Audio File Name
* must provide value
Clinician's First and Last Name
* must provide value
Session Date
* must provide value
Today M-D-Y
Client's Initials
* must provide value
Example: John Smith = JS
Type of Audio
* must provide value
Pre-Workshop
Post-Workshop
3-month
6-month
One of 11 additional audio
Recertification
Retry for 6-month or Recertification
Reminder: You should only select Pre-Workshop, Post-Workshop, 3-Month, and 6-Month ONE TIME over the course of your training. For all other audio you should select either "One of the 11 additional audio" or "Retry for 6-Month" if this is not your first 6-Month submission.
Upload your audio here
* must provide value
PLEASE NOTE: In submitting this audio you are confirming that you have collected this client's written consent to record this session and share it with UPenn for educational and program evaluation purposes. You are responsible for keeping a copy of this consent form with your client's records.
Considering your total clinical experience with this particular population, how distressed/impaired is the client at this time?
* must provide value
1 = Not at all distressed/impaired
2 = Borderline distressed/impaired
3 = Mildly distressed/impaired
4 = Moderately distressed/impaired
5 = Markedly distressed/impaired
6 = Severely distressed/impaired
7 = Among the most extremely distressed/impaired clients
Compared to the client's condition at admission to the project, this client's condition is:
* must provide value
1 = Very much improved since the initiation of treatment
2 = Much improved
3 = Minimally improved
4 = No change from baseline (the initiation of treatment)*
5 = Minimally worse
6 = Much worse
7 = Very much worse since the initiation of treatment.
*please select "no change" if this is your first session with this client
What language was primarily used during this session?
* must provide value
English
Spanish
Please select the language that was used most often (more than 50% of the session)
Email to contact regarding issues with this audio (if necessary)
* must provide value
Are you submitting another audio today?
* must provide value
Yes
No
Audio File Name
* must provide value
Clinician's First and Last Name
* must provide value
Session Date
* must provide value
Today M-D-Y
Client's Initials
* must provide value
Example: John Smith = JS
Type of Audio
* must provide value
Pre-Workshop
Post-Workshop
3-month
6-month
One of 11 additional audio
Recertification
Retry for 6-month or Recertification
Upload your audio here
* must provide value
Reminder: Before uploading audio, be sure your client has signed a consent form that allows you to share this recording with us. You are responsible for keeping a copy of this consent form with your client's records.
Considering your total clinical experience with this particular population, how distressed/impaired is the client at this time?
* must provide value
1 = Not at all distressed/impaired
2 = Borderline distressed/impaired
3 = Mildly distressed/impaired
4 = Moderately distressed/impaired
5 = Markedly distressed/impaired
6 = Severely distressed/impaired
7 = Among the most extremely distressed/impaired clients
Compared to the client's condition at admission to the project, this client's condition is:
* must provide value
1 = Very much improved since the initiation of treatment
2 = Much improved
3 = Minimally improved
4 = No change from baseline (the initiation of treatment)*
5 = Minimally worse
6 = Much worse
7 = Very much worse since the initiation of treatment.
*please select "no change" if this is your first session with this client
What language was primarily used during this session?
* must provide value
English
Spanish
Please select the language that was used most often (more than 50% of the session)
Email to contact regarding issues with this audio (if necessary)
* must provide value
Are you submitting another audio today?
* must provide value
Yes
No
Audio File Name
* must provide value
Clinician's First and Last Name
* must provide value
Session Date
* must provide value
Today M-D-Y
Client's Initials
* must provide value
Example: John Smith = JS
Type of Audio
* must provide value
Pre-Workshop
Post-Workshop
3-month
6-month
One of 11 additional audio
Recertification
Retry for 6-month or Recertification
Upload your audio here
* must provide value
Reminder: Before uploading audio, be sure your client has signed a consent form that allows you to share this recording with us. You are responsible for keeping a copy of this consent form with your client's records.
Considering your total clinical experience with this particular population, how distressed/impaired is the client at this time?
* must provide value
1 = Not at all distressed/impaired
2 = Borderline distressed/impaired
3 = Mildly distressed/impaired
4 = Moderately distressed/impaired
5 = Markedly distressed/impaired
6 = Severely distressed/impaired
7 = Among the most extremely distressed/impaired clients
Compared to the client's condition at admission to the project, this client's condition is:
* must provide value
1 = Very much improved since the initiation of treatment
2 = Much improved
3 = Minimally improved
4 = No change from baseline (the initiation of treatment)*
5 = Minimally worse
6 = Much worse
7 = Very much worse since the initiation of treatment.
*please select "no change" if this is your first session with this client
What language was primarily used during this session?
* must provide value
English
Spanish
Please select the language that was used most often (more than 50% of the session)
Email to contact regarding issues with this audio (if necessary)
* must provide value
Are you submitting another audio today?
* must provide value
Yes
No
Audio File Name
* must provide value
Clinician's First and Last Name
* must provide value
Session Date
* must provide value
Today M-D-Y
Client's Initials
* must provide value
Example: John Smith = JS
Type of Audio
* must provide value
Pre-Workshop
Post-Workshop
3-month
6-month
One of 11 additional audio
Recertification
Retry for 6-month or Recertification
Upload your audio here
* must provide value
Reminder: Before uploading audio, be sure your client has signed a consent form that allows you to share this recording with us. You are responsible for keeping a copy of this consent form with your client's records.
Considering your total clinical experience with this particular population, how distressed/impaired is the client at this time?
* must provide value
1 = Not at all distressed/impaired
2 = Borderline distressed/impaired
3 = Mildly distressed/impaired
4 = Moderately distressed/impaired
5 = Markedly distressed/impaired
6 = Severely distressed/impaired
7 = Among the most extremely distressed/impaired clients
Compared to the client's condition at admission to the project, this client's condition is:
* must provide value
1 = Very much improved since the initiation of treatment
2 = Much improved
3 = Minimally improved
4 = No change from baseline (the initiation of treatment)*
5 = Minimally worse
6 = Much worse
7 = Very much worse since the initiation of treatment.
*please select "no change" if this is your first session with this client
What language was primarily used during this session?
* must provide value
English
Spanish
Please select the language that was used most often (more than 50% of the session)
Email to contact regarding issues with this audio (if necessary)
* must provide value
Are you submitting another audio today?
* must provide value
Yes
No
Audio File Name
* must provide value
Clinician's First and Last Name
* must provide value
Session Date
* must provide value
Today M-D-Y
Client's Initials
* must provide value
Example: John Smith = JS
Type of Audio
* must provide value
Pre-Workshop
Post-Workshop
3-month
6-month
One of 11 additional audio
Recertification
Retry for 6-month or Recertification
Upload your audio here
* must provide value
Reminder: Before uploading audio, be sure your client has signed a consent form that allows you to share this recording with us. You are responsible for keeping a copy of this consent form with your client's records.
Considering your total clinical experience with this particular population, how distressed/impaired is the client at this time?
* must provide value
1 = Not at all distressed/impaired
2 = Borderline distressed/impaired
3 = Mildly distressed/impaired
4 = Moderately distressed/impaired
5 = Markedly distressed/impaired
6 = Severely distressed/impaired
7 = Among the most extremely distressed/impaired clients
Compared to the client's condition at admission to the project, this client's condition is:
* must provide value
1 = Very much improved since the initiation of treatment
2 = Much improved
3 = Minimally improved
4 = No change from baseline (the initiation of treatment)*
5 = Minimally worse
6 = Much worse
7 = Very much worse since the initiation of treatment.
*please select "no change" if this is your first session with this client
What language was primarily used during this session?
* must provide value
English
Spanish
Please select the language that was used most often (more than 50% of the session)
Email to contact regarding issues with this audio (if necessary)
* must provide value
Are you submitting another audio today?
* must provide value
Yes
No
Audio File Name
* must provide value
Clinician's First and Last Name
* must provide value
Session Date
* must provide value
Today M-D-Y
Client's Initials
* must provide value
Example: John Smith = JS
Type of Audio
* must provide value
Pre-Workshop
Post-Workshop
3-month
6-month
One of 11 additional audio
Recertification
Retry for 6-month or Recertification
Upload your audio here
* must provide value
Reminder: Before uploading audio, be sure your client has signed a consent form that allows you to share this recording with us. You are responsible for keeping a copy of this consent form with your client's records.
Considering your total clinical experience with this particular population, how distressed/impaired is the client at this time?
* must provide value
1 = Not at all distressed/impaired
2 = Borderline distressed/impaired
3 = Mildly distressed/impaired
4 = Moderately distressed/impaired
5 = Markedly distressed/impaired
6 = Severely distressed/impaired
7 = Among the most extremely distressed/impaired clients
Compared to the client's condition at admission to the project, this client's condition is:
* must provide value
1 = Very much improved since the initiation of treatment
2 = Much improved
3 = Minimally improved
4 = No change from baseline (the initiation of treatment)*
5 = Minimally worse
6 = Much worse
7 = Very much worse since the initiation of treatment.
*please select "no change" if this is your first session with this client
What language was primarily used during this session?
* must provide value
English
Spanish
Please select the language that was used most often (more than 50% of the session)
Email to contact regarding issues with this audio (if necessary)
* must provide value
Are you submitting another audio today?
* must provide value
Yes
No
Audio File Name
* must provide value
Clinician's First and Last Name
* must provide value
Session Date
* must provide value
Today M-D-Y
Client's Initials
* must provide value
Example: John Smith = JS
Type of Audio
* must provide value
Pre-Workshop
Post-Workshop
3-month
6-month
One of 11 additional audio
Recertification
Retry for 6-month or Recertification
Upload your audio here
* must provide value
Reminder: Before uploading audio, be sure your client has signed a consent form that allows you to share this recording with us. You are responsible for keeping a copy of this consent form with your client's records.
Considering your total clinical experience with this particular population, how distressed/impaired is the client at this time?
* must provide value
1 = Not at all distressed/impaired
2 = Borderline distressed/impaired
3 = Mildly distressed/impaired
4 = Moderately distressed/impaired
5 = Markedly distressed/impaired
6 = Severely distressed/impaired
7 = Among the most extremely distressed/impaired clients
Compared to the client's condition at admission to the project, this client's condition is:
* must provide value
1 = Very much improved since the initiation of treatment
2 = Much improved
3 = Minimally improved
4 = No change from baseline (the initiation of treatment)*
5 = Minimally worse
6 = Much worse
7 = Very much worse since the initiation of treatment.
*please select "no change" if this is your first session with this client
What language was primarily used during this session?
* must provide value
English
Spanish
Please select the language that was used most often (more than 50% of the session)
Email to contact regarding issues with this audio (if necessary)
* must provide value
Are you submitting another audio today?
* must provide value
Yes
No
Audio File Name
* must provide value
Clinician's First and Last Name
* must provide value
Session Date
* must provide value
Today M-D-Y
Client's Initials
* must provide value
Example: John Smith = JS
Type of Audio
* must provide value
Pre-Workshop
Post-Workshop
3-month
6-month
One of 11 additional audio
Recertification
Retry for 6-month or Recertification
Upload your audio here
* must provide value
Reminder: Before uploading audio, be sure your client has signed a consent form that allows you to share this recording with us. You are responsible for keeping a copy of this consent form with your client's records.
Considering your total clinical experience with this particular population, how distressed/impaired is the client at this time?
* must provide value
1 = Not at all distressed/impaired
2 = Borderline distressed/impaired
3 = Mildly distressed/impaired
4 = Moderately distressed/impaired
5 = Markedly distressed/impaired
6 = Severely distressed/impaired
7 = Among the most extremely distressed/impaired clients
Compared to the client's condition at admission to the project, this client's condition is:
* must provide value
1 = Very much improved since the initiation of treatment
2 = Much improved
3 = Minimally improved
4 = No change from baseline (the initiation of treatment)*
5 = Minimally worse
6 = Much worse
7 = Very much worse since the initiation of treatment.
*please select "no change" if this is your first session with this client
What language was primarily used during this session?
* must provide value
English
Spanish
Please select the language that was used most often (more than 50% of the session)
Email to contact regarding issues with this audio (if necessary)
* must provide value
Are you submitting another audio today?
* must provide value
Yes
No
Audio File Name
* must provide value
Clinician's First and Last Name
* must provide value
Session Date
* must provide value
Today M-D-Y
Client's Initials
* must provide value
Example: John Smith = JS
Type of Audio
* must provide value
Pre-Workshop
Post-Workshop
3-month
6-month
One of 11 additional audio
Recertification
Retry for 6-month or Recertification
Upload your audio here
* must provide value
Reminder: Before uploading audio, be sure your client has signed a consent form that allows you to share this recording with us. You are responsible for keeping a copy of this consent form with your client's records.
Considering your total clinical experience with this particular population, how distressed/impaired is the client at this time?
* must provide value
1 = Not at all distressed/impaired
2 = Borderline distressed/impaired
3 = Mildly distressed/impaired
4 = Moderately distressed/impaired
5 = Markedly distressed/impaired
6 = Severely distressed/impaired
7 = Among the most extremely distressed/impaired clients
Compared to the client's condition at admission to the project, this client's condition is:
* must provide value
1 = Very much improved since the initiation of treatment
2 = Much improved
3 = Minimally improved
4 = No change from baseline (the initiation of treatment)*
5 = Minimally worse
6 = Much worse
7 = Very much worse since the initiation of treatment.
*please select "no change" if this is your first session with this client
What language was primarily used during this session?
* must provide value
English
Spanish
Please select the language that was used most often (more than 50% of the session)
Email to contact regarding issues with this audio (if necessary)
* must provide value
Are you submitting another audio today?
* must provide value
Yes
No
Audio File Name
* must provide value
Clinician's First and Last Name
* must provide value
Session Date
* must provide value
Today M-D-Y
Client's Initials
* must provide value
Example: John Smith = JS
Type of Audio
* must provide value
Pre-Workshop
Post-Workshop
3-month
6-month
One of 11 additional audio
Recertification
Retry for 6-month or Recertification
Upload your audio here
* must provide value
Reminder: Before uploading audio, be sure your client has signed a consent form that allows you to share this recording with us. You are responsible for keeping a copy of this consent form with your client's records.
Considering your total clinical experience with this particular population, how distressed/impaired is the client at this time?
* must provide value
1 = Not at all distressed/impaired
2 = Borderline distressed/impaired
3 = Mildly distressed/impaired
4 = Moderately distressed/impaired
5 = Markedly distressed/impaired
6 = Severely distressed/impaired
7 = Among the most extremely distressed/impaired clients
Compared to the client's condition at admission to the project, this client's condition is:
* must provide value
1 = Very much improved since the initiation of treatment
2 = Much improved
3 = Minimally improved
4 = No change from baseline (the initiation of treatment)*
5 = Minimally worse
6 = Much worse
7 = Very much worse since the initiation of treatment.
*please select "no change" if this is your first session with this client
What language was primarily used during this session?
* must provide value
English
Spanish
Please select the language that was used most often (more than 50% of the session)
Email to contact regarding issues with this audio (if necessary)
* must provide value
Are you submitting another audio today?
* must provide value
Yes
No
Audio File Name
* must provide value
Clinician's First and Last Name
* must provide value
Session Date
* must provide value
Today M-D-Y
Client's Initials
* must provide value
Example: John Smith = JS
Type of Audio
* must provide value
Pre-Workshop
Post-Workshop
3-month
6-month
One of 11 additional audio
Recertification
Retry for 6-month or Recertification
Upload your audio here
* must provide value
Reminder: Before uploading audio, be sure your client has signed a consent form that allows you to share this recording with us. You are responsible for keeping a copy of this consent form with your client's records.
Considering your total clinical experience with this particular population, how distressed/impaired is the client at this time?
* must provide value
1 = Not at all distressed/impaired
2 = Borderline distressed/impaired
3 = Mildly distressed/impaired
4 = Moderately distressed/impaired
5 = Markedly distressed/impaired
6 = Severely distressed/impaired
7 = Among the most extremely distressed/impaired clients
Compared to the client's condition at admission to the project, this client's condition is:
* must provide value
1 = Very much improved since the initiation of treatment
2 = Much improved
3 = Minimally improved
4 = No change from baseline (the initiation of treatment)*
5 = Minimally worse
6 = Much worse
7 = Very much worse since the initiation of treatment.
*please select "no change" if this is your first session with this client
What language was primarily used during this session?
* must provide value
English
Spanish
Please select the language that was used most often (more than 50% of the session)
Email to contact regarding issues with this audio (if necessary)
* must provide value
Are you submitting another audio today?
* must provide value
Yes
No
Audio File Name
* must provide value
Clinician's First and Last Name
* must provide value
Session Date
* must provide value
Today M-D-Y
Client's Initials
* must provide value
Example: John Smith = JS
Type of Audio
* must provide value
Pre-Workshop
Post-Workshop
3-month
6-month
One of 11 additional audio
Recertification
Retry for 6-month or Recertification
Upload your audio here
* must provide value
Reminder: Before uploading audio, be sure your client has signed a consent form that allows you to share this recording with us. You are responsible for keeping a copy of this consent form with your client's records.
Considering your total clinical experience with this particular population, how distressed/impaired is the client at this time?
* must provide value
1 = Not at all distressed/impaired
2 = Borderline distressed/impaired
3 = Mildly distressed/impaired
4 = Moderately distressed/impaired
5 = Markedly distressed/impaired
6 = Severely distressed/impaired
7 = Among the most extremely distressed/impaired clients
Compared to the client's condition at admission to the project, this client's condition is:
* must provide value
1 = Very much improved since the initiation of treatment
2 = Much improved
3 = Minimally improved
4 = No change from baseline (the initiation of treatment)*
5 = Minimally worse
6 = Much worse
7 = Very much worse since the initiation of treatment.
*please select "no change" if this is your first session with this client
What language was primarily used during this session?
* must provide value
English
Spanish
Please select the language that was used most often (more than 50% of the session)
Email to contact regarding issues with this audio (if necessary)
* must provide value
Any additional information regarding uploaded audio file(s)
(i.e. 2 part audio, short audio, etc.)
