AAP Environmental Health ECHO Registration

Program Registration

Through the Pediatric Environmental Health Specialty Unit (PEHSU) program, the American Academy of Pediatrics (AAP) is implementing a national Project ECHO® (Extension for Community Healthcare Outcomes) for reproductive and pediatric environmental health.

The AAP Environmental Health ECHO serves as a forum for health care professionals to learn how to identify, diagnose and treat environmentally-related health conditions in children and reproductive-age adults. This project uses the ECHO model^TM, a tele-mentoring hub and spoke platform that leverages video conference technology to bring together specialty care providers at academic medical centers (hub) and primary care providers in local communities (spokes).

Each ECHO session includes a brief lecture by a national expert, followed by a de-identified patient case presentation and discussion. All attendees are invited to share and actively participate. We will cover a variety of topics including lead, mold, food safety, indoor and outdoor air quality, and more.

Sessions last one hour and take place via Zoom video conference, and will occur regularly at the following times:

2nd Thursday of the month at 9am CST, and
4th Tuesday of the month, at 4pm CST

Participants are strongly encouraged to attend calls regularly, so that we may build a learning community.

If you are interested in participating in the AAP Environmental Health ECHO, please complete the details below. AAP staff will follow up with you with further details.

This Project ECHO was supported by the American Academy of Pediatrics (AAP) and funded (in part) by the cooperative agreement FAIN: 5 NU61TS000237-04 from the Agency for Toxic Substances and Disease Registry (ATSDR).

Acknowledgement: The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing partial funding to ATSDR under Inter-Agency Agreement number DW-75-95877701-4. Neither EPA nor ATSDR endorse the purchase of any commercial products or services mentioned in PEHSU publications.

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* 1. Name (First, Last, Credentials)

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* 2. Which of the following best describes your training?

Doctor (MD, DO)

Advanced Clinical Provider (PA, NP)

Social Worker

Nurse

Other (please specify)

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* 3. Email Address

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* 4. City, State, Country

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* 5. Please describe your practice setting

Academic medical center

Primary care, urban setting

Primary care, rural setting

Primary care, suburban setting

Specialty care

N/A, I do not see patients

Other (please specify)

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* 6. Please tell us a bit about the patients you serve at your practice:

I see only children in my practice.

I see children and adults in my practice.

I see only adults in my practice.

I see pregnant women in my practice.

N/A, I do not currently see patients.

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* 7. Please tell us approximately how many patients you serve at your practice per month.

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* 8. Please list the approximate percentage (%) payor mix at your practice:

Private insurance

Medicaid

Medicare

Other government funded insurance

Self-pay

Other

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* 9. Please indicate the approximate percentage (%) of your patient population in each racial/ethnic category.

	0	1-9%	10-19%	20-29%	30-39%	40-49%	50-59%	60-69%	70-79%	80-89%	90-100%
American Indian / Alaska Native	American Indian / Alaska Native 0	American Indian / Alaska Native 1-9%	American Indian / Alaska Native 10-19%	American Indian / Alaska Native 20-29%	American Indian / Alaska Native 30-39%	American Indian / Alaska Native 40-49%	American Indian / Alaska Native 50-59%	American Indian / Alaska Native 60-69%	American Indian / Alaska Native 70-79%	American Indian / Alaska Native 80-89%	American Indian / Alaska Native 90-100%
Black or African-American	Black or African-American 0	Black or African-American 1-9%	Black or African-American 10-19%	Black or African-American 20-29%	Black or African-American 30-39%	Black or African-American 40-49%	Black or African-American 50-59%	Black or African-American 60-69%	Black or African-American 70-79%	Black or African-American 80-89%	Black or African-American 90-100%
Caucasian / White	Caucasian / White 0	Caucasian / White 1-9%	Caucasian / White 10-19%	Caucasian / White 20-29%	Caucasian / White 30-39%	Caucasian / White 40-49%	Caucasian / White 50-59%	Caucasian / White 60-69%	Caucasian / White 70-79%	Caucasian / White 80-89%	Caucasian / White 90-100%
Asian	Asian 0	Asian 1-9%	Asian 10-19%	Asian 20-29%	Asian 30-39%	Asian 40-49%	Asian 50-59%	Asian 60-69%	Asian 70-79%	Asian 80-89%	Asian 90-100%
Native Hawaiian or other Pacific Islander	Native Hawaiian or other Pacific Islander 0	Native Hawaiian or other Pacific Islander 1-9%	Native Hawaiian or other Pacific Islander 10-19%	Native Hawaiian or other Pacific Islander 20-29%	Native Hawaiian or other Pacific Islander 30-39%	Native Hawaiian or other Pacific Islander 40-49%	Native Hawaiian or other Pacific Islander 50-59%	Native Hawaiian or other Pacific Islander 60-69%	Native Hawaiian or other Pacific Islander 70-79%	Native Hawaiian or other Pacific Islander 80-89%	Native Hawaiian or other Pacific Islander 90-100%
Hispanic/Latino	Hispanic/Latino 0	Hispanic/Latino 1-9%	Hispanic/Latino 10-19%	Hispanic/Latino 20-29%	Hispanic/Latino 30-39%	Hispanic/Latino 40-49%	Hispanic/Latino 50-59%	Hispanic/Latino 60-69%	Hispanic/Latino 70-79%	Hispanic/Latino 80-89%	Hispanic/Latino 90-100%
Multi-racial	Multi-racial 0	Multi-racial 1-9%	Multi-racial 10-19%	Multi-racial 20-29%	Multi-racial 30-39%	Multi-racial 40-49%	Multi-racial 50-59%	Multi-racial 60-69%	Multi-racial 70-79%	Multi-racial 80-89%	Multi-racial 90-100%
Other	Other 0	Other 1-9%	Other 10-19%	Other 20-29%	Other 30-39%	Other 40-49%	Other 50-59%	Other 60-69%	Other 70-79%	Other 80-89%	Other 90-100%
Unknown	Unknown 0	Unknown 1-9%	Unknown 10-19%	Unknown 20-29%	Unknown 30-39%	Unknown 40-49%	Unknown 50-59%	Unknown 60-69%	Unknown 70-79%	Unknown 80-89%	Unknown 90-100%

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* 10. Please check the following times that you would be likely to participate in our Environmental Health ECHO sessions.

Second Thursday of the month, 9:00-10:00am CST

Fourth Tuesday of the month, 4:00-5:00pm CST

Neither of these times work for me, however I would be interested in participating if sessions were held at a different time (please list day/time below)

AAP Environmental Health ECHO Registration

Program Registration

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* 1. Name (First, Last, Credentials)

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* 2. Which of the following best describes your training?

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* 3. Email Address

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* 4. City, State, Country

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* 5. Please describe your practice setting

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* 6. Please tell us a bit about the patients you serve at your practice:

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* 7. Please tell us approximately how many patients you serve at your practice per month.

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* 8. Please list the approximate percentage (%) payor mix at your practice:

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* 9. Please indicate the approximate percentage (%) of your patient population in each racial/ethnic category.

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* 10. Please check the following times that you would be likely to participate in our Environmental Health ECHO sessions.

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* 11. What topics are you interested in hearing about?

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* 12. If you have any questions or comments about the AAP Environmental Health ECHO, please list them below.