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Registration Survey: Free Learning Opportunity for Primary Care-Based Integrated Behavioral Health Clinicians
on Brief Interventions for Young Children
*
1.
Full Name (First & Last):
(Required.)
*
2.
Email Address:
(Required.)
*
3.
What is the name of your primary care clinic?
(Required.)
Asher Community Health Center
Columbia River Health
Grande Ronde Hospital – Children's Clinic
Grande Ronde Hospital – Regional Medical Clinic
Grande Ronde Hospital – Union Clinic
Grant County Health Department
La Pine Community Health Center
La Pine Community Health Center – La Pine School Based Health Center
Morrow County Health District – Ione Community Clinic
Morrow County Health District – Irrigon Medical Clinic
Morrow County Health District – Pioneer Memorial Clinic
Saint Alphonsus Medical Group – Baker City Clinic
Saint Alphonsus Medical Group – Fruitland Health Plaza
Snake River Pediatrics
St Luke's Eastern Oregon Medical Associates
St. Charles Family Care – La Pine
Stark Medical Group PC
Valley Family Health Care – Emmett
Valley Family Health Care – Fortner
Valley Family Health Care – New Plymouth
Valley Family Health Care – Ontario
Valley Family Health Care – Payette
Valley Family Health Care – Vale
Valley Family Health Care – Women & Children Clinic
Wallowa Memorial Medical Clinic – Joseph
Warner Mountain Medical Clinic
Winding Waters Medical Clinic
Yakima Valley Farm Workers Clinic – Mirasol Family Health Center
Yellowhawk Tribal Health Center
Other (please indicate site)
4.
What is your degree/license to practice?
In-Person Training (Late Fall 2026)
Participants will attend one in-person training session. We are identifying the date(s) and location that will be most convenient for participants based on registration responses.
*
5.
Which of the following dates would you be available to attend the in-person training?
Select all that apply
(Required.)
Wednesday, November 18th
Thursday, December 3rd
Friday, December 4th
I’m only able to attend online webinars
*
6.
What city will you be traveling from for the in-person training?
(Required.)
*
7.
Do you have any dietary restrictions or food allergies we should be aware of?
(Required.)
*
8.
Do you have any accessibility needs we should be aware of?
(Required.)
Four Webinars on Topic-Specific Brief Interventions (2027)
*
9.
Which webinar times would work best for you?
Select all that apply.
(Required.)
8-9am (Before Clinic)
12-1pm (Lunch Hour)
Neither of these times
Other (please provide time)
*
10.
Which days of the week work best for you for webinars?
Select all that apply.
(Required.)
Monday
Tuesday
Wednesday
Thursday
Friday
Training Topics
We want to tailor the curriculum content to best meet your needs.
*
11.
Below is a list of common behaviors in young children for which we can provide training. Please indicate which topics would be most helpful for you to receive evidence-based brief interventions:
Select all that apply
(Required.)
Emotional dysregulation
Disruptive behavior
Early childhood anxiety
Sleep issues
Toilet training
Other (please indicate)
About Your Practice
In tailoring our training content, we want to learn a bit about you:
*
12.
Do you routinely see children birth to five in your practice?
(Required.)
Yes
No – I don’t have time in my schedule
No – I don’t get referrals for this age group
No – I don’t have training in this age group
No – Other Reasons (Please indicate)
*
13.
Have you received specialized training on any of the following therapies to support children birth to five?
Select all that apply
(Required.)
Triple P (Positive Parenting Program)
Generation PMTO
Theraplay
Helping the Non-compliant Child
Trauma- Focused CBT
Parent Child Interaction Therapy (PCIT)
Child Parent Psychotherapy (CPP)
Family Check-Up
Incredible Years
Attachment and Biobehavioral Catch-up (ABC)
Cards for Connection
*
14.
In your scheduling template, how long are your visits?
Select all that apply
(Required.)
15 Minutes
30 Minutes
45 Minutes
1 hour
Other (please specify)
*
15.
Do you have a goal for the maximum number of sessions you complete per patient?
(Required.)
0-3 Sessions
4-6 Sessions
6-10 Sessions
11+ Sessions
Not applicable
