Psychiatric Competency Self Assessment



Similar documents
[KQ 804] FEBRUARY 2007 Sub. Code: 9105

DSM-5 to ICD-9 Crosswalk for Psychiatric Disorders

opiates alcohol 27 opiates and alcohol 30 April 2016 drug addiction signs 42 Ranked #1 123 Drug Rehab Centers in New Jersey 100 Top

Specialty Mental Health Services OUTPATIENT TABLE

Complete List of DSM-IV Codes

EXHIBIT D, COVERED BEHAVIORAL HEALTH DIAGNOSES

ICD-9/DSM IV TO ICD-10 CROSSWALK TABLE

Mental Health ICD-10 Codes Department of Health and Mental Hygiene

Covered Diagnoses & Crosswalk of DSM-IV Codes to ICD-9-CM Codes

Diagnosis Codes Requiring PASRR Level II_ xls

Provider Notice May 30, Pre-Authorization 1915(b) Service

F43.22 Adjustment disorder with mixed anxiety and depressed mood Adjustment disorder with disturbance of conduct

Abnormal Psychology PSY-350-TE

ICD-10 Mental Health Billable Diagnosis Codes in Alphabetical Order by Description

Unit 4: Personality, Psychological Disorders, and Treatment

Care Management Scale--Youth Rev. 10/26/07

Behavioral Health Best Practice Documentation

DSM IV TR Diagnostic Codes. (In Numeric Order) DSM IV Codes: Through revisions on and Code Description Code Description

Washington State Regional Support Network (RSN)

Crosswalk to DSM-IV-TR

CRITERIA CHECKLIST. Serious Mental Illness (SMI)

Feeling Moody? Major Depressive. Disorder. Is it just a bad mood or is it a disorder? Mood Disorders. S Eclairer

Behavioral Health Screening Coding Requirements

Brief Review of Common Mental Illnesses and Treatment

Transitioning to ICD-10 Behavioral Health

ICD- 9 Source Description ICD- 10 Source Description

BRIEF NOTES ON THE MENTAL HEALTH OF CHILDREN AND ADOLESCENTS

Mental health issues in the elderly. January 28th 2008 Presented by Éric R. Thériault

Table of Contents. Preface...xv. Part I: Introduction to Mental Health Disorders and Depression

TABLE 6E--REVISED DIAGNOSIS CODE TITLES Page 1 of 9 October 1, 2004

Attachment A. Code Beginning Review

PhD. IN (Psychological and Educational Counseling)

North Bay Regional Health Centre

Clinical Audit: Prescribing antipsychotic medication for people with dementia

THERASCRIBE INFORMATION

Dual diagnosis: working together

CO-OCCURRING DISORDERS. Michaelene Spence MA LADC 8/8/12

Mental Health 101 for Criminal Justice Professionals David A. D Amora, M.S.

SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011

Mental Health Ombudsman Training Manual. Advocacy and the Adult Home Resident. Module V: Substance Abuse and Common Mental Health Disorders

APPENDIX C: PROCEDURES FOR IDENTIFYING INDIVIDUALS WITH MENTAL ILLNESS DEFINITION OF INPATIENT STAYS

IL DHS/DMH DSM 5 Diagnoses Effective Target Population: Serious Mental Illness (SMI) for DHS/DMH funded MH services

Florida Medicaid: Mental Health and Substance Abuse Services

APPIC APPLICATION Summary of Practicum Experiences

DIAGNOSTIC RELATED GROUP (DRG) DESCRIPTIONS

BOARD OF PHARMACY SPECIALITIES 2215 Constitution Avenue, NW Washington, DC FAX

I. Each evaluator will have experience in diagnosing and treating the disease of chemical dependence.

MENTAL DISORDERS ORGANIC PSYCHOTIC CONDITIONS ( )

ADULT INTAKE QUESTIONNAIRE. Today s Date: Home phone: Ok to leave message? Yes No. Work phone: Ok to leave message? Yes No

Electroconvulsive Therapy - ECT

Approvable Antipsychotic ICD-9 Diagnoses

Drugs PSYCHOSIS. Depression. Stress Medical Illness. Mania. Schizophrenia

AP PSYCHOLOGY CASE STUDY

Billing for other services for members in psychiatric residential treatment facilities

DSM-5 Do Not Use ICD -10 Codes

PSYCHOPHARMACOLOGY AND WORKING WITH PSYCHIATRY PROVIDERS. Juanaelena Garcia, MD Psychiatry Director Institute for Family Health

Co-Occurring Disorders

PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL TESTING

WORKERS COMPENSATION PROTOCOLS WHEN PRIMARY INJURY IS PSYCHIATRIC/PSYCHOLOGICAL

Delusions are false beliefs that are not part of their real-life. The person keeps on believing his delusions even when other people prove that the be

ADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines

Planning Services for Persons with Developmental Disabilities and Mental Health Diagnoses

Depression is a common biological brain disorder and occurs in 7-12% of all individuals over

Dementia in other diseases classified elsewhere with behavioral disturbance

Illinois Insurance Facts Illinois Department of Insurance Mental Health and Substance Use Disorder Coverage

Phenotype Processing Algorithm

REFERRAL FORM FOR ADMISSION TO HOMEWOOD HEALTH CENTRE

BIPOLAR DISORDER A GUIDE FOR INDIVIDUALS AND FAMILIES FOR THE TREATMENT OF BIPOLAR DISORDER IN ADULTS

Optum By United Behavioral Health Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines

Let s talk about Eating Disorders

How To Treat A Mental Illness At Riveredge Hospital

Documentation Requirements ADHD

Amicus Trust have been providing support to vulnerable people for over 40 years

Durham SOC Care Review LEVELS OF RESIDENTIAL CARE

Step 4: Complex and severe depression in adults

DEPRESSION CODING FACT SHEET FOR PRIMARY CARE CLINICIANS

PHENOTYPE PROCESSING METHODS.

Personality Disorders (PD) Summary (print version)

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery

Medical Necessity Criteria

Preadmission Screening. Who Is Subject to PASRR Screens. Who can Complete the ACH PASRR Level I Screen. Getting Help

Grade: 11 th & 12 th grade, Psychology TEKS Guiding Questions Content Vocabulary Resources/Lesson Ideas

Topics In Addictions and Mental Health: Concurrent disorders and Community resources. Laurence Bosley, MD, FRCPC

Procedure/ Revenue Code. Billing NPI Required. Rendering NPI Required. Service/Revenue Code Description. Yes No No

REFERRAL INFORMATION CHILD, YOUTH AND FAMILY PROGRAM

Traumatic Stress. and Substance Use Problems

Introduction to the DSM-IV and Psychological Testing

Austen Riggs Center Patient Demographics

Test Content Outline Effective Date: October 25, Psychiatric and Mental Health Nursing Board Certification Examination

Sunderland Psychological Wellbeing Service

CalChoice HMO Aetna* No Deductible. No Deductible DR OFFICE VISITS $15 Copay. $25 Copay. $100 Copay. $100 Copay HOSPITAL SERVICES 100%

Bipolar Disorder. When people with bipolar disorder feel very happy and "up," they are also much more active than usual. This is called mania.

Inpatient Behavioral Health and Inpatient Substance Abuse Treatment: Aligning Care Efficiencies with Effective Treatment

Butte County Behavioral Health. Anne Robin, MFT Director

Transcription:

Psychiatric Competency Self Assessment Directions Please circle a value for each question to provide us and the interested facilities with an assessment of your clinical experience. These values confirm your strengths within your specialty and assist the facility in the selection process of the healthcare professional. 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Print Name Last 4 Digits of SS# Date Treatment Settings Inpatient hospital psychiatric unit 0 1 2 3 4 5 Inpatient acute psychiatric facility 0 1 2 3 4 5 Chronic psychiatric facility 0 1 2 3 4 5 Outpatient clinic/community setting 0 1 2 3 4 5 Forensic unit (prison) 0 1 2 3 4 5 Eating disorder unit 0 1 2 3 4 5 Substance abuse/rehab unit 0 1 2 3 4 5 Locked unit/ward 0 1 2 3 4 5 Legal/Ethical Advanced directives 0 1 2 3 4 5 Legal right s of the mentally ill 0 1 2 3 4 5 Informed consent 0 1 2 3 4 5 Right to refuse treatment 0 1 2 3 4 5 Voluntary commitment 0 1 2 3 4 5 Involuntary commitment 0 1 2 3 4 5 Restrictive devices (restraints) 0 1 2 3 4 5 Use of seclusion 0 1 2 3 4 5 Terrasoff duty to warn 0 1 2 3 4 5 Emergency Care Use of rapid response teams 0 1 2 3 4 5 Cardiac arrest/cpr 0 1 2 3 4 5 Airway management 0 1 2 3 4 5 Oxygen therapy 0 1 2 3 4 5 Oral/nasotracheal suctioning 0 1 2 3 4 5 Pulse oximetry 0 1 2 3 4 5 IV therapy 0 1 2 3 4 5 Start & maintaining peripheral IVs 0 1 2 3 4 5 2012 Cross Country Healthcare, Inc. Rev. 09/12 F0054 Psychiatric 1 of 6

1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Emergency Care - cont. Blood draw: venous 0 1 2 3 4 5 Infusion pumps 0 1 2 3 4 5 Skilled Nursing Care Assessment of circulation/peripheral pulses 0 1 2 3 4 5 Blood Glucose Monitoring (BGM) 0 1 2 3 4 5 Foley catheter insertion/maintenance 0 1 2 3 4 5 NG tube insertion/maintenance 0 1 2 3 4 5 Wound care/dressing changes 0 1 2 3 4 5 Administration of blood/blood products 0 1 2 3 4 5 Management of fluid/electrolyte balance 0 1 2 3 4 5 Seizure precautions 0 1 2 3 4 5 National Patient Safety Goals 0 1 2 3 4 5 Accurate patient identification 0 1 2 3 4 5 Effective communication 0 1 2 3 4 5 Interpretation & communication of lab values 0 1 2 3 4 5 Medication administration 0 1 2 3 4 5 Awareness of HCAHPS 0 1 2 3 4 5 Bar coding for medication administration 0 1 2 3 4 5 Labeling (medications & specimens) 0 1 2 3 4 5 Medication reconciliation 0 1 2 3 4 5 Anticoagulation therapy 0 1 2 3 4 5 Pain assessment & management 0 1 2 3 4 5 Infection control 0 1 2 3 4 5 Universal precautions 0 1 2 3 4 5 Isolation 0 1 2 3 4 5 Minimize risk for falls 0 1 2 3 4 5 Prevention of pressure ulcers 0 1 2 3 4 5 Clinical Assessment Tools Intelligence Assessment Wechsler Intelligence Scale (WAIS) 0 1 2 3 4 5 Wechsler Intelligence Scale for Children 0 1 2 3 4 5 Psychological Testing Minnesota Multiphasic Personality Inventory (MMPI) 0 1 2 3 4 5 Beck Depression Inventory (BDI) 0 1 2 3 4 5 Thematic Apperception Test (TAT) 0 1 2 3 4 5 Child s Apperception Test (CAT) 0 1 2 3 4 5 2012 Cross Country Healthcare, Inc. Rev. 09/12 F0054 Psychiatric 2 of 6

1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Clinical Assessment Tools - cont. Informal cognitive status assessment 0 1 2 3 4 5 Mental status assessment 0 1 2 3 4 5 Gestalt test 0 1 2 3 4 5 Stanford-Binet test 0 1 2 3 4 5 Communication Techniques Active listening 0 1 2 3 4 5 Restatement/reflection 0 1 2 3 4 5 Clarification 0 1 2 3 4 5 Focusing 0 1 2 3 4 5 Confronting 0 1 2 3 4 5 Summarizing 0 1 2 3 4 5 Therapeutic Interventions Limit setting 0 1 2 3 4 5 Positive reinforcement 0 1 2 3 4 5 Reality orientation 0 1 2 3 4 5 Questioning 0 1 2 3 4 5 Psychiatric Disorders Mood Disorders Major depression 0 1 2 3 4 5 Dysthymia 0 1 2 3 4 5 Bipolar disorder (manic-depressive illness) 0 1 2 3 4 5 Type I 0 1 2 3 4 5 Type II 0 1 2 3 4 5 Anxiety Disorders GAD - Generalized Anxiety Disorder 0 1 2 3 4 5 Panic 0 1 2 3 4 5 Post Traumatic Stress Disorder 0 1 2 3 4 5 Obsessive-compulsive 0 1 2 3 4 5 Phobias 0 1 2 3 4 5 Psychotic Disorders Schizophrenia 0 1 2 3 4 5 Schizoaffective disorder 0 1 2 3 4 5 Schizophreniform disorder 0 1 2 3 4 5 Personality Disorders Antisocial 0 1 2 3 4 5 2012 Cross Country Healthcare, Inc. Rev. 09/12 F0054 Psychiatric 3 of 6

1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Psychiatric Disorders - cont. Passive/aggressive 0 1 2 3 4 5 Paranoia 0 1 2 3 4 5 Borderline 0 1 2 3 4 5 Schizotypal personality disorder 0 1 2 3 4 5 Congenital Disorders Mental retardation 0 1 2 3 4 5 Down s syndrome 0 1 2 3 4 5 Cystic fibrosis 0 1 2 3 4 5 Cerebral palsy 0 1 2 3 4 5 Spina bifida 0 1 2 3 4 5 Degenerative Disorders Alzheimer s disease 0 1 2 3 4 5 Parkinson s disease 0 1 2 3 4 5 Huntington s chorea 0 1 2 3 4 5 Eating Disorders Anorexia nervosa 0 1 2 3 4 5 Bulimia nervosa 0 1 2 3 4 5 Pica 0 1 2 3 4 5 Crisis Management Homicide 0 1 2 3 4 5 Suicide/suicide precautions 0 1 2 3 4 5 Rape 0 1 2 3 4 5 Violence/family & individuals 0 1 2 3 4 5 Substance Use / Abuse Withdrawal syndrome 0 1 2 3 4 5 Alcohol or ETOH 0 1 2 3 4 5 CIWA scale 0 1 2 3 4 5 Delirium tremens (DTs) 0 1 2 3 4 5 Wernicke-Korsakoff 0 1 2 3 4 5 Drug Use/Abuse Hallucinogenics 0 1 2 3 4 5 Opiates 0 1 2 3 4 5 Heroin 0 1 2 3 4 5 Prescription 0 1 2 3 4 5 Stimulants (amphetamines/cocaine/mdma) 0 1 2 3 4 5 Benzodiazepine 0 1 2 3 4 5 2012 Cross Country Healthcare, Inc. Rev. 09/12 F0054 Psychiatric 4 of 6

1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Substance Use / Abuse - cont. Drug withdrawal/detoxification 0 1 2 3 4 5 COWS scale for opiate withdrawal symptom assessment 0 1 2 3 4 5 Sexuality Dysfunction Gender Identity Disorders Paraphilias 0 1 2 3 4 5 Psychosexual dysfunctions 0 1 2 3 4 5 Child/Adolescent Dysfunction Conduct disorder 0 1 2 3 4 5 Separation anxiety disorders 0 1 2 3 4 5 ADHD (Attention Deficit Hyperactivity Disorder) 0 1 2 3 4 5 ADD (Attention Deficit Disorder) 0 1 2 3 4 5 Elimination Disorders Encopresis 0 1 2 3 4 5 Enuresis 0 1 2 3 4 5 Pervasive Developmental Disorders Autism 0 1 2 3 4 5 Asperger s syndrome 0 1 2 3 4 5 Rett syndrome 0 1 2 3 4 5 Self destructiveness 0 1 2 3 4 5 Suicidal behavior 0 1 2 3 4 5 Runaway behavior 0 1 2 3 4 5 Substance abuse 0 1 2 3 4 5 Delinquent behavior 0 1 2 3 4 5 Neglect/lack of parental involvement 0 1 2 3 4 5 Physical/sexual abuse 0 1 2 3 4 5 Care of the patient with delusions 0 1 2 3 4 5 Care of the patient with hallucinations 0 1 2 3 4 5 Therapeutic Approaches Psychotherapy 0 1 2 3 4 5 Behavior therapy 0 1 2 3 4 5 Milieu management 0 1 2 3 4 5 Relationship/family therapy 0 1 2 3 4 5 Electroconvulsive Therapy (ECT) 0 1 2 3 4 5 Crisis counseling 0 1 2 3 4 5 Behavior modification 0 1 2 3 4 5 Group therapy 0 1 2 3 4 5 2012 Cross Country Healthcare, Inc. Rev. 09/12 F0054 Psychiatric 5 of 6

1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Medications Analgesics/narcotics (MS, Dilaudid, Demerol, fentanyl, methadone) 0 1 2 3 4 5 Antidepressants (TCA, MAOIs, SSRIs) 0 1 2 3 4 5 Antiolytics (Valium, Ativan, Xanax) 0 1 2 3 4 5 Antiparkinson (levodopa, Sinemet) 0 1 2 3 4 5 Antipsychotic (Thorazine, Haldol, zyrexa, Seroquel) 0 1 2 3 4 5 Mood stabilizer (lithium, Depakote, Tegretol) 0 1 2 3 4 5 Automated Medication Dispensing System, Pyxis, Omnicell, or other 0 1 2 3 4 5 Age Specific Competencies School age (ages 6-12 years) 0 1 2 3 4 5 Adolescents (ages 13-21 years) 0 1 2 3 4 5 Young adult (ages 22-39 years) 0 1 2 3 4 5 Adults (ages 40-64 years) 0 1 2 3 4 5 Older adult (ages 65-79 years) 0 1 2 3 4 5 Elderly (ages 80+ years) 0 1 2 3 4 5 Please list any Additional Skills: 1. 2. 3. 4. Additional training: 1. 2. 3. 4. Additional equipment: 1. 2. 3. 4. Fax to: 1-888-298-3146 The information on this and all preceding pages is true and correct. Signature Date 2012 Cross Country Healthcare, Inc. Rev. 09/12 F0054 Psychiatric 6 of 6

2026 © DocPlayer.net Privacy Policy | Terms of Service | Feedback  | Do Not Sell My Personal Information