2023 GAFP & DPH Child Health & Referral & Screening Programs Assessment

The Georgia Department of Public Health (DPH), Child Health & Referral & Screening Programs Unit is collaborating with the Georgia Academy of Family Physicians (GAFP) to raise physicians’ awareness of local public health programs and services. Please complete the brief survey below regarding your practice’s utilization of public health programs, services and resources. Your valued feedback will help us evaluate ways to improve outreach efforts to your office.

As a thank you for your input, 15 participants will be randomly selected to receive a $30 Amazon gift card (assessment must completed by April 18 to be in the running!)

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* 1. What are the age ranges of the pediatric patients you see in your office? (Check all that apply)

Birth – 3 years

4 – 5 years

6 – 9 years

10-18 years

I do not see pediatric patients in my office (please skip to the bottom of the survey and click Done)

Other

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* 2. What percent of the patients seen in your office are under the age of 18?

10 % or less

11% – 20 %

21% – 49 %

Over 50 %

I do not see patients under the age of 18 in my office

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* 3. Is the practice that you primarily provide services for considered a patient centered medical home?

Yes

I don’t know

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* 4. Do you utilize an evidence-based standardized periodicity schedule with the infant, child, and adolescent populations that you serve?

Yes

I don’t know

Please provide the name of the evidence-based tool:

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* 5. Do you utilize an evidence-based anticipatory guidance for the infant, child, and adolescent populations that you serve?

Yes

I do not know

Please provide the name of the evidence-based tool

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* 6. Do you currently share CDC Milestone Moments/Milestones tracker app materials with caregivers who have children under 5-years of age?

Yes, I do share Milestones Moments materials

No, I do not share any information on child development

I am unfamiliar with Milestone Moments

I do not provide care for children under 5 years of age.

I share information on child development, but I do not use CDC Milestone Moments materials. I use the following materials:

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* 7. How often do you refer your pediatric patients for public health services?

Sometimes

Never

Always

I am unfamiliar with the public health services available in my area.

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* 8. Within the past two years, which public health programs/services have you referred your pediatric patients? (select all that apply)

WIC

Children 1st

Babies Can’t Wait

Developmental Screening/Autism Screening

Children’s Medical Services

Early Hearing Detection & Intervention

Home Visiting

Oral Health/dental

Other (please specify)

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* 9. Which programs mentioned in the previous question would you like to learn more about? (Check all that apply)

WIC

Children 1st

Babies Can’t Wait

Developmental Screening/Autism Screening

Children’s Medical Services

Early Hearing Detection & Intervention

Home Visiting

Oral Health/dental

Would you like more info about these or other programs? Please enter your name and contact information for follow up by the Department of Public Health.

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* 10. Rate how helpful you would find each of the following as a means to learning more about public health programs.

	Most Helpful	Very Helpful	Helpful	Somewhat Helpful	Least Helpful
In-person presentation	In-person presentation Most Helpful	In-person presentation Very Helpful	In-person presentation Helpful	In-person presentation Somewhat Helpful	In-person presentation Least Helpful
Virtual presentation	Virtual presentation Most Helpful	Virtual presentation Very Helpful	Virtual presentation Helpful	Virtual presentation Somewhat Helpful	Virtual presentation Least Helpful
CME training	CME training Most Helpful	CME training Very Helpful	CME training Helpful	CME training Somewhat Helpful	CME training Least Helpful
Website	Website Most Helpful	Website Very Helpful	Website Helpful	Website Somewhat Helpful	Website Least Helpful
Written information – brochures/implementation guide(s)	Written information – brochures/implementation guide(s) Most Helpful	Written information – brochures/implementation guide(s) Very Helpful	Written information – brochures/implementation guide(s) Helpful	Written information – brochures/implementation guide(s) Somewhat Helpful	Written information – brochures/implementation guide(s) Least Helpful
Talking with another health care provider	Talking with another health care provider Most Helpful	Talking with another health care provider Very Helpful	Talking with another health care provider Helpful	Talking with another health care provider Somewhat Helpful	Talking with another health care provider Least Helpful

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* 11. What is the most pervasive need you have identified in your pediatric population?

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* 12. How often do you access or recommend the following resource databases to families?

	Always	Sometimes	Never
Healthy Mothers, Healthy Babies Coalition of Georgia	Healthy Mothers, Healthy Babies Coalition of Georgia Always	Healthy Mothers, Healthy Babies Coalition of Georgia Sometimes	Healthy Mothers, Healthy Babies Coalition of Georgia Never
Parent to Parent of Georgia	Parent to Parent of Georgia Always	Parent to Parent of Georgia Sometimes	Parent to Parent of Georgia Never
Family Connections	Family Connections Always	Family Connections Sometimes	Family Connections Never
United Way	United Way Always	United Way Sometimes	United Way Never
888-HLP-GROW Help Me Grow	888-HLP-GROW Help Me Grow Always	888-HLP-GROW Help Me Grow Sometimes	888-HLP-GROW Help Me Grow Never
Findhelpga.org	Findhelpga.org Always	Findhelpga.org Sometimes	Findhelpga.org Never

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* 13. What questions do you have regarding services/programs available through public health? (list up to 3)

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* 14. Within the past two years, have you submitted a referral using the Children 1st Screening and Referral form?

Yes

Yes, and I have some recommendations for revisions to the form that will benefit staff and patients.

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* 15. Within the past two years, have you included developmental screening/autism screening results with the Children 1st Screening and Referral form?

Yes

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* 16. Which developmental screening tools do you use in your practice?

Parents' Evaluation of Developmental Status (PEDS)

Ages and Stages Questionnaires (ASQ)

The Modified Checklist for Autism in Toddlers (M-CHAT)

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* 17. Are you aware of online Ages and Stages Questionnaires?

Yes

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* 18. Would you like to implement online Ages and Stages Questionnaires in your practice?

Yes, here is my name and contact information for follow up by the Department of Public Health.

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* 19. Do you perform follow up hearing screening in your practice for infants who fail before hospital discharge?

Yes - please also specify below if you report hearing screening results to the EHDI program as mandated (yes/no).

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* 20. Would you like more information about where to refer infants for diagnostic hearing evaluations in your practice?

Yes, here is my name and contact information for follow up by the Department of Public Health.

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* 21. If you wish to be entered into the raffle, please provide name/email.

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* 22. If you would like more information on the public health child health referral system for patients 0-5, please include your name, email, organization/office, and phone number.