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Partners' Child/Adolescent Residential Provider Survey

Child/Adolescent Residential Provider Input/Feedback Requested

Partners is always looking for ways to garner feedback and input from our providers. We are seeking feedback regarding our child/adolescent residential providers. The information collected in this survey will help us develop additional information sharing and outreach to ensure members are able to access needed child/adolescent residential services. Thank you for taking the time to provide some information. Please complete this survey by January 3, 2025.
1.Provider Contact Information(Required.)
2.Practice/Agency Tax ID Number:(Required.)
3.What Residential Services are you currently contracted with Partners' to provide? Please check all that apply.
4.Are you currently receiving referrals from Partners
5.Are you currently ACCEPTING Referrals from Partners
6.If you answered that you are not accepting referrals from Partners, can you tell us the reason.
7.Do you have any special admission requirements (example: only take DSS children, Need specific items/assessments for admission to your program)
8.Do you delineate beds/homes by gender (example, are all your beds for females or males or other gender specific criteria).
9.Do you only provide residential services in NC?
10.What age groups do you currently serve? Please check all that apply
11.Do you provide any specialized programming that you would like Partners to know about? Please check all that apply.
12.What barriers are you experiencing in accepting/serving Partners' members?
13.If you checked any barriers/noted barriers in Q13, please share additional information that would be helpful for Partners to understand.
14.Would a Child/Adolescent Learning Collaborative be beneficial to you as a provider in Partners' network?
15.Please let us know if a follow up conversation would be beneficial?
16.Anything else you think would be beneficial to share?