Form Local Provider Ver Local Provider Ver Local Provider Version DBHNAS

Disaster Behavioral Health Needs Assessment Survey – Local Provider Version

SAMHSA DTAC Disaster Behavioral Health Needs Assessment Survey

Local Provider Version

Paper Draft of Web Survey

Landing Page #1

Welcome to the Disaster Behavioral Health Needs Assessment Survey.

What is the goal of this survey? SAMHSA Disaster Technical Assistance Center (DTAC) is gathering information on the needs of States, Territories, Federally-recognized Tribes, and local organizations and agencies as they integrate disaster behavioral health (DBH) into all-hazards disaster planning and response. The goal of this survey is to learn about the current needs of local DBH providers.

Why have I been selected for this survey? You work for a local provider and your current position involves DBH preparedness and response.

Your Participation. Participation is completely voluntary. You can choose whether or not to take the survey; you can skip any questions or stop without finishing the survey. Whether or not you complete the survey will not affect any services you receive from SAMHSA DTAC.

The Survey. The survey asks you to rate the difficulty and need for training and technical assistance on several job related activities. It also asks you to indicate how useful certain solutions and methods of training would be for your program. An Institutional Review Board (IRB) and the Office of Management and Budget (OMB) have approved all survey content. The survey will take 20-35 minutes to complete. If you choose to participate, we would like to receive your completed survey by [__/__/____].

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 .25 hours per client per year, 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, 1 Choke Cherry Road, Room 7-1044, Rockville, Maryland, 20857.

Click to Next Page for more information.

Landing Page #2

Who will view the survey results? If you choose to participate in the survey, any information you provide will be kept confidential to the extent provided by law and all information collected will be reported only at an aggregate level. SAMHSA/FEMA personnel, cleared by the project manager, and assigned to improving DBH services, will view State/Territory level results. Participants can request their own State/Territory level survey results. SAMHSA DTAC will not provide State/Territory level survey results to non-participants, including State/Territory employees. SAMHSA DTAC will aggregate your survey results at the national or regional level when distributing reports outside of cleared SAMHSA/FEMA personnel.

How will survey results be used? Data will be used to identify DBH activities that are difficult and are in need of training, useful solutions for addressing challenges/barriers and preferred methods of training and technical assistance. SAMHSA DTAC will then compare the identified activities, solutions and methods to the current training and technical assistance they offer as a basis for making improvements to better meet user needs. For example, SAMHSA DTAC will compare the preferred methods of training and technical assistance indicated by participants to current methods and determine areas where preferred methods can be incorporated.

Click one of the three options below. If you click on “Start Survey Now” or “Start Survey Later” you are giving SAMHSA DTAC permission to analyze and report on your responses to support making changes and improvement to the training and technical assistance the SAMHSA DTAC provides in order to better meet user needs.

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Start survey Now

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Start survey Later

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Exit survey/I do not want to participate

[Selecting “Start survey now” will take the participant to the first item of the survey]

[Selecting “Start survey later” will take them to a page telling the participant to use the original email to return]

[Selecting “Exit survey” will take the participant to a “Thank you” page.]

Important Contact Information
Questions about SAMHSA?	Contact SAMHSA Federal Project Officers: Dr. Nikki D. Bellamy, 240-276-2418, nikki.bellamy@samhsa.hhs.gov; Erik Hierholzer 240-276-0408, erik.hierholzer@samhsa.hhs.gov
Questions about the survey?	Contact SAMHSA DTAC Survey Helpdesk, DTACSurvey@icfi.com, 1-800-xxx-xxxx
Questions about SAMHSA DTAC?	Call 800-308-3515, or e-mail dtac@samhsa.hhs.gov
Questions about your rights as a participant?	Contact Dr. Janet Griffith, (703) 225-2243.

Definitions

Review the following terms and definitions before beginning the survey.

Program—a collection of work, activities, tasks, staff, and funding focused on disaster mental health preparedness and/or response, disaster substance abuse preparedness and/or response, or both (i.e., the State/Territory has a program and your organization has a program)

Local—the area that is served by the program/provider for which you work

Provider—the organization for which you currently provide DBH services and/or manage a DBH program

State/Territory—the State/Territory government in the State/Territory where your DBH work takes place

Coordinator—State/Territory employee who manages the State/Territory DBH program

Disaster Behavioral Health (DBH)—a behavioral health practice aimed at addressing incident-specific mental health or substance abuse reactions; DBH encompasses both disaster mental health and disaster substance abuse practices

Activities—actions you take while performing your job that directly involve mental health and/or substance abuse disaster preparedness and response

Staff—employees who, as part of their work, focus on a component of DBH preparedness and response in some capacity and collaborate with other DBH personnel to discuss these topics at some interval

Training—any instruction, from web-based to classroom, that develops knowledge, skills, and abilities in program staff or local providers

Technical Assistance—any resource, from text to deployed personnel, that provides guidance, organization, or administration to a program or local provider

Preliminary Item Review the item and mark the box that best represents your DBH role. Your response to this question will customize the survey to your specific experience.
Which of the following best describes your role in the DBH field?		My role involves only disaster substance abuse work.
		My role involves only disaster mental health work.
		My role involves both disaster substance abuse and disaster mental health work.
		Other (jobs that involve DBH)

Section 1: Disaster Behavioral Health Mark the box below the response option that indicates how aware your staff are in terms of SAMHSA DTAC training and/or technical assistance. Mark only one box.
	Not at all aware		Slightly aware		Moderately aware		Very aware		Extremely aware
	1		2		3		4		5

First, review the DBH Preparedness Activities listed below. Preparedness activities are DBH activities that occur before a disaster. In the section marked Difficulty, mark the box below the response option that indicates how difficult each activity is for your staff who perform disaster behavioral health preparation and response roles in addition to their usual responsibilities.
Activities	Difficulty
	Not at all difficult	Slightly difficult	Moderately difficult	Very difficult	Extremely difficult	Does not apply
	1	2	3	4	5	N/A
Soliciting contract approvals from the State/Territory
Working with State/Territory emergency management to include local providers in planning
Getting the State/Territory to prepare for issues with shelter sizes
Working with the State/Territory to tailor DBH plans to address cultural nuances (e.g., rural/urban differences)
Working with the State/Territory to tailor DBH plans to address local priorities (e.g., areas/populations that need attention first)
Identifying opportunities for face-to-face communication with the State/Territory
Maintaining non-DBH responsibilities while traveling for DBH responsibilities
Educating State/Territory representatives on the importance of DBH
Working with State/Territory DBH personnel to plan for first responder substance abuse and mental health reactions

First, review the Disaster Preparedness Solutions listed below. Solutions can help your staff with its DBH activities. In the section marked Need, mark the box below the response option that best represents the need for training and/or technical assistance on each solution, of your staff who perform disaster behavioral health preparation and response roles in addition to their usual responsibilities.
Solutions	Need
	No need	Slight need	Moderate need	Strong need	Extremely strong need	Does not apply
	1	2	3	4	5	N/A
Guidance in how to accelerate the contract and amendment approval process
Guidance on managing shelters of various sizes
Recommendations on tailoring standard preparedness plans to different cultural scenarios (e.g., urban/rural differences)
Strategy for educating State/Territories on the utility of local providers during planning
Information on resources to support virtual meetings with two or more parties
Guidance in allocating more staff to DBH
Guidance in how to increase DBH involvement in State/Territory response planning.
Guidance on developing and coordinating DBH drilling at the local level
Support in identifying opportunities for networking between local providers, local emergency medical services (EMS), and State/Territory representatives
Guidance in increasing access to State/Territory coordinators during an incident

First, review the training and technical assistance Methods listed below. Methods are ways that solutions can be delivered. In the section marked Usefulness, mark the box below the response option that best represents how useful each of the following methods is when receiving training and/or technical assistance on DBH Preparedness.
Methods	Usefulness
	Not at all useful	Slightly useful	Moderately useful	Very useful	Extremely useful	Does not apply
	1	2	3	4	5	N/A
Conference
Distance Learning/Web
Onsite Consultation
Peer-to-Peer Learning
Phone Consultation
Fact Sheet
Toolkit
Article
Curricula
Seminar Workshop
Training of Trainers

Indicate the Level of training and/or technical assistance that would be most useful in supporting your agency’s DBH Preparedness efforts. To do this, mark the box below the level that best matches the level needed.
Beginner			Intermediate			Advanced
1			2			3

First, review the DBH Response Activities listed below. Response Activities are DBH activities that occur after a disaster. In the section marked Difficulty, mark the box below the response that indicates how difficult each activity is for your staff who perform disaster behavioral health preparation and response roles in addition to their usual responsibilities.
Activities	Difficulty
	Not at all difficult	Slightly difficult	Moderately difficult	Very difficult	Extremely difficult	Does not apply
	1	2	3	4	5	N/A
Using State/Territory response plans that do not specifically address DBH activities
Contributing DBH expertise without specific State/Territory training or certification
Working with State/Territory personnel who do not have experience in DBH
Working with State/Territory response plans that are too standardized to adapt to local needs
Working with response centers that provide inconsistent State/Territory-supplied information to victims
Working with State/Territory personnel who lack knowledge of local resources
Working with the State/Territory to ensure a law enforcement presence at shelters
Working with the State/Territory to transport medical resources to victims
Obtaining agreement from shelters to allocate space (e.g., beds) for mental health and substance abuse clients
Obtaining participation from partners who will not be reimbursed for indirect costs by the Crisis Counseling Assistance and Training Program

First, review the DBH Response Solutions listed below. Solutions can help your staff with its DBH activities. In the section marked Need, mark the box below the response option that best represents the need for training and/or technical assistance on each solution, for your staff who perform disaster behavioral health preparation and response roles in addition to their usual responsibilities.
Solutions	Need
	No need	Slight need	Moderate need	Strong need	Extremely strong need	Does not apply
	1	2	3	4	5	N/A
Support in obtaining affordable DBH certification
Guidance on working with personnel who do not have EMS/DBH experience
Strategy for working with State/Territory personnel to tailor DBH response plans to local needs
A method of sharing and updating local information with the State
Strategy to ensure law-enforcement presence in facilities and shelters during disasters
A method by which a person’s DBH qualifications can be quickly identified during a disaster
Information on technology that will be useful during an incident
Support from the State/Territory in gathering a reserve supply of medication to use during disasters
Guidance on opioid treatment continuity after a disaster

First, review the training and technical assistance Methods listed below. Methods are ways that solutions can be delivered. In the section marked Usefulness, mark the box below the response option that best represents how useful each of the following methods is when receiving training and/or technical assistance on DBH Response.
Methods	Usefulness
	Not at all useful	Slightly useful	Moderately useful	Very useful	Extremely useful	Does not apply
	1	2	3	4	5	N/A
Conference
Distance Learning/Web
Onsite Consultation
Peer-to-Peer Learning
Phone Consultation
Fact Sheet
Toolkit
Article
Curricula
Seminar Workshop
Training of Trainers

Indicate the Level of training and/or technical assistance that would be most useful in supporting your agency’s DBH Response efforts. To do this, mark the box below the level that best matches the level needed.
Beginner			Intermediate			Advanced
1			2			3

Section 2: Mental Health Preparedness and Response Mark the box below the response option that indicates the extent to which your agency collaborates with the State/Territory DBH program on Mental Health Preparedness activities. Mark only one box.
	None		A little		Some		A lot		A great deal
	1		2		3		4		5

Mark the box below the response option that indicates the extent to which your agency receives Mental Health Preparedness resources from the State/Territory DBH program. Mark only one box.
	None		A little		Some		A lot		A great deal
	1		2		3		4		5

Mark the box below the response option that indicates the extent to which your agency collaborates with the State/Territory DBH program on Mental Health Response activities. Mark only one box.
	None		A little		Some		A lot		A great deal
	1		2		3		4		5

Mark the box below the response option that indicates the extent to which your agency receives Mental Health Response resources from the State/Territory DBH program. Mark only one box.
	None		A little		Some		A lot		A great deal
	1		2		3		4		5

Section 3: Substance Abuse Preparedness and Response Mark the box below the response option that indicates the extent to which your agency collaborates with the State/Territory DBH program on Substance Abuse Preparedness activities. Mark only one box.
	None		A little		Some		A lot		A great deal
	1		2		3		4		5

Mark the box below the response option that indicates the extent to which your agency receives Substance Abuse Preparedness resources from State/Territory DBH programs. Mark only one box.
	None		A little		Some		A lot		A great deal
	1		2		3		4		5

Mark the box below the response option that indicates the extent to which your agency collaborates with the State/Territory DBH program on Substance Abuse Response activities. Mark only one box.
	None		A little		Some		A lot		A great deal
	1		2		3		4		5

Mark the box below the response option that indicates the extent to which your agency receives Substance Abuse Response resources from the State/Territory DBH program. Mark only one box.
	None		A little		Some		A lot		A great deal
	1		2		3		4		5

Section 4: Demographics

Indicate your response by marking the box next to the response option that applies to you.

Which of the following best describes your title?		Director
		Manager
		Supervisor
		Other

How many years of experience do you have in the DBH field?		Less than 3 years
		3 to 5 years
		6 to 10 years
		More than 10 years

Which of the following best describes how long you have held your current position?		Less than 1 year
		1 to 4 years
		5 to 8 years
		More than 8 years

Indicate your response by marking the box next to the response option that applies to your agency.

In which State/Territory is your agency located?
	Alabama		Idaho		Nebraska		Rhode Island
	Alaska		Illinois		Nevada		South Carolina
	American Samoa		Indiana		New Hampshire		South Dakota
	Arizona		Iowa		New Jersey		Tennessee
	Arkansas		Kansas		New Mexico		Texas
	California		Kentucky		New York		Utah
	Colorado		Louisiana		North Carolina		Vermont
	Connecticut		Maine		North Dakota		Virginia
	Delaware		Maryland		Northern Mariana Islands		U.S. Virgin Islands
	District of Columbia		Massachusetts		Ohio		Washington
	Federated States of Micronesia		Michigan		Oklahoma		West Virginia
	Florida		Minnesota		Oregon		Wisconsin
	Georgia		Mississippi		Palau		Wyoming
	Guam		Missouri		Pennsylvania
	Hawaii		Montana		Puerto Rico

Estimate the percentage of time your staff spends on DBH preparedness. Your best guess is fine. Please round to the nearest percentage.

___%

Estimate the percentage of time your staff spends on DBH response. Your best guess is fine. Please round to the nearest percentage.

___%

Indicate the number of your staff members who are involved in DBH preparedness.

___ staff members

Indicate the number of your staff members who are involved in DBH response.

___ staff members

Section 5: Open-Ended Items

1. Please use the space below to share any additional comments with SAMHSA DTAC.

[Enter response here.]

Exit Page

To submit your survey responses, click on the SUBMIT link below. Your responses will be submitted, and you will be taken to the SAMHSA Disaster Technical Assistance (DTAC) website. Your responses will not be submitted if you do not click on the SUBMIT link.

[SUBMIT Link]

Thank you for your participation!

SAMHSA DTAC

31 May 2011 6