Pre-Screening Questionnaire



You were recommended to participate in our research study by your Bicycle Health provider after recently completing computerized screenings about the status of your mental health, social vulnerability, stress level and recovery status.



The purpose of this research study is to support your recovery and help you set goals related to your individual social service needs, mental health symptoms, and/or overall stress and wellness during your recovery from opioid use disorder (OUD). This study may give you the opportunity to set an action plan goal for getting additional support in one of the following areas, including your mental health, stress reduction, and/or social service support. This action plan goal will help you be clear about what help you need from your Bicycle Health providers and help you access additional resources, case management services, or mental health referrals.



Please complete the survey below to determine if you are eligible to participate in the research study titled “Effects of Remote Motivational Enhancement on Engagement in Buprenorphine Treatment.” The answers to these questions will help the study team determine if you meet the following criteria needed to participate. Below is a summary of the criteria that will be used to determine eligibility to participate in the study:

  • Age 18 years or older

  • You have completed online mental health and social vulnerability screenings.

  • You are a current patient of Bicycle Health receiving Opioid Use Disorder (OUD) treatment with buprenorphine/naloxone (for example, “Suboxone”)

  • You understand English well enough to understand procedures and questionnaires and provide informed consent.

  • You have access to the internet and an electronic device with adequate data capacity to complete questionnaires and meet with motivational coaches virtually.

  • You can fill out surveys on a computer or an electronic device at home.

  • You do not expect to be hospitalized in the next 12 weeks for a physical health problem

  • You do not expect to go to jail in the next 12 weeks

  • You are not in your third trimester of pregnancy or plan to deliver within 12 weeks of study consent.

  • You are not currently participating in other investigational studies, including studies providing stress reduction, mental health, or social services. If you are planning to participate in another study, it is acceptable to do so but only if you enroll in the other studies after week 2 of this current study.



The study team will record your answers electronically in a secure database, but only collect detailed contact information if you qualify for the study and want to schedule a follow-up visit. The risk of allowing us to record your name with your answers is a loss of confidentiality. We will take reasonable steps to protect the confidentiality of your information.



If you are found to be eligible for the study, you will be asked to complete study assessments throughout the first 12 weeks of the study. At study week 24, the research team will collect buprenorphine prescription data from your electronic health record at Bicycle Health, but you will not be required to engage in any research assessments beyond 12 weeks.



You will be expected to complete online surveys at the start of the study (baseline), week 2, week 4, and week 12. The baseline survey session may last up to 15 minutes, the survey session at week 2 may last up to 20 minutes, the survey session at week 4 may last up to approximately 40 minutes and the final survey session at week 12 may last up to 1 hour. You will be paid for time spent completing study tasks at week 2, 4 and 12.










Name of Principal Investigator and the Research Facilities:

Zev Schuman-Olivier, MD, Cambridge Health Alliance (CHA)

Kathleen Moore, PhD, University of South Florida (USF)

Name of Co-Investigator(s): Holly Hills, PhD, (USF) Khary Rigg, PhD, (USF), Amanda Sharp, PhD, (USF).

Name and telephone number of study contact to call with questions:

Cassandra Harding, Study Coordinator (857-366-0748, charding@challiance.org)