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2006 NSDUH CAI Specs for Programming - Substance Abuse and ...

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DK/REF<br />

ADMT15<br />

[IF ADMT14 = 6] Please type in a description of this other place where you received outpatient mental health<br />

treatment or counseling. When you have finished, press the [ENTER] key to go to the next question.<br />

________________<br />

DK/REF<br />

ADMT16<br />

[IF ADMT14 = 1] During the past 12 months, how many visits did you make to an outpatient mental health<br />

clinic or center <strong>for</strong> mental health care?<br />

# OF VISITS: [RANGE: 1 - 366]<br />

DK/REF<br />

ADMT17<br />

[IF ADMT14 = 2] During the past 12 months, how many outpatient visits did you make to a private<br />

therapist, psychologist, psychiatrist, social worker, or counselor <strong>for</strong> mental health care?<br />

# OF VISITS: [RANGE: 1 - 366]<br />

DK/REF<br />

ADMT18<br />

[IF ADMT14 = 3] During the past 12 months, how many outpatient visits did you make to a doctor’s office<br />

<strong>for</strong> mental health care?<br />

# OF VISITS: [RANGE: 1 - 366]<br />

DK/REF<br />

ADMT19<br />

[IF ADMT14 = 4] During the past 12 months, how many outpatient visits did you make to an outpatient<br />

medical clinic <strong>for</strong> mental health care?<br />

# OF VISITS: [RANGE: 1 - 366]<br />

DK/REF<br />

ADMT20<br />

[IF ADMT14 = 5] During the past 12 months, how many outpatient visits did you make to a partial day<br />

hospital or day treatment program <strong>for</strong> mental health care?<br />

# OF VISITS: [RANGE: 1 - 366]<br />

DK/REF<br />

ADMT21<br />

[IF ADMT14 = 6] During the past 12 months, how many outpatient visits did you make to some other type<br />

of facility <strong>for</strong> mental health care?<br />

# OF VISITS: [RANGE: 1 - 366]<br />

DK/REF<br />

ADMT22<br />

[IF ADMT14 NE BLANK] Who paid or will pay <strong>for</strong> the outpatient mental health care you received during<br />

the past 12 months?<br />

To select more than one answer, press the space bar between each number you type. When you have<br />

finished, press the [ENTER] key to go to the next question.<br />

1 Self or a family member living with you<br />

2 A family member who does not live with you<br />

3 Private health insurance<br />

4 Medicare<br />

5 Medicaid<br />

6 Rehabilitation program<br />

7 Employer<br />

8 VA or other military program<br />

9 Other public source<br />

10 Other private source<br />

11 No one paid because the treatment was free<br />

DK/REF<br />

ADMT23<br />

[IF MORE THAN 1 RESPONSE SELECTED IN ADMT22 AND ADMT14 NE DK/REF] Who paid or will<br />

pay most of the cost <strong>for</strong> the outpatient mental health care you received during the past 12 months?<br />

December 2, 2005 312

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