Appendix A - Program & Service Details(complete a new sheet for each program/service)

Program/Service Name:

Intensive CBT

New/Existing: ☐ NewX Existing Clinical Practice Guidelines finalized for Program/Service?☐Yes☐No

Type:X Chronic Disease Management Health Promotion Prevention Priority Addressed (choose the one most appropriate):

☐Acute/Episodic Care ☐ Seniors Care ☐ Diabetes ☐Obesity/Nutrition☐ Smoking/Addictions

X Mental Health☐ Lung Health ☐ Heart Health☐ Other -

Provider / FTE
Social work / 0.05

Planned Staff Involvement (FTE):

OTN, external CBT professional

Collaboration with other organizations for program/service:

High Level Description & Goals
(2014/15) / 1)Target Number of Patients, and
2)Target Population
(2014/15) / 1)# of Patients Served
2)Patient Encounters**
(2013/14) / Activities
(2014/15) /
  • Performance Measures
  • Corresponding Targets
  • Actual Measure
(2013/14) /
  • Performance Measures
  • Corresponding Targets
(2014/15) / Planned Quality Improvements
(2014/15)
Provide CBT counselling by an out of town professional to improve access and address confidentiality issues of patients of small town. / 1) 20
2) Screened candidates suitiable to intensive CBT counselling based on evidence based practice guidelines / 1) 12
2) 168 sessions with out of town professional, /
  • Screen patients for suitability of intensive CBT
  • Receive referrals and triage and maintain wait list
  • Provide pre and post CBT support as needed
  • Gather and provide relevant information to professional providing the service
  • Assist in recruitment of new CBT professional so program can continue
/
  • Number of patients served
  • 20
  • 12
  • % patients completing CBT
  • 100%
  • 83%
/
  • Number of patients served
  • 10
  • % patients completing CBT
  • 100%
/
  • Recruit new provider for this service as previous provider is out of province and no longer able to continue to offer the service to patients in Ontario

Stories and Highlights (2013/14)

*For new programs/services, do not complete the shaded cells

**Patient encounters may include but are not limited to in-person appointments, telephone contacts, OTN and home visits. Group sessions should count each participant in each session as a patient encounter.

Programs share the following characteristics: a) specific patient group, b) meaningful, measurable objectives/indicators, and c) outcome measures/indicators that allow the FHT to determine whether the objectives have been achieved