CCHAP is proud to be partnering with the Rose Community Foundation on an exciting new project to assist primary care pediatric practices in enhancing the behavioral health services your practice offers.  However, we need to hear from you to understand what barriers and challenges you are facing so we can be sure we are offering the support you need. This survey is not anonymous but answers will be kept confidential.

This survey is intended for practices that offer behavioral health services. If you practice DOES NOT, please contact jodi.carpinello@cchap.org.

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* 1. Please indicate your role in your practice

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* 2. Our practice is best described as a

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* 3. How would you best describe your practice's comfort with managing behavioral health needs that arise with children during medical visits?

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* 4. How would you best describe your practice's comfort with managing behavioral health needs that arise with children ages Birth to 5 (ie Early Childhood behavioral health) during medical visits?

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* 5. How would you best describe you practice's comfort with managing behavioral health needs that arise with caregivers/parents during medical visits?

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* 6. How would you best describe your behavioral health provider's role in your practice?

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* 7. Who employees your behavioral health provider?

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* 8. What barriers do you face with this arrangement? Please rank in order of most challenging (1) to least challenging (5)

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* 9. How satisfied are you with the type of behavioral health services your practice currently provides?

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* 10. Do you provide teen depression screening? 

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* 11. Do you have any of the following concerns with teen depression screening?

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* 12. Do you provide pregnancy related depression screening in your practice?

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* 13. Do you have any of the following concerns with PRD screening? Check all that apply

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* 14. In what areas would you be interested in receiving support, training or assistance from CCHAP?

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* 15. Do you currently, or have you in the past, participated in the State Innovation Model (SIM)?

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* 16. Do you participate in Behavioral Health in Pediatric Populations Birth to 5 (BHIPP: 0-5)?

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* 17. We will contact practices that have indicated interest in receiving support, training or assistance from CCHAP.  Feel free to contact either Bridget Burnett (bridget.burnett@cchap.org) or Mindy Craig (mindy.craig@cchap.org) with any questions or concerns.

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