EXP-2 | HRSA EHBs

EXP-2 - Selecting Training Program and Site Name

Warning
Multiple steps are required to complete this portion of the subform. Please read instructions carefully.

Type of Training Program	Site Name
(1)	(2) Block 1

Figure 1. EXP-2 - Selecting Training Program and Site Name

Type of Training Program: Select a training program by clicking on the drop-down menu in Column 1 and choosing a practicum/field placement program. The options available will be programs marked as "Active" on the Training Program Setup Form.
Site Name:

Pair the selected training program with a training site by clicking on the drop-down menu in Column 2 (Block 1) and choosing one a site name. The options available will be sites that were marked as "Used" in the current reporting period on EXP-1.

EXP-2 - Selecting Profession and Discipline/Specialty of Individuals Trained

Select Profession of Individuals Trained	Select Discipline/Specialty of Individuals Trained
(3)	(3a)

Figure 2. EXP-2 - Selecting Profession and Discipline/Specialty of Individuals Trained

Select Profession of Individuals Trained: Select the individual’s profession by clicking on the drop-down menu in Column 3 and selecting one of the available options.

Allied Health
Allied Health - Student
Behavioral Health
Behavioral Health - Student
Dentistry
Dentistry - Student
Medicine
Medicine - Student
Nursing
Nursing - Student
Other
Other - Student
Paraprofessional
Paraprofessional - Student
Physician Assistant
Physician Assistant - Student
Public Health
Public Health - Student

Select Discipline/Specialty of Individuals Trained: Select the individual’s discipline/specialty by clicking on the drop-down menu in Column 3a and choosing from one of the available options. Please note that you must select a discipline/specialty that is associated with the profession you selected in Column 26c. The disciplines/specialties are organized by profession in the drop-down; please scroll to find the correct option.

ALLIED HEALTH OPTIONS (please select)
Audiology
Certified Nursing Assistant
Community Health Worker
Dental Assistant
Dental Hygiene
Dental Hygiene/Public Health
Dental Therapy
EMT/Paramedic
Home Health Aide
Medical Assistant
Midwife (non-nurse)
Nurse Assistant/Patient Care Associate
Nutritionist/Dietician
Occupational Therapy
Pharmacy Aide/Technician
Phlebotomy Technician
Physical Therapy
Physical Therapy Assistant
Radiological Technician
Rehabilitation Therapy
Respiratory Therapy
Speech Pathology/Therapy
BEHAVIORAL HEALTH OPTIONS (please select)
Addictions Counseling
Clinical Mental Health Counseling
Clinical Psychology
Clinical Social Work
Counseling Psychology
Marriage and Family Therapy
Pastoral/Spiritual Care
School Counseling
School Psychology
School Social Work
DENTISTRY OPTIONS (please select)
Advanced General Dentistry
Dental Anesthesiology
Dental Public Health
Endodontics
General Dentistry
Oral and Maxillofacial Pathology
Oral and Maxillofacial Radiology
Oral and Maxillofacial Surgery
Oral Medicine
Orofacial Pain
Orthodontics and Dentofacial Orthopedics
Pediatric
Periodontics
Prosthodontics
DENTAL SCHOOL OPTIONS (please select)
Dental School
Dental School/Public Health
MEDICAL OPTIONS (please select)
Aerospace Medicine
Allergy and Immunology
Anesthesiology
Colon and Rectal Surgery
Dermatology
Diagnostic Radiology
Emergency Medicine
Family Medicine
General Surgery
Geriatric Medicine
Geriatric Psychiatry
Integrative Medicine
Internal Medicine
Internal Medicine/Family Medicine
Internal Medicine/Pediatrics
Medical Genetics
Medical Oncology
Neurological Surgery
Neurology
Nuclear Medicine
Obstetrics and Gynecology
Ophthalmology
Orthopaedic Surgery
Otolaryngology
Palliative Care
Pathology
Pediatrics
Physical Medicine and Rehabilitation
Plastic Surgery
Preventive Medicine
Preventive Medicine/Aerospace Medicine
Preventive Medicine/Family Medicine
Preventive Medicine/Internal Medicine
Preventive Medicine/Occupational Medicine
Preventive Medicine/Pediatrics
Preventive Medicine/Public Health
Preventive Medicine/Sports Medicine
Psychiatry
Radiation Oncology
Thoracic Surgery
Urology
Vascular Surgery
MEDICAL SCHOOL OPTION (please select)
Medical School
NURSING OPTIONS (please select)
Advanced Practice Nursing
Aggregate/Systems/Organizational
Alternative/Complementary
Clinical Nurse Leader (CNL)
Clinical Nurse Specialist (CNS)
Community Health Nursing
Forensics
Licensed Practical/Vocational Nurse (LPN/LVN)
Nurse Administrator
Nurse Anesthetist
Nurse Educator
Nurse Midwife
Nurse Practitioner (NP)
Nursing Informatics
Public Health Nurse
Registered Nurse (RN)
Researcher/Scientist
OTHER OPTIONS (please select)
Chiropractic
Doula
Exercise Physiology
Facility Administrator
Firefighter
Health Informatics/Information Technology
Law Enforcement
Lay/Family Caregiver
Medical Laboratory Sciences
Office/Support Staff
Optometry
Pharmacy
Podiatry
Profession Not Listed
Radiologic Technology
Veterinary Medicine
Primary School (grades K-8)
Secondary School (grades 9-12)
Post-high School/Pre-college
Undergraduate School
Post-baccaluareate Premedical
PARAPROFESSIONAL OPTIONS (please select)
Behavioral Health Technician/Aide
Direct Service Worker
Mental Health Worker
Outreach Worker
Peer Paraprofessional
Promotora
Recovery Coach
Social Services Aide
Substance Use/Addictions Worker
Youth Worker
Discipline/Specialty Not Listed
PHYSICIAN ASSISTANT OPTION (please select)
Physician Assistant
PUBLIC HEALTH OPTIONS (please select)
Biostatistics
Community Health
Disaster Preparedness
Disease Prevention/Health Promotion
Environmental Health
Epidemiology
Global Health
Health Administration
Health Communication
Health Education
Health Policy/Management
Infectious Disease Control
Injury Control/Prevention
Maternal/Child Health
Nutrition
Social/Behavioral Sciences

Example:
If you are reporting on an individual who is a Plastic Surgeon, the Individual’s Profession would be “Medicine” and the Individual’s Discipline/Specialty would be “Plastic Surgery”.

Example: If you are reporting on an individual who is studying to be an Occupational Therapist, the Individual’s Profession would be “Allied Health – Student” and the Individual’s Discipline/Specialty would be “Occupational Therapy”.

Example: If you are reporting on an individual who is a Clinical Social Worker, the Individual’s Profession would be “Behavioral Health” and the Individual’s Discipline/Specialty would be “Clinical Social Work”.

EXP-2 - Entering # Trained in the Profession and Discipline

Enter # Trained in this Profession and Discipline
(4) Block 3

Figure 3. EXP-2 - Entering # Trained in the Profession and Discipline

Enter # Trained in this Profession and Discipline: For each row, enter the number of "Principal" trainees in the profession and discipline listed.

Note
Principal trainees are those who were directly or indirectly supported through your grant. For your grant program, these are the individuals reported on the INDGEN form.

Note
Counts provided for "Principal" trainees in Column 4 (Block 3) should be based on individuals reported on INDGEN.

Note
Do not count faculty, site staff, or other non-trainees.

EXP-2 - Entering # of Other Interprofessional trainees who participated in team-based care

Enter # of Other Trainees in this Profession and Discipline Who Participated in Interprofessional Team-based care
(5) Block 8

Figure 4. EXP-2 - Entering # of Other Interprofessional trainees who participated in team-based care

Enter # of Other Trainees in this Profession and Discipline Who Participated in Interprofessional Team-based care: For each row, enter the number of all "Other Interprofessional" trainees in each profession and discipline listed.

Note
Other Interprofessional” trainees are those individuals who trained at the same site on an interdisciplinary team with your principal trainees, but who did not received support from or have an association with your HRSA grant. The count provided should be of the participants as the site who were not included on the INDGEN form.

Note
Do not enter counts for faculty, site staff, or other non-trainees.

EXP-2 - Adding Individuals Trained Example 1

Figure 5. EXP-2 - Adding Individuals Trained Example 1

Example 1. Principal Trainees ONLY (no interprofessional trainees): In Example 1, students from the Psychology internship program did not participate in interprofessional experiences, so only principal trainees are being reported. The principal Psychology internship students trained at 3 different clinical training sites.

• At Site 1, there were 24 principal Psychology interns and no “other interprofessional” trainees (see row 1).

• At Site 2, there were 10 principal Psychology interns and no “other interprofessional” trainees (see row 2).

• At Site 3, there were 4 principal Psychology interns and no “other interprofessional” trainees (see row 3).

EXP-2 - Adding Individuals Trained Example 2

Figure 6. EXP-2 - Adding Individuals Trained Example 2

Example 2. Principal AND Interprofessional Trainees: In Example 2, students from the Psychology internship program participated in interprofessional training experiences alongside other trainees.

· At Site 1, 24 principal Psychology interns trained alongside “other interprofessional” trainees: 2 medical students and 3 Psychiatry residents who were not associated with the HRSA grant (see rows 1-3).

· At Site 2, 15 principal Psychology interns trained alongside “other interprofessional” trainees: 4 pharmacy students who were not associated with the HRSA grant (see rows 4 and 5).

EXP-2 - Adding Individuals Trained Example 3

Figure 7. EXP-2 - Adding Individuals Trained Example 3

Example 3. Principal AND Interprofessional Trainees: In Example 3, students from the Psychology internship program participated in interprofessional training experiences alongside other trainees, including other Psychology interns who were not associated with the HRSA grant.

· At Site 1, 24 principal Psychology interns trained alongside “other interprofessional” trainees: 2 Psychiatry residents and 10 other Psychology interns who were not associated with the HRSA grant (see rows 1 and 2).

· At Site 2, 10 principal Psychology interns trained alongside “other interprofessional” trainees: 5 medical students and 22 other Psychology interns who were not associated with the HRSA grant (see rows 3 and 4).

EXP-2 - Selecting Type of Site Used

Select Type of Site Used
(6)

Figure 8. EXP-2 - Selecting Type of Site Used

Select Type of Site Used: Following the selection of a training site in EXP-1, the associated type of site will be automatically populated when the save and validate button is selected.

Academic institution
Acute Care for the Elderly (ACE) Units
Acute care services
Aerospace operations setting
Ambulatory practice sites
Assisted Living Community
Community Behavioral Health Center
Certified Community Behavioral Health Clinic (CCBHC)
Community Health Center (CHC)
Community Care Programs for Elderly Mentally Challenged Individuals
Community-based Care Programs for Elderly Mentally Challenged Individuals
Community Mental Health Center
Community-based Organization
Dental Services
Critical Access Hospital
Day and Home Care Programs (e.g. Home Health)
Extended care facilities
Dentist Office
Emergency Room
Federal and State Bureau of Prisons
Federal Government - Other
FQHC or look-alike
Local and County Jails
Hospital - academic center
Geriatric Ambulatory Care and Comprehensive Units
Hospital - community
Geriatric Behavioral or Mental Health Units
Hospital - federal
Geriatric Consultation Services
Hospice
Hospital - for profit
Hospital - Nonprofit
Hospital
National health association
Independent Living Facility
Indian Health Service (IHS) Site
International Nonprofit/Nongovernmental Organization
Local Government Office or Agency
Local Health Department
Long-Term Care Facility
Mobile Clinic/Site
National Health Association or Affiliate
Nurse Managed Health Clinics
Nursing Home
Other
Other Community Health Center (e.g. free clinic)
Other Oral Health Facility
Physician Office
Surgery Clinic
Program of All Inclusive Care for the Elderly
Veterans Affairs Healthcare (e.g. VA Hospital or clinic)
Residential Living Facility
Rural Health Clinic
School-based Clinic
Senior Centers
Specialty Clinics (e.g. mental health practice/rehabilitation/substance abuse clinic)
State Government Office or Agency
State Health Department
Tribal Health Department
Tribal Organization
Veterans Affairs Hospital or Clinic

EXP-2 - Selecting Type of Setting Where the Site was Located

Select Type of Setting Where the Site was Located
(7)

Figure 9. EXP-2 - Selecting Type of Setting Where the Site was Located

Select Type of Setting Where the Site was Located: Following the selection of a training site in EXP-1, the associated settings will be automatically populated when the save and validate button is selected.

Medically underserved community
Primary Care Setting
Rural area
None of the above

To Complete the Form: Click on the “Save and Validate” button located on the bottom right corner of your screen. If no errors are found, the BPMH system will automatically route you to the next required subform.

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EXP-2: Experiential Characteristics - Trainees by Profession/Discipline

EXP-2 - Selecting Training Program and Site Name

EXP-2 - Selecting Training Program and Site Name

EXP-2 - Selecting Profession and Discipline/Specialty of Individuals Trained

EXP-2 - Selecting Profession and Discipline/Specialty of Individuals Trained

EXP-2 - Entering # Trained in the Profession and Discipline

EXP-2 - Entering # Trained in the Profession and Discipline

EXP-2 - Entering # of Other Interprofessional trainees who participated in team-based care

EXP-2 - Entering # of Other Interprofessional trainees who participated in team-based care

EXP-2 - Adding Individuals Trained Example 1

EXP-2 - Adding Individuals Trained Example 1

EXP-2 - Adding Individuals Trained Example 2

EXP-2 - Adding Individuals Trained Example 2

EXP-2 - Adding Individuals Trained Example 3

EXP-2 - Adding Individuals Trained Example 3

EXP-2 - Selecting Type of Site Used

EXP-2 - Selecting Type of Site Used

EXP-2 - Selecting Type of Setting Where the Site was Located

EXP-2 - Selecting Type of Setting Where the Site was Located

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