Massachusetts_Early_Psychosis_Program_Self-Assessment.docx

Massachusetts Early Psychosis Program Self-Assessment Tool Current/Existing EP CSC Programs

Name of EP Program:

Parent Agency/Hospital:

EP Clinic Address & Zip Code:

Name (Primary Contact):

Position (Primary Contact):

Email (Primary Contact):

Phone (Primary Contact):

Date of Completion:

Section 1. Early Psychosis Coordinated Specialty Care (EP CSC) Program Overview

1. Please indicate what stage of development best describes your EP CSC program:

☐ Operational for more than 2 years with all or nearly all staff trained in EP CSC EBPs ☐ Operational for less than 2 years with most staff enrolled in ongoing training and consultation ☐ Preparing to launch a new program ☐ Other: ________________

2. Indicate the month and year that your program first started enrolling clients with early psychosis? If your program has not started enrolling yet, please estimate when you expect to begin (month and year).

3. What geographic area does your program serve? (e.g., Suffolk County, DMH Western Massachusetts Area, state of Massachusetts)

EP CSC Individuals Served

4. Referral Network:

4.1. Please select all referral sources for your CSC program:

☐ Psychiatric inpatient facilities ☐ Outpatient mental health clinics within the agency ☐ Outpatient mental health clinics outside the agency ☐ Emergency departments ☐ Private practice psychiatrists, counselors, therapists ☐ Primary care practitioners ☐ Courts/correctional facilities ☐ Colleges, high schools, or other educational institutions ☐ Consumer, professional, or family organizations (e.g., NAMI, Mental Health America) ☐ Self-referral ☐ Family referral ☐ Other (Specify):

4.2 How/where does the CSC Program promote its services?

☐ MAPNET Website ☐ Agency Website ☐ Brochure ☐ PCP Practices ☐ CBHCs ☐ Colleges, high schools, other schools ☐ Consumer, professional, or family organizations (e.g., NAMI, Mental Health America) ☐ Radio, Print, Internet Ads ☐ Other (Specify):

5. Census:

5.1. What is the maximum capacity of people that may be enrolled in your CSC program? ___________

5.2. How many new people has your CSC program enrolled in total over the past 12 months? ___________

5.3 How many people are currently enrolled in your CSC program? ___________

6. Population Served:

6.1. What are the eligibility criteria for participation in your EP CSC program, e.g., age, diagnoses, duration/stage of illness? Indicate conditions under which a person may not be eligible for your EP CSC program.

6.2. Please total the demographic makeup of your EP CSC program’s current staff (S) and people currently enrolled in EP CSC patient population (P).

Hispanic or Latino

American Indian or Native American

Not Hispanic or Latino

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Two or more Races

Female

Private or Commercial

Male

Public or MassHealth/Medicaid

Transgender or Nonbinary

Uninsured

Other (specify):

Other (specify):

7. Do any team members in your CSC program offer services in a language other than English?

Describe: ☐ Yes ☐ No

8. Apart from bilingual services provided by team members, does your program offer live translation for languages other than English? ☐ Yes ☐ No Describe:

Do you offer materials (inc. website) that are translated into other languages at your clinic? Describe: ☐ Yes ☐ No

9. Duration of Services.

9.1. What is the typical length of time that clients are served through your CSC program?

Select one: Choose an item.

9.2. What is the maximum length of time that clients may receive services within your CSC program?

Select one: Choose an item.

10. Summarize your EP CSC program’s strengths in meeting needs of communities you serve.

11. Identify areas of growth your program may undertake to better meet the needs of communities you serve.

Section 2. EP CSC Staff and Roles

12. Team Members Indicate the total number of team members who are a part of your CSC team: ______

In the table below, list each current team member. Complete a separate row for each role that the individual team member holds. (In the drop down menu, core roles are preceded by a ‘C’; other allowable roles are preceded by an ‘O’).

Team Member’s Name (list more than once if more than one role) Total FTE with

EP CSC

Identify

ROLE

(none, all, or X.X FTE)

Select a Role

Select a Role

Select a Role

Select a Role

Select a Role

Select a Role

Select a Role

13. EBP Training and Core Service Components For each current team member identified above, please indicate whether the individual has completed training in the Core EP CSC EBPs (Section 1) and other EBPs relevant for their role(s) on the EP CSC team (Section 2).

Supported Employ / Education Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item.

14. New or Vacant Positions/Roles List all new (planned) positions and vacant positions and the associated role(s). For each new/vacant position, complete a separate row for each role that the new team member will hold.

Job Title of Position

# of weeks vacant

(drop down)

(none, all, or X.X FTE)

Choose an item.

Choose an item.

Choose an item.

Choose an item.

Choose an item.

Choose an item.

Choose an item.

15. Please indicate how coverage is provided for vacant roles (e.g. volunteers, trainees, other community organizations) and how staff will be recruited to fill vacancies. Detail efforts to recruit diverse staff.

15.1. In the past year, how many staff members have left the team? ___________

15.2. In the past year, how many staff members have joined the team? ___________

16. Summarize the strengths of your program related to EP CSC Staffing & Roles.

17. Summarize the needs of your program related to EP CSC Staffing & Roles.

Section 3. EP CSC Operational Requirements

18. Please indicate the frequency of the following meetings at your CSC program:

Specify if “Other schedule”:

19. MA EP Assessment Battery

19.1 Indicate when the EP Assessment Battery is administered:

19.2 Describe your current use of the MA EP Assessment Battery, including: (1) who is responsible for obtaining input from team members and completing it;

(2) how the data is integrated into the Electronic Health Record; and

(3) how the data is used to inform treatment planning and program development.

20. Treatment Planning.

20.1 Is it standard practice for vocational/educational goals to be part of the treatment plans for individuals receiving EP CSC services? ☐ Yes ☐ No

20.2 Describe how the multidisciplinary team develops a treatment plan with the individual and the family.

21. Crisis and Safety.

21.1 Does the EP CSC team provide 24-hour support? ☐ Yes ☐ No

21.2 Describe what after-hours and/or crisis support is offered, e.g. who is responsible and what services are available

22 Inpatient Coordination.

22.1 Does the EP CSC team coordinate with the inpatient team when an individual served is inpatient? ☐ Yes ☐ No

22.2 Describe who is responsible for outreaching to the inpatient team and how EP CSC team members coordinate with the inpatient team:

23 Transitions of Care.

23.1 Does the EP CSC team provide warm handoffs and transition support to individuals served and their families who use supports external to the EP CSC team and/or are exiting CSC services and enrolling with new providers? ☐ Yes ☐ No

24 Third-Party Billing Maximized.

24.1 Do you maximize all 3rd Billing avenues? ☐ Yes ☐ No

24.2 Describe how you assure that 3rd party billing is maximized. Indicate what insurances you currently accept. Indicate any limitations/barriers you’ve encountered in billing for EP CSC services.

25 Space Please indicate the types of spaces in which staff engage Young Adults/Families.

25.1 Do all EP CSC staff have access to reliable office space with technology and equipment sufficient to provide in-person and HIPAA-compliant telehealth services? ☐ Yes ☐ No

25.2 Does the EP CSC program have use of conference and group rooms to meet the needs of families and, if relevant, offer group programming? ☐ Yes ☐ No

25.3 Is the Clinic space youth friendly and welcoming to people of diverse backgrounds? ☐ Yes ☐ No

25.4 Describe the space and how people of diverse backgrounds are welcomed:

26 Records.

26.1 Does the EP CSC program maintain all records for young adults in the standard medical records format of the DPH licensed outpatient clinic where the EP CSC program is located? ☐ Yes ☐ No

26.2 Are all newly enrolled individuals and their families provided with the DMH Notice of Privacy Practices Acknowledgement Form? ☐ Yes ☐ No

26.3 Describe how/where the completed DMH EP Assessment Batteries are stored in the medical record.

27 Summarize the strengths of your program related to EP CSC Operations

28 Summarize the needs of your program related to EP CSC Operations.

29 Ongoing Growth of EP CSC.

29.1 Do you provide opportunities for trainees in your EP CSC program? ☐ Yes ☐ No Describe:

29.2 Do you currently partner with researchers on EP-relevant research studies?

Describe: ☐ Yes ☐ No

SECTION 5. CONTINUOUS QUALITY IMPROVEMENT

30 Describe how feedback from young adults and families is solicited and incorporated into programmatic decisions. Please provide an example of the most recent feedback or suggestion received (if any).

31 Summarize the needs of your program related to Quality Improvement.

32 Summarize the strengths of your program related to Quality Improvement.

33 Describe your program’s development goals and plan for the next 2 years to assure full model fidelity. Indicate how data from the assessment battery, youth/family feedback, research findings, etc. informs these goals and plans.

34 Indicate the total amount requested from DMH to support on-going fidelity with EP CSC model and provide a brief summary of how you propose to use the funds