Building

Your Program

MedTEAM

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov

Building MedTEAM

Your Program

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services
Acknowledgments

This document was prepared for the Substance Abuse and Mental Health Services Administration 

(SAMHSA) by the New Hampshire-Dartmouth Psychiatric Research Center under contract 

number 280-00-8049 and Westat under contract number 270-03-6005, with SAMHSA, U.S. 

Department of Health and Human Services (HHS). Pamela Fischer, Ph.D., and Crystal Blyler, 

Ph.D., served as SAMHSA Government Project Officers.

Disclaimer

The views, opinions, and content of this publication are those of the authors and contributors 

and do not necessarily reflect the views, opinions, or policies of the Center for Mental Health 

Services (CMHS), SAMHSA, or HHS.

Public Domain Notice

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or copied without permission from SAMHSA. Citation of the source is appreciated. However, 

this publication may not be reproduced or distributed for a fee without the specific, written 

authorization from the Office of Communications, SAMHSA, HHS.

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Recommended Citation

Substance Abuse and Mental Health Services Administration. MedTEAM: Building Your Program. 

HHS Pub. No. SMA-10-4548, Rockville, MD: Center for Mental Health Services, Substance Abuse 

and Mental Health Services Administration, U.S. Department of Health and Human Services, 2010.

Originating Office

Center for Mental Health Services

Substance Abuse and Mental Health Services Administration

1 Choke Cherry Road

Rockville, MD 20857

HHS Publication No. SMA-10-4548

Printed 2010
MedTEAM

Building Your Program

Building Your Program is intended to help mental health 

authorities, agency administrators, and program leaders think 

through and develop Medication Treatment, Evaluation and 

Management (MedTEAM). The first part of this booklet gives 

you background information about the MedTEAM model. 

Specific information about your role in implementing and 

sustaining MedTEAM follows. Although you will work closely 

together to build MedTEAM, for ease, we separated tips into 

two sections:

■ Tips for Mental Health Authorities; and

■ Tips for Agency Administrators and MedTEAM Leaders.

In preparing this information, we could think of no one better 

to advise you than people who have worked successfully 

with MedTEAM. Therefore, we based the information in 

this booklet on the experience of veteran MedTEAM leaders 

and administrators.

For references, see the booklet, The Evidence.
This KIT is part of a series of Evidence-Based Practices KITs created 

by the Center for Mental Health Services, Substance Abuse and 

Mental Health Services Administration, U.S. Department of Health 

and Human Services.

This booklet is part of the MedTEAM KIT that includes a DVD,

CD-ROM, and seven booklets:

How to Use the Evidence-Based Practices KITs

Getting Started with Evidence-Based Practices

Building Your Program

Training Frontline Staff

Evaluating Your Program

The Evidence

Using Multimedia to Introduce Your EBP
MedTEAM

What’s in Building Your Program

What Is MedTEAM?............................................................ 1

Tips for Mental Health Authorities....................................... 7

Tips for Agency Administrators and MedTEAM Leaders....... 17

Building Your Program 1 What is MedTEAM?

Building Your Program

What Is MedTEAM?

Medication Treatment, Evaluation and 

Management, or MedTEAM, is an 

evidence-based approach for offering 

medication management to people with 

serious mental illnesses. Four factors are 

involved in providing evidence-based 

medication management:

■ People who prescribe medications 

(prescribers) must know the best 

current evidence from systematic 

research;

■ They must integrate that information 

with their own clinical expertise;

■ Prescribers must be aware of 

consumers’ experience and be able 

to integrate that experience into 

medication decisions (Parks, 2007; 

Sackett, Rosenberg, Gray, Haynes, 

& Richardson, 1996); and

■ Medication management should 

be based on active consumer 

participation, mutual communication, 

and shared decisionmaking.

Factors involved in evidencebased medication management

■	Best evidence from systematic 

research

■	Clinical expertise

■	Consumer experience

■	Shared decisionmaking
What is MedTEAM? 2 Building Your Program

Staying up to date on the research evidence for 

medication management is a complex endeavor in 

itself. Research about for whom the medication will 

be effective, dosing, contraindications, and possible 

side effects to monitor is continuously evolving.

Similarly, as a result of increasingly reduced time 

for medication visits, the tasks of collecting and 

integrating clinical expertise and consumers’ 

experience is more challenging than ever before.

Consequently, studies on medication practices 

show that providing effective, evidence-based 

medication management requires a systematic 

approach (Cabana et al., 1999; Katon et al., 1995; 

Toprac et al., 2006).

The overriding philosophy of MedTEAM is that 

informed clinical judgment and shared decisionmaking 

are at the core of effective prescribing. MedTEAM 

enhances prescribers’ and consumers’ ability to 

effectively select and manage medications; it does 

not tell prescribers which medications to prescribe 

or consumers which medications to take.

MedTEAM offers agencies and the systems in 

which they participate guidance on developing 

a systematic approach to medication management. 

The approach includes developing a plan to keep 

up with the evidence about medications, including 

using treatment guidelines or algorithms to inform 

medication decisions.

Access to the most up-to-date scientific evidence 

and expert consensus on using medications for 

specific consumers is increased by offering routine 

training and using a team approach to clinical care. 

Team members support prescribers by ensuring 

that they have the information they need to make 

medication decisions.

MedTEAM also involves developing procedures 

to facilitate exchanging information between 

treatment facilities and streamlining documentation 

so that information is more accessible in the 

medication record. MedTEAM does not rely solely 

on prescribers; it requires the entire mental health 

agency to examine its practices, ranging from 

appointment scheduling to prescribing practices.

Treatment team collaboration is only one piece of 

MedTEAM. MedTEAM also emphasizes integrating 

consumer experience and partnering with 

consumers to make medication decisions together.

In MedTEAM, medication management is focused 

on recovery, not just on avoiding harm. Treatment 

should do more than helping consumers avoid 

hospitalization, crises, and contacts with the 

criminal justice system; it should help consumers 

live meaningful lives and strive to achieve their 

full potential.

Consumers work closely with all members of the 

team to share their recovery goals and ensure 

that their treatment plan helps them achieve 

those goals. Prescribers and consumers also work 

together to identify medication-related measures 

to evaluate their progress. These measures provide 

important information to consider when deciding 

whether and how to change medications.

MedTEAM is based on a core set of practice 

principles. These principles form the foundation 

of the approach.

Practice Principles of MedTEAM

■	The latest scientific evidence guides 

medication decisions.

■	Medication management requires

a team approach.

■	Systematically assessing medication-related 

outcomes is key to evaluating clinical 

progress.

■	High-quality documentation provides 

a record of medication response over 

consumers’ lifetime.

■	Consumers and prescribers share 

in the decisionmaking process.
Building Your Program 3 What is MedTEAM?

Principle 1: The latest scientific evidence 

guides medication decisions

Mental health systems and agencies develop a 

systematic plan. The plan ensures that the most 

up-to-date scientific evidence or expert consensus 

about the types of medications that work best for 

consumers under specific circumstances guide 

medication decisions.

For example, plans may include offering routine 

statewide training or developing procedures for 

how treatment team members can work together 

to access information on scientific updates and 

expert recommendations.

Principle 2: Medication management 

requires a team approach

Consumer-prescriber visits for medication 

management are often too short for prescribers 

to obtain all relevant information. In MedTEAM, 

consumers and prescribers work together 

with other practitioners and agency staff to 

systematically gather the information needed 

for effective medication management. Prescribers 

participate in weekly treatment team meetings 

and communicate regularly with team members.

Principle 3: Systematically assessing 

medication-related outcomes 

is key to evaluating clinical 

progress

Determining whether improvements have been 

made between visits can be difficult. Routinely 

using medication-related outcome measures such 

as brief rating scales help prescribers and consumers 

evaluate if medications have the desired effect.

Principle 4: High-quality documentation 

provides a record of 

medication response 

over consumers’ lifetime

In MedTEAM, mental health systems and agencies 

evaluate current paperwork requirements and 

streamline documentation to ensure that 

prescribers have access to all the information 

needed to make effective medication decisions 

about particular consumers.

This process often involves working across 

agencies and different types of health care facilities. 

For example, mental health systems and agencies 

develop systematic plans to improve transferring 

information after visits to hospitals, emergency 

rooms, and general medical practitioners and 

using medications prescribed by other mental 

health practitioners.

Principle 5: Consumers and prescribers 

share in the decisionmaking 

process

Ultimately, consumers decide which medications 

they will or will not take. Therefore, MedTEAM 

recognizes the importance of involving consumers 

in the decisionmaking process about medication 

prescription. Consumers who understand how 

medications work, are given choices in medication 

decisions, and are involved in evaluating their 

progress are likely to be more satisfied with their 

treatment and take their medications as prescribed.
What is MedTEAM? 4 Building Your Program

How do we know that 

MedTEAM is effective?

MedTEAM is based on expert consensus that 

asserts that medication management decisions 

that integrate treatment guidelines, clinical 

expertise, and consumer experience lead to 

improved consumer outcomes. Specifically, 

the evidence shows the following:

■ In four controlled trials, effectively implementing 

treatment guidelines was associated with 

improved outcomes such as fewer mental 

health symptoms, improved quality of care, and 

increased retention of employment (Katon et 

al., 1995; Simon, Von Korff, Rutter, & Wagner, 

2000; Wells et al., 2000; Worrall, Angel, Chaulk, 

Clarke, & Robbins, 1999).

■ Applying treatment guidelines requires clinical 

and consumer expertise (Sernyak, Dausey, 

Desai, & Rosenheck, 2003).

■ Consumer education and involvement 

increases satisfaction with treatment, 

adherence to treatment regimes, and 

outcomes (Katon et al., 1995).

Furthermore, prescribers were more likely to 

integrate treatment guidelines into medication 

decisions when agencies took a systematic and 

collaborative approach to medication management. 

Specifically, the evidence shows the following:

■ Interventions that successfully promoted 

integrating treatment guidelines included 

educational efforts for prescribers, consumers, 

and families; system redesign to streamline 

documentation; and supervision or consultation 

(Parks, 2007; Bauer, 2002; Weinmann, Koester, 

& Becker, 2007).

■ Prescribers were more likely to implement 

treatment guidelines when they fully understood 

them and believed that they would produce the 

expected outcomes (Cabana et al., 1999).

■ Treatment guidelines were more likely to 

be implemented when consumers understood 

them and believed that they would help them 

meet their goals (Cabana et al., 1999; Sernyak 

et al., 2003).

■ Prescribers who specialized in specific disorders 

(for example, those who saw mostly consumers 

with schizophrenia) were more likely 

to integrate treatment guidelines (Young, 

Mohr, Meterko, Seibert, & McGlynn, 2006).

For more information, see The Evidence in this KIT.

Who benefits most from MedTEAM?

Using medications varies by symptomatology, 

diagnosis, and other clinical circumstances. 

To simplify presenting information, this KIT 

focuses many examples on schizophrenia, one 

of the most serious and impairing psychiatric 

disorders. However, MedTEAM’s general 

principles apply across the board. Therefore, most 

suggestions either directly apply to other mental 

illnesses or can be easily modified when working 

with consumers who have other mental illnesses. 

To adapt the KIT for other mental illnesses, you 

must do the following:

■ Identify scientific evidence for medication 

management of the disorder including 

recommended dose ranges, side effect profiles, 

and monitoring recommendations; and

■ Select outcome measures such as brief rating 

scales that are specific to the disorder.

Integrate this new information into your agency’s 

treatment guidelines and MedTEAM fidelity scales.
Building Your Program 5 What is MedTEAM?

Where should MedTEAM be provided?

Mental health systems operate under a variety 

of organizational structures. Commonly, a mental 

health authority has overall responsibility for 

multiple agencies or services. The authority may 

have a designated medical director who supervises 

medical staff within those agencies.

Agencies usually have their own administrator 

or medical director. In many systems of care, 

consumers see different prescribers in different 

agencies. Also, within each agency, prescribers 

change over time.

Consequently, it is almost always preferable 

for each agency within a system to implement 

MedTEAM in the same way. Many steps to create 

a systematic approach are best made at the system 

level, with support from the mental health 

authority and with all agencies participating, 

rather than having each agency develop its own 

way of doing things.

The remaining sections of this booklet include 

tips targeted specifically to mental health 

authorities and to agency administrators and 

MedTEAM leaders to promote a coordinated 

effort to implement MedTEAM.

Building Your Program 7 Tips for Mental Health Authorities

Building Your Program

Tips for Mental Health Authorities

Successfully implementing evidence-based practices requires the leadership and 

involvement of mental health authorities. This section discusses why you should 

be involved in implementing MedTEAM and the types of activities that mental 

health authorities typically undertake.

Why should you be 

interested in MedTEAM?

In a variety of states and practice settings, 

studies of medication practices show 

frequent problems, both in how 

medications are used and in how 

decisions are documented in medical 

records. For example:

■ Doses of antipsychotic medication for 

those in outpatient settings were found 

to be outside the recommended range 

71 percent of the time (Lehman & 

Steinwachs, 1998).

■ Medication management of consumers 

with schizophrenia was of poor quality 

38 percent of the time (Young, 

Sullivan, Burnam, & Brook, 1998).

■ Documentation of psychotic symptoms 

and side effects was inadequate 55 and 

85 percent of the time, respectively 

(Cradock, Young, & Sullivan, 2001).

As a result, benefits of medication 

management are delayed or not realized 

for consumers, which is costly for both 

consumers and the mental health system.
Tips for Mental Health Authorities 8 Building Your Program

Can MedTEAM make 

a difference?

Whenever new programs come along, 

administrators have to ask whether reorganization 

is worthwhile: Is the new program really going 

to make a difference?

When it comes to MedTEAM, research shows that 

the answer is, “Yes.” MedTEAM is based on expert 

consensus that asserts that medication management 

decisions that integrate treatment guidelines, 

clinical expertise, and consumer experience lead 

to improved consumer outcomes.

Research has demonstrated that MedTEAM

has a consistent, positive impact on the lives of 

consumers. The MedTEAM KIT gives public 

mental health authorities a unique opportunity 

to improve clinical services for adults with serious 

mental illnesses. It gives you information and 

guidance for implementing this evidence-based 

practice in a comprehensive and easy-to-use format.

Aren’t we already doing this?

Medication is a core component of treatment 

for every mental health system. The question, 

then, is not whether to adopt the practice of 

treating mental illnesses with medications. 

Rather, the question is how effective is medication 

management in your mental health system?

MedTEAM is a systematic approach to increase 

the effectiveness of medication management. 

It is based on the following principles:

■ The latest scientific evidence guides medication 

decisions.

■ Medication management requires a team 

approach.

■ Systematically assessing medication-related 

outcomes is key to evaluating clinical progress.

■ High-quality documentation provides a record 

of medication response over consumers’ 

lifetimes.

■ Consumers and prescribers share in the 

decisionmaking process.
Building Your Program 9 Tips for Mental Health Authorities

How can mental health 

authorities support MedTEAM?

As you read about MedTEAM, you may think 

that it sounds great but unaffordable. We want to 

challenge that notion because other mental health 

systems with limited resources are implementing 

MedTEAM systemwide. These systems have 

leaders who become convinced of the benefits of 

providing this evidence-based practice and who 

have persisted in overcoming challenges to ensure 

its success.

Implementing MedTEAM must be a consolidated 

effort by mental health authorities, agency staff, 

consumers, and families. However, for this 

initiative to be successful, mental health authorities 

must lead and be involved in developing 

MedTEAM in local communities.

Be involved in implementing medteam

Step 1 Create a vision by clearly 

articulating MedTEAM principles 

and goals. Designate a staff person 

to oversee your MedTEAM initiative.

Step 2 Form advisory groups to build 

support, plan, and provide 

feedback for your MedTEAM 

initiative.

Step 3 Establish program standards that 

support implementation. Make 

adherence to those standards part 

of licensing criteria.

Step 4 Develop a training structure 

tailored to the needs of different 

stakeholders.

Step 5 Monitor MedTEAM fidelity and 

outcomes to maintain and sustain 

program effectiveness.

Create a vision

Agencies commonly set out to implement one 

program but end up with something entirely 

different. Sometimes these variations are intentional, 

but often they occur for the following reasons:

■ One administration starts an initiative and 

another with a different vision and different 

priorities subsequently assumes leadership;

■ The model wasn’t clearly understood to begin 

with; or

■ The staff drifted back to doing things in a way 

that was more familiar and comfortable.

Articulating the vision that medication 

management should be a systematic, teamoriented approach and consumers should share 

in the decisionmaking process is essential to 

successfully implementing MedTEAM.

Place the MedTEAM initiative in the context of the 

larger recovery paradigm. Medication management 

has traditionally been viewed from a harmavoidance perspective. That is, if medications help 

consumers avoid hospitalization, crisis intervention, 

and contact with the criminal justice system, then 

treatment is succeeding.

However, the perspective is different in the 

recovery model. The question is whether 

medications are being optimally used to support 

recovery goals. This means that prescribers must 

be attuned to consumers’ goals. They also must 

communicate with treatment team members 

to find out if medication-related issues interfere 

with movement towards recovery. Communicate 

this message by explaining how MedTEAM’s 

systematic approach to medication management 

helps agencies fulfill their mission—assisting 

consumers in their recovery process.
Tips for Mental Health Authorities 10 Building Your Program

To ensure that your vision is clearly articulated, 

designate a staff person to oversee your initiative 

who has experience with the MedTEAM model, 

such as your medical director. Some mental health 

authorities designate an office or staff with whom 

agencies may consult throughout the process 

of building and sustaining their EBP programs. 

Designated staff may also have oversight 

responsibility for implementing MedTEAM 

across the state.

Form advisory groups

You can ensure that the MedTEAM model 

is implemented appropriately if you mandate 

that stakeholder advisory groups guide the 

implementation initiative. Your MedTEAM 

initiative can benefit in many ways from an 

advisory group. Among other things, an advisory 

group can help you do the following:

■ Build internal and external support;

■ Increase program visibility; and

■ Obtain input and feedback that contribute 

to ongoing planning efforts.

Consider forming local and state-level advisory 

groups. State-level advisory groups may include 

the following members:

■ Representatives from the mental health 

authority, substance abuse authority, and other 

state agencies that would be invested in the 

initiative;

■ Representatives from state medical or hospital 

associations that may be invested in the initiative 

(for the purposes of improving access to 

information and coordination of care);

■ Representatives of Pharmaceutical and 

Therapeutics Committees;

■ Leadership from implementing agencies; and

■ Representatives from consumer and family 

advocacy organizations.

Local advisory groups can serve as liaisons between 

the community and agencies that implement 

MedTEAM. Community stakeholders who have 

an interest in the success of MedTEAM include 

the following:

■ Agency administrators and the MedTEAM 

leader;

■ MedTEAM staff members;

■ Representatives of Pharmaceutical and 

Therapeutics Committees;

■ Local providers (such as representatives of 

psychiatric and general hospitals or other local 

providers who may be invested in the initiative); 

and

■ Local consumer and family organizations.

Facilitating your advisory group

From the beginning, you must lead your advisory 

groups in understanding and articulating what 

MedTEAM is and how it is going to be developed 

in your mental health system. For training 

materials that you can use to help stakeholders 

develop a basic understanding of the evidencebased practice, see Using Multimedia to Introduce 

Your EBP in this KIT.

Your mental health system may already have 

components of MedTEAM in place. Use the tools 

in Evaluating Your Program in this KIT to assess 

which components of MedTEAM are already in 

place in your mental health system and within each 

implementing agency.

Use your state and local advisory committees as 

working groups to help develop your MedTEAM 

implementation plan based on the results of your 

readiness assessment. The process can involve the 

committee working as a whole, or you could break 

into smaller work groups that will report back to 

the committee.
Building Your Program 11 Tips for Mental Health Authorities

Use the results of your readiness assessment to set 

priorities. You may have a long list of problematic 

items and a sense that the task is too big. 

Remember that MedTEAM comprises a number 

of separate elements that do not all have to be 

implemented simultaneously.

For purposes of gaining buy-in, it may be best to 

start with minor changes that have wide support. 

However, remember, do not sacrifice key elements 

of MedTEAM for the sake of achieving acceptance. 

Instead, develop short- and long-term action steps 

to work on areas that may be harder to address.

It is very important that advisory committee 

members have a thorough grasp of clinical workflow 

in the system. The goal is to transform the system, 

rather than simply adding new components into 

a system that may be overburdened and operating 

inefficiently. The operative principles are to be 

transformative, not additive, while maintaining 

items that are currently being done well.

Advisory groups should continue to meet well after 

MedTEAM has been established. We suggest that 

they meet about once a month for the first year, 

once every 2 months for the second year, and 

quarterly for the third year.

By the second and third years, advisory groups 

may help agencies sustain high fidelity by assisting 

with fidelity evaluations, outcomes monitoring, or 

translating evaluation data into steps for continuous 

quality improvement. For more information on the 

role of advisory groups, see Getting Started with 

Evidence-Based Practices in this KIT.

Planning your MedTEAM initiative

With a vision firmly in place, the process of 

unfolding MedTEAM across the service system 

can begin. Carefully planning this process will 

help ensure a successful outcome.

Implementing MedTEAM first in pilot or 

demonstration sites may be useful. Working with 

pilot sites can help you manage problems as they 

arise and give constituents the opportunity to see 

that MedTEAM works.

Multiple pilot sites are preferable to just one. 

When only one site is used, idiosyncrasies can occur 

that misrepresent the model. In contrast, when 

mental health authorities roll the program out 

systemwide, training all MedTEAM staff members 

presents a challenge. In that case, system problems 

that may have been resolved easily on a smaller 

scale with a few MedTEAM sites can cause havoc.
Tips for Mental Health Authorities 12 Building Your Program

Establish program standards

Studies of agencies that have tried to replicate 

evidence-based models have found that if agencies 

did not achieve positive outcomes, it was often 

because they failed to implement all of the model’s 

components (Becker et al., 2001; Bond & Salyers, 

2004). As a mental health authority, you have the 

capacity to ensure that the system has incentives 

to implement MedTEAM. Attention to aligning 

these incentives in a positive way (such as 

attaching financial incentives to achieving 

improved outcomes) is vital to successfully 

implementing MedTEAM.

States have the authority to adopt regulations that 

govern services to consumers. These regulations set 

standards for the quality and adequacy of programs, 

including criteria that govern these areas:

■ Assessment and treatment planning;

■ Staffing;

■ Service components;

■ Consumer medical records;

■ Consumer rights; and

■ Supervision and program evaluation.

Integrate MedTEAM’s systematic approach 

to medication management at the state level 

to decrease variability and inefficiencies. 

Examples of MedTEAM components that you may 

implement at the state level include the following:

■ Standardize documentation so that admissions, 

annual updates, and ongoing treatment forms 

include core items that are essential to informing 

medication management. These core items are 

outlined in the MedTEAM Organizational 

Fidelity Scale which you can find in Evaluating 

Your Program in this KIT.

■ Collaborate with psychiatric hospitals 

and emergency rooms to improve access 

to needed information.

■ Mandate that consumers must be seen within 

7 days for urgent visits and within 3 days after 

hospital and emergency room visits for 

psychiatric treatment.

■ Mandate that MedTEAM staff (including 

prescribers) meet weekly to promote integrating 

services and support medication management 

as a team approach.

■ Mandate that MedTEAM staff (including 

prescribers) meet monthly with a supervisor 

who is experienced in the MedTEAM model 

for clinical supervision.

■ Select or develop medication guidelines 

or algorithms that specify what constitutes 

an adequate trial for each medication 

(for example, dose and duration) and 

recommended medication sequences 

for inadequate responses. Develop a plan 

to update those guidelines annually.

For more information about the components 

of MedTEAM, see the MedTEAM fidelity scales 

in Evaluating Your Program in this KIT.

Support implementing MedTEAM by explicitly 

referencing MedTEAM in licensing standards 

and other program review documents (for 

example, grant applications, contracts, requests 

for proposals, and so forth).

You should also review current administrative 

rules and regulations to identify any barriers 

to implementing MedTEAM. Work closely with 

agency administrators to ensure that mental health 

authority policies support high-fidelity 

MedTEAM practice.
Building Your Program 13 Tips for Mental Health Authorities

Develop a training structure

Agencies that implement evidence-based practices 

are often stymied in their efforts because people 

misunderstand the model or lack information. 

It is important that key stakeholders (consumers, 

families, and other essential community members) 

and agency-wide staff develop a basic 

understanding of MedTEAM.

We encourage you to support agency administrators 

in their efforts to develop a training structure for 

implementing MedTEAM. The training plan should 

include the following:

■ Basic training for key stakeholders, including:

❑ Advisory group members;

❑ Staff at all levels across the agency;

❑ Consumers and families; and

❑ Staff from key community organizations.

■ Intensive training for staff designated to provide 

MedTEAM services. Intensive training may 

include training in the following:

❑ New documentation practices;

❑ Ongoing training on medications; and

❑ Integrating outcome measures into clinical 

assessments.

For more information, see Training Frontline Staff

in this KIT.

Choose your trainer

An intensive training plan for prescribers may 

be designed in several different ways, but you 

must first decide who will conduct the training. 

MedTEAM leaders may develop the initial training 

for prescribers and other MedTEAM staff by using 

the guidelines in Training Frontline Staff in this 

KIT. Some mental health authorities choose to hire 

external trainers.

One successful strategy in training MedTEAM 

staff entails having new staff visit an existing, 

well-functioning, high-fidelity MedTEAM program 

to observe how the program works. New staff will 

benefit most from this visit if they have a basic 

understanding of the MedTEAM model.

Once trained, MedTEAM leaders and staff will 

be able to use the tools in Using Multimedia to 

Introduce Your EBP in this KIT to provide basic 

training to key stakeholders.

Offer ongoing training and consultation

Throughout the first year, we encourage you to 

offer MedTEAM staff intermittent booster training 

sessions. After the first year, consider establishing 

an annual statewide conference on the evidencebased model.

Routine onsite and telephone consultation is also 

important, particularly for MedTEAM leaders. 

Supervising MedTEAM staff requires a complex 

set of administrative and clinical skills. For example, 

MedTEAM leaders provide direct services and 

supervision, which may require a shift in thinking 

about consumers’ role in medication decisions 

and about how colleagues work together.

MedTEAM leaders also may have administrative 

responsibilities such as hiring, preparing 

administrative reports, and developing policies and 

procedures. Perhaps more important, MedTEAM 

leaders are responsible for ensuring that the program 

operates with fidelity to the MedTEAM model.

It is very difficult for any MedTEAM leader to 

grasp everything that has to be learned in a brief 

time. Also, understanding what must be done 

and translating that understanding into action 

are different and equally difficult. Strong daily 

leadership is essential to ensure that the 

MedTEAM model is faithfully carried out.
Tips for Mental Health Authorities 14 Building Your Program

For at least the first year a new program is in 

operation, MedTEAM leaders need someone who 

is experienced in MedTEAM to provide ongoing 

consultation on organizational and clinical issues. 

Consultation ranges from integrating MedTEAM 

principles into the agency’s policies and procedures 

to consulting on cases.

Some states develop MedTEAM in a few sites at 

a time so that the first MedTEAM site can help 

train those who are in newly developed programs. 

Generally, it takes about a year for staff to feel 

confident in using an evidence-based practice 

approach, but this can vary depending on how 

much structural change is needed. Agencies that 

are not already team oriented or staff who are 

reluctant to accept new models can take longer 

to change.

It may take 2 to 3 years for an agency to become 

sufficiently proficient in the MedTEAM model 

to assume the added responsibility of training 

other agencies’ staff. Agencies that have become 

evidence-based practice training sites indicate 

that involving their staff in training staff from new 

programs reinforces the evidence-based principles 

and their knowledge of the model.

Other states have established training centers 

or enhanced existing education and training 

centers that offer education, training, and ongoing 

consultation or supervision. A state- or county-wide 

coordinator who is experienced with the MedTEAM 

model can also help new MedTEAM sites through 

ongoing contact, assessment, and troubleshooting.

Monitor fidelity and outcomes

Providing MedTEAM involves incorporating 

a new approach into the service delivery system. 

The best way to protect your investment is to make 

certain that agencies actually provide medication 

management in a way that positively affects 

the lives of consumers.

Agencies that adhere more closely to the 

evidence-based model are more effective 

than those that do not follow the model.

Adhering to the model is called fidelity.

The MedTEAM Fidelity Scales measure how well 

programs follow key elements of the MedTEAM 

model. Research tells us that the higher an agency 

scores on a fidelity scale, the greater the likelihood 

that the agency will achieve favorable outcomes 

(Bond & Salyers, 2004; Drake, Bond, & Rapp, 

2006). For this reason, it is important to monitor 

both fidelity and outcomes.

As a central part of the initial planning process, 

you must address how you will monitor fidelity 

and outcomes for MedTEAM. Too many excellent 

initiatives had positive beginnings and enthusiastic 

support but floundered at the end of a year 

because people did not plan how they would 

maintain MedTEAM. Monitoring MedTEAM 

fidelity and outcomes on an ongoing basis is a good 

way to ensure that MedTEAM is fully implemented 

and increasing the effectiveness and efficiency of 

medication management in your system. For more 

information about monitoring fidelity and outcomes, 

see Evaluating Your Program in this KIT.

Consider developing routine supervision and 

evaluations for sites that are implementing 

MedTEAM. If that is impossible, use strategies 

(for example, rules, contracts, or financial incentives) 

to support fidelity and outcomes monitoring on the 

local level or within individual agencies.

The characteristics of an agency that would have 

a perfect score on the MedTEAM Organizational 

Fidelity Scale are shown on the next page. For 

more information about MedTEAM fidelity scales, 

see Evaluating Your Program in this KIT.
Building Your Program 15 Tips for Mental Health Authorities

Characteristics of an agency that would have a perfect score on the 

MedTEAM Organizational Fidelity Scale

Standardized admissions form Agency has a standardized admissions form including core elements defined 

in the MedTEAM Organizational Fidelity Scale.

Standardized annual 

update form

Agency has a standardized annual update form covering the same core elements 

defined in the standardized admissions form.

Standardized ongoing 

treatment form

Agency has a standardized ongoing treatment form including core elements defined in 

the MedTEAM Organizational Fidelity Scale.

Prescriber access to 

information at first medication 

visit after admission (for new 

consumers only)

Updated charts with all pertinent information are available for consumers’ 

first appointment with the prescriber.

Prescriber access to 

information after hospital or 

emergency room visit

Updated charts with all pertinent information are available for consumers’ appointment 

after discharge from hospital or from emergency room for a psychiatric emergency.

Prescriber access to 

information at each 

routine visit

Updated charts with all pertinent information are available for 

consumers’ appointments.

Treatment refractory Outcomes are routinely monitored to identify consumers with treatment-refractory 

illnesses (for example, multiple medications were given without achieving the desired 

outcome) and to ensure that those consumers are offered appropriate treatments for 

their treatment-refractory condition.

Consumer education Agency has educational materials for consumers and families. Procedures outline how 

materials are distributed and how prescribers are involved in consumer education.

Agency medication guidelines Agency has written guidelines that include a definition of what constitutes an adequate 

trial for each medication (that is, dose and duration), recommended medication 

sequences for inadequate responses, and a plan to update the guidelines annually.

Scheduling flexibility for 

unscheduled urgent visits

Agency adheres to explicit scheduling policies that allow consumers to be seen within 

7 days for urgent care.

Scheduling flexibility after 

hospital visits

Agency adheres to explicit scheduling policies that allow consumers to be seen within 

3 days after being discharged from the hospital for psychiatric treatment.

Scheduling flexibility after 

emergency room visits

Agency adheres to explicit scheduling policies that allow consumers to be seen within 

3 days after an emergency room visit for a psychiatric emergency.

Integration of services MedTEAM staff members are part of a mental health treatment team and attend 

weekly treatment team meetings (which are not replaced by administrative meetings) 

and have frequent contact with treatment team members.

Clinical supervision MedTEAM staff receive structured, monthly supervision (group or individual format) 

from a program leader experienced in MedTEAM.

Quality assurance Agency has a committee that comprehensively reviews MedTEAM (using all items on 

MedTEAM fidelity scales) every 6 months and uses assessment information to improve 

the program.

Building Your Program 17 Tips for Agency Administrators and MedTEAM Leaders

Building Your Program

Tips for Agency Administrators

and MedTEAM Leaders

Successfully implementing MedTEAM requires a broad range of activities and 

collaboration between mental health authorities and agencies. This section 

assumes that the mental health authority has initiated efforts to implement 

MedTEAM. It outlines the types of activities in which agency administrators 

and MedTEAM leaders are often involved.

Recruit your staff

A variety of people are legally 

empowered to prescribe medications, 

either independently or under a 

physician’s supervision. For example, 

in many locations, advanced nurse 

practitioners do a great deal of prescribing. 

This KIT uses the term prescriber to 

encompass all those who can legally 

authorize prescriptions for consumers.

Traditionally, medication management 

occurred in one-to-one interactions 

between prescribers and consumers. 

As such, it was a highly individualized 

practice that simply required training 

prescribers about evidence-based medicine.

But today, medication visits are far too 

short to rely solely on prescribers to find 

and record all of the needed information. 

Moreover, physician time is relatively 

expensive, so having less expensive 

personnel gather core information makes 

good sense. In MedTEAM, medication 

management is a team approach. 

MedTEAM leaders, prescribers, 

and practitioners partner to promote 

effective medication management.
Tips for Agency Administrators and MedTEAM Leaders 18 Building Your Program

Choose a MedTEAM leader

It is important to hire or designate a leader to 

implement MedTEAM in your agency. We suggest 

that MedTEAM leaders be full-time employees 

whose time is completely dedicated to MedTEAM.

MedTEAM leaders are often medical directors 

who have the authority to make or suggest 

administrative changes within the agency. 

Successful MedTEAM leaders have both 

administrative and clinical skills.

As part of their administrative responsibilities, 

MedTEAM leaders undertake the following tasks:

■ Oversee MedTEAM staff;

■ Develop MedTEAM policies and procedures;

■ Act as a liaison with other agency administrators;

■ Monitor the program’s fidelity to the 

MedTEAM model; and

■ Oversee various other quality control and 

financial responsibilities.

As part of their clinical responsibilities, MedTEAM 

leaders undertake the following:

■ Provide medication management;

■ Provide monthly individual or group 

supervision; and

■ Give program feedback to the MedTEAM staff.

When hiring or designating staff for this position, 

choose someone who is a consensus-builder. Your 

MedTEAM leader should be respected by others 

and prepared to champion the cause.
Building Your Program 19 Tips for Agency Administrators and MedTEAM Leaders

Build support for your program

Successfully implementing MedTEAM depends 

on the support and collaboration of a number 

of stakeholders. Internally, it is important that 

your agency director and staff across the agency 

understand and support implementing MedTEAM. 

Your agency is more likely to achieve high fidelity 

in the MedTEAM approach if your agency director 

is informed and involved in the implementation 

process from the start.

It is important that your agency director take 

the lead in promoting the MedTEAM approach 

and addressing any misconceptions. Articulate 

internal and public support for MedTEAM 

by telling key stakeholders that medication 

management should be a systematic, teamoriented approach and consumers should share 

in the decisionmaking process.

Place the MedTEAM initiative in the context of the 

larger recovery paradigm. Medication management 

has traditionally been viewed from a harmavoidance perspective. That is, if medications help 

consumers avoid hospitalization, crisis interventions, 

and contacts with the criminal justice system, then 

treatment is succeeding. In the recovery model, 

however, the perspective is different. The question 

is whether medications are being optimally used 

to support recovery goals.

For example, excessive sedation may not be an 

issue in the harm-avoidance model, but it is very 

much an issue for consumers with the goals of 

being employed and having an active social life. 

This means that prescribers must be attuned 

to consumers’ goals.

They must also communicate with treatment team 

members to find out if medication-related issues 

interfere with movement towards recovery. 

Communicate this message by explaining how 

MedTEAM’s systematic approach to medication 

management helps your agency fulfill its mission—

assisting consumers in their recovery process.

Once your agency director has articulated a clear 

vision for implementing MedTEAM, continue to 

bolster internal support for MedTEAM by clearing 

up misconceptions. Ensure staff that MedTEAM is 

transformative, not additive. For example, explain 

that paperwork and procedures will be reevaluated 

and streamlined to reduce burden, not to increase it.

Give all agency staff basic information about 

MedTEAM to build support across the agency. 

For more information, see Develop a training 

plan later in this booklet.
Tips for Agency Administrators and MedTEAM Leaders 20 Building Your Program

Form advisory committees

Forming a local advisory committee is an effective 

way to gain key stakeholders’ support for MedTEAM. 

To serve on your committee, identify community 

stakeholders who have an interest in the success 

of MedTEAM. Committees often include the 

following people:

■ Agency administrators and the MedTEAM 

leader;

■ MedTEAM staff;

■ Representatives of Pharmaceutical and 

Therapeutics Committees;

■ Local providers (such as representatives of 

psychiatric and general hospitals or other local 

providers who may be invested in the initiative); 

and

■ Representatives from local consumer

and family organizations.

To start, your mental health authority representative 

or agency director should voice support for the 

initiative. Next, provide basic training to help 

advisory group members understand the MedTEAM 

model. Once established, advisory groups may help 

implement MedTEAM in a variety of ways. For 

more information, see Getting Started with EBPs 

in this KIT.

Sustain support for MedTEAM

Building support for MedTEAM should be 

an ongoing effort. Find ways to recognize and 

reward the achievements of MedTEAM staff 

and consumers. For example, organize meetings 

with key stakeholders in which consumers share 

success stories and administrators highlight 

staff achievements.

Another option is to sponsor a banquet to celebrate 

the program’s accomplishments with consumers, 

family members, and agency staff members. 

Banquets are particularly helpful if a wide array 

of stakeholders (such as physicians, administrators, 

and key public officials) attend.

Your agency director and MedTEAM leader 

should meet regularly to review program 

evaluation data, discuss roadblocks, and plan ways 

to improve your MedTEAM initiative. Building 

support from internal staff and key community 

stakeholders is essential to implementing 

MedTEAM effectively.
Building Your Program 21 Tips for Agency Administrators and MedTEAM Leaders

Form collaborative relationships

In many mental health systems, consumers 

see different prescribers in different agencies. 

Also, within each agency, prescribers change over 

time. Without good documentation of consumers’ 

medication history, prescribers rely on consumers’ 

recall, which is likely to be at its worst when 

they present to a new prescriber with an 

illness exacerbation.

For this reason, it is important to form 

collaborative relationships and processes that 

promote sharing information with key outside 

organizations such as the following:

■ Psychiatric hospitals;

■ Emergency rooms in general hospitals;

■ General medical providers; and

■ Other mental health specialists.

Establish procedures to ensure that prescribers 

have access to needed information for medication 

visits. Procedures may range from documenting 

contact information for primary care providers to 

providing limited access to core elements within 

electronic medical records.

Understanding the guidelines and practices of each 

other’s systems will close the gaps that have formed 

barriers. Collaborations will help create new ways 

of working together to provide more effective 

services for consumers.

In summary, building support from internal 

staff and key community stakeholders for your 

MedTEAM initiative is essential to effective 

medication management.

Agency directors can lead this effort

■ Articulate clear support for MedTEAM 

to internal staff and key community 

stakeholders.

■ Attend some MedTEAM trainings and 

supervision and advisory group meetings.

■ Meet monthly with the MedTEAM leader 

to address roadblocks.

■ Facilitate ongoing planning and program 

improvement efforts.

■ Partner with mental health authority 

representatives and key stakeholders.
Tips for Agency Administrators and MedTEAM Leaders 22 Building Your Program

Develop effective policies 

and procedures

Starting a new MedTEAM initiative means 

developing policies and procedures that support 

the activities of the MedTEAM model.

What Policies and Procedures 

Should Cover

■	Assessment and treatment planning criteria

■	Staffing criteria

■	Program organization and communication

■	Consumer records requirements

■	Consumers’ rights

■	Program and staff performance evaluation

Develop assessment and treatment 

planning criteria

The expert consensus panel that developed 

MedTEAM identified specific types of information 

that prescribers need to effectively inform 

medication decisions. If your mental health 

authority has not already done so, we encourage 

you to review your documentation to assess which 

of these areas are already included and identify 

changes that must be made.

Often existing forms, used for years, capture 

information that, at one point, the agency, mental 

health authority, or some other entity deemed 

important. Some agencies resist changing forms 

and simply add new forms. This is a mistake that 

effectively creates more work and inefficiencies. 

Instead, look critically at the entire informationgathering and recording process and eliminate 

tasks that have little or no clinical value.

Medication visits fall into three broad categories:

■ Initial visit (or admission to the agency);

■ Annual update; and

■ Routine visits.

The first two categories are occasions for obtaining 

or updating the complete medication history and 

consumer issues related to medications. They 

contain vital historical information that is not 

recorded at every visit.
Building Your Program 23 Tips for Agency Administrators and MedTEAM Leaders

MedTEAM has identified 11 core areas that 

documentation should cover for initial and annual 

update visits:

■ Diagnoses;

■ Symptoms and severity;

■ Illness history (including age of onset, 

hospitalizations, and suicide attempts);

■ Past medication history (dose, duration, 

interactions, tolerability, and response);

■ Current medications (dose, duration, 

interactions, tolerability, and response);

■ Assessment of the effectiveness of current 

medications and any plans for future 

medication changes;

■ Current medication adherence;

■ Current side effects and treatments for them;

■ Current consumer functioning;

■ Consumer preferences and goals; and

■ Contact information for previous providers.

Furthermore, MedTEAM recommends 

documenting the following information during 

routine medication visits:

■ Diagnoses;

■ Symptoms and severity;

■ Current medications, (dose, duration, 

interactions, tolerability, and response);

■ Rationale for any medication changes;

■ Current medication adherence;

■ Current side effects and treatments for them; 

and

■ Current consumer functioning.

Sample admissions and annual update and 

ongoing treatment forms are provided on 

the next few pages.
Tips for Agency Administrators and MedTEAM Leaders 24 Building Your Program

Sample Admissions or Annual Update Form

Consumer’s name: Consumer’s I.D. 

number:

Date completed:

____/___/_____

Appointment 

time:

MedTEAM staff 

or prescriber name:

Vital signs:

Height ___________ Weight ___________

Blood pressure ___________ Pulse ___________

Temperature ___________

Body Mass Index (BMI):

 weight (pounds) ____ x 703

Principal

Axis I diagnosis: Age at onset:

Other

Axis I diagnoses: Age at onset:

Axis II diagnoses 

and comments:

Axis III diagnoses and 

comments on general 

medical conditions:

Discharge date 

from most recent 

hospitalization: ____/___/_____

Number of 

psychiatric 

hospitalizations:

Past year

Past 5 years

Lifetime

___________

___________

___________

Number 

of suicide 

attempts:

Past year

Past 5 years

Lifetime

___________

___________

___________

Is consumer 

presently 

suicidal?

Yes. Describe:

No
Building Your Program 25 Tips for Agency Administrators and MedTEAM Leaders

Family History of Psychiatric Disorders

Have any family members had any of the following disorders?

Parents Siblings Children Aunts or uncles Grandparents

Depression: ❑ Yes

❑ Treated ______

❑	Yes

❑ Treated ______

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

Schizophrenia: ❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

Bipolar disorder: ❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

Alcohol or 

substance abuse:

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

Another 

psychiatric 

or emotional 

disorder:

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

❑ Yes

❑ Treated ______

Information About the Previous Provider

Previous provider:

Provider’s contact 

information:
Tips for Agency Administrators and MedTEAM Leaders 26 Building Your Program

Past Psychiatric Medications (Consumer Self-Report/Records)

Medication 

for at least 

the past 

5 years

Highest 

daily 

dose

Number 

of years 

taken

Interactions 

or 

tolerability Response Check one: Comments

List most 

recent first Full Partial Failure Unable to assess

❑ ❑ ❑ Intolerable 

side effects

❑	No response

❑ Always used in 

combination

❑	Medication non-adherence

❑	Discontinued by request

❑	Inadequate trial 

(time/dose)

❑ ❑ ❑ Intolerable 

side effects

❑	No response

❑ Always used in 

combination

❑	Medication non-adherence

❑	Discontinued by request

❑	Inadequate trial 

(time/dose)

❑ ❑ ❑ Intolerable 

side effects

❑	No response

❑ Always used in 

combination

❑	Medication non-adherence

❑	Discontinued by request

❑	Inadequate trial 

(time/dose)

❑ ❑ ❑ Intolerable 

side effects

❑	No response

❑ Always used in 

combination

❑	Medication non-adherence

❑	Discontinued by request

❑	Inadequate trial 

(time/dose)

❑ ❑ ❑ Intolerable 

side effects

❑	No response

❑ Always used in 

combination

❑	Medication non-adherence

❑	Discontinued by request

❑	Inadequate trial 

(time/dose)

❑ ❑ ❑ Intolerable 

side effects

❑	No response

❑ Always used in 

combination

❑	Medication non-adherence

❑	Discontinued by request

❑	Inadequate trial 

(time/dose)
Building Your Program 27 Tips for Agency Administrators and MedTEAM Leaders

Current Non-Psychiatric Medications, Including Over-the-Counter Medications

(Consumer Self-Report/Records)

Medication for at 

least the past 5 years

Highest 

daily 

dose

Number 

of years 

taken

Interactions 

or 

tolerability Response Check one: Comments

List most 

recent first

Prescribed 

by mental 

health 

provider? Full Partial Failure Unable to assess

❑ Yes

❑ No

❑ ❑ ❑ Intolerable 

side effects

❑ No response

❑ Always used in 

combination

❑ Medication non-adherence

❑ Discontinued by request

❑ Inadequate trial 

(time/dose)

❑ Yes

❑ No

❑ ❑ ❑ Intolerable 

side effects

❑ No response

❑ Always used in 

combination

❑ Medication non-adherence

❑ Discontinued by request

❑ Inadequate trial 

(time/dose)

❑ Yes

❑ No

❑ ❑ ❑ Intolerable 

side effects

❑ No response

❑ Always used in 

combination

❑ Medication non-adherence

❑ Discontinued by request

❑ Inadequate trial 

(time/dose)

❑ Yes

❑ No

❑ ❑ ❑ Intolerable 

side effects

❑ No response

❑ Always used in 

combination

❑ Medication non-adherence

❑ Discontinued by request

❑ Inadequate trial 

(time/dose)

❑ Yes

❑ No

❑ ❑ ❑ Intolerable 

side effects

❑ No response

❑ Always used in 

combination

❑ Medication non-adherence

❑ Discontinued by request

❑ Inadequate trial 

(time/dose)

❑ Yes

❑ No

❑ ❑ ❑ Intolerable 

side effects

❑ No response

❑ Always used in 

combination

❑ Medication non-adherence

❑ Discontinued by request

❑ Inadequate trial 

(time/dose)
Tips for Agency Administrators and MedTEAM Leaders 28 Building Your Program

Current Psychiatric Medications

Medication

Highest 

daily dose

Date 

started

Interactions 

or 

tolerability

Current 

response Taken as prescribed?

Assessment 

of medication 

effectiveness

Plan for future 

medication 

change

❑ Full

❑ Partial

❑ Minimal

❑ None

❑ Symptoms 

worsening

❑ Mostly yes. More than 

80% of the time

❑ Sometimes. 50-80% 

of the time

❑ No. Less than 50% 

of the time

❑ Full

❑ Partial

❑ Minimal

❑ None

❑ Symptoms 

worsening

❑ Mostly yes. More than 

80% of the time

❑ Sometimes. 50-80% 

of the time

❑ No. Less than 50% 

of the time

❑ Full

❑ Partial

❑ Minimal

❑ None

❑ Symptoms 

worsening

❑ Mostly yes. More than 

80% of the time

❑ Sometimes. 50-80% 

of the time

❑ No. Less than 50% 

of the time

❑ Full

❑ Partial

❑ Minimal

❑ None

❑ Symptoms 

worsening

❑ Mostly yes. More than 

80% of the time

❑ Sometimes. 50-80% 

of the time

❑ No. Less than 50% 

of the time

❑ Full

❑ Partial

❑ Minimal

❑ None

❑ Symptoms 

worsening

❑ Mostly yes. More than 

80% of the time

❑ Sometimes. 50-80% 

of the time

❑ No. Less than 50% 

of the time

❑ Full

❑ Partial

❑ Minimal

❑ None

❑ Symptoms 

worsening

❑ Mostly yes. More than 

80% of the time

❑ Sometimes. 50-80% 

of the time

❑ No. Less than 50% 

of the time
Building Your Program 29 Tips for Agency Administrators and MedTEAM Leaders

Mental Status Exam

Symptoms and Severity (Functioning)

Appearance, 

behavior, 

speech:

Mood and 

affect:

Sensorium:

Intellectual 

functioning:

Thought 

processes 

and content:
Tips for Agency Administrators and MedTEAM Leaders 30 Building Your Program

Mental Status Exam. Check all that apply

Appearance Behavior Speech Mood Affect Sensorium

❑ Well groomed

❑ Disheveled

❑ Unkempt

❑ Bizarre

❑ Eccentric

❑ Malodorous

❑ Appears older than 

stated age

❑ Appears younger 

than stated age

❑ Appears stated age

❑ Engaged

❑ Guarded

❑ Suspicious

❑ Friendly

❑ Cooperative

❑ Hostile

❑ Threatening

❑ Seductive

❑ Disinterested

❑ Distracted

❑ Self-absorbed

❑ Good eye contact

❑ Poor eye contact

❑ Psychomotor 

agitation

❑ Psychomotor 

retardation

❑ Stereotypy

❑ Hand-wringing

❑ Pacing

❑ Bizarre posturing

❑ Use of gestures

❑ Tardive dyskinesia

❑ Tremor

❑ Mutism

❑ Retardation

❑ Pressured

❑ Poverty of speech

❑ Slurred

❑ Dysarthria

❑ Normal volume

❑ Low volume

❑ High volume

❑ Over-inclusive

❑ Euthymic

❑ Depressed

❑ Anxious

❑ Fearful

❑ Suspicious

❑ Euphoric

❑ Angry

❑ Irritable

Range

❑ Normal range

❑ Constricted

❑ Increased

Intensity

❑ Normal

❑ Intense

❑ Blunted

❑ Flat

❑ Increased

Stability

❑ Stable affect

❑ Labile 

Appropriateness

❑ Appropriate

❑ Inappropriate

Oriented to

❑ Name

❑ Place

❑ Date

❑ Situation

Intelligence

❑ Average

❑ Below average

❑ Above average

Based on:

❑ Vocabulary

❑ Fund of knowledge

Thought 

Processes Thought Content Concentration Memory

Quality of 

Delusions Insight

❑ Logical

❑ Coherent

❑ Goal-directed

❑ Perseveration

❑ Circumstantiality

❑ Distractibility

❑ Loose associations

❑ Vagueness

❑ Blocking

❑ Tangentiality

❑ Derailment

❑ Incoherent

❑ Word salad

❑ Neologism

❑ Clanging

❑ Punning

❑ Flight of ideas

❑ Normal

❑ Preoccupation

❑ Guilt

❑ Ruminations

❑ Fantasies

❑ Phobias

❑ Obsessions

❑ Compulsions

❑ Delusions

❑ Hallucinations

❑ Illusions

❑ Depersonalization

❑ Morbid

❑ Suicidal

❑ Homicidal

❑ Aggressive 

ideations

Serial 7s (or 3s)

❑ Pass

❑ Fail

Spell world 

backwards

❑ Pass

❑ Fail

Digit span

❑ Pass

❑ Fail

Remote

❑ Intact

❑ Impaired

Recent

❑ Intact

❑ Impaired

Immediate recall

❑ Intact

❑ Impaired

❑ Persecutory

❑ Grandiose

❑ Bizarre

❑ Somatic

❑ Jealous

❑ Nihilistic

❑ Intact

❑ Impaired

Abstract 

Reasoning

Quality of 

Hallucinations Judgment

❑ Intact

❑ Impaired

❑ Concrete

❑ Bizarre

❑ Auditory

❑ Visual

❑ Tactile

❑ Gustatory

❑ Olfactory

❑ Intact

❑ Impaired
Building Your Program 31 Tips for Agency Administrators and MedTEAM Leaders

Consumer Global 

Self-Report (0-10)

0 = No symptoms

5 = moderate

10 = extreme

Symptom severity: ________

Side effects: ________

Clinical Rating Scales

0 = No symptoms

5 = moderate

10 = extreme

Positive Symptom Rating Scale (PSRS): ________

Brief Negative Symptom Assessment (BNSA): ________

Side Effect Scales

0 = No symptoms

5 = moderate

10 = extreme

Abnormal Involuntary Movement Scale (AIMS): ________

Simpson-Angus Scale (SAS): ________

Description of 

current side effects:

Recommended 

psychosocial treatment 

for side effects:

Note: List medication-related 

treatment under current 

medications above.

Additional observation 

notes specific to 

consumer (for example, 

specific nature of 

delusions):
Tips for Agency Administrators and MedTEAM Leaders 32 Building Your Program

Consumer Education and Preferences

Consumer education 

provided:

Check all that apply.

❑ Purpose of specific medications provided by:

❑ Benefits and risks of specific medications provided by:

❑ Potential side effects of specific medications provided by:

❑ Alternative treatments provided by:

Consumer preferences 

and goals:

Include specific examples 

of consumer input that 

affected medication 

decisions.

Latest Laboratory Values

Initial Assessment:

Which tests are available 

from prior records? Which 

were abnormal? When 

were abnormal results 

obtained?

Tests available from 

prior records

Tests that were abnormal When the abnormal results 

were obtained

Annual Assessment:

Consumers should have 

a chemistry profile done 

annually, along with any 

other measures indicated 

in monitoring guidelines 

(such as lipid screening).

Tests available from 

prior records

Tests that were abnormal When the abnormal results 

were obtained
Building Your Program 33 Tips for Agency Administrators and MedTEAM Leaders

Progress Note

Subjective:

Objective:

Assessment:

Plan:

Signature: Title:
Tips for Agency Administrators and MedTEAM Leaders 34 Building Your Program

 Sample Admissions or Annual Update Form: Instructions

Caution: This form may not meet local requirements for billing or documentation and should be reviewed 

for any deficiencies in these areas.

An electronic medical record (EMR) gives you 

the opportunity to pre-populate many fields with 

information from the most recent prior assessment, 

so that MedTEAM staff only need to update items 

that have changed. Even if you use paper records, 

it is helpful to record this information electronically 

for each consumer, such as with Microsoft Word, 

so that you only have to enter updates.

For the first six items: If you use EMRs, you can 

program these items to prefill in the document.

■ Consumer’s name. Self-explanatory.

■ Consumer’s I.D. number. Self-explanatory.

■ Date completed. Self-explanatory.

■ Appointment time. Self-explanatory.

■ MedTEAM staff or prescriber name. Enter 

the name of the MedTEAM staff member 

or the prescriber seeing consumer for the visit.

■ Vital signs:

Height. Enter height in inches (in.). If you use 

EMRs, you can program this item to prefill 

when you access the document since it does not 

change. You can also program it to convert 

height in feet to inches for ease of use.

Weight. Enter current weight in pounds (lbs.).

Blood pressure. Enter current blood pressure 

(systolic/diastolic).

Pulse. Enter current pulse rate (beats 

per minute).

Temperature. Enter body temperature in 

degrees Fahrenheit.

Body Mass Index (BMI). Calculate BMI using 

the following equation:

weight (lbs.) x 703

 ________________ = B.M.I.

height (in.)2

Example:

6’2” consumer who weighs 160 lbs. =

160 x 703 = 160 x 703 = 0.0292 x 703 = 20.5

 742 5476

If you have Internet access, you can use a 

BMI calculator from the National Heart 

Lung, and Blood Institute Web site: 

http://www.nhlbisupport.com/bmi

■ Principal Axis I diagnosis. Enter the principal 

DSM-IV-TR1

 diagnosis for which the consumer 

is being seen for this visit. You can also include 

the ICD-102

 code if you want to capture 

this information.

Example: A consumer with schizophrenia may 

have an appointment focusing on alcohol 

dependence. The primary Axis I diagnosis would 

be alcohol dependence. If you use EMRs, you 

can program this item to have a dropdown menu 

of all DSM-IV-TR Axis I diagnoses or of all the 

DSM-IV-TR Axis I diagnoses ever entered for 

that consumer, with an option to add more. You 

can also program the ICD-10 codes to prefill 

when you access the document.

1 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 

Text Revision.

2 The International Statistical Classification of Diseases and Related Health 

Problems, Tenth Revision, Second Edition.
Building Your Program 35 Tips for Agency Administrators and MedTEAM Leaders

■ Age at onset. Enter the age of onset for the 

principal Axis I diagnosis for this visit. If you use 

EMRs, you can program this item to prefill.

■ Other Axis I diagnoses. Enter the other active 

DSM-IV-TR diagnoses for the consumer. If you 

use EMRs, you can program this item to have 

a dropdown menu of all DSM-IV-TR Axis I 

diagnoses or of all the DSM-IV-TR Axis I 

diagnoses ever entered for that consumer. 

You can also program the item to prefill.

■ Age at onset. Enter the age of onset for the 

other active Axis I diagnoses for this visit. If you 

use EMRs, you can program this item to prefill.

■ Axis II diagnoses and comments. List any 

active Axis II diagnoses and enter any necessary 

comments about the impact that these diagnoses 

have on the Axis I diagnoses and any additional 

pertinent information about the Axis II diagnoses. 

If you use EMRs, you can program this item 

to prefill.

■ Axis III diagnoses and comments. List any 

active Axis III diagnoses and enter any necessary 

comments about the impact that these diagnoses 

have on the Axis I diagnoses and any additional 

pertinent information about the Axis III 

diagnoses. If you use EMRs, you can program 

this item to prefill.

■ Discharge date from most recent hospitalization. 

Enter the date of the consumer’s most recent 

psychiatric hospitalization. If it is not in the 

medical records, ask the consumer. Enter 

whatever information is available. If the 

consumer does not know the exact day of the 

hospitalization, then enter just the month and 

year. If you use EMRs, you may program this 

item to prefill from previous forms with the 

option for the date to be changed if a psychiatric 

hospitalization has occurred since admission or 

the last annual review.

■ Number of psychiatric hospitalizations and 

number of suicide attempts: Enter the number 

of the consumer’s psychiatric hospitalizations 

for the past year, past 5 years, and lifetime. 

Use medical records if possible, but, if they are 

unavailable, ask the consumer. If you use EMRs, 

you may program this item to prefill from 

previous forms with the option for the date 

to be changed if a psychiatric hospitalization 

has occurred since admission or the last 

annual review.

■ Is the consumer presently suicidal?

Check either Yes or No. If Yes, then supply 

detailed information about the consumer’s 

response, intent, plan, and means to carry 

out a given plan.

Family history of psychiatric disorders

Complete the table using information from the 

consumer. Check Yes if a family member has had 

any of the psychiatric conditions listed.

If Yes for any item, ask the consumer if a family 

member had any treatments for that condition 

that provided benefit. Check Treated and describe 

it. Be as specific as possible when describing the 

treatment, such as medication name or type 

of therapy. Unfortunately, many times consumers 

may not know the specific medication. In those 

cases, use general terms, such as “antidepressant,” 

“psychotherapy,” “antipsychotic,” etc.

If you use EMRs, you can program this item to 

prefill it with the option to update any information 

if any family history has changed since admission 

or last annual review.
Tips for Agency Administrators and MedTEAM Leaders 36 Building Your Program

Information about the previous provider

Previous provider and provider’s contact information

Ask the consumer about previous providers, trying 

to obtain as much information as possible. Then fill 

in the blanks by looking the provider up in the phone 

book, online, board of medicine, etc. You can use 

the provider contact information to obtain past and 

current psychiatric and medical records.

Past psychiatric medications

This table consists of multiple data elements.

■ Medication. Fill in medications taken for at least 

the past 5 years. You can use the generic or 

brand name. List the most recent first.

■ Highest daily dose taken while on the 

medication.

■ Number of years taken. Note how long the 

consumer took the medication. Record this 

information in years, such as 0.5 years = 6 

months.

■ Medication effects. Under Interactions and 

tolerability, capture how the medications 

worked for the consumer. Note any medication 

interactions and assess how well the consumer 

is able to tolerate the medication. Under 

Response, check the appropriate box. If you 

check Failure or Unable to Assess, then also 

check the box that further explains the answer.

In the Comments column, enter any pertinent 

information about the medication that you 

received from the consumer or the medical 

records, such as serious side effects or consumer 

opinion about the medication.

If you use EMRs, you have various options 

to capture each element. You can program 

Medication to have a dropdown menu with 

medication categories and names. For Comments, 

you can list frequently used comments or simply 

use the column for free text. For all fields, you can 

prefill the form from the prior assessment and 

update it as needed. The most common updates 

will be medications that were current in the prior 

assessment but that have been discontinued.

Current nonpsychiatric medications

This item functions the same way as the previous; 

the only difference is the addition of check boxes 

in the medication column. Check whether the 

mental health provider prescribed the nonpsychiatric medication to the consumer.

If you use EMRs, you have the same programming 

opportunities as in the previous table.

Current psychiatric medications

This table has multiple elements.

■ Medication. Fill in the medication name.

■ Highest daily dose. For example, you would list 

ziprasidone 80mg twice daily as 160mg.

■ Date started. Note when the medication was 

started or how long the consumer took the 

medication. Record this information in years, 

such as 0.5 years = 6 months.

■ Interactions or tolerability. Assess the 

consumer’s ability to tolerate the medication 

and medication interactions.
Building Your Program 37 Tips for Agency Administrators and MedTEAM Leaders

■ Current response. Asks about medication 

response over the past month for each 

medication. Check the most appropriate 

response criteria based on objective and 

subjective data.

■ Taken as prescribed? Check the most 

appropriate level of adherence to each 

medication based on consumer report/

pill counts, etc.

■ Assessment of medication effectiveness.

Assess medication effectiveness, that is, has 

the consumer achieved the desired outcomes?

■ Plan for future medication change.

Indicate a plan for medication change.

You can program this item in many ways in an 

EMR to ease the burden of having to look up this 

information from previous records and retyping 

this data. You could program each element to 

prefill from previous records.

Mental Status Exam

You can complete the Mental Status Exam either 

in free text or checklists. Checklists are quicker 

and have the advantage of collecting uniform data, 

but do not allow you to record observations that 

are specific to consumers, such as the nature of 

their delusion. Therefore, the checklist should also 

provide space to record this type of information.

■ Consumer Global Self-Report.

Symptom severity. This item asks consumers 

to describe their current symptom severity 

on a scale from 0 to 10:

 0 = No symptoms

 5 = Moderate symptoms

10 = Extreme (worst symptoms imaginable)

If you use EMRs, you can program this item 

to display the previous score on this item or a 

graphical representation of all scores recorded 

for the consumer.

Side effects. This item asks consumers to 

describe their current side effects on a scale 

from 0 to 10:

 0 = No side effects

 5 = Moderate side effects

10 = Extreme (worst side effects imaginable)

If you use EMRs, you can program this item 

to display the previous score on this item or a 

graphical representation of all scores recorded 

for the consumer.

■ Clinical Rating Scales.

Positive Symptom Rating Scale (PSRS). Enter 

the total score for the four-item PSRS completed 

during the interview with the consumer.

If you use EMRs, you can program this item 

to display the previous score and the date it was 

conducted or a graphical representation of all 

the scores and dates for each scale recorded for 

the consumer.

Brief Negative Symptom Assessment (BNSA).

Rater enters the total score for the four-item 

BNSA that was completed during the interview 

with the consumer.

If you use EMRs, you can program this 

item to display the previous score and date 

it was conducted on this item or a graphical 

representation of all the scores and dates 

for each scale recorded for the consumer.

■ Side Effect Scales.

Abnormal Involuntary Movement Scale (AIMS).

Enter the consumer’s score on the AIMS. This 

item may not be conducted at every visit if the 

consumer does not show any signs of tardive 

dyskinesia and may only be conducted every 6 

to 12 months. It is recommended that you carry 

this information over from previous forms, along 

with the date that the scale was administered.
Tips for Agency Administrators and MedTEAM Leaders 38 Building Your Program

If you use EMRs, you can program this item 

to display the previous score and date it 

was conducted on this item or a graphical 

representation of all the scores and dates 

for each scale recorded for the consumer.

Simpson-Angus Scale (SAS). Enter the 

consumer’s score on the SAS. This item may not 

be conducted at every visit if the consumer does 

not show any signs of extrapyramidal symptoms 

and may only be conducted every 6 to 12 

months. It is recommended that you carry this 

information over from previous forms along 

with the date that the scale was administered.

If you use EMRs, you can program this item 

to display the previous score and date it 

was conducted on this item or a graphical 

representation of all the scores and dates 

for each scale recorded for the consumer.

Description of current side effects. Enter 

comments about the consumer’s side effects. 

If the consumer responded greater than 0 for 

Consumer Global Self-Report of side effects, 

the AIMS, or the SAS, there should be some 

description of side effects, interventions for side 

effects, and when the side effects and 

interventions will be reviewed again.

If you use EMRs, you can generate a list 

of common side effects in a dropdown menu. 

Then for each side effect chosen, you can 

choose interventions from a dropdown menu.

Additional information about living situation, 

life events, physical problems, or other 

symptoms. In this section, add any pertinent 

information about what is occurring in the 

consumer’s life, such as changes in housing, 

employment, health, and family dynamics 

that can help or hinder their mental 

health treatment.

If you use EMRs, you can program this section 

to prefill from previous intake or annual reviews. 

If any changes occur, you can delete or update 

the necessary information.

Consumer Education and Preferences

Check all options that apply to the consumer. 

Enter which MedTEAM staff member provided 

the educational materials. Document the 

prescriber’s role in the consumer education 

process. Document consumer preferences 

and goals including specific examples of how 

consumer input affected medication decisions.

If you use EMRs, you can program this section to 

prefill from admissions or annual updates. If any 

changes occur, you can delete or update the 

necessary information.
Building Your Program 39 Tips for Agency Administrators and MedTEAM Leaders

Latest Laboratory Values

Initial Assessment. Indicate which laboratory 

values were available in the consumer’s medical 

and psychiatric records, which were abnormal, 

and when these tests were completed.

Annual Assessment. You should have a chemistry 

profile done annually for each consumer, along 

with any other tests indicated by the monitoring 

guidelines (such as lipid screening). Enter which 

tests were drawn, when they were drawn, and note 

any abnormal results.

If you use EMRs, you can have the latest laboratory 

information prefill from results section of EMR.

Chemistry profile results. (Note: Reference range 

was provided by Medline Plus; your laboratory 

reference range may slightly differ.)

Albumin: 3.9 to 5.0 g/dL

Alkaline phosphatase: 44 to 147 IU/L

ALT (alanine transaminase): 8 to 37 IU/L

AST (aspartate aminotransferase): 10 to 34 IU/L

BUN (blood urea nitrogen): 7 to 20 mg/dL

Calcium–serum: 8.5 to 10.9 mg/dL

Serum chloride: 101 to 111 mmol/L

CO2 (carbon dioxide): 20 to 29 mmol/L

Creatinine: 0.8 to 1.4 mg/dL

Direct bilirubin: 0.0 to 0.3 mg/dL

Gamma-GT (gamma-glutamyl transpeptidase):

0 to 51 IU/L

Glucose test: 64 to 128 mg/dL

LDH (lactate dehydrogenase): 105 to 333 IU/L

Phosphorus–serum: 2.4 to 4.1 mg/dL

Potassium test: 3.7 to 5.2 mEq/L

Serum sodium: 136 to 144 mEq/L

Total bilirubin: 0.2 to 1.9 mg/dL

Total cholesterol: 100 to 240 mg/dL

Total protein: 6.3 to 7.9 g/dL

Uric acid: 4.1 to 8.8 mg/dL

Progress Note

This section is in the form of a standard SOAP 

(Subjective, Objective, Assessment, and Plan) 

note. It allows MedTEAM staff to provide specific 

information about the consumer that may not 

be captured elsewhere or to expand on information 

captured earlier in the form.
Tips for Agency Administrators and MedTEAM Leaders 40 Building Your Program

Sample Ongoing Treatment Form

Consumer’s name: Consumer’s 

I.D. number:

Date completed:

____/___/_____

Appointment 

time:

MedTEAM staff 

or prescriber name:

Vital signs:

Height ___________ Weight ___________

Blood pressure ___________ Pulse ___________

Temperature ___________

Body Mass Index (BMI):

weight (pounds) ____ x 703

_________________________ = B.M.I. height (inches)2

Principal

Axis I diagnosis:

Other

Axis I diagnoses:

Axis II diagnoses: Comments:

Axis III diagnoses: Comments:
Building Your Program 41 Tips for Agency Administrators and MedTEAM Leaders

Current Psychiatric Medications

Medication

Highest 

daily dose

Date 

started

Interactions 

or 

tolerability

Current 

response Taken as prescribed?

Assessment 

of medication 

effectiveness

Plan for future 

medication 

change

❑ Full

❑ Partial

❑ Minimal

❑ None

❑ Symptoms 

worsening

❑ Mostly yes. More than 

80% of the time

❑ Sometimes. 50-80% 

of the time

❑ No. Less than 50% 

of the time

❑ Full

❑ Partial

❑ Minimal

❑ None

❑ Symptoms 

worsening

❑ Mostly yes. More than 

80% of the time

❑ Sometimes. 50-80% 

of the time

❑ No. Less than 50% 

of the time

❑ Full

❑ Partial

❑ Minimal

❑ None

❑ Symptoms 

worsening

❑ Mostly yes. More than 

80% of the time

❑ Sometimes. 50-80% 

of the time

❑ No. Less than 50% 

of the time

❑ Full

❑ Partial

❑ Minimal

❑ None

❑ Symptoms 

worsening

❑ Mostly yes. More than 

80% of the time

❑ Sometimes. 50-80% 

of the time

❑ No. Less than 50% 

of the time

❑ Full

❑ Partial

❑ Minimal

❑ None

❑ Symptoms 

worsening

❑ Mostly yes. More than 

80% of the time

❑ Sometimes. 50-80% 

of the time

❑ No. Less than 50% 

of the time

❑ Full

❑ Partial

❑ Minimal

❑ None

❑ Symptoms 

worsening

❑ Mostly yes. More than 

80% of the time

❑ Sometimes. 50-80% 

of the time

❑ No. Less than 50% 

of the time
Tips for Agency Administrators and MedTEAM Leaders 42 Building Your Program

Mental Status Exam

Symptoms and Severity (Functioning)

Appearance, 

behavior, 

speech:

Mood 

and affect:

Sensorium:

Intellectual 

functioning:

Thought 

processes 

and content:
Building Your Program 43 Tips for Agency Administrators and MedTEAM Leaders

Mental Status Exam. Check all that apply

Appearance Behavior Speech Mood Affect Sensorium

❑ Well groomed

❑ Disheveled

❑ Unkempt

❑ Bizarre

❑ Eccentric

❑ Malodorous

❑ Appears older than 

stated age

❑ Appears younger 

than stated age

❑ Appears stated age

❑ Engaged

❑ Guarded

❑ Suspicious

❑ Friendly

❑ Cooperative

❑ Hostile

❑ Threatening

❑ Seductive

❑ Disinterested

❑ Distracted

❑ Self-absorbed

❑ Good eye contact

❑ Poor eye contact

❑ Psychomotor 

agitation

❑ Psychomotor 

retardation

❑ Stereotypy

❑ Hand-wringing

❑ Pacing

❑ Bizarre posturing

❑ Use of gestures

❑ Tardive dyskinesia

❑ Tremor

❑ Mutism

❑ Retardation

❑ Pressured

❑ Poverty of speech

❑ Slurred

❑ Dysarthria

❑ Normal volume

❑ Low volume

❑ High volume

❑ Over-inclusive

❑ Euthymic

❑ Depressed

❑ Anxious

❑ Fearful

❑ Suspicious

❑ Euphoric

❑ Angry

❑ Irritable

Range

❑ Normal range

❑ Constricted

❑ Increased

Intensity

❑ Normal

❑ Intense

❑ Blunted

❑ Flat

❑ Increased

Stability

❑ Stable affect

❑ Labile 

Appropriateness

❑ Appropriate

❑ Inappropriate

Oriented to

❑ Name

❑ Place

❑ Date

❑ Situation

Intelligence

❑ Average

❑ Below average

❑ Above average

Based on:

❑ Vocabulary

❑ Fund of knowledge

Thought 

Processes

Thought

Content Concentration Memory

Quality of 

Delusions Insight

❑ Logical

❑ Coherent

❑ Goal-directed

❑ Perseveration

❑ Circumstantiality

❑ Distractibility

❑ Loose associations

❑ Vagueness

❑ Blocking

❑ Tangentiality

❑ Derailment

❑ Incoherent

❑ Word salad

❑ Neologism

❑ Clanging

❑ Punning

❑ Flight of ideas

❑ Normal

❑ Preoccupation

❑ Guilt

❑ Ruminations

❑ Fantasies

❑ Phobias

❑ Obsessions

❑ Compulsions

❑ Delusions

❑ Hallucinations

❑ Illusions

❑ Depersonalization

❑ Morbid

❑ Suicidal

❑ Homicidal

❑ Aggressive 

ideations

Serial 7s (or 3s)

❑ Pass

❑ Fail

Spell world 

backwards

❑ Pass

❑ Fail

Digit span

❑ Pass

❑ Fail

Remote

❑ Intact

❑ Impaired

Recent

❑ Intact

❑ Impaired

Immediate recall

❑ Intact

❑ Impaired

❑ Persecutory

❑ Grandiose

❑ Bizarre

❑ Somatic

❑ Jealous

❑ Nihilistic

❑ Intact

❑ Impaired

Abstract 

Reasoning

Quality of 

Hallucinations Judgment

❑ Intact

❑ Impaired

❑ Concrete

❑ Bizarre

❑ Auditory

❑ Visual

❑ Tactile

❑ Gustatory

❑ Olfactory

❑ Intact

❑ Impaired
Tips for Agency Administrators and MedTEAM Leaders 44 Building Your Program

Consumer Global 

Self-Report (0-10)

 0 = No symptoms

 5 = moderate

10 = extreme

Symptom severity: ________

Side effects: ________

Clinical Rating Scales

 0 = No symptoms

 5 = moderate

10 = extreme

Positive Symptom Rating Scale (PSRS): ________

Brief Negative Symptom Assessment (BNSA): ________

Side Effect Scales

 0 = No symptoms

 5 = moderate

10 = extreme

Abnormal Involuntary Movement Scale (AIMS): ________

Simpson-Angus Scale (SAS): ________

Description of current 

side effects:

Is consumer suicidal? Yes. Describe:

No

Is consumer homicidal? Yes. Describe:

No

Additional information about 

living situation, life events, 

physical problems, or other 

symptoms:

Yes. Describe:

No

Drug levels:

Date and drug level. 

Enter only if changes 

have occurred since last 

medication visit.

Participation in other 

treatment or support 

services:

Enter only if changes 

have occurred since last 

medication
Building Your Program 45 Tips for Agency Administrators and MedTEAM Leaders

Consumer Education and Preferences

Check all that apply.

Enter only if changes 

have occurred since last 

medication visit.

❑ Purpose of specific medications provided by:

❑ Benefits and risks of specific medications provided by:

❑ Potential side effects of specific medications provided by:

❑ Alternative treatments provided by:

Consumer preferences 

and goals:

Include specific examples 

of consumer input that 

affected medication 

decisions.

Latest Laboratory Values:

Consumers should have 

a chemistry profile done 

annually, along with any 

other measures indicated 

in monitoring guidelines 

(such as lipid screening).

Tests performed When were they drawn Abnormal lab values
Tips for Agency Administrators and MedTEAM Leaders 46 Building Your Program

Progress Note

Subjective:

Objective:

Assessment:

Plan:

Signature: Title:
Building Your Program 47 Tips for Agency Administrators and MedTEAM Leaders

Sample Ongoing Treatment Form: Instructions

Caution: This form may not meet local requirements for billing or documentation and should be reviewed 

for any deficiencies in these areas.

An electronic medical record (EMR) gives you 

the opportunity to pre-populate many fields with 

information from the most recent prior assessment, 

so that MedTEAM staff only need to update items 

that have changed. Even if you use paper records, 

it is helpful to record this information electronically 

for each consumer, such as with Microsoft Word, 

so that you only have to enter updates.

For the first five items: If you use EMRs, you can 

program these item to prefill in the document.

■ Consumer’s name. Self-explanatory.

■ Consumer’s I.D. number. Self-explanatory.

■ Date completed. Self-explanatory.

■ Appointment time. Self-explanatory.

■ MedTEAM staff or prescriber name. Enter 

the name of the MedTEAM staff member 

or prescriber seeing consumer for the visit.

■ Vital signs:

Height. Enter height in inches. If you use 

EMRs, you can program this item to prefill 

when you access the document since it does 

not change. You can also program it to convert 

height in feet to inches for ease of use.

Weight. Enter current weight in pounds (lbs.).

Blood pressure. Enter current blood pressure 

(systolic/diastolic).

Pulse. Enter current pulse rate (beats 

per minute).

Temperature. Enter body temperature in 

degrees Fahrenheit.

Body Mass Index (BMI). Calculate BMI using 

the following equation:

weight (lbs.) x 703

 ________________ = B.M.I.

height (in.)2

Example:

6’2” consumer who weighs 160 lbs. =

160 x 703 = 160 x 703 = 0.0292 x 703 = 20.5

 742 5476

If you have Internet access, you can use a 

BMI calculator from the National Heart 

Lung, and Blood Institute Web site: 

http://www.nhlbisupport.com/bmi
Tips for Agency Administrators and MedTEAM Leaders 48 Building Your Program

■ Principal Axis I diagnoses. Enter the principal 

DSM-IV-TR diagnosis for which the consumer 

is being seen for this visit. You can also include 

the ICD-10 code if you want to capture 

this information.

If you use EMRs, you can program this item 

to have a dropdown menu of all DSM-IV-TR 

Axis I diagnoses or of all the DSM-IV-TR Axis I 

diagnoses ever entered for that consumer, with 

an option to add more. You can also program 

the ICD-10 codes to prefill when you access 

the document.

■ Other Axis I diagnoses. Enter the other active 

DSM-IV-TR diagnoses for the consumer. If you 

use EMRs, you can program this item to have 

a dropdown menu of all DSM-IV-TR Axis I 

diagnoses or of all the DSM-IV-TR Axis I 

diagnoses ever entered for that consumer. 

You can also program the item to prefill.

■ Axis II diagnoses and comments. List any 

active Axis II diagnoses and enter any necessary 

comments about the impact that these diagnoses 

have on the Axis I diagnoses and any additional 

pertinent information about the Axis II diagnoses. 

If you use EMRs, you can program this item 

to prefill.

■ Axis III diagnoses and comments. List any 

active Axis III diagnoses and enter any necessary 

comments about the impact that these diagnoses 

have on the Axis I diagnoses and any additional 

pertinent information about the Axis III 

diagnoses. If you use EMRs, you can program 

this item to prefill.

Current psychiatric medications

This table has multiple elements.

■ Medication. Fill in the medication name.

■ Highest daily dose. For example, you would list 

ziprasidone 80mg twice daily as 160mg.

■ Date started. When the medication was started 

or how long the consumer took the medication. 

Record this information in years, such as 0.5 

years = 6 months.

■ Interactions or tolerability. Assess the 

consumer’s ability to tolerate the medication 

and medication interactions.

■ Current response. Asks about medication 

response over the past month for each 

medication. Check the most appropriate 

response criteria based on objective and 

subjective data.

■ Taken as prescribed? Check the most 

appropriate level of adherence to each 

medication based on consumer report

or pill counts.

■ Assessment of medication effectiveness.

Assess medication effectiveness, that is, has 

the medication achieved the desired outcomes?

■ Plan for future medication change. Indicate 

a plan for medication change.

You can program this item in many ways in an 

EMR to ease the burden of having to look up this 

information from previous records and retyping 

this data. You could program each element to 

prefill from previous records.
Building Your Program 49 Tips for Agency Administrators and MedTEAM Leaders

Mental Status Exam

You can complete the Mental Status Exam either 

in free text or checklists. Checklists are quicker 

and have the advantage of collecting uniform data, 

but do not allow you to record observations that 

are specific to consumers, such as the nature of 

their delusion. Therefore, the checklist should also 

provide space to record this type of information.

■ Consumer Global Self-Report.

Symptom severity. This item asks consumers 

to describe their current symptom severity on 

a scale from 0 to 10:

 0 = No symptoms

 5 = Moderate symptoms

10 = Extreme (worst symptoms imaginable)

If you use EMRs, you can program this item 

to display the previous score on this item or a 

graphical representation of all scores recorded 

for the consumer.

Side effects. This item asks consumers to 

describe their current side effects on a scale 

from 0 to 10:

 0 = No symptoms

 5 = Moderate symptoms

10 = Extreme (worst symptoms imaginable)

If you use EMRs, you can program this item 

to display the previous score on this item or a 

graphical representation of all scores recorded 

for the consumer.

■ Clinical Rating Scales.

Positive Symptom Rating Scale (PSRS).

Enter the total score for the four-item 

PSRS completed during the interview

with the consumer.

If you use EMRs, you can program this item 

to display the previous score and the date it was 

conducted or a graphical representation of all 

the scores and dates for each scale recorded 

for the consumer.

Brief Negative Symptom Assessment (BNSA). 

Rater enters the total score for the four-item 

BNSA that was completed during the interview 

with the consumer.

If you use EMRs, you can program this item 

to display the previous score and date it was 

conducted on this item or a graphical 

representation of all the scores and dates 

for each scale recorded for the consumer.

■ Side Effect Scales.

Abnormal Involuntary Movement Scale (AIMS).

Enter the consumer’s score on the AIMS. This 

item may not be conducted at every visit if the 

consumer does not show any signs of tardive 

dyskinesia and may only be conducted every 6 

to 12 months. It is recommended that you carry 

this information over from previous forms, along 

with the date that the scale was administered.

If you use EMRs, you can program this item 

to display the previous score and date it was 

conducted on this item or a graphical 

representation of all the scores and dates 

for each scale recorded for the consumer.
Tips for Agency Administrators and MedTEAM Leaders 50 Building Your Program

Simpson-Angus Scale (SAS). Enter the consumer’s 

score on the SAS. This item may not be 

conducted at every visit if the consumer does 

not show any signs of extrapyramidal symptoms 

and may only be conducted every 6 to 12 

months. It is recommended that you carry this 

information over from previous forms along 

with the date that the scale was administered.

If you use EMRs, you can program this item 

to display the previous score and date it was 

conducted on this item or a graphical 

representation of all the scores and dates 

for each scale recorded for the consumer.

■ Description of current side effects. Enter 

comments about the consumer’s side effects. 

If the consumer responded greater than 0 for 

Consumer Global Self-Report of side effects, 

the AIMS, or the SAS, there should be some 

description of side effects, interventions for 

side effects, and when the side effects and 

interventions will be reviewed again.

If you use EMRs, you can generate a list of 

common side effects in a dropdown menu. 

Then for each side effect chosen, you can 

choose interventions from a dropdown menu.

■ Is the consumer suicidal? Check either Yes or 

No. If Yes, then give detailed information about 

the consumer’s response, intent, plan, and 

means to carry out a given plan.

■ Is the consumer homicidal? Check either Yes or 

No. If Yes, then give detailed information about 

the consumer’s response, intent, plan, and 

means to carry out a given plan.

❑ Additional information about living 

situation, life events, physical problems, 

or other symptoms. In this section, add 

any pertinent information about what is 

occurring in the consumer’s life, such as, 

changes in housing, employment, health, 

family dynamics that can help or hinder 

their mental health treatment.

If you use EMRs, you can program this 

section to prefill from previous intake or 

annual reviews. If any changes occur, you can 

delete or update the necessary information.

■ Drug levels. Date and drug level. Enter the 

most recent drug levels for any agents that the 

consumer is taking where drug levels may be 

used to guide treatment or evaluate response. 

You only need to update information if changes 

have occurred since the last medication visit. 

Examples: haloperidol, clozapine, lithium, and 

valproic acid.

If you use EMRs, you can program this item to 

display the previous drug level and date it was 

drawn or a graphical representation of all the 

drug levels and dates for each level drawn for 

the consumer.
Building Your Program 51 Tips for Agency Administrators and MedTEAM Leaders

■ Participation in other treatment or support 

services. Update information about other 

treatments and services that the consumer is 

receiving. You only need to update information 

if changes have occurred since the last 

medication visit.

If you use EMRs, you can program this section 

to prefill from previous intake and annual 

reviews. If any changes occur, you can delete 

or update the necessary information.

Consumer Education and Preferences

■ Consumer education provided. Check all 

consumer education categories that apply and 

who provided the educational information.

■ Consumer preferences and goals. Provide 

specific examples in which you took consumers’ 

wishes, preferences, and objections into account 

and incorporated consumers’ views into 

decisions about medication selections.

■ Latest laboratory values. You should have 

a chemistry profile done annually for each 

consumer, along with any other indicated tests 

and as shown by the monitoring guidelines 

(such as lipid screening). Indicate which tests 

were completed, when they were drawn, 

and note any abnormal results. You need only 

update information if changes have occurred 

since the last medication visit. If you use EMRs, 

you can have the latest laboratory information 

prefill from laboratory results.

Progress Note

This section is in the form of a standard SOAP 

(Subjective, Objective, Assessment, Plan) Note. 

It allows MedTEAM staff to provide specific 

information about the consumer that may not be 

captured elsewhere or to expand on information 

captured earlier in the form.

If your mental health authority has not already 

adapted these forms, we strongly encourage you 

to do so and incorporate them into your routine 

paperwork. For printable copies of the forms, see 

the CD-ROM for this KIT. For information about 

documentation practices training for MedTEAM 

staff, see Training Frontline Staff in this KIT.
Tips for Agency Administrators and MedTEAM Leaders 52 Building Your Program

Establish staffing criteria

Your MedTEAM policies and procedures should 

specify the staffing criteria for your program. 

Carefully consider the roles of each MedTEAM 

staff member. MedTEAM does not change the 

amount of personnel time available for consumer 

visits. Instead, it recommends assessing your 

workflow and making personnel changes to increase 

the effectiveness of your medication management.

While MedTEAM defines core types of information 

to collect during each medication visit, decisions 

about who will do each task must be made at the 

local level. Consider your local resources and 

personnel while assessing your current workflow. 

For example, some agencies pair each prescriber 

with an experienced practitioner. In these agencies, 

consumers meet with practitioners before each 

medication visit. Practitioners support prescribers 

by collecting and documenting information from 

consumers about their symptoms, response, and 

adherence to medications.

Practitioners pass this information on to prescribers 

at the time of the medication visit. As a result, 

prescribers have more consumer information 

to inform medication decisions. This workflow 

is analogous to what occurs in most primary care 

settings, where a nurse obtains and records recent 

medical history, blood pressure, and other 

information before the doctor sees the patient.

It may help to develop task-specific position 

descriptions, outline the main task categories, 

and detail specific duties. For job applicants, 

a good position description clarifies whether 

a particular position matches their skills and 

expectations. Clear job descriptions allow 

MedTEAM leaders to effectively supervise 

new employees and also allow employees to 

focus on the basic elements of their jobs.

Discuss program organization 

and communication

MedTEAM policies and procedures should include 

criteria for how MedTEAM is organized and how 

MedTEAM staff members relate to one another. 

Criteria should include procedures to ensure that 

medication management is provided through a 

team approach.

To be effective, MedTEAM staff must be able 

to work both independently and collaboratively. 

Prescribers should also communicate regularly 

with other members of the treatment team. 

MedTEAM is most effective in an environment 

where prescribers are part of a treatment team 

that meets for at least 1 hour a week. Closely 

coordinating medication management with other 

mental health treatment and rehabilitation ensures 

that everyone involved provides services that 

support consumers’ recovery goals.

Treatment teams are organized differently from 

one agency to the next. Some teams quickly 

run through the list of consumers they serve, 

communicating with team members about clinical 

issues. Other teams just share information about 

crisis situations. It is important that treatment 

team meetings focus on clinical issues, not on 

administrative ones. It is also important that 

treatment team members have the time to discuss 

consumers who are not in crisis and to assess their 

progress in meeting their recovery goals.
Building Your Program 53 Tips for Agency Administrators and MedTEAM Leaders

Involve and educate consumers

MedTEAM policies and procedures should 

encourage and facilitate involving and educating 

consumers about their medication management. 

Consumer education should cover the following:

■ Purpose of specific medications;

■ Benefits and risks of specific medications;

■ Potential side effects of specific medications; 

and

■ Alternative treatments.

If your agency offers the evidence-based practice 

Illness Management and Recovery (IMR), (see 

the IMR KIT in the SAMHSA Evidence-Based 

Practices KIT series) prescribers can work together 

with IMR practitioners as they cover similar 

educational topics in the curriculum. MedTEAM 

recommends that prescribers be involved in 

the process of educating consumers. Develop 

procedures for distributing consumer education 

materials and for documenting prescriber 

involvement in consumer education.

MedTEAM policies and procedures should also 

encourage consumer involvement in medicationrelated decisions. Document consumer 

preferences and input in the medical record.

Involve family and other supporters

MedTEAM policies and procedures should 

encourage and facilitate involving family and other 

supporters to help consumers increase their 

natural supports. Instruct MedTEAM staff to ask 

consumers to identify a family member or other 

supporter whom they would like to involve in the 

treatment process.

Involving family or other supporters helps 

MedTEAM staff to do the following:

■ Clarify consumer goals, strengths, and 

preferences;

■ Identify early warning signs and symptoms; and

■ Monitor side effects.

With consumers’ permission, family or other 

supporters may attend medication visits, meet 

or talk with MedTEAM staff alone, or attend 

treatment team meetings. If your agency offers 

evidence-based practice Family Psychoeducation 

(FPE) (see the FPE KIT in the SAMHSA 

Evidence-Based Practices KIT series), MedTEAM 

members can work together with FPE practitioners 

to involve families or other supporters in the 

treatment process.

Involve support staff

MedTEAM policies and procedures should promote 

scheduling flexibility for consumers who have 

special circumstances. Involve support staff to 

ensure that they are aware of the need for flexible 

scheduling. For example, use open time slots to 

accommodate providing urgent care within 7 days 

and visits after hospital and emergency room visits 

within 3 days.
Tips for Agency Administrators and MedTEAM Leaders 54 Building Your Program

Describe how to maintain 

consumer records

In your MedTEAM policies and procedures, 

describe how you will maintain consumers’ records. 

You must keep records for each consumer and 

safeguard them against loss, tampering, and 

unauthorized use. The records should be consistent 

with The Joint Commission (TJC) (formerly called 

Joint Commission on Accreditation of Healthcare 

Organizations) and Centers for Medicaid and 

Medicare Services (CMS) requirements.

Organize your medical record

Make information easy to find within the record 

to facilitate efficient and effective care. Having a 

medical record with the elements of a high fidelity 

chart does not mean much if it requires hours to 

find needed information.

The organization of the medical record is a crucial 

piece for effective medication management. You can 

accomplish this in many ways. For example, create 

discrete sections for comprehensive summaries 

or medication histories instead of requiring 

MedTEAM staff to search for this information 

in Progress Notes. These discrete sections can 

increase the usefulness of your forms. Making the 

sections as homogeneous as possible allows those 

who are involved in medication management to 

quickly know where information is located, instead 

of filtering through extraneous information.

Another way to organize your charts is to colorcode documents within given sections. These 

standards can also hold true for electronic medical 

records where information tabs can organize the 

location of key forms into discrete sections.

Use electronic medical records

A thoughtfully designed electronic medical record 

system can be enormously helpful in facilitating 

documentation of medication management and 

in monitoring quality. The term electronic medical 

record (EMR) describes a wide variety of products.

Some EMRs have the primary purpose of 

supporting billing processes, but also add other 

consumer record-type features. Some may focus 

on personnel performance, which shapes how they 

are designed. Some products may be electronic, 

but are not medical records. It is important to 

understand these differences when considering 

EMRs for your agency.

To do this, the following resources may be helpful 

starting points.

■ http://www.capterra.com/mental-health-software:

an extensive list of EMRs and other electronic 

(scheduling, notes, prescriptions) software 

vendors;

■ http://www.askesis.com/: a link to the vendor for 

the PsychConsult product, developed within 

and used by Western Psychiatric Institute, 

among other clients; and

■ Clinical Management Research Information Systems 

(CMRIS), a system developed over the past 

decade by Duke University Department of 

Psychiatry. It is not only a true EMR, but it also 

has extensive research and clinical trial 

capabilities that are being used by top centers in 

the country and overseas.

You can purchase or develop an EMR locally. 

Purchased products may have a single format 

or a menu of features to select from. It may also 

be programmable to meet local needs. All added 

features come at a price, and local development 

requires allocating up front considerable information 

technology resources. It also requires an ability and 

commitment to maintain and grow the system.
Building Your Program 55 Tips for Agency Administrators and MedTEAM Leaders

Migrating old records into the EMR is a major 

issue that you must consider. The EMR should 

do the following:

■ Be labor-saving;

■ Contain prompts;

■ Display data over time; and

■ Search and aggregate data in any way needed 

for the purpose of quality improvement.

Some of the features that can be especially laborsaving include the following:

■ Electronic forms with checkboxes and 

dropdown menus;

■ Automatic carry-forwards of information that 

should be recorded at each visit, but often does 

not change (for example, diagnoses, medications, 

medical problems);

■ Single-click generation of written or 

electronically transmitted prescriptions;

■ Side menus with links to other documents in the 

record (for example, most recent illness, history 

summary, medication summary, treatment plan, 

symptom ratings, hospitalization or emergency 

room records, laboratory values); and

■ Prewritten text with fill-in-the-blank sections for 

topics that should be covered at each medication 

visit (for example, side effects and adherence).

The goals are to make data entry simple, to amend 

rather than re-enter information that is likely not 

to change, to prompt recording all essential 

information, and to minimize time spent searching 

the record for medication-related information.

Prompts in the EMR can promote good practices 

and reduce errors. Again, you must balance 

efficient use of user time (too many prompts are 

wasteful, especially if they require a response.), 

value of the prompt (How useful is it? What will 

happen if it is ignored?), and programming time 

to create the prompt. Consulting with others who 

have worked with electronic prompts is highly 

recommended in deciding what to include.

Building displays of data over time into your EMR 

is very useful. For example, a symptom measure 

graphed over time can reveal trends that may not 

otherwise be obvious. See Evaluating Your 

Program in this KIT for more information.

Finally, an EMR can significantly reduce time 

spent on quality assurance reviews and can make 

the data more accurate. First, documents may be 

either missing or misfiled so that reviewers end up 

looking through the entire chart multiple times, 

item by item. You can easily search an electronic 

record. Second, with proper programming, you can 

automate electronic chart reviews and sort the 

results as needed (for example, by prescriber). In 

contrast, reviewers must record paper review 

results one at a time.

Even in systems that do not use EMRs, it is 

worthwhile to store the medication history 

document electronically, so that updating it 

becomes a matter of editing rather than re-creating 

a large document. For example, adding dropdown 

menus for medication names prevents medications 

from being misspelled or having extraneous 

information in areas where only the medication 

name should be placed.

Selecting and designing an EMR system is often 

an iterative process. You may be unsure of what 

you need until you try it out. Allow key stakeholders 

in your agency to have input into selecting and 

designing your EMR. Consider consulting with 

other agencies who have successful EMR systems.

Make sure that MedTEAM staff are familiar with 

your policies and procedures for documenting and 

maintaining records. MedTEAM recommends 

offering training on documentation practices. 

For more information, see Develop a training 

plan later in this booklet.
Tips for Agency Administrators and MedTEAM Leaders 56 Building Your Program

Discuss how to ensure consumers’ rights

In your MedTEAM policies and procedures, discuss 

how you will ensure that consumers’ rights are 

upheld. MedTEAM staff should do the following:

■ Be aware of the state and federal consumer 

rights requirements;

■ Inform consumers of their rights in a 

meaningful way; and

■ Help consumers exercise their rights.

Also, policies and procedures should reflect the 

model’s recovery orientation. Most traditional 

services were developed with a biomedical 

approach to mental health treatment. They focus 

on reducing symptoms and preventing relapse. In 

contrast, the MedTEAM model is based on the 

concept of recovery. In the recovery framework, 

the expectation is that consumers can have lives in 

which mental illnesses are not the driving factors. 

Recovery means more than maintaining people 

with mental illnesses in the community. Recoveryoriented services encourage consumers to define 

and fulfill their personal goals, such as a goal to 

work or finish college.

MedTEAM members must believe in and be true 

to the recovery principles within the MedTEAM 

model. Be careful not to replicate those elements 

of traditional services that simply emphasize 

containing symptoms and complying with medication.

The value of consumer choice in medication 

decisions and service delivery and the importance 

of consumer perceptions must be infused in how 

you provide MedTEAM. Most practitioners have 

never examined their own attitudes and behaviors 

about consumer recovery and uncritically accept 

many clinical traditions without paying attention 

to how disempowering these practices are 

for consumers.

In recovery-based services, establishing a trusting 

relationship is critical. Base interactions with 

consumers on mutuality and respect. Challenge 

MedTEAM staff to listen to, believe in, and 

understand consumers’ perspectives and take 

into account consumers’ experiences.

MedTEAM staff should also focus on consumerdefined needs and preferences and accept 

consumers’ choices in medication decisions. 

Providing MedTEAM with a recovery orientation 

means that you support and empower consumers 

to achieve their individual goals.

How administrators and MedTEAM 

leaders can help provide recoveryoriented services

■ Clearly explain consumer rights in 

MedTEAM policies and procedures.

■ Offer training on recovery principles and 

consumer rights.

■ Hold community forums using the 

multimedia tools in this KIT.

■ Involve consumers in local advisory groups.
Building Your Program 57 Tips for Agency Administrators and MedTEAM Leaders

Evaluate program and staff performance

When it is properly implemented, MedTEAM 

is associated with a variety of positive outcomes. 

Evaluating the performance of MedTEAM will 

help you provide high-quality services to 

consumers and assure stakeholders of the 

program’s effective performance.

Use the guidelines in Evaluating Your Program

in this KIT to assess which components of 

MedTEAM your agency has in place and 

develop an implementation plan. MedTEAM 

also recommends developing a quality assurance 

committee that comprehensively reviews MedTEAM 

(using all items on MedTEAM fidelity scales) every 

6 months.

Quality assurance members, advisory group 

members and MedTEAM staff should work 

together to ensure that assessment information 

is used to improve the program. For more 

information including the two MedTEAM fidelity 

scales, see Evaluating Your Program in this KIT.

Also, develop procedures for how you will 

supervise and evaluate the performance of your 

MedTEAM staff. To a large extent, clinical 

supervision is the process that will determine 

whether MedTEAM staff understand and 

consistently apply the evidence-based model 

or whether further leadership, training, and 

accountability are required to meet this goal.

MedTEAM leaders who are experienced in the 

evidence-based model should provide monthly 

individual or group supervision to MedTEAM 

staff. Clinical supervision should be consumercentered and explicitly address MedTEAM and 

its application to specific consumer situations.

Because MedTEAM leaders dedicate some time 

to direct services, they will be familiar with all of 

the parts of providing medication management. 

MedTEAM leaders will not just review cases that 

MedTEAM staff present, but will also be able to 

actively problem-solve using MedTEAM principles 

and techniques.

MedTEAM leaders may also disseminate the 

fidelity assessment results during supervisory 

meetings. A useful form of feedback is to 

disseminate staff averages (for example, percentage 

of consumers with psychotic symptoms who are on 

antipsychotic polypharmacy) along with 

distributing individual performance data. When 

possible, compare staff averages with accepted 

norms or with goals that are based on established 

and accepted standards. Most MedTEAM staff 

find it helpful and motivating to see where they 

stand in relation to their peers.

MedTEAM leaders also provide individual 

supervision to discuss performance and give 

feedback. MedTEAM leaders may schedule 

regular meetings with MedTEAM staff to review 

specific cases. They should be regularly available 

to consult with MedTEAM staff, as needed.

If the MedTEAM staff is working with a 

consultant, the MedTEAM leader should involve 

the consultant in group supervision and treatment 

team meetings. Many new evidence-based practice 

programs have found that feedback from an 

external consultant is a crucial component for 

improving staff performance and the quality 

of their program as a whole.
Tips for Agency Administrators and MedTEAM Leaders 58 Building Your Program

Develop a training plan

Developing MedTEAM is a complex undertaking. 

Agencies that have successfully implemented 

MedTEAM indicate that offering one-time training 

for prescribers is not enough. Instead, you should 

assess the knowledge level of key stakeholders (See 

Evaluating Your Program in this KIT) and develop 

a training plan.

What should your training

plan include?

■	Basic training for staff at all levels across 

the agency

■	Basic training for key stakeholders, 

including consumers, families, advisory 

group members, mental health authorities, 

and members of key community 

organizations

■	Intensive training for MedTEAM staff 

including the following:

■	New documentation practices

■	Ongoing training on medications

■	Integrating outcome measures into 

clinical assessments

Practitioners who implement evidence-based 

practices are often stymied in their efforts 

because people misunderstand the model or lack 

information. It is important that key stakeholders 

(consumers, families, and other essential 

community members) and agencywide staff 

develop a basic understanding of MedTEAM.

This training will build support for implementing 

MedTEAM in your agency. Since implementing 

MedTEAM effectively depends on a collaborative 

approach, it is important for all practitioners to have 

a basic understanding of the MedTEAM model.

In addition to these internal basic training 

activities, consider organizing routine educational 

meetings for consumers, families, or other key 

stakeholders in the community where consumers 

who have received medication management 

through the MedTEAM approach share their 

experiences. Events such as these can correct 

false beliefs before they impede implementing 

the evidence-based model.

Next, consider how you will offer MedTEAM 

staff intensive training to allow them to master 

the evidence-based model. We suggest organizing 

three types of training:

■ New documentation practices;

■ Ongoing training on medications; and

■ Integrating outcome measures into 

clinical assessments.

Training on new documentation practices

As described above, MedTEAM recommends 

collecting information in 11 core areas to inform 

medication management. MedTEAM also 

recommends assessing workflow for collecting 

and documenting this information. These 

recommendations may result in changes 

to your agency’s documentation practices.

Training Frontline Staff in this KIT describes 

the rationale for providing training on new 

documentation practices. The booklet also provides 

information on the types of topics that you may 

include in this training.
Building Your Program 59 Tips for Agency Administrators and MedTEAM Leaders

Ongoing training on medications

Two aspects of serious mental illnesses have led 

to developing a number of medication guidelines 

and algorithms that make recommendations for 

sequencing specific medications for long-term 

medication treatment.

■ First, these illnesses are typically recurrent 

or chronic.

■ Second, the first treatment typically does not 

work for the duration of the consumer’s illness.

Therefore, most consumers will respond 

inadequately to at least one medication and need 

either a medication change or addition.

Training Frontline Staff provides information 

about a number of algorithms and treatment 

guidelines that are currently available. No 

algorithm or guideline has been found to be 

superior to others. However, some generally 

shared characteristics span many of the currently 

available guidelines. For example, in treating 

schizophrenia, the following three tenets are 

shared across numerous guidelines and algorithms:

■ Antipsychotics are the core of 

medication treatment;

■ Clozapine is recommended for those who have 

a history of inadequate response to two or more 

other antipsychotics; and

■ Combination antipsychotics are a last resort 

because they lack a strong evidence base.

MedTEAM recommends developing a systematic 

plan to train MedTEAM staff. Training should 

include a review of the available guidelines and 

algorithms for the purpose of adopting one that 

follows expert consensus based on the latest research.

Written guidelines or algorithms should specify 

what constitutes an adequate trial for each 

medication including the dose and duration. 

MedTEAM also recommends that guidelines 

include a plan for identifying and treating 

consumers with treatment-refractory disorders 

(or those whose symptoms have inadequately 

responded to medications). The systematic plan 

should include procedures for updating these 

guidelines annually and providing ongoing training 

for MedTEAM staff.

Keeping current in a changing world

The knowledge base about specific medications 

is growing rapidly. New findings quickly render 

prior information outdated and even incorrect. 

Prescribers need to keep up as new drugs are 

approved and new information emerges about 

existing ones. Various ways of dealing with the 

fluidity of knowledge about medication exist.

First, offer routine training for prescribers. 

Second, consider designating a staff member who 

may serve as a point person within your agency for 

medication updates. Have that person routinely 

update staff during treatment team meetings or 

other inservice sessions.
Tips for Agency Administrators and MedTEAM Leaders 60 Building Your Program

Time and effort to access information often 

compete with time devoted to consumer care. 

Designated staff can support prescribers with 

their effort to keep up with scientific updates.

Some agencies may also further specify roles so 

that one staff member serves as a point person for 

medications related to schizophrenia and another 

for mood disorders. Designated staff members may 

participate in additional training activities.

Routine self training is complex. Many sources 

of information about medications exist. A few 

examples include the following:

■ Continuing Medical Education (CME) 

programs;

■ Primary research literature;

■ Research reviews and meta-analyses;

■ Pharmaceutical representatives and programs; 

and

■ Medication-related Web sites and newsletters.

Considerable information is available through the 

Internet, which also has a plethora of Web sites 

devoted to specific mental illnesses and psychiatric 

issues. Unfortunately, the quality of information 

varies hugely from source to source. Timeliness and 

reliability of information may be difficult to judge. 

Provide training to support MedTEAM staff in 

gaining the skills necessary to undertake these tasks.

For more information about how to design training 

to support MedTEAM staff members in their 

effort to keep current on scientific evidence related 

to medication management, see Training Frontline 

Staff in this KIT.

Integrating outcome measures 

into clinical assessments

Prescribers collect an enormous amount of 

information during medication visits that is 

difficult to record and track simply through 

handwritten notes. MedTEAM recommends 

integrating outcome measures, such as brief rating 

scales, to help assess the effectiveness of current 

medications, establish a plan for any future 

medication changes, and document this 

information in the medical record.

Integrating outcome measures into clinical 

assessments enhances prescribers’ ability to 

effectively manage medications. Prescribers 

should also document their rationale for 

medication decisions, in order to facilitate 

seamless care when multiple prescribers 

become involved in the treatment process.

Develop a training plan to help prescribers 

integrate outcome measures into routine practice. 

For more information, see Training Frontline Staff

in this KIT.

Educate and involve consumers

MedTEAM also recommends developing 

procedures to educate and involve consumers 

in their medication management. It is important 

to train MedTEAM staff members on these 

procedures to ensure that they are properly 

integrated into the medication management 

process. For more information, see resources 

on shared decisionmaking in The Evidence

in this KIT.
Building Your Program 61 Tips for Agency Administrators and MedTEAM Leaders

Hire an external consultant and trainer

Establishing processes for providing quality 

services requires great attention to detail. 

Consequently, during the first 1 to 2 years of 

implementing MedTEAM, many agencies have 

found it helpful to work with an experienced 

external consultant and trainer.

Consultants and MedTEAM leaders often work 

together over the first 2 years to ensure that 

MedTEAM is structured appropriately. They 

integrate MedTEAM principles into the agency’s 

policies and tailor MedTEAM procedures to meet 

local needs.

Once the program has been launched, it is 

important that you do not allow staff to revert 

to older and more familiar ways of doing things. 

External consultants and trainers who are 

experienced in implementing MedTEAM can 

provide ongoing technical assistance, supervision, 

and periodic booster training sessions. This type of 

assistance, along with ongoing evaluation of fidelity 

and outcomes, has been found to be critical in 

sustaining an evidence-based approach.

In summary, implementing the MedTEAM 

approach effectively is a developmental process. 

We encourage you to periodically revisit the 

information in this KIT throughout the first year 

after starting your MedTEAM initiative. We believe 

that these materials will take on a new meaning as 

the process of implementing MedTEAM evolves.


HHS Publication No. SMA-10-4548

Printed 2010

28611.0610.8712010401