Form B2 Attachment B2 - NHSC LRP Site Survey_FINAL 04.08.20

NHSC Site Survey OMB Number (0915-XXXX)

Expiration date (XX/XX/202X)

Note: The survey will start with a login page, followed by the Public Burden Statement, introduction, consent, and instructions. Then the survey will begin.

Public Burden Statement: This survey is intended to gather information from National Health Service Corps (NHSC) Sites. The information gathered will contribute to the Bureau of Health Workforce (BHW) Substance Use Disorder (SUD) Evaluation. 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 0915-XXXX and it is valid until XX/XX/202X. This information collection is voluntary. Public reporting burden for this collection of information is estimated to average 20 minutes 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].

Introduction/Consent:

Thank you for participating in our Survey of National Health Service Corps (NHSC) sites! We value your input.

Your responses will be kept confidential. For all of the data we collect for analysis, we will use unique survey identifiers, not respondents’ names. Any published reports will summarize the results in the aggregate and will not include individual responses. At the end of the evaluation, all of the data that are collected will be provided to the Health Resources and Services Administration (HRSA).

Instructions:

Please use the “Continue” and “Previous” buttons to navigate through the questions in the survey. You must use the "Continue" button on the screen after you have responded to a question in order for your answer to be saved. Please do not use your browser buttons.

To exit the survey at any time, use the “Quit” button at the top of each screen. Using the “Quit” button saves your data and allows you to return to the same location later to complete the survey.

Throughout this survey, the term “site” refers to all locations/facilities at which NHSC clinicians are placed at your organization.

We have provided definitions on certain terms throughout the survey. When available, you will see a question mark icon appear above a term where a definition is available. (OMB Reviewers: These definitions only appear at their first mention in this document to conserve space, but these definitions will be made available in the programmed web survey at every mention of the relevant term.)

Again, we greatly appreciate your time and participation. Let’s get started!

Preload variables required for survey administration:

Point of contact email address

NHSC site SUD designation

A. Background: Please tell us about your role at the site.

1. What is your role at your NHSC site?
   Please select ALL that apply.

[ ] Clinical provider

[ ] Medical/clinical director

[ ] Mental health administrator/office manager

[ ] Mental health department director
[ ] Human resources administrator
[ ] Chief Executive Officer, Chief Financial Officer, or some other administrator (you have significant responsibilities for the site operations and management)

[ ] Practice manager
[ ] Other: please specify _______________________

Now tell us more about the site itself.

2. Which of the following was the MAIN reason that your site chose to become an NHSC site?

[ ] To improve clinician recruitment

[ ] To improve clinician retention

[ ] To receive access to technical assistance

[ ] To expand services

[ ] To reduce costs

[ ] To improve service delivery

[ ] Other: please specify _______________________

[ ] Don’t know [DISALLOW IF ANOTHER OPTION SELECTED]

3. Were you aware that the NHSC Loan Repayment Program was expanded in FY2019 to include the Substance Use Disorder Loan Repayment Program and Rural Community Loan Repayment Program?

Please select ALL that apply or indicate that you were not aware.

[ ] Yes, I was aware of the expansion to include the Substance Use Disorder Loan Repayment Program

[ ] Yes, I was aware of the expansion to include the Rural Community Loan Repayment Program

[ ] No, I was not aware of these new Loan Repayment Programs [DISALLOW IF OTHER OPTIONS SELECTED]

4. [ASK IF ADMINISTRATIVE DATA INDICATE THE SITE IS NOT DESIGNATED AN NHSC SUBSTANCE USE DISORDER SITE]

Were you aware that NHSC sites could “opt-in” to become NHSC substance use disorder-approved sites?

[ ] Yes
[ ] No

5. Our records indicate that your site currently has an NHSC clinician who began their service in FY2019. Is this correct?

[ ] Yes

[ ] No

6. [ASK IF Q5=NO] Has your site ever had an NHSC clinician?

[ ] Yes

[ ] No

[ ] Don’t know

7. [ASK IF Q6=YES] When did your site last have an NHSC clinician?

[ ] Within the last six months

[ ] More than six months ago but within the last year

[ ] More than a year ago

[ ] Don’t know

B. Care Delivery: Next, we’ll ask about your site’s participation in the NHSC program and how service delivery changed after the NHSC substance use disorder/opioid expansion in October 2018. This is the expansion that allowed sites to “opt-in” to become NHSC substance use disorder-approved sites.

8. Has your site ever offered any of the following services?

Please check ALL that apply.

(HOVER OVER WEB FEATURE: Please note that the term “site” refers to any of the locations/facilities at which NHSC clinicians are placed at your organization.)

Behavioral health services

[ ] Screening and assessment for behavioral health disorders, such as Screening, Brief Intervention, and Referral to Treatment (SBIRT)

[ ] Development of treatment plans

[ ] Care coordination (i.e., integrating the efforts of different types of care providers)

[ ] Consultative services (i.e., collaborating with health care or social service providers)

[ ] Crisis/emergency services

[ ] Case management (i.e., assisting patients in gaining access to services)

Specific services for opioid use disorder and other substance use disorder patients

[ ] Diagnosis by a licensed professional (e.g., clinical drug and alcohol counselor or psychologist)

[ ] Substance use disorder treatment, excluding opioid use disorder treatment

[ ] Opioid use disorder treatment, excluding medication-assisted treatment (e.g., addiction counseling or cognitive behavioral therapy)

Note: Other terms for medication-assisted treatment (MAT) include medication for opioid use disorder (MOUD) and opioid agonist therapy (OAT). This survey uses MAT to cover all three terms.

[ ] Medication-assisted treatment for opioid use disorder (i.e., buprenorphine, methadone, or naltrexone)

[ ] None of the above [DISALLOW IF ANOTHER OPTION SELECTED]

9. [SKIP IF Q8=NONE OF THE ABOVE] How have your site’s services changed, if at all, since October 2018?

Please select a response for ALL rows.

Service	Added	Expanded	Reduced	No change	Don’t know
[AUTOPOPULATE WITH RESPONSES SELECTED IN Q8]

10. [ASK IF Q5=YES OR IF Q7=WITHIN THE LAST SIX MONTHS] Please report your best estimate of the approximate number of patients and patient encounters in the past SIX MONTHS among the NHSC clinicians at your site.

(HOVER OVER WEB FEATURE: Please note that the term “site” refers to any of the locations/facilities at which NHSC clinicians are placed at your organization. For sites with more than one location/facility, please provide an aggregate count.)

Please enter a number in EACH box, including zero if applicable, or select “Do not offer service” or “Don’t know.” [QC CHECK: ONLY ALLOW INTEGERS FOR FIRST TWO COLUMNS]

Service	Number of patients served [RANGE 0-10,000]	Number of patient encounters [RANGE 0-20,000]	Do not offer service [DISALLOW IF ANOTHER OPTION SELECTED]	Don’t know [DISALLOW IF ANOTHER OPTION SELECTED]
Primary Medical Care (HOVER OVER WEB FEATURE: Includes general primary care, family medicine, general internal medicine, general pediatrics, geriatrics, obstetrics/gynecology, women’s health)	N=	N=
Primary Behavioral Health Care
General Mental Health Care	N=	N=
General Substance Use Disorder Treatment	N=	N=
Medication-Assisted Treatment	N=	N-
Primary Behavioral Health Care: Opioid Treatment Program	N=	N=
Primary Dental Health Care (HOVER OVER WEB FEATURE: Includes general and pediatric dentistry)	N=	N=

11. [ASK IF N PROVIDED FOR ANY ROW IN Q10] What was the source for your responses to the previous question?

[ ] From a report or data analytics dashboard

[ ] Best guess

[ ] Other: please specify _______________________

12. What are CHALLENGES that you have faced in providing substance use disorder services at your site(s)?

Please select ALL that apply.

[ ] A lack of routine screening for substance use disorder

[ ] Limited treatment resources (e.g., referrals to counselors, detoxification programs)

[ ] Limited capacity to provide telehealth for substance use disorder

[ ] Limited time for one-on-one services

[ ] Limited number of trained staff

[ ] Limited space or poor infrastructure

[ ] Limited integration or coordination with primary health care services 

[ ] Limited access to opioid use disorder treatment options (including diagnosis by a licensed professional, addiction counseling, medication-assisted treatment) [IF THIS ITEM SELECTED, DISPLAY NEXT THREE OPTIONS AND “PLEASE SPECIFY WHICH SERVICES YOUR SITE LACKS.”]

[ ] Diagnosis by a licensed professional (e.g., clinical drug/alcohol counselor, psychologist)

[ ] Addiction counseling

[ ] Medication-assisted treatment (i.e., buprenorphine, methadone, or naltrexone)

[ ] Other: please specify_______________________

[ ] Insufficient team-based care

[ ] Other: please specify_______________________

[ ] No challenges [DISALLOW IF ANOTHER OPTION SELECTED]

C. Recruitment and Staffing: The next set of questions asks about recruitment of clinicians and staffing challenges.

13. How many staff (FTEs) currently provide care at your site? For sites with more than one location/facility, please provide an aggregate count. Please select a response for ALL columns.

	Primary Medical Care (HOVER OVER WEB FEATURE: Medical doctors (allopathic or osteopathic, all specialties), nurse practitioners/physician assistants, nurses, certified nurse-midwives, other medical support personnel)	Behavioral/Mental Health (HOVER OVER WEB FEATURE: Psychiatrists, psychologists, other licensed mental and behavioral health care providers (social workers, therapists, psychologists, counselors, psychiatric nurse specialists)	Dental (HOVER OVER WEB FEATURE: Dentists, dental hygienists, dental assistants, aides, technicians, and support personnel)
FTE [RANGE 0-100]	N=	N=	N=
	[ ] Don’t know	[ ] Don’t know	[ ] Don’t know

14. Has the NHSC designation helped your site attract qualified clinicians?

[ ] Yes
[ ] No

[ ] Don’t know

[ASK Q15 AND Q16 IF ADMINISTRATIVE DATA INDICATE THAT THE SITE IS A DESIGNATED NHSC SUBSTANCE USE DISORDER SITE]

15. Has the NHSC substance use disorder designation helped your site ATTRACT clinicians who can provide:

    1. Primary care services, excluding substance use disorder services?

[ ] Yes

[ ] No
[ ] Don’t know

1. Substance use disorder services, excluding opioid use disorder?

[ ] Yes

[ ] No

[ ] Don’t know

2. Opioid use disorder services?

[ ] Yes

[ ] No

[ ] Don’t know

16. [ASK IF Q5=YES OR IF Q6=YES] Has the NHSC substance use disorder designation helped your site RETAIN clinicians who can provide:

1. Primary care services, excluding substance use disorder services?

[ ] Yes

[ ] No
[ ] Don’t know

3. Substance use disorder services, excluding opioid use disorder?

[ ] Yes

[ ] No

[ ] Don’t know

2. Opioid use disorder services?

[ ] Yes

[ ] No

[ ] Don’t know

17. [ASK IF Q5=YES OR IF Q6=YES] Has the presence of an NHSC clinician at your site improved the retention of other staff and other health care providers?

[ ] Yes

[ ] No

[ ] Don’t know

18. In the past year, which resources have you used to recruit NHSC-eligible candidates?
    Please select ALL that apply.

[ ] Health Workforce Connector

[ ] Health Resources and Services Administration (HRSA) virtual job fair

[ ] Internal (site) postings

[ ] Social media

[ ] Other online recruitment sites: please specify_______________________

[ ] Other: please specify_______________________

[ ] We have not tried to recruit NHSC-eligible candidates in the past year. [DISALLOW IF ANOTHER OPTION SELECTED]

19. [SKIP Q19 IF ONLY ONE RESPONSE SELECTED AT Q18 OR IF Q18=“WE HAVE NOT TRIED TO RECRUIT NHSC-ELIGIBLE CANDIDATES IN THE PAST YEAR”] Which has been the most successful resource for recruiting NHSC-eligible candidates?
    
    
    

[AUTO POPULATE WITH RESPONSES FROM Q18]

[ ] No resource has been successful

[ ] Don’t know

20. Next, indicate whether or not you have been able to recruit each of the following types of professionals (both part-time and full-time) since October 2018.

Please provide a response for ALL rows.

Type of Professional	Successfully recruited	Unable to recruit	Did not attempt to recruit	Don’t know
Physician (osteopathic or allopathic)
Physician Assistant
Nurse Practitioner
Certified Nurse-Midwife
Psychiatric Nurse Specialist
Dentist
Dental Hygienist
Health Service Psychologist
Licensed Clinical Psychologist
Licensed Clinical Social Worker
Licensed Professional Counselor
Marriage and Family Therapist
Behavioral Health Professional
Substance Use Disorder Counselor/Licensed Clinical Alcohol and Drug Counselor
Registered Nurse
Pharmacist

21. [ASK IF Q5=YES OR IF Q6=YES] What types of incentives and/or supportive services are, or have been, offered to your NHSC clinician(s)?
    Please select ALL that apply.

[ ] Competitive salary

[ ] Leadership opportunities, such as being included in key practice decisions or policies

[ ] Flexible work hours

[ ] Time away for teaching and/or research responsibilities

[ ] Availability of mentorship or clinical supervision

[ ] Availability of team-based care

[ ] Professional development (e.g., continuing medical education, career guidance, conference support)

[ ] Pension or retirement plan

[ ] Bonuses or performance-based compensation

[ ] Other: please specify_______________________

[ ] No incentives/supportive services have been offered [DISALLOW IF ANOTHER OPTION SELECTED]

[ ] Don’t know [DISALLOW IF ANOTHER OPTION SELECTED]

22. [ASK IF Q5=YES OR IF Q6=YES] Have you experienced any challenges with RETENTION of NHSC clinicians after the completion of their service?

[ ] Yes

[ ] No

[ ] Don’t know

23. [ASK IF Q22=YES] What specific challenges have you faced with RETENTION of NHSC clinicians after the completion of their service?

Please select ALL that apply.

[ ] Low Medicaid/managed care organization payment rates

[ ] Lack of competitive salary or benefits (e.g., compensation package, health insurance)

[ ] Additional management burden stemming from supervisory responsibilities

[ ] Lack of internal mentoring system for clinicians

[ ] Lack of support staff to do care coordination or case management

[ ] Lack of opportunities for advancement

[ ] Lack of opportunities for distance learning

[ ] Community and/or lifestyle factors (e.g., limited social opportunities, family considerations, work/life balance)

[ ] Other: please specify_______________________

[ ] No challenges [DISALLOW IF ANOTHER OPTION SELECTED]

24. [ASK IF Q5=YES OR IF Q6=YES, AND IF MORE THAN ONE RESPONSE SELECTED FOR Q23]

Which has been the MAIN CHALLENGE you have faced with NHSC clinician RETENTION after their service period?

[AUTO POPULATE WITH RESPONSES FROM Q23]

[ ] Don’t know

25. [ASK IF Q5=YES OR IF Q6=YES] On average, how long have NHSC clinicians typically remained working at your site after they have completed their NHSC service obligation?

[ ] They typically leave our site immediately after their obligation is complete

[ ] Less than 1 year

[ ] At least 1 year but less than 3 years

[ ] At least 3 years but less than 5 years

[ ] 5 years or more
[ ] Don’t know

D. Technical Assistance Needs: The next questions ask about the types of technical assistance you have received and your experiences with care delivery, before and after the NHSC substance use disorder expansion.

26. [ASK IF Q5=YES OR IF Q6=YES] In which areas have NHSC clinicians received technical assistance at your site?

Please select ALL that apply.

[ ] Clinical issues (e.g., safety, quality)

[ ] Health-care financing (e.g., managed care payment)

[ ] Workforce development (e.g., building staff skills)

[ ] Site operations (e.g., board member engagement, strategic planning)

[ ] Health information technology and data (e.g., use of electronic health records)

[ ] Social determinants of health

[ ] Peer-to-peer learning

[ ] Health literacy among patients

[ ] Pandemic emergency preparedness

[ ] Other: please specify _______________________

[ ] None [DISALLOW IF ANOTHER OPTION SELECTED]

27. Has your site trained staff on how to reduce social stigma around behavioral health issues?

[ ] Yes

[ ] No

[ ] Don’t know

E. Patient Population: Next we would like to learn more about the patient population that you serve.

28. During the last six months, what percentage of your patients have used each of the following as their primary source of coverage?

For sites that have more than one location/facility, please provide an aggregate percentage across sites. Please enter a percentage for ALL rows.

Patient Coverage Source	% of Patients [RANGE CHECK 0-100/ITEM]	Don’t know
Uninsured (including charity care, out-of-pocket, sliding scale, self-pay)
Medicaid/Children’s Health Insurance Program (CHIP)/State-sponsored insurance plan
Medicare
Private insurance (including TRICARE, Veterans, and military)
Other: please specify____________________
[QC CHECK: REQUIRE TOTAL TO BE 100%]	=100%

29. [ASK IF PERCENTAGE PROVIDED FOR ANY ROW IN Q28] What was the source for your response(s) to the previous question?

[ ] From a report or data analytics dashboard

[ ] Best guess

[ ] Other: please specify _______________________

F. COVID-19 Pandemic: The final set of questions asks about your site’s experiences during the COVID-19 pandemic.

30. Which of the following did your NHSC site experience during the COVID-19 pandemic?

Please select ALL that apply.

[ ] Staff missed work due to self-isolation or quarantine

[ ] Site closed

[ ] Site reduced number of staff or staff hours

[ ] Administered COVID-19 testing

[ ] Provided more acute/urgent care visits, as opposed to well visits

[ ] Provided fewer patient visits overall (including all visit types)

[ ] Temporarily eliminated clinical service hours and permitted only administrative work

[ ] Provided more care via telehealth for primary care visits

[ ] Changed delivery of behavioral health services

[ ] Lack of capacity (e.g., hospital beds or staff resources) to meet patient demand

[ ] Limited availability of personal protective equipment (PPE)

[ ] Lack of emergency policies/protocols in place

[ ] Additional time spent on reporting requirements for COVID-19

[ ] Other: please specify _______________________

[ ] Did not experience any changes during the COVID-19 pandemic [DISALLOW IF ANOTHER OPTION SELECTED]

31. [ASK IF Q30 = CHANGED DELIVERY OF BEHAVIORAL HEALTH SERVICES] How did the delivery of behavioral health services change during the COVID-19 pandemic?

Please select ALL that apply.

[ ] Provided more substance use disorder services through telehealth

[ ] Delayed scheduling visits with new patients for substance use disorder services

[ ] Delayed scheduling routine follow-up visits with patients for substance use disorder services

[ ] Delayed toxicology testing for patients who are prescribed buprenorphine

[ ] Limited ability to provide mental health visits, excluding substance use disorder treatment (e.g., took time away from conducting these visits, or limited ability to schedule these visits)

[ ] Limited ability to provide substance use disorder services

[ ] Limited ability to provide opioid use disorder services, excluding medication-assisted treatment (i.e., buprenorphine, methadone, or naltrexone)

[ ] Limited ability to provide medication-assisted treatment

[ ] Other: please specify _______________________

32. Did you receive additional funding from HRSA or other federal agencies (e.g., Centers for Medicare & Medicaid Services) in spring 2020 to help your site respond to the COVID-19 pandemic?

[ ] Yes

[ ] No

[ ] Don’t know

33. [ASK IF Q32=YES] How did you use the additional funding?

Please select ALL that apply.

[ ] Increased testing for COVID-19

[ ] Acquired personal protective equipment (PPE)

[ ] Acquired medical supplies other than PPE

[ ] Improved telehealth capabilities

[ ] Provided safety education for staff

[ ] Provided overtime pay for staff

[ ] Other: please specify _______________________

[ ] Don’t know

Please click on the “Submit” button to submit your responses. Once submitted, your answers cannot be changed.

[END] Thank you for participating in our Survey of NHSC sites!

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