Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

General Organizational Index (GOI)

Date:____________________

Rater(s): _________________________________________

Program Name: ___________________________________

Address: ________________________________________

Contact Person: (Title: ) ____________________________

Phone: ____________________________

Fax: ______________________________

E-mail: _________________________________________

Sources Used:

____ Chart review

____ Agency brochure review

____ Team meeting observation

____ Supervision observation

____ Interview with Program Director/Coordinator

____ Interview with practitioners

____ Interview with clients

____ Interview with supervisors

____ Interview with rehabilitation service providers

____ Interview with ____________________

____ ____________________

# of EBP Practitioners: _________

# of active clients served by EBP: _________

# of clients served by EBP in preceding year: _______

# of charts reviewed _______

Date program was started: ____________________