Summary
In this report we address the MHSIP Consumer Survey (CPS) - OLDER ADULT+QOL. This assessment tool has some odd 13 sub-scales. We include our scored version of the CPS in this report. On August 10, 2018 our subject, Keith “Buster” Torkelson scored 67.6% as his perception of satisfaction. We have spent a good deal of time working to transform this survey into an easy to quantify version. The quality of our transformation is weak. The original survey uses a Likert Style scoring method. In our transformation we use our Binary Plus Scoring Method (Modified Dichotomous). At the end: The survey asks for freeform comments and suggestions. Buster has taken and submitted this survey several times. We would like his quantitative results mailed to 9011 Knott #105, Buena Park, CA 90620. In addition, it would be nice to receive a stipend for any consumer scoring and submitting this Consumer Perception Survey (CPS).
Scored by and for Keith “Buster” Torkelson MS, BS
Contents – Assessments Related – Sample Scored Coming Next
HSF = High Scores are Favorable
QOL and Services Sub-score 10 Items (HSF)
QOL and Services (HSF) 10 Items
Total QOL and Services Score 20 Items (HSF)
Service Outcomes Score 12 Items (HSF)
Result of Services Score 4 Items (HSF)
General Life Satisfaction & Housing Score 4 Items (HSF)
Satisfaction with ADLs Score 4 Items (HSF)
Family Score 2 Items (HSF)
Social Resources Score 4 Items (HSF)
Crime Free Score 3 Items (HSF)
Impression of Safety Score 3 Items (HSF)
Health Impression Score 3 Items (HSF)
Small Images of Assessment
CPS = Consumer Perception Survey
[Link to 2025 Assessment]
MHSIP Consumer Survey - OLDER ADULT+QOL - Spring 2025
https://www.uclaisap.org/assets2/docs/cps/2025/Surveys/OlderQOL/MHSIP_Older_QOL_EN_2025.pdf
Services of
Central City Community Health Center
Brand New Day - Bum Soo Lee MD
Estimate of Perceptions – Health Related (HSF) 10 Items
HSF = High Scores are Favorable for ALL | RT = Real Time
Note - 20260128-W-Shared with Behavioral Health Advisory Board (BHAB)
Scored by and for Keith “Buster” Torkelson
Scored 10-11-25 (5 Pages – A PHR)
Consumer Perception Survey (CPS) Approach – A Measure of Satisfaction
Acronym List
Research Question
Will writing and publishing this paper impact our Quality Of Life?
Writing and publishing a paper can significantly impact your quality of life, both positively and negatively. While the process is demanding and can cause considerable stress, it can also lead to great rewards. Your final experience will depend on how you navigate the challenges and maximize the potential benefits.
What are the benefits of writing a research paper?
Writing a research paper enhances critical thinking, communication, and research skills while establishing expertise and credibility within a field. It contributes to the body of knowledge by disseminating new findings, provides a platform for networking and collaboration, and can open doors to academic and professional opportunities like grants, scholarships, and better career prospects.
If so, in what ways would said project impact our Quality Of Life?
To assess how a hypothetical project would impact your quality of life, the project in question must first be identified. Projects of any scale can affect quality of life in myriad ways, touching on your finances, health, relationships, and daily routine. Based on general project outcomes, potential impacts on your quality of lifecan be positive, negative, or a mix of both.
How is it a transformation?
To determine how something is a transformation, one must identify the process of a radical or thorough change from one form, state, or nature to another. A transformation is not merely a small tweak, but a fundamental shift.
Theme Teach to the Test
"Theme" and "Teach to the Test" are two distinct educational concepts: a theme is a central idea or big concept that can guide a curriculum, while teaching to the test is a pedagogical method where instruction focuses specifically on the content and format of a particular standardized test to improve student performance on that assessment. While they can sometimes intersect, a thematic curriculum provides a broad framework, whereas teaching to the test is a narrow, assessment-driven approach
Consumer Perception
Consumer perception is the mental process by which individuals interpret information and form opinions about a product, service, or brand, influencing their attitudes and purchasing decisions. It is shaped by personal experiences, marketing efforts, brand values, and external factors like reviews, creating a subjective "image" that can impact loyalty and trust. Understanding and managing consumer perception is crucial for businesses to make informed decisions, identify opportunities for improvement, and build stronger customer relationships.
Quality of Life (QOL)
Quality of life is a broad, subjective measure of an individual's overall well-being and satisfaction with their life, encompassing their personal perceptions within a specific cultural and value system, and relating to their goals, expectations, standards, and concerns. It includes factors like physical health, psychological state, social relationships, and the surrounding environment, along with more abstract elements such as a sense of safety, autonomy, and social belonging.
Define Perception
Perception is the organization, identification, and interpretation of sensory information in order to represent and understand the presented information, or the environment – also - the ability to see, hear, or become aware of something through the senses. Example: The state of being or process of becoming aware of something through the senses. Examples: The perception of pain & our perception of our own limitations. A way of regarding, understanding, or interpreting something; a mental impression.
Syno-Term (Perception)
In House > Metadata >
Assess_CPS_Perception_MHSIP_18092301_Develop
[20250823-SA-LINK BROKEN-404 Not Found]
https://www.cibhs.org/sites/main/files/file-attachments/adult_with_qol-english.pdf
Index – Related to MHSIP Measure
Nested Survey Questions
Nested survey questions (branching/conditional logic) allow for follow-up questions to appear immediately below a selected answer, creating a, personalized, and, less overwhelming experience. They are ideal for reducing survey length by only showing relevant, detailed questions based on previous choices, often used in checkboxes and radio buttons
Ditto - Small Images of Assessment
MHSIP Consumer Survey - Older Adult+QOL - DHCS 1744 EN
Spring 2025 Version [20251130-SU-LINK WORKS]
https://www.uclaisap.org/assets2/docs/cps/2025/Surveys/OlderQOL/MHSIP_Older_QOL_EN_2025.pdf
Summary – Older Adult QOL – From Consumer Perception Surveys
HSF = High Scores are Favorable
MHSIP Consumer Survey - OLDER ADULT+QOL Spring 2025 (Ditto)
https://www.uclaisap.org/assets2/docs/cps/2025/Surveys/OlderQOL/MHSIP_Older_QOL_EN_2025.pdf
Older Adult QOL Screener – 7 Items – Quick Score Method (QSM)
HSF = High Scores are Favorable
FYI - “Misplacing Materials, Records and Data”
Aside - HUGE TOPIC
Misplacing materials, records, and data can lead to severe consequences, including significant financial losses, legal liability, reputational damage, and operational disruptions. Poor record-keeping can result from inadequate policies, human error, or a reliance on outdated systems.
FYI - ©2015 California Institute for Behavioral Health Solutions
CIBHS Consumer Perception Surveys
[All three LINKS BROKEN]
https://www.cibhs.org/consumer-perception-surveys
https://www.cibhs.org/adult-forms-with-QOL
https://www.cibhs.org/post/older-adult-forms-qol
The ones we used (2015 & 2025)
In House > Metadata >
Updated Version - Spring 2025 Version
[20260307-SA-LINK CHECK = PASSES]
https://www.uclaisap.org/assets2/docs/cps/2025/Surveys/OlderQOL/MHSIP_Older_QOL_EN_2025.pdf (Ditto)
Older Adult Survey – 2015 - Evaluation
In House > Metadata >
Assessment Qualities & Specifications
(*) FYI - Ownership & Purpose
The California Department of Health Care Services (DHCS) owns the consumer perception survey data and its collection process for publicly funded mental health programs in California.
The DHCS is required by federal regulations to collect this data to report on National Outcome Measures (NOMs), which are necessary for receiving federal Community Mental Health Services Block Grant funding. DHCS contracts with the UCLA Integrated Substance Use and Addiction Programs (ISAP) to coordinate, scan, process, and aggregate the submitted survey data. Counties are responsible for administering the survey to their clients, using either paper forms or online links provided by UCLA-ISAP. The specific survey tool used is the Mental Health Statistics Improvement Project (MHSIP) survey.
The data is ultimately used for…
Complying with federal reporting requirements
Quality improvement efforts at both the state and county levels
Providing feedback to stakeholders on the effectiveness of services
For more information, you can visit the UCLA ISAP website which hosts information and materials related to the survey process.
https://www.uclaisap.org/mh-consumer-perception-survey.html
With QOL - Spring 2025 - Instructions
Please help CalOptima and Central City Community Health Center make services better by answering some questions. Your answers are confidential and will not influence current or future services you receive. For each survey item below, please fill in the circle that corresponds to your choice. Please fill in the circle completely.
EXAMPLE (Binary Plus Scoring Method)
Correct or Yes (1.00) – SoSo (0.50) - Incorrect or No (0.00)
Use any number between 1.00 and 0.00 inclusive
MHSIP Consumer Survey*
Please answer the following questions based on the LAST 6 MONTHS OR if you have not received services for 6 months, just give answers based on the services you have received so far. Indicate if you Strongly Agree, Agree, are Neutral, Disagree, or Strongly Disagree with each of the statements below. If the question is about something you have not experienced, fill in the circle for Not Applicable to indicate that this item does not apply to you.
Development
*This survey was developed through a collaborative effort of consumers, the Mental Health Statistics Improvement Program (MHSIP), Community and the Center for Mental Health Services.
DHCS 1743 EN (05/13) - CSI County Client Number
Client Number must be entered on EVERY page - English with QOL
[DITTO] - Scoring – Binary Plus Method (B+M)
Binary Plus Scoring Method (B+SM) – Modified Dichotomous Scoring
We use our B+M – Record any number between 0.00 and 1.00
FYI - 20260102-F-Recurrent Issue with Medication
>Back in 2024 we first ran into a hurdle to overcome with regard to our sleeping medication, Zolpidem (Tartrate) 10mg per night. It requires prior authorization each year first for the second half of 2024 and then for 2025. Now again for 2026 our Zolpidem requires prior authorization. We called Customer Service @ 877-412-2734 for a determination of coverage. On 20260107 (W) we discussed this issue with our psychiatrist, RBB MD. As of 20260109 (F) our prior authorization still hadn’t reached our pharmacy therefore with got to pay $15 cash for our January Zolpidem prescription. The $15 was non-refundable. On 20260116 (F) Med Impact approved our Zolpidem so it will be covered for the rest of the year. Next year, December (2026), we plan to get going early on this recurrent issue.
Satisfaction with Service 2018 > 20 Questions – Part 1 of 2
Pertains to Central City Community Health Center
HSF = High Scores are Favorable
Decrease use of Likert
Strongly Agree – Agree – I’m Neutral – Disagree – Strongly Disagree – Not Applicable
Service (Continued)
Satisfaction with Service 2018 – 20 Questions – Part 2 of 2
Quality of Life
Likert Not Used
Strongly Agree – Agree – I’m Neutral – Disagree – Strongly Disagree – Not Applicable
HSF = High Scores are Favorable
As a direct result of the services I received
Non-provider Relationships
For Questions #33-36, please answer for relationships with persons other than your mental health provider(s).
Likert Not Used
Strongly Agree – Agree – I’m Neutral – Disagree – Strongly Disagree – Not Applicable
HSF = High Scores are Favorable
As a direct result of the services I received:
How do you feel about?
Please answer the following questions to let us know how you are doing.
FYI - Quality of Life Questions
Please answer each of the following questions by filling in the circle that best describes your experience or how you feel. Please fill in only one circle for each question. For some questions, you may choose
Format Not Used
Not Applicable if the question does not apply to you.
Likert Not Used
Terrible – Unhappy - Mostly Dissatisfied – Mixed - Mostly Satisfied – Pleased – Delighted
General Life Satisfaction
HSF = High Scores are Favorable | QSM = Quick Score Method
Statement | 2018 0811 SU-RT QSM |
How do you feel about your life in general? [PARITY] | 0.75 |
Date Scored: 20180811-SU: Last Reviewed: 20190713-SAT:
Associated with > In House > Metadata >
Assess_OCHCA_Satisfaction_My_Life_23071401_Notes V2025
Living Situation
Think about your current living situation. How do you feel about?
Not Applicable if the question does not apply to you.
Terrible – Unhappy - Mostly Dissatisfied – Mixed - Mostly Satisfied – Pleased - Delighted
Daily Activities (ADL) & Functioning
3. Think about how you spend your spare time. How do you feel about?
Terrible - Unhappy – Mostly Dissatisfied – Mixed- Mostly Satisfied – Pleased – Delighted – Not Applicable
Family & Social Relations
4. How do you feel about…Family?
Social Relations
5. How do you feel about…?
Legal & Safety
6. In the past MONTH, were you a victim of crime? No Yes [NO]
In the past MONTH, how many times have you been arrested for any crimes?
No arrests - 1 arrest - 2 arrests - 3 arrests - 4 - or more arrests
8. How do you feel about:
Terrible – Unhappy – Mostly Dissatisfied - Mixed Mostly - Pleased – Delighted
Health
Excellent | Very Good | Good | Fair | Poor
9. In general, would you say your health is?
ORG # | Health | 2018 0810 F-RT |
9 | In general, would you say your health is? (HSF) | 0.75 |
10. How do you feel about?
Terrible (0.00)
Unhappy
Mostly Dissatisfied (0.50)
Mixed Mostly
Pleased
Delighted (1.00)
How are you doing?
Please answer the following questions to let us know how you are doing.
Approximately, how long have you received services at Central City?
Central City Community Health Center Garden Grove – 2012-2025
Aside - CalOptima about 1 and a half year (As of 20251216-TU)
FYI – The table implies that the longer one receives services the better off they are.
Note - Duration
For services like therapy, education, or ongoing medical treatment, a longer duration is often necessary to achieve long-term success, recovery, or mastery.
Relate Services to Legal Status
Please answer Questions #2 - 4 if you have been receiving services for ONE YEAR OR LESS. If you have been receiving services for "MORE THAN ONE YEAR," please SKIP to Questions #5.
Rigorous Legal is Stayed
Please answer Questions #5 - 7 only if you have been receiving mental health services for
"MORE THAN ONE YEAR".
Now thinking about the services you received how much of it was by telehealth by telephone or video-conferencing?
How helpful were your telehealth visits compared to traditional in-person visits?
Telehealth
>We had one telehealth appointment with our psychiatrist and it went SoSo. We have had two Teledoc appointments and both were exceptional. Overall our telehealth appointments were comparable to our in person appointments. Gradually, I would prefer to receive more of my mental health treatment at this program by telehealth.
>For the upcoming year 2026 we would like to maintain in person appointments.
Work Done (COPD Risk Factor)
Tuesday, September 10, 2019
2018-2019 COPD Season by and For Keith “Buster” Torkelson, MS Brand New Day Teladoc Benefit Pulls Through
https://brandnewdayhmo.blogspot.com/2019/09/2018-2019-copd-season-by-and-for-keith.html
Please answer the following questions to let us know a little about you.
What is your gender? Female V Male V Other [MALE]
Are you of Mexican / Hispanic / Latino origin? Yes V No V Unknown [NO]
What is your race? (Please check all that apply.)
Implications
>Checklist above implies that race matters with regards to health, supports and services.
Based on extensive research, race does not matter as a biological factor but has a significant impact on health and services due to the societal effects of racism, discrimination, and historical inequities. This means that persistent racial disparities in health outcomes, access to care, and quality of treatment are caused by systemic issues, not biological ones.
Implies that gender matters with regard to health and service
Based on biology and deeply rooted social and cultural factors, gender significantly impacts health outcomes and how people access and experience healthcare services. Biological differences - Sex-related biological differences influence disease patterns and how the body responds to treatment.
FYI - Question 11
>What is your date of birth? [HELD BACK] – I am an older adult
(Write it in the boxes AND fill in the circles that correspond.)
Date of Birth (mm-dd-yyyy)
EXAMPLE: Date of birth on April 30, 1937 = 04-30-1937
Were the services you received provided in the language you prefer? Yes V No [YES]
Was written information (e.g., brochures describing available services, your rights as a consumer, and mental health education materials) available to you in the language you prefer?
Yes V No [YES]
What was the primary reason you became involved with this program? (Mark one)
Note BND went defunct in 2022
Note - Must be entered on EVERY page (5 pages)
CSI - Client Services Information
CCN - County Client Number
Question 15
Please identify who helped you complete any part of this survey (Mark all that apply)
Who helped?
Question 16
Please provide comments here and /or on the back of this form, if needed. We are interested in both positive and negative feedback. Also, if there are areas which were not covered by this questionnaire, which you feel should have been, please write them here. Thank you for your time and cooperation in completing this questionnaire. Thank you for taking the time to answer these questions!
Feedback
We have submitted several of these surveys and would like you to send our results to Keith “Buster” Torkelson, 9011 Knott #105, Buena Park, CA 90620.
