NJ SEEDlings Request for Applications Survey

Thank you for your interest in submitting an application for the NJ SEEDlings: Supporting Equity in Early Development Program, an initiative of the New Jersey Chapter, American Academy of Pediatrics (NJAAP), with funding from HRSA.

The purpose of NJ SEEDlings is to transform the way pediatric primary care is delivered for the prenatal-to-five-year-old (P-5) population who are eligible for NJ FamilyCare (Medicaid or CHIP) or are uninsured, by enhancing the capacity of NJ’s early childhood workforce to deliver equitable, high quality ECD services that meet the needs of young children and their families.

If you have any questions about this application, please email Program Director, Brittany Johnson, MPH at bjohnson@njaap.org.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $4,000,000 with no percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

1.Primary Contact Information (person completing application):(Required.)

First and Last Name:

Credentials:

Title:

Email Address:

Phone Number:

Preferred Pronouns:

2.Practice Name:(Required.)

3.Practice Address:(Required.)

4.Please tell us what sparked your interested in applying to the NJ SEEDlings program?(Required.)

5.Where do you see opportunities for improvement in the care your practice provides for P-5 patients and families?(Required.)

6.Please identify two practice team members to serve in the following roles on your Quality Improvement (QI) team:

Physician Champion: A physician who will be the primary contact and take leadership over the project for your practice team. This person will ensure the team participates in all requirements of the project.

Data Lead: A member of the IT or change management team who can support EHR builds, pull data, and de-identify data for aggregate reporting.(Required.)

Physician Champion Name and Credentials:

Physician Champion Title:

Physician Champion Email Address:

Physician Champion Phone Number:

Physician Champion Preferred Pronouns:

Data Lead Name and Credentials:

Data Lead Title:

Data Lead Email Address:

Data Lead Phone Number:

Data Lead Preferred Pronouns:

7.Has your practice participated in any previous Quality Improvement (QI) Projects or Project ECHO Programs?(Required.)

Yes

QI Projects

Yes

Project ECHO Programs

Yes

8.Is your practice currently engaged in other QI initiatives?(Required.)

Yes (please specify type and duration)