SURVEY OF THE DELIVERY OF EVIDENCE BASED PSYCHOTHERAPY: SUPERVISORS
Instructions: Please complete this survey based on your observation of the recent therapy sessions with ________________________________(clinician) and ________________________ (client).
Note: Not every therapeutic element will be delivered in every therapy session.
- Only endorse "yes" to those survey items that reflect the treatment you observed provided in this session.
- If the item did not occur in this session, please mark "no".
Your responses will be kept confidential and not be shared with your supervisee, anyone within your organization, or anyone outside of the Mathematica research team.
|1.||What is the date of the session that you observed (i.e. date of session that supervision occurred)?||____ / ____ / _____ [mm/dd/yyyy]|
|During this session:||Please select one response|
|2.||Did the therapist set an agenda?|
|3.||Did the therapist go over the agenda with the client?|
|4.||Did the therapist provide background on the treatment rationales and concepts during this session (i.e., explaining why the therapist is asking the client to do something or explaining why something is occurring within the session)?|
|5.||Did the therapist discuss or check-in on the client's treatment expectations (i.e., what will happen, how treatment will progress, expectations for improvement)?|
|6.||Did the therapist and his/her client mutually set or check-in on goals for treatment?|
|7.||Did the therapist identify salient problem areas related to the trauma?
|8.||Did the therapist 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?|
|9.||Did the therapist use a Socratic discussion method, that is, statements or questions designed for the client to examine his/her beliefs?
|10.||Did the therapist facilitate the development of alternative hypotheses (i.e., alternative viewpoints or explanations) to problematic beliefs?
Examples of alternative hypotheses to problematic thinking might include:
|11.||Did the therapist 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.|
|12.||Did the therapist 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?
|13.||Did the therapist 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|
|14.||Did the therapist discuss and process the details of the client's recounting of the trauma, including the emotions surrounding the event?|
|15.||Did the therapist struggle to manage time for any of the reasons below:
|16.||Was the therapist directive (i.e., followed the agenda or guided the client to relevant discussion) during this session?|
|17.||Did the therapist ask the client for feedback or input on his/her treatment (i.e., "how is this working?"; "Are we working on things that you think are important?")? This would exclude progress monitoring.|
|18.||Did the therapist ask the client for feedback on himself/herself?|
|19.||Did the therapist assign his/her 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?|
|20.||Did the therapist review the assignment instructions and verify the client has a thorough understanding of the homework for the next session?|
|21.||Did the therapist address difficulties or barriers related to the completion of homework from the previous session?|
|22.||Did the therapist work with the client to come up with solutions to difficulties, barriers, or issues in completing the homework from the previous session?|
|23.||Did the therapist review and discuss the client's homework assigned during the previous session?|
|24.||When reviewing the homework assigned from the previous session, did the therapist encourage the client or provide him/her with constructive feedback?|
|For question part a., please think about the overall course of treatment with this client.
For question part b., focus on the care given during the selected session.
|Please select one response|
|28.||a. To your knowledge, has the therapist ever conducted a suicide risk assessment with this client?|
|b. Did the therapist conduct suicide risk assessment during this session?|
|29.||a. To your knowledge, has the therapist ever used information from a suicide risk assessment to influence treatment or monitor progress with this client?|
|b. Did the therapist use information from the suicide risk assessment to influence treatment or monitor progress during this session?|
|30.||a.To your knowledge, has the therapist used any valid standardized instruments (e.g., The Revised PTSD Checklist) or psychometric scales to monitor PTSD symptoms and assess change?|
|b.Did the therapist use any valid standardized instruments (e.g., The Revised PTSD Checklist) or psychometric scales to monitor PTSD symptoms and assess change during this session?|
|31.||a. To your knowledge has the therapist ever provided the client with education on their symptoms (i.e., education on avoidance, flashbacks, etc.)?|
|b. Did the therapist provide the client with education on their symptoms (i.e., education on avoidance, flashbacks, etc.) during this session?|
|32.||a. To your knowledge, has the therapist 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 the therapist 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?
|33.||a. To your knowledge, has the therapist 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 the therapist 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