- Case Management Treatment Plan Review Directions (PDF)
- Case Management Treatment Plan Review Form (PDF)
- Complex Case Team Form (Excel)
- Service Agreement Form (PDF)
- Telephone Response Monthly Report (Excel) –Crisis
- OBH Project Proposal Form (Word)
- Naloxone Request Form (Word) | or as PDF | or as SurveyMonkey Form
- Rights and Legal Issues
- Application For Emergency Involuntary Admission To A Psychiatric Hospital (PDF) 03/01/2021
- Notification To Judicial Officer Of Identification Of Psychiatric Hospital (PDF) 03/01/2021
- Involuntary Hold Form (PDF)
- Application to District Court for Involuntary Commitment to a Mental Hospital and Request for Involuntary Treatment (Word) | also as PDF
- Motion and Order for Transfer, MH 109 (for use after application for hearing is filed but before hearing is held) (Word) | also as PDF
- Motion and Order for Dismissal MH 106 (Word) (for use after application for hearing is filed but before hearing is held) | also as PDF
- Application to District Court for Involuntary Commitment to a Mental Hospital (Word) | PDF
- Request and Endorsement for Transfer, MH 101 (for use during blue paper period) (Word | PDF
- Grievance Process Guide (PDF)
- GPRA Overview & Implementation
What is the GPRA Survey?
The Substance Abuse and Mental Health Services Administration (SAMHSA) awarded the State of Maine the State Opioid Response (SOR) grant to expand treatment and recovery services to individuals with opioid and stimulant use disorders. A requirement of the SOR grant is to administer the Government Performance and Results Act (GPRA) Survey to clients who are receiving grant-funded treatment and recovery services.
The GPRA Survey is a tool that collects data on a client’s behavior and activities. This tool sets performance goals and measures client outcomes and progress in the enrolled program. It helps us examine the effectiveness of the services provided to clients and helps the federal government assess the efficacy of how funding is being utilized. Each GPRA Survey takes approximately 40-55 minutes to complete and is de-identified.
For a short overview of the GPRA Survey, watch the GPRA Survey Overview video (YouTube).
GPRA Survey Timeline Survey Type When to Conduct Survey Due to OBH Intake Within 4 days of entry into SOR grant-funded services* Within 5 days of completion 6 Month Follow-up 5-8 months after the Intake Survey** Within 5 days of completion Discharge Upon completion or termination from SOR grant-funded services, or 30 days from last service Within 5 days of completion
* Grant-funded services entry = when the client began utilizing SOR grant funding. This does not mean entry into your program.
** Follow-ups completed outside of the timeline do not meet the SAMHSA requirement.
Implementing GPRA Surveys:
- GPRA Survey Tool (PDF): The PDF form used to conduct the GPRA Survey with clients. The Survey tool has been updated. Please use this most current version.
- GPRA Survey Overview (YouTube): A brief overview of GPRA, the different survey types, and advice on how to effectively conduct surveys.
- Implementation Guide (PDF): An optional guide for implementing the GPRA Survey in your organization.
- GPRA Flowchart (PDF): A detailed timeline of when to conduct GPRA Surveys and an explanation of the different survey types and which sections to complete for each survey.
- Client Consent & Contact Form (PDF): An optional tool to keep track of client consent and contact information for follow-ups.
- Client Tracking Sheet (Excel): A recommended tool to keep track of GPRA Surveys that have been conducted and when follow-ups are due.
Performing GPRA Surveys:
- Question-by-Question Guide (PDF): A quick guide that offers best practices for conducting the survey and targets some of the more challenging GPRA questions.
- Trauma-Informed Interviewing Manual (PDF): A SAMHSA manual on utilizing a trauma-informed, person-centered, and recovery-oriented framework of care when conducting surveys.
- Motivational Interviewing to Enhance GPRA Assessments: A recorded webinar from the Opioid Response Network, presented by Dr. Brian Hurley. Motivational Interviewing (MI) has emerged as one of the most critical evidence-based approaches when working with clients to promote behavior change. MI is a collaborative method of communication that pays particular attention to the language of change.
- Intake Surveys (YouTube): Completed within 4 days of intake into grant-funded services, when the client consents to a full Intake Survey.
- Administrative Intake Surveys (YouTube): Completed within 4 days of entry into grant-funded services, when the client does not consent to a full Intake Survey.
- 6 Month Follow-up Surveys (YouTube): Completed 5-8 months after the Intake Survey, when the client is contacted and consents to a full Follow-up Survey.
- Administrative 6 Month Follow-up Surveys (YouTube): Completed 5-8 months after the Intake Survey, when the client cannot be contacted or does not consent to a full Follow-up Survey.
- Discharge Surveys (YouTube): Completed upon termination from grant-funded services or 30 days from last service, when the client is contacted and consents to a full Discharge Survey.
- Administrative Discharge Surveys (YouTube): Completed upon termination from grant-funded services or 30 days from last service, when the client cannot be contacted or does not consent to a full Discharge Survey.
- Prescription Monitoring Program
- Critical Incident Reporting
The Office of Behavioral Health is no longer accepting submissions of Critical Incident Reports via fax, email, mail, etc. Organizations that do not currently use the Kepro Atrezzo portal should contact Kepro’s provider relations staff at (866)521-0027, Option 1 or email ProviderRelationsME@Kepro.com. Kepro hours of operation are Monday thru Friday 8am to 6pm. Failure to proactively set up a login is not an acceptable reason for late submission of a CIR. Phone notification within 4 hours of learning of a Level 1 incident are still required; the phone number for notification is now (866)521-0027, option 6.