Form State-Territory

Disaster Behavioral Health Needs Assessment Survey – State/Territory Version

OMB No. xxxx-xxxx

Expiration Date: xx/xx/20xx

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Welcome to the Disaster Behavioral Health Needs Assessment Survey.

What is the goal of this survey? The Substance Abuse and Mental Health Services Administration (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 state and territory coordinators.

Why have I been selected for this survey? You are a state/territory coordinator and your current position involves DBH preparedness and/or 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 20–30 minutes to complete.

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 xxxx-xxxx and the expiration date is xx/xx/20xx.  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.

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Who will view your State/Territory’s 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

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, 1-866-657-2798
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

1. Which of the following best describes your responsibilities related to disaster behavioral health preparation and response in your state or territory? (select only one)

	I am responsible for coordination of disaster mental health preparation/response only
	I am responsible for coordination of disaster substance abuse preparation/response only
	I am responsible for coordination of both disaster mental health and disaster substance abuse preparation/response

2. Which of the following best describes your familiarity with the training and technical assistance offered by SAMHSA DTAC? (circle one)

Not At All Familiar

Slightly Familiar

Familiar

Very Familiar

Extremely Familiar

The Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Technical Assistance Center (DTAC) provides disaster technical assistance, training, and consultation to help disaster behavioral health (DBH) professionals plan for and respond effectively to mental health and substance abuse needs following a disaster.

SAMHSA DTAC provides this support for DBH professionals by offering onsite and web-based consultation and training; grant-specific technical assistance and support for the Federal Emergency Management Agency’s Crisis Counseling Assistance and Training Program (CCP); a resource collection of over 1,800 fact sheets, publications, studies, and articles; providing disaster preparation and response toolkits; establishing partnerships and encouraging collaboration between stakeholders in DBH preparedness and response; numerous webinars and podcasts; and an online discussion board.

The purpose of this survey is to assess the needs of DBH professionals so that SAMHSA DTAC can provide the most relevant and useful support.

Disaster Behavioral Health Preparedness Activities

For each of 13 DBH preparedness activities listed below, please rate the Importance of each activity to performing your job effectively and your Need for Support from SAMHSA DTAC.

[If hover cursor over Need for Support: “Examples of support include onsite and web-based consultation and training; grant-specific technical assistance and support for the Federal Emergency Management Agency’s Crisis Counseling Assistance and Training Program (CCP);  fact sheets, publications, studies, and articles; disaster preparation and response toolkits; assistance with establishing partnerships and collaboration with other DBH preparedness and response stakeholders; webinars and podcasts; and online discussion boards.”]

	Importance						Need for Support
	Not at all important	Slightly important	Important	Very important	Extremely important	Does not apply	No need	Slight need	Moderate need	Strong need	Extremely strong need	Does not apply
1. Developing/updating the state/territory’s all-hazards DBH preparedness plan
2. Participating in preparedness exercises
3. Becoming familiar with the National Incident Management System (NIMS) and Incident Command System (ICS)
4. Getting emergency management offices to include DBH in disaster preparedness planning
5. Getting local governments to incorporate DBH preparedness in county plans
6. Getting community health, substance abuse, or behavioral health centers to participate in DBH preparedness
7. Establishing memoranda of understanding with local providers
8. Increasing awareness of disaster behavioral health among behavioral health professionals
9. Participating in disaster behavioral health committees and task forces
10. Getting agreement from organizations to shelter mental health patients during disaster
11. Getting agreement from organizations to shelter active substance users during disaster
12. Providing training on disaster mental health (e.g., identify trainers or useful training materials)
13. Providing training on disaster substance misuse (e.g., identify trainers or useful training materials)

14. Please list some types of support (i.e., training and technical assistance) related to DBH preparedness that would be useful to you in your job.

Disaster Behavioral Health Response Activities

For each of 16 DBH response activities listed below, please rate the Importance of each activity to performing your job effectively and your Need for Support from SAMHSA DTAC.

[If hover cursor over Need for Support: “Examples of support include onsite and web-based consultation and training; grant-specific technical assistance and support for the Federal Emergency Management Agency’s Crisis Counseling Assistance and Training Program (CCP);  fact sheets, publications, studies, and articles; disaster preparation and response toolkits; assistance with establishing partnerships and collaboration with other DBH preparedness and response stakeholders; webinars and podcasts; and online discussion boards.”]

	Importance						Need for Support
	Not at all important	Slightly important	Important	Very important	Extremely important	Does not apply	No need	Slight need	Moderate need	Strong need	Extremely strong need	Does not apply
1. Deploying DBH professionals as part of disaster response
2. Maintaining communication and support with DBH responders
3. Administering DBH needs assessments
4. Determining the need for DBH grants (e.g., Crisis Counseling Assistance and Training Program; CCP)
5. Writing the CCP application while responding to a disaster
6. Acquiring accurate information during a disaster to assist with writing grant applications
7. Developing budgets for grant applications
8. Managing DBH grants (if implemented)
9. Interfacing with different fiscal management software programs
10. Reporting on fiscal grant progress and activities
11. Supporting substance abuse providers in meeting the needs of pre-disaster clients and facilities affected by disasters
12. Supporting mental health providers in meeting the needs of pre-disaster clients and facilities affected by disasters
13. Creating a standardized approach to substance misuse treatment provider continuity
14. Creating a standardized approach to mental health provider continuity
15. Incorporating Psychological First Aid into immediate response efforts
16. Providing instructional materials on Psychological First Aid

17. Please list some types of support (i.e., training and technical assistance) related to DBH response that would be useful to you in your job.

DBH Activities Related to Specific Populations and Incidents

For each of 12 DBH activities related to specific populations and incidents listed below, please rate the Importance of each activity to performing your job effectively and your Need for Support from SAMHSA DTAC.

[If hover cursor over Need for Support: “Examples of support include onsite and web-based consultation and training; grant-specific technical assistance and support for the Federal Emergency Management Agency’s Crisis Counseling Assistance and Training Program (CCP);  fact sheets, publications, studies, and articles; disaster preparation and response toolkits; assistance with establishing partnerships and collaboration with other DBH preparedness and response stakeholders; webinars and podcasts; and online discussion boards.”]

	Importance						Need for Support
	Not at all important	Slightly important	Important	Very important	Extremely important	Does not apply	No need	Slight need	Moderate need	Strong need	Extremely strong need	Does not apply
1. Accessing rural areas prior to and during disasters
2. Addressing the unique DBH preparation and response needs of rural population
3. Tailoring outreach efforts to rural culture
4. Accessing American Indian tribal communities prior to and during disasters
5. Addressing the unique DBH preparation and response needs of American Indian tribal communities
6. Tailoring outreach efforts to American Indian tribal communities
7. Training outreach staff on the sensitivities required to serve specific populations (e.g. elderly, individuals with disabilities)
8. Tailoring training to explain how to respond to specific populations (e.g. elderly, individuals with disabilities) during disasters
9. Addressing language and cultural barriers
10. Supporting DBH preparedness efforts with decreased budgets
11. Supporting DBH response efforts with decreased budgets
12. Identifying information on how to cope with the state of the current economy

13. Please list some types of support (i.e., training and technical assistance) that SAMHSA DTAC may provide to support your DBH activities related to specific populations and incidents?

DBH Collaboration

Please provide a rating on the Importance of and Need for Support in collaborating with each of the 10 entities listed below.

[If hover cursor over Need for Support: “Examples of support include onsite and web-based consultation and training; grant-specific technical assistance and support for the Federal Emergency Management Agency’s Crisis Counseling Assistance and Training Program (CCP);  fact sheets, publications, studies, and articles; disaster preparation and response toolkits; assistance with establishing partnerships and collaboration with other DBH preparedness and response stakeholders; webinars and podcasts; and online discussion boards.”]

	Importance						Need for Support
	Not at all important	Slightly important	Important	Very important	Extremely important	Does not apply	No need	Slight need	Moderate need	Strong need	Extremely strong need	Does not apply
1. Emergency management staff
2. Department of Homeland Security (DHS) staff (e.g., FEMA)
3. Federal government staff other than DHS
4. Public health entities (e.g., hospitals, doctors, nurses)
5. Disaster relief groups (e.g., Red Cross)
6. Community groups
7. Other state/territory DBH coordinators to share information and lessons learned
8. State/territory government staff within your state/ territory
9. Local government
10. American Indian tribal communities

11. Please list some types of support (i.e., training and technical assistance) that SAMHSA DTAC may provide to support your need to collaborate with other entities.

Methods of Training and Technical Assistance

1. Please select the three methods of training and technical assistance that you prefer most.

Methods
Conference
Distance Learning/Web
Onsite Consultation
Peer-to-Peer Learning
Phone Consultation
Fact Sheet
Toolkit
Article (technical, academic, or popular literature)
Curricula
Seminar Workshop
Webinar (i.e., live online presentation with audience)
Podcast (i.e., recorded presentation)
Mobile applications (i.e., apps for mobile phone or tablet)

2. We understand that meeting in person when participating in training and technical assistance activities is often preferred; however, due to cost considerations, it is often not feasible. Please describe some of your preferences for non-in-person methods of training and technical assistance. Please include additional detail, such as specific topics best suited for particular non-in-person methods, if possible.

Demographics

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

Which of the following best describes your employment status in terms of the DBH field?		State/Territory Employee
		Consultant/Contractor
		Other

Which of the following best describes your current employment?		Full-time
		Part-time

Which of the following best describes your years of experience 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

Select the state/territory where you are 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

Please estimate the percentage of time over the last 12 months you spent on DBH preparedness. Your best guess is fine. Please round to the nearest percentage.

___%

Please estimate the percentage of time over the last 12 months you spent on DBH response. Your best guess is fine. Please round to the nearest percentage.

___%

Please indicate the number of staff members (including you) your state/territory’s DBH program has devoted to DBH preparedness.

___ staff members

Please indicate the number of staff members (including you) your state/territory’s DBH program has devoted to DBH response.

___ staff members

Additional Comments

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

Exit Page

To submit your survey responses, click on the SUBMIT button below. Your responses will be submitted, and you will be taken to the SAMHSA DTAC website. Your responses will not be submitted if you do not click on the SUBMIT button.

[SUBMIT button]

Thank you for your participation!

SAMHSA DTAC

July 2013 12