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[null,null,"Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ) Toolkit"]
["Welcome to the PPAQ Toolkit"]
["The Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ) is a self-report instrument designed by investigators at the VA Center for Integrated Healthcare to assess how often behavioral health providers report engaging in certain behaviors or actions while providing services in primary care.  In particular, the PPAQ is intended for use by behavioral health providers to assess fidelity to models of primary care-mental health integration health services delivery, such as Primary Care Behavioral Health.\n\n\n"]
["Within this toolkit you will find:\n\n  • The PPAQ Worksheet\n  • PPAQ Scoring and Interpretation Information\n  • PPAQ Domain Interpretation Information \n  • Steps for Moving Forward with your PPAQ Results "]
["Using the PPAQ Toolkit"]
["The key components of the Toolkit are organized into five tabs, described in more detail below.  The Toolkit is designed to be user-friendly; step-by-step instructions for moving through each component of the toolkit are provided throughout.  Users are instructed to begin by completing the PPAQ worksheet, located on the following (second) tab.  They should then proceed through each of the subsequent tabs.\n\n\n"]
["An overview of each tab is provided below"]
[null,"Tab 1: Welcome to the PPAQ Toolkit"]
[null,null,"Provides and overview of Toolkit features and use."]
[null,"Tab 2: The PPAQ Worksheet"]
[null,null,"Provides the self-report form for completing the PPAQ."]
[null,"Tab 3: PPAQ Scoring and Interpretation"]
[null,null,"Provides automatic scoring of the PPAQ worksheet and walks users through interpreting results."]
[null,"Tab 4: PPAQ Domains"]
[null,null,"Provides further interpretive information regarding results in relation to domains of PC-MHI practice"]
[null,"Tab 5: Moving Forward"]
[null,null,"Suggests a process for using the Toolkit results to guide practice improvements"]
["\nIf you would like more background about the research behind the PPAQ, please right click the PowerPoint icon on the right and choose \"presentation object\" then choose \"open\" from the sub-menu.  Otherwise, click on the green arrow to begin the PPAQ Worksheet. Please note if you may need to \"enable editing\" and \"enable macros\" before beginning.Once completed the PPAQ toolkit has been formatted to be easily printed for paper copies\n"]

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[null,null,"Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ) Toolkit"]
["PPAQ Worksheet"]
["Provider: ",null,null,null,null,null,null,null,null,null,"Date: ",{"$f":"TODAY()","v":"2017-10-24"}]
["Clinic and Location: "]
["Instructions: For each item below, please indicate the frequency with which you typically engage in the behavior described while providing behavioral health services in primary care. Please do not leave any question blank. Click on the answer box next to each question to open the drop down box. Select your answer based on the PPAQ Response Categories. \n"]
["PPAQ Response Categories: 1=Never  2=Rarely  3=Sometimes  4=Often  5=Always"]
["Question ",null,null,null,null,null,null,null,null,null,null,"Answer"]
[]
["1. During clinical encounters with patients, I see patients for 30 minutes or less."]
["2. I manage patients reporting mild and moderate symptoms in primary care, and I refer those with more severe symptoms to specialty mental health services when possible."]
["3. During patient appointments, I discuss barriers to implementing a plan or adhering to treatment recommendations."]
["4. I accept referrals for patients with common mental health problems (i.e., depression, anxiety, etc.)."]
["5. During clinical encounters with a patient, I implement behavioral and/or cognitive interventions."]
["6. In introducing my role in the clinic to patients, I explain that I want to get an idea of what is and what is not working for the patient and then together develop a plan to help them manage their concerns."]
["7. During clinical encounters with patients, I triage patients to determine if they can be treated in primary care or should be referred to a specialty mental health or a community agency."]
["8. I accept referrals for patients who might benefit from brief, targeted behavioral health interventions for chronic pain."]
["9. I accept referrals for patients who might benefit from brief, targeted behavioral health interventions for adjustment to illness (e.g., diabetes, heart disease, spinal cord injury, TBI, etc.)."]
["10. My progress notes in the shared medical record include focused recommendations for the Primary Care Provider and/or primary care team."]
["11. I meet briefly with primary care staff as a team to provide both a behavioral health perspective and behavioral data."]
["12. My progress notes include focused recommendations for the patient."]
["13. I consult with various members of the primary care team (e.g., pharmacist, dietician) in addition to the Primary Care Provider about behavioral aspects of medical conditions (e.g., medications that cause nightmares.)"]
["14. At follow-up encounters with patients, I inquire about progress on goals or action plans set at the previous appointment."]
["15. I administer one or more brief validated measures (e.g., Patient Health Questionnaire-9, or PHQ-9) for an initial screening of symptoms of interest, or I review these findings if measures were administered by other primary care staff."]
["16. It takes 30 minutes or more for me to complete all documentation following the initial appointment."]
["17. Following patient appointments, I provide feedback to Primary Care Providers (based on their preferred method of communication) within 1 business day of an initial appointment."]
["18. During clinical encounters with patients, I clarify, confirm, and discuss the patient's concerns."]
["19. My progress notes include brief clinical impressions of the patient’s presenting problem(s)."]
["20. During a clinical encounter with a patient, I provide full neuropsychological, cognitive, or personality assessments."]
["21. I see patients for weekly, open-ended therapy."]
["22. In introducing my role in the clinic to patients, I explain that our appointments typically will be 30 minutes or less."]
["23. I provide suicide risk assessment for primary care patients in crisis and refer to a higher level of care as indicated."]
["24. I typically see patients for 50-minute appointments."]
["25. During patient appointments, I use local community resources to assist me in meeting the behavioral health needs of patients."]
["26. I provide education to the primary care team on behavioral health issues (e.g., presentations and handouts)."]
["27. I provide advice to the primary care team about appropriate referrals to specialty behavioral health services."]
["28. I provide family or couples therapy for 10 or more appointments per episode of care."]
["29. My progress notes include findings from functional assessments and brief screening."]
["30. I administer one or more brief validated measures (e.g., Patient Health Questionnaire-9, or PHQ-9) for follow up screening of symptoms of interest, or I review these findings if measures were administered by other primary care staff."]
["31. I routinely consult with Primary Care Providers to increase my knowledge about behavioral aspects of medical conditions, such as the role of anxiety in cardiac distress."]
["32. During a patient appointment, I provide full length empirically supported treatments, such as Prolonged Exposure or Dialectical Behavior Therapy."]
["33. Following clinical encounters with patients, I continue to provide feedback to the Primary Care Provider about follow-up appointments, when needed."]
["34. During clinical encounters with patients, I work with the patient to develop a specific plan to address their presenting problem and document this plan."]
["35. I accept referrals for patients who need lifestyle interventions (e.g., tobacco cessation, weight control, stress management)."]
["36. I accept referrals for patients in need of behavioral health interventions for medication issues (e.g., adherence)."]
["37. I typically see patients for 10 or more appointments per episode of care."]
["38. I accept referrals for patients in need of behavioral health interventions for adjustment to aging and issues specific to older patients."]
["39. During a patient appointment, I provide functional assessment, focused intervention, and address disposition."]
["40.  I accept referrals for patients from Primary Care Providers as a warm hand off (i.e., the Primary Care Provider introduces me to the patient)."]
["41. In introducing my role in the clinic to patients, I explain that I work with the Primary Care Providers in situations where good health care involves paying attention to physical health, habits, behaviors, emotional health and how those things interact."]
["42. I provide long-term (i.e., greater than 8 sessions) group psychotherapy."]
["43. I meet with a patient for greater than 50 minutes to gather a full psycho-social history and comprehensive psychiatric interview."]
["44. During a patient appointment, I typically provide medical social work services, including, but not limited to, assistance with disability claims, obtaining health insurance, and/or assisting with housing."]
["45. During clinical encounters with patients, I address the Primary Care Providers’ reason for referral."]
["46. I employ strategies to identify and prevent exacerbation of at-risk, sub-syndromal behaviors and symptoms."]
["47. I provide information regarding a patient's symptoms and functioning to assist Primary Care Providers (and/or clinical pharmacists, primary care psychiatrists, psychiatric nurse practitioners) in initiating or modifying common psychotropic medications, such as antidepressants."]
["48. I participate in primary care based clinical pathways for common health conditions, such as chronic pain or comorbid depression and cardiovascular disease."]

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[null,null,"Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ) Toolkit"]
["Scoring and Interpretation Guide"]
["Provider: ",null,null,{"$f":"IF('PPAQ Worksheet'!D3:J3=\"\",\"\",'PPAQ Worksheet'!D3:J3)","v":""},null,null,null,null,null,null,"Date: ",{"$f":"TODAY()","v":"2017-10-24"}]
["Clinic and Location: ",null,null,{"$f":"IF('PPAQ Worksheet'!D4:J4=\"\",\"\",'PPAQ Worksheet'!D4:J4)","v":""}]
["Overview: The PPAQ items are summed to create two subscales.  The first subscale is for the PPAQ items that measure essential behaviors that are highly consistent with Primary Care Behavioral Health.  Higher scores on this subscale indicate higher fidelity.  The second subscale is for the PPAQ items that measure behaviors that are typically inconsistent with Primary Care Behavioral Health.  Higher scores on this subscale indicate lower fidelity.  "]
["Step 1: Your subscale scores are shown below:"]
["Item #","Value","Item #","Value","Item #","Value","Item #","Value","Item #","Value"]
[1,{"$f":"IF('PPAQ Worksheet'!L9=\"\",\"\",'PPAQ Worksheet'!L9)","v":""},11,{"$f":"IF('PPAQ Worksheet'!L19=\"\",\"\",'PPAQ Worksheet'!L19)","v":""},21,{"$f":"IF('PPAQ Worksheet'!L29=\"\",\"\",'PPAQ Worksheet'!L29)","v":""},31,{"$f":"IF('PPAQ Worksheet'!L39=\"\",\"\",'PPAQ Worksheet'!L39)","v":""},41,{"$f":"IF('PPAQ Worksheet'!L49=\"\",\"\",'PPAQ Worksheet'!L49)","v":""}]
[2,{"$f":"IF('PPAQ Worksheet'!L10=\"\",\"\",'PPAQ Worksheet'!L10)","v":""},12,{"$f":"IF('PPAQ Worksheet'!L20=\"\",\"\",'PPAQ Worksheet'!L20)","v":""},22,{"$f":"IF('PPAQ Worksheet'!L30=\"\",\"\",'PPAQ Worksheet'!L30)","v":""},32,{"$f":"IF('PPAQ Worksheet'!L40=\"\",\"\",'PPAQ Worksheet'!L40)","v":""},42,{"$f":"IF('PPAQ Worksheet'!L50=\"\",\"\",'PPAQ Worksheet'!L50)","v":""},null,"PPAQ Response Categories"]
[3,{"$f":"IF('PPAQ Worksheet'!L11=\"\",\"\",'PPAQ Worksheet'!L11)","v":""},13,{"$f":"IF('PPAQ Worksheet'!L21=\"\",\"\",'PPAQ Worksheet'!L21)","v":""},23,{"$f":"IF('PPAQ Worksheet'!L31=\"\",\"\",'PPAQ Worksheet'!L31)","v":""},33,{"$f":"IF('PPAQ Worksheet'!L41=\"\",\"\",'PPAQ Worksheet'!L41)","v":""},43,{"$f":"IF('PPAQ Worksheet'!L51=\"\",\"\",'PPAQ Worksheet'!L51)","v":""}]
[4,{"$f":"IF('PPAQ Worksheet'!L12=\"\",\"\",'PPAQ Worksheet'!L12)","v":""},14,{"$f":"IF('PPAQ Worksheet'!L22=\"\",\"\",'PPAQ Worksheet'!L22)","v":""},24,{"$f":"IF('PPAQ Worksheet'!L32=\"\",\"\",'PPAQ Worksheet'!L32)","v":""},34,{"$f":"IF('PPAQ Worksheet'!L42=\"\",\"\",'PPAQ Worksheet'!L42)","v":""},44,{"$f":"IF('PPAQ Worksheet'!L52=\"\",\"\",'PPAQ Worksheet'!L52)","v":""},null,1,"Never"]
[5,{"$f":"IF('PPAQ Worksheet'!L13=\"\",\"\",'PPAQ Worksheet'!L13)","v":""},15,{"$f":"IF('PPAQ Worksheet'!L23=\"\",\"\",'PPAQ Worksheet'!L23)","v":""},25,{"$f":"IF('PPAQ Worksheet'!L33=\"\",\"\",'PPAQ Worksheet'!L33)","v":""},35,{"$f":"IF('PPAQ Worksheet'!L43=\"\",\"\",'PPAQ Worksheet'!L43)","v":""},45,{"$f":"IF('PPAQ Worksheet'!L53=\"\",\"\",'PPAQ Worksheet'!L53)","v":""},null,2,"Rarely"]
[6,{"$f":"IF('PPAQ Worksheet'!L14=\"\",\"\",'PPAQ Worksheet'!L14)","v":""},16,{"$f":"IF('PPAQ Worksheet'!L24=\"\",\"\",'PPAQ Worksheet'!L24)","v":""},26,{"$f":"IF('PPAQ Worksheet'!L34=\"\",\"\",'PPAQ Worksheet'!L34)","v":""},36,{"$f":"IF('PPAQ Worksheet'!L44=\"\",\"\",'PPAQ Worksheet'!L44)","v":""},46,{"$f":"IF('PPAQ Worksheet'!L54=\"\",\"\",'PPAQ Worksheet'!L54)","v":""},null,3,"Sometimes"]
[7,{"$f":"IF('PPAQ Worksheet'!L15=\"\",\"\",'PPAQ Worksheet'!L15)","v":""},17,{"$f":"IF('PPAQ Worksheet'!L25=\"\",\"\",'PPAQ Worksheet'!L25)","v":""},27,{"$f":"IF('PPAQ Worksheet'!L35=\"\",\"\",'PPAQ Worksheet'!L35)","v":""},37,{"$f":"IF('PPAQ Worksheet'!L45=\"\",\"\",'PPAQ Worksheet'!L45)","v":""},47,{"$f":"IF('PPAQ Worksheet'!L55=\"\",\"\",'PPAQ Worksheet'!L55)","v":""},null,4,"Often"]
[8,{"$f":"IF('PPAQ Worksheet'!L16=\"\",\"\",'PPAQ Worksheet'!L16)","v":""},18,{"$f":"IF('PPAQ Worksheet'!L26=\"\",\"\",'PPAQ Worksheet'!L26)","v":""},28,{"$f":"IF('PPAQ Worksheet'!L36=\"\",\"\",'PPAQ Worksheet'!L36)","v":""},38,{"$f":"IF('PPAQ Worksheet'!L46=\"\",\"\",'PPAQ Worksheet'!L46)","v":""},48,{"$f":"IF('PPAQ Worksheet'!L56=\"\",\"\",'PPAQ Worksheet'!L56)","v":""},null,5,"Always"]
[9,{"$f":"IF('PPAQ Worksheet'!L17=\"\",\"\",'PPAQ Worksheet'!L17)","v":""},19,{"$f":"IF('PPAQ Worksheet'!L27=\"\",\"\",'PPAQ Worksheet'!L27)","v":""},29,{"$f":"IF('PPAQ Worksheet'!L37=\"\",\"\",'PPAQ Worksheet'!L37)","v":""},39,{"$f":"IF('PPAQ Worksheet'!L47=\"\",\"\",'PPAQ Worksheet'!L47)","v":""},"PPAQ-E",{"$f":"SUM(B8:B17,D8:D12,D14:D16,F9:F10,F12:F14,F16:F17,H8,H10:H13,H15:H17,J8,J12:J15)","v":0}]
[10,{"$f":"IF('PPAQ Worksheet'!L18=\"\",\"\",'PPAQ Worksheet'!L18)","v":""},20,{"$f":"IF('PPAQ Worksheet'!L28=\"\",\"\",'PPAQ Worksheet'!L28)","v":""},30,{"$f":"IF('PPAQ Worksheet'!L38=\"\",\"\",'PPAQ Worksheet'!L38)","v":""},40,{"$f":"IF('PPAQ Worksheet'!L48=\"\",\"\",'PPAQ Worksheet'!L48)","v":""},"PPAQ-I",{"$f":"SUM(D13,D17,F8,F11,F15,H9,H14,J9:J11)","v":0}]
[null,"Subscale Score 1: \nEssential Behaviors\nHigher score desired",null,null,{"$f":"+J16","v":0},"   out of\n/190","Subscale Score 2: Inconsistent Behaviors\nLower score desired",null,null,{"$f":"J17","v":0},"  out of\n/50"]
[]
["Step 2:  Your score for the first subscale (items essential for Primary Care Behavioral Health) is indicated under Provider Score with an arrow (←).  Scores in the green range are in the optimal range of fidelity, with yellow indicating moderate fidelity scores, and red indicating low fidelity scores."]
["Essential Items Possible Score",null,"Reference",null,null,null,"Provider Score ",null,"Interpretation"]
[190,null,"Highest Score ",null,null,null,{"$f":"IF(J16 = 190,\"←\",\"\")","v":""},null,"Your score is in the preferred level of fidelity for essential items. However, even within this range your practices might be improved by modifying any low items noted in Step 4 below.   "]
[null,null,null,null,null,null,{"$f":"IF(AND(J16<190,J16>139),\"←\",\"\")","v":""}]
[139,null,"Top third ",null,null,null,{"$f":"IF(J16 = 139,\"←\",\"\")","v":""}]
[null,null,null,null,null,null,{"$f":"IF(AND(J16<139,J16>114),\"←\",\"\")","v":""},null,"Your score indicates a moderate level of fidelity for essential items.  Although several of your behaviors are in line with good practices, Step 4 will indicate which specific behaviors could be improved."]
[114,null,"Midpoint ",null,null,null,{"$f":"IF(J16 = 114,\"←\",\"\")","v":""}]
[null,null,null,null,null,null,{"$f":"IF(AND(J16<114,J16>88),\"←\",\"\")","v":""}]
[88,null,"Bottom third ",null,null,null,{"$f":"IF(J16 = 88,\"←\",\"\")","v":""},null,"Your score indicates a low level of fidelity for essential items.  Although some of your behaviors are in line with good practices, Step 4 will assist in identifying and prioritizing areas for improvement. "]
[null,null,null,null,null,null,{"$f":"IF(AND(J16<88,J16>38),\"←\",\"\")","v":""}]
[38,null,"Lowest score ",null,null,null,{"$f":"IF(J16 = 38,\"←\",\"\")","v":""}]
[]
["Step 3:  Your score for the second subscale (items typically inconsistent with Primary Care Behavioral Health) is indicated under Provider Score with an arrow (←).  Scores in the green range are in the optimal range of fidelity, with yellow indicating moderate fidelity scores, and red indicating low fidelity scores."]
["Inconsistent Items Possible Score",null,"Reference",null,null,null,"Provider Score ",null,"Interpretation"]
[10,null,"Lowest Score ",null,null,null,{"$f":"IF(J17 = 10,\"←\",\"\")","v":""},null,"Your score is the preferred level of fidelity for these items. However, even within this range your practices might be improved by modifying any areas of suboptimal fidelity noted in Step 4 below.   "]
[null,null,null,null,null,null,{"$f":"IF(AND(J17>10,J17<23),\"←\",\"\")","v":""}]
[23,null,"Top third ",null,null,null,{"$f":"IF(J17 = 23,\"←\",\"\")","v":""}]
[null,null,null,null,null,null,{"$f":"IF(AND(J17>23,J17<30),\"←\",\"\")","v":""},null,"Your score indicates a moderate level of fidelity for these items.  Although several of your behaviors are in line with good practices, Step 4 will indicate which specific behaviors could be improved."]
[30,null,"Midpoint",null,null,null,{"$f":"IF(J17 = 30,\"←\",\"\")","v":""}]
[null,null,null,null,null,null,{"$f":"IF(AND(J17>30,J17<36),\"←\",\"\")","v":""}]
[36,null,"Bottom third ",null,null,null,{"$f":"IF(J17 = 36,\"←\",\"\")","v":""},null,"Your score indicates a low level of fidelity for these items. Although some of your behaviors are in line with good practices, Step 4 will assist in identifying and prioritizing areas for improvement."]
[null,null,null,null,null,null,{"$f":"IF(AND(J17>36,J17<50),\"←\",\"\")","v":""}]
[50,null,"Highest score",null,null,null,{"$f":"IF(J17 = 50,\"←\",\"\")","v":""}]
[]
["Step 4:  In addition to subscale scores noted above, the tables below identify specific areas of low fidelity that can be targeted for improvement.  An asterisk (*) appears for any individual item which scored in the low fidelity range.  Note that items for subscale 2  (behaviors that are typically inconsistent with Primary Care Behavioral Health) are shaded in gray. Place mouse cursor over item # to view question."]
["Item #","Answer","Low?",null,"Item #","Answer","Low?",null,"Item #","Answer","Low?"]
[1,{"$f":"IF(B8=1,\"Never\",IF(B8=2,\"Rarely\",IF(B8=3,\"Sometimes\",IF(B8=4,\"Often\",IF(B8=5,\"Always\",\"\")))))","v":""},{"$f":"IF(AND(B8<4,B8>0),\"*\",\"\")","v":""},null,17,{"$f":"IF(D14=1,\"Never\",IF(D14=2,\"Rarely\",IF(D14=3,\"Sometimes\",IF(D14=4,\"Often\",IF(D14=5,\"Always\",\"\")))))","v":""},{"$f":"IF(AND(D14<4,D14>0),\"*\",\"\")","v":""},null,33,{"$f":"IF(H10=1,\"Never\",IF(H10=2,\"Rarely\",IF(H10=3,\"Sometimes\",IF(H10=4,\"Often\",IF(H10=5,\"Always\",\"\")))))","v":""},{"$f":"IF(AND(H10<4,H10>0),\"*\",\"\")","v":""}]
[2,"",{"$f":"IF(AND(B9<4,B9>0),\"*\",\"\")","v":""},null,18,{"$f":"IF(D15=1,\"Never\",IF(D15=2,\"Rarely\",IF(D15=3,\"Sometimes\",IF(D15=4,\"Often\",IF(D15=5,\"Always\",\"\")))))","v":""},{"$f":"IF(AND(D15<4,D15>0),\"*\",\"\")","v":""},null,34,{"$f":"IF(H11=1,\"Never\",IF(H11=2,\"Rarely\",IF(H11=3,\"Sometimes\",IF(H11=4,\"Often\",IF(H11=5,\"Always\",\"\")))))","v":""},{"$f":"IF(AND(H11<4,H11>0),\"*\",\"\")","v":""}]
[3,"","",null,19,"","",null,35,"",""]
[4,"","",null,20,"",{"$f":"IF(AND(D17<6,D17>2),\"*\",\"\")","v":""},null,36,"",""]
[5,"","",null,21,{"$f":"IF(F8=1,\"Never\",IF(F8=2,\"Rarely\",IF(F8=3,\"Sometimes\",IF(F8=4,\"Often\",IF(F8=5,\"Always\",\"\")))))","v":""},{"$f":"IF(AND(F8<6,F8>2),\"*\",\"\")","v":""},null,37,"",{"$f":"IF(AND(H14<6,H14>2),\"*\",\"\")","v":""}]
[6,"","",null,22,{"$f":"IF(F9=1,\"Never\",IF(F9=2,\"Rarely\",IF(F9=3,\"Sometimes\",IF(F9=4,\"Often\",IF(F9=5,\"Always\",\"\")))))","v":""},{"$f":"IF(AND(F9<4,F9>0),\"*\",\"\")","v":""},null,38,"",""]
[7,"","",null,23,"",{"$f":"IF(AND(F10<4,F10>0),\"*\",\"\")","v":""},null,39,"",""]
[8,"","",null,24,"",{"$f":"IF(AND(F11<6,F11>2),\"*\",\"\")","v":""},null,40,"",""]
[9,"","",null,25,"",{"$f":"IF(AND(F12<4,F12>0),\"*\",\"\")","v":""},null,41,{"$f":"IF(J8=1,\"Never\",IF(J8=2,\"Rarely\",IF(J8=3,\"Sometimes\",IF(J8=4,\"Often\",IF(J8=5,\"Always\",\"\")))))","v":""},{"$f":"IF(AND(J8<4,J8>0),\"*\",\"\")","v":""}]
[10,"","",null,26,"",{"$f":"IF(AND(F13<4,F13>0),\"*\",\"\")","v":""},null,42,{"$f":"IF(J9=1,\"Never\",IF(J9=2,\"Rarely\",IF(J9=3,\"Sometimes\",IF(J9=4,\"Often\",IF(J9=5,\"Always\",\"\")))))","v":""},{"$f":"IF(AND(J9<6,J9>2),\"*\",\"\")","v":""}]
[11,{"$f":"IF(D8=1,\"Never\",IF(D8=2,\"Rarely\",IF(D8=3,\"Sometimes\",IF(D8=4,\"Often\",IF(D8=5,\"Always\",\"\")))))","v":""},{"$f":"IF(AND(D8<4,D8>0),\"*\",\"\")","v":""},null,27,"","",null,43,"",{"$f":"IF(AND(J10<6,J10>2),\"*\",\"\")","v":""}]
[12,"",{"$f":"IF(AND(D9<4,D9>0),\"*\",\"\")","v":""},null,28,"",{"$f":"IF(AND(F15<6,F15>2),\"*\",\"\")","v":""},null,44,"",""]
[13,"","",null,29,"",{"$f":"IF(AND(F16<4,F16>0),\"*\",\"\")","v":""},null,45,"",{"$f":"IF(AND(J12<4,J12>0),\"*\",\"\")","v":""}]
[14,"","",null,30,"",{"$f":"IF(AND(F17<4,F17>0),\"*\",\"\")","v":""},null,46,"",{"$f":"IF(AND(J13<4,J13>0),\"*\",\"\")","v":""}]
[15,"","",null,31,{"$f":"IF(H8=1,\"Never\",IF(H8=2,\"Rarely\",IF(H8=3,\"Sometimes\",IF(H8=4,\"Often\",IF(H8=5,\"Always\",\"\")))))","v":""},{"$f":"IF(AND(H8<4,H8>0),\"*\",\"\")","v":""},null,47,"",""]
[16,"",{"$f":"IF(AND(D13<6,D13>2),\"*\",\"\")","v":""},null,32,{"$f":"IF(H9=1,\"Never\",IF(H9=2,\"Rarely\",IF(H9=3,\"Sometimes\",IF(H9=4,\"Often\",IF(H9=5,\"Always\",\"\")))))","v":""},{"$f":"IF(AND(H9<6,H9>2),\"*\",\"\")","v":""},null,48,"",""]
[]
["Please move to next page for step 5: PPAQ Domains"]

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[null,"Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ) Toolkit"]
["PPAQ Domains"]
[]
[]
["Step 5:  PPAQ items can be grouped into one of four domains of practice.  Below you will find a description of each domain and the PPAQ items that are in each domain.  Items with low fidelity based on your responses appear in red text. Place your mouse over the question number to review item text. Domains with the most low fidelity items can be the starting point for improving your practice.  Links to clinical and educational resources relevant to that domain are provided."]
["Domain 1: Clinical Scope and Interventions"]
["Definition","Items in this domain",null,null,null,null,null,null,null,"Links to Relevant Clinical and Educational Resources"]
["This domain refers to integrated care provider behaviors related to providing clinical services to patients, including the type and nature of interventions utilized."]
[]
[null,"5,","20,","23,","28,","32,","37,","42,","43,"]
[null,null,null,"44,","46,",48]
[]
[]
["Domain 2: Practice and Session Management"]
["Definition","Items in this domain",null,null,null,null,null,null,null,"Links to Relevant Clinical and Educational Resources"]
["This domain refers to integrated care provider behaviors that characterize their overall approach to integrated health care using a population-based model. "]
[null,"1,","2,","3,","6,","7,","10,","12,","14,"]
[null,"15,","16,","18,","19,","21,","22,","24,","25,"]
[null,null,"29,","30,","34,","39,","41,",45]
[]
["Domain 3: Referral Management and Care Continuity"]
["Definition","Items in this domain",null,null,null,null,null,null,null,"Links to Relevant Clinical and Educational Resources"]
["This domain refers to integrated care provider behaviors related to the types of referrals they accept from PCPs, including advice to PCPs about referring to specialty mental health. "]
[]
[null,"4,","8,","9,","27,","35,","36,","38,",40]
[]
[]
["Domain 4: Consultation, Collaboration, and Interprofessional Communication"]
["Definition","Items in this domain",null,null,null,null,null,null,null,"Links to Relevant Clinical and Educational Resources"]
["This domain refers to integrated care provider behaviors related to communicating and collaborating with other members of the primary care team. "]
[]
[null,"11,","13,","17,","26,","31,","33,",47,null,"Consultation and Collaboration links to abstracts:"]

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[null,null,"Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ) Toolkit"]
["Moving Forward with your PPAQ Results"]
["    The following steps are optional but can further assist you in applying the results of the PPAQ Toolkit.  Modifying some behaviors identified in the PPAQ can require more coordination and planning than others, including the support of supervisors or other primary care team members. The process below is one approach to address larger practice change goals."]
["\n"]
[]
[]
["The first step in the process is Prioritizing areas for change.  Based on the item analysis you conducted on tab 2 step 4, select one or two items of low adherence that seem the most feasible to address at this time.  The goal is to start small by identifying just one or two related behaviors to address.  "]
[]
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[]
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[]
["The second step is to Partner with integrated advocates or peers for assistance. This process can include reaching out to the designated integrated care champion at your facility, a colleague, your supervisor, or other experts who act as coaches and advocates for front line integrated care providers.  Sharing the results of your PPAQ self-assessment is a great way to receive additional support. If there is no one designated in these roles at your facility, consider joining or starting a local or regional peer support network of other integrated care providers.  Collaborating with peers can be an excellent way to share firsthand knowledge regarding integrated care practices.  Also consider requesting consultation from experts at either the VA Center for Integrated Healthcare or the PC-MHI Program Office. Their contact information is available below."]
[]
["The third step is Accessing educational and clinical resources.  Several of these resources were listed in the PPAQ Scoring and Interpretation Guide.  There are additional resources available at the Center for Integrated Healthcare website and PC-MHI Program Office SharePoint that can assist you in meeting your goals for change.  Several additional relevant resources are noted below. "]
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["The fourth step is an optional one, but is strongly recommended for more complex goals for change. If larger modifications to your practice are necessary, consider engaging in a structured quality improvement process.  Quality improvement can be as simple as conducting Plan-Do-Study-Act cycles that consist of breaking down a larger goal into several steps.  For practice changes that require inter-professional collaboration with primary care team members, consider if developing a small team of interested individuals can facilitate change.  Either way, you don’t need to be a quality improvement expert to use Plan-Do-Study-Act.  There are links to several resources at the end of this to assist you in this process. "]
[]
["Additional Resources to Assist with Moving Forward"]
["Key Websites:"]
[]
[]
["Online Training Courses:\nUse link to access site and search by course title or ID#"]
[]
["Mood and Anxiety Disorders in Primary Care: Definitions and Incidence (Nursing) ID#NFED 3852229",null,null,null,null,null,null,"The 30-Minute PCMHI Appointment Part 2 – The Functional Assessment"]
["Cognitive Screening of the Elderly in Primary Care (Psychology)  ID#NFED 11355",null,null,null,null,null,null,"The 30-Minute PCMHI Appointment Part 3 – The Follow-Up Appointment"]
["Post-traumatic Stress Disorder (Nursing)\nID#NFED 3885804",null,null,null,null,null,null,"The 30-Minute PC-MHI Appointment – Warm Hand-Off, Initial Assessment and Patient-Centered Action Planning"]
["BMI (Brief Motivational Interviewing) Part I: Motivational Interviewing Basics ID#VA 7643"]
["Mental & Behavioral Health in PACT ListServ:"]
[]
["To request expert clinical consultation from the Center for Integrated Healthcare: "]
[]
["Integrated Care Texts and Literature:"]
["Behavioral Consultation and Primary care: A guide to integrating services. Robinson, P. J., & Reiter, J. T. (2007). New York, NY: Springer."]
["Integrated Behavioral Health in Primary Care: Step-by-step guidance for assessment and intervention. Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2009). Washington, DC: American Psychological Association."]
["Real Behavior Change in Primary Care: Improving patient outcomes & increasing job satisfaction.  Robinson, P. J., Gould, D. A., & Strosahl, K. D. (2010). Oakland, CA: New Harbinger."]
[]
["Quality Improvement and Plan-Do-Study-Act (PDSA) Basics*:\n                  *Please contact local IT for policy regarding YouTube access"]
[]
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["Contact Information "]
["It is our sincere hope that this presentation has been a source of learning and support in your role as an interated care provider that ultimately enhances the provision of care for Veterans and families.  For additional information about the PPAQ Toolkit or content of this presentation, contact: "]
[]
["Dr. Gregory P. Beehler, VA Center for Integrated Healthcare"]
[]
["Phone: 716-862-7934"]
[]
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