Clinical Mental Health Day Programme Proposal Template

Please use this template for a proposal for a clinical mental health outpatient day programme, referring to DVA’s Guide to Clinical Mental Health Day Programmes.

Name of Provider
Name of Hospital(s)
Name of Proposal

1. Programme Information

Element / Information to be supplied by providers on programme
Programme title
Title suitably describes proposed programme
Programme focus
Target condition or problem
The programmes should clearly state the target condition being treated and outline a clear set of goals or expected outcomes for the programme that the client can easily understand.
Programme content
  • Topics/activities included
  • Core content includes reference to therapy elements which should be best practice and derived from a sound evidence base. Programmes may use other types of therapy not listed but these need to be in addition to the core content elements. Examples of other therapeutic approaches may include, for example Acceptance and Commitment Therapy; Art Therapy; Somatic Therapy; Music Therapy; Yoga. (Note this is not intended as an exhaustive list).
Please provide copies of facilitator and participant manuals.
Programme format
Detail number of treatment days per programme. / ______days
Number of contact hours per treatment day (specify whether half day or full day programme).
NOTE:
For half day programmes minimum of 2.5 contact hours.
For full day programmes a minimum of 4.5 hours contact hours. / ______half day contact hours:
______full day contact hours
Number of hours of core content on each treatment day.
NOTE:
For half day programmes aminimum 1-1.5 hours of core content.
For full day programmes and a minimum of 2 - 3 hours of core content. / ______hours of core content (per half day)
______hours of core content (per full day)
Provide details of mode of delivery (structured / unstructured / experiential / didactic)
Number of participants per cohort
(NOTE: Number of facilitators - one facilitator for up to 12 participants and more than twelve two facilitators. / ______participants
Please indicate if homework is routinely included. / Yes / No
If yes, please describe
Timetable
Provide timetable, detailing what is covered in each session and number and qualifications of facilitator/s. / (Please attach a copy of the timetable)
Evaluation
Provide details as follows:
  • List established outcome measures used (including publication details)
  • Data collection time points
  • Client Satisfaction Surveys
  • Utilisation of data
It is recognised that both subjective and objective measures will be used – please provide both.
Reporting
An outline of reporting timelines, including reporting format. The reports should include relevant statistical and qualitative data as well as analysis of patient outcomes and comparison with best practice.

2. Staffing

Element / Information to be supplied by providers on programme
Qualifications
Provide details of discipline and qualifications for all staff involved in the programme.
For OTs and SWs please specify eligibility for mental health accreditation.
For nurses, please specify Registered Mental Health Nurse endorsement.
Expertise
Provide details of specific training and experience in the programme content and treatment approach – please list for each facilitator.
Supervision
Provide details of the nature and frequency (e.g. discipline specific, team, group, individual) of clinical supervision

3. Clinical Care

Element / Information to be supplied by providers on programme
Pre-programme assessment
Please provide details and/or copy of the following:
  • Qualifications of assessor
  • Intake assessment protocol
  • Inclusion and exclusion criteria

Treatment planning, liaison and monitoring
Please describe processes in place, for:
Please describe processes in place, for:
  • Liaison regarding intake (e.g. with referrer, Veterans and Veterans Families Counselling Service, other providers
  • Details of multidisciplinary input
  • Client involvement in treatment planning
  • Written treatment plans developed (provide copy of treatment plan template)
  • System for monitoring progress

Ongoing risk assessment and management
Provide details of:
  • Risk assessment system
  • Risk management system
/ Please provide copy of risk assessment protocol
Programme discharge planning
Provide details of:
  • Discharge planning procedures (incl. persons involved)
  • Provision of discharge summaries

Liaison with other services
Provide details of liaison with any other services involved with discharge, including:
  • Which services
  • Type and frequency of contact

4. Cost

Element / Information to be supplied by providers on programme
Cost
Please provide a detailed analysis of programme costs