>a1a< Was [name of facility] offering substance abuse services on October 1, 1999? This could include treatment, prevention, administrative, or other non-treatment services.
>a2< On October 1, 1999, which of the following substance abuse services were being offered by this facility, at this location? Please answer “Yes” or “No” for each.
>a2a< Substance abuse prevention services? (By this we mean activities such as information dissemination or education directed at individuals not identified as needing treatment.)
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a2b< Intake, assessment, or referral services for substance abuse treatment?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a2c<Either substance abuse treatment or detoxification? (By treatment, we mean services that focus on initiating and maintaining an individual’s recovery from substance abuse and averting relapse.)
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a2d< Administrative services such as billing, personnel, and scheduling?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
è PROGRAMMED SKIP: IF a2c = YES, GO TO a3. OTHERWISE GO TO a7.
>a3< [ONLY IF a2c = YES] Does this facility offer a special program for DUI/DWI or other drunk driver offenders?
>a4< [ONLY IF a3 = YES] Does this facility offer substance abuse treatment services to clients other than DUI/DWI clients?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a5< Is this facility owned or operated by . . . [CODE ONLY ONE]
<1> a private for-profit organization, [go to a5b]
<2> a private non-profit organization, [go to a6]
<3> the state government, [go to a6]
<4> a local, county or community government, [go to a6]
<5> a tribal government, [go to a6]
<6> or the Federal government?
>a5a< [ONLY IF a5 = 6] Which federal government agency?
<1> Department of Veterans Affairs
<2> Department of Defense
<3> Bureau of Prisons [go to End]
<4> Indian Health Service
<5> Other (Specify: ____________________)
<d> DON’T KNOW
<r> REFUSED
>a5b< [ONLY IF a5 = 1] Is this a solo practice; that is, an office with a single practitioner or therapist?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a6< Does this facility operate or participate in a substance abuse hotline? (A hotline is a telephone service that provides information and referral and immediate counseling, frequently in a crisis situation. For the purpose of this study, 9-1-1 is not considered a hotline.)
>a8b< [ONLY IF a8a = YES] What type of hospital is that . . .
<1> A general hospital?
<2> A psychiatric hospital, or
<3> Another type of specialized hospital (such as alcoholism, maternity, children’s, orthopedic)?
<d> DON’T KNOW
<r> REFUSED
>a9< Does this facility dispense methadone or LAAM at this location?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a10< Does this facility offer treatment for alcohol abuse, drug abuse or both?
<1> Both alcohol and drug abuse
<2> Alcohol abuse only
<3> Drug abuse only
<d> DON’T KNOW
<r> REFUSED
>a11< Some facilities have specially designed substance abuse treatment programs or groups for particular kinds of clients. Does this facility offer a specially designed substance abuse treatment program or group especially for . . .
>a11a<Adolescents?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a11b< Dually-diagnosed clients (this is, clients with both mental and substance abuse disorders)?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a11c< Persons with HIV/AIDS?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a11d< Pregnant or postpartum women?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a11e<Other women’s groups?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a11f< Criminal justice clients? (NOTE: THIS TREATMENT COULD BE PROVIDED OFF SITE)
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a11g< Some other type of substance abuse client?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a11h< [ONLY IF a11f = YES] Does this facility only treat persons who are currently incarcerated in a prison, jail or detention center?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a12< On October 1, 1999, which of the following types of substance abuse care were offered by this facility at this location?
>a12a< Hospital inpatient?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a12b< Non-hospital residential?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a12c< Any kind of outpatient substance abuse care?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a13< [ONLY IF a12a = YES] On October 1, 1999, what kind of hospital inpatient substance abuse care was offered—detoxification, rehabilitation or both? [CODE ONLY ONE]
<1> Detoxification
<2> Rehabilitation
<3> Both
<4> Neither
<d> DON’T KNOW
<r> REFUSED
>a14< [ONLY IF a12b = YES] On October 1, 1999, what kind of residential substance abuse care was offered at this facility—detoxification, rehabilitation or both?
<1> Detoxification
<2> Rehabilitation
<3> Both
<4> Neither
<d> DON’T KNOW
<r> REFUSED
>a15< [ONLY IF a12c = YES] On October 1, 1999, which of the following kinds of outpatient substance abuse care were offered at this facility?
>a15a< Ambulatory detoxification? (This means detoxification on an outpatient basis. The client does not stay at the facility 24 hours a day.)
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a15b< Partial hospitalization or day treatment? (This involves 20 hours or more of outpatient treatment per week.)
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a15c<Intensive outpatient?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a15d< Other outpatient treatment?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a15e< [ONLY IF a15c = YES] What minimum number of hours per week defines intensive outpatient treatment at this facility?
<1> RECORD MINIMUM NUMBER OF HOURS:_________________________
<2> No minimum
<d> DON’T KNOW
<r> REFUSED
>a16< Which of the following types of payments are accepted by this facility? Please answer “Yes” or “No” for each type of payment. Does this facility accept. . .
>a16a<Cash or self-payment?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a16b< Medicare payments?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a16c< Medicaid payments? NOTE: Some states call their medicaid programs by other names; include those programs here.
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a16d<A state-administered health insurance plan other than Medicaid? (Example: A state-administered health plan for State employees.)
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a16e< Federal military insurance, such as CHAMPUS, CHAMP-VA or TRICARE?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a16f< Private health insurance?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a16g< Indian Health Service contract payments?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a16h< Does this facility accept other types of payment for treatment?
<1> YES (Specify: _______________)
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a16i< Does [name of facility] receive any [other] public funds such as federal, state, county, or local funds to subsidize substance abuse treatment programs?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a17a< Does this facility offer fully subsidized care to some or all of its clients?
<1> Some
<2> All
<3> None
<d> DON’T KNOW
<r> REFUSED
>a17b< Does this facility use a sliding fee scale?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a18< On October 1, 1999, did this facility have agreements or contracts with managed care organizations for providing substance abuse treatment services?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a19< [ONLY IF FACILITY IS NOT STATE-APPROVED] I’m going to read the names of some of the agencies that license or certify substance abuse facilities. Please tell me if this facility is licensed, certified, accredited, or otherwise approved by any of the following.
>a19a<Joint Commission on Accreditation of Health Care Organizations (JCAHO)?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a19b<Commission on Accreditation of Rehabilitation Facilities (CARF)?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a19c< National Committee on Quality Assurance (NCQA)?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a19d< [ONLY IF FACILITY IS NOT STATE-APPROVED] Is this facility licensed or certified by your State substance abuse agency?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a19e< [ONLY IF FACILITY IS NOT STATE-APPROVED] Are any staff members at this facility licensed or certified addiction counselors?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a20< What telephone number should a potential client call to schedule an intake appointment?
<1> RECORD INTAKE TELEPHONE NUMBER:_________________________
<2> Initial intake not usually done here
<3> No intake, other reason (Specify: ____________________)
<4> Same number you just called
<d> DON’T KNOW
<r> REFUSED
>u1< At this time I would like to update your facility’s address and telephone information.
>u2< Is your correct mailing address [read mailing address]?
>u3< Now I’d like to update [name of facility]’s fax number.
>u3a< [ONLY IF FAX NUMBER IS ON CATI] Our records list this facility’s fax number as [read number]. Is that correct?
<d> DON’T KNOW [go to a22]
<r> REFUSED [go to a22]
>u4a< [ONLY IF u4 = YES] What is [name of facility]’s URL, or home page address?
<1> RECORD HOME PAGE ADDRESS:_________________________
<d> DON’T KNOW
<r> REFUSED
>a22< [Note: At this point, the actual interview included a lengthy series of questions to determine whether the facility is administratively linked with other substance abuse treatment facilities, which facilities it is linked to, and the nature of the links. These questions are excluded here because they were for purposes of survey administration only.]
>a23< Facilities participating in this survey that are licensed or approved through their State substance abuse agency will be listed in SAMHSA’s National Directory of Drug Abuse and Alcoholism Treatment Programs. This Directory will be available on SAMHSA’s Internet web site at www.samhsa.gov and in print. Would you like to receive a paper copy of the Directory when it is published?
<1> YES
<0> NO
<d> DON’T KNOW
<r> REFUSED
>a23a< INTERVIEWER: IF RESPONDENT VOLUNTEERS THAT THIS FACILITY DOES NOT WANT TO BE LISTED IN THE DIRECTORY, RECORD HERE.
<1> DO NOT LIST FACILITY IN DIRECTORY.
>End< That’s all the questions I have. Thank you for your time.