Maryland Health Manager Network

We are trying to build a network for Head Start health managers in Maryland. Please take a little time to complete these few questions. Thank you.

Question Title

* 1. Name

Question Title

* 2. Title

Question Title

* 3. Email address

Question Title

* 4. Program

Question Title

* 5. Please list the names and email addresses for any other staff in your program that might benefit from participating in a Head Start health services peer support network.

Question Title

* 6. Please rate the following Head Start health service functions. 1 means you would like more support. 5 means you don't need any additional support. NOTE: All answers are confidential and will be used for planning purposes only.

	1	2	3	4	5	N/A
Physical Health & Wellness	Physical Health & Wellness 1	Physical Health & Wellness 2	Physical Health & Wellness 3	Physical Health & Wellness 4	Physical Health & Wellness 5	Physical Health & Wellness N/A
Nutrition & Physical Activity	Nutrition & Physical Activity 1	Nutrition & Physical Activity 2	Nutrition & Physical Activity 3	Nutrition & Physical Activity 4	Nutrition & Physical Activity 5	Nutrition & Physical Activity N/A
Oral Health & Wellness	Oral Health & Wellness 1	Oral Health & Wellness 2	Oral Health & Wellness 3	Oral Health & Wellness 4	Oral Health & Wellness 5	Oral Health & Wellness N/A
Safety & Injury Prevention	Safety & Injury Prevention 1	Safety & Injury Prevention 2	Safety & Injury Prevention 3	Safety & Injury Prevention 4	Safety & Injury Prevention 5	Safety & Injury Prevention N/A
Mental Health & Wellness	Mental Health & Wellness 1	Mental Health & Wellness 2	Mental Health & Wellness 3	Mental Health & Wellness 4	Mental Health & Wellness 5	Mental Health & Wellness N/A
Family Health Literacy/Parent Communication	Family Health Literacy/Parent Communication 1	Family Health Literacy/Parent Communication 2	Family Health Literacy/Parent Communication 3	Family Health Literacy/Parent Communication 4	Family Health Literacy/Parent Communication 5	Family Health Literacy/Parent Communication N/A
Services to Pregnant Women & Expectant Families	Services to Pregnant Women & Expectant Families 1	Services to Pregnant Women & Expectant Families 2	Services to Pregnant Women & Expectant Families 3	Services to Pregnant Women & Expectant Families 4	Services to Pregnant Women & Expectant Families 5	Services to Pregnant Women & Expectant Families N/A
Children w/Special Health Care Needs	Children w/Special Health Care Needs 1	Children w/Special Health Care Needs 2	Children w/Special Health Care Needs 3	Children w/Special Health Care Needs 4	Children w/Special Health Care Needs 5	Children w/Special Health Care Needs N/A
Sanitation & Hygiene	Sanitation & Hygiene 1	Sanitation & Hygiene 2	Sanitation & Hygiene 3	Sanitation & Hygiene 4	Sanitation & Hygiene 5	Sanitation & Hygiene N/A
Health Services Advisory Committee	Health Services Advisory Committee 1	Health Services Advisory Committee 2	Health Services Advisory Committee 3	Health Services Advisory Committee 4	Health Services Advisory Committee 5	Health Services Advisory Committee N/A
Staff Wellness	Staff Wellness 1	Staff Wellness 2	Staff Wellness 3	Staff Wellness 4	Staff Wellness 5	Staff Wellness N/A
Sensory Screening	Sensory Screening 1	Sensory Screening 2	Sensory Screening 3	Sensory Screening 4	Sensory Screening 5	Sensory Screening N/A
Policies & Procedures	Policies & Procedures 1	Policies & Procedures 2	Policies & Procedures 3	Policies & Procedures 4	Policies & Procedures 5	Policies & Procedures N/A
Training staff & parents	Training staff & parents 1	Training staff & parents 2	Training staff & parents 3	Training staff & parents 4	Training staff & parents 5	Training staff & parents N/A
Engaging families in their child's health	Engaging families in their child's health 1	Engaging families in their child's health 2	Engaging families in their child's health 3	Engaging families in their child's health 4	Engaging families in their child's health 5	Engaging families in their child's health N/A
Engaging community health partners	Engaging community health partners 1	Engaging community health partners 2	Engaging community health partners 3	Engaging community health partners 4	Engaging community health partners 5	Engaging community health partners N/A

Other (please specify)

Question Title

* 7. Do you have other health sand safety concerns for children and families in your community?

Question Title

* 8. What benefit would you like to see coming from a health manager network?

Question Title

* 9. Would you be interested in helping to get a health manager network started?

Yes

No