FY 25 Executives Monthly Cohort Call Registration

CCBHC-E Executives Monthly Cohort Call

The CCBHC-E NTTAC conducts monthly cohort calls for CCBHC-E executives, program directors, evaluators/continuous quality improvement (CQI) leads and medical directors. These monthly, hour-long meetings will serve as a regular space to support peer sharing, solution generation and cross-collaboration for staff at CCBHC-E Grantees.
Name*

First NameLast Name
Email*
example@example.com
City*
State/Territory*
Zip Code/Postal*
Organization*
If Other, please specify
Job Title*

CCBHC Program DirectorManagement/Administrator/ExecutiveClinical/Mental Health or Substance Use ProfessionalParaprofessional/Peer Support/Care Coordination/Case ManagementEvaluation/Data Management/AnalystGrants Management/ComplianceQuality Improvement/AssuranceAdministrative Support StaffFinancial/Reimbursement/Billing StaffConsultant/ContractorOther
Do you need translation services during the event?

YesNo
If yes, what language would you like to request translation services?
How would you describe yourself?

African AmericanHispanic or LatinoWhite (Non-Hispanic)AsianAmerican Indian/Alaska NativeNative Hawaiian/Other Pacific IslanderTwo or More RacesPrefer Not to Answer
Which of the following best describes your gender?

MaleFemaleAnother Gender
Which of the following best describes your sexual orientation?

BisexualGayLesbianStraightPrefer not to sayPrefer to self-describe
CCBHC Information
What is your organization’s CCBHC status? (Select all that apply)*

CCBHC Expansion GranteeMedicaid CCBHC Demonstration SiteIndependent State Certified CCBHCProspective CCBHC/Interested in Adopting the ModelCurrent CCBHC PartnerState Government Official or Policy MakerOther
If you are CCBHC Expansion grantee, what year were you awarded your grant? [Multi-select]*

201720182019202020212022Other
What is your CCBHC PDI Status?*

CCBHC PDI grantee – First CCBHC grantCCBHC PDI grantee – Past grantee but adding a new clinic locationOther
How would you describe your knowledge about the CCBHC model?*

Limited knowledge on the CCBHC model – minimal past education or learning on the CCBHC model, new staff on the project team who do not know CCBHCModerate knowledge on the CCBHC model – some foundational knowledge on CCBHC, have participated in webinars, events or reviewed resources, a lot of research on the model was conducted before applyingStrong foundational knowledge of the CCBHC model – clear understanding of the criteria, have been educating and training staff and stakeholders on the model, some staff may have experience in implementing the modelOther
Support Needed
Which of the following clinical areas are you most in need of support? (Select all that apply)*

Behavioral health workforceStaffing and licensureCare coordinationCrisis servicesTargeted case managementPsychiatric rehabilitation servicesPeer supportPrimary care screening and monitoringEvidence-based practice adoptionScreening, assessment and diagnosisIntegrated careOutpatient substance use servicesOutpatient mental health servicesSustainability
Which other areas are you most in need of support? (Select all that apply)*

Billing and reimbursementData collection, reporting and analysisCCBHC partnershipsData sharing and/or interoperabilityFinancial management and sustainabilityHealth information technologyManaging organizational changeUnderstanding the CCBHC model and criteria
What type of support is most beneficial to you? (Select all that apply)*

Direct consultationLearning communitiesOn demand resourcesWebinars and office hoursPeer to peer support
SESSION-SPECIFIC
Which questions would you most like answered in this session?*
Would you like to receive emails on upcoming events from the TTA Center?*

YesNo
Should be Empty:

CCBHC-E Executives Monthly Cohort Call

CCBHC Information

Support Needed

SESSION-SPECIFIC