Employer Survey Qu Employer Survey Questionnaire 7/21/2021

OMB No. 0930-XXXX

Expiration Date: MM/DD/YYYY

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 15 minutes per respondent, 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, 5600 Fishers Lane, Room 15E57-A, Rockville, Maryland, 20857

Survey Instrument

2021 Survey of Behavioral Health Workforce Employers

Organizational Characteristics

1) What is the primary treatment focus of your organization?

( ) Mental Health

( ) Substance Use Disorder

( ) Integrated Mental Health and Substance Use Disorder

( ) Primary Care only

( ) Integrated Primary Care and Behavioral Health

( ) Do not provide direct care services (end survey)

( ) Other (please specify): ____________________________________________

2) Which of the following describes your organization’s practice setting? (Check all that apply)

Outpatient Ambulatory Facility

[ ] Certified community behavioral health clinic

[ ] Community mental health center or clinic

[ ] Community health center

[ ] Rural health clinic

[ ] Group practice or private practice

[ ] Substance use disorder outpatient center (including withdrawal management)

[ ] Crisis outpatient services (stand-alone)

Inpatient, Residential, or Long-Term Care Facility

[ ] Psychiatric rehabilitation facility (stand-alone)

[ ] Inpatient psychiatric or addiction treatment hospital

[ ] Academic medical center

[ ] Community hospital

[ ] Residential treatment facility (e.g. group home, supportive housing for individuals with mental illness, transitional housing)

[ ] Long term care facility or nursing home

[ ] Long-term acute care facility (LTAC)

[ ] Crisis residential facility

[ ] Hospice or palliative care facility

[ ] Rehabilitation facility

Other Setting

[ ] School (pre-K, elementary, middle, or high school)

[ ] Student health or counseling center at a college or university

[ ] Criminal justice system

[ ] Government agency (e.g. mental health/substance use agency, Medicaid agency, child welfare agency, veterans, etc.)

[ ] Managed care organization

[ ] Other (please specify): ____________________________________________

Q3) In which state or U.S. territory is your organization located? If your organization has locations in more than one state, check all that apply.

[ ] Alabama

[ ] Alaska

[ ] American Samoa

[ ] Arizona

[ ] Arkansas

[ ] California

[ ] Colorado

[ ] Connecticut

[ ] Delaware

[ ] District of Columbia

[ ] Florida

[ ] Georgia

[ ] Guam

[ ] 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

[ ] Northern Mariana Islands

[ ] Ohio

[ ] Oklahoma

[ ] Oregon

[ ] Pennsylvania

[ ] Puerto Rico

[ ] Rhode Island

[ ] South Carolina

[ ] South Dakota

[ ] Tennessee

[ ] Texas

[ ] Utah

[ ] U.S. Virgin Islands

[ ] Vermont

[ ] Virginia

4) What behavioral health services does your organization provide? Some categories may overlap, but please check all that apply.

[ ] Acute care services

[ ] Applied behavioral analysis

[ ] Assertive community treatment (ACT or PACT)

[ ] Assisted outpatient treatment (AOT)

[ ] Care coordination/case management

[ ] Coordinated specialty care

[ ] Crisis stabilization

[ ] Discharge planning services

[ ] Diversion and jail-based services

[ ] Geriatric behavioral health services

[ ] Home health services

[ ] Intensive outpatient treatment (IOT) or intensive outpatient program (IOP)

[ ] Medication assisted treatment (MAT)

[ ] Mental health inpatient services

[ ] Mental health outpatient services

[ ] Opioid Treatment Program (OTP)

[ ] Outpatient day or evening treatment programs

[ ] Partial hospitalization program (PHP)

[ ] Psychiatric hospitalization

[ ] Psychological screening

[ ] Psychological testing and assessment

[ ] Residential mental health treatment services

[ ] Residential substance use disorder treatment services

[ ] Residential detox services

[ ] Substance use inpatient services

[ ] Substance use outpatient services

[ ] Support and recovery services (including peer support)

[ ] Other (please specify): ____________________________________________

5) What is the typical approximate wait time for new clients and access to crisis services? 

	Same Day	One week	Two weeks	Three weeks	Four weeks	Five weeks or more	N/A
New client intake (non-urgent)	( )	( )	( )	( )	( )	( )	( )
New client visit with psychiatrist (or other prescriber)	( )	( )	( )	( )	( )	( )	( )
Crisis services	( )	( )	( )	( )	( )	( )	( )

Logic: IF Question “Does your organization currently offer telehealth services to your clients” #5 is one of the following answers (“No”) THEN Jump to Question “Does your treatment program or model include a Hub and Spokes for Opioid Use Disorder? If yes, please select if you are the Hub or Spoke.” #8

6) Does your organization currently offer telehealth services to your clients? 

( ) Yes

( ) No

7) Approximately what percent (%) of your visits are currently delivered via telehealth?

____________________________________________

8) Approximately what percent (%) of your visits were delivered via telehealth in 2019 (i.e. the year before the COVID-19 pandemic)? (indicate “0” if none)

____________________________________________

9) Does your treatment program or model include a Hub and Spokes for Opioid Use Disorder?

( ) Yes, as a Hub (specialty opioid treatment program clinic that dispenses medication and provides daily dosing and therapeutic services)

( ) Yes, as a Spoke (general medical settings providing office-based opioid treatment in which medications are prescribed and patients are seen weekly or monthly)

( ) No

( ) Don’t know

Staffing

10) Which of the following occupations are employed or contracted by your organization to provide mental health, substance use disorder, or addiction services? (Check all that apply)  

Clinical Staff

[ ] Addiction Medicine Specialists

[ ] Addiction Psychiatrists

[ ] Licensed Clinical Social Workers or Licensed Certified Social Workers

[ ] Licensed Marriage and Family Therapists (LMFT)

[ ] Licensed Practical/Vocational Nurses

[ ] Licensed Professional Counselors (LPC; or LMHC, LCPC, LPCC, LCMHC, and LMHP)

[ ] Occupational therapist/physical therapists

[ ] PAs providing psychiatric care

[ ] Pharmacists

[ ] Primary Care Providers (MD, DO, NP, PA)

[ ] Psychiatric NPs

[ ] Psychiatric Clinical Nurse Specialists

[ ] Psychiatrists-Adult

[ ] Psychiatrists-Child & Adolescent

[ ] Psychologists

[ ] Registered Nurses

[ ] Speech and language therapists

[ ] Substance Use / Addiction Counselors

Support Staff

[ ] Care coordinators/case managers

[ ] Community Health Workers

[ ] Dietitians

[ ] Employment and Education Specialists

[ ] Health Education Specialists

[ ] Home Health and Personal Aides

[ ] Housing Specialists

[ ] Nursing Assistants

[ ] Patient Navigators

[ ] Peer Support Specialists/Recovery Specialists (lived experience providing services to peers)

[ ] Psychiatric Aides

[ ] Psychiatric Technicians

[ ] Social Workers (non-clinical)

[ ] Other (please specify): ____________________________________________

Logic: Hidden unless: Question “What behavioral health services does your organization provide? Some categories may overlap, but please check all that apply.” #3 is one of the following answers (“Assertive community treatment (ACT or PACT)”)

11) Approximately how many assertive community treatment (ACT) care teams does your organization currently have?

____________________________________________

Logic: Hidden unless: Question “What behavioral health services does your organization provide? Some categories may overlap, but please check all that apply.” #3 is one of the following answers (“Assertive community treatment (ACT or PACT)”)

12) What is the staff composition of a typical assertive community treatment (ACT) team at your organization? Please list full time equivalents (FTEs).

	FTEs
Psychiatrist	________
Psychiatric Nurse Practitioner	________
Psychiatric Clinical Nurse Specialist	________
Psychologist	________
Licensed Professional Counselor/Therapist (e.g. LCSW, LPC, LMFT)	________
Case manager	________
Registered Nurse	________
Licensed Practical/Vocational Nurses	________
Social Worker (non-clinical)	________
Peer Support Specialist/Recovery Coach	________
Employment or education specialist	________
Community Health Workers	________
Other (please specify): __________________	________
Don’t know (indicate “0”)	________

Logic: Hidden unless: Question “What behavioral health services does your organization provide? Some categories may overlap, but please check all that apply.” #3 is one of the following answers (“Assertive community treatment (ACT or PACT)”)

13) Which profession(s) typically fill the supervisor role in ACT teams at your organization? (Check all that apply) 

[ ] Psychiatrist

[ ] Psychiatric Nurse Practitioner

[ ] Psychiatric Clinical Nurse Specialist

[ ] Psychologist

[ ] Licensed Professional Counselor/Therapist (e.g. LCSW, LPC, LMFT)

[ ] Other (please specify): ____________________________________________

Logic: Hidden unless: Question “What behavioral health services does your organization provide? Some categories may overlap, but please check all that apply.” #3 is one of the following answers (“Assertive community treatment (ACT or PACT)”)

14) What is the typical caseload of your ACT teams?

( ) Clients per team: ____________________________________________

( ) Don’t know

Logic: Hidden unless: Question “What behavioral health services does your organization provide? Some categories may overlap, but please check all that apply.” #3 is one of the following answers (“Assisted outpatient treatment (AOT)”)

15) What is the staffing composition of a typical assisted outpatient treatment (AOT) team at your organization? Please list full time equivalents (FTEs).

	FTEs
Psychiatrist	________
Psychiatric Nurse Practitioner	________
Psychiatric Clinical Nurse Specialist	________
Psychologist	________
Licensed Professional Counselor/Therapist (e.g. LCSW, LPC, LMFT)	________
Case manager	________
Registered Nurse	________
Licensed Practical/Vocational Nurses	________
Social Worker (non-clinical)	________
Peer Support Specialist/Recovery Coach	________
Employment or education specialist	________
Community Health Workers	________
Other (please specify): __________________	________
Don’t know (indicate “0”)	________

Logic: Hidden unless: Question “What behavioral health services does your organization provide? Some categories may overlap, but please check all that apply.” #3 is one of the following answers (“Assisted outpatient treatment (AOT)”)

16) Approximately how many clients received AOT services from your organization in the past 30 days?

( ) Clients per team: ____________________________________________

( ) Don’t know

Logic: Hidden unless: Question “Which of the following occupations are employed or contracted by your organization to provide mental health, substance use disorder, or addiction services? (Check all that apply)” #9 is one of the following answers (“Peer support specialists/Recovery specialists (lived experience providing services to peers)”)

17) You indicated your organization offers peer support services. Are your peer support specialists (also referred to as recovery support specialists) certified? 

( ) Yes, all are certified

( ) Yes, some are certified but not all

( ) No

( ) Don’t know

Logic: Hidden unless: Question “Which of the following occupations are employed or contracted by your organization to provide mental health, substance use disorder, or addiction services? (Check all that apply)” #9 is one of the following answers (“Peer support specialists/Recovery specialists (lived experience providing services to peers)”)

18) Are your peer support specialists pursuing certification while working at your organization? 

( ) Yes

( ) No

( ) Don’t know

Logic: Hidden unless: Question “Which of the following occupations are employed or contracted by your organization to provide mental health, substance use disorder, or addiction services? (Check all that apply)” #9 is one of the following answers (“Peer support specialists/Recovery specialists (lived experience providing services to peers)”)

19) How are peer support specialists compensated?

( ) All are paid

( ) All are volunteers

( ) Some are paid and others volunteer

( ) Don’t know

Logic: Hidden unless: Question “Which of the following occupations are employed or contracted by your organization to provide mental health, substance use disorder, or addiction services? (Check all that apply)” #9 is one of the following answers (“Peer support specialists/Recovery specialists (lived experience providing services to peers)”)

20) Does your organization receive any financial support for peer support specialist services? (Check all that apply) 

[ ] Medicaid reimbursement

[ ] Private payer reimbursement

[ ] Other payers (e.g. TRICARE)

[ ] Federal grant funding

[ ] State grant funding

[ ] Other grant funding (e.g. private philanthropy, foundations)

[ ] We do not receive any reimbursement for peer support specialists

Logic: Hidden unless: Question “Which of the following occupations are employed or contracted by your organization to provide mental health, substance use disorder, or addiction services? (Check all that apply)” #9 is one of the following answers (“Peer support specialists/Recovery specialists (lived experience providing services to peers)”)

21) In your setting, are peer support specialists used for patients with: (Check all that apply) 

[ ] Serious mental illness

[ ] Substance use disorder

[ ] Homelessness

[ ] Other (please specify): _______________________________________________

Logic: Hidden unless: Question “Which of the following occupations are employed or contracted by your organization to provide mental health, substance use disorder, or addiction services? (Check all that apply)” #9 is one of the following answers (“Care coordinators/case managers)”)

22) You indicated your organization has case managers and/or care coordinators. What professions do you typically recruit/hire for this role? (Check all that apply) 

[ ] Licensed Clinical Social Worker

[ ] Licensed Practical Nurse or Vocational Nurse (LPN or LVN)

[ ] Medical Assistant

[ ] Registered Nurse

[ ] Social Worker (non-clinical)

[ ] Community Health Worker

[ ] Other (please specify): ____________________________________________

Logic: Hidden unless: Question “Which of the following occupations are employed or contracted by your organization to provide mental health, substance use disorder, or addiction services? (Check all that apply)” #9 is one of the following answers (“Pharmacists)”)

23) You indicated your organization has pharmacists. Are any of your pharmacists board certified psychiatric pharmacists?  

( ) Yes

( ) No

( ) Don’t know

Logic: Hidden unless: Question “Which of the following occupations are employed or contracted by your organization to provide mental health, substance use disorder, or addiction services? (Check all that apply)” #9 is one of the following answers (“Pharmacists)”)

24) Do pharmacists at your site perform any of the following activities? (Check all that apply)

[ ] Medication management or medication review/reconciliation

[ ] Monitor/track medication adherence

[ ] Patient education

[ ] Dispense Naloxone using standing orders

[ ] Prescribe medications

[ ] None of the above

Recruitment and Retention

25) Does your organization have difficulty recruiting or retaining the following staff members?  (Check all that apply)  

CLINICAL STAFF
Addiction Medicine Specialists	[ ]
Addiction Psychiatrist	[ ]
Licensed Clinical Social Workers or Licensed Certified Social Workers	[ ]
Licensed Marriage and Family Therapists
Licensed Practical/Vocational Nurses	[ ]
Licensed Professional Counselors (LPC; or LMHC, LCPC, LPCC, LCMHC, and LMHP)	[ ]
Occupational therapist/physical therapist	[ ]
PAs providing psychiatric care	[ ]
Pharmacists	[ ]
Primary Care Providers (MD, DO, NP, PA)	[ ]
Psychiatric Nurse Practitioners	[ ]
Psychiatric Clinical Nurse Specialists	[ ]
Psychiatrists-Adult	[ ]
Psychiatrists-Child & Adolescent	[ ]
Psychologists	[ ]
Registered Nurses	[ ]
Speech and language therapist	[ ]
Substance Use / Addiction Counselors	[ ]
SUPPORT STAFF
Care coordinators/case managers	[ ]
Community Health Workers	[ ]
Dietitians	[ ]
Employment and education specialists	[ ]
Health education specialists	[ ]
Home Health and personal Aides	[ ]
Housing specialists	[ ]
Nursing Assistants	[ ]
Patient navigators	[ ]
Peer support specialists/recovery specialists (lived experience providing services to peers)	[ ]
Psychiatric aides	[ ]
Psychiatric technicians	[ ]
Social Workers (non-clinical)	[ ]
Other (please specify): _____________________	[ ]

26a) What are some of the likely reasons behind your clinical staff recruitment and retention challenges? (Check all that apply) 

[ ] General shortage of occupation(s) in area

[ ] Insufficient educational pipeline in the area

[ ] Wages not competitive

[ ] Limited benefits

[ ] Limited job security due to grant funding or other issue

[ ] Lack of peers/professional network

[ ] Geographic location

[ ] Office conditions (e.g. space limitations, outdated facilities)

[ ] Lack of support personnel

[ ] High case load requirements

[ ] Challenging patient/client population

[ ] Other (please explain): ________________________________________________

b) What are some of the likely reasons behind your support staff recruitment and retention challenges? (Check all that apply)

[ ] General shortage of occupation(s) in area

[ ] Insufficient educational pipeline in the area

[ ] Wages not competitive

[ ] Limited benefits

[ ] Limited job security due to grant funding or other issue

[ ] Lack of peers/professional network

[ ] Geographic location

[ ] Office conditions (e.g. space limitations, outdated facilities)

[ ] Lack of support personnel

[ ] High case load requirements

[ ] Challenging patient/client population

[ ] Other (please explain): ________________________________________________

27) Are there any occupations where recruitment or retention challenges led you to do any of the following in the last 6 months? (Check all that apply)

[ ] Use locum tenens

[ ] Contract with providers outside the organization

[ ] Substitute other professions

[ ] Use psychologists/counselors-in-training

[ ] Use service extenders

[ ] Use volunteers

[ ] Other (please specify): ________________________________________________

[ ] None of the above

STAFFING NEEDS

28) How would you rate the adequacy of your organization’s current level of staffing to meet patient/client needs in the following areas?

	Overstaffed	Adequately Staffed	Somewhat Understaffed	Severely Understaffed	N/A
Services for serious mental illness	( )	( )	( )	( )	( )
Services for substance use disorder		( )	( )	( )	( )
Mental health services for mild/moderate mental illness	( )	( )	( )	( )	( )
Prevention and recovery Services	( )	( )	( )	( )	( )
Support services (e.g. housing, vocational, food, transportation)	( )	( )	( )	( )	( )
Bilingual services (language/translation)	( )	( )	( )	( )	( )

29) If funding were not an issue, approximately how many FTEs of each profession listed below would you hire immediately to address staffing gaps identified above? 

	1 or fewer FTEs	2-4 FTEs	5-10 FTEs	>10 FTEs	N/A
Addiction Psychiatrist	( )	( )	( )	( )	( )
Addiction Medicine Specialists	( )	( )	( )	( )	( )
Psychiatrists-Adult	( )	( )	( )	( )	( )
Psychiatrists-Child & Adolescent	( )	( )	( )	( )	( )
Psychiatric Nurse Practitioners	( )	( )	( )	( )	( )
Psychiatric Clinical Nurse Specialists	( )	( )	( )	( )	( )
Primary Care Providers (MD, DO, NP, PA)	( )	( )	( )	( )	( )
Pharmacists	( )	( )	( )	( )	( )
Nurses	( )	( )	( )	( )	( )
Psychologists (PhD, PsyD)	( )	( )	( )	( )	( )
Clinical behavioral health specialists (e.g. LCSWs, LPCs, MFT)	( )	( )	( )	( )	( )
Care coordinators/case managers and/or housing specialists, vocational specialists	( )	( )	( )	( )	( )
Peer Support Specialists/recovery specialists	( )	( )	( )	( )	( )
Technicians	( )	( )	( )	( )	( )
Other (please specify): ______________	( )	( )	( )	( )	( )

30) What are the barriers to addressing these staffing needs?

________________________________________________________________

31) What policy, regulatory, and/or payment changes (if any) are needed to further optimize use of your behavioral health workforce?

________________________________________________________________

32) Did your organization have to furlough any employees as a result of COVID-19? 

( ) Yes, but we have since rehired all (or nearly all) positions

( ) Yes, and staffing remains significantly reduced

( ) Yes, and staffing remains moderately reduced

( ) No, but it was financially challenging to keep people on

( ) No, this was not an issue for us

33) What populations are served by your organization? (Check all that apply)  

[ ] Adolescents (ages 12-17)

[ ] Adults (ages 18-64)

[ ] American Indian or Alaska Native

[ ] Asian or Asian American

[ ] Black or African American

[ ] Children (ages 5-11)

[ ] Hispanic, Latino/a, or Spanish origin

[ ] Immigrants

[ ] Individuals experiencing homelessness

[ ] Individuals for whom English is a second language

[ ] Individuals with developmental disabilities

[ ] Individuals with justice-involvement (currently or formerly)

[ ] Individuals with low socioeconomic status

[ ] LGBTQ

[ ] Military service members and dependents

[ ] Native Hawaiian or other Pacific Islander

[ ] Pregnant/postpartum women

[ ] Rural/agricultural

[ ] Seniors (older adults aged 65+)

[ ] Veterans

[ ] Other (please specify): ________________________________________________

34) Which form(s) of payment does your organization accept? (Check all that apply)  

[ ] Medicaid

[ ] Medicare

[ ] Commercial insurance

[ ] TRICARE (Military/DOD)

[ ] Other federal insurance (VA, CHAMPVA)

[ ] Self-pay

[ ] Sliding scale

[ ] Grants/contracts/private fundraising

[ ] Other (please specify): __________________________________________________

35) Approximately how many unique clients does your organization serve annually? 

( ) Fewer than 1,000

( ) 1,000-4,999

( ) 5,000-9,999

( ) 10,000-24,999

( ) 25,000-49,999

( ) 50,000 or more

( ) Don’t know

Thank you for participating in this important survey. Your responses will provide critical insight into the workforce caring for individuals with mental health and substance use disorders.