SURVEY OF THE DELIVERY OF EVIDENCE BASED PSYCHOTHERAPY: CLINICIANS
Instructions: Please complete this survey based on the recent therapy session you had with ______________________________ on _____________________.
Note: Not every therapeutic element will be delivered in every therapy session.
- Only endorse "yes" to those survey items that reflect the treatment you provided in this session. If the item did not occur in this session, please mark "no".
Your responses will be kept confidential and will not be shared with your client, anyone within your organization, or anyone outside the Mathematica research team.
|During this session on:||Please select one response|
|1.||Did you set an agenda?|
|2.||Did you go over the agenda with the client?|
|3.||Did you provide background on the treatment rationales and concepts during this session (i.e., why you are asking the client to do something or explaining why something is occurring within the session)?|
|4.||Did you discuss or check-in on the client's treatment expectations (i.e., what will happen, how treatment will progress, expectations for improvement)?|
|5.||Did you and your client mutually set or check-in on goals for treatment?|
|6.||Did you identify salient problem areas related to the trauma?
|7.||Did you use cognitive restructuring techniques (techniques to address cognitive issues such as negative thoughts, distortions, false beliefs or perceptions and replace them with accurate and more useful cognitions) to work on the identified problem areas?|
|8.||Did you use a Socratic discussion method, that is, statements or questions designed for the client to examine their beliefs?
|9.||Did you facilitate the development of alternative hypotheses (i.e., alternative viewpoints or explanations) to problematic beliefs?
Examples of alternative hypotheses to problematic thinking might include:
|10.||Did you identify areas of trauma related avoidance, where the trauma has shifted or restricted daily patterns of living (i.e., the trauma has influenced daily functioning)? For example, a client may avoid places with loud noises and lots of people.|
|11.||Did you use techniques to systematically approach areas of trauma related avoidance, where the trauma has shifted daily patterns of living (i.e., the trauma has influenced daily functioning) from easier to more difficult situations?
|12.||Did you use any of the following techniques to deal with trauma related avoidance?|
|a. Ask the client to imagine their traumatic experience for longer than 10 minutes|
|b. Ask the client to write about their traumatic experience|
|c. Socratic discussion method (i.e., "How do you know this? Can you give me an example?")|
|d. Real world experiments like visiting a place related to the traumatic experience with the client for longer than 10 minutes|
|13.||Did you discuss and process the details of the client's recounting of the trauma, including the emotions surrounding the event?|
|14.||Did you struggle to manage time for anyof the reasons below:
|15.||Were you directive (i.e., followed the agenda or guided the client to relevant discussion) during this session?|
|16.||Did you ask your client for feedback or input on their treatment (i.e., "how is this working?"; "Are we working on things that you think are important?")? This would not include progress monitoring.|
|17.||Did you ask your client for feedback on you?|
|18.||Did you assign your client homework or practice assignments (to be completed by the next session) to deal with issues surrounding PTSD symptoms (i.e., avoidance, thought monitoring, problematic beliefs, anxiety) or issues related to the trauma?|
|19.||Did you review the assignment instructions and verify the client has a thorough understanding of the homework for the next session?|
|20.||Did you address difficulties or barriers related to completing of homework from the previous session?|
|21.||Did you work with your client to come up with solutions to difficulties, barriers, or issues in completing the homework from the previous session?|
|22.||Did you review and discuss your client's homework assigned during the previous session?|
|23.||When reviewing the homework assigned from the previous session, did you encourage the client or provide them with constructive feedback?|
|For question part a., please think about the overall course of treatment with this client.
For question part b., focus on care given during this selected treatment session.
|Please select one response|
|27.||a. Have you ever conducted a suicide risk assessment for this client?|
|b. Did you conduct suicide risk assessment during this session?|
|28.||a. Have you ever used information from your suicide risk assessment to influence treatment or monitor progress for this client?|
|b. Did you use information from your suicide risk assessment to influence treatment or monitor progress during this session?|
|29.||a. Have you ever used any valid standardized instruments (e.g., The Revised PTSD Checklist) or psychometric scales to monitor PTSD symptoms and assess change?|
|b. Did you use any valid standardized instruments (e.g., The Revised PTSD Checklist) or psychometric scales to monitor PTSD symptoms and assess change during this session?|
|30.||a. Have you ever provided the client with education on their symptoms (i.e., education on avoidance, flashbacks, etc.)?|
|b. Did you provide the client with education on their symptoms (i.e., education on avoidance, flashbacks, etc.) during this session?|
|31.||a. Have you ever provided the client with specific education on the nature of the traumatic event (i.e., changes in viewpoint or perception or facts about the type of trauma)?
|b. Did you provide the client with specific education on the nature of the traumatic event (i.e., changes in viewpoint or perception or facts about the type of trauma) during this session?
|32.||a. Have you ever provided the client with an outline or overview of the treatment process (i.e., what will happen over the course of treatment)?|
|b. Did you provide the client with an outline or overview of the treatment process (i.e., what will happen over the course of treatment) during this session?|
Thank you for your participation!
|According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Assistant Secretary of Planning and Evaluation,, Room 415F, US Department of Health and Human Services, 200 Independence Ave. SW, Washington, DC 20201. Do not return the completed for to this address.|
OMB NO. 0990-0418
Exp. Date 05/31/2017
Approved by NEIRB on 4/29/2014
NEIRB Version No. 1.0