Module 8: Self-Administered Provider Service System
Perceptions Questionnaire

A Module Used in The Measurement Group's Cross-Cutting Evaluation of the HRSA HIV/AIDS Bureau's Special Projects of National Significance on Innovative Models of HIV/AIDS Care

Citation: Huba, G. J., Melchior, L. A., Staff of The Measurement Group, and HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1995). Module 8: Self-Administered Provider Service System Perceptions Questionnaire. Available: www.TheMeasurementGroup.com. Culver City, California: The Measurement Group.

 

This questionnaire asks you for some perceptions about how the service system for HIV/AIDS services works in your city/region. The data collected will be used in studies of the cities that receive funding for an Adolescent Special Project of National Significance from the Health Resources and Services Administration (HRSA). Please complete this questionnaire to indicate your individual views and give it to the interviewer. If you have any questions about the items in this questionnaire, please ask the interviewer. We ask you to self-generate an identifying code so that your responses can be tracked if you also complete another questionnaire for us in the future. Your individual responses will be held confidential. This information will be used only to provide a group profile of the experts providing information to us about drug and alcohol problems. This information will not be used to identify any individual, nor will it be used to attribute any statements or opinions to any individual participant.

The Special Project of National Significance (SPNS) grantee in your city/region has received federal monies from HRSA to develop a national model program for adolescent HIV/AIDS services and to evaluate the model of service delivery. That agency will give you this questionnaire and explain their program to you if you do not already know about it.

SPNS grantees have been funded nationally to develop and evaluate services both for HIV-infected youth and for youth who are at high-risk-to-become-infected-with-HIV.


Information used to generate an unique code for the respondent

What are the first two letters of your mother’s first name? (use X's if unknown): ____ ____

What are the first two letters of your oldest brother’s first name? (use X's if no brother): ____ ____

What are the first two letters of your oldest sister’s first name? (use X's if no sister): ____ ____

What are the first two letters of your mother's maiden name? (use X's if unknown): ____ ____

What day of the month were you born? ____ ____


1. Sex (circle one):

Male

Female

 

2. Age: ___________

 

3. Ethnic/Cultural/Racial Background (check one):

1q African American/Black 4q Asian or Pacific Islander
2q White/Caucasian 5q Native American (American Indian) or Alaskan Native
3q Hispanic/Latino 6q Other (Specify:____________________)

 

4. Current Job Type (check one that fits best):

1q Administration/Management
2q Supervisor of direct service staff
3q Provider of direct services
4q Other (specify: __________________________________________)

 

5. Educational Background (check highest level achieved):

1q Grade School 2q High School
3q Associates Degree 4q Bachelors Degree
5q Masters Degree 6q Doctorate
7q Professional (law, business) 8q Other (specify:___________________________)

 

6. Professional Licenses (check all you possess):

1q Certified Alcohol or Drug Abuse Counselor

2q MFCC

3q LCSW/Social Worker

4q Nurse/Nurse Practitioner/Physician's Assistant

5q Psychologist

6q Physician

7q Other (specify:______________)

 

7. How many years of "professional" experience do you have in working on youth services and problems? _________________ years

 

8. How many years of "professional" experience do you have in working on HIV-related services and problems? _________________ years

 

Please indicate the degree to which you agree or disagree with each of the following statements by checking one response for each item.

9. A major role for the Special Project of National Significance grantee in our city/region should be to provide the training and expertise to other agencies and organizations to permit them to design and implement effective programs for youth. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

10. Instead of providing services for all youth infected with HIV in our city/region, it is more important to target those youth with advanced HIV disease. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

11. One of the largest problems in services for HIV-infected and high-risk-for-HIV youth is the lack of services in this city (metropolitan area) specifically for young women. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

12. A key ingredient to the success of programs working with HIV-infected and high-risk-for-HIV youth is that the people who design and run them should be as much like the clients as possible (including people who are HIV-infected, in recovery, and of similar gender, gender orientation, ethnic-cultural background, age, etc.). (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

13. One of the most important, low cost ways to make all of our HIV/AIDS programs more effective in serving youth is to "cross-train" service providers in the expertise, knowledge, and operating methods of agencies that work with this population. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

14. The decision-making process about HIV treatment and prevention programs needs more continuing input from the youth to be served themselves. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

15. The same HIV-infected and high-risk-for-HIV youth are known and serviced by several agencies in this city/region. Much more emphasis should be placed on multi-agency programs where resources are pooled. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

16. As a city/region we spend too much time arguing about "models," "turf" and "theories" of service delivery to youth, and not enough time actually doing something. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

17. One of the largest problems in services for HIV-infected and high-risk-for-HIV youth is the lack of services in this city (metropolitan area) for racial, cultural, and ethnic minorities. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

18. Until we bring together drug treatment, social, family, health, and mental health services, we will make little progress in effectively serving HIV-infected and high-risk-for-HIV youth. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

19. We need fewer "mainstream" HIV/AIDS service organizations/programs and more programs designed to meet the special needs of various groups (youth, women, substance abusers, etc.). (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

20. In order to stretch "tight" resources further, we need to be able to carefully assess HIV-infected youth for their motivation and ability to comply with the requirements of treatment and then select the most appropriate cases for intensive intervention. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

21. There should be a better way of communicating information about what services are available for HIV-infected youth on a given day in this city/region so that appropriate referrals and placements can be made. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

22. One of the largest problemsin this city/region in services for HIV-infected people is the lack of services for youth and adolescents. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

23. Professionals involved in decisions regarding HIV services need to be better educated about the particular issues related to adolescence so that they do not allow problems to continue because of a lack of understanding. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

24. Services for HIV-infected and high-risk-for-HIV youth need to be more decentralized so that appropriate and sensitive services are available in all parts of the city/region. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

25. It is too easy for youth to "slip through the cracks" between the various agencies where they need to receive help for being HIV-infected or at high-risk-for-HIV. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

26. We are achieving about as much as could be expected for the number of dollars we spend on HIV programs for youth. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

27. It seems like a lot of agencies want to "do their own thing" and call it appropriate care or services for HIV-infected or high-risk-for-HIV youth. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

28. The "SYSTEM" forces individuals, agencies, and providers to "stretch the truth" about who they are, what they do, and who they treat. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

29. HIV-infected youth should be a very high priority group for receiving publicly-supported services. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

30. Given the priority I would assign to their treatment, our city/region has sufficient capacity to meet the treatment needs of HIV-infected youth. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

 

31. HIV-infected youth should be a higher priority group for receiving scarce publicly-supported services than high-risk-for-HIV youth. (check one)

1q Strongly Disagree 3q Agree 5q Don't Know
2q Disagree 4q Strongly Agree

32. Assume that there are NEW or EXTRA public monies to spend on HIV-infected and high-risk-for-HIV youth in your city/region. How would you spend these NEW funds. Distribute 100 percentage points among the listed activities to indicate how you would divide the NEW or EXTRA public funds so that they would best serve HIV-infected and high-risk-for-HIV youth.

Percentage of funds Activity

__________% a. Basic "street" education/prevention programs (condoms, brochures, etc.).

__________% b. Group homes for youth.

__________% c. Residential substance abuse treatment/recovery programs.

__________% d. Outpatient substance abuse treatment/recovery programs.

__________% e. Long-term housing.

__________% f. Short-term shelters.

__________% g. Basic needs of food and clothing.

__________% h. Outpatient routine medical services.

__________% i. Emergency room medical services.

__________% j. HIV-specific medical services and self-care.

__________% k. HIV home care and hospices.

__________% l. Mental health services (outpatient and inpatient).

__________% m. Family services and supports.

__________% n. Medication or pharmacy programs.

__________% o. Vocational training, placement, and services.

__________% p. Infrastructure development (construction and renovation, development of information and fiscal management systems).

__________% q. Service provider training.

__________% r. Administration and evaluation.

__________% s. Other (what?________________________________________________________)

 

100 % TOTAL OF ABOVE PERCENTAGES


Thank you very much for completing this questionnaire. Your responses are very important and will help the Health Services and Resources Administration (HRSA) and the local SPNS agency provide better services for HIV-infected and high-risk-for-HIV youth.

 

SITE CODE: ___________

 


Developed by The Measurement Group under contract to HRSA, portions taken from instruments © 1990-1992 by The Measurement Group LLC and used with permission for this instrument. Version of 1/3/95.