Form Provider Survey Qu Provider Survey Qu Provider Survey Questionnaire 7/21/2021

OMB No. 0930-XXXX

Expiration Date: MM/DD/YYYY

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-XXXX. Public reporting burden for this collection of information is estimated to average 15 minutes 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-, Rockville, Maryland, 20857

Survey Instrument

2021 Survey of Clinical Behavioral Health Workforce Providers

Licensure and Training

1) Which of the following professional licenses do you currently hold? (Check all that apply)

[ ] Licensed Psychologist

[ ] Licensed Clinical Social Worker

[ ] Licensed Marriage and Family Therapist

[ ] Licensed Professional Counselor or Licensed Mental Health Counselor (e.g. LPC, LMHC, LCPC, LPCC, LCMHC, LMHP, etc.)

[ ] Licensed Addiction Counselor (e.g. LADC, LSDC, etc.)

[ ] Other (please specify): _______________________________________________

2) Do you hold any additional professional certifications in substance use disorder counseling?

( ) Yes (please list certifications): __________________________________________

( ) No

( ) Other (please specify): ________________________________________________

3) In what state(s) or territory(ies) are you currently licensed as a {display options selected from Question #1}? (Check all that apply)

[ ] Alabama

[ ] Alaska

[ ] American Samoa

[ ] Arizona

[ ] Arkansas

[ ] California

[ ] Colorado

[ ] Connecticut

[ ] Delaware

[ ] District of Columbia

[ ] Florida

[ ] Georgia

[ ] Guam

[ ] Hawaii

[ ] Idaho

[ ] Illinois

[ ] Indiana

[ ] Iowa

[ ] Kansas

[ ] Kentucky

[ ] Louisiana

[ ] Maine

[ ] Maryland

[ ] Massachusetts

[ ] Michigan

[ ] Minnesota

[ ] Mississippi

[ ] Missouri

[ ] Montana

[ ] Nebraska

[ ] Nevada

[ ] New Hampshire

[ ] New Jersey

[ ] New Mexico

[ ] New York

[ ] North Carolina

[ ] North Dakota

[ ] Northern Mariana Islands

[ ] Ohio

[ ] Oklahoma

[ ] Oregon

[ ] Pennsylvania

[ ] Puerto Rico

[ ] Rhode Island

[ ] South Carolina

[ ] South Dakota

[ ] Tennessee

[ ] Texas

[ ] Utah

[ ] U.S. Virgin Islands

[ ] Vermont

[ ] Virginia

[ ] Washington

[ ] West Virginia

[ ] Wisconsin

[ ] Wyoming

4) Are you currently providing behavioral health treatment or services to clients in a position that requires a professional license?  

( ) Yes

( ) No

Logic: Hidden unless: Question “Are you currently seeing behavioral health clients in a position that requires a professional license?” #4 is one of the following answers (“No”).

5) What best describes your current practice status?

( ) Actively providing services to behavioral health clients in a position that does not require a professional license

( ) Working in the field of behavioral health but not seeing clients

( ) Actively working in a field other than behavioral health

( ) Retired

( ) Temporarily out of practice

( ) Other (please specify): ________________________________________________

6) What is your highest educational degree?  

( ) Doctorate in Counseling (PhD, EdD)

( ) Doctorate in Marriage and Family Therapy (PhD, DMFT, EdD)

( ) Doctorate in Psychology (PhD, PsyD, EdD)

( ) Doctorate in Social Work (PhD, DSW, EdD)

( ) Masters in Counseling

( ) Masters in Marriage and Family Therapy

( ) Masters in Psychology

( ) Master of Social Work

( ) Other (please specify): ________________________________________________

7) In what year did you complete your highest earned degree? (YYYY)

________________________________________________________________

8) In what state or territory did you complete your highest educational degree?

( ) Alabama

( ) Alaska

( ) Arizona

( ) Arkansas

( ) California

( ) Colorado

( ) Connecticut

( ) Delaware

( ) District of Columbia

( ) Florida

( ) Guam

( ) Georgia

( ) Hawaii

( ) Idaho

( ) Illinois

( ) Indiana

( ) Iowa

( ) Kansas

( ) Kentucky

( ) Louisiana

( ) Maine

( ) Maryland

( ) Massachusetts

( ) Michigan

( ) Minnesota

( ) Mississippi

( ) Missouri

( ) Montana

( ) Nebraska

( ) Nevada

( ) New Hampshire

( ) New Jersey

( ) New Mexico

( ) New York

( ) North Carolina

( ) North Dakota

( ) Ohio

( ) Oklahoma

( ) Oregon

( ) Pennsylvania

( ) Puerto Rico

( ) Rhode Island

( ) South Carolina

( ) South Dakota

( ) Tennessee

( ) Texas

( ) Utah

( ) U.S. Virgin Islands

( ) Vermont

( ) Virginia

( ) Washington

( ) West Virginia

( ) Wisconsin

( ) Wyoming

( ) Outside United States

Focus of Practice

When answering the following questions about the focus of your practice, please think about a typical week and across all locations/positions if you work in more than one.

9) With which client populations do you primarily work in a typical week? (Check all that apply)

a) Client age groups:

[ ] Children (ages 5-11)

[ ] Adolescents (ages 12-17)

[ ] Adults (ages 18-64)

[ ] Seniors (older adults aged 65+)

[ ] No specific age groups

b) Client racial and ethnic groups:

[ ] American Indian or Alaska Native

[ ] Asian or Asian American

[ ] Black or African American

[ ] Hispanic, Latino/a, or Spanish origin

[ ] Native Hawaiian or Other Pacific Islander

[ ] White

[ ] Other (please specify) ________________________________________________

[ ] No specific racial/ethnic populations

C) In a typical week, do you see any of the following special populations? (Check all that apply)

[ ] Immigrants

[ ] Individuals experiencing homelessness

[ ] Individuals for whom English is a second language

[ ] Individuals with developmental disabilities

[ ] Individuals with justice-involvement (currently or formerly)

[ ] Individuals with low socioeconomic status

[ ] LGBTQ

[ ] Military Service Members and dependents

[ ] Pregnant/postpartum women

[ ] Rural/agricultural

[ ] Veterans

[ ] Other (please specify) ________________________________________________

[ ] No special populations

10) What behavioral health services do you provide in a typical week? (Check all that apply)

[ ] Applied behavioral analysis

[ ] Assertive community treatment (ACT)

[ ] Care coordination

[ ] Case management

[ ] Crisis stabilization

[ ] Discharge planning services

[ ] Diversion and jail-based services

[ ] Family therapy

[ ] Group therapy

[ ] Health home

[ ] Home and community-based services

[ ] Individual counseling

[ ] Integrated health care services or collaborative care

[ ] Intensive outpatient treatment (IOT) or intensive outpatient program (IOP)

[ ] Medication assisted treatment (MAT)

[ ] Medication management/reconciliation

[ ] Opioid Treatment Program (OTP)

[ ] Outpatient behavioral health services

[ ] Partial hospitalization program (PHP)

[ ] Peer support services

[ ] Prescribe medications

[ ] Psychological assessment

[ ] Psychological diagnosis

[ ] Psychological screening/testing

[ ] Substance use treatment services

[ ] Support and recovery services

[ ] Other (please specify): ________________________________________________

11) On average, how many clients do you see in a typical week (across all locations/positions if more than one)?  

( ) Clients/Week ________________________________________________

12) What types of insurance do you accept? (Check all that apply)

[ ] Medicaid

[ ] Medicare

[ ] Commercial insurance

[ ] TRICARE (Military/DOD)

[ ] Other Federal insurance (VA, CHAMPVA)

[ ] Self-pay

[ ] Other (please specify): ________________________________________________

[ ] Do not take insurance

13) What is the average number of hours you spend per week on each major job activity (across all positions/locations if more than one)? Please provide your best estimate.  

	Number of Hours Per Week
Direct client care/clinical services	________________
Clinical supervision	________________
Care coordination/case management (including work with other human/social support services such as local housing, job support and social networks)	________________
Other (e.g. research, administration)	________________

14) What was your annual income in 2020 (across all locations/positions if more than one)? (in US$)

( ) Less than $40,000

( ) $40,000 - $54,999

( ) $55,000 - $69,999

( ) $70,000 - $84,999

( ) $85,000 - $99,999

( ) $100,000 - $114,999

( ) $115,000 - $129,999

( ) $130,000 - $144,999

( ) $145,000 - $159,999

( ) $160,000 or more

( ) Prefer not to answer

Practice Setting

15) Which of the following best describes your current employment arrangement at your primary practice location? (Where you spend the most time)

( ) Contracted by organization

( ) Employed directly by organization

( ) Self employed

( ) Volunteer, intern, or trainee

16) What is the treatment focus of your primary practice location? 

( ) Mental Health

( ) Substance Use Disorder

( ) Integrated Mental Health and Substance Use Disorder (MH/SUD)

( ) Primary Care

( ) Integrated MH/SUD and Primary Care

( ) Other (please specify): ________________________________________________

17) Which of the following best describes your primary practice setting? (Where you spend the most time)

OUTPATIENT/AMBULATORY FACILITY

( ) Certified community behavioral health clinic

( ) Community health center or clinic

( ) Community mental health center or clinic

( ) Physicians' office or other outpatient clinic

( ) Private practice (including home office or other setting)

( ) Psychiatric rehabilitation facility (stand-alone)

( ) Rural health clinic

( ) Substance use disorder treatment center (including withdrawal management)

INPATIENT, RESIDENTIAL, OR LONG-TERM CARE FACILITY

( ) Inpatient psychiatric or addiction treatment hospital

( ) Academic medical center

( ) Community hospital

( ) Residential treatment facility (e.g. group home, supportive housing for individuals with mental illness, transitional housing)

( ) Long term care facility or nursing home

( ) Long-term acute care facility (LTAC)

( ) Crisis residential facility

( ) Hospice or palliative care facility

( ) Rehabilitation facility

OTHER SETTING

( ) Academic department at a college or university

( ) Criminal justice system

( ) Government agency (e.g. child welfare agency, social service agency, veterans, etc.)

( ) Managed care organization

( ) School (pre-K, elementary, middle, or high school)

( ) Student health or counseling center at a college or university

( ) Other (please specify): ________________________________________________

18) What is the zip code of your primary practice location? (5 digits)

________________________________________________________________

19) Do you use telehealth/telemedicine as part of your job responsibilities? 

( ) Yes, starting before COVID-19 pandemic

( ) Yes, starting during/after COVID-19 pandemic

( ) No

20) Were you ever furloughed or did you otherwise stop seeing clients due to the COVID-19 pandemic?

( ) Yes, was temporarily furloughed but am now back in practice

( ) Yes, am currently furloughed or laid off but hope to resume practice soon

( ) Yes, permanently left practice as a result of pandemic

( ) No, but significantly reduced client activity during pandemic

( ) No, and my client activity significantly increased due to pandemic

( ) No change in practice activity due to pandemic.

21) Do you expect to retire in the next 12 months?  

( ) Yes

( ) No

( ) Don’t know

Career Satisfaction

22) How would you rate your overall satisfaction with your career? 

( ) Very satisfied

( ) Somewhat satisfied

( ) Neither satisfied nor dissatisfied

( ) Somewhat dissatisfied

( ) Very dissatisfied

23) Overall, based on your definition of burnout, how would you rate your level of burnout?

( ) I enjoy my work. I have no symptoms of burnout.

( ) Occasionally I am under stress and I don’t always have as much energy as I once did, but I don’t feel burned out.

( ) I am definitely burning out and have one or more symptoms of burnout, such as physical and emotional exhaustion.

( ) The symptoms of burnout that I am experiencing won’t go away.  I think about frustration at work a lot.

( ) I feel completely burned out and often wonder if I can go on. I am at a point where I may need some changes or may need to seek some sort of help.

Demographics

24) What is your birth year? (YYYY)

________________________________________________________________

25) How would you describe your race/ethnicity? (Check all that apply) 

[ ] American Indian or Alaska Native

[ ] Asian

[ ] Black or African American

[ ] Hispanic or Latino

[ ] Native Hawaiian or Other Pacific Islander

[ ] White

[ ] Other (please specify) ________________________________________________

[ ] Decline to answer

26) What is your gender?

( ) Female

( ) Male

( ) Prefer to self-describe as: ________________________________________________

( ) Decline to answer

27) Do you consider yourself to be:   

( ) Bisexual

( ) Gay or lesbian

( ) Heterosexual or straight

( ) Different identity (please state): ________________________________________________

( ) Decline to answer

28) Do you have a National Provider Identification (NPI) number? 
NPI is a unique 10-digit identification number issued to health care providers in the U.S. by the Centers for Medicare & Medicaid Services.

( ) Yes

( ) No

( ) Don’t know

Thank you for participating in this important survey. Your responses will provide critical insight into the workforce caring for individuals with mental health and substance use disorders.