As a participant in the Growing Healthy Minds Project ECHO series, we invite you to complete this Case Presentation Form if you are interested in sharing a deidentified case example to be featured for discussion on an upcoming session. 

We encourage the submission of cases on the following topics that will be featured on our upcoming sessions:

November: Threat assessment and suicide risk assessment
December: Equity, inclusion & belonging
January: Student athlete mental health
February: Body image and social media
March: Chronic absenteeism
April: Self-care for school staff

In order to protect the identity of school staff and students, we ask that you do not share identifiable information in the form below. If your case is selected for discussion on an upcoming ECHO session, we will invite you to discuss your case with our Hub faculty, and a member of our team will present your case on the session.

Please contact Growing Healthy Minds Program Manager, Tizana Hoggs, MPA at thoggs@njaap.org with any questions or concerns.

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* 1. First & Last Name:

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* 2. Credentials (i.e. MEd, PhD, RN, etc.):

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* 3. Email Address:

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* 4. School District:
*Please note that this is for Hub Faculty only, this will not be disclosed to participants during the ECHO session

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* 5. Student’s Grade Level:

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* 6. Primary Language Spoken at Home:

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* 7. Student Demographic Information:

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* 8. Please indicate which session topic your case submission corresponds with:

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* 9. Please indicate what challenges you encountered during this case (i.e. related to your skillset, school/community resources, personal child/family barriers, financial constraints/insurance, culture/identity, etc.):
*As a reminder, please do not include any identifiable information.

In questions 10-14 below, please provide details relevant to this case to help our hub faculty and participants get a clear understanding of the scenario:
*As a reminder, please do not include any identifiable information.

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* 10. Please provide an overview of this case (i.e., relevant background on student, any significant incidents, support provided, outcomes):

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* 11. Student and family strengths identified:

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* 12. Engagement and role of school staff:

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* 13. Student’s relevant social history (i.e., family dynamics, home life, housing, etc.):

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* 14. Please provide any other information on this case that may be relevant (I.e. cognitive development, comorbidities, previous interventions, services/programs family is connected with)

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* 15. Please indicate all of the interventions recommended to the student and/or parent/caregiver (check all that apply):

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* 16. What question(s) do you have for Growing Healthy Minds participants and Hub Faculty?

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