Addressing Social Health and Early Childhood Wellness (ASHEW)

This initiative, brought to you by Oregon Pediatric Society and the AAP, will provide practices with the strategies, tools, and resources needed to develop systems and processes for identifying and managing maternal depression, social determinants of health, social-emotional development, and resilience in primary care practice.

Question Title

* 1. Practice name:

Question Title

* 2. Practice location:

Please list the contact information for your core QI team. Core QI teams should include a primary care physician (physician champion/MOC local leader), a clinical support staff, and an additional team member such as front office staff, practice manager, or care coordinator. If your practice has already identified a family advisor, please include the name of this individual as well.

Question Title

* 3. Team Member 1: Physician Champion/MOC local Leader

Question Title

* 4. Team member 2 - Clinical Support Staff:

Question Title

* 5. Team member 3 - front office, practice manager, care coordinator, etc. (Please note that this person will be responsible for data submission):

Question Title

* 6. Family Advisor

Question Title

* 7. Team member 4 – Family Advisor:

Question Title

* 8. Which of the following best describes your practice?

Question Title

* 9. Which of the following best describes the setting of your practice?

Question Title

* 10. Please indicate the number of full time equivalent (FTE) employees in your practice that may participate in this project:

Approximately how many well child visits do you conduct each month for the following ages:

Question Title

* 11. 0-6 months Well Child Visits monthly

Question Title

* 12. 15 months Well Child Visits monthly

Question Title

* 13. 24 months Well Child Visits monthly

Question Title

* 14. 48 months Well Child Visits monthly

Question Title

* 15. How easy or difficult is it to make changes in your EHR?

Question Title

* 16. What type of EHR does your practice site use?

T