GOI Protocol Page 1. General Organizational Index (GOI) (Expanded) Item Definitions and Scoring

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4 GOI Protocol Page 4 The calculation of the penetration rate depends of the availability of the two statistics defining this rate. Numerator: The number receiving the service is based on a roster of names maintained by the program leader. Ideally, this total should be corroborated with service contact sheets and other supporting evidence that the identified clients are actively receiving treatment. As a practical matter, agencies have many conventions for defining active clients and dropouts, so that it may be difficult to standardize the definition for this item. The best estimate of the number actively receiving treatment should be used. Denominator: If the provider agency systematically tracks eligibility, then this number is used in the denominator. (See rules listed above in G2 to determine target population before using estimates below.) If the agency does not, then the denominator must be estimated by multiplying the total target population by the corresponding percentage based on the literature for each EBP. According to the literature, the estimates should be as follows: o Supported Employment 60% o Integrated Dual Disorders Treatment 40% o Illness Management & Recovery 80% o Family Psychoeducation 100% (some kind of significant other) o Assertive Community Treatment 20% Example for calculating denominator: Suppose you don t know how many consumers are eligible for supported employment (i.e., the community support program has not surveyed the clients to determine those who are interested). Let s say the community support program has 120 clients. Then you would estimate the denominator to be: 120 x.6 = 72. Item Response Coding: Calculate this ratio and record it on the fidelity scale in the space provided. If the program serves >80% of eligible clients, the item would be coded as a 5. G4. Assessment Definition: All EBP clients receive standardized, high quality, comprehensive, and timely assessments. Standardization refers to a reporting format that is easily interpreted and consistent across clients. High quality refers to assessments that provide concrete, specific information that differentiates between clients. If most clients are assessed using identical words, or if the assessment consists of broad, noninformative checklists, then this would be considered low quality. Comprehensive assessments include: history and treatment of medical, psychiatric, and substance use disorders, current stages of all existing disorders, vocational history, any existing support network, and evaluation of biopsychosocial risk factors. Timely assessments are those updated at least annually. Rationale: Comprehensive assessment/re-assessment is indispensable in identifying target domains of functioning that may need intervention, in addition to the client s progress toward recovery.

5 GOI Protocol Page 5 a) Program leader interview, b) Senior staff interview and c) Practitioner interview: Do you give a comprehensive assessment to new clients? What are the components that you assess? Request a copy of the standardized assessment form, if available, and have the practitioners go through the form. How often do you re-assess clients? d) Chart review: Look for individual domains of comprehensive assessment in multiple assessments in the charts. Are the domains present each time an assessment is performed? Is the assessment updated at least yearly? Item Response Coding: If >80% of clients receive standardized, high quality, comprehensive, and timely assessments, the item would be coded as a 5. G5. Individualized Treatment Plan Definition: For all EBP clients, there is an explicit, individualized treatment plan (even if it is not called this) related to the EBP that is consistent with assessment and updated every 3 months. Individualized means that goals, steps to reaching the goals, services/ interventions, and intensity of involvement are unique to this client. Plans that are the same or similar across clients are not individualized. One test is to place a treatment plan without identifying information in front of the supervisor and see if they can identify the client. Rationale: Core values of EBP include individualization of services and supporting clients pursuit of their goals and progress in their recovery at their own pace. Therefore, the treatment plan needs ongoing evaluation and modification. Note: This item and the next are assessed together; i.e., follow up questions about specific treatment plans with question about the treatment. a) Chart review (treatment plan): Using the same charts as examined during the EBP-specific fidelity assessment, look for documentation of specific goal(s) and client-based goal-setting process. Are the treatment recommendations consistent with assessment? Evidence for a quarterly review (and modification)? b) Program leader interview: Please describe the process of developing a treatment plan. What are the critical components of a typical treatment plan and how are they documented? c) Practitioner interview: When feasible, use the specific charts selected above. Ask the practitioners to go over a sample treatment plan.

6 GOI Protocol Page 6 How do you come up with client goals? Listen for client involvement and individualization of goals. How often do you review (or follow up on) the treatment plan? d) Client interview: What are your goals in this program? How did you set these goals? Do you and your practitioner together review your progress toward achieving your goal(s)? [If yes] How often? Please describe the review process. e) Team meeting/supervision observation, if available: Observe how treatment plan is developed. Listen especially for discussion of assessment, client preferences, and individualization of treatment. Do they review treatment plans? Item Response Coding: If >80% of EBP clients have an explicit, individualized treatment plan that is updated every 3 months, the item would be coded as a 5. If the treatment plan is individualized but updated only every 6 months, then the item would be coded as a 3. G6. Individualized Treatment Definition: All EBP clients receive individualized treatment meeting the goals of the EBP. Individualized treatment means that steps, strategies, services/interventions, and intensity of involvement are focused on specific client goals and are unique for each client. Progress notes are often a good source of what really goes on. Treatment could be highly individualized despite the presence of generic treatment plans. An example of a low score on this item for Integrated Dual Disorders Treatment: a client in the engagement phase of recovery is assigned to a relapse prevention group and constantly told he needs to quit using, rather than using motivational interventions. An example for a low score on this item for Assertive Community Treatment: the majority of progress notes are written by day treatment staff who see the client 3-4 days per week, while the Assertive Community Treatment team only sees the client about once per week to issue his check. Rationale: The key to the success of an EBP is implementing a plan that is individualized and meets the goals for the EBP for each client. a) Chart review (treatment plan): Using the same charts as examined during the EBP-specific fidelity assessment, examine the treatment provided. Limit the focus to a recent treatment plan related to the EBP. The assessor should judge whether an appropriate treatment occurred during the time frame indicated by the treatment plan. b) Practitioner interview: When feasible, use the specific charts selected above. Ask the practitioners to go over a sample treatment plan and treatment. c) Client interview:

9 GOI Protocol Page 9 The key outcome indicators for each EBP are discussed in the implementation resource kits. A provisional list is as follows: o Supported Employment competitive employment rate o Integrated Dual Disorders Treatment substance use (such as the Stages of Treatment Scale) o Illness Management & Recovery hospitalization rates; relapse prevention plans; medication compliance rates o Family Psychoeducation hospitalization and family burden o Assertive Community Treatment hospitalization and housing a) Program leader interview, b) Senior staff interview and c) Practitioner interview: Does your program have a systematic method for tracking outcome data? [If yes] Probe for specifics: how (computerized vs. chart only), frequency, type of outcome variables, who collects data, etc. Do you use any checklist/scale to monitor client outcome (e.g., Substance Abuse Treatment Scale)? What do you do with the outcome data? Do your practitioners review the data on regular basis? [If yes] How is the review done (e.g., cumulative graph)? Have the outcome data impacted how your services are provided? For example? d) Review of internal reports/documentation, if available Item Response Coding: If standardized outcome monitoring occurs quarterly and results are shared with EBP practitioners, the item would be coded as a 5. G11. Quality Assurance (QA) Definition: The agency's QA Committee has an explicit plan to review the EBP or components of the program every 6 months. The steering committee for the EBP can serve this function. Good QA committees help the agency in important decisions, such as penetration goals, placement of the EBP within the agency, hiring/staffing needs. QA committees also help guide and sustain the implementation by reviewing fidelity to the EBP model, making recommendations for improvement, advocating/promoting the EBP within the agency and in the community, and deciding on and keeping track of key outcomes relevant to the EBP. Rationale: Research has shown that programs that most successfully implement EBPs have better outcomes. Again, systematic and regular collection of process and outcome data is imperative in evaluating program effectiveness. a) Program leader interview: Does your agency have an established team/committee that is in charge of reviewing the components of your [EBP area] program? [If yes] Probe for specifics: who, how, when, etc.

10 GOI Protocol Page 10 b) QA Committee member interview: Please describe the tasks and responsibilities of the QA Committee. Probe for specifics: purpose, who, how, when, etc. How do you utilize your reviews to improve the program s services? Item Response Coding: If agency has an established QA group or steering committee that reviews the EBP or components of the program every 6 months, the item would be coded as a 5. G12. Client Choice Regarding Service Provision Definition: All clients receiving EBP services are offered a reasonable range of choices consistent with the EBP; the EBP practitioners consider and abide by client preferences for treatment when offering and providing services. Choice is defined narrowly in this item to refer to services provided. This item does not address broader issues of client choice, such as choosing to engage in self-destructive behaviors. To score high on this item, it is not sufficient that a program offers choices. The choices must be consonant with EBP. So, for example, a program implementing Supported Employment would score low if the only employment choices it offers were sheltered workshops. A reasonable range of choices means that EBP practitioners offer realistic options to clients rather than prescribing only one or a couple of choices or dictating a fixed sequence or prescribing conditions that a client must complete before becoming eligible for a service. Sample of Relevant Choices by EBP: o Assertive Community Treatment: - Type and location of housing - Nature of health promotion - Nature of assistance with financial management - Specific goals - Daily living skills to be taught - Nature of medication support - Nature of substance abuse treatment o Family Psychoeducation: - Client readiness for involving family - Who to involve - Choice of problems/issues to work on o Illness Management & Recovery: - Selection of significant others to be involved - Specific self management goals - Nature of behavioral tailoring - Skills to be taught

11 GOI Protocol Page 11 o Integrated Dual Disorders Treatment: - Group or individual interventions - Frequency of DD treatment - Specific self-management goals o Supported Employment: - Type of occupation - Type of work setting - Schedules of work and number of hours - Whether to disclose - Nature of accommodations - Type and frequency of follow-up supports Rationale: A major premise of EBP is that clients are capable of playing a vital role in the management of their illnesses and in making progress towards achieving their goals. Providers accept the responsibility of getting information to clients so that they can become more effective participants in the treatment process. a) Program leader interview. Please tell us what your program philosophy is regarding client choice. How do you incorporate their preferences in the services you provide? What options are there for your services? Please give examples. b) Practitioner interview. What do you do when there is a disagreement between what you think is the best treatment for a client and what he/she wants? Please describe a time when you were unable to abide by a client s preferences. c) Client interview. Does the program give you options for the services you receive? Are you receiving the services you want? d) Team meeting/supervision observation. Look for discussion of service options and client preferences. e) Chart review (especially treatment plan). Look for documentation of client preferences and choices. Item Response Coding: If all sources support that type and frequency of EBP services always reflect client choice, the item would be coded as a 5. If agency embraces client choice fully except in one area (e.g., requiring the agency to assume representative payeeships for all clients), then the item would be coded as a 4. G13. Practice Is Integrated into Daily Work (Note: Item added since version) Definition: If specific productivity standards are part of agency policies, the system incorporates the following activities for EBP practitioners: Participate in EBP skills training Prepare for EBP sessions

14 GOI Protocol Page 14 General Organizational Index (GOI) Cover Sheet Date: Rater(s): Program Name: Address: Contact Person: (Title: ) : Fax: Sources Used: Chart review Team meeting observation Agency brochure review Supervision observation Interview with Program Director/Coordinator Interview with Practitioners Interview with supervisors Interview with clients Interview with supervisors Interview with rehabilitation service providers Interview with Interview with # of EBP Practitioners: # of active clients served by EBPDD: # of clients served by EBP in preceding year: # of charts reviewed Date program was started:

15 GOI Score Sheet Program: Date of Visit: Informants Name(s) and Position(s):,,,,, Number of Records Reviewed: Rater 1: Rater 2: Rater 1 Rater 2 Consensus G1 Program Philosophy G2 Eligibility/Client Identification G3 Penetration G4 Assessment G5 Individualized Treatment Plan G6 Individualized Treatment G7 Training G8 Supervision G9 Process Monitoring G10 Outcome Monitoring G11 Quality Assurance (QA) G12 Client Choice Regarding Service Provision G13 Practice Is Integrated into Daily Work G14 EBP Coordinator/Program Leader TOTAL MEAN SCORE:

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