD program, more pregnant and postpartum patients of your practice are…
|
Strongly Disagree |
Disagree |
Neither Agree or Disagree |
Agree |
Strongly Agree |
N/A |
Screened for behavioral health conditions |
o |
o |
o |
o |
o |
o |
Referred for behavioral health conditions |
o |
o |
o |
o |
o |
o |
Treated for behavioral health conditions |
o |
o |
o |
o |
o |
o |
In the last 12 months, approximately what percentage of pregnant and postpartum patients were seen for complaints related to a behavioral health condition?
0%
1 – 25%
26 – 50%
51 – 75%
76 – 100%
In the last 12 months, approximately what percentage of pregnant and postpartum patients received treatment for a behavioral health condition by one or more of the health care providers in your practice?
0%
1 – 25%
26 – 50%
51 – 75%
76 – 100%
As a result of the MDRBD program, the practice is better able to meet the needs of pregnant and postpartum patients with behavioral health conditions.
As a result of the MDRBD program, the continuum of care available for pregnant and postpartum patients with behavioral health conditions has improved.
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
Practice staff access the MDRBD clinical behavioral health consultation service via: (Select all that apply.)
Screensharing
Telephone (terrestrial and/or wireless communications)
Text messaging
Video conferencing
Other (specify)
How easy was it for your practice to incorporate these telehealth mechanism(s) listed above for consulting with the MDRBD clinical behavioral health consultation service?
Very Easy
Easy
Neutral
Difficult
Very Difficult
How does your practice identify community resources to link your patients to? Select all that apply.
MDRBD Program facilitates linkages.
The practice is approached by service providers in the community.
Providers or staff at the practice build a professional relationship with community service providers.
Community coalitions or governmental entities facilitated.
Other (specify)
As a result of the MDRBD program, the practice has established linkages with the following types types of community resources, programs, or services. Select all that apply.
Counseling
Childcare
Employment/job-seeking training
Food programs
Housing support
Parenting support
Support groups
Transportation support
Education support
Other (specify)
With what percentage of these community linkage partners did your practice establish memoranda of understanding?
What additional costs have been incurred by the practice because of changes related to behavioral health care for pregnant and postpartum patients?
[OPEN-ENDED RESPONSE]
How does your practice expect to cover these costs?
[OPEN-ENDED RESPONSE]
Which one factor did you expect would be most challenging in implementing screening, assessment, and treatment for behavioral health conditions in your practice?
Provider/staff acceptance
Communication and coordination
Institutional policies
Leadership and support from a clinician champion
Staffing
Reimbursement by payers
Telehealth technology
Workflow
Staff knowledge and skills
Other (specify)
Which one factor actually presented the greatest challenge to implementing screening, assessment, and treatment of behavioral health conditions in your practice?
Provider/staff acceptance
Communication and coordination
Institutional policies
Leadership and support from a clinician champion
Staffing
Reimbursement by payers
Telehealth technology
Workflow
Staff knowledge and skills
Other (specify)
Which one factor do you expect will be most challenging in sustaining screening, assessment and treatment for behavioral health conditions in your practice when grant-funded support is no longer available?
Provider/staff acceptance
Communication and coordination
Institutional policies
Leadership and support from a clinician champion
Staffing
Reimbursement by payers
Telehealth technology
Workflow
Staff knowledge and skills
Other (specify)
How does your practice disseminate information about practice changes related to behavioral health care to pregnant and postpartum patients? Select all that apply.
Brochures/Briefs
Email/E-blasts
Individual provider communications with patients
Newsletters
Posters/Infographics
Social media
Videos
Websites
Other (specify)
Where does your staff to receive behavioral health training? Select all that apply.
State licensing board
Professional organization
MDRBD program training
Other publicly funded training
Other (specify)
How do staff access training in behavioral health care through the MDRBD program? Select all that apply.
In-person training event
Webinar
Self-study with program resources
Video conferencing
Learning Collaborative (e.g., Project ECHO, Project REACH)
No staff have been trained through the MDRBD program
Other (specify)
How often do staff participate in trainings through the MDRBD program?
Monthly
Quarterly
Bi-Annually
Annually
No staff have been trained through the MDRBD program
Other (specify)
What other behavioral health care training resources are utilized by your staff?
[OPEN-ENDED RESPONSE]
Which best describes your primary clinical practice site?
University-based practice
Non-academic, hospital-based practice
Emergency department
Managed care organization
Private practice
Community health center/Federally Qualified Health Center
Other (specify)
How would you describe your practice setting?
Urban, inner city
Urban, non-inner city/suburban
Rural
Please provide the ZIP code in which your practice is located. If your practice has multiple locations, please indicate the ZIP code for the primary location.
[OPEN-ENDED RESPONSE]
Is your practice in a federally designated medically underserved area?
Yes
No
Do not know
Is your practice in a federally designated rural area?
Yes
No
Do not know
What types of clinical and support staff work in your practice? Select all that apply.
Obstetricians/Gynecologists
Family physicians
Pediatricians
Nurse midwives/Advanced practice nurses/Nurse practitioners
Physician assistants
Registered nurses
Licensed practical nurses
Medical assistants
Social workers
Other (specify)
How many health care providers work in your practice?
1
2 – 5
6 – 10
≥ 11
What is the ethnicity mix for pregnant and postpartum patients in your practice? Assign approximate percentage to all that apply.
Hispanic or Latino ____%
Not Hispanic or Latino ____%
What is the race mix for pregnant and postpartum patients in your practice? Assign approximate percentage to all that apply.
Black or African American ____%s
White ____%
Asian ____%
Native Hawaiian or Other Pacific Islander ____%
American Indian or Alaskan Native ____%
Other ____%
What is the payer mix for pregnant and postpartum patients in your practice? Assign approximate percentage to all that apply.
Medicaid ____%
Medicare ____%
Commercial ____%
Sliding fee scale/self-pay ____%
What is your current employment position?
[OPEN-ENDED RESPONSE]
How long have you been in this position?
[OPEN-ENDED RESPONSE]
What else would you like to share with HRSA about the MDRBD program?
[OPEN-ENDED RESPONSE]
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Veronica Junghahn |
| File Modified | 0000-00-00 |
| File Created | 2021-01-14 |