IHI Open School Recover Hope Campaign Interest Form

Getting Involved with the Open School Campaign

Thank you for your commitment to the IHI Open School Recover Hope Campaign.

The aim of the campaign is to promote awareness, prevention, and treatment of substance use disorders. Together, we will improve the lives of 50,000 people living with substance use disorders around the world by April 2020. We will do this by engaging 150,000 members of our diverse, global network of change agents and 150 IHI Open School Chapters to take action together.

We hope you'll join us. Please complete this form to share your interest in getting involved with the campaign.

Question Title

* 1. Contact Information:

Name *

City/Town

State/Province

Country

Email Address *

Question Title

* 2. What university or organization are you affiliated with?

Question Title

* 3. Are you a member of an IHI Open School Chapter?

Yes

Unsure

Question Title

* 4. If you answered yes to the previous question, please share the name of the Chapter:

Question Title

* 5. What is your role within the Open School?

Chapter Member

Chapter Leader

Faculty Advisor

Coaching Fellow with the Leadership and Organizing for Change course

Global Chapter Leader

Campaign Leadership Team member

Open School alumni (formerly in one of the above roles)

Other (please specify)

Question Title

* 6. Which action area of the campaign are you most passionate about working in?

Change the Narrative: Sharing stories to raise awareness of substance use disorders as a chronic disease, reduce stigma, promote recovery-focused language, and confront systematic oppression underlying substance use

Save Lives from Overdose: Train individuals to carry and administer naloxone, the opioid overdose rescue drug

Improve Pain Management: Support best practice opioid prescribing and alternative pain management in health systems

Reform University Curricula: Promote education and training on prevention, diagnosis, and treatment of substance use disorders in university curricula

Question Title

* 7. What level of involvement in the campaign are you interested in? (Please check all that apply.)

Raising awareness of the campaign via social media and local networks

Supporting existing work at my local Open School Chapter, community, or organization

Launching and leading a new campaign project within my Chapter, community, or organization

Engaging in other local activities to support the campaign (events, educational programming, etc)

Supporting the campaign in a leadership role at the network-level

Other (please specify)

Question Title

* 8. What support or resources would be most helpful to you as you launch and lead a campaign project? (Please check all that apply.)

Ideas of projects I can launch

Connecting with others who are leading similar work to exchange best practices

Educational resources on substance use disorders

Quality improvement training to start a project

Member recruitment and engagement strategies for starting or growing my Open School Chapter

Other (please specify)

Question Title

* 9. Are you interested in connecting with an Open School Global Chapter Leader to receive personal coaching and support as you become involved in the campaign?

Yes

Unsure

Thank you for completing the IHI Open School's Campaign interest form. We will be in touch to support your involvement in the campaign. Please reach out to openschool@ihi.org with any questions or concerns.