Colorado AIM: Obstetric Care for Women with Substance Use Disorder Please complete this brief survey to enroll with the Colorado AIM: Substance Use Disorder Learning Collaborative!If you have any questions, please reach out to Valerie Garrison at vgarrison@cpcqc.org. Question Title * 1. Organization: Question Title * 2. Please identify your Nurse Champion and their contact information: Name Email Address Question Title * 3. Please identify your Provider/Clinician Champion and their contact information: Name Email Address Question Title * 4. Please identify your Social Work/Case Management Champion and their contact information: Name Email Address Question Title * 5. If desired, please include the name and email address of an additional champion you'd like us to include in communications to your team's project leadership. Name (and Role) Email Address SBIRT Readiness Self-AssessmentNext, we will ask you a series of questions related to your current practices surrounding use of the SBIRT framework (Screening, Brief Intervention, and Referral to Treatment). Your answers to these questions will be tabulated to provide your organization a baseline score on the Self-Assessment. You will take this SBIRT Readiness Self-Assessment again after the program to measure your progress. Question Title * 6. Does your organization have management support for SBIRT implementation? (Organizational decision-makers endorse SBIRT implementation) Completed In process Not ready Question Title * 7. Have you defined your organization's population for screening? (For example, all patients or selected groups of patients, and all visits or selected visits) Completed In process Not ready Question Title * 8. Have you selected your organization's screening tools and outlined your screening process for brief screening and further screening for maternal substance use? Completed In process Not ready Question Title * 9. Have you selected your organization's screening tools and outlined your screening process for brief screening and further screening for maternal mental health? Completed In process Not ready Question Title * 10. Is your Electronic Health Record (EHR) set up to record screening results (with your selected tools)? Completed In process NA: not planning to enter screening results in EHR NA: no EHR Question Title * 11. Has your SBIRT workflow been defined? Note, this step has been completed when: - Staff roles and responsibilities are identified for: brief screening, further screening, brief interventions, coordinating referral to treatment, coordinating follow-up, and billing; and - When the SBIRT clinic flow (when and where) is determined for: screening, brief Intervention, and referrals Completed In process Not started Question Title * 12. Have you completed the following to support Brief Intervention in your organization?- Key staff trained,- Proficiency verified; and - documentation process established Completed In process Not started Question Title * 13. Have you completed all of the following to support Referral to Treatment in your organization? - Internal and external treatment services identified- Clinicians trained to provide MAT- Business and information sharing agreements with substance use treatment providers established- Care coordination protocols established- Documentation of treatment monitoring established- Community support and recovery services identified. Completed In process Not started Question Title * 14. Has your organization taken all of the following steps to integrate and sustain SBIRT in regular practice? Organization plans established to:- Monitor fidelity to SBIRT process- Train new staff- Periodically retrain staff- Monitor and update community referral and support resources- Monitor SBIRT process and data Completed In process Not started Question Title * 15. Has your organization determined a plan for seeking SBIRT reimbursement, including identification of health plan specific procedures and protocols and training key staff? Completed In process Not started Question Title * 16. Is there anything else you would like us to know about the current status of your SBIRT implementation? Thank you for completing your application! You will receive communications from CPCQC soon with next steps.If you have any questions, please reach out to Valerie Garrison at vgarrison@cpcqc.org. Done