1E 1E_MCHB_0906-0105_MMHSUD Health Professional Survey_Redl
Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access and Screening and Treatment for Maternal Mental Health and Substance Use Disorders Programs Project
1E_MCHB_0906-0105_MMHSUD Health Professional Survey_Redline
Health Professional Survey
OMB: 0906-0105
HP Survey, Version 2 – MMHSUD
Screening and Treatment for Maternal Mental Health and Substance Use Disorders Program Health Professional Survey
Health Resources and Services and Administration Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access and Screening and Treatment for Maternal Mental Health and Substance Use Disorders Programs Project
May 2025
Public Burden Statement: This data collection is for the evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access and Screening and Treatment for Maternal Mental Health and Substance Use Disorders programs. This project will collect data to provide HRSA with information to guide future program decisions regarding increasing health professionals’ (HPs) 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 0906-0105 and it is valid until 12/31/2027. This information collection is voluntary. Data will be private to the extent permitted by the law. Public reporting burden for this collection of information is estimated to average approximately 20 minutes per response, including the time for reviewing instructions 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 Information Collection Clearance Officer, 5600 Fishers Lane, Room 14NWH04, Rockville, Maryland, 20857 or paperwork@hrsa.gov. Please see https://www.hrsa.gov/about/508-resources for the HRSA digital accessibility statement.
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 Mental Health and Substance Use Disorders Program Health Professional Survey
Funding for data collection supported by the Maternal and Child Health Bureau Health Resources and Services Administration U.S. Department of Health and Human Services |
The Health Resources and Services Administration (HRSA) funded [insert name of state] to implement a Screening and Treatment for Maternal Mental Health and Substance Use Disorders (MMHSUD) Program, [insert program name]. HRSA also funded JBS International, Inc. (JBS) to conduct an evaluation of the Maternal and Child Health Bureau (MCHB) MMHSUD 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 professionals (e.g., obstetricians/gynecologists, family physicians, physician assistants, advanced practice nurse/nurse practitioners, licensed practical nurses, registered nurses, counselors, social workers, medical assistants, patient care navigators) who are enrolled/participating in [insert name of state]’s HRSA MMHSUD program. The survey is designed to collect information on your experiences with the MMHSUD program (e.g., assessing and treating behavioral health conditions, accessing behavioral health care services for your patients, capacity to address behavioral health conditions) and to assist HRSA in future program implementation.
Survey Instructions: This online survey should take less than twenty (20) minutes for you to complete. Please answer based on your current practice and understanding (you are not required to review data to answer the questions), 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: Each state’s MMHSUD program includes providing clinical behavioral health consultation and care coordination; enrolling health professionals, such as yourself into the MMHSUD program; and providing training on how to consult with the MMHSUD 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 MMHSUD 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 to 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.
Email address used for receiving communication from [insert program name]:
_____________________________________________
Note: Email addresses will only be used to confirm enrollment in the program and to track survey administration and completion.
Helpful Terminology: For the Purposes of This Survey:
A health professional includes obstetricians/gynecologists, family physicians, pediatricians, physician assistants, advanced practice nurses/nurse practitioners, licensed practical nurses, registered nurses, counselors, social workers, medical assistants, patient care navigators, etc.
Behavioral health consultation refers to tele-consultation service provided by a program's team of behavioral health experts for advising health professionals on providing behavioral health care.
Care coordination support refers to a program service providing resources and referrals to a provider when they contact the program, or to the patient/family when the program works with patients/families directly.
Behavioral Health Capacity
In the last 12 months, how often have you treated the following behavioral health conditions? (If Other, go to question 2.)
|
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 Conditions |
o |
o |
o |
o |
o |
Other |
o |
o |
o |
o |
o |
You selected an answer for Other in the question above. Please specify.
[OPEN-ENDED RESPONSE]
In the last 12 months, how did you receive training from the MMHSUD program? Select all that apply.
In-person training event (If selected, go to question 4.)
Webinar (If selected, go to question 4.)
Self-study with program resources (If selected, go to question 4.)
Video conferencing (If selected, go to question 4.)
Learning collaborative (e.g., Project ECHO, Project REACH) (If selected, go to question 4.)
Other (specify) (If selected, go to question 4.)
Did not participate in trainings (If selected, go to question 5.)
In the last 12 months, in how many MMHSUD program trainings did you participate?
1-2 trainings
3-5 trainings
6-7 trainings
8+ trainings
In the last 12 months, my state’s MMHSUD program provided training on the impact of stigma on the behavioral health of pregnant and postpartum patients and their families.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
In the last 12 months, I have contacted the MMHSUD clinical behavioral health consultation service for: Select all that apply.
In the last 12 months, how frequently did you contact the MMHSUD clinical behavioral health consultation service?
Less than once a month
1-2 times a month
3-4 times a month
More than 5 times a month
In the last 12 months, what were the most common reasons you contacted the MMHSUD clinical behavioral health consultation service? Select up to 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 MMHSUD 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
Community health factors/family environment
Other (specify)
In the last 12 months, how frequently did you interact with the MMHSUD clinical behavioral health consultation service using the following methods? (If Other, go to question 11.)
Method of Interaction |
Never |
Rarely |
Sometimes |
Often |
Always |
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 |
o |
o |
o |
o |
o |
You selected an answer for Other in the question above. Please specify.
[OPEN-ENDED RESPONSE]
I prefer to interact with the MMHSUD clinical behavioral health consultation service via: Select one.
Email
Telephone (terrestrial and/or wireless communications)
Text messaging
Video conferencing
Face to face
Other (Specify.)
I can readily obtain input from the MMHSUD clinical behavioral health consultation service when I have questions about how to assess or treat pregnant and postpartum patients with behavioral health conditions.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
In the last 12 months, my interaction with the MMHSUD clinical behavioral health consultation service informed my:
|
Strongly Disagree |
Disagree |
Neither Agree nor Disagree |
Agree |
Strongly Agree |
N/A |
Assessments of pregnant and postpartum patients |
o |
o |
o |
o |
o |
o |
Formulations of 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 |
Ability to address barriers to optimal access to behavioral health care |
o |
o |
o |
o |
o |
o |
As a result of participating in my state’s MMHSUD program, I am better able to utilize telehealth services to support my patients' access to behavioral health care.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
In the last 12 months, as a result of my state’s MMHSUD 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 nor Disagree
Agree
Strongly Agree
Do Not Know
In the last 12 months, as a result of my interaction with the MMHSUD program, I increased my referrals to services in the community to support pregnant and postpartum patients use of behavioral health services. (If Other, go to question 18.)
|
Strongly Disagree |
Disagree |
Neither Agree nor Disagree |
Agree |
Strongly Agree |
N/A |
Child care |
o |
o |
o |
o |
o |
o |
Substance use treatment |
|
|
|
|
|
|
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 |
o |
o |
o |
o |
o |
o |
You selected an answer for Other in the question above. Please specify.
[OPEN-ENDED RESPONSE]
As a result of your interaction with the MMHSUD program, how likely are you to refer patients to services in the community to address issues that you cannot or do not feel comfortable addressing yourself?
Not at All Likely
Not Very Likely
Neutral
Somewhat Likely
Very Likely
Currently, what additional assistance do you still need to improve the behavioral health of your pregnant and postpartum patients?
[OPEN-ENDED RESPONSE]
Program Usefulness
We would like to hear from you about how your state’s MMHSUD program is accomplishing its purpose of promoting behavioral health integration into primary care by supporting maternal mental health care telehealth access programs.
In the last 12 months, how helpful did you find the training you received from the MMSHUD program? [Display if answer to Q3 is not "Did not participate in trainings."]
Not at All Helpful
Not so Helpful
Somewhat Helpful
Very Helpful
Extremely Helpful
In the last 12 months, how helpful did you find the behavioral health consultation you received from the MMSHUD program? [Display if the answer to Q6 is "clinical behavioral health consultation."]
Not at All Helpful
Not so Helpful
Somewhat Helpful
Very Helpful
Extremely Helpful
In the last 12 months, how helpful did you find the care coordination you received from the MMSHUD program? [Display if the answer to Q6 is "care coordination or navigation services."]
Not at All Helpful
Not so Helpful
Somewhat Helpful
Very Helpful
Extremely Helpful
Overall, I feel more confident in my ability to screen, assess, and treat behavioral health conditions as a result of participating in my state’s MMHSUD program.
-
Screen
Assess
Treat
Strongly Disagree
o
o
o
Disagree
o
o
o
Neither Agree nor Disagree
o
o
o
Agree
o
o
o
Strongly Agree
o
o
o
I acquired valuable knowledge and information related to screening, assessing, and treating behavioral health conditions, as a result of participating in my state’s MMHSUD program.
-
Screening
Assessing
Treating
Strongly Disagree
o
o
o
Disagree
o
o
o
Neither Agree nor Disagree
o
o
o
Agree
o
o
o
Strongly Agree
o
o
o
I plan to use the information and knowledge acquired as a result of participating in my state’s MMHSUD program to screen, assess, and treat behavioral health in my practice once the program ends.
-
Screen
Assess
Treat
Strongly Disagree
o
o
o
Disagree
o
o
o
Neither Agree nor Disagree
o
o
o
Agree
o
o
o
Strongly Agree
o
o
o
What clinical practices have you adopted as a result of participating in your state’s MMHSUD program?
[OPEN-ENDED RESPONSE]
Overall, how have your pregnant and postpartum patients benefited from your participation in the MMHSUD program?
[OPEN-ENDED RESPONSE]
Screening, Assessment, and Treatment of Behavioral Health Conditions
What behavioral health screening tool(s) do you administer, interpret, or act upon? Select all that apply.
AUDIT
DAST
EPDS
GAD-7
MDQ
PHQ-2
PHQ-9/PHQ-9 modified/PHQ-A
Other (Specify.)
What behavioral health interventions do you personally provide? Select all that apply.
-
In-person
Via telehealth
Prescribe medication
o
o
Counseling (e.g., motivational interviewing, problem-solving therapy)
o
o
Link pregnant/postpartum patient to a specific behavioral health community resource
o
o
Other (Specify.)
o
o
I follow up (or someone from my practice follows up) with pregnant and postpartum patients to ensure that they have acted upon behavioral health referrals.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
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 nor Disagree
Agree
Strongly Agree
I am as willing to assess and treat pregnant and postpartum patients with common behavioral health conditions as I am to assess and treat common medical conditions in pregnant and postpartum patients.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Optimal Access to Behavioral Health Care
A goal of the overall MMHSUD program is to address barriers to optimal access to behavioral health care related to community health factors and demographic factors. Optimal access is intended to result in healthy outcomes for all. The following questions will be used to inform our goal of improving access.
In the last 12 months, how often have you engaged in the following activities to support optimal access to behavioral health care for your patients as a result of participating in your state’s MMHSUD program?
|
Never |
Rarely |
Sometimes |
Often |
Always |
Assess community health factors (e.g., food insecurity, housing insecurity) |
o |
o |
o |
o |
o |
Provide referrals to community resources to address needs related to community health factors |
o |
o |
o |
o |
o |
Make culturally and linguistically appropriate recommendations to promote behavioral health |
o |
o |
o |
o |
o |
As a result of participating in my state’s MMHSUD program, I am better able to address barriers to optimal access to behavioral health care.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
As a result of participating in my state’s MMHSUD program, I have incorporated telehealth services in my practice to improve optimal access to behavioral health care.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
What would be helpful from your state’s MMHSUD program to address health disparities in access to behavioral health care among your patients?
[OPEN-ENDED RESPONSE]
Demographic Information
What type of health professional are you?
Obstetrician/Gynecologist
Family physician
Pediatrician
Nurse midwife/Advanced practice nurse/nurse practitioner
Physician assistant
Licensed practical nurse
Registered Nurse
Counselor
Social worker
Medical assistant
Patient care navigator
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
Tribal Health System
Other (Specify.)
In what setting(s) does your patient population live? Select all that apply.
Urban
Suburban
Rural
Frontier
What is the race and/or ethnicity breakdown for pregnant and postpartum patients that you treat? Assign approximate percentage to all that apply; patients can be in more than one category and percentages can add up to more than 100%.
American Indian or Alaskan Native ____%
Asian ___%
Black or African American ___%
Hispanic or Latino ___%
Middle Eastern or North African ___%
Native Hawaiian or Pacific Islander ___%
White ___%
Unknown ___%
What is the payer breakdown for pregnant and postpartum patients that you treat? Assign approximate percentage to all that apply.
Medicaid ____%
Medicare ____%
Commercial ____%
Sliding fee scale/Self-pay ____%
Indian Health Service ____%
TRICARE ____%
Please provide the ZIP code for the primary location in which you practice.
[OPEN-ENDED RESPONSE]
Including yourself, how many health professionals (including pediatricians, family physicians, physician assistants, advanced practice nurse/nurse practitioners, licensed practical nurses, registered nurses, counselors, social workers, medical assistants, and patient care navigators) work in your practice?
1 (just me)
2-5
6-10
11-15
16-20
21-25
26-30
≥ 31
What is your race and/or ethnicity? Select all that apply and enter additional details in the spaces below.
American Indian or Alaskan Native – Enter, for example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya: ________________________________
Asian – Provide details below.
Chinese
Asian Indian
Filipino
Vietnamese
Korean
Japanese
Enter, for example, Pakistani, Hmong, Afghan:_______________
Black or African American – Provide details below.
African American
Jamaican
Haitian
Nigerian
Ethiopian
Somali
Enter, for example, Trinidadian and Tobagonian, Ghanian, Congolese: _______________
Hispanic or Latino – Provide details below.
Mexican
Puerto Rican
Salvadoran
Cuban
Dominican
Guatemalan
Enter, for example, Columbian, Honduran, Spaniard: _______________
Middle Eastern or North African – Provide details below.
Lebanese
Iranian
Egyptian
Syrian
Iraqi
Israeli
Enter, for example, Moroccan, Yemeni, Kurdish: _______________
Native Hawaiian or Pacific Islander – Provide details below.
Native Hawaiian
Samoan
Chamorro
Tongan
Fijian
Marshallese
Enter, for example, Chuukese, Palauan, Tahitian:_______________
White – Provide details below.
English
German
Irish
Italian
Polish
Scottish
Enter, for example, French, Swedish, Norwegian, etc. _______________
Additional Feedback
How can your state’s MMHSUD program be improved to better suit the needs of health professionals and/or patients?
[OPEN-ENDED RESPONSE]
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Haley Cooper |
| File Modified | 0000-00-00 |
| File Created | 2025-06-03 |
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