DBT Centres of Excellence: self-assessment and application form.

Name:





Organization:





Email:





Address





1. As accurately as reasonably possible, what percentage of the staff in the proposed centre of excellence have attended formal DBT training?





2. Using a 10 point scale, How much is DBT language built into the most important forms you use, where 0 is none at all, 10 is ‘as much as humanly possible’ and 5 is ‘some’?

10 9 8 7 6 5 4 3 2 1



3. Using a 10 point scale, How much DBT language is used in the most important meetings, where 0 is none at all, 10 is ‘it is the main concept we use’ and 5 is ‘some’?

10 9 8 7 6 5 4 3 2 1



4. If a DBT enthusiast were to visit your proposed centre of excellence and talk to the patients there and a range of professionals there, how much do you estimate he or she would feel that people think talk and act in DBT terms, where 0 is ‘not at all’, 10 is ‘completely, this is their main concept’, and 5 is ‘a fair amount’?

10 9 8 7 6 5 4 3 2 1



5. Using a 10 point scale, where 10 is ‘absolutely certain’ and 0 is ‘completely uncertain’, how much do you feel that you facilities genuinely represent a centre of excellence, for DBT.

10 9 8 7 6 5 4 3 2 1



6. Has the organization applying for Centre of Excellence status ever been the subject of adverse publicity? If so please give details. (Such publicity does not preclude CoE status, but failure to disclose relevant incidents which later come to light will lead to the status being revoked.)





7. Has your organization understood that the assessment fee of $5,040 (plus travel expenses for the inspector) is payable regardless of the outcome of the assessment visit? (If you are not successful in the first instance, you receive the assessor’s feedback so that you can rectify the issues if you wish to.)

Yes No