CHART REVIEW TALLY SHEET (Part I) - Tally list of 20% (minimum of 10) client charts. ***Reminder: Only count toward these items those face-to-face client contacts made by staff who met ACT team inclusion guidelines (See OS1 and OS5; e.g., exclude staff who work less than 16 hours with the team). Review each Chart Review Log PT I to exclude non-ACT staff before tallying data here. Also, for OS2 and CP1, only consider those charts with at least one contact. OS6. CT4. CT7, CP8, EP1 - EP3 Full Responsibility for Service Items, and EP7 Priority Psychiatric CP3: CP4: OS2: Team CP1: Service Provider Intensity Frequency Approach Services Contacts (and of Service of Contact For each code the following: CP7) How often seen % of total contacts # of ACT by ACT that are Mean/ + = If indicated by H = Evidence of Higher Quality * = If service systematically # of Unique team members in Does psychiatric care (collapse average # team as receiving best practice services provided (i.e., there is a this Service (Excel L = Evidence of Lower Quality deliberate pattern of Client contact with diagnosis provider?1 and of minutes “community” Spreadsheet) best practice services service delivery). ID client during a fit w/ Code: per “institution” contacts week period ACT 1 = within 6 together) over (office and (*DACTS criteria? weeks (Total # face-to-face week Standard is more If not, 2 = within 3 community-based period per than 1 team note months contacts/Total # of (Total over member in first 2 diagnosis. 3 = 3+ months face-to-face office & SEE WMR Integrated Tx for weeks) (add * if community-based services Psych Rehab Services Health Co-Occurring period therapy) contacts) (EP2) Services (CP8) (EP3) (EP7) (CT7) Disorders (EP1) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 27. 28. 28. 29. 30.
CHART REVIEW TALLY SHEET (Part I) - Tally list of 20% (minimum of 10) client charts. ***Reminder: Only count toward these items those face-to-face client contacts made by staff who met ACT team inclusion guidelines (See OS1 and OS5; e.g., exclude staff who work less than 16 hours with the team). Review each Chart Review Log PT I to exclude non-ACT staff before tallying data here. Also, for OS2 and CP1, only consider those charts with at least one contact. Unique Client ID OS2: Team Approach OS6. Priority Service CT4. Psychiatric Provider Contacts (and CP7) CP1: Services CP3: Intensity of Service CP4: Frequency of Contact CT7, CP8, EP1 - EP3 Full Responsibility for Service Items, and EP7 For each code the following: # of ACT team members in contact with client during a period (*DACTS Standard is more than 1 team member in first 2 weeks) Does diagnosis fit w/ ACT criteria? If not, note diagnosis. How often seen by ACT psychiatric care provider?1 Code: 1 = within 6 weeks 2 = within 3 months 3 = 3+ months (add * if therapy) % of total contacts that are (collapse “community” and “institution” together) (Total # face-to-face community-based contacts/Total # of face-to-face office & community-based contacts) Mean/ average # of minutes per week over period (Total # of contacts (office and per week over period + = If indicated by team as receiving this Service (Excel Spreadsheet) H = Evidence of Higher Quality best practice services L = Evidence of Lower Quality best practice services * = If service systematically provided (i.e., there is a deliberate pattern of service delivery). Integrated Tx for Co-Occurring Disorders (EP1) SEE services (EP2) Psych Rehab Services (CP8) WMR Services (EP3) (EP7) Health (CT7) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 27. 28. 29. 30.
CHART-REVIEW-TALLY-SHEET-Part-I-TMACT-1.0rev3.docx