California DMC-ODS Evaluation

Treatment Perceptions Survey (TPS)

(UPDATED 01/06/2021)

Please check back periodically for updates.

As part of the DMC-ODS waiver evaluation, counties are required to have their network of providers administer the client TPS. The information collected will be used to measure adult clients' perceptions of access to services and the quality of care.  The TPS is required to fulfill the county External Quality Review Organization (EQRO) requirement related to having a valid client survey.  The data may also be used by counties (and service providers) to evaluate and improve the quality of care and client experience.

Although counties/providers are encouraged to use the online survey, counties have the option of using one or more methods to administer the survey as described below. Counties are to provide county-specific guidance to providers on survey administration.  Each participating provider must ensure their individual implementation of TPS procedures adheres to 42 CFR, part 2.

  • Offer the online survey link, survey phone number/unique provider code, and/or paper survey form to clients receiving services in person, or by telephone or telehealth (video-conferencing).
  • Provide/email/text/enter in the chat box the unique provider online survey link, provide the phone number/unique provider code for the phone survey, or hand the survey form to all appropriate clients receiving services during the survey period using any contact method(s) the client has previously agreed to use to communicate with the provider.
  • Providers may also post/distribute a flier with the survey information (e.g., customized survey link, phone/voice survey phone number/unique provider code).  
  • Clients need complete only one questionnaire during the survey period.
  • Inform clients that the survey is anonymous. Clients should not type in/write/or say their names when completing the survey using any of the data collection methods.

If you have questions, please contact Cheryl Teruya, Ph.D., at cteruya@mednet.ucla.edu

TPS Information Notice: BHIN No. 20-067

TPS 2020

In response to the increased provision of services to adult and youth clients via telehealth due to COVID-19, counties will be given access to a secure online survey. If needed, paper forms (one-page and large print) will also be available, but counties that choose to use these will be responsible for scanning or data entering the data locally and submitting the electronic data files to UCLA, or entering the clients' responses using the data entry survey link that UCLA will provide to counties.

An automated telephone survey for clients who do not have access to the internet or prefer to complete the survey over the phone is also available.

If multiple data collection methods are used (online survey, phone/voice survey, paper survey forms), UCLA will merge the data collected into one dataset for each county.

Frequently Asked Questions (Updated 10/12/20)

Presentation Slides that Can Be Tailored by Counties for Training their Provider Network (Updated 10/13/20)

TPS Checklist for County Administrators and Providers (Updated 10/12/20)

TPS Flier Template

Online Survey

Clients receiving services from treatment providers whether in-person or by telephone or telehealth (e.g., video-conferencing) during the survey period should be given access to the online survey via a link/QR code. Each link/QR code is customized for a specific provider, meaning that the CalOMS Provider ID, Reporting Unit (if required by the county) and treatment setting have already been pre-filled in hidden fields. The list of unique provider links/QR codes have been provided to county TPS coordinators for distribution to their providers.

Both adults and youth can select among 13 languages (English, Spanish, Tagalog, Vietnamese, Russian, Chinese, Arabic, Korean, Eastern and Western Armenian, Cambodian, Hmong, and Farsi) after clicking on the link. Responses entered into the online survey are sent directly to UCLA.

The customized links/QR codes will be active as of midnight on November 9 through midnight on November 13, 2020.

Automated Phone Survey

An automated phone survey option will be available for the 2020 TPS.  Four-digit codes have been provided to county administrators for distribution to providers.  Clients may call the toll-free numbers below during the survey period.  Callers will be asked to enter their program's 4-digit code (or say the name of the county where they live if they do not know/have their code), and can respond to the questions by pressing the number and/or pound keys on their phones.  The survey will include all of the survey questions, but will not ask respondents for their comments. The phone survey will be available in English and Spanish.  (It may become available in other languages in the future.)

  • Toll-free TPS phone survey (Adults):  855-798-1523 (will activate on November 9)
  • Toll-free TPS phone survey (Youth):   844-943-4015 ((will activate on November 9)

Paper Survey Forms

Survey forms for both adults and youth are available in 13 languages, including English, Spanish, Tagalog, Vietnamese, Russian, Chinese, Arabic, Korean, Eastern and Western Armenian, Cambodian, Hmong, and Farsi. Forms are available in one-page and large print versions.

In the section at the top of each form, please pre-fill the following information by using either (1) the online "fillable" feature before printing the forms, or a pen (black or blue ink):

  • Six digit CalOMS Tx Provider ID
  • 10-digit (maximum) Program Reporting Unit ID (This field may be used for county-specific purposes and data analysis at the unit level. It is optional and may be left blank.)
  • Treatment setting/modality (If the same Provider ID is used for multiple treatment settings/modalities, prepare separate sets of forms. For example, if two different treatment settings/modalities use the same Provider ID, prepare one set of forms for the Residential clients and another set for the OP/IOP clients.)

Print the survey forms directly from the pdf files. Use both sides of the page (double-sided) when printing the two-page forms with the large print.

County-specific guidance should be communicated to providers in the county's network as data from the forms will need to be data entered locally. UCLA will send counties links below for data entry purposes only.  (These links are for county/provider use only.  Clients should be given the provider's customized links.)

All TPS Paper Survey Forms

All TPS Forms - zipped PDF files: (Adults) || (Youth)

Language Survey Forms (Adult)
English 1-page version Large-print version (2 pages)
Spanish 1-page version Large-print version (2 pages)
Chinese 1-page version Large-print version (2 pages)
Tagalog 1-page version Large-print version (2 pages)
Farsi 1-page version Large-print version (2 pages)
Arabic 1-page version Large-print version (2 pages)
Russian 1-page version Large-print version (2 pages)
Hmong 1-page version Large-print version (2 pages)
Korean 1-page version Large-print version (2 pages)
Armenian - Eastern 1-page version Large-print version (2 pages)
Armenian - Western 1-page version Large-print version (2 pages)
Vietnamese 1-page version Large-print version (2 pages)
Cambodian 1-page version Large-print version (2 pages)

 

Language Survey Forms (Youth)
English 1-page version Large-print version (2 pages)
Spanish 1-page version Large-print version (2 pages)
Chinese 1-page version Large-print version (2 pages)
Tagalog 1-page version Large-print version (2 pages)
Farsi 1-page version Large-print version (2 pages)
Arabic 1-page version Large-print version (2 pages)
Russian 1-page version Large-print version (2 pages)
Hmong 1-page version Large-print version (2 pages)
Korean 1-page version Large-print version (2 pages)
Armenian - Eastern 1-page version Large-print version (2 pages)
Armenian - Western 1-page version Large-print version (2 pages)
Vietnamese 1-page version Large-print version (2 pages)
Cambodian 1-page version Large-print version (2 pages)

 

TPS Summary Reports

  • Sample Reports
  • Statewide Results (2020 survey period)
    • Adults (30 counties and 1 regional model)
    • Youth (21 counties and 1 regional model)

Instructions for Using "Box" to Access TPS Reports and Data Files (Updated 10/20/20)