Evaluation Introduction: Contact Information and Satisfaction

Thank you for your interest in participating in the CHAMPS Resiliency Collaborative Pilot Project. 

The CHAMPS Resiliency Collaborative is a facilitated peer support group using concepts from the evidence-based framework, Finding Meaning in Medicine, in an online format. Each session will begin with a practice of mindfulness techniques followed by group discussion. This Resiliency Collaborative is a pilot project intended to evaluate the effectiveness of online meetings to build resiliency and reduce burnout in professionally isolated providers at Region VIII health centers. This pilot program will last for six months in duration- every two weeks for the first two months beginning on Tuesday, September 4th and then once per month for the next four months for a total of eight sessions. Each session will be held from 12:15 PM – 1:15 PM MT (1:15 PM – 2:15 PM CT).

This pilot cohort will be capped at 15 providers. Enrollment is open to all disciplines; medical, behavioral health, and oral health providers are welcome to apply. The following application will be reviewed by, and the cohort ultimately selected by, the CHAMPS Resiliency Collaborative Planning Committee. Preference will be given to those clinicians from professionally isolated environments. Additional placements will then be given to interested clinicians from larger health centers. A provider's perceived level of burnout is not a factor for or against consideration for this pilot program. 

The application period will close on Wednesday, August 15th.  However, applications will be considered on a rolling basis and the 15 person cohort may fill to capacity before that date. 

The Resiliency Collaborative will meet on the following Tuesdays:
September 4th and 18th
October 2nd and 16th
November 6th
December 4th
January 8th
February 5th

Thank you for completing this short application.  

Please provide your contact information.

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* 1. Please provide your contact information.

Please share more information about your professional situation.

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* 2. Please share more information about your professional situation.

How many years have you been in clinical practice?

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* 3. How many years have you been in clinical practice?

Commitment: This pilot program will last for six months in duration- every two weeks for two months and then once per month for next four months for a total of eight sessions. Each session will be held on Tuesdays from 12:15 PM – 1:15 PM MT (1:15 PM – 2:15 PM CT)

If selected for this cohort, will you be able to attend at least six of eight sessions?

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* 4. Commitment: This pilot program will last for six months in duration- every two weeks for two months and then once per month for next four months for a total of eight sessions. Each session will be held on Tuesdays from 12:15 PM – 1:15 PM MT (1:15 PM – 2:15 PM CT)

If selected for this cohort, will you be able to attend at least six of eight sessions?

In addition, participants in the collaborative will be asked to complete the Maslach Burnout Survey for Medical Personnel scale four times during the pilot, at the beginning, the middle, the end, and 6 months after the conclusion of the pilot program. Scores will be shared with participants and deidentified scores will be used for evaluation purposes.  Participants will also be asked to complete an evaluation survey at the end of the collaborative and a follow up survey six months later.

If selected for this cohort, will you be able to complete the four Maslach Burnout Survey for Medical Personnel and two program evaluation surveys to support the evaluation of this program?

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* 5. In addition, participants in the collaborative will be asked to complete the Maslach Burnout Survey for Medical Personnel scale four times during the pilot, at the beginning, the middle, the end, and 6 months after the conclusion of the pilot program. Scores will be shared with participants and deidentified scores will be used for evaluation purposes.  Participants will also be asked to complete an evaluation survey at the end of the collaborative and a follow up survey six months later.

If selected for this cohort, will you be able to complete the four Maslach Burnout Survey for Medical Personnel and two program evaluation surveys to support the evaluation of this program?

The Resiliency Collaborative will be hosted on Zoom.  Do you have access to a computer with a webcam to utilize this bidirectional video software?

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* 6. The Resiliency Collaborative will be hosted on Zoom.  Do you have access to a computer with a webcam to utilize this bidirectional video software?

Please tell us about the population of patients you work with.

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* 7. Please tell us about the population of patients you work with.

Do you practice mindfulness techniques regularly?

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* 8. Do you practice mindfulness techniques regularly?

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