Program:_____________ Date of Visit:_________ Rater 1 initials:______ Rater
2 initials:_____
| |
Rater 1 |
Rater 2 |
Consensus |
ACTUAL VALUE |
| H1 |
Small Caseload |
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| H2 |
Team Approach |
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| H3 |
Program Meeting |
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| H4 |
Practicing Team Leader |
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| H5 |
Continuity of Staffing |
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| H6 |
Staff Capacity |
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| H7 |
Psychiatrist on Staff |
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| H8 |
Nurse on Staff |
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| H9 |
Substance Abuse Specialist on Staff |
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| H10 |
Vocational Specialist on Staff |
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| H11 |
Program Size |
* |
* |
* |
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| |
HUMAN RESOURCES MEAN: |
| O1 |
Explicit Admission Criteria |
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| O2 |
Intake Rate |
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| O3 |
Full Responsibility for Treatment Services |
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| O4 |
Responsibility for Crisis Services |
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| O5 |
Responsibility for Hospital Admissions |
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| O6 |
Responsibility for Hospital Discharge Planning |
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| O7 |
Time-Unlimited Services |
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ORGANIZATONAL BOUNDARIES MEAN: |
| S1 |
In-Vivo Services |
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| S2 |
No Drop-Out Policy |
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| S3 |
Assertive Engagement Mechanisms |
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| S4 |
Intensity of Service |
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| S5 |
Frequency of Contact |
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| S6 |
Work with Support System |
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| S7 |
Individualized Substance Abuse Treatment |
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| S8 |
Dual Disorder Treatment Groups |
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| S9 |
Dual Disorders (DD) Model |
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| S10 |
Role of Consumers on Treatment Team |
* |
* |
* |
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NATURE OF SERVICES MEAN: |
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TOTAL MEAN SCORE |
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