Skip to Main Content

Office of Mental Health

First Year Evaluation Template for New York City with Instructions

View Adobe Acrobat Version | Download Adobe Acrobat Reader


To: Executive Directors and Program Directors of New York City Clinics Participating in the Continuous Quality Improvement (CQI) Initiative
From: Jayne Van Bramer, Director
Office of Quality Management
Date: February 7, 2007
Subject: OMH Continuous Quality Improvement (CQI) Initiative Template for the Annual Evaluation of Clinic Quality Improvement Programs Due May 30, 2007

The purpose of this document is to provide a template for participating New York City clinics to complete a summary and self-evaluation of quality improvement activities that occurred during 2006.  This evaluation will provide a basis on which to plan for second year activities.  You may download a copy of the enclosed template through the OMH website:

OMH will also use this summary to evaluate performance as related to our Memorandum of Agreement.  A key to successful quality improvement is a willingness to innovate, to experiment, and to learn from experience.  Given that, we encourage objectivity and candor in completing the self-assessment.  The focus of OMH’s evaluation will be a good faith effort in adopting quality improvement as an attitude, orientation and practice.

The Assessment Tool
Due to the diversity among participating clinics both in administrative structure and the level of development of a formal quality program, we have attempted to make provision for this diversity by creating a comprehensive assessment template.  You are encouraged to further edit the template to include whatever additional information you feel will best "tell your story."

Framework of the Template
Because we view this primarily as a self-assessment, the template has been designed as an annual report to the leadership and clinic staff who are the clinic quality stakeholders themselves.  Features of the template include generalized introductory and transitional comments, as well as instructions for completion which appear in italics.  Your specific program information should be written where these instructions occur, and the instructions subsequently deleted.  You are encouraged to add to the template to better describe your activities and results.

Note:  The language provided in the template describes a clinic which is not a part of a larger agency and which is initially developing a quality improvement program.  You are encouraged to modify this language in any way you wish to better describe the individual circumstances of your program.

Requirements for 2007
In addition to the current year’s assessment, completion of the template will also communicate your plans for activities in 2007.  Following is a list of requirements for second and third year activity as described in the MOA.

"…During the second and third years of this Agreement, the provider shall:

If you have already satisfied some or all these requirements, they should be addressed in your assessment of 2006.  The MOA provides minimum requirements of your quality improvement programs, and you should include any additional objectives you may have for 2007 in this section of the assessment.

Submission of the Evaluation
Your completed self-evaluation either on the template provided should be sent as a paper document and electronically to Alan McCollom, Ph.D.

Alan McCollom, Ph.D.
Bronx Psychiatric Center
1500 Waters Place
Bronx, New York  10461

You will receive an initial response indicating that your submission has been received and a later e-mail indicating whether your report has been accepted.

Enclosure (1)

cc:     Robert Myers
         Lloyd Sederer, MD
         Anita Appel
         Lisa Gilbert
         Alan McCollom
         Ellen Smith