Attachment B2:
Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program Health Care Provider 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
April 2020
|
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 Health Care Provider 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, [insert program name]. 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 of maternal health care providers who are participating in [insert name of state]’s HRSA MDRBD program. The survey is designed to collect information on your experiences with the MDRBD program (e.g., assessing and treating behavioral health conditions, accessing behavioral health care services for your patients, capacity to address behavioral health conditions) and assist HRSA in future program implementation.
Survey Instructions: This online survey should take less than ten (10) minutes 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 note that your responses will remain private and are voluntary. 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.
About Your State’s Program and Helpful Terminology: Each state’s MDRBD program includes creating a clinical behavioral health consultation service; enrolling health care providers, such as yourself into the MDRBD program; and providing training on how to consult with the clinical behavioral health consultation service in your state and/or to provide behavioral health care in your practice. The questions that follow ask about your experiences obtaining training, clinical behavioral health consultation, referral, and community linkage information from your state’s MDRBD program and about your current practices for addressing behavioral health conditions in your pregnant and postpartum patients.
Please create a Unique Identifier for your survey to maintain the privacy of your responses and allow us to match your future survey responses.
How to create your Unique Identifier: Use the first two letters of your first name, the first two letters of your last name, and the month of your birthday. For example, for John Smith, born in May, the Unique Identifier would be JOSM05.
In the last 12 months, how often have you managed treatment for the following behavioral health conditions?
|
Never |
Rarely |
Sometimes |
Often |
Always |
Depressive Disorder |
o |
o |
o |
o |
o |
Anxiety Disorder |
o |
o |
o |
o |
o |
Bipolar Disorder |
o |
o |
o |
o |
o |
Substance Use Disorder (SUD) |
o |
o |
o |
o |
o |
Concomitant Medical and Behavioral Health Condition |
o |
o |
o |
o |
o |
In the last 12 months, how did you receive training from the MDRBD program? Select all that apply.
In-person training event (if selected, go to question 3)
Webinar (if selected, go to question 3)
Self-study with program resources (if selected, go to question 3)
Video conferencing (if selected, go to question 3)
Learning collaborative (e.g., Project ECHO, Project REACH) (if selected, go to question 3)
Other (specify) (if selected, go to question 3)
Did not participate in trainings (if selected, go to question 4)
In the last 12 months, in how many MDRBD program trainings did you participate?
1-2 trainings
3-5 trainings
6-7 trainings
8+ trainings
In the last 12 months, have you contacted the MDRBD clinical behavioral health consultation service?
Yes (if yes, go to question 5)
No (if no go to question 11)
In the last 12 months, what were the most common reasons you contacted the MDRBD clinical behavioral health consultation service? Select three.
Interpret screening results
Determine appropriate assessment steps
Assist with diagnosis
Immediately manage patient safety
Help with referrals
Initiate pharmacotherapy
Discontinue pharmacotherapy
Determine pharmacotherapy effectiveness
Adjust pharmacotherapy to improve effectiveness
Adjust treatment due to change in status
Other (specify)
What patient issue(s) prompted you to contact the MDRBD clinical behavioral health consultation service? Select all that apply.
Comorbid medical conditions
Behavioral health conditions
High-risk pregnancy
Housing or food insecurity
Intimate partner violence
Complications at delivery
Premature birth
Substance-exposed infant
Social determinants of health/family environment
Other (specify)
In the last 12 months, how frequently did you interact with the MDRBD clinical behavioral health consultation service using the following methods?
Method of Interaction |
Never |
Rarely |
Sometimes |
Often |
Always |
o |
o |
o |
o |
o |
|
Screensharing |
o |
o |
o |
o |
o |
Telephone (terrestrial and/or wireless communications) |
o |
o |
o |
o |
o |
Text messaging |
o |
o |
o |
o |
o |
Video conferencing |
o |
o |
o |
o |
o |
Face-to-Face |
o |
o |
o |
o |
o |
Other (specify) |
o |
o |
o |
o |
o |
I prefer to interact with the MDRBD clinical behavioral health consultation service via: Select one.
Screensharing
Telephone (terrestrial and/or wireless communications)
Text messaging
Video conferencing
Face-to-Face
Other (specify)
I can readily obtain input from the MDRBD clinical behavioral health consultation service when I have questions.
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
In the last 12 months, my interaction with the MDRBD clinical behavioral health consultation service informed my:
|
Strongly Disagree |
Disagree |
Neither Agree or Disagree |
Agree |
Strongly Agree |
N/A |
Assessments of pregnant or postpartum patients |
o |
o |
o |
o |
o |
o |
Formulations of a diagnoses |
o |
o |
o |
o |
o |
o |
Use of pharmacotherapy |
o |
o |
o |
o |
o |
o |
Referrals to social services |
o |
o |
o |
o |
o |
o |
Referrals to counseling services |
o |
o |
o |
o |
o |
o |
In the last 12 months, as a result of the MDRBD program, more of my pregnant and postpartum patients received treatment (e.g., counseling, medication) for a behavioral health condition either in my office or from a behavioral health clinician.
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
In the last 12 months, my interaction with the MDRBD program increased my pregnant and postpartum patients’ use of services in the community to support their behavioral health.
|
Strongly Disagree |
Disagree |
Neither Agree or Disagree |
Agree |
Strongly Agree |
N/A |
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 |
What clinical practices have you adopted as a result of participation in the MDRBD program?
[OPEN-ENDED RESPONSE]
Overall, how have your pregnant and post-partum patients benefited from your participation in the MDRBD program?
[OPEN-ENDED RESPONSE]
Currently, what additional assistance do you still need to improve the behavioral health of your pregnant and postpartum patients?
[OPEN-ENDED RESPONSE]
What behavioral health screening tool(s) do you administer, interpret, or act upon? Select all that apply.
4 Ps/4 Ps Plus/5 Ps
ASSIST/Modified ASSIST
AUDIT
DAST
EPDS
GAD-7
OFWBA
PASS-3
PHQ-2
PHQ-9
T-ACE
TWEAK
Other (specify)
What behavioral health interventions do you personally provide? Select all that apply.
I am as comfortable assessing and treating pregnant and postpartum patients with common behavioral health conditions as I am assessing and treating common medical conditions in pregnant and postpartum patients.
Strongly Disagree
Disagree
Neither Agree or Disagree
Agree
Strongly Agree
What type of health care provider are you?
Obstetrician/Gynecologist
Family physician
Pediatrician
Advanced practice nurse/nurse practitioner/nurse midwife
Physician assistant
Other (specify)
Which best describes your primary clinical practice site? Choose one option.
University-based practice
Non-academic, hospital-based practice
Emergency department
Managed care organization
Private practice
Community health center/Federally Qualified Health Center
Other (specify)
In what setting(s) does your patient population live? Select all that apply.
Urban, inner city
Urban, non-inner city
Suburban
Rural
Frontier
Please provide the ZIP code for the primary location in which you practice.
Including yourself, how many providers (including physicians, advanced practices nurses, nurse midwives, and physician assistants) work in your practice?
1 (just myself)
2 – 5
6 – 10
≥ 11
What is your ethnicity? Choose one option.
Hispanic or Latino
Not Hispanic or Latino
What is your race? Select all that apply.
Black or African American
White
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaskan Native
Other
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 | 2022-06-20 |