TEAMSS Site Application Survey

Thank you for expressing interest in the Transformative & Evidence-based Approaches to Mental health & Substance use Screening (TEAMSS) project. This survey is for pediatric primary care practice teams to apply for this Quality Improvement learning collaborative. Please click here to access the promotional webinar recording and accompanying slides. Also see our FAQ document and application questions attached in PDF form, so you can review with your practice team in advance of completing the application.
Space for participation is limited, so submission of an application does not guarantee enrollment. Applications will be reviewed by national team leaders. Selection criteria include: practice setting, location, and type; patient population; QI experience; current screening practices and needs. Only one survey should be completed per practice.
The survey will take approximately 10 minutes to complete.

Question Title

* 1. Practice information:

Name (please avoid abbreviations) *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country

Question Title

* 2. Multi-Site Participation

If multiple practices from a larger “Network” with a governing body and/or Healthcare System brand across multiple geographic locations are interested in participation, sites should determine whether they will participate as one practice team or as separate practice teams. Each participating practice team should submit a separate Site Application.

Please note, if multiple, affiliated sites decide to participate as separate practice teams, the PPC Quality Network can provide a mechanism for aggregating and viewing data across affiliated sites during project implementation. However, it is not possible to disaggregate data from a single, larger practice network into site-specific data. If a practice team wants the ability to review site-specific data, they must apply as a separate site.

Please contact Anna Correa (acorrea@aap.org) with questions.

To your knowledge, will your practice team include participants from multiple practice sites?

Unsure

Yes. Pease provide the site name(s) if known.