Attachment B6:
Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program
Program Implementation 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
|
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 Program Implementation 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 |
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].
HRSA funded [insert name of state] to implement a Screening and Treatment for Maternal Depression and Related Behavioral Disorders (MDRBD) program. HRSA also funded JBS International, Inc. (JBS) to conduct an outcome and impact evaluation of the 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 to learn more about the implementation of [insert name of state]’s HRSA MDRBD program. The survey is designed to collect information on your experiences with the MDRBD program (e.g., program implementation activities, health care provider enrollment, health care provider training, behavioral health service delivery, care coordination support, community linkages, sustainability) and assist HRSA in future program implementation.
Survey Instructions: This online survey should take twenty (20) minutes or less 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 feel free to consult with your colleagues to gather information, as necessary, to complete this survey. Please note that your responses will remain private. 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.
What is your current employment position?
[OPEN-ENDED RESPONSE]
How long have you been in this position?
[OPEN-ENDED RESPONSE]
What is your project role in your MDRBD program?
Project Director
Principal Investigator
Program Manger
Other (specify)
How many provider FTEs, by provider type, are funded by this HRSA-funded cooperative agreement for your clinical behavioral health consultation service? For example, if two psychiatrists are funded, the first at 1 FTE and the second at .5 FTE, indicate 2 in the Number column and 1.5 in the FTE column.
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Number |
FTE |
Psychiatrists |
|
|
Psychologists |
|
|
Advanced practice nurses |
|
|
Social workers |
|
|
Licensed mental health counselors |
|
|
Substance use disorder counselors |
|
|
Case coordinators |
|
|
Other (specify) |
|
|
Are you enrolling health care practices or individual health care providers into your MDRBD program? Select one.
Only health care practices (If selected, move on to Question 6)
Only individual health care providers (If selected, move on to Question 8)
Both health care practices and individual health care providers (If selected, move on to Question 6)
How many health care practices have been enrolled in your MDRBD program to date?
[OPEN-ENDED RESPONSE]
What type(s) of health care practices have been enrolled in your MDRBD program to date? Select all that apply.
University-based practice(s)
Non-academic, hospital-based practice(s)
Emergency department(s)
Managed care organization(s)
Private practice(s)
Community health center(s)/Federally Qualified Health Center(s)
Other (specify)
How many individual health care providers have been enrolled in your MDRBD program to date?
[OPEN-ENDED RESPONSE]
How many and what types of health professionals have enrolled in your MDRBD program to date? Assign approximate number to all that apply.
Obstetricians/Gynecologists ______
Pediatricians ______
Family physicians ______
Nurse midwives/Advance practice nurses/nurse practitioners ______
Physician assistants ______
Medical assistants ______
Nurses ______
Social workers ______
Other (specify) ______
How many health professionals have been trained by your MDRBD program to date (e.g., via Webinar, in-person trainings)?
[OPEN-ENDED RESPONSE]
What factor(s) facilitated your implementation of health professional training? Select all that apply.
Provider acceptance
Ability to offer Continuing Medical Education (CME)/Continuing Education (CE) credits
Champion support
Participant engagement
Scheduling
Length of training/training sessions
Training format
Training promotion
Other (specify)
What challenges did you encounter while implementing health professional training? Select all that apply.
Lack of provider acceptance
Inability to offer CME/CE credits
Infrastructure challenges (e.g., facilities, technology, staffing)
Lack of champion support
Lack of participant engagement
Scheduling
Length of training/training sessions
Training format
Training promotion
Other (specify)
[Note: This question will only be asked in Option Year 1.] When did you begin implementing clinical behavioral health consultation in your MDRBD program?
[RESPONSE TO BE PROVIDED IN MONTH/YEAR FORMAT]
What telehealth mechanism(s) do you use in your MDRBD program for clinical behavioral health consultation? Select all that apply.
Screensharing
Telephone (terrestrial and/or wireless communications)
Text messaging
Video conferencing
Other (specify)
[Note: This question will only be asked in Option Year 1.] When did you begin implementing care coordination support (i.e., communication/collaboration, accessing resources, referral services) in your MDRBD program?
[RESPONSE TO BE PROVIDED IN MONTH/YEAR FORMAT]
What telehealth mechanism(s) do you use in your MDRBD program for care coordination support? Select all that apply.
Screensharing
Telephone (terrestrial and/or wireless communications)
Text messaging
Video conferencing
Other (specify)
What types of community linkages has your MDRBD program established to support behavioral health care? Select all that apply.
Counseling
Childcare
Employment/job-seeking training
Food programs
Housing support
Parenting support
Support groups
Transportation support
Education support
Other (specify)
To what extent is your MDRBD program using the established community linkages?
Not at all
To a small extent
To a moderate extent
To a great extent
To a very great extent
How was the process of establishing the following community linkages?
|
Very difficult |
Difficult |
Neutral |
Easy |
Very easy |
N/A |
Counseling |
o |
o |
o |
o |
o |
o |
Childcare |
o |
o |
o |
o |
o |
o |
Employment/job-seeking training |
o |
o |
o |
o |
o |
o |
Food programs |
o |
o |
o |
o |
o |
o |
Housing support |
o |
o |
o |
o |
o |
o |
Parenting support |
o |
o |
o |
o |
o |
o |
Support groups |
o |
o |
o |
o |
o |
o |
Transportation support |
o |
o |
o |
o |
o |
o |
Education support |
o |
o |
o |
o |
o |
o |
Other (specify) |
o |
o |
o |
o |
o |
o |
To whom does your MDRBD program disseminate information about program services? Select all that apply.
Health care providers
Behavioral health care providers
Patients
Partners
Public
Other (specify)
How are you promoting your MDRBD program? Select all that apply.
Brochures/Briefs
Conferences/Workgroup presentations
Email/E-blasts
Newsletters
Posters/Infographics
Social media
Videos
Websites
Other (specify)
Did your state have funding in place to support activities similar to your MDRBD program prior to receiving HRSA cooperative agreement funding?
Yes
No
Do not know
Since receiving HRSA cooperative agreement funding, has your state received other funding to support MDRBD program activities?
Yes (If yes, move on to Question 24).
No (If no, move on to Question 25).
What additional funding have you received for your MDRBD program? Select all that apply.
Medicaid
Third-party payer reimbursement
Other federal funding
State budget allocation
State/tribal/jurisdiction grants
Foundation/nonprofit organization grants
Other (specify)
Do you have a sustainability plan for funding for your MDRBD program once HRSA cooperative agreement funding ends?
Yes
No
How do you anticipate supporting your MDRBD program once HRSA cooperative agreement funding ends? Select all that apply.
Medicaid
Third-party payer reimbursement
Other federal funding
State budget allocation
State/tribal/jurisdiction grants
Foundation/nonprofit organization grants
Other (specify)
What factors have facilitated your program implementation? Select all that apply.
Health care provider recruitment
Health care provider engagement
Stakeholder communication and coordination
Champion support
Telehealth technology
Workflow
Data collection/reporting
Advisory Committee involvement
Other (specify)
What factors have challenged your program implementation? Select all that apply.
Health care provider recruitment
Health care provider engagement
Stakeholder communication and coordination
Champion support
Telehealth technology
Workflow
Data collection/reporting
Advisory Committee involvement
Other (specify)
Will your MDRBD program require any of the following evaluation capacity-building support or technical assistance in the upcoming year? Select all that apply.
Program evaluation design refinement
Development of data collection tools/instruments
Collection and reporting of HRSA-required measures
Provider training evaluation
Data analysis
Dissemination of evaluation results
Other (specify)
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 |