Scenario 8a: completes high-intensity treatment and referred internally to low-intensity service

Scenario 8a: Client referred » client assessed » eligible for service in OSP » most appropriate for treatment offered at Assessment NLO » completes treatment and referred to lower intensity OSP service » client completes treatment » exits OSP


StageElement

Response Option

Cells in yellow represent specific response options for a scenario.

Fields in grey with ‘--‘ should be left blank because they are not applicable to the listed scenario.

SERVICE PROVIDER 1 (NLO) (receiving initial referral into OSP)
1. Referral ReceivedHub/ Network Lead Organization100, 200, 300, 400, 600, 800, 900, 1000, 1100, 1300
Date referral receivedYYYYMMDD
OHIP #Number
Referral Source Type1-8, 77
OHIP billing numberNumber
PHQ 9 referral scoreScore
GAD 7 referral scoreScore
2. Referral CompletedDate referral completedYYYYMMDD
Referral Type1
OHIP # (if not collected prior)Number
Unique Client IDNumber
Client/Patient First NameAs written
Client/Patient Last NameAs written
AddressAs written
CityAs written
Postal CodeAs written, NFA, UNK, FSA
Service Request ID- Incoming--
3. Initial Screen/ Screen for EligibilityScreening for eligibility dateYYYYMMDD
Outcome of eligibility screen1
4. Clinical Intake and Triage AssessmentDate of BirthYYYYMMDD
Francophone1-2, 88, 99
Requires French language services1-2
Main spoken language1-35, 77, 88, 99
Main spoken language – OtherAs written
Interpreter required1-2
Gender1-7, 77, 88, 99
Sexual Orientation1-6, 77, 88, 99
Racial/ethnic group1-8, 10-16, 77, 88, 99
Work status1-6, 77, 88, 99
Student status1-3, 77, 88, 99
Client has less than 5 years in Canada1-2, 88, 99
Was client born in Canada?1-2, 88, 99
If no, what year did client arrive in Canada?YYYY
Family income1-8, 77, 88, 99
How many people does this income support?Number
Health status1-8, 77, 88, 99
Prior mental health counselling1-2, 88, 99
Session dateYYYYMMDD
Session type1
Session attendance1-5
Duration of sessionNumber
Provider IDNumber
Triage service recommendation1
Reason for triage decision1-13
PHQ-9 score (ASSESSMENT)Score
GAD-7 score (ASSESSMENT)Score
WHODAS score (ASSESSMENT)Score
HAI-SW scale score (ASSESSMENT)Score
OCI-R scale score (ASSESSMENT)Score
PDSS-SR scale score (ASSESSMENT)Score
PCL-5 scale score (ASSESSMENT)Score
SPIN scale score (ASSESSMENT)Score
Severity Measure for Specific Phobia- Adult Scale scoreScore
(ASSESSMENT)
AUDIT-C score (ASSESSMENT)Score
DUDIT score (ASSESSMENT)Score
PSWQ scale score (ASSESSMENT)Score
Main Problem descriptor (ASSESSMENT)2-5, 7-11
5. EnrollmentOSP Program enrollment dateYYYYMMDD
6. Service/TreatmentService Delivery SiteSite Number
Treatment start dateYYYYMMDD
Session dateYYYYMMDD
Session type1-4
Session attendance1-5
Duration of sessionNumber
Provider IDNumber
OSP Program Service1-6
Service Delivery Type1-7, 77
Linguistic/ culturally specific service1-5, 77
PHQ-9 score (TREATMENT)Score
GAD-7 score (TREATMENT)Score
WHODAS score (TREATMENT)Score
WSAS score (TREATMENT)Score
HAI-SW scale score (TREATMENT)Score
OCI-R scale score (TREATMENT)Score
PDSS-SR scale score (TREATMENT)Score
PCL-5 scale score (TREATMENT)Score
SPIN scale score (TREATMENT)Score
Severity Measure for Specific Phobia- AdultScore
Scale score (TREATMENT)
AUDIT-C score (TREATMENT)Score
DUDIT score (TREATMENT)Score
PSWQ scale score (TREATMENT)Score
Main Problem descriptor (TREATMENT)2-5, 7-11
Treatment completion dateYYYYMMDD
7. Client HoldType of client hold--
Stage of client hold--
Client hold start date--
Client hold end date--
8. Client Exit/ Not Accepted to Program/ Service Request OutgoingExit dateYYYYMMDD
Stage of client exit or referral3
Exit disposition2
Ineligible due to:--
Where was referral/service request made?500, 700, 1200
Date referral/service request was madeYYYYMMDD
Service Request ID- OutgoingNumber (new)
SERVICE PROVIDER 2 (low intensity provider receiving service request from Service Provider 1)
1. Referral ReceivedHub/ Network Lead Organization500, 700, 1200
Date referral receivedYYYYMMDD
OHIP #Number
Referral Source Type--
OHIP billing number--
PHQ 9 referral score--
GAD 7 referral score--
2. Referral CompletedDate referral completedYYYYMMDD
Referral Type5
OHIP # (if not collected prior)Number
Unique Client IDNumber
Client/Patient First NameAs written
Client/Patient Last NameAs written
AddressAs written
CityAs written
Postal CodeAs written, NFA, UNK, FSA
Service Request ID- IncomingNumber
3. Initial Screen/ Screen for EligibilityScreening for eligibility date--
Outcome of eligibility screen--
4. Clinical Intake and Triage AssessmentDate of BirthYYYYMMDD
Francophone--
Requires French language services--
Main spoken language--
Main spoken language – Other--
Interpreter required--
Gender--
Sexual Orientation--
Racial/ethnic group--
Work status--
Student status--
Client has less than 5 years in Canada--
Was client born in Canada?--
If no, what year did client arrive in Canada?--
Family income--
How many people does this income support?--
Health status--
Prior mental health counselling--
Session date--
Session type--
Session attendance--
Duration of session--
Provider ID--
Triage service recommendation--
Reason for triage decision--
PHQ-9 score (ASSESSMENT)--
GAD-7 score (ASSESSMENT)--
WHODAS score (ASSESSMENT)--
HAI-SW scale score (ASSESSMENT)--
OCI-R scale score (ASSESSMENT)--
PDSS-SR scale score (ASSESSMENT)--
PCL-5 scale score (ASSESSMENT)--
SPIN scale score (ASSESSMENT)--
Severity Measure for Specific Phobia- Adult Scale score--
(ASSESSMENT)
AUDIT-C score (ASSESSMENT)--
DUDIT score (ASSESSMENT)--
PSWQ scale score (ASSESSMENT)--
Main Problem descriptor (ASSESSMENT)--
5. EnrollmentOSP Program enrollment dateYYYYMMDD
6. Service/TreatmentService Delivery SiteSite Number
Treatment start dateYYYYMMDD
Session dateYYYYMMDD
Session type1-4
Session attendance1-5
Duration of sessionNumber
Provider IDNumber
OSP Program Service1-6
Service Delivery Type1-7, 77
Linguistic/ culturally specific service1-5, 77
PHQ-9 score (TREATMENT)Score
GAD-7 score (TREATMENT)Score
WHODAS score (TREATMENT)Score
WSAS score (TREATMENT)Score
HAI-SW scale score (TREATMENT)Score
OCI-R scale score (TREATMENT)Score
PDSS-SR scale score (TREATMENT)Score
PCL-5 scale score (TREATMENT)Score
SPIN scale score (TREATMENT)Score
Severity Measure for Specific Phobia- AdultScore
Scale score (TREATMENT)
AUDIT-C score (TREATMENT)Score
DUDIT score (TREATMENT)Score
PSWQ scale score (TREATMENT)Score
Main Problem descriptor (TREATMENT)2-5, 7-11
Treatment completion dateYYYYMMDD
7. Client HoldType of client hold--
Stage of client hold--
Client hold start date--
Client hold end date--
8. Client Exit/ Not Accepted to Program/ Service Request OutgoingExit dateYYYYMMDD

Stage of client exit or referral3
Exit disposition1
Ineligible due to:--
Where was referral/service request made?--
Date referral/service request was made--
Service Request ID- Outgoing--

 


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Scenario 8b: Client transferred to low-intensity treatment