Section I: Practice Information and Demographics

Thank you for your interest in the American Academy of Pediatrics Systems of Care for Healthy Mental Development ECHO!

The American Academy of Pediatrics (AAP) Systems of Care for Healthy Mental Development ECHO will serve as a forum to build capacity for systems of care to support healthy mental development for pediatric patients and their families.  The program will increase participants’ knowledge and self-efficacy around identification, assessment, and management of disruptions to healthy mental development.

The ECHO session will be held on the second Wednesday of the month and the quality improvement (QI) session will be held on the fourth Wednesday of the month from 4:00 - 5:00 pm CT beginning in September 2022  and ending in April 2023.  A kick off call will be held in August 2022 (TBD). 
  
Practices that wish to participate in the Quality Improvement (QI) component must:
  • Provide primary care to patients 0-21 years
  • Secure approval from practice leadership to participate in this project.
  • Agree to following participation requirements:
    • Participate in the project for its duration of 8-months.
    • Each PRACTICE must complete monthly de-identified retrospective chart reviews (up to 20 charts or more) for a total of 7 cycles through AAP Quality Improvement Data Aggregator (QIDA)
      • If a multi-site health system, each site leader should complete a separate practice application and adhere to the same participation requirements.
      • Monthly chart reviews will include charts from their respective sites ONLY
    • Each PRACTICE submits a PDSA (Plan, Do, Study, Act) worksheet monthly
    • Each PRACTICE conducts at least 1 coaching call with the AAP QI Consultant within the first two months of the project
    • Each INDIVIDUAL attend 75% of ECHO sessions “LIVE”
    • Each INDIVIDUAL views 100% of the archived ECHO sessions for any sessions they did not attend live
    • Each INDIVIDUAL attends 90% of team huddles to review data and plan and implement PDSA process improvement cycles
    • Each INDIVIDUAL completes all program evaluations and participates in a focus group
  • Identify a core project team that will be responsible for providing leadership and oversight within the practice for the initiative. The team may include, at a minimum, a primary care physician who will serve as physician lead; a nurse; and/or an additional team member such as a front office person, practice manager, or care coordinator (this role will be responsible for data submission for the project). Practices may choose to include additional members on the core project team, and all practice staff can participate in educational offerings.
  • If required by their institution, seek Institutional Review Board (IRB) approval for participation. (Please note: The AAP IRB has reviewed and issued an exempt determination for this project, consistent with how it handles all AAP QI projects. AAP IRB review is usually sufficient for most participating practices).  This application can be completed by the physician champion or their designee. 
Contact Kristin Conrad at kconrad@aap.org with any questions.

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* 1. Please enter your name, email address, phone number, and credentials below:

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* 2. Are you or your  practice/organization participating in the Quality Improvement (QI) portion of this ECHO project? 

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* 3. Are you a member of the American Academy of Pediatrics? (You do not need to be an AAP member to participate in the ECHO, but an AAP ID is required. There is NO fee to create an AAP ID.)

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* 4. Practice/Organization Name:

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* 5. Practice/Organization Location:

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* 6. Which of the following best describes your work setting? (check all that apply)

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* 7. Which of the following best describes your profession?

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* 8. Please estimate the number of children and youth that you see in an average month for behavioral/mental health services. (Please enter N/A if you do not directly treat patients)

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* 9. Do you have additional team members that will participate in this ECHO program?

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* 10. Please list the contact information for your project team.
Team may include a primary care physician (physician champion/MOC local leader), a nurse and/or an additional team member, such as a front office person, practice manager, or care coordinator. This information is required for your application to be considered complete; however if you do not have this information now, you may submit your application and follow-up with your team member details at a later date

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* 11. Team Member 2

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* 12. Team Member 3 (optional)

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* 13. Please list additional participants, if applicable. 

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* 14. Approximately what percentage of your patients who are seen for behavioral/mental health services have private insurance, public insurance, or no insurance?

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* 15. Why are you interested in participating in the AAP Systems of Care for Healthy Mental Development ECHO?

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* 16. What factors do you believe limit your patients/clients from receiving care?

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* 17. Which of the following social emotional screening tools do you currently use? (select all that apply)

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