Identifying Potential Challenges and Opportunities Form

Downloadable Form

Adapted by the AETC Mental Health Committee in 2014-2015.

How to Use this Form

Health care team members document challenges and opportunities regarding each component of mental health care (screening, diagnosing, treating, and following-up) in their clinics.

Where to Obtain Additional Assistance

Contact the HRSA-funded AIDS Education and Training Center (AETC) for your region for training, consultation and technical assistance OR send requests to [email protected], and you will be connected to your regional AETC for further assistance.

Screening Potential Challenge/Opportunity
Challenges:
Solution(s):Person(s) Responsible:
Solution(s):Person(s) Responsible:
Diagnosis Potential Challenge/Opportunity
Challenges:
Solution(s):Person(s) Responsible:
Solution(s):Person(s) Responsible:
Treatment Potential Challenge/Opportunity
Challenges:
Solution(s):Person(s) Responsible:
Solution(s):Person(s) Responsible:
Follow-up Potential Challenge/Opportunity
Challenges:
Solution(s):Person(s) Responsible:
Solution(s):Person(s) Responsible:

Based on a template from: Centers for Disease Control and Prevention. (2005). Anti-Retroviral Treatment and Access to Services (ARTAS): An individual-level, multi-session intervention for people who are recently diagnosed with HIV: Implementation Manual. Retrieved from www.cdc.gov/ hiv/topics/cba/pdf/artas_implementation_manual.pdf.