2022 Evidence-Based Practice Survey for Behavioral Health Providers

Evidence-based practices (EBPs) are interventions based on scientific evidence demonstrating that they improve client outcomes in treatment. The Kentucky Department of Medicaid Services (DMS) has requested all Managed Care Organizations survey network Behavioral Health providers on what EBPs they currently utilize upon enrollment and at least annually thereafter.

Please complete this brief 6-question survey on the EBPs you use in your practice. It will take approximately 2 minutes.

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* 1. Provider Last Name (For an individual Provider report the name of the provider. For an organization or group provide the organization or group name)

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* 2. Provider First Name (LEAVE BLANK if this is for an organization or group)

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* 3. NPI associated with the above Provider

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* 4. TIN

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* 5. County

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* 6. Please select your provider type:

02 - Mental Hospital

03 - Behavioral Health Organization (BHSO)

04 - Psychiatric Residential Treatment Facility

05 - Psychiatric Residential Treatment Facility 2

06 - Chemical Dependency

26 - Residential Crisis Treatment Stabilization Unit

30 - Community Mental Health

62 - Licensed Professional Art Therapist (LPAT)

63 - Licensed Behavioral Analyst (LBA)

66 - Behavioral Health Multi-Specialty Group

67 - License Clinical Alcohol and Drug Counselors

81 - Licensed Professional Clinical Counselor

82 - Clinical Social Worker

83 - Licensed Marriage and Family Therapist

84 - Licensed Psychological Practitioner

89 - Psychologist

92 - Psychiatric DPU

64 - MD; Psychiatric Specialty

78 - Certified Nurse Practitioner; Psychiatric Specialty

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* 7. Please select all of the Evidence-Based Practices (EBPs) you use in your practice. If you do not use EBPs, please check the 'I do not use Evidence-Based Practices' option.

Assertive Community Treatment

Assessing and Managing Suicide Risk (AMSR)

Cognitive Behavioral Therapy (CBT)

Consumer Operated Programs

Coordinated Care Model for Early Interventions for First Episode Psychosis

Dialectical Behavior Therapy (DBT)

Dual Diagnosis Capability in Addiction Treatment (DDCAT)

Eye Movement Desensitization and Reprocessing (EMDR)

Family Psychoeducational

First Episode Psychosis

Functional Family Therapy (FFT)

First Episode Psychosis

Functional Family Therapy (FFT)

Individual Placement and Support (IPS) Supported Employment

Integrated Treatment for Co-occurring Disorders (MH and SUD)

Medication Assisted Treatment

Motivational Interviewing

NIATx Model for Addiction Treatment

Peer Support

Screening Brief Intervention and Referral to Treatment

Seeking Safety

Supported Employment

Supportive Housing

Trauma Informed Therapy

Trauma Recovery and Empowerment Model (TREM)

Treatment for Depression in Older Adults

I do not use Evidence-Based Practices

Other (please specify)

2022 Evidence-Based Practice Survey for Behavioral Health Providers

Question Title

* 1. Provider Last Name (For an individual Provider report the name of the provider. For an organization or group provide the organization or group name)

Question Title

* 2. Provider First Name (LEAVE BLANK if this is for an organization or group)

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* 3. NPI associated with the above Provider

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* 4. TIN

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* 5. County

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* 6. Please select your provider type:

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* 7. Please select all of the Evidence-Based Practices (EBPs) you use in your practice. If you do not use EBPs, please check the 'I do not use Evidence-Based Practices' option.

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* 8. Comments