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BDADcRv4wCFdBELHhJWZAsyBLpDbD3XhVLUocFEGDHcZYxexvQXV6g72nzp3d4IvibD

ECHO IDD Wraparound Registration form

Thank you for your interest in joining an ECHO IDD Wraparound TeleECHO™ clinic.

Please fill in the following information to register for an ECHO IDD program. A confirmation email will be sent to you within a few hours of your registration being submitted (it may be routed to your junk/spam folder at first). You can expect to start receiving invitations to ECHO sessions within 48-64 hours. If you are registering for an ECHO with a session today, you will be able to request the latest invitation in your confirmation email.

Contact Swee May Cripe or Sennie Rose at echoiddd@uw.edu if you have any questions or problems registering.

Thank you!

Extension for Community Health Outcomes (ECHO) Intellectual and/or Developmental Disabilities (IDD) Wraparound is a program designed to provide training and support to Washington State community health providers who work with children, youth and young adults with intellectual and developmental disabilities and behavioral health needs. The training program connects care providers with experts at the University of Washington, the Seattle Children’s Autism Center (SCAC), and other organizations.

ECHO IDD Wraparound is funded by Washington State Legislature and is a partnership between the University of Washington’s Clinical Training Unit at the Center on Human Development and Disability, Project ECHO at the University of New Mexico, and Washington State’s Health Care Authority. We launched the ECHO IDD Wraparound pilot program in September 2020 and conducted it for 10 months. There was overwhelming response from community health providers. With a successful pilot program and additional funding from the Washington State Legislature, we are looking forward to offering this program again. We have re-designed the program based on excellent suggestions and feedback from former ECHO IDD participants and interdisciplinary resource team members. Please find a list of our upcoming teleECHO™ clinics below here:

A. ECHO IDD Wraparound offers two virtual teleECHO™ program tracks:

An Introduction* (2nd Wednesday of each month)
Next Step/Advance* (4th Wednesday of each month)

B. ECHO IDD Resources and Resource Navigation (3rd Wednesday of each month)

C. ECHO IDD Psychiatric Care (1st Wednesday of each month)

Program details are provided below here:

A.1. ECHO IDD - An Introduction* (November 10, 2021 - November 9, 2022)

What: This track covers introductory topics to IDD, ASD, and behavioral health, e.g., introduction to autism, introduction to evaluation and diagnosis, available resources, and behavioral interventions.

Who: Care coordinators, parent and peer partners, family and self-advocates, clinicians, and other professionals who are relatively new to working with children with IDD and behavioral health needs or for those who would like a refresher to the basics.

When: Each virtual teleECHO™ clinic session is 90 minutes in length (8:30 - 10:00 AM); occurs on the 2nd Wednesday of each month, starts on November 10th, 2021. Sessions will be offered through Zoom technology.

A.2. ECHO IDD - Next Step/Advance* (November 24, 2021 - October 26, 2022)

What: This track covers discussion of more advanced topics related to individuals with IDD and behavioral health needs, e.g., working with individuals with severe behavioral needs and / or non-verbal, medication management, and others. Note that discussions go beyond the basics of topics related to IDD, ASD, and behavioral health.

Who: Care coordinators, parent and peer partners, family and self-advocates, clinicians, and other professionals with experience working with individuals with IDD/ASD and more challenging behavioral health needs. These are individuals who are interested in going to the next step, beyond the basics of IDD, ASD, and behavioral health.

When: Each teleECHO™ clinic session is 90 minutes in length (8:30 - 10:00 AM); occurs on the 4th Wednesday of each month, starts on November 24th, 2021. Sessions will be offered through Zoom technology.

B. ECHO IDD - Resources and Resource Navigation (starts on February 16th, 2022)

What: This track covers discussion of resources, services, supports, and information related to individuals with IDD/ASD diagnosis, ages 0 through the lifespan. Topics will include what to do while waiting for an evaluation, getting started following a diagnosis, understanding and navigating early intervention services, Developmental Disabilities Administration, state and federal resources, commonly recommended therapies, mental health services, resources for challenging behaviors, managing crisis, and other vital supports for parents, caregivers, families, and individuals with IDD/ASD.

Who: Family advocates, care coordinators, case managers, resource navigators, Health Care Workers, parent and self-advocates, clinicians, and any other professionals who support the IDD/ASD population and seek to gain deeper understanding and knowledge of IDD/ASD resources, services, information, and supports. These are individuals who are going to use this information to support parents, caregivers, and individuals with IDD/ASD as they navigate the complex maze that often accompanies an IDD/ASD diagnosis.

When: Each teleECHO™ clinic session is 90 minutes in length (8:30 - 10:00 AM); occurs on the 3rd Wednesday of each month, starts on February 16th, 2022. Sessions will be offered through Zoom technology.

C. ECHO IDD Psychiatric Care (starts on March 2, 2022)

What: This track will focus on support and training around diagnostic assessment and psychopharmacology for managing the co-occurring behavioral health conditions experienced by youth and young adults with IDD/ASD. Topics will also include navigating resources and supporting parents, caregivers, and the individual with IDD/ASD.

Who: Primary Care Providers, Psychiatrists, Psychiatric Nurse Practitioners, Physician Assistants, Naturopathic Doctors. There is a strong emphasis on providing care for youth and young adults on state insurance. Providers should be enrolled with a Managed Care Organization (MCO) or considering enrollment with an MCO.

When: Each teleECHO™ clinic session is 90 minutes in length (8:30 - 10:00 AM); occurs on the 1st Wednesday of each month, starts on March 2, 2022. Sessions will be offered through Zoom technology.

Interested participants have the option to select:

ONE of the four programs listed above as a Primary teleECHO™ clinic,

***Expectations for participation in the Primary teleECHO™ clinic – Participate in at least 70% of the teleECHO™ sessions and interested and willing to present a client's case for discussion, appropriate to the focus of the program. We also request participants to actively engage in the peer learning and teaching community by sharing ideas in breakout and large group discussions.

AND

NONE to THREE of the four program(s) listed above as Elective(s) teleECHO™ clinic(s)

Questions: Contact Swee May Cripe (echoiddd@uw.edu) or Sennie Rose (echoautismwa@uw.edu or ladyrose@uw.edu)

* The University of Washington School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Washington School of Medicine designates this live activity for a maximum of 36 AMA PRA Category 1 CreditsTM. Participants should claim only the credit commensurate with the extent of their participation in the activity.

(Each session is 1.5 credits)

Which primary ECHO would you like to register for?
Please select ONE from the list below here.

* must provide value

ECHO IDD - An introduction (begins November 2021)

ECHO IDD - Next step/Advance (begins November 2021)

ECHO IDD - Resources and Resource navigation (begins February 2022)

ECHO IDD Psychiatric Care (begins March 2022)

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Which elective ECHO would you like to register for, in addition to the primary ECHO you selected?
You may select None, One or more. Please do not check the program that you have selected as your primary ECHO program track. Thank you!

* must provide value

ECHO IDD - An introduction (begins November 2021)

ECHO IDD - Next step/Advance (begins November 2021)

ECHO IDD - Resources and Resource navigation (begins February 2022)

Not interested in an elective ECHO program

ECHO IDD Psychiatric Care (begins March 2022)

How did you hear about us?

* must provide value

Other, please specify how you heard about us

Salutation

Other, please specify salutation if desired:

First name:

* must provide value

Last name:

* must provide value

E-mail:

* must provide value

Telephone number (Work)

* must provide value

Telephone number (mobile)

* must provide value

Practice setting:
(Please select all that apply)

* must provide value

Home-based services

School

Community-based clinic/organization

Hospital

Other

Other practice setting, please specify:

Practice or organization name:

* must provide value

Practice location street address:
(include personal address if not affiliated with an organization)

* must provide value

City:

* must provide value

Zipcode:

* must provide value

Which county or counties do you work in?
(Please select all that apply)

* must provide value

Adams

Asotin

Benton

Chelan

Clallam

Clark

Columbia

Cowlitz

Douglas

Ferry

Franklin

Garfield

Grant

Grays Harbor

Island

Jefferson

King

Kitsap

Kittitas

Klickitat

Lewis

Lincoln

Mason

Okanogan

Pacific

Pend Oreille

Pierce

San Juan

Skagit

Skamania

Snohomish

Spokane

Stevens

Thurston

Wahkiakum

Walla Walla

Whatcom

Whitman

Yakima

Education:
(Please select all that apply)

* must provide value

High school diploma

Some college

Associate's degree

Bachelor's degree

Master's degree

Doctoral degree

Student

Other

Other, please specify:

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Professional role:

* must provide value

Credentials:
(BA, BS, MA, MSW, MHP, LMHC, RN, LPN, MD, PsycD, DNP, ARNP, etc.)

* must provide value

How would you describe your race/ethnicity?
(please select all that apply)

* must provide value

American Indian/Alaska Native

Asian - regional ancestry not specified

Central Asian

Eastern Asian

Southeastern Asian

South Asian

Black - regional ancestry not specified

Black - African American

Black - African Canadian

Black - East African

Black - Latin American

Black - West African

Hispanic, Latina(a)(x), Mexico and Central American

Hispanic, Latina(a)(x), Caribbean

Hispanic, Latina(a)(x), South American

Hispanic, Latina(a)(x), Spanish origin

Hispanic, Latina(a)(x) - regional ancestry not specified

Middle Eastern/North African

Native Hawaiian/Pacific Islander

White

Prefer not to say

Prefer to self-describe

If Prefer to self-describe, please specify:

* must provide value

Please indicate the specific racial, ethnic, and/or tribal group(s) that you identify with:

* must provide value

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Number of clients:

* must provide value

Age range of clients:
(Please select all that apply)

* must provide value

0 - 3

4 - 9

10 - 13

14 - 18

19 - 24

25 and above

Race/ethnicity of clients:
(Please select all that apply)

* must provide value

American Indian/Alaska Native

Asian - regional ancestry not specified

Central Asian

Eastern Asian

Southeastern Asian

South Asian

Black - regional ancestry not specified

Black - African American

Black - African Canadian

Black - East African

Black - Latin American

Black - West African

Hispanic, Latina(a)(x), Central American

Hispanic, Latina(a)(x), Caribbean

Hispanic, Latina(a)(x), South American

Hispanic, Latina(a)(x), Spanish origin

Hispanic, Latina(a)(x) - regional ancestry not specified

Middle Eastern/North African

Native Hawaiian/Pacific Islander

White

Do not know

Other

Other, please specify:

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Diagnosis 1

* must provide value

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Diagnosis 2

* must provide value

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Diagnosis 3

* must provide value

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Client barrier or challenge 1:

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Client barrier or challenge 2:

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Client barrier or challenge 3:

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Client barrier or challenge 4:

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Client barrier or challenge 5:

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How far do clients travel to receive your services?
(e.g., miles, travel time)

* must provide value

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What types of support services are available in your community for clients with IDD and mental health needs and their families?
(e.g., speech-language, occupational therapy, applied behavioral analysis, individualized education plan, and others)

* must provide value

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Three to five challenges program staff face when working with clients with IDD and behavioral health needs and their families:
(e.g., sharing diagnosis with client and family, connecting to resources, lack of resources, engaging with parents)

* must provide value

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What are the issues and pitfalls with existing programs for clients with IDD and mental health needs?

* must provide value

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What additional services and resources would benefit children/youth with IDD and mental health needs and families you serve?

* must provide value

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How long have you been in practice?
(years)

* must provide value

Please describe specific training you have had for working with children and young adults with dual diagnosis (IDD and mental health).

* must provide value

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Please tell us why you are interested in participating in this teleECHO program:

* must provide value

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What topics would you like addressed in this teleECHO program?

* must provide value

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Please tell us about your short-term (2 years) professional goals and how you think this teleECHO program can help you accomplish those goals.

* must provide value

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Please tell us about your long-term (5 years or more) professional goals and how you think teleECHO program can help you accomplish those goals.

* must provide value

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Please include a copy of your resume.
Note: Not to worry if you do not have a resume. You may upload a blank document in order to submit the registration.

* must provide value

Upload file

In order to support the growth of the ECHO movement, Project ECHO® collects participation data for each teleECHO™ program. This data allows Project ECHO to measure, analyze, and report on the movement's reach. Aggregate data is used in reports, on maps and visualizations, for research, for communications and surveys, for data quality assurance activities, and for decision-making related to new initiatives.

By checking this box, you agree to allow us to store the data from this form and agree to receive further email communication about our products/services and other news. You can change your mind at any time by contacting us or clicking the unsubscribe link on any email.

* must provide value

I agree

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