APPLICATION

About the Opportunity
The National Council for Behavioral Health, through a grant award from the Conrad N. Hilton Foundation, is accepting applications for participation in a Youth Screening, Brief Intervention and Referral to Treatment (YSBIRT) learning collaborative for primary care associations (PCAs) interested in learning about, implementing, and sustaining YSBIRT among their member community health centers.

Participating PCAs will receive an honorarium of $2,000 to allocate at their own discretion. Examples of how funds may be used include supporting staff time of participating health centers or to disseminate YSBIRT information and resources to PCA members.

Eligibility
  • Organization must be a regional or state PCA.
  • Identify up to four (4) staff to participate in all program events.
  • Include two (2) member community health centers who also identify three (3) staff to participate in all program events.
  • Must share YSBIRT resources and training opportunities among members.
  • Demonstrate executive leadership sponsorship and support.

All applications are due by 11:59pm ET on Friday, May 14, 2021. We encourage PCAs across all levels of readiness to apply, as we are looking for a range of experiences to foster peer learning.

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* 1. General Information

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* 2. Community Health Center Member Participant #1

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* 3. Are three staff from this health center able to participate in all learning collaborative activities?

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* 4. Community Health Center Member Participant #2

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* 5. Are three staff from this health center able to participate in all learning collaborative activities?

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* 6. Total number of full-time PCA employees

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* 7. Total number of member organizations

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* 8. Approximate number of youth served by your members

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* 9. How familiar are you with youth SBIRT (YSBIRT) practices?

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* 10. Have PCA staff had formal training in SBIRT?

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* 11. Has Health Center Member Participant #1 implemented any of the following? (Check all that apply)

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* 12. Has Health Center Member Participant #2 implemented any of the following? (Check all that apply)

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* 13. What stage of youth SBIRT implementation are your participating health centers currently in? If you would like, please use the comment box to further explain their stage of implementation.

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* 14. Please explain why you would like to be a part of this learning collaborative.

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* 15. PCA Core Implementation Team (Up to 4 Contacts)

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* 16. Health Center #1 Core Implementation Team

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* 17. Health Center #2 Core Implementation Team

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* 18. Letter of Support from CEO/Executive Director

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If you should have any questions about this opportunity or as you're completing this application, please reach out to Rachel Shaheen at RachelS@thenationalcouncil.org.

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