RCORP-Psychostimulant Measures

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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 0906-0044 and is valid until 03/31/2025.  Public reporting burden for this collection of information is estimated to average 1.24 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.

SERVICE AREA AND CONSORTIUM

#
Measure Instructions
Measure
1
Identify the number and types of medical organizations and agencies in your consortium.  
    • Co-occurring mental and substance abuse treatment provider
    • Hospital - Critical Access Hospital (CAH)
    • Hospital - Small Rural (49 beds or less, non-CAH)
    • Hospital - Other (e.g., Sole Community, Rural Referral Center, etc.)
    • Emergency medical services entity
    • Federally Qualified Health Center (FQHC)
    • FQHC Look-alike
    • Local or state health department
    • Mental and behavioral health organization, practice, or provider
    • Mental health treatment provider – Community based organization
    • Mental health treatment provider – Licensed therapist
    • Mental health treatment provider – Psychiatrist / psychiatric services
    • Mental health treatment provider – Other
    • Primary care practice or provider
    • Rural Health Clinic
    • Ryan White HIV/AIDS clinic
    • Substance abuse treatment provider – Methadone clinic
    • Substance abuse treatment provider – Opioid treatment program (OTP) 
    • Substance abuse treatment provider – Other
    • Other medical agency or organization, Type 1- Specify:
    • Other medical agency or organization, Type 2- Specify
    • Other medical agency or organization, Type 3- Specify

2
Identify the number and types of social service and non-medical organizations and agencies in the consortium
    • Community-based organization
    • Cooperative extension system office
    • Criminal justice entity – Law enforcement
    • Criminal justice entity – Court system
    • Criminal justice entity - Prison
    • Criminal justice entity – Probation and parole
    • Faith-based organization
    • Healthy Start site
    • HIV and HCV prevention organization
    • Maternal, Infant, and Early Childhood Home Visiting Program local implementation agency
    • Poison Control Center
    • Primary Care Association (PCA)
    • Primary Care Organization (PCO)
    • Recovery Community Organization (RCO)
    • Research / Academic Organization
    • School system
    • Single State Agency (SSA)
    • State Office of Rural Health (SORH)
    • Tribe/Tribal organization
    • Other social service and non-medical agency or organization, Type 1- Specify
    • Other social service and non-medical agency or organization, Type 2- Specify
    • Other social service and non-medical agency or organization, Type 3- specify
3
Select the option that best describes your project’s service area
    • Single County
    • Multiple Counties
    • State	         
    • Multiple States       
    • National
4
Identify the State(s)/Territories and county/counties included in the project service area. Select from the 'States/Territories' and ‘Counties’ drop-down and then click on the 'Add' button and repeat if needed. Territories are listed at the bottom of the drop-down. Please note that only HRSA-designated rural counties should be included in your service area.
    • Dropdown for States/Territories
    • Dropdown for Counties 

5
Please report the total number of people that live in the project’s rural service area.
Total population in the project’s rural service area
6
Please report the total number of consortium meetings conducted in the current reporting period in which the majority (>75%) of members participated.
Total number of consortium meetings conducted in the current reporting period
7
Please report the total unduplicated number of service delivery sites within the consortium in the target rural service area offering at least one prevention, treatment and/or recovery service within the current reporting period.
Total number of unduplicated service delivery sites offering at least one prevention, 
treatment and/or recovery service

8
For each of the following services, please report the total number of service delivery sites within the consortium in the target rural service area that offered that service within the current reporting period.  If no service delivery sites offered the service, please input 0.
    • Prevention services (not including naloxone)
    • Screening and/or assessment services
    • Medication-Assisted Treatment (with or without psychosocial)
    • SUD/OUD treatment other than MAT
    • Infectious disease testing (i.e., HIV or HCV)
    • Recovery support services
    • Mental health treatment
    • Other - specify
9
Report the total unduplicated number of service delivery sites within the consortium in the target rural service area offering at least one harm reduction service within the current reporting period.
Total number of unduplicated service delivery sites offering at least one harm reduction service 

10
For each of the following harm reduction services, please report the total number of service delivery sites within the consortium in the target rural service area that offered that service within the current reporting period. If no service delivery sites offered the service, please input 0.
    • Naloxone access
    • Syringe services
    • Fentanyl test strips
    • Safe smoking kits
    • Sex worker services
    • Other - specify
11
For each service listed, select whether it was newly established with or without RCORP-Psychostimulant Support funds, expanded with or without RCORP-Psychostimulant Support funds, remained the same, or did not exist in the current reporting period (dropdown).
    • Prevention service (any except naloxone)
    • Screening and/or assessment service
    • MAT (with or without psychosocial therapy)
    • SUD/OUD treatment other than MAT
    • Mental health treatment
    • Infectious disease testing (i.e., HIV or HCV)
    • Recovery support services (any)
    • Harm reduction services (any)
    • Other – please specify
12
NOTE:  Sustainability measures only reported in final reporting period of the grant (Sept. 2024)
Will the consortium as a unit and/or at least one key consortium activity be sustained after the RCORP grant ends? 
    • Yes
    • No
13
If you selected yes in previous sub-section, what will sustain? (check all that apply)
    • Consortium as a unit
    • At least one key consortium activity
14
If you selected “At least one key consortium activity” in the previous sub-section how will the activity or activities be sustained?  (check all that apply)
    • Absorption of services or other means of in-kind support
    • Reimbursement by third party payers
    • RCORP grant funding
    • HRSA grant funding (not including RCORP grants)
    • 15Other grant funding (not including HRSA and RCORP grant funding)
    • Fees
    • Formulary funds
    • Other: please describe (text box)


DEMOGRAPHICS
These tables collect demographic information for all individuals who have received direct services for psychostimulant use disorder, within the current reporting period in the project’s rural service area. The total number of each sub-section should equal the total number of individuals who have received direct services within the current reporting period.  Each sub-section should total to the same amount. Please do not leave any sections blank or use N/A (not applicable) since the measures are applicable to all RCORP grantees providing direct services. If the number for a particular category is zero (0), please put zero in the appropriate section (e.g., if the total number that is Hispanic or Latino is zero (0), enter zero in that section). If data are incomplete or have other limitations, please enter the data you have, indicate the data have limitations, and explain those limitations in the comments box below.

#
Measure Instructions
Measure
15
Please report the number of individuals served, by ethnicity, during the current reporting period.
    • Hispanic or Latino
    • Not Hispanic or Latino
    • Unknown
    • Total
16
Please report the number of individuals served, by race, during the current reporting period.
    • American Indian or Alaska Native 
    • Asian 
    • Black or African American 
    • Native Hawaiian or Other Pacific Islander 
    • White 
    • More than one race
    • Unknown
    • Total
17
Please report the number of individuals served, by age, during the current reporting period.
    • 0-12
    • 13-17
    • 18-24
    • 25-34
    • 35-44
    • 45-54
    • 55-64
    • 65 and over
    • Total
18
Please report the number of individuals served, by insurance status, during the current reporting period.
    • Self-pay
    • None/Uninsured
    • Dual Eligible (covered by both Medicaid and Medicare)
    • Medicaid/CHIP only
    • Medicare only
    • Medicare plus supplemental
    • TriCARE
    • Other third party (e.g., privately insured)
    • Unknown
    • Total
19
Please report the number of individuals served, by sex, during the current reporting period.
    • Male
    • Female
    • Unknown
    • Total
20
Please report the number of individuals served, by LGBTQI+, during the current reporting period.
    • LGBTQI+
    • Non-LGBTQI+
    • Unknown
    • Total


DIRECT SERVICES

#
Measure Instructions
Measure
21
Please report the total number of individuals who have been screened for substance use disorder (SUD) in the current reporting period.
Number of individuals screened for SUD

22
Please report the total number of individuals who screened positive for SUD, or at risk for overuse/misuse, in the current reporting period. If known, please specify the number of individuals who screened positive for specific substances.  While individuals could screen positive for multiple substances, each subcategory should not exceed the total.
    • Total number of individuals who screened positive for alcohol or substance use
    • Number of individuals who screened positive for alcohol overuse/misuse (or at risk for this)
    • Number of individuals who screened positive for opioid overuse/misuse (or at risk of this)
    • Number of individuals who screened positive for psychostimulant overuse/misuse (or at risk of this)
    • Number of individuals who screened positive for other substance overuse/misuse (or at risk of this) (specify)
23
Please report the total number of individuals diagnosed with substance use disorder (SUD) in the current reporting period. If known, please specify the number of individuals who were diagnosed for specific SUDs. While individuals could be diagnosed with multiple SUDs, each subcategory should not exceed the total.
    • Total number of individuals diagnosed with an SUD
    • Number of individuals diagnosed with alcohol use disorder
    • Number of individuals diagnosed with opioid use disorder
    • Number of individuals diagnosed with psychostimulant use disorder
    • Number of individuals diagnosed with other SUD (specify)
24
Please report the total number of individuals with a positive screen and/or diagnosis of substance use disorder (SUD) who were referred to SUD treatment during the current reporting period.  
Number of individuals with a positive screen and/or an SUD diagnosis who were referred to SUD treatment

25
Please report the total number of individuals who have received contingency management services in the current reporting period.  
Number of individuals who received Contingency Management services for 
psychostimulant use disorder

26
Please report the total number of individuals who received an SUD treatment service other than contingency management in the current reporting period.
Number of individuals who received an SUD treatment service other than contingency management

27
Please report the total number of individuals who received recovery support services in the current reporting period.  
Number of individuals who received recovery support services
28
Please report the total number of individuals who have been screened for a mental health disorder in the current reporting period.  
Total number of individuals screened for a mental health disorder

29
Please report the total number of individuals who screened positive and/or had a mental health diagnosis who were referred to mental health treatment during the current reporting period.
Number of individuals who screened positive or had a mental health diagnosis who were referred to mental health treatment

30
Report the total number of individuals diagnosed with a mental health disorder in the current reporting period. If known, please specify the number of individuals who were diagnosed for a specific mental health disorder within the following subcategories. Each subcategory should not exceed the total.
    • Total number of individuals diagnosed with a mental health disorder
    • Number of individuals diagnosed with an anxiety disorder
    • Number of individuals diagnosed with a mood disorder (e.g., major depressive disorder)
    • Number of individuals diagnosed with a trauma- and stressor-related  disorder
    • Number of individuals diagnosed with an eating disorder
    • Number of individuals diagnosed with a psychotic disorder
    • Number of individuals diagnosed with a personality  disorder
    • Number of individuals diagnosed with other mental health disorder (specify)
31
Please report the total number of individuals who were tested for HIV during the current reporting period.
Number of individuals who were tested for HIV
32
Please report the total number of individuals who were tested for HCV during the current reporting period.
Number of individuals who were tested for HCV
33
Report the total number of individuals with a SUD and/or mental health diagnosis who were referred to support services during the current reporting period, by type of service.  While individuals could be referred to multiple services, each subcategory should not exceed the total.
    • Total number of individuals with an SUD and/or mental health diagnosis who were referred to support services
    • Number of individuals referred to childcare services
    • Number of individuals referred to employment services
    • Number of individuals referred to recovery housing services
    • Number of individuals referred to prenatal/postpartum care services
    • Number of individuals referred to transportation to treatment 
    • Number of individuals referred to trauma-informed services 
    • Other – specify



WORKFORCE

#
Measure Instructions
Measure
34
Please report the total number of unduplicated providers within the consortium who provided SUD/OUD treatment services, mental/behavioral health services, and/or recovery support services in the target rural service area in the current reporting period.  Of the total number of providers, please also report how many were newly hired with grant funds (e.g., their salary was paid for in full or in part with RCORP grant funds) during the current reporting period.
    • Total number of unduplicated providers (i.e., individuals)
    • Total number of providers newly hired with RCORP-Psychostimulant grant funds

35
Please report the total number of providers (i.e., individuals) within the consortium who have a Drug Addiction Treatment Act 2000 (DATA) Waiver to prescribe buprenorphine-containing products for medication-assisted  treatment (MAT) within the target rural service area
Total number of providers (i.e. individuals) who have a Drug Addiction Treatment Act 2000 (DATA) Waiver 

36
Please report the total number of providers (i.e. individuals) within the consortium who have prescribed medications used to treat OUD during the current reporting period.
Total number of providers (i.e. individuals) who have prescribed medications used to treat OUD
37
Please report the total number of providers (i.e., individuals) within the consortium who have provided SUD/OUD treatment services, including MAT, during the current reporting period in the target rural service area.  Of those providers, please specify how many were medical providers, non-medical counseling staff, peer recovery support specialists, or other (specify).
    • Total Number of Providers
    • Number of Medical Providers
    • Number of Non-Medical Counseling Staff
    • Number of Peer Recovery Support Specialists
    • Other – specify

38
Please report the total number of providers (i.e. individuals) within the consortium who have provided SUD/OUD treatment services other than MAT, during the current reporting period in the target rural service area.  Of those providers, please specify how many were medical providers, non-medical counseling staff, peer recovery support specialists, or other (specify).
    • Total Number of Providers
    • Number of Medical Providers
    • Number of Non-Medical Counseling Staff
    • Number of Peer Recovery Support Specialists
    • Other – specify

39
Please report the total number of providers (i.e., individuals) within the consortium who have provided recovery support services during the current reporting period in the target rural service area.
    • Total Number of Providers
    • Number of Medical Providers
    • Number of Non-Medical Counseling Staff
    • Number of Peer Recovery Support Specialists
    • Other – specify
40
Please report the total number of providers (i.e., individuals) who have provided mental/behavioral health treatment services during the current reporting period in the target rural service area. Of those providers, please specify how many were medical providers, non-medical counseling staff, peer recovery support specialists, or other (specify).
    • Total Number of Providers
    • Number of Medical Providers
    • Number of Non-Medical Counseling Staff
    • Number of Peer Recovery Support Specialists
    • Other – specify
41
Report the total number of SUD and/or mental health disorder trainings conducted in the current reporting period as a result of RCORP funding in the target rural service area. For each topic area, please provide the number of trainings in each category.
    • Number of ACES trainings
    • Number of contingency management trainings
    • Number of behavioral therapy trainings
    • Number of mental health first aid trainings
    • Number of Naloxone trainings
    • Number of Opioid prescribing guidelines trainings
    • Number of school-based evidence-based practices trainings
    • Number of stigma reduction trainings
    • Number of trauma-informed evidence-based practices trainings
    • Other - specify

PREVALENCE

#
Measure Instructions
Measure
42
Using the following scale, please indicate the degree to which non-fatal overdoses have changed within the current reporting period.
    • Significantly increased
    • Increased
    • Decreased
    • Significantly Decreased
    • No change
43
Using the following scale, please indicate the degree to which fatal overdoses have changed within the current reporting period.
    • Significantly increased
    • Increased
    • Decreased
    • Significantly Decreased
    • No change

OTHER