Form EBP Self-Assessmen EBP Self-Assessmen EBP Self-Assessment Part 1 and Part 2

Evaluation of Programs to Provide Services to Persons Who Are Homeless with Mental and /or Substance Use Disorders

Attachment 03_EBP Self-Assessment Part 1 and Part 2

EBP Self-Assessment Part 2

OMB: 0930-0339

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Attachment 3: EBP Self-Assessment Part 1 & Part 2

OMB No. 0930-XXXX

Expiration Date XX/XX/XXXX





Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  The OMB control number for this project is 0930-XXXX.  Public reporting burden for this collection of information is estimated to average XX hours per respondent, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 7-1044, Rockville, Maryland, 20857.

Substance Abuse and Mental Health Services Administration (SAMHSA)

National Evaluation of SAMHSA’s Homeless Programs

EBP Self-Assessment Part 1 – General Implementation Questions

Instructions

The cross-program evaluation team is interested in learning more about the primary evidence-based service practices (EBPs) being implemented by SSH/GBHI/CABHI program grantees. We know some grantee projects are implementing multiple EBPs. Primary EBPs are defined as those that are received by the largest number of consumers or clients served by the SSH/GBHI/CABHI project. During the grantee Project Director interview, information was collected on the primary EBPs being implemented in your site, as well as who is delivering and receiving these EBPs.

The cross-program evaluation team will be seeking to confirm the extent to which key components of certain EBPs1 are being implemented, degree of implementation fidelity, and specific modifications that may have been made for use by local grantee programs. Information on practice-specific EBP implementation for these select EBPs will be collected from qualifying projects through a separate web-based self-assessment, and may also be explored and verified during key informant interviews and/or grantee site visits.

Here, we want to learn more generally about implementation of your site’s primary EBPs, and about factors that may serve as barriers or facilitators to implementation fidelity within grantee projects, such as readiness to implement the EBP, leadership, funding, training and supervision, quality improvement, and outcomes. Some of the questions are focused on the grantee agency and/or the overall grant project, and others are focused on the provider implementing the EBP, which may or may not be different from the grantee agency. Each SSH/GBHI/CABHI grantee project should have a key respondent which is typically the grantee Project Director or his/her appropriate designee (e.g., local site evaluator or other project staff familiar with EBP implementation at the site) or Program Manager/Supervisor at the provider agency implementing the primary EBP(s) complete the self-assessment. If needed, the key respondent may ask questions of staff familiar with the characteristics and implementation of your project’s EBP(s).



Primary EBP Information [PREPOULATED FROM PD INTERVIEW & VERIFIED]

Questions

Response Options

During the Project Director interview, the primary EBPs identified for this grantee program included:

EBP

Proposed for implementation in grant application?

Status of implementation

% program participants that receive

Who provides

(grantee or other agency); SAMHSA grant funds used

Where provided

If grant has ended, still implementing?

1.







2.







3.










Respondent Information

Name/Title of Respondent #1:_____________________________

Primary Role in SAMHSA Grantee Project: (check all that apply)

Project Director

Project Coordinator

Program Manager

Local Evaluator

Housing Provider

Mental Health Counselor/Treatment Provider/Supervisor

Substance Abuse Counselor/Treatment Provider/Supervisor

Integrated Treatment (Mental Health & Substance Abuse) Counselor

Trauma Specialist

Case Manager

Benefits Specialist

Peer Specialist/Consumer

Housing Specialist

Vocational Specialist

Educational Specialist

Other: _______________________________________________

Respondent Agency/Organization:__________________________

Agency’s Primary Role in SAMHSA Grantee Project: (check all that apply)

Grantee agency

Administrative/Project Coordination/Oversight

Research/Evaluation

Substance abuse treatment provider

Mental health treatment provider

Integrated treatment (Mental Health & Substance Abuse) provider

Shelter

Housing provider

Case management provider

Medical (primary/specialized) care provider

Benefits assistance provider

Education provider

Employment or job training provider

Veterans Administration (VA) services provider

Justice/criminal justice services provider

Child and family services provider

Other:______________________________________




Basic Program Information [PREPOPULATED FROM PD INTERVIEW & VERIFIED]

Questions

Response Options

  1. The target populations for this grantee program who is receiving this EBP includes:

(Check all that apply)


EBP :________________

Mental Disorders Only

Substance Abuse/Dependence Only

Co-Occurring Mental and Substance Use Disorders

Veterans

Youth (under 18 years old)

Young adults (e.g., ages 18-21)

Older adults (e.g., 55 and over)

Immigrants

Criminal justice (e.g., previously incarcerated, reentry/diversion or on probation/adjudication)

Families

Persons at risk or living with HIV/AIDS

Chronic public inebriates

Domestic violence victims

Lesbian, gay, bisexual, transgender, questioning individuals and allies (LGBT/LGBTQA)

Pregnant

Developmentally or physically disabled

Other, specify:      

None of the above specifically targeted

If not correct, explain:      

  1. The homeless populations that participate in this grantee program & therefore receive this EBP includes:


At Risk for Becoming Homeless

Acute (first time) Homeless

Episodically Homeless

Chronically homeless

Homeless, Not Specified

If not correct, explain:      



EBP:___________________

Readiness to Implement EBP

  1. Why was this EBP selected by the grantee project?

(check all that apply)

Fit with population(s) served

Fit with overall organization philosophy

Already had the practice in place

Outcomes align with program goals

Required by SAMHSA grant

Other, specify: ___________________

  1. How long has the provider agency been implementing this EBP?




Haven’t started implementing yet

Less than one year

1-2 years

3-4 years

5 or more years

  1. Which of the following best describes the current stage of implementation of this EBP for program participants?

Preparation (e.g., hiring staff, conducting initial training, creating new operation polices & procedures, developing/finalizing strategic implementation plan)

Early Implementation (e.g., referrals, screening & assessments occurring, services are underway)

Full Implementation (e.g., staff skillful in service delivery, new policies & procedures are routine, practice is fully integrated into agency/program)

Sustainability (e.g., sustainability plan developed & underway, continuous staff training & funding secured for future, outcomes used for program improvement)

Other, specify:_______________

  1. How is the priority the implementing agency places on this EBP demonstrated?

(check all that apply)

There is an agency plan to implement the EBP

Leadership frequently talks about the EBP

Recruitment/selection of staff to implement the EBP

Allocation of funding/other resources for the EBP

Other, specify­­­­_______

  1. Does the implementing agency have a formal plan to guide implementation of this EBP?

No

Don’t know

Yes

If yes, which is true of the agency’s plan? (check all that apply)

It is a written document

It is discussed at staff meetings or meetings devoted to the plan

All project staff are fully aware of the plan

It has specific short- and long-term objectives regarding EBP implementation

It identifies strategies for stakeholder outreach/consensus building for the EBP

It identifies sources of funding for the EBP

It identifies training resources for EBP implementation

It identifies strategies for EBP implementation and outcomes evaluation

Other, specify­­­­_______

  1. Is leadership within the implementing agency supportive of this EBP’s implementation?


Extremely supportive

Somewhat supportive

Not at all supportive

If supportive, at what leadership level(s) within the agency is this demonstrated? (check all that apply)

Executive Management (e.g., agency executive director)

Program Management

Clinical/Front Line Supervisors

Other, specify­­­­_______

If supportive, how is this demonstrated? (check all that apply)

Leadership is actively involved in EBP implementation

Barriers that impede implementation or effectiveness are addressed

Support exists for coaching/ active supervision of staff directly implementing EBP

Other, specify­­­­_______

  1. Has a staff person at the implementing agency been assigned to lead implementation of the EBP?

No

Yes

If yes, what percent of his/her time is dedicated to the EBP’s implementation?

100%

76-99%

51-75%

25-50%

less than 25%

If yes, which of the following is true? (check all that apply)

S/he has the necessary authority to lead implementation

S/he has adequate training/expertise in the EBP

S/he has a good relationship with staff directly implementing the EBP

His/her leadership of EBP implementation is perceived positively by others

  1. Would you say the implementing agency’s interest in this EBP is:

Limited to this SAMHSA-funded grant program/project only

Extends beyond this program/project

Other, specify­­­­_______

  1. Are there any explicit policies the implementing agency has that support implementation of this EBP?

No

Yes

If yes, explain:      

  1. Are there any explicit policies the implementing agency has that serve as barriers to implementation of this EBP?

No

Yes

If yes, explain:      


  1. Are there any state or local (e.g., mental health or substance abuse authority) regulations or policies that support implementation of this EBP?

No

Yes

If yes, explain:      


  1. Are there any state or local regulations or policies that serve as barriers to implementation of this EBP?

No

Yes

If yes, explain:      

  1. Are there state or local standards that have to be followed in implementing the EBP? For example, some states have specific implementation guidelines related to staffing, fidelity checks, satisfaction surveys, etc.

No

Yes

If yes, describe      

If yes, how are these standards established and enforced?

Contracting

Licensing

Other, specify      

If yes, which of the following consequences may occur for not meeting standards?

Corrective action plan

Financial consequences

Other, specify      

Funding

  1. How is this EBP funded?

(check all that apply)

Medicaid (fee-for-service, Waiver, etc.)

State agency funding, specify:_______________

SAMHSA grant funds, specify:__________________

Other special grant funds, specify:________________

Other, specify­­­­_______

Don’t know

  1. How have start up or conversion costs associated with this EBP (e.g., lost productivity for training, hiring staff before clients enrolled, changing medical records and/or computer systems, etc.) been financed?

Costs were covered within the implementing agency’s own operating budget

There was a discreet funding source that covered all costs (specify___________)

There was a discreet funding source that covered some costs (specify_________)

Don’t know

  1. Which of the following best describes the financing for this EBP?

No components of service are reimbursable

Some costs are reimbursable

Most costs are reimbursable

Service pays for itself (i.e. all costs covered adequately, or funding of covered components compensates for non-covered components)

Service pays for itself and reimbursement rates are attractive relative to competing non-EBP services

Don’t know

  1. Is there a plan to continue the EBP once SAMHSA grant funding has ended? (Or if grant funding has already ended has the practice continued?)

Yes

Don’t know

No

If no, why not? (check all that apply)

Plan not developed yet but intend to continue the EBP

Insufficient funding

Lack of support from partnering agencies

Too many barriers to implementation

Insufficient numbers of eligible participants

Model was not viewed as successful

Other, specify:­­­­______

Hiring, Training & Supervision

  1. Did the implementing agency receive expert advice/consultation regarding strategies to support implementation of this EBP?

No

Don’t know

Yes, initially only

Yes, initially & ongoing

If yes, who received this consultation? (check all that apply)

Agency Administrators

Program Directors/Supervisors

Other, specify ___________

If yes, who supported/funded this consultation? (check all that apply)

SAMHSA

Other, specify ___________

If yes, who provided this consultation? Specify:__________________

  1. Did staff selection/recruitment include attention to ensuring staff have the pre-requisite skills and/or credentials required by this EBP?

No

Don’t know

Yes


  1. Was initial skills training provided to practitioners to support implementation of this EBP?

No

Yes

If yes, which of the following was true of this training? (check all that apply)

Trainer was an expert who is experienced or certified in the EBP

Training comprehensively addressed all elements of the EBP

Active learning strategies were used (e.g., role play, group work, feedback)

Teaching aides (e.g., worksheets, manuals, handouts) were used

A SAMHSA Took Kit was utilized or referenced as part of the training

  1. Is ongoing or refresher training available for practitioners to reinforce application of this EBP & help staff deal with emerging practice issues?

No

Yes

If yes, how often is this made available? (check all that apply)

Monthly or more frequently

Quarterly

Annually

Only as needed/requested

  1. Which of the following training methods are used? (check all that apply)

Computer assisted training

In-person training workshops

Staff provided with training materials to “self-teach”

Staff observe/shadow experienced staff person(s)

Other, specify _________

  1. Does all staff implementing this EBP receive the same training?

Yes

No

If no, explain:      

  1. Do all practitioners delivering this EBP receive ongoing supervision and oversight?

No

Yes

If yes, which of the following is true? (check all that apply)

Practitioners receive structured face-to-face supervision on a weekly basis

Practitioners receive supervision but less than weekly (specify:_______)

Supervision is provided by a practitioner experienced in this EBP

Supervision includes observation of EBP implementation, coaching & feedback

Supervision is provided but is not specific to the practice

Other, specify ___________

  1. Is there support/buy-in for implementation of this EBP among practitioners?

No

Yes

If yes, which of the following is true? (check all that apply)

Practitioners voice support for the EBP

Practitioners can describe how they’ve used the EBP

Practitioners can describe how the approach benefits/helps clients

Other, specify_______

Fidelity/Outcomes Monitoring & Performance Improvement

  1. Are all clients screened to determine whether they qualify for receiving this EBP using standardized tools or admission criteria?

Yes

No

If no, why not? (check all that apply)

All clients receive the intervention

No standardized tool or admission criteria available

Other, specify_________

  1. To date, how many clients participated in this EBP during the grant period?


_______

  1. How many clients were eligible to participate during the grant period?


_______

  1. How is fidelity to this EBP monitored?

(check all that apply)


Regular use of a standardized fidelity tool/checklist, specify:­­­­________

Direct observation

Document review

Focus groups or interviews with program participants

Key informant interviews

Tape/video recorded sessions/groups

Other, specify:_________

We do not monitor fidelity to this EBP (Skip 32 – 37)

  1. How often is fidelity data collected/assessed for this EBP?

Ongoing

Every six months

Annually

Other, specify:____________

  1. Who conducts fidelity assessments for this EBP?

(check all that apply)


Staff internal to provider agency

Staff external to provider agency

Grant program evaluator

Consultant

Other, specify:____________

  1. When was the last fidelity assessment done and what were the results?

Date conducted:      

Measure Used:      

Score/results:      

  1. To what degree have the core components of this EBP been implemented to fidelity so far?

Low – Less than 50% of components implemented to fidelity

Moderate 50-80% of components implemented to fidelity

High – 81-100% of components implemented to fidelity

  1. If this EBP has been implemented with moderate to low fidelity so far, why?

NA – Implemented with high fidelity

All components planned but not yet fully implemented

Some components were purposefully modified

If modified, describe how and why (e.g., why certain components were not implemented or revised or new components added)     

  1. Which of the following is true regarding the use of fidelity performance data?

(check all that apply)

Data is shared with program staff

Data is shared with internal advisory groups, board members, etc.

Data is shared publicly via the web, agency annual reports, etc.

Data is used for quality improvement

Implementation adjustments have been made based on fidelity data

  1. Are there any plans to maintain fidelity to this practice beyond the grant period?

No

Don’t know

Yes

If yes, describe     

  1. Are outcome data (e.g. changes in client functioning, access to treatment, housing/homeless status) related to this EBP collected?

No

Yes

If yes, how are these data used? (check all that apply)

Don’t know

Data are shared with practitioners to help them track/monitor client progress.

Data are shared with agency leadership to help inform implementation of the EBP.

Data are shared with stakeholders to solicit support (e.g. additional funding/ resources) for EBP implementation.

Other, specify:      

Overall Barriers/Facilitators

  1. Overall, what factors have served as barriers to implementation of this EBP during this project (i.e. have hindered successful implementation)? (check all that apply)

Lack of clear strategic plan for implementing the EBP

Inadequate financing for the EBP

Limited staff time/staff resources for EBP implementation

Lack of on-going training, supervision, and consultation on the EBP

Lack of positive practitioner attitudes toward the EBP

Lack of prior experience with this EBP

Lack of prior experience with other EBPs

State or local policy/regulations

Grantee or partner agency policies or practices

Lack of support for implementation from key leaders at grantee or partner agency

Lack of support for implementation from key external stakeholders

Other, specify­­­­_______

Other, specify­­­­_______

None

  1. Overall, what factors have served as facilitators to implementation of this EBP during this project (i.e. have helped with successful implementation)? (check all that apply)

Clear strategic plan for implementing the EBP

Adequate financing for the EBP

Adequate allocation of staff time/staff resources for EBP implementation

Access to on-going training, supervision, and consultation on the EBP

Positive practitioner attitudes toward the EBP

Prior experience with this EBP

Prior experience with other EBPs

Supportive state or local policy/regulations

Supportive grantee or partner agency policies or practices

Support for implementation from key leaders at grantee or partner agency

Support for implementation from key external stakeholders

Other, specify­­­­_______

Other, specify­­­­_______

None

[**Repeat same questions for up to 2 more primary EBPs identified through the Project Director (PD) Interview]

Substance Abuse and Mental Health Services Administration (SAMHSA)

National Evaluation of SAMHSA’s Homeless Programs

EBP Self-Assessment Part 2 – Practice Specific Questions



Instructions

The cross-program evaluation team is interested in learning more about the primary evidence-based service practices (EBPs) being implemented by SSH/GBHI/CABHI program grantees. We know some grantee projects are implementing multiple EBPs. Primary EBPs are defined as those that are received by the largest number of consumers or clients served by the SSH/GBHI/CABHI project. During the grantee Project Director interview, information was collected on the primary EBPs being implemented in your site, as well as who is delivering and receiving these EBPs.

Through a separate web-based self-assessment, data is being collected from all grantees about general implementation of their site’s primary EBPs, and factors that may serve as barriers or facilitators to implementation fidelity within grantee projects, such as readiness to implement the EBP, leadership, funding, training and supervision, quality improvement, and outcomes.

Here, we are interested in confirming the extent to which key components of certain EBPs2 are being implemented, degree of implementation fidelity, and specific modifications that may have been made for use by local grantee programs. This self-assessment should only be responded to by SSH/GBHI/CABHI grantees that identified one or more (up to 3) of the selected EBPs as their primary EBP(s) being implemented. Grantees meeting this criteria should have a key respondent which is typically the grantee Project Director or his/her appropriate designee (e.g., local site evaluator or other project staff familiar with EBP implementation at the site) or Program Manager/Supervisor at the provider agency implementing the primary EBP(s) complete the self-assessment. If needed, the key respondent may ask questions of staff familiar with the characteristics and implementation of your project’s EBP(s).

Practice-specific EBP implementation may also be explored and verified during key informant interviews and/or grantee site visits.

Basic Grantee/Program Information [PREPOPULATED FROM PD INTERVIEW & VERIFIED]

Questions

Response Options

During the Project Director interview, the primary EBPs identified for this grantee program included:

EBP

Proposed for implementation in grant application?

Status of implementation

% program participants that receive

Who provides

(grantee or other agency); SAMHSA grant funds used

Where provided

If grant has ended, still implementing?

1.







2.







3.










Respondent Information

Name/Title of Respondent #1:_____________________________

Primary Role in SAMHSA Grantee Project: (check all that apply)

Project Director

Project Coordinator

Program Manager

Local Evaluator

Housing Provider

Mental Health Counselor/Treatment Provider/Supervisor

Substance Abuse Counselor/Treatment Provider/Supervisor

Integrated Treatment (Mental Health & Substance Abuse) Counselor

Trauma Specialist

Case Manager

Benefits Specialist

Peer Specialist/Consumer

Housing Specialist

Vocational Specialist

Educational Specialist

Other: _______________________________________________

Respondent Agency/Organization:__________________________

Agency’s Primary Role in SAMHSA Grantee Project: (check all that apply)

Grantee agency

Administrative/Project Coordination/Oversight

Research/Evaluation

Substance abuse treatment provider

Mental health treatment provider

Integrated treatment (Mental Health & Substance Abuse) provider

Shelter

Housing provider

Case management provider

Medical (primary/specialized) care provider

Benefits assistance provider

Education provider

Employment or job training provider

Veterans Administration (VA) services provider

Justice/criminal justice services provider

Child and family services provider

Other:______________________________________





Assertive Community Treatment (ACT)/Intensive Case Management (ICM) Module

Dimension

Measure

Question

Response

(Not visible to respondents)

Human Resources:

Small caseload



ACT consumer/ provider ratio = 10:1

  1. What is the average case load size per ACT team member/ICM staff?

50 consumers or more

35 to 49 consumers

21 to 34 consumers

11 to 20 consumers

10 or fewer consumers

Human Resources:

Team approach

Provider group functions as a team; team members know and work with all consumers.

  1. Do ACT/ICM clients see the same staff person over and over (i.e. staff carry individual caseloads) or do they see different people (i.e. team shares caseload and members work with all clients)?

Staff members carry individual caseloads

Staff members share caseload and members work with all clients


  1. In a typical 2-week period, what percentage of consumers has face-to-face contact with more than one member of the team?

90% - 100%

64 - 89%

37 - 63%

11 - 36%

0 - 10%

Human Resources:

Program meeting

Program meets frequently to plan and review services for each consumer.

  1. How often do the ACT team/ICM staff members meet as a full group to review services provided to consumers?

At least 4 days/week

At least 2 days/week but less than 4 times/week

1 day per week

At least twice per month but less than 1day/ week

Once per month or less

Staff do not meet as a full group to discuss consumers

  1. How many consumers are reviewed at each meeting?

Each consumer reviewed at each meeting, even if briefly

Each consumer is not discussed each time staff meet

Staff do not meet as a full group to discuss consumers

Human Resources:

Practicing ACT lead

Supervisor of front-line ACT team members provides direct service.

  1. Does the ACT team leader/ICM supervisor provide direct services to consumers?

Yes

No


  1. What percentage of the ACT team leader/ICM supervisor’s time is devoted to direct services?




Over 50% of the time

25- 50% of the time

Less than 25% of the time or routinely as back-up

No regular percentage; only on rare occasions as back-up

Team leader/Supervisor does not provide direct services

Human Resources:

Continuity of staffing

Program maintains the same staffing over time.

  1. What is the total number of staff positions on the ACT team/in the ICM program?


___________

  1. How many staff people have left the team/program?

If team/program has been existence for at least 2 years:

_____(#) staff who have left over the last 2 years

If team/program has been existence for less than 2 years:

_____(#) staff who have left over the last _____ (# months) since the team/program began

Human Resources:

Staff capacity

Program operates at full staffing.

  1. Which of the following best represents ACT team/ICM program staffing capacity over the past 12 months?

Operated at 95% or more of full staffing

Operated at 80-94% of full staffing

Operated at 65-79% of full staffing

Operated at 50-64% of full staffing

Operated at less than 50% of full staffing

Human Resources:

Psychiatrist on staff

For 100 consumers, at least 1 full-time psychiatrist is assigned to work with the program.

  1. How many consumers are served by the ACT/ICM program?


_____# consumers served by ACT team/ICM program

  1. How many full-time equivalent (FTE) psychiatrists are assigned to work with the ACT/ICM program?

_____ FTE

A psychiatrist is not assigned to work with the program


Human Resources:

Nurse on staff

At least 2 full-time nurses are assigned to work with a 100 consumer program.

  1. How many full-time equivalent (FTE) nurses are assigned to work with the ACT/ICM program?

_____ FTE

A nurse is not assigned to work with the program


Human Resources:

Substance abuse specialist on staff

At least 2 staff members with at least 1 year of training or clinical experience in substance abuse treatment per 100 consumer program.

  1. How many full-time equivalent (FTE) substance abuse specialists are assigned to work with the ACT/ICM program?

_____ FTE

A substance abuse specialist is not assigned to work with the program


  1. What types of training or clinical experience are assigned substance abuse specialists required to have? (check all that apply)


At least one year of substance abuse training

Less than one year of substance abuse training

At least one year of supervised substance abuse treatment experience

Less than one year of supervised substance abuse treatment experience

A substance abuse specialist is not assigned to work with the program

Human Resources:

Vocational specialist on staff

At least 2 team members with 1 year training/ experience in vocational rehabilitation and support.

  1. How many full-time equivalent (FTE) vocational specialists are assigned to work with the ACT/ICM program?

_____ FTE

A vocational specialist is not assigned to work with the program


  1. Are assigned vocational specialists required to have at least one year of training/experience in vocational rehabilitation and support?

Yes

No

A vocational specialist is not assigned to work with the program

Human Resources:

Program size

Program is of sufficient size to consistently provide necessary staffing diversity and coverage.

  1. How many full-time equivalent (FTE) staff does the program have?

At least 10 FTE staff

7.5- 9.9 FTE staff

5.0- 7.4 FTE staff

2.5- 4.9 FTE staff

Less than 2.5 FTE staff

Organizational Boundaries:

Explicit admission criteria



Clearly identified mission to serve a particular population; has and uses measureable, operationally defined criteria to screen out inappropriate referrals.

  1. Are there formal admission criteria the ACT/ICM program uses to screen potential consumers?


No

Yes

If yes, which of the following criteria are used (check all that apply)?

Diagnosis of serious mental illness

Diagnosis of co-occurring substance use disorder

Pattern of frequent hospital admissions

Frequent use of emergency services

Consumers discharged from long-term hospitalization

Homelessness

Involvement with the criminal justice system

Not adhering to medications as prescribed

Not benefitting from usual mental health services (e.g. day treatment)

Other, specify:________________

  1. Do all consumers served by the program meet the admission criteria you indicated in your response to Question 19?

Yes, all cases comply with this admission criteria

Sometimes we accept clients who do not meet these criteria

We accept most referrals

There are no formal admission criteria for the program

Organizational Boundaries:

Intake rate

Takes consumers in at a low rate to maintain stable service environment.

  1. On average, how many new consumers has the ACT/ICM program taken on per month during the last six months?

6 or fewer consumers per month

7-9 consumers per month

10-12 consumers per month

13-15 consumers per month

16 or more consumers per month

Organizational Boundaries:

Full responsibility for treatment services

In addition to case management, directly provides psychiatric services, counseling/ psychotherapy, housing support, substance abuse treatment, employment and rehabilitative services.

  1. Which of the following services are delivered to ACT/ICM program consumers directly by program staff, and which are delivered by another department or agency?

(check all that apply)

Directly by program staff:

Case management

Medication prescription, administration, monitoring, and documentation

Counseling/individual supportive therapy

Housing support

Substance abuse treatment

Employment or other rehabilitative services (e.g., ADLs)

By other department/agency:

Case management

Medication prescription, administration, monitoring, and documentation

Counseling/individual supportive therapy

Housing support

Substance abuse treatment

Employment or other rehabilitative services (e.g., ADLs)

Organizational Boundaries:

Responsibility for crisis services

Has 24-hour responsibility for covering psychiatric crises.

  1. What is the ACT team/ICM program staff role in providing 24 hour emergency services?

Provides 24 hour crisis coverage directly (i.e. a staff member is on-call at all times)

Provides back-up support to emergency/on-call service (e.g., crisis program is called first, makes decision about need for direct ACT/ICM program involvement)

Is available by phone, mostly in consulting role

Emergency service has program-generated protocol to follow for program consumers

Has no responsibility for handling crises after hours

Organizational Boundaries:

Responsibility for hospital admissions

Is closely involved in hospital admissions

  1. How often are program staff involved in the decision to admit consumers for psychiatric hospitalization?

Program staff are involved in 95% or more of admissions

Program staff are involved in 65-94% of admissions

Program staff are involved in 35-64% of admissions

Program staff are involved in 5-34% of admissions

Program staff are involved in less than 5% of admissions

Organizational Boundaries:

Responsibility for hospital discharge planning

Is involved in planning for hospital discharges

  1. How often is program staff involved with discharge planning when consumers are hospitalized for psychiatric or substance abuse reasons?

95% or more of discharges planned jointly with program staff

65-94% of discharges planned jointly with program staff

35-64% of discharges planned jointly with program staff

5-34% of discharges planned jointly with program staff

Less than5% of discharges planned jointly with program staff

Organizational Boundaries:

Time-unlimited services

Rarely closes cases; remains the point of contact for all consumers indefinitely as needed.

  1. Which of the following happens when a ACT/ICM consumer’s need for services is reduced?

They continue to be served on a time-unlimited basis

They are discharged because they have graduated from services

They are stepped down to less intensive services (specify:______)

Other, specify:_______________________

  1. What percentage of consumers is expected to graduate from the program within the next 12 months?

Less than 5%

5-17 %

18-37%

38-90%

More than 90%

Nature of Services:

Community-based services

Program works to monitor status, develop community living skills in community rather than in office.

  1. What percentage of face-to-face contacts with program consumers occur in the community (vs. in an office setting)?

80% or more

60-79%

40-59%

20-39%

Less than 20%

Nature of Services:

No dropout policy

Program retains high percentage of consumers.

  1. How many consumers dropped out of the program over the last 12 months for the following reasons? Do not include consumers who graduated because their services needs were reduced.

_____# who refused services

_____# who cannot be located

_____# who have been closed because staff determined they could not serve them

_____#who dropped out for other reasons (specify:_________)

Nature of Services:

Assertive engagement mechanisms

Program uses street outreach, legal mechanisms, or other techniques to ensure ongoing engagement.

  1. What happens if a consumer continually refuses or does not comply with (e.g., misses appointments for) program services?

(check all that apply)

They are immediately discharged from the program

Staff initially attempts to engage but may eventually discharge

Staff attempt to engage using assertive techniques as much as possible

Staff consistently use assertive techniques to keep consumers involved in services

Other, specify:__________

None of the above

  1. What methods do program staff use to keep consumers involved in services?

(check all that apply)

Outpatient commitment

Representative payee services

Contacts with probation/parole

Street/Shelter outreach after enrollment

Other, specify:__________

None of the above

Nature of Services:

Intensity of service

High amount of face-to-face service time as needed.

  1. On average, how much face-to-face time do program staff have with consumers per week?

2 hours/week or more

85-119 minutes/week

50-84 minutes/week

15-49 minutes/week

Less than 15 minutes/week

Nature of Services:

Frequency of contact

High amount of face-to-face service contacts as needed.

  1. On average, how many face-to-face contacts do program staff have with consumers per week?

5 or more contacts/week

3-4 contacts/week

1-2 contacts/week

No contacts/week

Nature of Services:

Work with informal support system

Program provides support and skills for consumers’ informal support network.

  1. On average, how often do program staff work with the family, landlord, employer, or other informal support network members for each consumer with a support system in the community?

5 or more contacts/month

3-4 contacts/month

1-2 contacts/month

No contacts/month

Nature of Services:

Individualized substance abuse treatment

One or more team members provide direct substance abuse treatment for consumers with substance use disorders.

  1. Do program consumers with substance use disorders receive formal individual counseling for substance use from a team/program staff member?

Yes, on weekly basis or more

Yes, but not regularly

No


Nature of Services:

Co-occurring disorder treatment groups

Program uses group modalities as a treatment strategy for consumers with dual disorders.

  1. What percentage of consumers with substance use disorders attend at least one substance abuse treatment group per month that is run by program staff?

50% or more

35-49%

20-34%

5-19%

less than 5%

Nature of Services:

Co-occurring disorders model

Program uses no-confrontational, stage wise treatment model, follows behavioral principles, consider interactions of mental illness and substance use, has gradual expectations for abstinence

  1. Which of the following principles and approaches does the program use to treat consumers with substance use issues?

(check all that apply)

Confrontation

Abstinence only

Reduction of use (i.e. harm reduction)

Stage wise approach

Referrals to rehab

Referrals to detox - only when medically necessary

Referrals to detox for other purposes

Referrals to AA, NA, etc.

Other, specify:_________

Nature of Services:

Role of consumers on team

Consumers are members of the team who provides direct services.

  1. How are consumers involved as team/program staff members?

(check all that apply)

As full-time paid employees

As part-time paid employees

As volunteers

As full professional team members/staff

As case managers with reduced responsibilities

As aides to the team/program staff

In consumer-specific roles (e.g., self-help)

Not at all



  1. Were any components of the ACT program model difficult to implement?

No

Yes

If yes, which ones? (check all that apply)

Small caseload size (10:1)

Team approach

Frequent program meetings to review each consumer

Practicing program lead

Continuity of staffing

Operating at full staff capacity

1 FTE psychiatrist on staff per 100 consumers

2 FTE nurses on staff per 100 consumers

2 substance use specialists on staff per 100 consumers

2 vocational specialists on staff per 100 consumers

Program size (appropriate # of FTE staff)

Explicit admission criteria

Low intake rate

Full responsibility of treatment services

24 hour responsibility for crisis services

Responsibility for hospital admission

Responsibility for hospital discharge planning

Time-unlimited services

Services delivered in community (vs. office based settings)

No dropout policy

Assertive engagement mechanisms used

High intensity of services

High frequency of contacts

Work with informal support system

Direct provision of individualized substance abuse treatment

Co-Occurring disorder treatment groups provided

Co-occurring disorder model used

Consumers provide direct services



  1. Did you make any adjustments or modifications to the program model?

No

Yes

If yes, please describe     



  1. Were any of the following types of evidence-based service interventions fully imbedded within your implementation of the ACT/ICM program model?

Motivational Interviewing

Cognitive Behavioral Therapy (CBT)

Motivational Enhancement Therapy (MET)

Peer Support

Strengths-Based Case Management/Approach

SSI/DI Outreach, Access & Recovery (SOAR)

Trauma-Specific Intervention (specify:___________)

Other (specify:___________________)











Integrated Dual Disorders Treatment (IDDT) Module

Dimension

Measure

Question

Response

(Not visible to respondents)

Multidisciplinary team (MDT)



Case managers, psychiatrist, nurses, residential staff, employment specialists, and rehab specialists work collaboratively on mental health treatment team.

  1. Do staff work with consumers individually or as part of a multidisciplinary team (MDT)?

Individually (Skip to Q #4)

As a MDT

Other (explain:___________________)

  1. What staff members comprise the MDT? (check all that apply)

Psychiatrist

Nurse

Case manager

Employment specialist(s)

Integrated treatment specialist

Clinicians (e.g. psychologist, licensed social worker, etc.)

Practitioners of other ancillary rehabilitation services

Other (specify:_____________________)

  1. Are all members of the MDT required to attend treatment team meetings?

Yes

No

Integrated treatment specialists



Integrated treatment specialists work collaboratively with the MDT, modeling integrated treatment skills and training other staff in evidence-based practice principles and practice.

  1. Does your agency assign integrated treatment specialists to the program or are consumers referred to integrated treatment specialists (e.g., through a separate program within the agency)?

Integrated treatment specialists are assigned to program

Consumers are referred to integrated treatment specialists

No integrated treatment specialists connected with the agency

  1. How often do integrated treatment specialists attend MDT meetings?


Always

Frequently

Sometimes

Rarely

Never

NA

  1. How involved are integrated treatment specialists in treatment planning with other members of the treatment team?

Very involved

Somewhat involved

Not at all involved

NA

Stage-wise interventions


All services are consistent with and determined by each consumer’s stage of treatment. The stages of treatment include the following:

  • Engagement

  • Persuasion

  • Active treatment

  • Relapse prevention


  1. Which of the following philosophies or goals are used by staff when treating individuals with co-occurring disorders?

Confrontation

Abstinence

Stages of change

Reduction of use

Relapse prevention

Other (specify:____________)

  1. How often would you say that interventions are consistent with the individual’s stage of treatment?


80-100% of the time

61-79% of the time

41-60% of the time

21-40% of the time

0-20% of the time

  1. Are program staff offered training on stages of change and the stages of treatment?

Yes

No

Access to comprehensive services



Individuals in the program have access to comprehensive services including:

  • Residential services

  • SE

  • Family interventions

  • IMR

  • ACT

  1. Which of the following services do program consumers have genuine access to at the agency? (check all that apply)

Residential Services

Supported Employment (SE)

Family Intervention

Illness Management and Recovery (IMR)

Assertive Community Treatment (ACT)

Other (specify:_______________)


Time-unlimited services



Individuals in the program are treated on a time-unlimited basis with intensity modified according to each person’s needs.

  1. Does the program graduate consumers after they have completed a certain number of sessions or groups?

Yes

No


  1. Which of the following happens when a consumer’s need for services is reduced?


They are closed out of services after a defined period of time (Skip to Q#13)

They continue to be served indefinitely and the intensity of services is modified based on individual consumer need. If yes, how often is this true?

80-100% of the time

61-79% of the time

41-60% of the time

21-40% of the time

Less than 20% of the time

Outreach



Integrated treatment specialists demonstrate consistently well-thought out outreach strategies and connect consumers to community services, whenever appropriate, to keep consumers engaged in the program.

  1. What happens if a consumer continually refuses or does not comply with (e.g., misses appointments for) program services? (check all that apply)

They are immediately discharged from the program

Staff initially attempts to engage but may eventually discharge

Staff attempt to engage using assertive outreach techniques as much as possible

Staff consistently use assertive techniques to keep consumers involved in services

Other, specify:__________

None of the above

  1. What types of assistance do integrated treatment specialists offer to connect consumers with as a means of engagement? (check all that apply)

Housing assistance

Legal aid

Meals or other food resources

Clothing

Medical care

Crisis management

Other (specify:____________)

Motivational interventions



All interactions with consumers in the program are based on motivational interventions:

  • Expressing empathy

  • Developing discrepancy

  • Avoiding argumentation

  • Rolling with resistance

  • Instilling self-efficacy and hope

  1. Are integrated treatment specialists offered training in motivational interventions?

Yes

No

  1. Which of the following techniques are used by integrated treatment specialists with program consumers? (check all that apply)

Expressing empathy

Developing discrepancy

Avoiding argumentation

Rolling with resistance

Instilling self-efficacy and hope

Other (specify:__________)

  1. How often do staff use a motivational approach in their interactions with consumers?

80-100% of the time

61-79% of the time

41-60% of the time

21-40% of the time

0-20% of the time

Substance abuse counseling





Individuals who are in the active treatment or relapse prevention stages receive substance abuse counseling that includes:

  • How to manage cues to use and consequences of use

  • Relapse prevention strategies

  • Drug and alcohol refusal skills training

  • Problem-solving skills training to avoid high-risk situations

  • Coping skills and social skills training

  • Challenging consumers’ beliefs about substance abuse

  1. During which phase(s) of treatment are program consumers offered some form of substance abuse counseling?

(check all that apply)

Engagement: while forming a trusting working alliance/relationship

Persuasion: while helping engaged consumers become motivated to participate in recovery

Active Treatment: while helping motivated consumers acquire skills/supports for managing illness and pursuing goals

Relapse Prevention: while helping consumers in stable remission develop/use strategies to maintain recovery

  1. Which of the following knowledge/skills are taught to consumers who receive substance abuse counseling in the program? (check all that apply)

How to manage cues to use and consequences of use

Relapse prevention strategies

Drug and alcohol refusal skills

Problem-solving skills training to avoid high-risk situations

Coping skills and social skills training to deal with symptoms or negative mood states

Relaxation

Other (Specify:______________)

Group treatment for co-occurring disorders



All consumers in the program are offered group treatment specifically designed to address both mental health and substance use problems.

  1. Which of the following best describes the types of group treatment offered by the program?

No group treatment is offered (Skip to Q#21)

Substance use or mental health specific groups are offered only (Skip to Q#21)

Groups that address both mental health and substance use are offered

  1. What proportion of program consumers regularly attend group treatment focused on both mental health and substance use?

65-100%

50-64%

35-49%

20-34%

Less than 20%

Family interventions for co-occurring disorders



With individuals’ permission program involves consumers’ family members (or other supports) provide education about co-occurring disorders, offer coping skills training and support to reduce stress in the family, and promote collaboration with the treatment team.

  1. Are family interventions offered to consumers in the program?

No (Skip to Q#25)

Yes

  1. Are all consumers asked permission to involve family members or other supporters in family interventions?

No

Yes

  1. What proportion of consumers’ family members or other supporters receive family interventions for co-occurring disorders?

65-100%

50-64%

35-49%

20-34%

Less than 20%

Alcohol and drug self-help groups



Individuals in the active treatment or relapse prevention stages attend self-help programs in the community.

  1. Does the program ever refer consumers to self-help groups in the community (e.g., AA, NA, etc)?

No (Skip to Q# 28)

Yes


  1. During which phase(s) of treatment do referrals to self-help groups occur?

(check all that apply)

Engagement: forming a trusting working alliance/relationship

Persuasion: helping engaged consumers become motivated to participate in recovery

Active Treatment: helping motivated consumers acquire skills/supports for managing illness and pursuing goals

Relapse Prevention: helping consumers in stable remission develop/use strategies to maintain recovery

  1. How many consumers in your program regularly attend self-help programs in the community?



65-100%

50-64%

35-49%

20-34%

Less than 20%

Pharmacological treatment



Prescribers for consumers in the program are trained in the evidence-based model & use the following:

  • Prescribe despite active substance use

  • Work closely with consumers and treatment team

  • Focus on increasing adherence to psych meds

  • Avoid prescribing meds that may be addictive

  • Prescribe meds that help reduce addictive behavior

  1. Are prescribers (e.g., physicians or nurses) who work with consumers in the program trained in the evidence-based model?

No

Yes


  1. Are psychotropic medications prescribed to consumers with active substance use problems?

No

Yes


  1. How often is the treatment team in contact with program consumers’ prescribers?

Always

Frequently

Sometimes

Rarely

Never

  1. What types of strategies do prescribers typically use for consumers who do not take psychiatric medications as prescribed?

Encourage consumers’ right to refuse medications

Encourage consumers’ adherence to medications

Other (specify:___________)


  1. Are consumers in the program prescribed medications that may be addictive?

Always

Frequently

Sometimes

Rarely

Never

  1. Are consumers in the program prescribed medications known to be effective in reducing addictive behavior?

Always

Frequently

Sometimes

Rarely

Never

Interventions to promote health



Integrated treatment specialists promote health by encouraging consumers with co-occurring disorders to do the following:

  • Avoid high-risk behavior and situations that can lead to infectious diseases

  • Find safe housing

  • Practice proper diet and exercise

  1. Do integrated treatment specialists offer consumers interventions to promote health?

No

Yes

  1. Which of the following areas do integrated treatment specialists typically address with program consumers? (check all that apply)

Switching to less harmful substances

Finding safe housing

Proper diet and exercise

Safe sex practices

The risk of losing friends and family

Other (specify:_______________)

  1. How many program consumers receive interventions to help them reduce the negative consequences of substance abuse?



80-100%

50-79%

Less than 50%

Secondary interventions for non-responders



Program has a protocol to identify consumers who do not respond to basic treatment for co-occurring disorders, to evaluate them, and to link them to appropriate secondary interventions.

  1. Does your program have a protocol to identify consumers who do not respond to basic treatment?

No

Yes


  1. How often are individuals assessed to determine if they are progressing toward recovery?

There is no evaluation or assessment process

Annually

At a minimum of every 6 months

At a minimum of every 3 months

  1. What percentage of consumers who do not respond to basic treatment are referred for secondary interventions?

80-100%

61-79%

41-60%

21-40%

Less than 20%



  1. Were any components of this program model difficult to implement?

No

Yes

If yes, which ones? (check all that apply)

Staff work as a multidisciplinary team (MDT)

Integrated Treatment Specialists work collaboratively w/MDT

Services are consistent with consumers’ stage of treatment

Consumers have access to comprehensive services

Time-unlimited services

Outreach strategies used to keep consumers engaged

Motivational interventions used

Substance abuse counseling at appropriate stage

Group treatment for co-occurring disorders offered

Family interventions for co-occurring disorders offered

Alcohol & drug self-help groups offered at appropriate stage

Pharmacological treatment consistent with EBP

Interventions to promote health used

Secondary interventions for non-responders used



  1. Did you make any adjustments or modifications to the Integrated Treatment model?

No

Yes

If yes, please describe.     



  1. Were any of the following types of evidence-based service interventions fully imbedded within your implementation of the Integrated Treatment program model?

Motivational Interviewing

Cognitive Behavioral Therapy (CBT)

Motivational Enhancement Therapy (MET)

Peer Support

Strengths-Based Case Management/Approach

SSI/DI Outreach, Access & Recovery (SOAR)

Trauma-Specific Intervention (specify:___________)

Other (specify:___________________)





Illness Management and Recovery (IMR) Module

Dimension

Measure

Question

Response

(Not visible to respondents)

Staffing:

Number of people in a session/group



IMR is taught individually or in groups of eight or fewer consumers

  1. Are IMR sessions taught individually, in a group format, or both?


Individually

In Groups

Both individually and in groups


  1. How many people typically participate in an IMR session or group?


15 or more consumers

13-15 consumers

11-12 consumers

9-10 consumers

8 or fewer consumers

IMR is only taught individually

Program length

Consumers receive at least 3 months of weekly IMR sessions or an equivalent number of IMR sessions


  1. How often and for what length of time do consumers typically attend IMR sessions?


Note: Exclude from consideration consumers who drop out prematurely.

______total # of sessions attended

______total length of time attended (in months)

Are sessions held:

Weekly

Bi-weekly

Once per month

Other (specify:___________)

Comprehensiveness of the curriculum

Curriculum is comprehensive & includes:

  • Recovery strategies

  • Practical facts about MI

  • Stress-Vulnerability Model & tx strategies

  • Building social support

  • Using medication effectively

  • Drug & alcohol use

  • Reducing relapses

  • Coping with stress

  • Coping with problems and persistent symptoms

  • Getting your needs met in the mental health system.

  1. Is there an established curriculum for the IMR sessions?

No

Yes



  1. Which of the following topics are covered in IMR sessions? (check all that apply)

Recovery strategies

Practical facts about mental illnesses

Stress-Vulnerability Model and treatment strategies

Building social support

Using medication effectively

Drug and alcohol use

Reducing relapses

Coping with stress

Coping with problems and persistent symptoms

Getting needs met in the mental health system

Other (specify:________________)


Provision of educational handouts



All consumers participating in IMR receive IMR handouts

  1. Do IMR consumers receive educational handouts as part of the program?




No

Yes

If yes, is this true:

90-100% of the time

70-89% of the time

40-69% of the time

20-39% of the time

Less than 20% of the time

Involvement of significant others



Developing and enhancing natural support is one of IMR’s goals. Social support helps people generalize information and skills learned in sessions to their natural environment.

  1. Does the IMR program involve consumers’ significant others (e.g. family, friends, other non-paid supports)?

No (Skip to Q#9)

Yes


  1. How are significant others involved:

(check all that apply)

IMR practitioners have regular contact with significant others

Significant others assist consumers in pursuing IMR goals

Other (specify:________________)

Is this type of involvement true for:

At least 50% of IMR consumers

30-49% of IMR consumers

Less than 30% of consumers

Assignments:

IMR goal setting



One of the objectives of the IMR program is to help consumers establish personally meaningful goals.

  1. To what extent do IMR consumers have personally established goals that are realistic and measurable?


90-100% of consumers have at least one such goal

70-89% of consumers have at least one such goal

40-69% of consumers have at least one such goal

20-39% of consumers have at least one such goal

Less than 20% of consumers have at least one such goal

Assignments:

IMR goal follow-up



Practitioners and consumers collaboratively follow up on goals identified above.

  1. How often is progress toward achieving consumers’ IMR goals reviewed?

At every session

Some other frequency (e.g. every other session, monthly, etc.)

Infrequently/only as needed

Progress is not reviewed

Is the above true for:

All IMR consumers

Most IMR consumers

Some IMR consumers

Assignments:

Motivation-based strategies



Practitioners regularly use motivation-based strategies.

  1. Which of the following strategies are used in IMR sessions? (check all that apply)

Teaching new information and skills to achieve goals

Encouraging positive perspectives of past experiences

Exploring the pros and cons of change

Instilling hope and belief in self-efficacy

Other (specify ________)

  1. How often are motivation based strategies used in IMR sessions?

They are used in at least half of the sessions

They are used in some sessions

They are used in a few sessions

They are never used in sessions

Assignments:

Educational techniques

Practitioners embrace the concept of and regularly apply educational techniques.

  1. Which of the following educational techniques are used in IMR sessions? (check all that apply)

Interactive teaching

Checking for understanding

Breaking down information

Reviewing information

Other (specify ________)

  1. How often are educational techniques used in IMR sessions?

They are used in at least half of the sessions

They are used in some sessions

They are used in a few sessions

They are never used in sessions

Assignments:

Cognitive-behavioral techniques

Practitioners regularly use cognitive-behavioral techniques to teach IMR information and skills.

  1. Which of the following techniques are used in IMR sessions? (check all that apply)

Reinforcement

Shaping

Modeling

Role playing

Cognitive restructuring

Relaxation training

Other (specify _______)

  1. How often are cognitive-behavioral techniques used in IMR sessions?

They are used in at least half of the sessions

They are used in some sessions

They are used in a few sessions

They are never used in sessions

Assignments:

Coping skills training

Practitioners embrace the concept of and systematically provide, coping skills training.

  1. Are IMR practitioners familiar with the principles of coping skills training?

No

Some are familiar

The majority are familiar

All practitioners are familiar

  1. How frequently do IMR practitioners use coping skills principles in their IMR sessions?

Regularly

Moderately

Not often

Never

Assignments:

Relapse prevention training

Practitioners embrace the concept of relapse prevention training and systematically apply it.

  1. Are IMR practitioners familiar with the principles of relapse prevention training?

No

Some are familiar

The majority are familiar

All practitioners are familiar

  1. How frequently do IMR practitioners use relapse prevention training in their IMR sessions?

Regularly

Moderately

Not often

Never

Assignments:

Behavioral tailoring for medication

Practitioners embrace the concept of and use behavioral tailoring for medication.

  1. Are IMR practitioners familiar with the principles of behavioral tailoring for medication?

No

Some are familiar

The majority are familiar

All practitioners are familiar

  1. How frequently do IMR practitioners use behavioral tailoring for medication techniques in their IMR sessions?

Regularly

Moderately

Not often

Never



  1. Were any components of this program model difficult to implement?

No

Yes

If yes, which ones? (check all that apply)

IMR taught individually or in groups of 8 or fewer consumers

At least 3 months of weekly sessions or equivalent

Comprehensiveness of curriculum

Provision of educational handouts

Involvement of significant others

IMR goal setting

IMR goal follow-up

Motivation-based strategies used

Educational techniques used

Cognitive-behavioral techniques used

Coping skills training provided

Relapse prevention training provided

Behavioral tailoring for medications used



  1. Did you make any adjustments or modifications to the IMR model?

No

Yes

If yes, please describe.     



  1. Were any of the following types of evidence-based service interventions fully imbedded within your implementation of the IMR model?

Motivational Interviewing

Cognitive Behavioral Therapy (CBT)

Motivational Enhancement Therapy (MET)

Peer Support

Strengths-Based Case Management/Approach

SSI/DI Outreach, Access & Recovery (SOAR)

Trauma-Specific Intervention (specify:___________)

Other (specify:___________________)



Supported Employment (SE) Module

Dimension

Measure

Question

Response

(Not visible to respondents)

Staffing:

Caseload size



Employment specialists (ES) manage caseloads of up to 25 consumers

  1. What is the average caseload size for an employment specialist?

81 or more consumers

61 to 80 consumers

41 to 60 consumers

26 to 40 consumers

25 or fewer consumers

Staffing:

Focus of vocational services staff time

ES provide only vocational services.

  1. What services do employment specialists provide? (check all that apply)


Vocational services

Case management

Individual or group therapy

Staffing for day or residential programming

Other (specify:_____________)

If only selected vocational services above, SKIP to Q#4

  1. How much of the time do employment specialists provide non-vocational services?

Less than 20%

20-39%

40-59%

60-79%

80% or more

Staffing:

Vocational generalists role/responsibilities

Each ES carries out all phases of vocational service including engagement, assessment, job development, job placement, job coaching, and follow-along supports.

  1. Which of the following most accurately describes the role of employment specialists (ES) in the program?

Each ES carries out all phases of vocational service, including engagement, assessment, job development, placement, and coaching, and follow-along supports.

ES provides 2 or more phases of vocational service but not the entire service (e.g. some do engagement and assessment only while others do job development and placement, etc.)

ES specializes in 1 aspect of vocational service

ES maintain caseloads but refer consumers to other programs for vocational service

ES do not carry caseloads and only provide vocational referrals to other vendors or programs

Other (specify:_________________)

Organization:

Integration of rehabilitation with mental health treatment



ES are part of the mental health treatment teams with shared decision making. They attend regular treatment team meetings and have frequent contact with treatment team members.

  1. Do employment specialists interact with the mental health treatment team?

No

Yes, but infrequently

Yes, regularly

If yes, how & how frequently is contact made:

(check all that apply)

Telephone contact ____ times per month

Face-to-face contact ____ times per month

Attendance at treatment team meetings ____ times per month

  1. Do employment specialists and case managers or case management teams participate in shared decision making about consumer services?

No

Yes


Organization:

Vocational unit functioning



ES function as a unit rather than a group of practitioners. They have group supervision, share information, and help each other with cases.

  1. Do all employment specialists have the same supervisor?

No

Yes

If yes, how & how frequently do they receive supervision:

Individually ____ times per month

As a group ____ times per month

  1. Do employment specialists provide services for one another’s consumers?

No

Yes

Organization:

Zero-exclusion criteria



No eligibility requirements such as job readiness, lack of substance abuse, no history of violent behavior, minimal intellectual function, and mild symptoms

  1. Must consumers meet certain eligibility criteria in order to receive supported employment services?





No

Yes

If yes, which of the following screening criteria are used (check all that apply):

Job readiness

Abstinence from substance use

No history of violent behavior

Other (specify:_________________)

  1. Where does the supported employment program accept referrals from?


Case Managers

Therapists

Psychiatrists

Family members

Self-referral

Other (specify:_____________________)

Services:

Ongoing, work-based vocational assessment



Vocational assessment is an ongoing process based on work experiences in competitive jobs.

  1. Are vocational assessments that are conducted in the supported employment program primarily:

Office-based assessments done prior to job placement?

Pre-vocational assessments conducted at a day program site?

Carried out in a sheltered work environment?

Based on a series of temporary job experiences?

Ongoing assessments that occur in community jobs?

Other (specify:___________)

Services:

Rapid search for competitive jobs



The search for competitive jobs occurs rapidly after program entry.


  1. Must consumers take any steps in the program before beginning a job search?

Yes, some pre-requisites exist (e.g. pre-vocational counseling, participation in an enclave or sheltered work, etc.) before search for a competitive job can begin.

No, the job search begins as soon as a consumer expresses interest in competitive employment

  1. How soon after program entry does a consumer typically begin having contact with competitive employers (i.e. start their job search)?


Within 1 month

1-6 months

6-9 months

9-12 months

More than 12 months

Services:

Individualized job search



Employer contacts are based on consumers’ job preferences (relating to what they enjoy and their personal goals) and needs rather than the job market, that is, what jobs are readily available.

  1. How are employer contacts selected?

(Check all that apply)




Based on the local job market (i.e. which jobs are readily available)

Based on the employment specialists decisions

Based on the consumer’s preferences and needs

Other (specify:___________)

  1. How often are employer contacts made based on consumer preferences and needs rather than the job market?

Most of the time

About 75% of the time

About 50% of the time

About 25% of the time

Never

Services:

Diversity of jobs developed

ES provide job options that are in different settings.

  1. What proportion of the types of job options and settings offered to consumers are:



The same/similar (e.g., all janitorial, or in food service settings)_____%

Different (e.g., consist of all types of jobs/settings) ______%

  1. What percentage of consumers work in the same types of jobs or settings?



75-100%

About 75%

About 50%

About 25%

Less than 10%

Services:

Permanence of jobs developed



ES provide competitive job options that have permanent status rather than temporary or time-limited status.

  1. Do employment specialists ever suggest jobs to consumers that are temporary, time-limited, or volunteer?

Yes, always

Yes, sometimes

No, never

  1. How often do employment specialists provide options to consumers for permanent, competitive jobs?



75-100% of the time

About 75% of the time

About 50% of the time

About 25% of the time

Employment specialists do not provide options for permanent, competitive jobs

Services:

Jobs as transitions



All jobs are viewed as positive experiences on the path of vocational growth and development. ES help consumers end jobs when appropriate and then find new jobs.

  1. When a job has ended, do employment specialists offer to assist consumers in finding another job?


Not usually

Yes always

Depends on the situation

If it depends, how often are they likely to assist?

About 75% of the time

About 50% of the time

About 25% of the time

Please provide an example of a reason an employment specialist might be less likely to assist a consumer in finding a new job? ____________________

Services:

Follow along supports



Individualized, follow-along supports are provided to employer and consumer on a time-unlimited basis.

  1. Are follow-along supports provided:

To consumers (e.g., job coaching/counseling, job support groups, etc.)?

No not provided

Yes provided to most

Provided to less than half

To employers (e.g., education, guidance)?

No not provided

Yes provided to most

Provided to less than half



  1. Is there a time limit for providing supports:

To consumers?

No

Yes

If yes, what is the limit? ____

To employers?

No

Yes

If yes, what is the limit? _____

Services:

Community-based services



Vocational services such as engagement, job-finding, and follow-along supports are provided in community settings

  1. What percentage the services employment specialists provide are in the community (vs. in an office or mental health facility)?

70-100%

60-69%

40-59%

11-39%

0-10%

Services:

Assertive engagement and outreach



Assertive engagement and outreach are conducted as needed

  1. Do employment specialists conduct outreach to engage consumers?



Yes, initially

Avg. # of contacts: _____ OR frequency____ (e.g., once per week, month, etc.)

Yes, if they stop attending vocational services

Avg. # of contacts: ___ OR frequency____ (e.g., once per week, month, etc.)

No (Skip to Q# 26)

  1. What types of outreach are typically used? (check all that apply)

Letters or other written materials sent to the consumer’s residence

Phone calls to the consumer

Phone calls to consumers’ case manager/other care provider (with consent)

Community visits with consumers



  1. Where there components of the Supported Employment program model that were difficult to implement?

No

Yes

If yes, which ones? (check all that apply)

Caseload size (1:25)

ES provide only vocational services

ES carry out all phases of vocational service

Integrating ES with mental health treatment team

ES share a supervisor and help each other with cases

Zero-exclusion criteria

Ongoing, work-based vocational assessments.

Rapid search for competitive jobs

Employer contacts based on consumer preferences/needs vs. job market

Job options provided are in different settings.

Providing permanent, competitive job options

Helping consumers find new jobs

Providing follow-along

Providing vocational services in community settings

Providing assertive engagement and outreach



  1. Did your agency make any adjustments or modifications to the Supported Employment model?

No

Yes

If yes, please describe.          



  1. Were any of the following types of evidence-based service interventions fully imbedded within your implementation of the Supported Employment model?

Motivational Interviewing

Cognitive Behavioral Therapy (CBT)

Motivational Enhancement Therapy (MET)

Peer Support

Strengths-Based Case Management/Approach

SSI/DI Outreach, Access & Recovery (SOAR)

Trauma-Specific Intervention (specify:___________)

Other (specify:___________________)



Critical Time Intervention (CTI) Module

Component/Measure

(not visible to respondents)

Question

Response

Program Structure/Staffing

  1. Which settings are consumers who receive CTI services directly transitioning between?

Transitioning from:

Hospital

Shelter

Housing setting (e.g., residential, transitional housing) specify:_______

Streets

Prison

Jail

Other, specify_______

Transitioning to:

Transitional housing

Permanent housing

Other, specify_______





  1. In what setting is the CTI program based?

Drop-in center

Shelter

Mental health impatient unit

Other, specify_______

  1. What staff members comprise the CTI team?

Psychiatrist

Nurse

Team leader /coordinator (specify credentials, e.g., MSW___________)

Housing case manager or specialist

CTI case managers/workers (specify #_____)

Other, specify_______

  1. What is the average case load size per CTI worker?

35 to 50 consumers

21 to 34 consumers

15 to 20 consumers

10 or fewer consumers

Does caseload size vary by phase of service? If yes, explain:_____

  1. Does CTI staff meet as a team to discuss clients’ needs and care?

No

Yes

If yes, how often are team meetings held?

Weekly

Bi-weekly

Monthly

Only as needed

Other, specify___________

If yes, who conducts the team meetings? ________

If yes, what percentage of CTI clients are reviewed at each team meeting: ____%

  1. How often are each CTI client’s needs and care reviewed and discussed by CTI program staff?

Weekly

Bi-weekly

Monthly

Only as needed

Other, specify___________

  1. What types of supervision and organizational support does CTI program staff receive?

Individual clinical supervision (specify frequency________)

Field work observation/feedback

Team case presentations/feedback

Review/feedback of client case notes

Resources to support work in the field (specify:_______)

Other, specify___________

Early Engagement


  1. Are CTI workers able to establish relationships and begin to engage consumers prior to their transition to a new setting in the community?

Yes

No (SKIP to Q 11)

  1. What is the typical length of time between initial contact and a consumers’ discharge or move to the community (i.e. length of pre-CTI period)?

Less than 1 week

1-2 weeks

2-4 weeks

More than 1 month

Other, specify______

  1. How often do CTI workers typically meet with consumers during the ‘pre-CTI period’?

Once

2-3 times

4 times

Other, specify_____

Assessment/Treatment Planning

  1. Is a CTI intake assessment completed?

No (SKIP to Q 13)

Yes

If yes, when is it completed? _____________

  1. Which of the following are components of the intake assessment?

Demographic information

Psychiatric history (diagnosis, symptoms, medications, hospitalizations)

Substance use history (diagnosis, symptoms, treatment history)

Homelessness/housing history

Reasons for housing loss/risks to housing stability

Financial supports

Formal & informal supports

ADL skills

Strengths & interests of consumer

Other, specify______

  1. Are CTI services delivered in phases?

No

Yes

If yes, how many phases? ____

If yes, how long does each phase last? _____

  1. Is a CTI treatment plan completed?

Yes, at the beginning of CTI services only

Yes, for each phase of service

Other, specify_____

  1. What is the typical timeframe for completion of the treatment plan?

Within two weeks prior to services/phase beginning

Within two weeks after services/phase beginning

3-4 weeks after services/phase beginning

Other, specify___________

  1. What focus areas do CTI treatment plans typically address?

(check all that apply)

Psychiatric treatment & medication management

Money management

Substance abuse management

Housing crisis management & prevention

Family interventions

Life skills training

Other, specify:_________________

  1. How many of the focus areas selected in Question #16 typically comprise a CTI treatment plan at any one time?

More than 6

6

4-5

1-3


  1. Which of the following best describes how treatment plan focus areas are chosen:

Based on consumer ‘s history of risk of homelessness

Based on goal attainment/new risk areas identified at end of previous phase of CTI service

Other, specify______

Does this vary by phase of service? If yes, explain:_____

Outreach/Early Linking

  1. During the first phase (i.e. first 1-3 months) of CTI services, how is contact maintained between CTI workers and consumers? (check all that apply)

Phone contact is made

Home visits are made

If home visits made, how soon after the start of Phase One do they occur?

Within one week

Within two weeks

Within one month

Other, specify______

Visits are made to clients at their treatment setting (e.g., day program)

If clients visited at treatment setting, how soon after the start of Phase One do they occur?

Within one week

Within two weeks

Within one month

Other, specify______

Workers accompany consumers on appointments

Other, specify:_______________

  1. How often do CTI workers typically make contact with consumers during the initial phase (1-3 months) of service?

Once per month

2-3 times per month

4 times per month

Other, specify_____

  1. How often do CTI workers typically meet with primary mental health and/or substance use treatment providers during the initial phase (1-3 months) of service?

Once

2-3 times

4 times

Other, specify_____

  1. How often do CTI workers typically meet with housing providers including landlords during the initial phase (1-3 months) of service?

Once

2-3 times

4 times

Other, specify_____

  1. During the initial phase (1-3 months) of service, do CTI workers hold joint meetings between:

Consumers and their community linkages?

Yes

No

Linkages from different agencies?

Yes

No

Nature/Length of Services

  1. Which of the following principles and approaches do CTI staff use in their work with consumers? (check all that apply)

Confrontation

Abstinence only

Harm reduction

Stage wise approach

Office-based assessments

Community-based assessment & skill building

Other, specify:_________

  1. What is the total length of time consumers typically receive CTI services?



3 months

6 months

9 months

12 months

Other, specify____

  1. Are consumers ever discharged from services early?

No

Yes

If yes, why? _______________

  1. Which of the following activities are most likely to occur during the initial phase (1-3 months) of CTI services?

CTI worker focuses with consumer on work accomplished and long-term goals

CTI worker focuses on assessment and linkage with supports

CTI worker accompanies consumer to appointments

CTI worker observes consumer trying out skills and adjusts consumer support network

CTI worker encourages consumer and caregivers to work out problems on their own

CTI worker substitutes for caregivers when necessary

CTI worker mediates conflicts between consumer and caregivers

  1. Which of the following activities are most likely to occur during the middle phase (e.g., months 4-6) of CTI services?

CTI worker focuses with consumer on work accomplished and long-term goals

CTI worker focuses on assessment and linkage with supports

CTI worker accompanies consumer to appointments

CTI worker observes consumer trying out skills and adjusts consumer support network

CTI worker encourages consumer and caregivers to work out problems on their own

CTI worker substitutes for caregivers when necessary

CTI worker mediates conflicts between consumer and caregivers

  1. Which of the following activities are most likely to occur during the final phase (e.g., months 7-9) of CTI services?

CTI worker focuses with consumer on work accomplished and long-term goals

CTI worker focuses on assessment and linkage with supports

CTI worker accompanies consumer to appointments

CTI worker observes consumer trying out skills and adjusts consumer support network

CTI worker encourages consumer and caregivers to work out problems on their own

CTI worker substitutes for caregivers when necessary

CTI worker mediates conflicts between consumer and caregivers

  1. How often do CTI workers typically have contact with consumers during the final phase (e.g., months 7-9) of CTI services?

Once per month

2-3 times per month

4 times per month

Other, specify____


  1. Were any components of this program model difficult to implement?

No

Yes

If yes, specify_________________


  1. Did you make any adjustments or modifications to the CTI model?

No

Yes

If yes, please describe     


  1. Were any of the following types of evidence-based service interventions fully imbedded within your implementation of the CTI program model?

Motivational Interviewing

Cognitive Behavioral Therapy (CBT)

Motivational Enhancement Therapy (MET)

Peer Support

Strengths-Based Case Management/Approach

SSI/DI Outreach, Access & Recovery (SOAR)

Trauma-Specific Intervention (specify:___________)

Other (specify:___________________)





1 Defined as those primary EBPs that are program-level models being implemented in 14 or more sites for which a fidelity toolkit/scale exists.

2 Defined as those primary EBPs that are program-level models being implemented in 14 or more sites for which a fidelity toolkit/scale exists.



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AuthorKelly English
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File Created2021-01-28

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