Please complete this baseline survey for the hospital you are representing.
The survey will capture - for each participating hospital - the current practices regarding perinatal mental health patient education, screening, and referrals; existing documented policies and protocols; and anticipated needs for technical assistance and coaching.
We recommend that you begin by downloading a PDF version of the survey here and then use the paper version as a worksheet. This will allow you to review the questions and, if needed, consult with internal colleagues before providing answers into the online survey.
When you are ready, please enter the responses into the online survey below. The survey allows you to edit responses, as needed, until you click "done" for the final submission. Your answers will be lost if you exit the survey before clicking “done”.
If you are responding on behalf of multiple hospitals, please complete a separate survey for each hospital one at a time.
If you have questions, please contact Julia Slininger, RN,BS,CPHQ Program Manager, Perinatal Mental Health Initiative at jslininger@hqinstitute.org or (213) 453-4519.