Innovative and Promising Practices for Improving Quality Care for Children and Youth with Epilepsy Survey

The National Coordinating Center for Epilepsy (Center) invites practices that serve children and youth with epilepsy (CYE) to share successful strategies and innovative approaches to improving the quality of epilepsy care. These practices and/or strategies will be reviewed by an expert panel and displayed on the Center webpages to encourage pediatric health care professionals to implement similar strategies within their practices.

Instructions: Please provide the following information. If selected to be highlighted on our website, a high resolution organizational logo will be requested.

Applicant Information

1.Please provide the following information.(Required.)

Contact Name:

Contact Title:

Credentials:

Organization/Practice Name:

City:

State:

Organization/Practice Website URL (if available):

Email Address:

Phone Number:

2.May we share your contact information on our website?

Yes

4.Which of the following best describes your practice?

Pediatric Practice

Family Practice

Multi-specialty Practice

Other (please specify)

5.How would you describe where your practice is located?

Urban (50,000 residents or more)

Suburban (between 10,000 and 49,999 residents)

Rural (9,999 residents or fewer)

Other (please specify)

6.Approximately how many children and youth with epilepsy (CYE) are served by your practice annually?

7.Does your practice population include members of underserved or vulnerable populations?

Yes

If yes, please specify.

Epilepsy Care Program Information

8.Enter the name or a short descriptive title of your promising practice (this is how your listing will be titled on our website):

9.Enter the names and credentials of the pediatric health care professionals involved in the process:

10.Select the epilepsy care topics that are part of your promising practice.

Other epilepsy-related care component (please specify)

11.In the space below, provide a brief overview of your successful strategy. If needed, you may email photos, process models, videos, or other forms of media to present your promising practice to epilepsy@aap.org.

12.Describe your project’s most important results and how they were measured. Results refer to any important changes, improvements, outputs, outcomes, and/or impacts of your program achieved. Please include the evaluation design and names of any measurement tools, if applicable.

13.To your knowledge, has your project been replicated?

Yes

If yes, please describe.

Lessons Learned

14.What were the main challenges you faced when implementing your promising practice? How did you address these challenges?

15.If you were to start over, what would do again? What would you change?

Thank you for completing this application. We may contact you for additional details. For assistance, please email epilepsy@aap.org.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U23MC26252, Awareness and Access to care for Children and Youth with Epilepsy/cooperative agreement. This information or content and conclusions are those of the author and should not be construed at the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the U.S. Government.

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