Form SSI

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 40 minutes per respondent, per year, 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 2-1057, Rockville, Maryland, 20857.

ATTACHMENT 11: Services and Supports Inventory

SERVICES & SUPPORTS INVENTORY

Interviewer Script & Probes

INSTRUCTIONS (to be read by interviewer): Please indicate the name of the largest evidence-based or promising practice (EBP/PP) for youth and young adults with or at risk of a serious mental health condition in this learning laboratory. By “largest” we mean the EBP/PP currently serving the most youth and young adults. We will ask further questions about this EBP/PP. Please omit practices specifically designed to address early episode psychosis. We will ask about those separately.

Topic/Area of Focus:	Possible Probes:
Identification of Evidence-based or Promising Practices	What is this approach called locally? What program/s offer/s it? Please briefly describe the practice [DIRECTIONS TO INTERVIEWER: does it sound like the EBP or promising practice? (see “ADDITIONAL INSTRUCTIONS: below)]
Verification of Formal Implementation Efforts	How well does the organization implement the EBP/PP? Are there aspects of the EBP/PP that the organization has struggled to implement? Are there aspects of the EBP/PP that the organization has trouble finding funding for? Does the organization have a copy of the manual (if there is one)? Does this organization provide the amount and type of supervision called for in the manual? To what extent are program staff members trained according to the manual? To what extent are the clients served, similar to the clients the EBP was originally designed for? Is there a quality assurance procedure, or a fidelity measure to help the program implement the EBP/PP accurately? If so, how well do they use it?
Identification of Key Informants on Practice	Who would be the person in that organization that could best tell me about the use of this EBP/PP in their organization? [obtain name, position; organization name, email/phone numbers] If that individual is unavailable, who else might be able to provide information about this EBP/PP?
Are there any other EBP/PPs for youth and young adults with or at risk of a serious mental health condition in this learning laboratory? Please tell me the name of the one that serves the second largest group of youth and young adults:__________________________________ ***Repeat qualitative questions about this, and up to 5 more EBPs/PPs for this learning laboratory, THEN proceed with the next section***
Early Intervention Services for First Episode Psychosis:	Beyond those practices already mentioned, is your grantee community currently providing any early intervention services designed to improve outcomes/ quality of life for individuals experiencing a first episode of psychosis?  Such interventions might include: Individualized medication management assisted by a computerized decision support system for the prescriber Individualized medication management (without assistance from a computerized decision support system for the prescriber) Family Psychoeducation or other SPECIFIC family support approach. Cognitive remediation Individual resiliency training Supported education, employment, employment/education hybrid SPECIFIC TYPE of cognitive behavioral therapy (designed for individuals with psychosis) Potential program names: NAVIGATE, Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP), OnTrackNY
How adherent is the organization	How well does the organization implement the EBP/PP? Are there aspects of the EBP/PP that the organization has struggled to implement? Are there aspects of the EBP/PP that the organization has trouble finding funding for? Does the organization have a copy of the manual (if there is one)? Does this organization provide the amount and type of supervision called for in the manual? To what extent are program staff members trained according to the manual? To what extent are the clients served, similar to the clients the EBP/PP was originally designed for? Is there a quality assurance procedure, or a fidelity measure to help the program implement the EBP/PP accurately? If so, how well do they use it?
Who to talk to	Who would be the person in that organization that could best tell me about the use of this EBP/PP in their organization [obtain name, position; organization name, email/phone numbers]
Are there any other EBP/PPs for youth and young adults experiencing a first episode of psychosis in this learning laboratory? Please tell me the name of the one that serves the second largest group of youth and young adults:__________________________________ ***Repeat qualitative questions about this, and up to 3 more EBP/PPs for early episode psychosis***

ADDITIONAL INSTRUCTIONS

A practice that “sounds like” an EBP or promising practice may have any of the following elements:

• A SPECIFIC name (e.g., not “cognitive behavioral therapy” but “cognitive behavioral therapy for trauma”)

• It is the organization’s own, but grounded in a more widely used practice (e.g., “TIP-informed” services)

• There is a specific person “in charge” of overseeing its implementation.

• Manual, other written materials describing guidelines, activities involved in, training for, etc. the practice.

• It is associated with a quality assurance or fidelity measure

• There is set aside funding to support it.

Attachment 11: Services and Supports Inventory

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