NSSSP Instrument 2024+
[NCHHSTP] National Syringe Services Program (SSP) Evaluation
Att 7a_NSSSP Instrument 2024+_final
National Syringe Services Program Evaluation
OMB: 0920-1359
Page
Public reporting burden of this collection of information is estimated to average 35 minutes per survey, including the time for reviewing instructions, administering questions and entering responses. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-1359);
Form Approved
OMB No. 0920-1359
Expiration: 12/31/2024
Thank you for taking the time to complete this survey. We know that you are incredibly busy, and we have worked hard to design a set of questions that accurately captures the current experience of syringe services programs (SSPs) throughout the country. Your participation will help us tell these stories more accurately.
When answering questions, please refer to the period from [DATE], to [DATE] unless otherwise stated. If program data are not available, please use your best estimate to complete the questions below. If your SSP only operated during some of the specified time period, please provide information reflective of the time period(s) during which your SSP did operate.
During the survey, you may need to refer to your records to answer some questions. If you need to step away, please select “Save & Return” at the bottom of the page. You can return to the survey using the link in your invitation email, or you will have the option to enter an email address and the same survey link will be sent to the specified email. If you are unable to answer a question, but later find the answer in your records, you can reach us later to provide this additional information by contacting [NAME] at [EMAIL].
If you need any clarifications about any of the questions in this survey or how this information will be used, please contact [NAME] at [EMAIL].
All information will be kept confidential.
To begin, please let us know a couple of details about your SSP.
PRELIMINARY INFORMATION
PI.1 What is the name of your organization?
________________________________
PI.2 Please specify any nicknames (i.e., abbreviated name or acronym) that are used for your SSP.
________________________________
PI.3 What is the city or town and state where your SSP headquarters is located?
______________________
(REDCap instructions: enter city name; drop down menu for state)
PI.4 Did your SSP provide any services at any time in [YEAR]?
Yes
No
(REDCap instructions: send to “thank you but you’re not eligible this year” page)
PI.5 How did your SSP deliver services in [YEAR]? Please select all that apply.
Brick and mortar fixed site (including drop-in centers)
Backpack/outreach
Pop-up sites (tables, tent, etc.)
Delivery to regular locations (e.g., established route)
Delivery to participant requested locations (e.g., home delivery)
Mail-based distribution
Vending machine
Other (please describe)______
Don't know
Choose not to answer
PI.6 Please select whether your SSP provides services in any of the following state(s), U.S. territory or in a Tribal Nation in [YEAR].]. Please select all that apply.
We operated in all states
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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
Tribal Nation (please specify): ________
US Virgin Islands
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Choose not to answer
PI.7 In which counties did your SSP provide services in [YEAR]? Please include all counties served, including those with mobile services, deliveries, etc. _______________________________________________________________________________
We operated throughout the entire state.
PI.8 In what year did your SSP start providing services?
___________________________
(Please enter four digit year)
PROGRAM CHARACTERISTICS
PC.1 How would you best classify your SSP? Please select all that apply.
Community-based organization without 501(c)(3) status
Community-based organization with our own 501(c)(3) status
Community-based organization with a sponsor's 501(c)(3) status
City or County health department
State health department
Tribal affiliated organization
Academic health care organization
Private or commercial health care organization
Mutual aid organization
Other (please specify): ____________
Choose not to answer
PC.2 What were your SSP's sources of funding in [YEAR]? Please select all that apply.
City government
County government
State government
Federal government
Foundation
Individual donations
Personal funds from program managers or staff
Corporate donation
Other (please specify): ______________
Don't know
Choose not to answer
PC.2a (If ‘federal government’ is selected for PC.2) Which federal funding sources provided your SSP with funding? Please select all that apply.
Substance Abuse and Mental Health Services Administration (SAMHSA)
Centers for Disease Control and Prevention (CDC)
Health Resources and Services Administration (HRSA)
Medicare
Medicaid
Billable services to private insurance
Other (please specify): _________
Don’t know
Choose not to answer
PC.3 Did your SSP receive funding in [YEAR] from NASTAD’s Strengthening Syringe Services Programs (SSP) through Direct Program Funding opportunity?
Yes
No
Don’t know
Choose not to answer
PC.4 What was your SSP’s annual budget in [YEAR]?
If your SSP is part of a larger, multi-service organization, only provide the budget for the SSP. Please provide the best estimate to your knowledge, rounded to the nearest $1,000.
$
(Please do not include commas)
PC.5 How many full-time paid employees (³35 hours per week) did your SSP employ last month?
____________
PC.6 How many part-time paid employees (<35 hours per week) did your SSP employ last month?
______
PC.7 How many volunteers, including unpaid volunteers or those receiving a stipend, did your SSP have last month?
______
PC.8 Please indicate the involvement of people with lived and living drug use experience at your SSP in [YEAR]. Please select all that apply.
No involvement
Employed as full-time paid staff
Employed as part-time paid staff
Served as volunteer(s)
Provided participant-facing services (e.g. patient navigation)
Provided non-participant facing services (e.g. advisory board)
PC.9 In the last week, how many hours did your SSP provide syringe services to participants?
_______
PC.10 Did your SSP serve communities that you would consider urban, suburban, or rural? Please select all that apply.
Urban
Suburban
Rural
Choose not to answer
PC.11 Did your SSP stop providing services in [YEAR] (i.e., your SSP could not provide services when you had expected to be open)?
Yes
No
Don’t know
Choose not to answer
PC.11a (If yes to PC.11) For how long in [YEAR] did your SSP stop providing services?
Less than one day
One day to up to one week
One week up to one month
One month or more
PC.11b (if yes to PC.11) Please choose the reason(s) for service disruption. Please select all that apply.
Inadequate funding for materials or supplies
Inadequate funding for operations
Inadequate funding for staff salaries
Lack of personnel to staff program
Legal or political intervention
COVID-19 pandemic
Pushback from neighbors or landlords
Inclement weatherOther (please describe) ______
Don't know
Choose not to answer
PC.11b.1 (If select ‘lack of personnel to staff program’ for PC.11b) What contributed to lack of personnel to staff your SSP? Please select all that apply.
Staff burnout or fatigue
Physical illness
Lack of childcare
Community bereavement
Inability to hire new staff
Other (with text option)
PC.12 Did your SSP analyze data you collected from participants to inform program planning and improvement in [YEAR]?
Yes
No
Don’t know
Choose not to answer
PC.13 How many participant encounters occurred at your SSP in [YEAR]?
By participant encounters, we mean the number of encounters or participant visits occurring with your SSP.
_________________________________
(Please do not include commas)
PC.14 Can you report the number of unique individuals who received services from your SSP in [YEAR]?
If your SSP does not collect this data, please select “no”.
Yes
No
Don’t know
Choose not to answer
PC.15 (If select ‘yes’ for PC.14) How many unique individuals received services from your SSP in [YEAR]?
_________________________________
(Please do not include commas)
PC.16 In [YEAR], did your SSP have residency restrictions on who could access services, that is, only people from certain geographic locations could receive services from your program?
Yes
No
Don’t know
Choose not to answer
PC.17 In [YEAR], did your SSP require participants to provide identifying documents (for example, a driver's license) to enroll or receive syringe services (not including health care)?
Yes
No
Don’t know
Choose not to answer
PC.18 Please indicate your level of agreement with the following statements.
Our SSP staff are under too many pressures to do their job effectively.
Strongly Disagree - 1 2 3 4 5 - Strongly Agree
Our SSP staff often show signs of stress and strain.
Strongly Disagree - 1 2 3 4 5 - Strongly Agree
The heavy workload at our SSP reduces program effectiveness.
Strongly Disagree - 1 2 3 4 5 - Strongly Agree
Staff frustration is common at our SSP.
Strongly Disagree - 1 2 3 4 5 - Strongly Agree
When there is agreement that change needs to happen in the SSP, we have the necessary financial and human resources to do so.
Strongly Disagree - 1 2 3 4 5 - Strongly Agree
When there is agreement that change needs to happen in the SSP, we have the necessary technical assistance to do so.
Strongly Disagree - 1 2 3 4 5 - Strongly Agree
PC.19 Does your SSP employ or partner with an organization that uses licensed clinical staff (e.g., physician, nurse, psychologist, etc.) to provide services?
Yes
No
Don’t know
Choose not to answer
PC.20 Does your SSP conduct activities designed to engage any of the following demographic groups? Please select all that apply.
If your SSP serves participants in any of these categories but does not conduct activities specifically designed to engage them, do not mark the box for that category.
Lesbian, gay, bisexual, or queer persons
Transgender, genderqueer, or non-binary persons
Women
American Indian or Alaska Native persons
Asian persons
Black or African-American persons
Hispanic or Latinx persons
Native Hawaiian or Other Pacific Islander persons
Persons aged < 18 years
Persons aged 18 to 29 years
Persons aged 30 to 39 years
Persons aged 40 to 59 years
Persons aged ≥60 years
Other (please describe)______
Choose not to answer
COMMUNITY SUPPORT AND OPPOSITION
CSO.1 How would you rate your SSP’s relationship with the surrounding community in [YEAR]?
Very good
Somewhat good
Neither good nor poor
Somewhat poor
Very poor
Nonexistent
Choose not to answer
CSO.2 Which community groups supported or advocated for your SSP in [YEAR]? Please select all that apply.
Local health officials/health department
Law enforcement
Religious organizations
Local politicians
Neighbors or local residents
Landlords
Other community-based organizations
Business owners
HIV or other medical providers
Drug user unions
No groups advocated for us
Other (please describe)_______
Choose not to answer
CSO.3 Which community groups opposed your SSP in [YEAR]? Please select all that apply.
Local health officials/health department
Law enforcement
Religious organizations
Local politicians
Neighbors or local residents
Landlords
Other community-based organizations
Business owners
No groups opposed us
Other (please describe) ________
Choose not to answer 77
CSO.4 Did your SSP face any of the following funding challenges in [YEAR]? Please select all that apply.
Insufficient funding
Future funding instability
Funder restrictions related to purchasing supplies or services provided
Our SSP did not face funding challenges
Other: __________________________
Choose not to answer
CSO.5 Did your SSP face any of the following staffing challenges in [YEAR]? Please select all that apply.
Insufficient number of staff
Staff burnout
Low retention of staff
Inadequately trained staff
Our SSP did not face staffing challenges
Other: __________________________
Choose not to answer
CSO.6 Did your SSP face challenges procuring any of the following supplies for your participants in [YEAR]? Select all that apply.
Naloxone
Syringes
Pipes
Other: _______________
We had no problems procuring supplies
Choose not to answer
CSO.7 (Skip if reported city, county, or state health department in PC.1) How would you describe your SSP's relationship with your local health department(s) in [YEAR]?
Very good
Somewhat good
Neither good nor poor
Somewhat poor
Very poor
Nonexistent
Choose not to answer
CSO.8 How would you describe your SSP's relationship with law enforcement in [YEAR]?
Very good
Somewhat good
Neither good nor poor
Somewhat poor
Very poor
Nonexistent
Choose not to answer
DRUG USE SUPPLIES
DU.1 How many sterile syringes did your SSP provide to participants in [YEAR]?
Please provide your best estimate if records are not readily available.
__________________________
(Please do not include commas)
DU.2 What was your syringe exchange policy for participants in [YEAR]?]
Participants can receive the same number of syringes as they drop off with the SSP (i.e., one-for-one)
Participants can receive up to a certain amount over the number of syringes than they drop off with the SSP (i.e., one-for-one plus)
Participants can request as many syringes as they need but our SSP has a cap on the number of syringes we can provide (i.e., needs-based with upper limit)
Participants can receive as many syringes as they need (i.e., needs-based)
Choose not to answer
DU.3 Did your SSP provide participants with syringes to distribute to other people in the community (i.e., secondary exchange or peer delivery) in [YEAR]?
Yes
No
Choose not to answer
DU.4 Which syringe disposal services did your SSP provide in [YEAR]. Please select all that apply.
Accepted used syringes for safe disposal
Provided training on safe disposal of used syringes
Provided sharps containers for carrying used syringes
No syringe disposal services were provided
Other (please specify):_______________
DU.5 For each of the following drug use supplies (other than syringes), please indicate which ones were provided to participants in [YEAR]. Select all that apply.
Pipes
Straws
Cookers
Cottons
Syringe/pill filters like Sterifilt®
Saline or sterile water
Ties/tourniquets
Alcohol pads
Wound care kits/bandages
Other safe smoking supplies
Other safe snorting supplies
Other (please specify): _____________
None of the above
Choose not to answer
OVERDOSE SERVICES
OS.1 Did your SSP provide opioid overdose education and response training to participants in [YEAR]?
Yes
No
Choose not to answer
OS.2 How many participant encounters involved providing naloxone in [YEAR]?
By participant encounters, we mean the number of encounters/participant visits made to your SSP to pick up naloxone (including Narcan). If your SSP does not collect these data, please provide your best estimate. If you did not distribute any naloxone, please enter 0.
________________________
OS.3 How many does of naloxone did your SSP distribute in [YEAR]?
For example, if your SSP gave out 100 kits, and there are 2 doses per kit, you would enter 200 doses. Include doses of Narcan distributed in this overall count. If your SSP does not collect these data, please provide your best estimate.
________________________
OS.4 In what ways did your SSP distribute doses of naloxone doses in [YEAR]? Please select all that apply.
Direct naloxone distribution from staff to participant at our program
In-person naloxone delivery (delivered directly to participant)
Mail delivery (naloxone mailed to participant)
Secondary naloxone distribution (participant distributed naloxone to other people)
Provider referral for prescription or referral to pharmacy
Offered at community-based overdose education events (open to the public)
Offered at overdose education events for staff or participants of other organizations
Choose not to answer
OS.5 What barriers, if any, did your SSP experience in providing naloxone to your participants in [YEAR]? Please select all that apply.
No barriers
High cost of naloxone
Shortage of low-cost of naloxone
Funding restrictions preventing naloxone purchase
Legal/political climate
Other (please describe): _________
Don't know
Choose not to answer
OS.6 Did your SSP provide education and response training on over-amping from stimulants, such as cocaine and methamphetamines, to participants in [YEAR]?
Yes
No
Choose not to answer
DRUG CHECKING
DC.1 Did your SSP provide any of the following drug testing supplies to participants in [YEAR]? Please select all that apply.
Fentanyl test strips
Benzodiazepine test strips
Xylazine test strips
Other test strips (please specify): ____________
DC.2 Were drug checking services other than test strips, including mass spectrometer, fourier-transform infrared spectroscopy (FTIR), available to your participants in [YEAR]?
Yes
No
Choose not to answer
SUPERVISED CONSUMPTION
SC.1 Did your SSP operate a supervised consumption site for your participants in [YEAR]?
A supervised consumption site is a place, either permanent or temporary, where people come to use their own drugs under the supervision of trained workers; have access to sterile equipment (syringes, cotton, cooker, water, etc...) and conditions; and receive referrals to appropriate health or social services.
Yes
No
Choose not to answer
SC.1a (If no to SC.1) If supervised consumption sites (SCS) were locally permitted in your area, would your SSP consider providing these services?
No we would not consider implementing SCS
We would explore implementation of SCS
We would start preparing for SCS implementation
We would be ready to implement SCS
OTHER SERVICE PROVISION
OSP.1 Which safer sex supplies were provided in-person to participants in [YEAR]? Please select all that apply.
External condoms (male condoms)
Internal condoms (female condoms)
Lubricant
Dental dams
None of the above
Choose not to answer
OSP.2 Which health screening services were provided in-person to participants (either by your SSP or by partners) in [YEAR]? Please select all that apply.
Partners might include medical staff from health departments or academic institutions providing clinical services onsite.
HIV rapid testing
HIV laboratory-based testing
Hepatitis C virus (HCV) rapid testing
Hepatitis C virus (HCV) laboratory-based testing
Hepatitis A virus testing
Hepatitis B virus testing
STI testing other than hepatitis or HIV
TB skin testing or laboratory-based screening for latent TB
Pregnancy testing
COVID-19 testing
Other (please describe): _________
None of the above
Choose not to answer
OSP.3 Which vaccinations were provided in-person to participants (either by your SSP or by partners) in [YEAR]? Please select all that apply.
Hepatitis A vaccination
Hepatitis B vaccination
Influenza vaccination
COVID-19 vaccination
Human papillomavirus (HPV) vaccination
Pneumococcal vaccination
Tetanus, Diphtheria and Pertussis (TDAP) vaccination
MPox vaccination
Meningitis vaccination
Other (please describe): _________
None of the above
Choose not to answer
OSP.4 Which of the following infectious disease medical services were provided in-person to participants (either by your SSP or by partners) in [YEAR]? Please select all that apply.
Please do not include telehealth services.
HIV treatment
Pre exposure prophylaxis for HIV (PrEP)
Post exposure prophylaxis for HIV (PEP)
Hepatitis C treatment
STI treatment other than hepatitis or HIV
Wound care/treatment
Other (please describe): ________
None of the above
Choose not to answer
OSP.5 Which substance use disorder treatment services were provided in-person to participants (either by your SSP or by partners) in [YEAR]?] Please select all that apply.
Please do not include telehealth services.
Buprenorphine (with or without naloxone)
Methadone
Naltrexone (Vivitrol)
Medications for non-opioid substance use disorders
Contingency management (e.g., incentives for attendance)
Cognitive behavioral therapy
Other (please describe): _________
None of the above
Choose not to answer
OSP.6 Which other types of medical services were provided in-person to participants (either by your SSP or by partners) in [YEAR]? Please select all that apply.
Please do not include telehealth services.
Mental health services
Gender affirming care (i.e., hormone therapy)
General primary care (e.g., blood pressure management)
Reproductive cancer screening (e.g., pap smears)
Family planning/contraception
Prenatal care and peripartum care
Other (please describe): _________
None of the above
Choose not to answer
OSP.7 Did your SSP or partners provide telehealth services for your participants in [YEAR]?
For this survey, telehealth is defined as services provided to participants via phone, tablet, or computer.
Yes
No
Choose not to answer
(REDCap instructions: skip to OSP.8 if no or choose not to answer)
OSP.7a (If yes to OSP.7) Which of the following infectious disease medical services were provided to participants via telehealth (either by your SSP or by partners) in [YEAR]? Please select all that apply.
HIV treatment
Pre-exposure prophylaxis (PrEP)
Post-exposure prophylaxis (PEP)
Hepatitis C treatment
STI treatment other than hepatitis or HIV
Wound care/treatment
Other (please describe): _________
None of the above
Choose not to answer
OSP.7b (If yes to OSP.7) Which substance use disorder treatment services were provided to participants via telehealth (either by your SSP or by partners) in [YEAR]? Please select all that apply.
Buprenorphine (with or without naloxone)
Methadone
Naltrexone (Vivitrol)
Medications for non-opioid substance use disorders
Contingency management (e.g., incentives for attendance)
Cognitive behavioral therapy
Other (please describe): __________
None of the above
Choose not to answer
OSP.7c (If yes to OSP.7) Which other types of medical services were provided to participants via telehealth (either by your SSP or by partners) in [YEAR]? Please select all that apply.
Mental health services
Gender affirming care (i.e., hormone therapy)
General primary care (e.g., blood pressure management)
Reproductive cancer screening (e.g., pap smears)
Family planning/contraception
Prenatal care and peripartum care
Other (please describe): _________
None of the above
Choose not to answer
OSP.8 Did your SSP provide navigation services for your participants in [YEAR]?
For this survey, navigation is defined as a strategy that improves linkage to offsite services, like assisting with appointment scheduling, transportation, and/or appointment accompaniment.
Yes
No
Choose not to answer
(REDCap instructions: skip to OSP.9 if no or choose not to answer)
OSP.8a (If yes to OSP.8) Which services were covered by your navigation program in [YEAR]? Please select all that apply.
HIV care
Pre-exposure prophylaxis for HIV prevention (PrEP)
Hepatitis C virus (HCV) care
Medications for opioid use disorder (MOUD)
Medications for non-opioid substance use disorders
Legal records (e.g., birth certificate, social
security card, state ID/driver's license)
Gender affirming care (i.e., hormone therapy)
Medicaid or other health insurance
Social support services (e.g., housing)
Other (please describe): _________
Choose not to answer
OSP. 9 Which social or supportive services were provided onsite to participants in [YEAR]? Please select all that apply.
Drop-in center
Enrollment in Medicaid or other health insurance
Family violence, domestic violence, or intimate partner violence services
Food/meals, including SNAP, WIC, food pantries, or meal delivery services
Housing support
Hygiene-related services (e.g., laundry, showers)
Job-related services (e.g., placement assistance, skills training)
Legal services/counseling
Legal records/identification (e.g., birth certificate, social security card, state identification, drivers license)
Language translation services
Substance use counseling by harm reduction counselors/therapists
Other (please describe): _________
None of the above
Choose not to answer
COMMUNICATION STRATEGIES
CS.1 Which topics does your SSP communicate about with others in the harm reduction community? Please select all that apply.
Program supplies (e.g., Naloxone, syringes, smoking supplies)
Drug supply alerts (i.e., information about which substances are in your local drug supply)
Overdose hotspots
Trainings
Funding opportunities
Conferences/convenings
Harm reduction research findings
Other (please specify): ___________________
CS.2 Which topics would your SSP like to know more about from the harm reduction community? Please select all that apply.
Program supplies (e.g., Naloxone, syringes, smoking supplies)
Drug supply alerts (i.e., information about which substances are in your local drug supply)
Overdose hotspots
Trainings
Funding opportunities
Conferences/convenings
Harm reduction research findings
Other (please specify): ___________________
CS.3 Which sources does your SSP rely on for information related to delivering or improving services? Please select all that apply.
Other harm reduction programs
National Harm Reduction Coalition (NHRC)
North American Syringe Exchange Network (NASEN)
National Alliance of State and Territorial AIDS Directors (NASTAD)
National Association of County and City Health Officials (NACCHO)
National Harm Reduction Technical Assistance Center
City or county government
State government
Federal government
Other (please specify):_________________________
CS.4 In which ways does your SSP prefer to receive information related to delivering or improving services? Please select all that apply.
State-wide or regional group meetings (online or in-person)
National conferences
Webinars
Issue Briefs or factsheets
Implementation manuals
Websites
Listservs
Facebook
Instagram
Twitter
Other (please specify):_________________________
CS.5 Please indicate your level of agreement with the following statements.
I have access to the information I need to improve my SSP’s operations.
Strongly Disagree - 1 2 3 4 5 - Strongly Agree
I have access to the most updated information to improve the health and wellbeing of my SSP’s participants.
Strongly Disagree - 1 2 3 4 5 - Strongly Agree
BARRIERS
B.1 If you have the time, please tell us about some of the biggest challenges you have faced over the past year that may or may not have been captured in this survey.
__________________________________________________________________________________________________________________________________________________________________________________________
CLOSE OUT
We value your input and would like to ask you a few questions about your experience taking this survey so that we can improve it and ensure that the information you provide is useful.
What topic(s) were missing from this survey and need to be added in the future? _________________________________________________________________________________________
Please use the space below for any other suggestions or comments for improving this survey to make it useful to SSPs.
_________________________________________________________________________________________
Are you willing to provide an address for us to mail you the $125 check as a thank you for completing this survey?
If you are unable or unwilling to provide an address to mail the check or would like to donate your incentive payment to another SSP, please answer "No" here and email [NAME] at [EMAIL] to arrange compensation.
Yes
No
Please tell us the name and mailing address of the organization that the $125 check should be made out to.
Organizational name for payment: ______________________
To whose attention should the check be mailed: ______________________
Address: ______________________
City: ______________________
State: ______________________
Zip: ______________________
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 2023-10-17 |
© 2024 OMB.report | Privacy Policy