0704-0553_Clinical Support Tools Survey_11.02.21. V2

CST USER SURVEY
Survey Text and Questions.
Introduction Text:
You have been invited to complete this survey because you have used and ordered one or more of the Clinical
Support Tools (CSTs) housed on the PHCoE’s and MEDCOM’s websites.
This voluntary feedback survey has been created to assess your satisfaction with on the value and use of various
CSTs. Along with the monthly number of ordered CSTs from MEDCOM’s website. Data provided by the
survey will help answer questions regarding utilization and perception of CSTs as part of a Post-Implementation
Review effort to determine the effectiveness of CSTs in meeting user needs, and to identify opportunities for
improving CSTs.
Please complete the survey below and provide your candid feedback. All responses will be anonymous and not
shared with anyone outside the PHCoE Review Team.
Thank you for taking the time to provide your feedback.
CONTROL NUMBER: 0704-0553
OMB EXPIRATION DATE: XX/XX/XXXX

AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0704-0553 is estimated to average 15 minutes
per response, 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 the burden estimate or burden reduction suggestions to the Department of Defense, Washington
Headquarters Services, at [email protected]. Respondents should
be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to
comply with a collection of information if it does not display a currently valid OMB control number.

CLINICAL SUPPORT TOOL (CST) FEEDBACK QUESTIONNAIRE
Question 1:
What is your age? (Below 17; 17-24; 25-34; 35-44; 45-54; 55-64; 65-74; 75 years or older)
Question 2:
What is the highest degree or level of school you have completed? (No High school diploma; High school
diploma or GED; Some college; Associates degree; Bachelor’s degree; Master’s degree; Professional Degree
(JD, MD, etc); Doctoral degree (PhD, EdD, etc))
Question 3:
In what capacity are you using this product? (Service member; Family of a Service member; Veterans; Medical
Healthcare Provider; Behavioral Health Provider; Researchers; Other; NA)

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Question 4:
Do you work in the Military Health System (MHS)? (Yes/No/Uncertain)
A. If yes: What military organization are you a member of? (Army; Air force; Navy; Marines; Coast
Guard; US Public Health; Department of Health Affairs; Other)
B. If yes: What job category do you best fit into in the MHS? (Active Duty military; Retiree; National
Guard/Reserve; Government Civilian/Contractor; Other; NA)
a. If they select ADM: How long have you been in the military? (Less than 1 year; 1-5; 6-10;
11-15; 16-20; 21+; NA)
Question 5:
What product did you order, download, or use MOST RECENTLY? (Please select from the following list)
General Tools
_____ Psychological Health Clinical Support Tools Brochure

_____
_____
_____
_____
_____
_____
_____
_____

Depression
Management of MDD Patient Guide
Management of MDD Pocket Card
Depression: Fast Facts for Families
Understanding Depression: A Resource for Providers and Patients
VA/DoD Clinical Practice Guidelines Summary
Taking control of depression
Dyslipidemia Patient Poster
Dyslipidemia Provider Poster

_____
_____
_____
_____
_____
_____
_____
_____

PTSD
Management of PTSD and ASD 2017
Recommended Medication for the Treatment of PTSD (PHCoE website only)
A Patient's Guide: Understanding PTSD and ASD
A Family's Guide to PTSD (Understanding PTSD Family Guide)
PTSD and ASD Pocket Card
PTSD and ASD Pocket Guide
Health Care Provider's Guide to Trauma-informed Care
PTS Clinical practice guideline summary

_____
_____
_____
_____
_____
_____
_____
_____
_____

Suicide
Assessment and Management of Patients at Risk for Suicide
Suicide Prevention: Risk Factors and Warning Signs for Family Members and Caregivers (Family
Guide)
A guide for Military and Veteran Families
Patient safety plan worksheet
Safety Plan Worksheet
Safety plan worksheet (digital version)
Safety Plan worksheet: Brief Instructions for Providers
Crisis Response Plan
Lethal Means Counseling: Recommendations for Providers

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_____
_____
_____
_____
_____
_____

Reducing Access to Firearms: A suicide Prevention Guide for Military Leaders
Suicide Risk Provider Pocket Guide
Suicide Prevention Pocket Card
Guide summary
Suicide Prevention: Overcoming suicidal Thoughts and Feelings
Suicide Prevention trifold

_____
_____
_____
_____
_____
_____
_____

Opioid
Opioid Therapy Pocket (Patient) Guide
Opioid Therapy Provider Pocket Guide
Patient Information Guide: Long-Term opioid Therapy for Chronic Pain
Managing Side Effects and Complications of Opioid Therapy for Chronic Pain
Opioid Therapy for Chronic Pain Pocket Guide
Opioid Therapy Summary Guideline VA/DoD
Tapering and Discontinuing Opioids

_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____

SUD
Management of SUD (2015)
SUD Affects Families
Is Your Body Ready for Pregnancy? Pregnancy and SU: It's Not Worth The Risk
Medications for the Treatment of AUD
Screening and Treatment Pocket Card
SUD Pocket Cards (A&B)
Stabilization Pocket Card
SUD: What line Leaders Need to Know
Alcohol Misuse: Facts about risky drinking fact sheet
Standard Drink Calculator Guide
VA/DoD Clinical Practice Guidelines Summary
Anger Management for substance abuse and mental health clients
Managing Chronic pain in Adults with SUD/SAMHSA
Buprenorphine in the treatment of Opioid Addiction

Insomnia
_____ Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea- Pocket Card
Pregnancy
_____ Management of Pregnancy- Pocket Card

Question 6:
What other product have you ordered, downloaded, or used? (Please select from the following list)
General Tools
_____ Psychological Health Clinical Support Tools Brochure

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CST CRD/V1.0

_____
_____
_____
_____
_____
_____
_____
_____

Depression
Management of MDD Patient Guide
Management of MDD Pocket Card
Depression: Fast Facts for Families
Understanding Depression: A Resource for Providers and Patients
VA/DoD Clinical Practice Guidelines Summary
Taking control of depression
Dyslipidemia Patient Poster
Dyslipidemia Provider Poster

_____
_____
_____
_____
_____
_____
_____
_____

PTSD
Management of PTSD and ASD 2017
Recommended Medication for the Treatment of PTSD (PHCoE website only)
A Patient's Guide: Understanding PTSD and ASD
A Family's Guide to PTSD (Understanding PTSD Family Guide)
PTSD and ASD Pocket Card
PTSD and ASD Pocket Guide
Health Care Provider's Guide to Trauma-informed Care
PTS Clinical practice guideline summary

Suicide
_____ Assessment and Management of Patients at Risk for Suicide
Suicide Prevention: Risk Factors and Warning Signs for Family Members and Caregivers (Family
_____ Guide)
_____ A guide for Military and Veteran Families
_____ Patient safety plan worksheet
_____ Safety Plan Worksheet
_____ Safety plan worksheet (digital version)
_____ Safety Plan worksheet: Brief Instructions for Providers
_____ Crisis Response Plan
_____ Lethal Means Counseling: Recommendations for Providers
_____ Reducing Access to Firearms: A suicide Prevention Guide for Military Leaders
_____ Suicide Risk Provider Pocket Guide
_____ Suicide Prevention Pocket Card
_____ Guide summary
_____ Suicide Prevention: Overcoming suicidal Thoughts and Feelings
_____ Suicide Prevention trifold

_____
_____
_____
_____
_____
_____
_____

Opioid
Opioid Therapy Pocket (Patient) Guide
Opioid Therapy Provider Pocket Guide
Patient Information Guide: Long-Term opioid Therapy for Chronic Pain
Managing Side Effects and Complications of Opioid Therapy for Chronic Pain
Opioid Therapy for Chronic Pain Pocket Guide
Opioid Therapy Summary Guideline VA/DoD
Tapering and Discontinuing Opioids

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UNCLASSIFIED // FOR OFFICIAL USE ONLY

CST CRD/V1.0

_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____

SUD
Management of SUD (2015)
SUD Affects Families
Is Your Body Ready for Pregnancy? Pregnancy and SU: It's Not Worth The Risk
Medications for the Treatment of AUD
Screening and Treatment Pocket Card
SUD Pocket Cards (A&B)
Stabilization Pocket Card
SUD: What line Leaders Need to Know
Alcohol Misuse: Facts about risky drinking fact sheet
Standard Drink Calculator Guide
VA/DoD Clinical Practice Guidelines Summary
Anger Management for substance abuse and mental health clients
Managing Chronic pain in Adults with SUD/SAMHSA
Buprenorphine in the treatment of Opioid Addiction

Insomnia
_____ Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea- Pocket Card
Pregnancy
_____ Management of Pregnancy- Pocket Card
Question 7:
Who did you order or download this Brochure products from: (PHCoE; MEDCOM; VA)
Question 8:
How did you learn about this product? (Conference; Colleague; DHA social media; VA social media;
MEDCOM social media; DHA website; Factsheet VA website; MEDCOM website; DHA presentation; VA
presentation; MEDCOM presentation; Email from community of interest; Family member/friend;
Flier/advertisement; Internet; Journal; Link in website; Newsletter; Professional organization; Provider;
Training/webinar; Word of mouth; other)

Likert Scale for all of the below:
Strongly agree; Agree; Neither agree nor disagree; Disagree; Strongly disagree; NA
Question 9:
It is easy to access the product online: (Strongly agree; Agree; Neither agree nor disagree; Disagree; Strongly
disagree; NA)

Question 10:
It is easy to order or download the product: (Strongly agree; Agree; Neither agree nor disagree; Disagree;
Strongly disagree; NA)

Question 11:
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The product is formatted for easy reference: (Strongly agree; Agree; Neither agree nor disagree; Disagree;
Strongly disagree; NA)
Question 12:
The product content is easy to understand: (Strongly agree; Agree; Neither agree nor disagree; Disagree;
Strongly disagree; NA)
Question 13:
I learned new information from the material: (Strongly agree; Agree; Neither agree nor disagree; Disagree;
Strongly disagree; NA)

QUESTIONS FOR PROVIDERS ONLY
Question 14:
Please rate how much you agree that the product has contributed to your professional effectiveness and ability
to execute the following:
a. Treat and/or manage my patients: (Strongly agree; Agree; Neither agree nor disagree; Disagree;
Strongly disagree; NA)
b. Manage my clinical practice: (Strongly agree; Agree; Neither agree nor disagree; Disagree; Strongly
disagree; NA)
c. Communicate with patients: (Strongly agree; Agree; Neither agree nor disagree; Disagree; Strongly
disagree; NA)
d. Patient’s communication with their family about their condition: (Strongly agree; Agree; Neither agree
nor disagree; Disagree; Strongly disagree; NA)
Question 15:
This product has helped improve my patient care. (Strongly agree; Agree; Neither agree nor disagree;
Disagree; Strongly disagree; NA)
Question 16:
This product was useful to use in my practice. (Strongly agree; Agree; Neither agree nor disagree; Disagree;
Strongly disagree; NA)
Question 17:
This product has positively affected patient outcome or my professional performance in the following ways.
(Strongly agree; Agree; Neither agree nor disagree; Disagree; Strongly disagree; NA)
Question 18:
My knowledge of the content in this product has increased after reading it. (Strongly agree; Agree; Neither
agree nor disagree; Disagree; Strongly disagree; NA)

Question 19:
My patient’s knowledge of the content in this product has increased after reading it. (Strongly agree; Agree;
Neither agree nor disagree; Disagree; Strongly disagree; NA)

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QUESTIONS FOR ALL SURVEY PARTICIPANTS:
Question 20:
In the past 30 days, how often did you refer or use this product? (Daily; A few times a week; Once or twice;
Never; NA)
Question 21:
Please rate how likely you are to use this product again: (Very Likely; Likely; Not sure; Unlikely; Very unlikely;
NA)
A. (For ‘Not sure’ to ‘very unlikely’responses) What would make you more likely to use this product?
(Free text)
Question 22:
How likely are you to recommend this product to someone else: (Very Likely; Likely; Not sure; Unlikely; Very
unlikely; NA)
Question 23:
Please rate your overall satisfaction with this product: (Very satisfied; Satisfied; Neutral; Dissatisfied; Very
dissatisfied; NA)
Question 24:
What did you like about this product? (Easy to understand; Relevant information; Good format; Graphics;
Resource links; Relevant to my work; Other (Free text))
Question 25:
What would you change about this product? (Format; Language; Organization; Content; Graphics; Resource
links; Make available online; Nothing to change; Other (Free text))
Question 26:
Please provide recommendations to improve this product? (Other (Free text))
Question 27:
Please provide suggestions for new products to accompany and/or enhance your treatment services. (Free text)

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