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Transcript of Patient reported unmet needs
PATIENT - REPORTED UNMET NEED 1
********Date: 3-10-15*********
Student’s Name: Allen Sutton NPP
Setting: Outpatient Mental Health Office
Population Impacted: Mentally Ill Patients with Substance Abuse
and other comorbid illness
Capstone Advisor and Credentials: Dr Barbara
Turner , DUSON - Chairperson and Principle investigator
Committee Members and Credentials: Dr Louis Teitlebaum
Investigator
Dr Pending New Investigator
Statement of the Problem
Dual diagnosed patients affected by severe mental illness (MI),
substance abuse (SA), and other chronic comorbidities continue to
be the core demographic treated by outpatient mental health
clinics. The outpatient mental health clinics on Long Island
offers comprehensive mental health treatment which includes
PATIENT - REPORTED UNMET NEED 2
individual therapy, psychoeducation and medication management.
Many private mental health clinics offer customized treatments
such as behavioral treatment, natural assisted detox for patients
that are dual diagnosis and medically guided maintenance. The
Garden City Outpatient Mental Health office of Doctor Louis
Teitlebaum , Board Certified Neuropsychiatrist and Psychiatric
Nurse Practitioner Allen Sutton , NPP are devoted to “effective
integrated treatment for people with severe mental illness”
citation . Their mission is the effective re-integration of
patients with severe mental illness into society and continuous
access to quality healthcare. This is accomplished
systematically by meeting patient needs and providing a
therapeutic alliance that encourage independent decision-making
and positive empowerment. The staff with in the clinical group
includes Psychiatrist, Nurse Practitioner , Psychologist and
Clinical Social Workers that believe in providing an understanding of
the concepts, principles and values inherent in everyday thinking about mental
health, psychiatric diagnoses and the theoretical drivers of mental health
policy, it can impact directly on the lives of people involved in all aspects
of mental health care . All individuals are referred from outside
PATIENT - REPORTED UNMET NEED 3
sources such as local hospitals , mental health agencies,
detoxes, penal and EAP programs. The team is multidisciplinary
and each office are sole proprietors. The patients are referred
to the individual contractors for services within the group as
needed. Some patients prefer the fact that they have affiliation
with more than one provider within the group and others are
paranoid about someone outside their primary provider having
access to pertinent medical information. Effective communication
with schizophrenic patients is particularly important because
they are so easily overwhelmed by the external environment.
However, the signs and symptoms of schizophrenia vary
dramatically from person to person, both in pattern and severity.
(Harvard Letter , October 2011, p.) Getting to know the unmet
needs of patients allows providers to make decisions on effective
interventions. Mental health needs include broad domains of
health and social functioning.
There are few psychological therapies that have been
significantly researched and shown to be effective with
schizophrenia, but the leading one is called Cognitive Behavioral
Therapy (CBT) for Psychosis / Schizophrenia. While medications
PATIENT - REPORTED UNMET NEED 4
can help minimize many of the “positive” symptoms – the voices,
delusions, etc. that are common with schizophrenia, even with the
medications many patients with severe symptoms are unable to
report what they perceive as unmet needs. CBT helps patients
develop skills to assess what is problematic in functioning in
the community and what unmet needs are associated. Unmet needs
are differentiated from met needs by the impact on their quality
of life (Phelan et al, 1995). Research has shown that mental
healthcare should be provided based on need and the goal of
improving quality of life. There are few psychological therapies
that have been significantly researched and shown to be effective
with schizophrenia, but the leading one is called Cognitive
Behavioral Therapy for Psychosis / Schizophrenia. While
medications can help minimize many of the “positive” symptoms –
the voices, delusions, etc. that is common with schizophrenia,
even with the medications many continue to have behavioral
problems.
The Assessment of Needs Questionnaire that can be completed
during normal psychiatric office visits can produce a wealth of
information important to identifying self-care deficits and unmet
PATIENT - REPORTED UNMET NEED 5
needs. A previous study conducted by Slade et al. (2005)
researched the extent to which phone prompts, reminders,
increased contact and similar mental health interventions could
satisfy unmet needs and lead to quality of life improvement. The
expected results demonstrated that patients experienced both a
perceived quality of life improvement and a decrease in unmet
needs over the three months of this pilot study (Slade et al.,
2005). The intervention described here uses outpatient resources
to build on this knowledge base and test the validity of low-cost
patient self-assessment in improving perceived QOL for the out
patient population.
A linear regression analysis study performed by Benaiges, Prat
and Adam (2012) analyzed three populations: individuals affected
by mental illness (MI), those affected by alcohol dependence and
individuals diagnosed with both. Of the three populations, the
dual-diagnosed SA/MI cohort exhibited the lowest quality-of-life
self-assessment; the addition of other chronic diagnoses would
probably make the situation more pronounced. A systematic review
by Meade & Sikkema (2005) further established strong correlative
linkages between MI and self-care deficits.
PATIENT - REPORTED UNMET NEED 6
In HRQOL scholarship, there have been several different
methodologies suggested (Prince & Gerber, 2001; Lehman, Postrado,
& Rachuba, 1993; Yamada, 2007; Smith, Avis, & Assmann, 1999;
Visser, Oort, & A.G. Spranger, 2005; Achat, Kawachi, & Levine,
1998). One of these is M. Becker, R. Diamond, & F. Sainfort’s
(1993) discovery of a lacuna in the research concerning
measurements of quality of life. While previous measurements,
they argue, took into account what may happen in research
settings, they did not take into account clinical settings. Thus,
they set out to create a better measurement tool. A subjective,
self-report measure—The unmet needs questionnaire will be used
here in conjunction with the CDC measures in order to determine
pre-test and post-test differences. , The questionnaire’s main
thrust is subjective questions; the scale will include categories
of satisfaction instead of merely a scale of levels of
dissatisfaction in order to determine more accurately how
patients truly feel about their quality of life (See Appendix A).
Project Aims
PATIENT - REPORTED UNMET NEED 7
Persons living with dual-diagnosed mental illness (MI),
substance abuse (SA), and other chronic medical diagnosis are a
vulnerable population in this country. Caregivers of psychiatric
patients know that giving more comprehensive mental health
treatment addresses the needs of the patients that are unmet.
The assessment of these needs is paramount in order to
provide tailored care to this population. Therefore the aim of
this project is to assess the self-reported unmet needs and
causative factors of self-care deficits among patients dually
diagnosed with mental illness, substance abuse, and chronic
medical issues being served by the Garden City Mental Health
Outpatient Clinic (GCMHOC).
Project Methods
This study will utilize a “pre- post-test” design and will
be limited to 50 patients served by the GCMHOC team. Inclusion
requirements are a mental disorder as specified by the criteria
of the Diagnostic and Statistical Manual 1st edition (DSM V, TR,
2014) with co morbid chronic medical illness and substance abuse
PATIENT - REPORTED UNMET NEED 8
disorders. Men and women are equally eligible, between the ages
of 18–70.
The team members will use two instruments to measure
patients unmet needs. The HRQOL - Healthy Days Questionnaire
(CDC, 2012) is a broad multidimensional concept that includes
self-reported measures of physical and mental health that may
affect quality of life and combined with the second instrument
which is the Unmet Needs Questionnaire. The Unmet Needs
Questionnaire was developed by providers of the Garden City team
to determine the obstacles that impede access to health and human
services. The results of the surveys will provide opportunities
for providers to plan for tailored interventions.
Administering these instruments will take less than 30 minutes
during a regular psychiatric office visit. Using the data from
each patient, the providers will develop interventions tailored
to meet the needs of the patient. At the end of three months the
instruments will be re-administered to assess changes in
perceived unmet needs.
PATIENT - REPORTED UNMET NEED 9
Recent federal policy changes endorse the use of
questionnaires to measure outcomes of specific impairment.
Data Collection Plan
Following IRB review the will administer the combined
instrument to their patients during a regularly scheduled
appointments. The assessment of their unmet needs will be
evaluated and plans for addressing the unmet needs will be
incorporated into the individual treatment plans of each patient.
At 3 months post assessment the instrument will be administered
once again to document changes in the perceived assessment of
unmet needs. Data will be analyzed and presented for assessment
of the utility of the instrument in helping patients address
their perceived unmet needs.
Measuring patient reported outcomes will help improve progress in
achieving healthcare objectives set nationally. Analysis of unmet
needs data can help identify subgroups with relatively poor
PATIENT - REPORTED UNMET NEED 10
perceived quality of life and help to guide interventions to
improve their situations (CDC, 2012).. Patient-reported measures
can help clinicians target interventions that will improve
patient outcomes of care.
Timeline
IRB review April 2014
Initiate first assessment August through October 2014
Administer second assessment November through January 2015
Data analysis February to April 2015
Evaluation Plan
Data will be entered into IBM SPSS v.20 (Chicago, IL).
CDC HRQOL Healthy Days Module: There are three variables of interest
in this module: general health, healthy days, and inability to
perform usual activities. Item 1, “Would you say that in general
your health is…” will be compared pre/post using Wilcoxon signed-
ranks test for paired, ordinal data. Unhealthy days are an
estimate of the overall number of days during the previous 30
PATIENT - REPORTED UNMET NEED 11
days when the respondent felt that either his or her physical or
mental health was not good. To obtain this estimate, responses to
questions 2 and 3 are combined to calculate a summary index of
overall unhealthy days, with a logical maximum of 30 unhealthy
days. For example, a person who reports 4 physically unhealthy
days and 2 mentally unhealthy days is assigned a value of 6
unhealthy days, and someone who reports 30 physically unhealthy
days and 30 mentally unhealthy days is assigned the maximum of 30
unhealthy days. Healthy days are the positive complementary form
of unhealthy days. Healthy days estimate the number of recent
days when a person's physical and mental health was good (or
better) and is calculated by subtracting the number of unhealthy
days from 30 days. Item 4 “ During the past 30 days, for about
how many days did poor physical or mental health keep you from
doing your usual activities, such as self-care, work or
recreation? “ will be compare pre/post using a paired t-test.
The CDC HRQOL Activity Module contains items that address physical,
mental, or emotional problems or limitations the respondent may
have in daily life. Each item will be analyzed separately. Item
1, “Are you limited in any way in any activities because of any
PATIENT - REPORTED UNMET NEED 12
impairment or health problem?” will be analyzed using a McNemar
test for paired categorical outcomes. Item 2 will be compared
using graphical display of the response to, “What is the MAJOR
impairment or health problem that limits your activities?” Item
3, “For HOW LONG have your activities been limited because of
your major impairment or health problem?” (In days), a paired t-
test will be conducted. Items 4 and 5 will be combined into one
item that addresses whether or not the individual needed help
from another person for personal care or routine needs. If a
respondent marks YES for either question, the combined item will
be scored as a YES. A McNemar test will be conducted to compare
proportion of individuals that needed help from another person at
pre and post.
CD HRQOL Healthy Days Symptom Module: There are five items that ask
the individual about the number of days in the past month that
s/he has dealt with lack of sleep, depression, anxiety, etc.
These items will be analyzed separately using paired t-tests.
Unmet Needs Questionnaire. An overall satisfaction score (averaging
12 items on general life satisfaction) will be compare at pre and
PATIENT - REPORTED UNMET NEED 13
post using a paired t-test. Other items in the questionnaire will
be compared using McNemar (for dichotomous items) and Wilcoxon
signed-ranks test (for ordinal items).
Protected Health Information
All data collected is de-identified and annotated by a code
number. The patient’s name and associated number will be kept by
the office manager and not available to the members of the team
collecting the data. When the team conducts the second visit at 3
months the office manager will put the data collection
instruments in the patient’s folder with the code number on them.
Privacy, Data Storage and Confidentiality
The patient name and code number linkage will be destroyed upon
completion of the data collection. No PHI will be collected as
part of this project. During data collection the data will be
recorded on paper and kept in the patient file in locked cabinets
in the office file room; data will be destroyed at the completion
of the project.
PATIENT - REPORTED UNMET NEED 14
References
Achat, H., Kawachi, I., Levine, S., Berkley, C., Coakley, E., &
Colditz, G. (1998). Social
Networks, stress and health related quality of life. Quality
of Life Research, 7, 735-750.
Batki, S.L. (1990). Drug abuse, psychiatric disorders, and AIDS.
Dual and triple diagnosis. West J Med, 152(5), 547-552.
Benaiges, I., Prat, G. & Adan, A. (2012). “Health related quality
of life in patients with dual
diagnosis: clinical correlates.” Health and Quality of
Life Outcomes. 10(106).
PATIENT - REPORTED UNMET NEED 15
Douaihy, A.B., Jou, R.J., Gorske, T., & Salloum, I.M. (2003).
Triple diagnosis: Dual diagnosis and HIV disease, part
I. AIDS Read. 13(7), 339-341.
Ferrans, C.E. (1990). Quality of life: Conceptual issues.
Seminars Oncol Nurs, 6, 248-254.
Ferrans, C.E. (1992). Psychometric assessment of the quality of
life index. Res. Nurs Health,
15, 29-38.
Gigantesco, A. & Guiliana, M. (2011). Quality of life in mental
health services with a focus
on psychiatric rehabilitation practice. Ann Ist Supra Sanita,
47(4), 363-372. Doi:
10.4415/ANN_11_07.
Harvard Mental Health Letter - October 2011 - Vol. 28 - p. 1-3 -
Ebscohost
Horsfall, J., Cleary, M., Hunt, G.E., & Walter, G.W. (2009).
Psychosocial treatments for people with co- occurring severe
PATIENT - REPORTED UNMET NEED 16
mental illness and substance use disorders (dual diagnosis):
A review of empirical evidence.
Harvard Review of Psychiatry, 17(1), 24-34.
Lehman, A.F., Postrado, L.J., & Rachuba, L.T. (1993). Convergent
validation of quality of
life assessment for persons with severe mental illnesses.
Quality of Life Research, 2(5),
327-338.
Meade, C. S., Graff, F. S., Griffin, M. L., & Weiss, R. D.
(2007). HIV risk behavior
among patients with co-occurring bipolar and
substance use disorders: Associations with mania and drug
abuse. Drug and Alcohol Dependence, 92(1-3), 296-300.
Meade, C. S., & Sikkema, K. J. (2005). HIV risk behavior among
adults with severe
mental illness: A systematic review. Clinical
Psychology Review, 25(4), 433-457.
PATIENT - REPORTED UNMET NEED 17
Prince, P. & Gerber, G. (2001). Measuring subjective quality of
life in people with serious
Mental illness using the SEIQoL-DW. Quality of Life
Research, 10(2), 117-122.
Shih, M., & Simon, P. (2008). Health related quality of life
among adults with serious
psychological distress and chronic medical conditions.
Quality of Life Research, 17(4),
521-528.
Slade, M., Morven, L., Cahill, S., Thornicroft, G. & Kuipers, E.
(2005). “Patient-related
mental health needs and quality of life improvement.”
British Journal of Psychiatry. 187:256-261.
Smith, K., Avis, N. & Assmann, S. (1999). Distinguishing between
quality of life and health
Status in quality of life research: A meta-analysis. Quality
of Life Research, 8(5), 447-
PATIENT - REPORTED UNMET NEED 18
459.
Vergara-Rodriguez, P.T., Watts, J., Tozzi, M., Bather-Gardner,
M., & Arenas, V. (2012) HIV substance treatment and
recovery (H-STAR) a comprehensive treatment program for HIV
positive persons with dual diagnosis. European Psychiatry,
27, 105.
Visser, R., Oort, F., & A.G. Spranger, M. (2005). Methods to
detect response shift in quality
of life data: A convergent validating study. Quality of Life
Research, 14(3), 629-639.
Yamada, K. (2007). Low level quality of life in patients with
mental and behavioral
disorders wanting complementary and alternative
(“kampo”) therapy. Quality
of Life Rese.
Zahari, M.M., Bae, W.H., Zainal, N.Z., Habil, H., Kamarulzaman,
A., & Altice, F.L. (2010). Psychiatric and substance
abuse comorbidity among HIV seropositive and HIV
PATIENT - REPORTED UNMET NEED 19
seronegative prisoners in Malaysia. The American Journal of Drug
and Alcohol Abuse, 36(1), 31-38. arch, 16(5), 787-792.
Fung, H Constance Qual Life Res. 2008 December; 17(10):
1297–1302.
Published online 2008 August 18. doi:
10.1007/s11136-008-9379-5
PATIENT - REPORTED UNMET NEED 20
Appendix 1
Healthy Days Core Module (CDC HRQOL-4)
1. Would you say that in general your health is:
a. Excellent 1
b. Very good 2
c. Good 3
d. Fair 4
e. Poor 5
f. Don’t know/Not sure 7
g. Refused 9
2. Now thinking about your physical health, which includes
physical illness and injury, how many days during the past
30 days was your physical health not good?
a. Number of Days ____
PATIENT - REPORTED UNMET NEED 21
b. None _88___
c. Don’t know/Not sure _77___
d. Refused 99___
3. Now thinking about your mental health, which includes
stress, depression and problems with emotions, for how many
days during the past 30 days was your mental health not
good?
a. Number of Days ___
b. None _88___ If both Q2 and Q3 = “None,”
skip next question
c. Don’t know/ Not sure _77___
d. Refused _99___
4. During the past 30 days, for about how many days did poor
physical or mental health keep you from doing your usual
activities, such as self-care, work or recreation?
PATIENT - REPORTED UNMET NEED 22
a. Number of Days ____
b. None __88__
Don’t know/Not sure __77__
d. Refused _99_
Healthy Days Symptoms Module
1. During the past 30 days, for about how many days did PAIN
make it hard for you to do your usual activities, such as
self-care, work or recreation?
a. Number of days ____
b. None 88__
Don’t know/Not sure __77__
d. Refused _99_
PATIENT - REPORTED UNMET NEED 23
2. During the past 30 days, for about how many days have you
felt SAD, BLUE, or DEPRESSED?
a. Number of Days ___
b. None _88_
c. Don’t know/ Not sure __ 77__
d. Refused _ 99_
3. During the past 30 days, for about how many days have you
felt WORRIED, TENSE, OR ANXIOUS?
a. Number of Days ____
b. None __ 88__
c. Don’t know /Not sure _ 77___
d. Refused ___99_
4. During the past 30 days, for about how many days have you
felt you did NOT get ENOUGH REST or SLEEP?
a. Number of Days ____
b. None 88
PATIENT - REPORTED UNMET NEED 24
c. Don’t know/Not sure 77
Refused 99
5. During the past 30 days, for about how many days have you
felt VERY HEALTHY AND FULL OF ENERGY?
a. Number of Days ____
b. None 88
c. Don’t know/Not sure 77
d. Refused 99
. Activity Limitations
These next questions are about physical, mental, or emotional
problems or limitations you
may have in your daily life.
1. Are you LIMITED in any way in any activities because of any
impairment or health problem?
a. Yes 1
PATIENT - REPORTED UNMET NEED 25
b. No 2
Go to Q1 of Healthy Days Symptoms Module
Don't know/Not sure 7
Go to Q1 of Healthy Days Symptoms Module
Refused 9
Go to Q1 of Healthy Days Symptoms Module
2. What is the MAJOR impairment or health problem that limits
your activities?
a. Number of Days _ _
b. None 8 8 If both Q2 AND Q3 = "None", skip next question
Don't know/Not sure
7 7
Refused
9 9
a. Number of Days _ _
b. None
8 8
PATIENT - REPORTED UNMET NEED 26
Don't know/Not sure
7 7
Refused
9 9
That is the MAJOR impairment or health problem that limits your
activities?
a. Arthritis/rheumatism
0 1
b. Back or neck problem
0 2
c. Fractures, bone/joint injury
0 3
d. Walking problem
0 4
e. Lung/breathing problem
0 5
PATIENT - REPORTED UNMET NEED 27
f. Hearing problem
0 6
g. Eye/vision problem
0 7
h. Heart problem
0 8
i. Stroke problem
0 9
j. Hypertension/high blood pressure
1 0
k. Diabetes
1 1
l. Cancer
1 2
m. Depression/anxiety/emotional problem 1 3
n. Other impairment/problem
1 4
PATIENT - REPORTED UNMET NEED 28
Don't know/Not sure
7
Refused
9
3. HOW LONG have your activities been limited because of your
major impairment or health problem?
b. Back or neck problem
0 2
c. Fractures, bone/joint injury
0 3
d. Walking problem
0 4
e. Lung/breathing problem
0 5
PATIENT - REPORTED UNMET NEED 29
f. Hearing problem
0 6
g. Eye/vision problem
0 7
h. Heart problem
0 8
i. Stroke problem
0 9
j. Hypertension/high blood pressure
1 0
k. Diabetes
1 1
l. Cancer
1 2
m. Depression/anxiety/emotional problem
1 3
PATIENT - REPORTED UNMET NEED 30
n. Other impairment/problem
1 4
Don't know/Not sure
9
Refused
7
Do Not Read. Code using respondent's unit of time.
a. Days 1 _ _
b. Weeks 2 _ _
c. Months 3 _ _
d. Years 4 _ _
Don't know/Not sure
7 7 7
Refused
9 9 9
PATIENT - REPORTED UNMET NEED 31
4. Because of any impairment or health problem, do you need the
help of other persons with your PERSONAL CARE needs, such as
eating, bathing, dressing, or getting around the house?
a. Yes
1
b. No
2
Don't know/Not sure
7
Refused
9
5. Because of any impairment or health problem, do you need the
help of other persons in handling your ROUTINE needs, such
as everyday household chores, doing necessary business,
shopping, or getting around for other purposes?
a. Yes
1
PATIENT - REPORTED UNMET NEED 32
b. No
2
Don't know/Not sure
7
Refused
9
This is the end of the Healthy Days Module (CDC HRQOL-14) Quality
of Life Assessment, thank you for your participation. If you have
any questions concerning the data generated by the questionnaire,
please feel free to contact Allen Sutton, NPP at 917 848 4558
Appendix B
Unmet Needs Questionnaire
1. How satisfied do you feel with access to healthcare from your
doctors?
a. Very satisfied
PATIENT - REPORTED UNMET NEED 33
b. A little satisfied
c. Neither satisfied nor dissatisfied
d. A little dissatisfied
e. Very dissatisfied
2. How satisfied do you feel with your access to health-related
services in general?
a. Very satisfied
b. A little satisfied
c. Neither satisfied nor dissatisfied
d. A little dissatisfied
e. Very dissatisfied
3. How satisfied do you feel with access to services related to
your mental health?
a. Very satisfied
b. A little satisfied
PATIENT - REPORTED UNMET NEED 34
c. Neither satisfied nor dissatisfied
d. A little dissatisfied
e. Very dissatisfied
4. How satisfied do you feel with the amount of access you have
to HIV/AIDS care?
a. Very satisfied
b. A little satisfied
c. Neither satisfied nor dissatisfied
d. A little dissatisfied
e. Very dissatisfied
5. How satisfied do you feel with access to a Dentist,
Podiatrist, Neurologist or Ophthalmologist?
a. Very satisfied
b. A little satisfied
c. Neither satisfied nor dissatisfied
d. A little dissatisfied
PATIENT - REPORTED UNMET NEED 35
e. Very dissatisfied
6. During the past 30 days, how many appointments with your
primary care doctor have you missed?
If appointments were missed, why?
__________________________________________
a. 0
b. 1
c. 2
d. 3
e. 4
f. 5 or more
7. How satisfied do you feel with your pharmacy?
a. Very satisfied
b. A little satisfied
c. Neither satisfied nor dissatisfied
d. A little dissatisfied
PATIENT - REPORTED UNMET NEED 36
e. Very dissatisfied
Are your medications delivered?
Yes
No
8. During the past 30 days, what were your financial needs?
Answer more than one if applicable.
a. My finances provide an acceptable quality of life.
b. Over the past 30 days, I could have used additional money for
transportation.
c. Over the past 30 days, I could have used additional money for
food.
d. Over the past 30 days, I could have used additional money for
laundry and cleaning supplies.
e. Over the past 30 days, I could have used additional money for
clothing and personal cosmetic products, shelter,
furnishings or entertainment.
9. Do you have a winter jacket and water proof boots?
PATIENT - REPORTED UNMET NEED 37
Yes
No
10. Over the past 30 days, have you had enough heat and hot water
in your apartment?
a. Plenty of heat and hot water
b. Acceptable amount of heat and hot water
c. Low amount of heat and hot water
d. No heat and hot water frequently
e. No heat in the last 30 days
11. How satisfied do you feel about the apartment where you live?
a. Very satisfied
b. A little satisfied
c Neither satisfied or dissatisfied
d. A little dissatisfied
e. Very dissatisfied
PATIENT - REPORTED UNMET NEED 38
Are you able to prepare meals in your apartment?
Yes
No
12. How satisfied do you feel with the relationships you have
with family, friends and significant others?
a. Very satisfied
b. A little satisfied
c. Neither satisfied nor dissatisfied
d. A little dissatisfied
e. Very dissatisfied
13. During the past 30 days, how many days has your quality of
life been affected by substance abuse?
a. 0-3 days
b. 4-7 days
PATIENT - REPORTED UNMET NEED 39
c. 8 -14 days
d. 15-21 days
e. 21+ days
Are you actively using Marijuana, Heroin, Crack, Cocaine, or K2?
Yes
No
Are you actively using Alcohol?
Yes
No
14. How satisfied do you feel with access to substance abuse
counseling or care?
a. Very satisfied
b. A little satisfied
c. Neither satisfied nor dissatisfied
d. A little dissatisfied
PATIENT - REPORTED UNMET NEED 40
e. Very dissatisfied
15. How satisfied do you feel with your level of education?
a. Very satisfied
b. A little satisfied
c. Neither satisfied nor dissatisfied
d. A little dissatisfied
e. Very dissatisfied
Do you have a desire to go to school or work?
Yes
No
16. How satisfied do you feel with you level/type of employment?
a. Very satisfied
b. A little satisfied
c. Neither satisfied nor dissatisfied
d. A little dissatisfied
PATIENT - REPORTED UNMET NEED 41
e. Very dissatisfied
17. How satisfied do you feel with being able to do things for
yourself?
a. Very satisfied
b. A little satisfied
c Neither satisfied nor dissatisfied
d. A little dissatisfied
e. Very dissatisfied
18. Over the past 30 days did you need support and did not get
it?
Yes
No
Please list any needs that you feel have been unmet.
1.
2.
3.