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AI Policy Questionnaire for Mental Health

This questionnaire will help assess your current and intended use of AI tools in your practice. Your responses will inform the structure, content, and scope of a customized AI policy that aligns with your clinical values, compliance needs, and risk tolerance.

Please answer each question thoroughly (the form will take 5 minutes). If a question does not apply to your practice, please write "N/A". 

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Section 1

Overview

Question 2 of 29

Your name and role

Question 3 of 29

If your practice has a mission statement, please share it here

Question 4 of 29

Email

Question 5 of 29

Practice size: Number of licensed clinicians and designation (LPC, PsyD, PhD, LMFT, LCSW, etc)

Question 6 of 29

Practice size: Number of interns or associates

Question 7 of 29

Practice size: Number of administrative staff

Question 8 of 29

Types of services offered (ie: individual therapy, group therapy, testing, supervision, training)

Question 9 of 29

Do you offer virtual care (if so, what platform do you use)?

Section 2

Current Use of AI Tools

Question 11 of 29

Are any AI tools currently in use at your practice? If yes, please list them and describe their primary function (ie: note summaries, scheduling, transcription, clinical suggestions, HR processes, etc.)

Question 12 of 29

Who uses these tools?

(Select all that apply)
A

Clinicians

B

Supervisors

C

Administrative staff

D

Interns or associates

E

Clients (patient-facing tools)

Question 13 of 29

Are clients aware that AI tools are being used in any part of their care? If yes, how is this disclosed?

Section 3

Planned or Intended Use of AI Tools

Question 15 of 29

Are you planning to expand your use of AI tools into any of the following within the next 6-12 months?

(Select all that apply)
A

Clinical documentation support

B

Risk assessment or diagnostic support

C

Treatment planning

D

Client-facing chatbots (for informational and/or therapeutic purposes)

E

Intake, scheduling, administrative automation

F

Supervision or training augmentation

G

Marketing or content generation

H

Other (if so, please describe in the following question)

Question 16 of 29

If you are planning on other tool implementation, describe here (if not, write N/A)

Question 17 of 29

What are your main goals for using AI in your practice? (ie: improving efficiency, enhancing documentation quality, expanding access, reducing clinician burden, increasing client engagement, etc.)

Question 18 of 29

Are there any areas where you explicitly do not want AI used (ie: direct clinical decision-making, client communication, documentation without clinician review, etc.)

Section 4

Consent and Privacy

Question 20 of 29

Have you developed a client-facing informed consent specific to AI use? (this is included in your AI policy development if you do not have one yet)

Question 21 of 29

Have you conducted any risk assessments or audits related to AI tools connected to vendor platforms (ie: Simple Practice, etc.)?

Question 22 of 29

Do you need your AI policy to help meet any of the following standards or requirements?

(Select all that apply)
A

HIPAA compliance

B

Accreditation standards

C

Professional ethical codes (ie: APA, NBCC, NASW, ACA)

D

State licensing boards

E

Other (if so, please describe in the next question)

Question 23 of 29

If other standards or requirements, describe here (if not, write N/A)

Section 5

Staff Competence and Culture

Question 25 of 29

Have your clinicians received any formal training on AI tools or digital ethics? (if so, describe)

Question 26 of 29

What values are most important to you as you implement and/or restrict AI use? (ie: transparency, client safety, relational care, efficiency, access, practice protection, etc.)

Section 6

Conclusion

Question 28 of 29

Are there any unique considerations about your practice or population served that might influence the design of your AI policy? (ie: trauma specialization, multilingual clients, pediatric or geriatric care, neurodiversity, etc.).
Please share anything else important before we begin drafting your AI policy.

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