Clinic Gap Analysis Tools
Training Deck:
• Conducting a Clinic Gap Analysis
o Training presentation on the benefits and logistics of conducting a clinical monitoring assessment in a military behavioral health clinic
Fact sheets & Handouts:
• Steps to Collect AHLTA Data
o Step-by-step instructions for clinic managers to pull data on total number of appointments, most prevalent diagnoses, and type of care (individual, group, psychiatry) from AHLTA
Forms & Templates:
• Clinic Gap Analysis: Patient Form
o Customizable form to administer to patients to ascertain services needed in the clinic
Spreadsheets & Databases:
• AHLTA Clinic Gap Analysis Spreadsheet Template
o Spreadsheet for clinic manager to aggregate total number of appointments, most prevalent diagnoses, and type of care (individual, group, psychiatry) from AHLTA data pull described in “Steps to Collect AHLTA Data” handout
• Clinic Gap Analysis: Patient Form Spreadsheet Template
o Spreadsheet for clinic manager to aggregate data from the “Clinic Monitoring Assessment Form”
EBP Training & Utilization
• EBP Training & Utilization Provider Questionnaire
o Questionnaire to be completed by providers to ascertain training and utilization of common EBPs for PTSD, depression, and Insomnia
• Instructions for Administering the EBP Training & Utilization Provider Questionnaire
o Handout with instructions for administering the EBP Training & Utilization Provider Questionnaire, as well as using the associated tracking sheet to enter the data
• EBP Training & Utilization Spreadsheet
o Spreadsheet for entering data from the EBP Training & Utilization Provider Questionnaire. The spreadsheet includes auto-generated graphs to help with data analysis
Standard Operating Procedure:
• SOP/OI for Administering the EBP Training & Utilization Provider Questionnaire
o Template for clinic managers to use in order to establish procedures for regularly administering the EBP Training & Utilization Provider Questionnaire. Data from this will be used to guide clinic-level decisions
Patient Management Tools
Training Decks:
• Managing Patient Throughput
o Training presentation on how to manage patients from referral source, through treatment and termination. Offers strategies for dealing with inappropriate referrals and patients who desire ongoing therapy when it is no longer clinically indicated
• Treatment Planning
o Training presentation on how to develop effective treatment goals incorporating outcome measures and plan for termination once treatment is no longer clinically indicated. Includes strategies for successful treatment planning with special populations
Fact sheets & Handouts:
For Patients:
• FAQs: What to Expect When You Start Psychotherapy
o Fact sheet that answers frequently asked questions regarding types of therapy, treatment duration, symptom reduction timeframe, etc.
• Starting an Evidence-Based Psychotherapy
o Fact sheet covering what to expect in terms of the structure of an EBP session
• FAQs: Therapy Continuation Groups
o Handout that answers frequently asked questions regarding therapy continuation groups including session structure, topics, and treatment duration.
For Providers:
• Planning for Termination of Treatment
o Fact sheet explaining the reasons to plan for termination, how to address with patients, and options for terminating treatment when no longer clinically indicated
o Handout that answers frequently asked questions regarding therapy continuation groups including process, format, patient selection, and benefits to the provider, clinic, and patient.
o Fact sheet explaining the benefits of writing a treatment plan
For Clinic Leadership:
• Clinic Outreach Handout
o Customizable handout to distribute to referral sources outlining clinic policies and indicating availability/non-availability of services in your clinic
o Customizable handout to distribute to patients and referral sources listing specific EBP groups and other services available within the clinic
Forms & Templates:
• 20/20 Treatment Team Review Form
o Template for completing a thorough treatment team review after a patient has completed 20 therapy sessions and desires continued treatment
• Best Practices for Changing Levels of Care Templates
o Example scripts and templates for changing the treatment plan of a patient who may not wish for/understand the need for change
• Introducing Prolonged Exposure Therapy to Patients
o Example script for introducing a patient to PE
• Best Practices Memoranda for Discontinuation of Care Template
o Example template for memorandum explaining termination of care
• Best Practices Treatment Plan Update (Attendance) Template
o Example template for changing the treatment plan of a patient who is cancelling/missing appointments regularly
• Best Practices Treatment Plan Update (Homework) Template
o Example template for changing the treatment plan of a patient who is not completing homework assignments
• Patient Input into Treatment Team Review Form
o Form soliciting patient feedback for the treatment team review process – including satisfaction and progress towards treatment goals
• Patient Treatment Expectations and Beliefs Scale
o Scale to solicit patient’s initial reason for seeking treatment and desire for improvement
Standard Operating Procedure:
• SOP/OI for Managing Sub-Clinical Patients
o Template for clinic managers to use in order to ensure providers set treatment expectations and terminate treatment when it is no longer clinically indicated
EBP Utilization Tools
Training Decks:
• Increasing EBP Utilization
o Training presentation on how to increase access to EBPs in the clinic. Focuses on building a pool of EBP providers by increasing training, providing incentives, and protecting time for EBP treatment
• Introduction to EBPs
o Training presentation providing a brief overview of DoD/VA recommended EBP treatments for PTSD and depression
• Best Practices in Documenting EBPs
o Training presentation focusing on the importance of accurately documenting EBP care. Includes an overview of note templates for group and individual EBP treatment
Fact Sheets & Handouts:
For Patients
• Myths about Exposure Therapy for PTSD (Patient)
o Fact sheet dispelling some common myths patients may have about exposure therapy
• Prolonged Exposure Therapy (PE) Patient Brochure
o Patient brochure for Prolonged Exposure (PE) therapy for PTSD. Provides a basic explanation of the therapy, goals of the therapy, and addresses some frequently asked questions
• Why You Should Ask Your Provider about EBPs
o Fact sheet explaining the benefits of EBP treatment and why patients should ask if EBPs may be appropriate for them
• Information on Other EBPs
o Acceptance and Commitment Therapy for Depression (ACT-D) Patient Brochure
o Patient brochure for Acceptance and Commitment Therapy (ACT) for Depression. Provides a basic explanation of the therapy, goals of the therapy, and addresses some frequently asked questions
• Behavioral Activation for Depression (BA) Patient Brochure
o Patient brochure for Behavioral Activation (BA) therapy for Depression. Provides a basic explanation of the therapy, goals of the therapy, and addresses some frequently asked questions
• Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) Patient Brochure
o Patient brochure for Cognitive Behavioral Therapy for Chronic Pain (CBT-CP). Provides a basic explanation of the therapy, goals of the therapy, and addresses some frequently asked questions
• Cognitive Behavioral Therapy for Depression (CBT-D) Patient Brochure
o Patient brochure for Cognitive Behavioral Therapy for Depression (CBT-D). Provides a basic explanation of the therapy, goals of the therapy, and addresses some frequently asked questions
• Cognitive Behavioral Therapy for Insomnia (CBT-I) Patient Brochure
o Patient brochure for Cognitive Behavioral Therapy for Insomnia (CBT-I). Provides a basic explanation of the therapy, goals of the therapy, and addresses some frequently asked questions
• Cognitive Processing Therapy (CPT) Patient Brochure
o Patient brochure for Cognitive Processing Therapy (CPT) for PTSD. Provides a basic explanation of the therapy, goals of the therapy, and addresses some frequently asked questions
• Eye Movement Desensitization and Reprocessing (EMDR) Therapy Patient Brochure
o Patient brochure for Eye Movement Desensitization and Reprocessing (EMDR) Therapy for PTSD. Provides a basic explanation of the therapy, goals of the therapy, and addresses some frequently asked questions
• Mindfulness Based Cognitive Therapy (MBCT) for Depression Patient Brochure
o Patient brochure for Mindfulness-Based Cognitive Therapy (MBCT) for Depression. Provides a basic explanation of the therapy, goals of the therapy, and addresses some frequently asked questions
For Providers
• 60-minute Prolonged Exposure Sessions
o Fact sheet on how to modify the PE protocol for a 60-minute session length
o Fact sheet on how and why providers set an agenda for EBP sessions
• Benefits of Massed Prolonged Exposure Therapy
o Fact sheet on the benefits of massed appointments for PE
• Benefits of Online EBP Training
o Fact sheet on the benefits of online EBP training and how to incorporate these trainings within DoD settings
• Benefits of Receiving Ongoing EBP Consultation
o Fact sheet comparing conceptual and logistical consultation models. Explains why conceptual consultation is often a better choice
• Coding for 90-Minute Appointments
o Handout explaining how providers can code for 90-minute appointments in AHLTA when necessary (such as for PE sessions)
• Dispelling Misconceptions around Consultation
o Fact sheet addressing some of the myths providers may have around consultation. Includes the difference between consultation and supervision as well as why formal consultation is often a superior choice to informal consultation
• FAQs: Using Prolonged Exposure Therapy
o Fact sheet answering common questions providers may ask when seeking consultation for PE
• Myths about Exposure Therapy (Provider)
o Fact sheet dispelling some common myths providers may have about exposure therapy
• Prolonged Exposure FAQs: Patient Appropriateness
o Fact sheet answering common questions providers may ask when determining if PE is appropriate for their patients
o Fact sheet on Prolonged Exposure (PE) therapy for PTSD. Provides a basic explanation of the components of the therapy, explains how the therapy works and why providers should use it with their patients
• Scheduling 90-Minute Appointments
o Handout
For Clinic Leadership
• Clinic Benefits of EBP Consultation
o Fact sheet outlining benefits of consultation and why clinic managers should help facilitate consultation for their providers
• Monthly Peer Review: EBP Addendum
o Template for adding a verification of EBP use with PTSD patients to monthly peer review forms.
• Provider Incentives for Evidence-Based Psychotherapy Use
o Fact sheet on incentives available to Clinic Managers to encourage providers to use EBPs
Forms & Templates:
• Business Case Analysis
o Customizable briefing that highlights the benefits a clinic gains when a majority of their providers shift to using EBPs
o Template for providers to structure notes for CBT treatment
o Template for clinic managers to request that newly arriving active duty providers be trained in EBPs
• HR Semi-Structured Interview Questions to Ascertain EBP Experience
o Interview template for interviewers to assess the level of EBP training and experience of civilian and contract applicants
• Letter of Appreciation for Employees Delivering EBPs
o Template for clinic managers to use to show appreciation for providers delivering high-quality EBP care to patients
• PE Competency Checklist
o Checklist to get providers up to competency in Prolonged Exposure therapy
• Sample EBP Language for Peer Review Forms
o Template for clinic managers to use in order to ascertain EBP usage through the peer review process
• Note Templates for Other Individual Therapy EBPs
• Building Blocks: Behavioral Activation for Depression Notes
o Template for documenting behavioral activation therapy sessions
• Building Blocks: Cognitive Behavioral Therapy for Depression Notes
o Template for documenting cognitive behavioral therapy sessions
• Building Blocks: Problem Solving Therapy Notes
o Template for documenting problem solving therapy sessions
Standard Operating Procedure:
• SOP/OI Establishing a PTSD Sub-clinic
o Template for clinic managers to use in order to set-up an EBP sub-clinic model that works for the clinic
• SOP/OI Peer Review Process
o Template for clinic managers to use in order to assess EBP usage as part of their clinics’ peer review process
• SOP/OI Referral for a Course of EBP
o Template for clinic managers to use in order to delineate the primary provider and EBP provider roles for patients referred within the clinic for a course of an EBP
Expanding EBP Groups Tools
Training Deck:
• Implementing Best Practices in EBP Groups
o Training presentation on how to implement an EBP group therapy focus within the clinic. Offers ways to build a compatible group schedule and streamline processes while gaining support from members of the clinic.
• Expanding Group Services: Benefits & Best Practices
o
Fact sheets & Handouts:
For Patients
• Acceptance and Commitment Therapy for Depression (ACT-D) Group Patient Flyer
o Patient flyer for Acceptance and Commitment Therapy (ACT) for Depression Group. Provides a basic explanation of the therapy and is customizable for clinics to input outcome data from previous group iterations and testimonials.
• Cognitive Behavioral Therapy for Depression (CBT-D) Group Patient Flyer
o Patient flyer for Cognitive Behavioral Therapy for Depression (CBT-D) Group. Provides a basic explanation of the therapy and is customizable for clinics to input outcome data from previous group iterations and testimonials.
• Cognitive Processing Therapy (CPT) for PTSD Group Patient Flyer
o Patient flyer for Cognitive Processing Therapy (CPT) for PTSD Group. Provides a basic explanation of the therapy and is customizable for clinics to input outcome data from previous group iterations and testimonials.
o Describes EBP groups, how they are different from other groups, which ones are available, and who to contact if interested.
• What to Expect from your EBP Group
o Explains general information and rules about EBP groups.
Forms & Templates:
Referral & Marketing:
• Clinic Services Sheet
o Patient handout to describe available group treatments in the behavioral health clinic and other services for behavioral health care
o Cover sheet for front desk binder containing group rosters. Includes reminders about group size, patient privacy, and checking referral sources
o Table to enter a list of referred patients and contact information
• Scheduling Form and Referral Binder Procedure
o Instructions to describe the process a provider/Behavioral Health Technician (BHT) will use to schedule a patient for group therapy in the clinic
o Provider form to indicate which groups, individual follow-ups, and outcome measures are needed for a patient. Also includes reminder slips for patients with their next group and/or individual appointment(s), as well as instructions on crisis procedures
Pre-Group Screening:
• Group Agreement Form
o Patient agreement to abide by the attendance policy and rules of the EBP group to which s/he is joining. Includes acknowledgement that homework is a regular part of treatment. Provides emergency contact information in case of patient crisis
o Form to be used to screen patients for EBP groups. To be used in conjunction with the Pre-group Screening Instruction Guide
• Pre-group Screening and Orientation Instruction Guide
o Provides instructions for screening patients prior to referring to an EBP group. Includes a records review checklist and screening interview criteria
Group Administration:
• Group Therapy Attendance and Outcomes Tracking Sheet
o Provider/ Behavioral Health Technician (BHT) form to track patient outcome measures for group members across sessions
o Patient form to provide feedback on group leader(s), features, and perceived symptom reduction
• Group Therapy Session Note Tracking Form
o Provider/Behavioral Health Technician (BHT) form to track patient name, outcome measure scores, participation, homework completion, mood, and comments for a group session
Note Templates for Group Therapies
• Administrative Separation (ADSEP) Group Note Template
o Session-by-session template for documenting an ADSEP group
• CBT for Depression (CBT-D) Group Note Template
o Session-by-session template for documenting a CBT-D group
• Cognitive Behavioral Therapy for Insomnia (CBT-I) Group Note Template
o Session-by-session template for documenting a CBT-I group
• Cognitive Processing Therapy (CPT) Group Note Template
o Session-by-session template for documenting a CBT-I group
• Problem Solving Therapy (PST) Group Note Template
o Session-by-session template for documenting a PST group
Standard Operating Procedure:
• SOP/OI to Establish EBP Group Procedures
o Template for clinic managers to use in order to streamline the group referral process, patient assignment, and group management procedures using behavioral health technician support.
Behavioral Health Technicians Tools
Training Deck:
• Utilizing Behavioral Health Technicians
o Training presentation on the benefits and logistics of utilizing behavioral health technicians in a military behavioral health clinic to assist with individual and group EBP treatment, group screenings, tracking outcome measures, and assisting with documentation.
Forms & Templates:
• EBP Competency Checklist for BHTs
o Customizable assessment form for providers/clinic managers to assess the competency of behavioral health technicians to assist with the provision of individual and group EBPs and to run psychoeducational groups.
Standard Operating Procedure:
• SOP/OI to Establish BHT Role in Support of EBPs
o Customizable SOP/OI establishing clinic policy regarding the use of behavioral health technicians to make the most effective use of their specialized training in support of our mission to provide the best care possible to patients using EBPs.
Metrics Tools
Patient-Level Metrics
Training Deck:
• Patient Level Metrics
o Training presentation implementing patient-level outcome measures within the clinic. Offers ways to build a compatible group schedule and streamline processes while gaining support from members of the clinic.
Fact sheets & Handouts:
For Providers:
• Benefits of Using Outcome Measures
o Fact sheet describing the benefits of using outcome measures with patients.
• DoD Recommended Outcome Measures for Psychological Health
o Fact sheet summarizing common DoD/VA recommended outcome measures to include scoring and interpretation.
• Steps to Change PCL Frequency in BHDP
o Handout providing step-by-step instructions for changing the frequency with which the PCL is administered in BHDP to facilitate monitoring at each visit.
o Fact sheet regarding the use of the PCL to include availability, scoring, interpretation, and treatment planning application.
• Patient Health Questionnaire (PHQ)
o Fact sheet regarding the use of the PHQ to include availability, scoring, interpretation, and treatment planning application.
• Other Outcome Measures
• Alcohol Use Disorders Identification Test (AUDIT)
o Fact sheet regarding the use of the AUDIT to include availability, scoring, interpretation, and treatment planning application.
• Behavior and Symptom Identification Scale (BASIS)
o Fact sheet regarding the use of the BASIS to include availability, scoring, interpretation, and treatment planning application.
• Brief Addiction Monitor (BAM)
o Fact sheet regarding the use of the BAM to include availability, scoring, interpretation, and treatment planning application.
• Columbia Suicide Severity Rating Scale (C-SSRS)
o Fact sheet regarding the use of the C-SSRS to include availability, scoring, interpretation, and treatment planning application.
• Generalized Anxiety Disorder Scale (GAD)
o Fact sheet regarding the use of the GAD to include availability, scoring, interpretation, and treatment planning application.
• Insomnia Severity Index (ISI)
o Fact sheet regarding the use of the ISI to include availability, scoring, interpretation, and treatment planning application.
For Patients:
• Frequently Asked Questions: Outcome Measures
o Fact sheet addressing questions patients may have about the need to complete outcome measure or how the information will be used.
For Clinic Leadership:
• Models for Implementing Outcome Measures
o Handout outlining the pros and cons of different types of outcome measures and frequency of measure
• Best Practices in Administering Patient-Level Outcome Measures
o Handout outlining the best practices in administering patient level outcome measures including patient messaging, patient status and environmental variables, and how to instruct staff in administration and interpretation
Standard Operating Procedure:
• SOP/OI for Patient-Level Outcome Measures
o Customizable standard operating procedure to establish clinic procedures for the administration, scoring, and use of patient level outcome measures.
Clinic-Level Metrics
Training Deck:
• Clinic Level Metrics
o Training presentation on how to use clinic level metrics to improve clinic function and patient care. Includes identifying sources of relevant data, recognizing limitations to using data, and calculating metrics
Spreadsheets & Databases:
Clinic Analyzer Tool (CAT): this tool will allow clinic managers to analyze clinic appointment data using a series of pre-made reports and graphs. This database has two parts: the CAT Database and CAT Reports.
• CAT Database
o This is the “back-end” of the database. Clinic appointment and encounter data is imported into this database
• CAT Reports
o This is the “front-end” of the database. Clinic managers will access and run reports on the data loaded using this part of the tool
• Pivot Charts
• M2 (MHS Mart) Data Request
o Detailed listing of fields that your M2 official can easily pull. Clinic managers will upload this data into the CAT Database, using the instructions in the CAT Instruction Guide
• Clinic Analyzer Tool Instruction Guide
o Guide to uploading data and troubleshooting issues with the CAT Database
o Chart describing the different reporting features available through the CAT Database, along with any available filters
Patient Dispositions Database
• Patient Disposition Database
o Database for tracking separations generated by the behavioral health clinic including administrative separations, medical evaluation boards, and profiles. Database generates pre-made charts and reports
• Behavioral Health Patient Disposition Tracking Sheet
o Sheet to gather information on patients who are on a profile or being separated. This information is input into the Patient Disposition Database for tracking
• Instruction Guide
o Guide to uploading data and running reports in the Patient Disposition Database
Evaluation Tools
Training Decks:
• Evaluating the Clinic Optimization Process
o Training presentation on how to evaluate clinic optimization. Differentiates between program evaluation, process improvement, and research. Provides examples for completing process improvement projects to evaluate the level of a clinic’s optimization.
Fact sheets & Handouts:
• Myths About Process Improvement
o Fact sheet that addresses common misconceptions regarding implementing performance improvement projects within military treatment facilities.
• Process Improvement Tools
o Handout describing common process improvement tools, including flowcharts, affinity diagrams, fishbone diagrams, 5 whys exercise, and common charts for displaying process improvement data. Handout provides simple and easy to follow steps for using these tools.
• Examples of Process Improvement Tools (Not Yet Linked to Rubric)
• Example Affinity Diagram Process: Low Use of Group Psychotherapy
o Handout showing the use of an affinity diagram to examine factors that contribute to low use of group therapy.
• Example Fishbone Diagram: Long Wait Times for Follow-ups
o Handout showing the use of a fishbone diagram to examine factors that contribute to long wait times for follow-up appointments.
• Process Improvement Tools
• Fishbone Diagram
o Blank template for creating a fishbone diagram for a process improvement project.
Forms & Templates:
Process Improvement Project Templates: This is a series of templates that detail how an example clinic implemented different parts of the clinic optimization process. Each template describes how a specific implementation project was undertaken, providing example information about outcomes. Examples are available for the following projects:
• Improving Levels of Group Therapy Utilization
• Expanding the use of EBPs for PTSD and Depressive Disorders
• Setting up a Sub-clinic for PTSD
• Conducting a Clinic Gap Analysis
• Expanding the Use of BHTs in Clinical Care
• Decreasing Wait Times for Follow-up Appointments
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