Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Illness Management and Recovery

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: _____________