EP_Program_Activity_Spreadsheet.xlsx

XLSX spreadsheet 518 KB Posted

Attached to
Early Psychosis Coordinated Specialty Care Program Staff Enhancement and Evidence Based MA RFA
Solicitation number
BD-23-1022-DMH08-8210C-87233
Issued by
Massachusetts

About this file

Written by GovTribe AI ·

This document is a government file related to an Early Psychosis Coordinated Specialty Care Program (EP CSC Program) staff enhancement and evidence-based practice implementation Request for Applications (RFA) issued by the Massachusetts Department of Mental Health (DMH). The RFA seeks to establish a pool of existing or planned EP CSC Programs to which DMH can award grants to enhance staffing or assist with the implementation of Evidence Based Practices. The RFA does not provide details on item quantities, response dates, due dates, site visits, bidder's meetings and conferences, award dates, or the term of any resulting contracts.

The document does not include information on pricing terms, set asides, incumbents, current environment, funding requirements and sources, or any other salient details beyond the high-level program description. It appears to be an internal document used to track program participant data and staff training hours, rather than the RFA itself.

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Show all 27

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Client Roster

CSC NAVIGATE Client RosterYesYes, as prescribed
NoYes, not as prescribed
Month:OctoberUpdated by (Name):Total # Active Clients:0% in IRT:0%% SEE:0%# Active Clients:0Adult0ChildCompletedNo, not as prescribed
OtherNo medication
Year:2022Program Name:% taking Medication:0%% in Family:0%% Peer:0%# Admissions, Past Year:0Adult0Child
Client InformationPrescriberIRTFamily EducationSEE SpecialistPeer SpecialistNotes
Client IDDate ReferredDate EnrolledDischarged?DiagnosisAgeRaceGenderCo-occuring Subst. Use?Prescriber NameMeets with Prescriber?Taking Meds?Clinician NameHaving IRT Sessions?IRT Module & NotesClinician NameFamily Sessions?Family Module & NotesSEE Specialist NameHaving SEE Sessions?Current SEE ActivitiesPeer Specialist NameHaving Peer Sessions?Current Peer ActivitiesDescribe any additional information or services relevant to this client.
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Monthly Review SAMHSA Annual Report (10/1/2022-9/30/2023)

Training & Staff Time

CSC Training & Staff Time Report Total Hours: 0

Instructions: Enter the total number of hours spent by CSC staff in the following activities during the indicated month. If there are multiple team members in a role, enter the total summed hours spent across staff in this role. If a team member fills multiple roles (e.g., team leader is also the prescriber), only count hours once under the most relevant heading (e.g., onboarding staff = Team Leader, medication webinar = Prescriber). Month: October

Year: 2022

Team LeaderPrescriber(s)Individual Clinician(s)Family Clinician(s)Peer Specialist(s)Employment/ EducationOther Staff
Weekly Team Meetings
Clinical Supervision
Webinars & Workshops (non-MAPNET/NAVIGATE)
Role-Specific Training (non-MAPNET/NAVIGATE)
Program Development (e.g. service design, protocols)
Staff Recruitment, Hiring, & Onboarding
Client Recruitment & Community Engagement
Collateral Calls/Care Coordination
Non-Billable Clinical Work (SEE, peer, uninsured clients, family work without client present, etc.)
NAVIGATE Implementation & Prep Work (taping calls, completing forms, etc.)
MAPNET Site Visit
MAPNET Community Didactic Calls
MAPNET Consultation Calls (Team Leader, Peer)N/AN/AN/AN/A
NAVIGATE Consultation Calls (IRT, Family, Prescriber, SEE)N/AN/A
NAVIGATE Onboarding Trainings
Totals0000000
Specify staff role:

Client Assessments

CSC Client Assessment DataVariableAssessment 1Assessment 2Assessment 3Assessment 4etc. →
Client_ID
Month:OctoberYear:2022Assessment_Type
Assessor_1
Total # of assessments completed:0Assessor_2
Assessor_3
% Completed Demographics:0%Assessor_4
Assessor_5
% Completed Clinical Interview:0%Assessor_6
Assessor_7
% Completed Self-Report:0%Complete_Demo
Complete_Edu
Average age:No data% Male:No dataComplete_ServiceUse
Complete_GFS
Complete_COMPASS
Instructions: Report client assessment data (Baseline, Follow-Up, or Discharge) for all patients who received services from your FEP CSC program between 10/1/2022-9/30/2023. EVERY PATIENT served in any capacity by your CSC FEP program during the reporting period* must AT MINIMUM have a completed Demographics form and, if discharged, the month & reason for discharge.

See below for step-by-step instructions on how to copy data from the Excel e-Forms into this report. If you do not use these eForms, please coordinate with MAPNET re: your submission.

*Examples include: a) someone who received family services without the client present; b) someone admitted to your program in May 2022 who continued to receive services throughout the reporting period (10/1/2022 to 9/30/2023); c) a person who participated in an initial assessment and received no additional services; d) a person discharged from your program at some point between 10/1/2022 and 9/30/2023.Complete_WHOAssist
Complete_Family
Complete_Prescribers
Complete_CSI
Complete_LEC
Complete_ASS
Complete_Medication
Complete_QOL
Complete_QPR
Complete_CSQ
Complete_Discharge
Complete_Notes
Age_Months
Age_Years
Demo_Admin_Date_Month
Demo_Admin_Date_Year
Current_Primary_Diagnosis
Current_Primary_Diagnosis_OS
DX_SUD
DX_DEP
DX_BPD
DX_OCD
DX_TRAUMA
DX_ANX
DX_DEV
Step 1. Open the "Data Summary" tab of the completed assessment form.DX_OTHER
DX_OS
Symptom_Onset_Month
Symptom_Onset_Year
Program_Entry_Month
Program_Entry_Year
Antipsychotic_Meds_Month
Antipsychotic_Meds_Year
Antipsychotic_Meds_Unknown
Antipsychotic_Meds_NA
Bio_Sex
Gender_ID
Gender_ID_OS
Sex_Orient
Sex_Orient_OS
Race_Black
Race_White
Step 2. Copy the "Response" column. This should contain a summary of the information entered in the previous tabs.Race_Asian
Race_AI
Race_NH
Race_Other
Race_PreferNot
Race_DK
Ethnicity
Language
Education_Parent1
Parent1
Education_Parent2
Parent2
Current_Housing
Homeless_Recent
Zipcode
Legal_Victim
Legal_Issues
Jail_Nights
Step 3. In this spreadsheet, right-click the first cell in a column (ex., the "Assessment 1" cell) and select "Paste Options - Values". Some computers may instead have the option to "Paste without formatting" or "Paste as plain text", which perform the same function.
NOTE: Each column represents one assessment. If a client received a 6-month, 12-month, and discharge assessment within the reporting period, each of these should be recorded as a seperate column.Jail_Nights_Num
Court_Ordered_TX
Current_Housing_OS
Health_Insurance
Health_Insurance_OS
Financial_Mother
Financial_Father
Financial_Guardian
Financial_Spouse
Financial_Other
Financial_OS
Financial_DK
Financial_None
SSI_Apply
Support_Disability
Support_TANF
Support_Unemployment
Support_SNAP
Support_Other
Support_OS
Support_DK
Support_None
Referred_Self
Referred_Family
Referred_School
Referred_ER
Referred_Hosp_Gen
Referred_Hosp_Psych
Referred_Agency
Referred_PCP
Referred_Crisis
Referred_Legal
Referred_Outpatient
Referred_Other
Referred_OS
Edu_Level
School_Attendance
Edu_Support
Goal_School
Goal_Employment
Internship_No
Internship_Unpaid
Internship_Paid
Internship_Unknown
Job_6mos_No
Job_6mos_PartTime
Job_6mos_FullTime
Job_6mos_Unknown
SSI
Job_Importance
Job_Confidence
Hospital_MH
Times_Hospital_MH
Total_Nights_Hospital
ER_MH_SU
ER_MH_SU_Times
Detox
Detox_Times
Detox_Nights
Hospital_Medical
Hospital_Medical_Times
Hospital_Medical_Nights
ER_Medical
ER_Medical_Times
DMH_Client
DCF_Report
Services_Med
Services_Therapy
Services_Educ
Services_Employ
Services_CaseMan
Services_Peer
Services_Fam
Services_Community
GF_Social_Scale
MIRECC_GAF_Occupational
Suicidal_Ideation
Suicide_Attempts
Suicide_Attempts_Number
Self-Injury
Violent_Thoughts
Violent_Behavior
COMPASS10_Depressed
COMPASS10_Anxiety
COMPASS10_Suicidal
COMPASS10_Hostility
COMPASS10_Suspiciousness
COMPASS10_Unusual
COMPASS10_Hallucinations
COMPASS10_Disorganization
COMPASS10_Avolition
COMPASS10_Asociality
LT_Nicotine
LT_Alcohol
LT_THC
LT_Cocaine
LT_Stimulant
LT_Inhalant
LT_Sedative
LT_Hallucinogen
LT_Opioids
LT_Other
LT_OS
P30D_Nicotine_Freq
P30D_Alcohol_Freq
P30D_THC_Freq
P30D_Cocaine_Freq
P30D_Stimulant_Freq
P30D_Inhalant_Freq
P30D_Sedative_Freq
P30D_Hallucinogen_Freq
P30D_Opioids_Freq
P30D_Other_Freq
P30D_OS_Freq
P6MO_Nicotine_Detox
P6MO_Alcohol_Detox
P6MO_THC_Detox
P6MO_Cocaine_Detox
P6MO_Stimulant_Detox
P6MO_Inhalant_Detox
P6MO_Sedative_Detox
P6MO_Hallucinogen_Detox
P6MO_Opioids_Detox
P6MO_Other_Detox
P6MO_OS_Detox
P6MO_Nicotine_Quit
P6MO_Alcohol_Quit
P6MO_THC_Quit
P6MO_Cocaine_Quit
P6MO_Stimulant_Quit
P6MO_Inhalant_Quit
P6MO_Sedative_Quit
P6MO_Hallucinogen_Quit
P6MO_Opioids_Quit
P6MO_Other_Quit
P6MO_OS_Quit
Family_Contact
Client_Preference
Family_TX
Family_Refuse_TX
Height_Feet
Height_Inches
Weight_Pounds
Weight_Ounces
Prescription_Meds
Oral_Aripiprazole
Oral_Asenapine
Oral_Brexpiprazole
Oral_Chlorpromazine
Oral_Clozapine
Oral_Fluphenazine
Oral_Haloperidol
Oral_Loxapine
Oral_Lurasidone
Oral_Olanzapine
Oral_Paliperidone
Oral_Perphenazine
Oral_Quetiapine
Oral_Risperidone
Oral_Ziprasidone
Other_Oral_Antipsychotic_Name
Other_Oral_Antipsychotic_Dose
LAI_Name
LAI_Dose
Other_Psychotropic_Meds_NA
Bupropion
Citalopram
Duloxetine
Desvenlafazine
Escitalopram
Fluoxetine
Mirtazapine
Paroxetine
Sertraline
Venlafaxine
Vilazodone
Vortioxetine
Antidepressants_Other
Antidepressants_OS
Lorazepam_Daily_PRN
Clonazepam_Daily_PRN
Zolpidem
Carbamazepine
Divalproex
Lamotrigine
Lithium_Citrate
Lithium_Carbonate
Oxcarbazepine
Topiramate
Amphetamine
Methylphenidate
Guanfacine
Atomoxetine
Buspirone
Bupropion
Varenacline
Gabapentin
Trazodone
Other_Drugs
Other_Drugs_OS
BARS_Doses_Taken
Side_Effects_Sedation
Side_Effects_Memory
Side_Effects_Appetite
Side_Effects_Muscles
Side_Effects_Restless
Side_Effects_Vision
Side_Effects_Sexual
Side_Effects_Menstruation
Side_Effects_Unlike_Self
Side_Effects_Other
Side_Effects_OS
Side_Effects_None
CSI_Nervous
CSI_Depressed
CSI_Lonely
CSI_Paranoid
CSI_Voices
CSI_Decisions
CSI_Concentration
CSI_Behavior
CSI_Out_Place
CSI_Forget
CSI_Racing_Thoughts
CSI_Suspicious
CSI_Harm_Self
CSI_Harm_Others
LEC5_Disaster_Happened
LEC5_Disaster_Witnessed
LEC5_Disaster_Learned
LEC5_Disaster_Job
LEC5_Disaster_Not_Sure
LEC5_Disaster_NA
LEC5_Fire_Happened
LEC5_Fire_Witnessed
LEC5_Fire_Learned
LEC5_Fire_Job
LEC5_Fire_Not_Sure
LEC5_Fire_NA
LEC5_Trans_Accident_Happened
LEC5_Trans_Accident_Witnessed
LEC5_Trans_Accident_Learned
LEC5_Trans_Accident_Job
LEC5_Trans_Accident_Not_Sure
LEC5_Trans_Accident_NA
LEC5_Accident_Happened
LEC5_Accident_Witnessed
LEC5_Accident_Learned
LEC5_Accident_Job
LEC5_Accident_Not_Sure
LEC5_Accident_NA
LEC5_Exposure_Happened
LEC5_Exposure_Witnessed
LEC5_Exposure_Learned
LEC5_Exposure_Job
LEC5_Exposure_Not sure
LEC5_Exposure_NA
LEC5_Assault_Physical_Happened
LEC5_Assault_Physical_Witnessed
LEC5_Assault_Physical_Learned
LEC5_Assault_Physical_Job
LEC5_Assault_Physical_Not_Sure
LEC5_Assault_Physical_NA
LEC5_Assault_Weapon_Happened
LEC5_Assault_Weapon_Witnessed
LEC5_Assault_Weapon_Learned
LEC5_Assault_Weapon_Job
LEC5_Assault_Weapon_Not_Sure
LEC5_Assault_Weapon_NA
LEC5_Assault_Sexual_Happened
LEC5_Assault_Sexual_Witnessed
LEC5_Assault_Sexual_Learned
LEC5_Assault_Sexual_Job
LEC5_Assault_Sexual_Not_Sure
LEC5_Assault_Sexual_NA
LEC5_Other_Sexual_Happened
LEC5_Other_Sexual_Witnessed
LEC5_Other_Sexual_Learned
LEC5_Other_Sexual_Job
LEC5_Other_Sexual_Not_Sure
LEC5_Other_Sexual_NA
LEC5_Combat_Happened
LEC5_Combat_Witnessed
LEC5_Combat_Learned
LEC5_Combat_Job
LEC5_Combat_Not_Sure
LEC5_Combat_NA
LEC5_Captivity_Happened
LEC5_Captivity_Witnessed
LEC5_Captivity_Learned
LEC5_Captivity_Job
LEC5_Captivity_Not_Sure
LEC5_Captivity_NA
LEC5_Illness_Happened
LEC5_Illness_Witnessed
LEC5_Illness_Learned
LEC5_Illness_Job
LEC5_Illness_Not_Sure
LEC5_Illness_NA
LEC5_Suffering_Happened
LEC5_Suffering_Witnessed
LEC5_Suffering_Learned
LEC5_Suffering_Job
LEC5_Suffering_Not_Sure
LEC5_Suffering_NA
LEC5_Death_Violent_Happened
LEC5_Death_Violent_Witnessed
LEC5_Death_Violent_Learned
LEC5_Death_Violent_Job
LEC5_Death_Violent_Not_Sure
LEC5_Death_Violent_NA
LEC5_Death_Unexpected_Happened
LEC5_Death_Unexpected_Witnessed
LEC5_Death_Unexpected_Learned
LEC5_Death_Unexpected_Job
LEC5_Death_Unexpected_Not_Sure
LEC5_Death_Unexpected_NA
LEC5_Injury_Happened
LEC5_Injury_Witnessed
LEC5_Injury_Learned
LEC5_Injury_Job
LEC5_Injury_Not_Sure
LEC5_Injury_NA
LEC5_Other_Happened
LEC5_Other_Witnessed
LEC5_Other_Learned
LEC5_Other_Job
LEC5_Other_Not_Sure
LEC5_Other_NA
LEC5_Race_Happened
LEC5_Race_Witnessed
LEC5_Race_Learned
LEC5_Race_Job
LEC5_Race_Not_Sure
LEC5_Race_NA
ASS_1
ASS_2
ASS_3
ASS_4
ASS_5
ASS_6
BARS_Doses_Taken_Client
QoL
QPR_Feel_Better
QPR_Take_Chances
QPR_Relationships
QPR_Society
QPR_Assert
QPR_Purpose
QPR_Experiences
QPR_Past
QPR_Motivated
QPR_Positive
QPR_Understand
QPR_Charge
QPR_Engage
QPR_Control
QPR_Time
CSQ_1
CSQ_2
CSQ_3
CSQ_4
CSQ_5
CSQ_6
CSQ_7
CSQ_8
CSQ_9
CSQ_10
discharge_confidence
discharge_month
discharge_year
discharge_number
discharge_number_specify
discharge_reason_1
discharge_reason_2
discharge_reason_2_os
discharge_reason_3
discharge_reason_3_os
discharge_reason_4
discharge_reason_5
discharge_reason_6
discharge_reason_7
discharge_reason_os
discharge_goals_tx
discharge_goals_sx
discharge_goals_su
discharge_goals_edu
discharge_goals_voc
discharge_education
discharge_education_os
discharge_work
discharge_work_os
discharge_followup_no
discharge_followup_specify
discharge_followup_yes
discharge_followup_recs
discharge_followup_unsure
discharge_referral_int_na
discharge_referral_int_no
discharge_referral_int_med
discharge_referral_int_therapy
discharge_referral_int_see
discharge_referral_int_hosp
discharge_referral_int_other
discharge_referral_int_os
discharge_referral_ex_na
discharge_referral_ex_no
discharge_referral_ex_med
discharge_referral_ex_therapy
discharge_referral_ex_see
discharge_referral_ex_hosp
discharge_referral_ex_other
discharge_referral_ex_os
discharge_care_none
discharge_care_pcp
discharge_care_cmh
discharge_care_fep
discharge_care_hosp
discharge_care_unsure
discharge_care_other
discharge_care_os

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