Consumer-Operated Service Program (COSP) Question-By-Question Guide For Multi-Site Follow-Up Protocol 1.2 --Interviewer Training Draft--
Program in Consumer Studies and Training Multi-Site
Question by Question Guide of the Baseline Common Protocol
COSP funded through cooperative agreement with Substance Abuse and mental Health Services
Administration, Center For Mental Health Services (GFA no. SM-95-01)
Table of Contents General Instructions .2 Cover Page .6 Demographics.7 Employment.11 Finances and Entitlements (EIDP), Judith Cook) .12 Housing (some items adapted from the New Hampshire State Outcome Measure) .17 TMHS Satisfaction (Mental Health Statistical Improvement Program Consumer Survey) .19 TMHS Outcomes of Services (Mental Health Statistical Improvement Program ConsumeSurvey) .21 COSP Satisfaction (Mental Health Statistical Improvement Program Consumer Survey) .23 COSP Outcomes of Services (Mental Health Statistical Improvement Program Consumer Survey) .25 Recent Service Use.27 Side Effects from Medication (Subjective Side Effects Rating Scale (SSRS), Peter Weiden) .28 Substance Use (Adapted from the Addiction Severity Index, McLellan et al.).30 List of Drugs.33 Empowerment (Empowerment Making Decisions, Rogers, et al.) .36
(Personal Empowerment, Segal, Silverman, Temkin).39 (Organizationally Mediated Empowerment, Segal, Silverman, Temkin) .41
Service Utilization (COSP Cost Analysis Subcommittee) .44 Program Activities (COSP Cost Analysis Subcommittee).47 Social Inclusion (Excerpts from the Quality of Life, A. Lehman) .50 Social Acceptance (Well Being Project, J. Campbell) .51 Discrimination (Adapted from the Schedule for Racist Events, Landrine and Klonoff).52 Quality of Life (Excerpts from the Quality of Life Interview, A. Lehman).54 Symptoms (Hopkins Symptom Checklist, Mattson et al.).55
(Health Problems/Health Status) .58 (Colorado Symptom Index, Shern, Wilson, Coen) .63 Recovery Assessment Scale (Corrigan et al.) .64 Meaning of Life/Framework (Sub-scale in the Life Regard Index, Battista & Almond).68 Religion/Spirituality (Zinnbauer et al.).70 Herth Hope Index (Herth) .71 Conclusion .73 GENERAL INSTRUCTIONS
Purpose of this Guide The purpose of this Question-by-Question Guide is to provide you with additional information that will help you in administering the common protocol. You should refer to this guide when additional explanation of any particular section or question is needed during an interview. Reading the Questions
When beginning an interview, you should reassure the respondent that there are no wrong or right answers. As an interviewer you must: § Read questions exactly as they are worded in the questionnaire. § Read questions in the order in which they are presented on the questionnaire. § Ask every question on the questionnaire (unless there are skip instructions). After reading the
question, listen quietly and patiently for the response. Do not interrupt or make a comment before the respondent has completed an answer.
§ Read questions with no additions, deletions, or substitutions. § Read each question slowly at about two words per second. § Use a tone of voice that conveys assurance, interest, and a professional manner that is neutral and
§ Emphasize underlined words to enhance meaning. Do not attempt to re-word or explain a question. If the respondent does not understand, repeat the question slowly or look to see if there is an explanation given for this question in this Question-by- Question Guide. To ensure that all interviewers use standardized responses, interviewers should read the shaded and italicized explanations exactly as they are written. For example, the question reads, “What is your preferred ethnic identification?” Below is the Question by Question instructions for that question. If the respondent asked the interviewer to explain the question further, the interview would read the shaded explanation. If the respondent continues to ask what it means, reply, "Whatever it means to you." Question 4c.
[Ethnicity]: Ask the respondent the question. If the respondent asks for further clarification, read the following definition: Ethnicity is a shared identity based on cultural tradition, language, biological kinship, or even historical/geographical region. Your answer should be linked to a group or groups of people that you feel a shared identity with, for example African American, Irish, Jewish, Puerto Rican, and Middle Eastern (Arab).
Sometimes a respondent will want to answer a question before you have finished reading it. It is crucial that the respondent hear the entire question before answering. If the respondent interrupts, you must continue reading the question. This allows the respondent to hear the entire question and it also discourages future interruptions. Don't skip a question because the answer was given earlier or because you "know" the answer. In those situations in which the respondent has already provided information that probably answers the next question, you may preface the question with some combination of the following phrases: § "I know we've talked about this,"--or--" I know you just mentioned this, but I need to ask each
question as it appears in the questionnaire."
§ "You have already touched on this, but let me ask you." § "You've told me something about this, and this next question asks." Do not direct the respondent toward an answer or assume that an "answer" you got in passing is the correct answer to a specific question at a particular point in the interview. Do not direct the respondent by mentioning an earlier answer. If an answer is different from the one you expect, do not remind the respondent of an earlier remark or try to force consistency. Finally, remember that although you may have read these questions many times, the respondent is hearing them for the first time and needs time to understand the questions in order to decide on the answers. Displaying the Scale Cards There are a number of questions on the survey form that have more than 4 or 5 responses. It would be too difficult for the respondent to remember all of the choices. For this type of question, a scale card is supplied with the reply choices listed on it. Each of these questions will tell you which scale card to use. Before you read the question, hand the card to the respondent. Read the question, ask the respondent to look at the code card as you read the responses, and ask the respondent to choose one answer from the list. In a few instances, respondents are asked to select more than one answer for a particular scale card if more than one answer applies. You will use a code packet, so that you can flip to the appropriate card to display to the respondent.
Coding Responses
The respondent's answers must be completely and properly coded on the questionnaire or in the laptop, or the interview results cannot be used for analysis. Record every answer in the appropriate category. If you must probe for a response, write P next to the question. If the respondent has difficulty in understanding the question, make a note next to the question. You may also use the interviewer's comment section for further explanations. Every question must have some recorded answer, or an explanatory mark, in the available space. Not Answered (8): Not Answered (NANS) should be used when there is no possible way for the respondent to logically answer the question based on her/his experiences. For example, Outcomes of Services, Question 7: I do better in school/work would not apply to someone who is neither working nor in school. This response can also be used when they don’t understand the question or simply don’t know how to respond to it. Not Asked(9): Not Asked (NASK) should only be used if an item was part of a skip pattern, or if you forgot to ask it. This response may also be used on the rare occasion when you feel that asking the question may jeopardize the completion of the interview. If this is the case, there must be a written note next to the question explaining why this question may jeopardize the interview.
NOTE: Remind interviewers to use the "not asked" code (9 or 99) when an item does not apply to a respondent. When using the "Not asked" code the interviewer should always make a margin note to explain why the question was not asked.
If you accidentally mark the wrong answer, cross out your mark, write 'error' next to it and circle the correct answer. If you are using a laptop, delete the previous answer and enter the correct answer. Some respondents may change their mind while giving an answer, so it is useful to wait a couple seconds between questions to be sure the respondent has finished speaking before marking their final answer. If you have finished the interview, but have some concern about whether the respondent answered accurately or truthfully, make a note of this or of any other concern in the section for interviewer's comments.
Probing and Coding for Answers There may be times during the interview when the respondent has difficulty choosing between two responses. As an interviewer, you should make every effort to encourage the respondent to select a single response choice. This includes repeating the question, repeating the answer choices, and narrowing down the responses for the respondents by probing. For example, if the respondent cannot choose between "somewhat agree" and "strongly agree" you should probe the respondent by asking, "Which is closer to the way that you feel?" If, after probing, the respondent cannot isolate an answer, you should offer to the respondent that you could circle "8" for "Not Answered." If the respondent continues to insist that you choose more than one answer, you should circle his or her chosen responses and code this question after the interview is completed. Following completion of the interview, if two answers are circled one will be chosen by the flip of a coin. If more than two answers are circled, several coin tosses can be employed. In some cases, interviewers may accidentally circle more than one response. When this occurs the interviewer may choose to locate the respondent and re-ask the question, or the above coding method can be used. Probing and Coding for Dates Throughout the protocol there are several questions that ask respondents to supply the day, month, and year of a specific event or situation, such as being hospitalized or moving into new housing. Respondents may not be able to remember exact dates for each of these questions, but as an interviewer it is your responsibility to probe respondents to be as specific as possible. Read the following examples of probing and coding for dates: DAY If a respondent is unsure about the day of a particular event, but can recall the month and year, ask the respondent to recall whether it was at the beginning, middle or end of the month. • If the respondent indicates it was at the beginning, code the day as "01."
• If the respondent indicates it was in the middle of the month, code the day as "15."
• If it was at the end of the month, code the day as 30 (unless it is February, then code 28).
• If the respondent is still unsure, code "15" as the day. MONTH If the respondent is unsure about the day and month of the event, probe the respondent to think about if it was at the first, middle, or last part of the year. • If the respondent is still unable to recall the month of the event, code the day as "15" and the month
DAY/MONTH/YEAR If the respondent is unable to recall the day, month and year of a specific event, even after probing, record "8" for "not answered."
COVER PAGE [Site]: This may be filled out already. If not, put the site’s one-digit identification number here. [Participant ID]: This may be filled out already. If not, put the participant’s ten-digit identification number here. [Interviewer Name]: Put your name here. [Group Assignment]: This may be filled out already. If not, code as follows: 1 = (TMHS only)—If the respondent was not assigned to participate in the consumer-operated
(TMHS plus COSP)—If the respondent was assigned to participate in the consumer-operated
service program (COSP). [Language]: This may be filled out already. If not, code as follows: 1 = English, 2 = Spanish, 3 = Other (please specify). If the person’s language is not English or Spanish please write it in next to other. [Wave]: Check whether the interview is at the 4 month, 8 month, or 12 month follow-up mark. [Date of Interview]: Put the date that you conducted the interview here. [Interview Session I]: Put the number of minutes that it took to conduct the interview here. This does not include time for long breaks. If the interview is broken into multiple sessions then only record the number of minutes for the first session here. Please note that there are 60 minutes in an hour. [Interview Session II]: If the interview was broken into multiple sessions, put the number of minutes for second session here. Please leave blank if this doesn’t apply. [Interview Session II]: If the interview was broken into multiple sessions, put the number of minutes for third session here. Please leave blank if this doesn’t apply. [Interview Session IV]: If the interview was broken into multiple sessions, put the number of minutes for fourth session here. Please leave blank if this doesn’t apply. [Total Interview Time]: Add up the total number of minutes from all sessions and put the total interview number of minutes here.
INTRODUCTION Read the introduction to the respondent. Insert your name and the name of the organization with which you are working in the blanks. Your site may have a specific protocol that allows for the distribution of a list of agencies in your area that may be contacted by the respondent if needed following the interview. Specific site IRB's may require the site to read the special instructions pertaining to individuals who express active thoughts about danger to oneself. Check with your site regarding this requirement. SPECIAL INTERVIEWER INSTRUCTION The special interviewer instructions should be used to help complete the timeline. DEMOGRAPHIC INFORMATION If respondents ask why we are asking these questions remind them that “in studies like this, we ask about things like marital status, cultural identity, gender, and sexual orientation, so that we can look at the accessibility and outcome of services from different perspectives. For example, married people may have different outcomes than single people, or young people may have different outcomes than older people.” Please also remind them that they have the right not to answer any of these questions. Question 1. [Preferred Reference]: The respondent should indicate the word he/she prefers. If the person requests for further clarification, please read the following: We would like you to answer based on your own experiences. Please answer with whatever term you feel most comfortable using.[Birth Date]: Code in mm/dd/yyyy format. So, for example, if a respondent says June 8, 1966 then code 06/08/1966. [Physical Disability]: The respondent’s answer should not include psychiatric disabilities or other disabilities that may be caused by psychiatric disabilities.
If the respondent asks for further clarification of the word “paralysis,” read the following:
Paralysis is the inability to move a limb. [Mobility]: Provide the following explanation if necessary: By mechanical devise we mean self-powered wheel chairs, walkers, canes, crutches, machine-powered wheel chairs, artificial limbs, or any other instrument used to assist you with mobility. [Hearing Loss]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Trouble Hearing]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Legally Blind]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Difficulty Seeing]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Marital Status]: If the person’s answer does not exactly match one of the categories, repeat all response choices and ask the respondent to choose. If the respondent indicates that he/she is single, prompt using the following statement: Have you ever been married? Marriage refers to legal marriage with a certificate or a common law marriage.
Question 10. [Significant Other]: If the respondent asks for clarification, read the following: By significant other we mean are you in a committed intimate relationship with someone to whom you are not legally married. Question 11. [Children]: If the respondent indicates that they do not have any natural, adopted, or
step-children, skip to question13. If the respondent asks for further clarification, read the following:
Natural children refer to children who you fathered, or gave birth to. Adopted children refer to children for whom you have legally been granted parental rights. Stepchildren refer to children who were born to your spouse, but who you did not conceive.
Question 12. [Number of Children]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 13. [Education]: Hand respondent the scale card, read the question then read the answer
choices. The respondent should indicate the highest levels of education he or she has completed in the last four months. If the answer does not exactly match one of the categories, repeat all response choices and ask the respondent to choose. The question addresses changes in educational status in the last four months. If an individual has completed a new/additional educational status/degree in the last four months, indicate the new status/degree. If no changes in educational status have occurred, indicate “None.” If the respondent asks for further clarification, read the following:
“GED” stands for General Equivalency Diploma or General Educational Development. Some people take this test to get their high school diploma equivalency.
Vocational specialty or trade certification refers to a specialized work-related degree or certificate received after completing either short courses, or longer classes at a community college, technical school, or another educational organization. This is typically pursed to advance one's occupational skills.
(If the Respondent asks whether advocacy training is considered a vocational specialty,
then read the following statement.) Advocacy training can be provided to advance occupational skills if the person receiving the training intends to be or is currently employed as an advocate.
AA or AS refers to an Associates or Arts degree or Associates of Sciences degree received from a community college or technical school.
BA or BS refers to a Bachelor of Arts or Bachelor of Science received from a college or university.
MA or MS refers to a Master of Arts or Master of Science degree received from a college or university.
Ph.D. refers to a doctoral degree received from a university.
Question 14. [Current Education]: Ask the respondent to indicate whether they are currently enrolled in an education program. If the respondent indicates that they are not currently enrolled in an education program, skip to question 17. If they ask for clarification of an education program, provide the following explanation: An education program refers to any formal program of instruction where you receive information pertaining to a specific area of study. For example, if you have began a program at a university or community college. Question 15. [Degree or certificate]: Ask the respondent to indicate what degree they are currently seeking. If the respondent asks for further clarification, refer to the definitions given in question 13. Question 16. [Military]: This question refers to whether the respondent has served in the military in
the last four months prior to the interview. Provide the following explanation if necessary:
Please answer with whatever this means to you. Question 17. [Life]: Record what the individual states verbatim if possible. Probe for up to three
possible responses. Some potential answers are (a) a job, (b) housing, (c) management of mental illness, etc., though respondents may elaborate on issues of relevance to them at this point in time.
EMPLOYMENT
Question 1. [Last 4 months]: This refers to employment during the last four months. If the respondent asks for further clarification, respond with the following: Please answer with whatever this means to you. [Current]: Provide the following explanation if necessary: Working for pay refers to activities you perform where you received money. Volunteering refers to performing activities on your own for an organization or group, but you are not paid money. [Status]: Hand respondent the card, read the question, read the answer choices. If their answer does not exactly match one of the categories, repeat all response choices and ask the respondent to choose all that apply. [Status 2]: Hand respondent the scale card, ask question, read answer choices and ask the respondent to choose all that apply. Include temporary disability under disabled, and include laid off under unemployed. [Important]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 5b. [Tell me more]: The respondent should indicate why having a paying job is or is not [Looking]: Provide the following explanation if necessary: Please answer with whatever this means to you. FINANCES AND ENTITLEMENTS General Note: Interviewers should take margin notes throughout this section if they or the respondent are unsure about the benefits, finances, or entitlements he or she receives. This information can be used to code the response at a later time.
Question 1. [Any]: If they say "no" code it as "00." If the respondent indicates the he or she does
not have any source of income, skip to section M.
Note: Question 2A – 2N refers to finances and entitlements received during the past 30 days. For these questions, hand respondent scale card. If the respondent indicates that he or she has received income from that source, ask him/her to tell you the number to the left on the range that his/her income falls into. If the person is uncertain of the range, please ask her/him to estimate.
Question 2A1. [Employment]: If respondent asks for further clarification, read the following: This includes money received through full or part-time employment at a job or sheltered workshop. Question 2A2. [2nd Job]: If the respondent has two jobs record his/her income from the second job
here. It might be necessary to help the respondent estimate his/her income by asking determining how much he/she brings home each week. Calculate in the margins if necessary. Make sure that these last four weeks were average weeks for the client and then you may multiply the weekly rate by four. If the client can only provide you with an hourly rate, you will need to work through each week, day by day. Come up with a daily total for each day working in the last month and then add these together.
[Social Security]: When a Respondent answers ‘Yes’ to receiving Social Security income or finances in the past 30 days and then indicates that part of their benefits have been from Survivor Benefits, check ‘Yes’ for Social Security Retirement, and record “Survivor Benefits” in margin notes. If respondent asks for further clarification, read the following: In addition to Social Security Retirement benefits, this category includes money from Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Supplemental Security Income (SSI) benefits are a monthly check from the Social Security Administration for people who are 65 or older who have worked at some point in their life, or for people who are blind, or have a disability but have not been employed. Social Security Disability Insurance (SSDI) benefits are cash benefits from the Social Security Administration for people who are unable to work for a year or more because of a disability. Social Security Administration (SSA) retirement check is a monthly check from the Social Security Administration for retired individuals. People normally can begin to receive a check at age 65, however, some individuals may begin to receive reduced benefits at age 62. [VA Disability]: If respondent asks for further clarification, read the following: This is a benefit someone may receive if he/she was disabled while serving in the armed services. If a Respondent answers that he has received a VA disability and a VA pension as a lump sum disbursement, code this as a VA pension. [VA Pension]: If respondent asks for further clarification, read the following: This is a pension provided to someone who served in the armed services for a significant period. [Welfare]: If respondent asks for further clarification, read the following: This includes general welfare/public aid, food stamps, fuel assistance, Temporary Assistance for Needy Families (TANF), state or county public assistance. Also, items such as a clothing allowance. [Vocational]: If respondent asks for further clarification, read the following: This includes Job Training Partnership Act (JTPA), vocational rehabilitation, Goodwill, or other vocational programs that teach skills to get jobs or assist with job placement. [Unemployment]: If respondent asks for further clarification, read the following: This is a temporary benefit to compensate workers who have been laid off or let go from their jobs. [Retirement/Investment]: If respondent asks for further clarification, read the following: This includes retirement benefits from a pension plan or other type of company sponsored retirement plan. It also includes income from investments (e.g., stocks, bonds, real estate) or interest income from savings in the bank (e.g., savings accounts, money market account, CDs). We are interested in monthly income, rather than the total amount of these investments. [Alimony/Child Support]: If respondent asks for further clarification, read the following: Alimony (also known as spousal support) is income that is usually received from a divorced or separated spouse to support you. When a child's parents are separated, the parent the child is living with may receive child support. Add both types of support together to arrive at a monthly total. [Rental Suppl.]: If respondent asks for further clarification, read the following: This includes HUD, Section 8 certificates, and living programs receiving public assistance. Regular supplements are received monthly. [Family/Friends]: If respondent asks for further clarification, read the following: This includes money earned by a spouse, or money received from family or friends. [Other Source]: If the respondent indicates any other source of income please specify the source. If necessary, please remind the respondent that this information is confidential. [Bartering]: If respondent asks for further clarification, read the following: Bartering is providing a service to someone in exchange for something of value other than money. For example, raking leaves in exchange for a meal or washing a car in exchange for a ride. [Other Assistance]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Benefits]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Health Plans]: If respondent asks for further clarification, read the following: Medicaid is a health insurance program for eligible low-income people. Recipients can be children, senior citizens, individuals who are blind and/or disabled, or individuals who receive federally assisted income maintenance programs. Medicare is a health insurance plan for people who are 65 or older. People who are disabled or have permanent kidney failure can get Medicare at any age Private insurance is health insurance that is purchased from a private company such as Blue Cross Blue Shield, United Health Care, etc. Veterans Administration or other Armed Services benefits are benefits awarded to veterans [Pay for Svcs]: Provide the following explanation if necessary: Please answer with whatever this means to you. HOUSING Note: In this section, you will ask the respondent to answer questions about housing until you have accounted for his or her housing situation over the past 4 months. Question 1. [Type]: Hand respondent scale card that lists the types of housing. The idea is to distinguish whether the respondent lives independently, shares a residence, or lives within a state-run facility. Read the question. If the respondent’s answer does not exactly fit one of the categories, read the closest choice and verify with the respondent.
[Own Apartment]: If respondent asks for further clarification, read the following:
This means living in an apartment or other rental unit such as a house or condo, town-house, or trailer in which your name is on the lease.
[Someone Else’s Apartment]: If respondent asks for further clarification, read the following:
This means that you stay in an apartment, but your name is not on the lease.
[Own House]: If respondent asks for further clarification, read the following:
This means that you living in a house, condo, town-house, or trailer in which your name is on the title.
[Someone Else’s Home]: If respondent asks for further clarification, read the following:
This means that you live in a house, condo, town-house, or trailer in which your name is not on the title. [Duration]: Ask the respondent to indicate the length of time they have lived in their current situation. Record the information in terms of days/months/years. If the respondent is uncertain about the date or duration, refer to page 4 for probing and coding of dates Questions 3-20 in this section should follow the same format until the last 4 months are accounted for.
Question 21. [Current]: This question is trying to get at whether the respondent feels that this is a
temporary living arrangement. If respondent asks for further clarification, read the following:
What is the length of time that you can stay where you are living right now. Question 22. [Homeless]: This question refers to whether the respondent has been homeless in the
past four months prior to this interview. If respondent asks for further clarification, read the following:
Homeless refers to a person who has no home or permanent residence. If they don’t know what this means say, “whatever it means to you.”
Question 23. [Roommates]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 24. [Live with]: Hand respondent the card, read the question, then read the response
choices and ask the respondent to choose all that apply. Select both “mental health consumer” and “with parents” if, for example, the respondent lives with a parent who is also a mental health consumer.
[Children]: If respondent asks for further clarification, read the following: Do you live with any children for whom you are a biological parent, even if someone brought up the children outside the family? Do you live with any children for whom you are the caregiver for example adopted children, foster children, or stepchildren.
Question 25. [Afford]: Hand respondent the scale card, ask question, read response choices. Provide Please answer with whatever this means to you.
Question 26. [Space]: Hand respondent the scale card. Provide the following explanation if necessary: Please answer with whatever this means to you. TMHS SATISFACTION This section focuses on the respondent’s overall satisfaction with mental health services received. Mental health services includes seeing a psychiatrist, therapist, case manager, etc. This question is not asking about satisfaction with other services that may have been received from consumer operated service programs. Question 1. [Receive]: If the respondent indicates that they have not received services from mental health service providers, skip to the Recent Service Use section. If the respondent asks for further clarification, read the following: Traditional mental health services include being an outpatient, inpatient, seeing a psychiatrist, therapist or case managers, or another mental health professional, receiving services in a hospital, or receiving services from another mental health service not run and governed by mental health consumers. [General Satisfy]: Hand respondent scale card, read question, and read answer choices. Remember that this is a question that asks about the respondent’s overall satisfaction with mental health services he/she received. If necessary, remind them that the time frame we are interested in is the past four months. If the respondent asks for further clarification, read the following: Please refer to all the mental health services that you have received in the last four months. Since some respondents receive services from more than one TMH provider and have strong feelings about each, if respondent insists on giving different answers for each provider, use standard probing procedures. If that is unsuccessful, ask the question again in the following manner: “Would you say in general, that you agree or disagree?” or “In general, do you disagree, or strongly disagree?” If respondent still refuses to answer, code this as “8”, Not answered, and add margin notes. [Choose]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Friend]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Location]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Willing]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Times]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Grow]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Complain]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 10. [Response]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 11.[Ethnic]: If the respondent asks for further clarification, read the following: Cultural and ethnic background refers to your race and/or ethnicity.
Question 12. [Best]: Provide the following explanation if necessary: Please answer with whatever this means to you. TMHS OUTCOMES OF SERVICES The next set of questions asks about outcomes that the respondent has had as a result of receiving services (i.e., how the respondent may have benefited). The questions should be read exactly as written. If the respondent does not understand the question, reread it and encourage the respondent to answer the best they can. If the respondent still has difficulty or the questions do not apply to them, select NANS and move on. If the respondent seeks further clarification, read the following: I do not have a standard definition for this question, please answer with whatever it means to you.[Problems]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Feel]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Control]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Crisis]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Family]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Social]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 7. [School/Work]: If this question is not applicable to the person, NANS should be coded. NOTE: Even if the respondent has previously indicated that they do not attend school or work, you should still ask the question. Provide the following explanation if necessary: Please answer with whatever this means to you. [Leisure]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Housing]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 10. [Symptoms]: Examples of symptoms include: hopelessness; anxiety; violent tendencies;
paranoia; hearing voices; feeling worthless. Provide the following explanation if necessary:
Please answer with whatever this means to you. Question 11.[Independent]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 12. [Need]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 13. [Deal]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 14. [Health]: Provide the following explanation if necessary: Please answer with whatever this means to you. COSP SATISFACTION This section focuses on the respondent’s overall satisfaction with services from consumer operated service providers. Mental health services includes seeing a psychiatrist, therapist, case manager, etc. This question is not asking about satisfaction with other services that may have been received from traditional mental health service providers. Question 1. [Receive]: If the respondent indicates that they have not received services from consumer operated service providers, skip to the Recent Service Use section. If the respondent asks for further clarification, read the following: Consumer operated services refers to a program that is administratively controlled and operated by consumers. It is intended to achieve improved outcomes and emphasizes self-help as its operational approach. When we say consumer operated services, we mean _______________(fill in the name of the COSP site). [General Satisfy]: Hand respondent scale card, read question, and read answer choices. Remember that this is a question that asks about the respondent’s overall satisfaction with consumer operated services he/she received. If necessary, remind them that the time frame we are interested in is the past four months. If the respondent asks for further clarification, read the following: Please refer to all the consumer operated services that you have received in the last four months. [Choose]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Friend]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Location]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Willing]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Times]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Grow]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Complain]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 10. [Response]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 11.[Ethnic]: If the respondent asks for further clarification, read the following: Cultural and ethnic background refers to your race and/or ethnicity.
Question 12. [Best]: Provide the following explanation if necessary: Please answer with whatever this means to you. COSP OUTCOMES OF SERVICES The next set of questions asks about outcomes that the respondent has had as a result of receiving services (i.e., how the respondent may have benefited). The questions should be read exactly as written. If the respondent does not understand the question, reread it and encourage the respondent to answer the best they can. If the respondent still has difficulty or the questions do not apply to them, select NANS and move on. If the respondent seeks further clarification, read the following: I do not have a standard definition for this question, please answer with whatever it means to you.[Problems]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Feel]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Control]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Crisis]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Family]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Social]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 7. [School/Work]: If this question is not applicable to the person, NANS should be coded. NOTE: Even if the respondent has previously indicated that they do not attend school or work, you should still ask the question. Provide the following explanation if necessary: Please answer with whatever this means to you. [Leisure]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Housing]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 10. [Symptoms]: Examples of symptoms include: hopelessness; anxiety; violent tendencies;
paranoia; hearing voices; feeling worthless. Provide the following explanation if necessary:
Please answer with whatever this means to you. Question 11.[Independent]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 12. [Need]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 13. [Deal]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 14. [Health]: Provide the following explanation if necessary: Please answer with whatever this means to you. RECENT SERVICE USE NOTE: The following questions refer to services received in the past four months.
Question 1. [Phys. health]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 1a. [Trouble]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 2a. [Meds]: This question is only asking about medication taken for psychiatric purposes
during the past 4 months, and is not asking about medication taken for physical health reasons. If the respondent is not sure whether a particular drug is for psychiatric purposes, see list of commonly prescribed psychotropic drugs on page ?? of this document. If the respondent answers "no" to this question the interviewer should skip to the substance use section. Provide the following explanation if necessary:
Please answer with whatever this means to you.
Question 2b. [Explain]: If the respondent asks for further clarification, read the following: Did the doctor tell you why you are taking this medication? [Informed]: If the respondent asks for further clarification, read the following: Has a doctor or other medical professional told you about reactions you might have as a result of taking this medication?
Question 2d. [[Help]: Provide the following explanation if necessary: Please answer with whatever this means to you. SIDE EFFECTS FROM MEDICATION
This section asks about side effects from medication taken orally over the past week and medication taken by injection which may not have been administered in the past week but would still be exerting an effect. Over the counter alternative treatments like kava kava or St John's wort would be excluded. Also excluded are psychiatric effects of drugs prescribed for non-psychiatric conditions. Do not read the words in parentheses for any of these questions. Hand respondent scale card.
Question 1. [Bother most]: Ask these questions of all participants. Some respondents may indicate that
they do not experience side effects. However, should this occur, do not skip this section. Code "8" in the blank and write in the margin notes "no side effects reported." Provide the following explanation if necessary:
Please answer with whatever this means to you. Question 2. [Akathisia]: Do not read the words in parentheses for this question. Question 3. [Rigidity]: Do not read the words in parentheses for this question.
Question 4. [Akinesia]: Do not read the words in parentheses for this question.
Question 5. [Tremor]: Do not read the words in parentheses for this question.
Question 6. [Embarrassment]: Do not read the words in parentheses for this question.
Question 7. [Dry Mouth]: Do not read the words in parentheses for this question.
Question 8. [Blurred Vision]: Do not read the words in parentheses for this question.
Question 9. [Constipation]: Do not read the words in parentheses for this question.
Question 10. [Sedation]: Do not read the words in parentheses for this question.
Question 11. [Insomnia]: Do not read the words in parentheses for this question.
Question 12. [Appetite Increase]: Do not read the words in parentheses for this question.
Question 13. [Appetite Loss]: Do not read the words in parentheses for this question.
Question 14. [Memory Loss]: Do not read the words in parentheses for this question.
Question 15. [Cognitive]: Do not read the words in parentheses for this question.
Question 16. [Depression]: Do not read the words in parentheses for this question.
Question 17. [Appearance]: Do not read the words in parentheses for this question.
Question 18. [Embarrassment]: Do not read the words in parentheses for this question.
Question 19. [Weight Gain]: Do not read the words in parentheses for this question.
Question 20. [Weight Gain Embarrassment.]: Do not read the words in parentheses for this
Question 21. [Weight Loss]: Do not read the words in parentheses for this question. Questions 22 and 23 are to be asked of all wo men. If the respondent is male, skip to question 24. The time frame is for taking the medication, not the side effect itself. Obviously some of the side effects take more than a week to manifest themselves. That is why for questions 22 and 23, there is no reference to a time frame, as “within the past week” is not appropriate. The instructions specify period secession as a result of the medication, so if the respondent answers that she had no periods, probe if this is a result of the medication. If so, then ask how bothered she is by this side effect. Question 22. [Amenorrhea/Dysmenorrhea]: Do not read the words in parentheses for this question.
This item should be asked of premenopausal women only. If you are in doubt whether a woman is premenopausal, please ask the question.
Question 23. [Galactorrhea]: Do not read the words in parentheses for this question.
Do not read the words in parentheses for any of this question. This item should be asked of premenopausal women only. If you are in doubt whether a woman is premenopausal, please ask the question.
Question 24. [Sexual Difficulties]: Do not read the words in parentheses for this question. This
question is for Males. Please read the appropriate question based on the respondent’s gender.
Question 25. This question is for females.
SUBSTANCE USE
If you have any questions about the definitions of drugs, please use the lists on pages 29-31. The respondent may also need clarification about the number of days that drugs were used over the past 30 days, or whether a doctor prescribed the drugs. If the respondent needs further clarification, respond using the corresponding answer below. ♦ If the respondent has questions about the number of days used, read the following: How many days in the last month did you use this drug(s)?
♦ If the respondent has questions about whether the drugs have been prescribed, read the following:
A prescribed drug is one that was prescribed by health care practitioner, not just someone saying, “you should take this.”
♦ During this section, the respondent may become uncomfortable or reluctant to answer the questions
honestly. In these cases, read the following:
I want to remind you that everything you tell me here is confidential. The information you provide will not be shared with anyone unconnected with the study. We just want to find out about your use of alcohol and other substances. So please be as open and honest as you feel you can be. Question 1. [Alcohol]: Self-explanatory. If respondent has questions about the named of drugs,
Question 2 [Alcohol feelings]: Self-explanatory. If respondent has questions about the named of
drugs, please refer to the list of drugs.
Question 3 [Methadone]: Self-explanatory. If respondent has questions about the named of drugs,
Question 4 [Other opiates]: Self-explanatory. If respondent has questions about the named of
drugs, please refer to the list of drugs.
Question 5. [Barbiturates]: Self-explanatory. If respondent has questions about the named of drugs,
Question 6. [Sedatives]: Self-explanatory. If respondent has questions about the named of drugs,
Question 7. [Amphetamines]: Self-explanatory. If respondent has questions about the named of
drugs, please refer to the list of drugs.
Question 8. [Cannabis or Marijuana]: Ask about prescribed use only in California. Self-
explanatory. If respondent has questions about the named of drugs, please refer to the list of drugs.
Question 9. [Cocaine or Crack]: Self-explanatory. If respondent has questions about the named of
drugs, please refer to the list of drugs.
Question 10. [Heroin]: Self-explanatory. If respondent has questions about the named of drugs,
Question 11. [Hallucinogens]: If respondent has questions about the named of drugs, please refer to
the list of drugs. Psilocybin is pronounced “sy-low-sy-bin.”
Question 12. [Inhalants]: Self-explanatory. If respondent has questions about the named of drugs,
Question 13. [More than one]: Self-explanatory. If respondent has questions about the named of
drugs, please refer to the list of drugs.
Question 14a. [Money on Alcohol]: If the individual is unable to provide an amount, you may probe
Question 14b. [Non-prescribed]: If the respondent asks for further clarification, read the following: We would like to know how many days you have used a substance when it was not prescribed for that day or for more than the prescribed times each day. Question 15. [Alcohol Problems]: Be sure to stress that you are interested in the number of days the
patient had problems directly related to alcohol use. Include carving for alcohol, withdrawal symptoms, disturbing effects of alcohol intoxication, or wanting to stop and not being able to do so. The respondent may not consider certain affects of alcohol use as being adverse effects, such as a hangover. Therefore, he/she should answer the question by referring specifically to those effects that he/she perceives as being adverse. If respondent asks for further clarification, read the following:
Please tell me about the effects from alcohol that you consider adverse and have experienced in the last 30 days. Question 16. [Drug Problems]: Be sure to stress that you are interested in the number of days the
patient had problems directly related to drug use. Include carving for drugs, withdrawal symptoms, disturbing effects of drug intoxication, or wanting to stop and not being able to do so. The respondent may not consider certain affects of drugs use as being adverse effects. Therefore, he/she should answer the question by referring specifically to those effects that he/she perceives as being adverse. If respondent asks for further clarification, read the following:
Please tell me about the effects from drugs that you consider adverse and have experienced in the last 30 days. If the respondent answers "00" days for both Question 15 and 16, then SKIP to the Empowerment Section.
Question 17a. [Bothered Alcohol]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 17b. [Bothered Drugs]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 17c. [Treatment Alcohol]: Although the respondent may have not reported any problems
associated with alcohol, you must still ask this question. If the respondent would like clarification, read the following:
Regardless of whether or not you may feel that you experience alcohol problems, I must ask you this question. How important to you is receiving treatment for alcohol problems? Question 17d. [Treatment Drugs]: Although the respondent may have not reported any problems
associated with drugs, you must still ask this question. If the respondent would like clarification, read the following:
Regardless of whether or not you may feel that you experience drug problems, I must ask you this question. How important to you is receiving treatment for drug problems? List of Drugs Commonly Prescribed Psychiatric Medications (Trade names are capitalized)
Adapin Type of Drug Street Name If Rx, Trade/Generic Name
Alcohol – please tell me about Beer, Wine, Liquor, Grain
any use at all (methyl alcohol) Methadone
Duramorph, Dilaudid, Demeral, Percocet, Percodan, Pantopon, Dia-Quel, Darvon, Darvocet, Talwin, Codeine (Tylenol 2,3,4), Syrups (Robitussin, Actifed-C) Fentany1)
Pentobarbital, Secobarbital, Phenobarbital, Fiorinal, Doriden, Placidyl
Valium, Librium, Activan, Serax, Tranxene,
Dalmane, Halcyon, Xanax, Thorazine, Stelazine,
Haldol, Navane, Serentil, Mellaril, Prolixin, compazine, Miltown Chloral Hydrate (Nactec), Quaaludes
Benzedrine, Dexedrine, Preludin, Biphetamine,
Methamphetamine (Desoxyn), Methylphenidate (Ritalin)
Sinsemilla, Smoke, Weed, Joints, Roaches, Weed, Mary Jane, Hashish, Hashish Oil
Blow, Girl, "Crack cocaine", Freebase rocks
Buttons, Cactus, Mesc, Magic, Mushrooms (Psilocybin), Purple Passion, Shrooms, Peyote, Green, PCP (Phencyclidine), Angel dust), Love Boat, Boat, Hog, Adam, Ectasy, STP, XTC, Green/Red Dragon, PCE, Beam me up Scottie, Microdot,
(Whippets, Popper, Gas in aerosol cans), glue, solvents, Butyl nitrite, Gasoline and Toluene vapors (Correction fluid, glue, marking pens)
EMPOWERMENT Making Decisions
[Life]: Hand respondent scale card. Self-explanatory. Provide the following explanation if necessary: Please answer with whatever this means to you.[Think]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Group]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Angry]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Attitude]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Confident]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Right]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Misfortunes]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 9. [Capable]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 10. [Waves]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 11. [Community]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 12. [Barriers]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 13. [Optimistic]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 14. [Plans]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 15. [Step]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 16. [Alone]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 17. [Experts]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 18. [Able]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 19. [Accomplish]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 20. [Live]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 21. [City hall]: If the respondent asks for further clarification, read the following:
“City hall” refers to government policies.
Question 22. [Powerless]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 23. [Unsure]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 24. [Worth]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 25. [Decisions]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 26. [Qualities]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 27. [Problem]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 28. [Community]: Provide the following explanation if necessary: Please answer with whatever this means to you. Personal Empowerment [Spend time]: Hand respondent scale card. Provide the following explanation if necessary: Please answer with whatever this means to you. [Spend money]: Provide the following explanation if necessary: Please answer with whatever this means to you. [TV/radio]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Get help]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Town/city]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Live in]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Guests]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Help when]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 9. [Possessions]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 10. [Living space]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 11. [Money%]: Hand respondent scale card. If the respondent answers, “mostly sure,” the
interviewer should clarify the answer repeating all response choices and ask the respondent to choose. Provide the following explanation if necessary:
Please answer with whatever this means to you.
Question 12. [Time%]: If the respondent answers, “mostly sure,” the interviewer should clarify the
answer repeating all response choices and ask the respondent to choose. Provide the following explanation if necessary:
Please answer with whatever this means to you. Question 13. [Fun]: Hand respondent scale card. Provide the following explanation if necessary: Please answer with whatever this means to you. Question 14. [Necessities]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 15. [Eat in]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 16. [Place to stay]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 17. [Safe place]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 18. [Ripped off]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 19. [Threatened]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 20. [Friends]: Provide the following explanation if necessary: Please answer with whatever this means to you. Organizationally Mediated Empowerment This refers to things done in a group, agency or organization in the past four months. Respondents may indicate that they belong to a group that is related to more than one response category. Indicate all that apply.
The intent of this question is to discover the types of agencies or organizations. The interviewer should only record one of these agencies/organizations. If they are involved in more than one, ask the individual to choose the organization he or she is most involved in. The agency in question will not be involved in any analysis, but rather the type of agency. For each of the items in this section, if the respondent indicates that they have participated in the noted activity, then ask the follow-up questions. If the respondent indicates that they have participated in several organizations or groups relevant to one type of organization (for example, they have set up a meeting at three organizations related to self-help groups) you should: • First repeat the question.
• If the respondent again indicates that they have participated in several groups/organizations pertaining
to that type of organization, you should ask the respondent to indicate which categories those organizations pertain to.
• You should then ask the respondent to indicate the name(s) of the organization. Record the name of
the program that they are more involved in or spent the most time at in the last four months.
• You may want to record the names of the additional organizations in the margin notes.
• If the respondent asks for further clarification of the types of organizations, read the following:
A Self-help organization involves people helping one another and helping themselves in the process. Experiences are shared, knowledge is pooled, options are multiplied, hopes are reinforced, and efforts are joined as members strive to help one another. A Mental Health organization is an organization that provides counseling, case management and a variety of other mental health services. A Social Service organization provides a wide variety of supports and services such as home health services, independent living services, case management and employment services. A Work (non-self-help) organization provides job readiness training and employment A school organization provides formal educational opportunities. A Church organization provides a variety of services and is affiliated with a religious institution, such as a church, synagogue, temple, or mosque. Question 1. [Membership]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Voted]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Served]: If the respondent asks for further clarification, read the following: The Board of Directors is a decision making group that governs the activities of the organization. Question 4. [Set up]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Meals]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Volunteer]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 7. [Paid staff]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Lead group]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Activities]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 10. [New program]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 11. [Hire]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 12. [Salary]: If the respondent asks for further clarification, read the following: Salary refers to how much money a person is paid for performing his/her job. Question 13. [Money spent]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 14. [Group meet]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 15. [Rules]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 16. [Break rules]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 17. [Suggested]: Provide the following explanation if necessary: Please answer with whatever this means to you. SERVICE UTILIZATION
Please read over the interviewer instructions in the common protocol and prompt for dates
If the respondent indicates that he/she has received a particular service in the last four
months, you will prompt to indicate how many visits he/she has had over the last four months, and if these visits were involuntary. If someone were to have more than 98 visits/sessions in the past 120-122 days, code it as 98 and then write the total number in the margin notes.
Throughout this section, if the respondent would like clarification of the term “involuntary”
Involuntary means that you were not given choice in whether or not you would perform an action or attend a particular service. Please ask the respondent to indicate all resources they have utilized when getting to the emergency room. Even if they have only visited the ER once in the last 4 months, he/she may answer "yes" to more than one response. For example, an individual may have taken an ambulance and been accompanied by a friend and a COSP staff member to the ER. It is important to record all of these. In cases where respondents have visited the ER more than once in the past 4 months, ask the respondent to indicate all that apply for the last 4 months. We are interested in the range of service/resource usage, rather than the number of times each resource was used. If the respondent asks for clarification regarding the questions, "How did you get to the emergency room?" you should reply with the following: We would like to know about how you got to the ER, such as whether you were taken by ambulance, by the police, and if you were accompanied by someone or went alone. [ER Psych]: If the respondent indicates “yes,” you will ask how many visits, how many were involuntary, and how they got to the emergency room. If the respondent asks for further clarification, read the following: This question does not include emergency room visits for substance use or physical health reasons. [ER Phys]: If the respondent asks for further clarification, read the following: This question does not include emergency room visits for substance use or [ER Both]: Please confirm that this visit is in addition to those already reported. If the respondent needs further clarification, read the following: This question does not include emergency room visits for substance use reasons. Question 4. [Hosp Psych]: If the respondent needs further clarification, read the following: This question does not include hospitalizations due to substance use or physical health reasons. [Hosp Phys]: If the respondent needs further clarification, read the following: This question does not include hospitalizations due to substance use or psychiatric reasons. [Hosp Both]: Please confirm that this visit is in addition to those already reported. If the respondent needs further clarification, read the following: This question does not include hospitalizations due to substance use reasons. [Crisis]: If the respondent needs further clarification, read the following: This question asks only about using crisis or emergency services due to psychiatric reasons. [Psychiatrist]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Therapy]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 10. [Group]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 11. [Hosp Sub]: Please confirm that this was in addition to those already reported. If the
respondent needs further clarification, read the following:
Substance use problems refer to those related to alcohol and drug use. I want to make sure that this is in addition to those that you may have already reported. Question 12. [Detox]: If the respondent needs further clarification, read the following: A detox facility is a place where people go to stop using alcohol or drugs.
Question 13. [ER Sub]: Please confirm that this was in addition to those already reported. If the
respondent needs further clarification, read the following:
Substance use problems refer to those related to alcohol and drug use. I want to make sure that this is in addition to those that you may have already reported. Question 14. [Crisis Sub]: Please confirm that this was in addition to those already reported. If the
respondent needs further clarification, read the following:
Substance use problems refer to those related to alcohol and drug use. I want to make sure that this is in addition to those that you may have already reported. Question 15. [Doctor]: If the respondent needs further clarification, read the following: This question does not include visiting a doctor for substance use or psychiatric reasons. Question 16. [Other Health]: If the respondent needs further clarification, read the following: Other healthcare professionals include a nurse, nurse practitioner, physician assistant, and acupuncturist. This question does not include visits for substance use or psychiatric reasons. Question 17. [COSP]: If the respondent needs further clarification, read the following: A consumer-operated service program (COSP) is a place where other mental health consumers serve as staff and decide on all policies and procedures. Question 18. [Arrested]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 19. [Jail]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 20. [Court]: If the respondent needs further clarification, read the following: This question is not asking about meeting with someone from civil court about noncriminal behavior. PROGRAM ACTIVITIES
All of these questions ask whether the statements are true because of participation in any program. Please be sure to emphasize this qualifier. If yes, then ask the respondent follow-up questions and record the name of the program(s). In order to ensure the accurate capture of COS utilization, probe the participant to be specific about the name of the COS and other Drop-In Centers, such as, “Do you mean (Program Name) at (give the address or any other unique identifier, such as the Program on the 2nd Floor)?” Also probe to make sure they are correctly identifying if they are currently attending the program, the frequency of involvement, and how long they usually participate in this activity. There are two scale cards for this section.
NOTE If the respondent is uncertain about the date that they last attended the program or organization, refer to page 4 for probing and coding of dates. Question 1. [Peer support]:If the respondent needs further clarification, read the following: Peer/Mutual Support involves people helping one another and helping themselves in the process. Experiences are shared, knowledge is pooled, options are multiplied, hopes are reinforced, and efforts are joined as members strive to help one another. Examples of activities or services that may fall into this category include individual, peer, group, phone, and natural supports. If the respondent asks about a particular program, such as NA or AA, respond with the following: Please answer with whatever this means to you. Question 2. [Social Activities]: If the respondent needs further clarification, read the following: This question asks about scheduled group social and recreational activities for individuals, such as dining, going to movies, attending sporting events, playing sports, as well as non-scheduled activities such as having a place to "hang out." Other examples of activities or services that may fall into this category include: holiday parties; celebrations; cultural activities; talent shows; art activities; spectator sporting activities; creative writing; active sporting activities; music/singing; field trips; theater group; retreats/conferences; and socials. [Schooling]: If the respondent needs further clarification, read the following: This question asks about skills that will enable an individual to obtain a high school or college degree, diploma, GED or other certificate of proficiency. [Advocacy Training]: If the respondent needs further clarification, read the following: Advocacy training is skills learned that will empower consumers in advocating for systems and individual change in mental health and addiction service systems. Examples of training that may fall into this category include individual, systems, and benefits advocacy education and empowerment training. [Education]: If the respondent needs further clarification, read the following: This may include attending classes or participating in activities designed to enable an individual to be better informed about mental health and other issue. For example the kinds of services that are available, how treatment is supposed to help you, and education related other things like medications, drugs, or alcohol. [Volunteer]: If the respondent needs further clarification, read the following: We are interested in knowing which program you may have received assistance with becoming a volunteer or a paid employee somewhere else. Have you been part of a program where you have performed activities such as contacting employers and employment agencies about job vacancies, having assistance preparing a resume or filling out employment application, and receiving coaching for job interviews? Opportunities offered could also include participation in governance activities, assisting with group meetings, special workshops, or volunteering as a staff member at the program. Question 7. [Housing]: If the respondent needs further clarification, read the following: Examples of housing assistance include, receiving information or receiving a referral for housing from someone from a program, or receiving assistance with rental application or housing subsidy applications. This category also includes providing accommodations that offer on-site support services and/or linkage to such places. Other activities include, housing coordination, supervised housing/supported living, roommate matching, group homes, moving; consumers crisis placement, transitional housing, respite services, independent living/in-home support services, homeless shelter beds, alternatives to incarceration (residential). [Needs]: If the respondent needs further clarification, read the following: Because of any program, have you received help with other services to resolve issues caused by lack of financial or housing resources? These issues may involve food, clothing, laundry facilities, bathing facilities, cash or vouchers, access to a telephone, or mail services. Assistance may include money, bus passes, rental assistance, use of lockers, stipends; supplies, food; furniture, medication provisions, use of showers, transportation, clothing, or use of washers/dryers. [Entitlements]: If the respondent needs further clarification, read the following: Have you received any assistance to acquire needed public benefits and resources in order to achieve or maintain self-sufficiency? Examples of assistance may include information services; help filling out forms, or a ride to the Medicaid/Social Security office. Note that Medicaid is sometimes called different things in different states.
Question 10. [Legal]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 11. [Advocate]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 12. [Case Management]: If the respondent needs further clarification, read the following: Case management services are activities designed to link persons to mental health and support services, and to acquire needed public benefits and resources in order to achieve or maintain self-sufficiency. Specific examples include: goal identification and need assessment; representative payee; linkage with services; assistance with entitlements; intensive case management; medication evaluation and management; assertive community treatment; hospitalization screening; jail discharge planning; homeless and forensic services; money management; information and referral services; and management of rental subsidies. Question 13. [Outreach]: If the respondent needs further clarification, read the following: Outreach is the process of interacting in the community to identify individuals who may benefit from services, provide information about the availability of services, and/or attempt to engage them in services.
Question 14. [Communication]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 15. [Drop-In]: If the respondent needs further clarification, read the following: A drop in center or a social club is a place where individuals may come and go as they please, and participate in a variety of activities such as recreation, education, and socialization.
Question 16. [Self-help]: If the respondent needs further clarification, read the following: A self-help/mutual help program involves people helping one another and helping themselves in the process. Experiences are shared, knowledge is pooled, options are multiplied, hopes are reinforced, and efforts are joined as members strive to help one another. Note that this question is only asking about self-help/mutual help programs for individuals with psychiatric disabilities.
Question 17. [12-Step]: If the respondent needs further clarification, read the following: Another 12-step program includes programs such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Overeaters Anonymous, or Gamblers Anonymous. It does not include programs related to psychiatric disability. SOCIAL INCLUSION
[Do things] Hand respondent scale card. If the respondent asks for further clarification, please read the explanation provided below: Doing things with a close friend refers to social activities and does not include things like medical appointments or calls to businesses.Visiting with someone who does not live with you refers to social activities and does not include things like medical appointments or calls to businesses.Please answer with whatever this means to you.Please answer with whatever this means to you.This refers to social activities and does not include things like medical appointments or calls to businesses. Planned ahead of time means you arranged with a friend to meet and do something, for example going to a movie on a specific day.This refers to a spouse, girlfriend, boyfriend or significant other. [Feel about] Hand respondent scale card. If the respondent asks for further clarification, please read the explanation provided below: Please answer with whatever this means to you.Please answer with whatever this means to you.Please answer with whatever this means to you.Please answer with whatever this means to you. Please answer with whatever this means to you.SOCIAL ACCEPTANCE Hand respondent scale card. If the respondent asks for further clarification please read the explanation provided below: Question 1. [Differently]: Hand respondent scale card. Provide the following explanation if necessary: Please answer with whatever this means to you. [Dangerous]: Hand respondent scale card at this point. Provide the following explanation if necessary: Please answer with whatever this means to you. [Child]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Unpredictable]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Know best]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Children]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Job]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Relationship]: Provide the following explanation if necessary: Please answer with whatever this means to you. DISCRIMINATION Question 1. [Discriminated]: If the respondent needs more information, read the following explanation: Discrimination refers to being treated unfairly by someone or some institution, business, or agency due to race, language, gender, disability, and/or some other personal reason. [Due to]: Hand respondent scale card, ask question and read the answer choices one at a time, allowing the respondent to answer in between each. Please be sure to code all that apply. If the respondent needs more information, read the following explanations: Mental disability/ability discrimination refers to your current or past mental health Race refers to being treated unfairly because of your race. For example, skin color or other physical feature(s). Gender discrimination refers to being treated unfairly because you identify yourself Sexual orientation discrimination refers to being treated unfairly because you identify yourself as heterosexual, gay or lesbian, or bisexual. Religious discrimination refers to being treated unfairly because of your Country of origin/ethnicity refers to being treated unfairly because of your ethnicity or country of origin. For example, language and/or customs, or other practices that identify you with your country of origin. Age refers to being treated unfairly because of your age. Economic Circumstance refers to being treated unfairly because of your level Physical disability refers to being treated unfairly because of your physical An arrest with jail time refers to being treated unfairly because you have a Prison time refers to being treated unfairly because you have a record for Homeless status refers to being treated unfairly because you are homeless. [Relationship to]: Hand respondent scale card. Read the question and the answer choices, pausing after each to allow the respondent to answer. If the respondent indicates that they have experienced discrimination related to this situation, continue asking how stressful it was. If the respondent indicates that they would like further clarification read the following explanation: Employment refers to discrimination you may have experienced at your place of employment, or in your attempt to gain employment through an application or interview process. Education refers to discrimination you may have experienced while you were pursuing education, or in your attempt to gain education by enrolling in a class or applying for a program. Housing, for example, would refer to discrimination you may have experienced while attempting to obtain housing such as a house, an apartment, a trailer, etcLaw Enforcement refers to discrimination you may have experienced while you were interacting with law enforcement officials, such as a police officer. Public Accommodation refers to discrimination you may have experienced in reference to public accommodation requirements such as handicap accessible parking spaces or entrance ramps. Consumer Operated Services refers to discrimination you may have experienced while participating in a service run by mental health consumers, or your attempt to participate in a Consumer Operated Service. Traditional Mental Health Services refers to discrimination you may have experienced while receiving traditional mental health services, or in your attempt to receive traditional mental health services, such as seeing therapist. QUALITY OF LIFE Hand respondent the scale card, read the question and the answer choices. If the respondent indicates that he/she would like further clarification, read the following explanations. [Life]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Fun]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Family]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Friendship]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Privacy]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Job]: Provide the following explanation if necessary: Please answer with whatever this means to you. SYMPTOMS Hopkins Symptom Checklist Hand respondent scale card. For all of the items in this scale, if the respondents asks "what does this mean" you should reply "whatever it means to you.’ Question 1. [Scared]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Fearful]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Faintness]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Nervousness]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Heart racing]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Trembling]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Tense]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Headache]: Provide the following explanation if necessary: Please answer with whatever this means to you. [Panic]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 10. [Restless]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 11.[Low energy]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 12. [Blaming self]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 13. [Crying]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 14. [Sexual loss]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 15. [Lonely]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 16. [Hopeless]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 17. [Blue]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 18. [End life]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 19. [Trapped]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 20. [Worrying]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 21. [No interest]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 22. [Effort]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 23. [Worthless]: Provide the following explanation if necessary: Please answer with whatever this means to you.
Question 24. [Appetite]: Provide the following explanation if necessary: Please answer with whatever this means to you. Question 25. [Sleep]: Provide the following explanation if necessary: Please answer with whatever this means to you. HEALTH PROBLEMS Health Status For these questions, the protocol is looking for the existence of a health condition rather than the manifestation of symptoms. For example, if a person has diabetes and is taking medication, and answers “no”, then probe with the following question: We are interested in whether you have ___________condition, regardless of whether or not you are currently having symptoms.
For this set of question, hand the respondent the scale card, read the question and slowly read the list of items. Emphasize that these should have been experienced in the last four months. If the respondent indicates that they would like further clarification, read the following explanations: Question 1.
[Anemia]: If the respondent would like further clarification, please read the following: Anemia is the condition of having less than the normal number of red blood cells or hemoglobin in the blood. People with anemia can feel tired, fatigue easily, appear pale, develop palpitations, and become short of breath. There are many causes of anemia, including: bleeding, abnormal hemoglobin formation (such as in sickle cell anemia), iron, B12 (pernicious anemia), or folate deficiency, rupture of red blood cells (hemolytic anemia), and bone marrow diseases. [Arthritis or Rheumatism]: If the respondent would like further clarification, please read the following:
MEDICAL COUNCIL M OF NEW ZEALAND www.mcnz.org.nz Statement on use of the internet and electronic communication01 The internet, email and other methods of06 Patients who obtain information from theelectronic communication are useful tools whichinternet may wish to discuss this with theircan help health professionals communicate withpatients and one another, find information andopportuni
Acta COFETRA Nº 30 En la Ciudad Autónoma de Buenos Aires, al día 11 del mes de abril de 2012 se reúnen en el Hotel de la COMRA, Av. Belgrano 1235, los delegados ante la Comisión Federal de Trasplante – COFETRA Estando representadas las provincias de Río Negro, Guillermina Krenz en representación de la Dra. Arslanián; Catamarca, Dr. Correa; Chubut, Dr. Vecchio; en representación del
Consumer-Operated Service Program (COSP)