Title Of IOP Note:[select name="Title_Of_IOP_GROUP_Note_for_BH" value="TBI/ISC MIST IOP--WxxDxx--BH GRP Note_CBT-i|TBI/ISC MIST IOP--WxxDxx--BH GRP Note_ART Therapy|TBI/ISC MIST IOP--WxxDxx--BH GRP Note_Journaling|TBI/ISC MIST IOP--WxxDxx--BH GRP Note_Emotional Regulation|TBI/ISC MIST IOP--WxxDxx--BH GRP Note_COPE w PAIN|TBI/ISC MIST IOP--WxxDxx--BH GRP Note_Mindfulness thru Senses (MTS)|TBI/ISC MIST IOP--WxxDxx--BH GRP Note_GOALS: Transitioning thru the MIST"] [textarea name="MIST_IOP" memo="Brief description of IOP " default="Madigan Intrepid Spirit Transitions (MIST) Intensive outpatient Program (IOP)\n\nMIST IOP is a full-time 5-week intensive program (6-8 hours per day, 5 days per week) that provides a structured course of evidence-based treatment.\nParticipants attend multiple behavioral health groups per week, developing new skills and strategies to reduce their psychological distress, identify cognitive distortions, and provide new ways of coping with sleep disturbances, cognitive inefficiencies, pain and emotional reactivity.\nThe goals of the program are to improve daily functioning by reducing cognitive, emotional, behavioral, and physical symptoms, promote behavioral activation, and improve adjustment in important domains (work, home, and leisure activities), as evidenced by significant changes on pre/post outcome measures including Self Efficacy for Symptom Management Scale (SESM), Pain Self-Efficacy Questionnaire (PSEQ-2), Satisfaction with Life Scale (SWLS), PROMIS Self Disturbance - Short Form 4a, PROMIS Pain Interference - Short Form 4a, Neuro-QOLv1.0 Positive Affect and Well-Being - Short Form, Life Orientation Test-Revised (LOT-R) and the Neurobehavioral Symptom Inventory (NSI).\n\nToday’s session contributes to the weekly hours of BH-oriented IOP group treatment."] Date of Service:[date name="Date_of_Service" memo="Actual date of service provided"] Session #:[text name="Session_number_1"] Time of Class:[text name="Time_of_Class" memo="Duration"] Title of Class:[select name="Title_of_Class" value="Art Therapy|Cognitive behavioral therapy for insomnia (CBT-i)|TBI education & lifestyle modification/Session 1-Cope with Pain|COPE with PAIN|Emotional Regulation|GOALS: Transitions through the MIST|Journaling|Mindfulness through Senses (MTS)"] Provider:[select name="Provider" value="Angela Bossut|Dr. Jaime Gonzalez|Dr. Rachel Satter|Dr. Jay Uomoto|Dr. Scott Wollman"] Overview of Intervention Goals: [textarea name="Overview_of_Intervention_Goals" memo="Overview of Intervention Goals:"] Session#[select name="Session_number_2" value="1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20"],[select name="Class_Name" value="Art Therapy|Cognitive behavioral therapy for insomnia (CBT-i)|TBI education & lifestyle modification/Session 1-Cope with Pain|COPE with PAIN|Emotional Regulation|GOALS: Transitions through the MIST|Journaling|Mindfulness through Senses (MTS)"] SUMMARY:[textarea name="Session_Summary_Review" memo="Summary of Session"] [textarea name=" Mood_and_demonstration" memo="SM Presented as " default="SM presented as being in a XXXXX mood, demonstrated a full range of affect, and was highly verbal during the duration of his attendance in today’s group. The SM discussed how XXXXX.SM compared XXXXX.\nSM realized how XXXXX. SM describe the specific paced approach using the Borg Exertion scale and self-monitoring his pain level to not exceed a 4 out of 10 level"] Mental Status Examination: Orientation:[select name="variable_2" value="alert and oriented in all spheres|obtunded|disoriented"]. Attention:[select name="variable_3" value="no difficulty with attention or concentration|had some attentional and concentration problems during the exam"]. Appearance:[select name="variable_4" value="well kempt|poorly kempt|appropriately dressed|inappropriately dressed|appropriately groomed|inappropriately groomed"]. Behavior – general:[select name="variable_5" value="in no acute distress|in acute psychological distress"]. Behavior – stability:[select name="variable_6" value="calm|agitated"]. Behavior – interactivity:[select name="variable_7" value="warm with comments and behavior|interactive|withdrawn"]. Behavior – eye contact:[select name="variable_8" value="eye contact good|eye contact fair|eye contact avoidant"]. Mood/Affect – stated:[select name="variable_9" value="normal|upbeat|euthymic|depressed"]. Mood/Affect – emotional range:[select name="variable_10" value="normal|broad|restricted"]. Mood/Affect – intensity:[select name="variable_11" value="normal|expansive|blunted|flat"]. Mood/Affect – congruence:[select name="variable_12" value="mood is congruent with affect|mood and affect are not congruent"]. Thought form and content:[select name="variable_13" value="normal|future oriented|logical, linear and goal-oriented|past oriented and somber|goal directed|scattered|hopeful|remorseful|enthusiastic|resigned"]. Perception – insight:[select name="variable_14" value="normal insight|poor insight"]. Perception – general:[select name="variable_15" value=normal|normal - denied any preoccupations, obsessions, delusions, hallucinations or perceptual disturbances"] Cognition/Memory:[select name="variable_16" value="normal|grossly intact|below average|above average"]. Cognition/Memory – abstraction:[select name="variable_17" value="Not objectively examined, but appears intact without the need for repetition of questions or material covered during the session.|normal ability to abstract|difficulty with abstract thought|inability for abstract thought"]. Insight:[select name="variable_18" value="normal/good judgment|poor"]. The following Daily Distress Measures are assessed daily. 1. Visual Analog Scales: (0 = None; 10 = Extreme; 5 and above are typical of those who are reporting a significant level of general emotional distress) 2. C-SSRS Results: [textarea memo="Visual Analog Results" default="Distress:\nAnxiety:\nDepression:\nAnger:\nNeeds Help:"] C-SSRS TOTAL Score:[text memo="C-SSRS total Score"] [textarea name="C-SSRS" memo="N/A if zero or indicate which question endorsed and plan of action"] Next Session Plan:[textarea name="Next_Session_Plan" memo="Next Session Plan:"] Diagnosis:[textarea name="Diagnosis" memo="Diagnosis:"]
There are 34 form elements.