Teaching Health Center Planning and Development Program

Health Resources and Services Administration
Academic Year: 2023-2024

Bureau of Health Workforce
OMB Number: 0906-0086

Annual Performance Report
OMB Expiration Date: 03/31/2027

EXP-1: Training Site Setup

EXP-1 - Entering Site Name

Warning
Enter all primary clinical training sites for the developing residency program, even if you don't have trainees yet.

Site Name
(1) Block 1

Figure 1. EXP-1 - Entering Site Name

Site Name:

Enter the name of any new sites used to train individuals during the current reporting period in the row labeled, “Enter the Site’s Name.” Next, click the “Add Record” button. New sites will be listed at the bottom of the data table, beneath all previously used sites (i.e., prior records). Repeat this process as necessary to enter the names of each NEW site used during the current reporting period.

Note

All THCPD grantees must complete this section regardless of whether training residents or not.

For THCPD grantees that are currently training residents, please enter information for all clinical training partner sites regardless of whether the resident trained at the site during the current reporting period.

For THCPD grantees that have not yet started training residents, report on primary clinical training sites for the developing residency program.

Note

There is an option to delete both new and prior records on EXP-1. This option should only be used if the clinical sites will not be used in the future, or were erroneously entered. The delete option is not reversible (i.e. if the site was erroneously deleted, it will need to be re-entered again).

EXP-1 - Selecting Whether the Site was Used in the Current Period

Select Whether the Site was Used in the Current Reporting Period
(2)

Figure 2. EXP-1 - Selecting Whether the Site was Used in the Current Period

Select Whether the Site was Used in the Current Reporting Period: Select whether each site was used during the current reporting period by clicking on the drop-down menu located under the column labeled "Select Whether Site Was used in the Current Reporting Period" and choosing one of the following options:

Warning
For NEW sites, you must select "Yes" in Column 2.

Note
If a clinical site was NOT used in the current reporting period, then it will not appear on EXP-2 as a dropdown option in Column 1.

EXP-1 - Selecting Type of Site Used

Select Type of Site Used
(3) Block 1a

Figure 3. EXP-1 - Selecting Type of Site Used

Select Type of Site Used: Select the type of sites used to train residents or fellows during the current reporting period by clicking on the drop-down menu in Column 3 (Block 1a) and choosing one of the following options:

Academic institution
Acute Care for the Elderly (ACE) Units
Acute care services
Aerospace operations setting
Ambulatory practice sites
Assisted Living Community
Certified Community Behavioral Health Clinic (CCBHC)
Community Care Programs for Elderly Mentally Challenged Individuals
Community-based Organization
Critical Access Hospital
Day and Home Care Programs (e.g. Home Health)
Dentist Office
Emergency Room
Federal and State Bureau of Prisons
Federal Government - Other
FQHC or look-alike
Hospice
Hospital
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
Program of All Inclusive Care for the Elderly
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 Government
Tribal Health Department
Tribal Organization
Veterans Affairs Hospital or Clinic

Note
If you select "Other" in Column 3, provide an explanation in the comments field and reference the site name.

EXP-1 - Selecting Type of Setting Where the Site was Located

Select Type of Setting Where the Site was Located
(4) Block 2

Figure 4. EXP-1 - Selecting Type of Setting Where the Site was Located

Select Type of Setting Where the Site was Located: Select whether each site used to train individuals during the current reporting period was located in a designated setting by clicking on the drop-down menu in Column 4 (Block 2) and choosing all that apply from the following options:

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

Warning
"None of the above" cannot be selected in combination with any other option.

Note
To determine whether a site is located in a medically underserved community, please visit HRSA’s Office of Shortage Designation at http://datawarehouse.hrsa.gov/GeoAdvisor/ShortageDesignationAdvisor.aspx

Note
To determine whether a site is located in a rural area, please visit HRSA’s Office of Rural Health Policy at http://datawarehouse.hrsa.gov/RuralAdvisor/ruralhealthadvisor.aspx

EXP-1 - Selecting Partnerships Developed Using BHW Funds

Select the Primary Purpose of the Grant Partnership(s) Developed or Enhanced using BHW Funding	Select Types of Partner Organizations for the Primary Purpose	Select Secondary Purpose(s) of the Grant Partnership(s)
(5a)	(5b)	(5c)

Figure 5. EXP-1 - Selecting Partnerships Developed Using BHW Funds

Select the Primary Purpose of the Grant Partnership(s) Developed or Enhanced using BHW Funding: Select the primary purpose of the site-related partnership(s) developed or enhanced using BHW funding by clicking on the drop-down menu in Column 5a and selecting the best option.

Clinical/experiential training
Community outreach
Curriculum development
Didactic training
Establishing and maintaining apprenticeships
Field placements in medically underserved and/or rural areas
Interprofessional training
Job placement
Matriculation into health professions schools
Mentoring students/trainees
Providing faculty development
Providing faculty/clinical preceptors
Recruitment of trainees
Recruitment of URM/disadvantaged/rural trainees
Technical assistance
No partnerships developed or expanded
None of the above

Select Types of Partner Organizations for the Primary Purpose: Select the type(s) of site-related partner organizations associated with the primary purpose indicated in column 5a by clicking on the drop-down menu in Column 5b and choosing all that apply.

Academic Institution
Academic Medical Center
Area Health Education Center
Certified Community Behavioral Health Center (CCBHC)
Community Behavioral Health/Mental Health Center
Community Health Center (CHC)
Critical Access Hospital
Federal Government
FQHC or Look-Alike
Health Department (local/state/tribal)
Hospital (non-academic)
Indian Health Service (IHS)/Tribal/Urban Indian Health Center
Nursing Home
Other Clinical Health Setting
Other Community-Based Organization
Other Long-term Care Facility
Other Specialty Clinic
Private Industry
Private Practice
Residential Living Facility (including independent and assisted living)
Rural Health Clinic
School-based Clinic
State or Local Government
US Armed Forces
Veterans Affairs Healthcare (e.g. VA hospital or clinic)
No additional partners for the primary purpose other than the site itself
N/A

Select Secondary Purpose(s) of the Grant Partnership(s): Select any additional purpose(s) of site-related partnerships by clicking on the drop-down menu in Column 5c and choosing all that apply.

Clinical/experiential training
Community outreach
Curriculum development
Didactic training
Establishing and maintaining apprenticeships
Field placements in medically underserved and/or rural areas
Interprofessional training
Job placement
Matriculation into health professions schools
Mentoring students/trainees
Providing faculty development
Providing faculty/clinical preceptors
Recruitment of trainees
Recruitment of URM/disadvantaged/rural trainees
Technical assistance
N/A

Example: Organization XYZ is offering clinical/experiential training for grant program trainees at a hospital. There are no additional partner organizations associated with the clinical/experiential training, but the hospital site has an additional partnership for the purpose of recruiting trainees for grant-related activities.

In this example, you would enter “Hospital” in Column 3 (Site Type), “Clinical/experiential training” in Column 5a (Primary Purpose), “No additional partners for the primary purpose other than the site itself” in Column 5b (Partner Organizations for the Primary Purpose), and “Recruitment of Trainees” in Column 5c (Secondary Purpose). Note that we are not capturing the partners associated with the recruitment of trainees, just the partnership purpose.

Example: Organization ABC is offering clinical/experiential training for grant program trainees at a Federally Qualified Health Center (FQHC). However, the main partnerships at this site are focused on offering interprofessional training. The partners associated with offering interprofessional training include Certified Community Behavioral Health Centers (CCBHCs), rural health clinics, and other community-based organizations. In this case, additional purpose of the partnerships at this site is to offer clinical/experiential training.

In this example, you would enter “FQHC or look-alike” in Column 3 (Site Type), “Interprofessional training” in Column 5a (Primary Purpose), “Certified Community Behavioral Health Center (CCBHC)”, “Rural Health Clinic”, and “Other Community-Based Organization” in Column 5b (Partner Organizations for the Primary Purpose), and “Clinical/experiential training” in Column 5c (Secondary Purpose). Note that you do not select “FQHC or look-alike” in Column 5b unless there is an additional FQHC or look-alike (one other than the site itself) involved in the partnership.

EXP-1 - Selecting Type(s) of Vulnerable Population

Select Type(s) of Vulnerable Population Served at this Site
(7)

Figure 6. EXP-1 - Selecting Type(s) of Vulnerable Population

Select Type(s) of Vulnerable Population Served at this Site: Select the type(s) of vulnerable populations served at each site during the current reporting period by clicking on the drop-down menu in Column 7 (Block 4) and choosing all that apply from the following options:

Children or Adolescents
Chronically ill
College students
Individuals experiencing homelessness
Individuals with HIV/AIDS
Individuals with limited English proficiency
Individuals with mental illness or substance use disorders
Low income persons/families
Military and/or military families
Older adults
People with disabilities
Pregnant women and infants
Tribal Populations
Unemployed
Uninsured/Underinsured persons/families
Veterans
Victims of interpersonal violence abuse or trauma
None of the above

Warning
You may not select "None of the above" in combination with any other option.

EXP-1 - Entering Site's Geographical Data

Street address information is required for each training site location. After saving and validating EXP-1, you will move to a new page which will allow you to standardize the addresses of your active sites.

Street Address 1	Street Address 2	Enter Zip Code	City	State	Four Digit Zip Code Extension
(7a)	(7b)	(8)	(9)	(10)	(11)

Figure 7. EXP-1 - Entering Site's Geographical Data

Street Address 1: Enter line 1 of the Street Address where each training site is located by using the textbox in Column 7a.Street Address 2: If needed, enter line 2 of the Street Address where each training site is located by using the textbox in Column 7b.Zip Code: Enter the zip code where each training site is located by using the textbox in Column 8.City: City will automatically populate after you save and validate this form.State: State will automatically populate after you save and validate this form.Four Digit Zip Code Extension: The Zip Code Extension will automatically populate after you complete the address standardization process.

EXP-1 - Entering Site's Payment Model

Payment Model
(12)

Figure 8. EXP-1 - Entering Site's Payment Model

Payment Model: Select the payment model used by each training site by clicking on the dropdown menu below Column 12 and selecting all that apply from the following options:

ACO
Bundled Payments
Charity Care
CHIP
Dual Eligible (Medicaid & Medicare)
Medicaid
Medicare
Military TRICARE
Other Private Insurance
Other Public
Patient Centered Medical Home
PPO
Self - Pay
Sliding Scale
Uninsured
VA
Workman’s Comp
N/A

EXP-1 - Selecting Whether the Training Site Implements Interprofessional Education and/or Practice

Select whether the training site implements interprofessional education and/or practice
(13)

Figure 9. EXP-1 - Selecting Whether the Training Site Implements Interprofessional Education and/or Practice

Select whether the training site implements interprofessional education and/or practice: Select whether the training site implements interprofessional education and/or practice

EXP-1 - Selecting any HHS Priorities Addressed at this Site

Select any HHS Priorities Addressed at this Site
(14)

Figure 10. EXP-1 - Selecting any HHS Priorities Addressed at this Site

Select any HHS Priorities Addressed at this Site:

Using the dropdown menu in Column 14, select all that apply from the list of HHS priorities that were addressed at this site.

This site offers integrated behavioral health services in a primary care setting
This site offers maternal health services
This site offers medications for opioid use disorder (MOUD)
This site offers substance use treatment services
This site offers telehealth services
None of the above

EXP-1 - Standardizing Addresses for Active Sites

To begin the address standardization process, click the “Process Addresses” button. The system will return suggested addresses for your active sites and identify sites that may need correction. This process is important because it ensures the accuracy of experiential training site locations and allows BHW to integrate your clinical training site data into the HRSA Health Sites Dashboard.

For step-by-step instructions on this process, please visit the Address Standardization Wiki.

Warning
Please confirm that the suggested addresses are correct before saving and continuing on to the EXP-2 form.

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 address standardization page.

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Program Manual

Teaching Health Center Planning and Development Program

EXP-1: Training Site Setup

EXP-1 - Entering Site Name

EXP-1 - Entering Site Name

EXP-1 - Selecting Whether the Site was Used in the Current Period

EXP-1 - Selecting Whether the Site was Used in the Current Period

EXP-1 - Selecting Type of Site Used

EXP-1 - Selecting Type of Site Used

EXP-1 - Selecting Type of Setting Where the Site was Located

EXP-1 - Selecting Type of Setting Where the Site was Located

EXP-1 - Selecting Partnerships Developed Using BHW Funds

EXP-1 - Selecting Partnerships Developed Using BHW Funds

EXP-1 - Selecting Type(s) of Vulnerable Population

EXP-1 - Selecting Type(s) of Vulnerable Population

EXP-1 - Entering Site's Geographical Data

EXP-1 - Entering Site's Geographical Data

EXP-1 - Entering Site's Payment Model

EXP-1 - Entering Site's Payment Model

EXP-1 - Selecting Whether the Training Site Implements Interprofessional Education and/or Practice

EXP-1 - Selecting Whether the Training Site Implements Interprofessional Education and/or Practice

EXP-1 - Selecting any HHS Priorities Addressed at this Site

EXP-1 - Selecting any HHS Priorities Addressed at this Site

EXP-1 - Standardizing Addresses for Active Sites

EXP-1 - Standardizing Addresses for Active Sites

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