ILAIMH: West Suburban Chapter

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* 1. What agency do you work at and what is your role?

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* 2. Are you a member of Illinois Association of Infant Mental Health(ILAIMH)?

Yes

No

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* 3. How long have you been in the field of infant/childhood mental health?

1-3 years

4-6 years

7-10 years

Over 10 years

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* 4. What population do you serve?

Parents

Children

Both Parents and Children

Early Childhood Teachers/Providers

Other (please specify)

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* 5. Would reflective case consultation benefit your work?

Yes

No

unsure

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* 6. Please check the following professional development topics that intrest you.

Cultural humility and equity

Maternal depression

0-5 diagnosis

Trauma informed practices

Executive function skill development in Early childhood years

Immigration and resources for families

Other (please specify)

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* 7. I'd like more information about the Association and local chapters.

Yes

No

Other (please specify) If yes, please leave your email address: