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Bridges to Mental Health
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3
- Event Registration
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Event Details
The training takes place over two days (8 AM-4:30 PM) through a series of engaging and interactive presentations. Attendees earn 13.25 CME. The sessions and CME are free thanks to Clarkson Regional Health Services and generous ongoing support from the Rhonda and Howard Hawks Foundation and others. Upon registering, you will receive more information including a session agenda, parking instructions, and CME instructions.
Which session are you registering for?
(Required)
Omaha (January 16-17, 2025; The Joslyn)
Your Information
Name
(Required)
First
Last
Affiliation/Organization
(Required)
Email Address
(Required)
Enter Email
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Phone
Primary Practice Location
(Required)
Street Address
Address Line 2
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Alabama
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Armed Forces Americas
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Dietary Restrictions
Please indicate below if applicable.
Vegetarian
Other/additional dietary restrictions and/or allergies
If you checked the second box above, please specify and we will do our best to accommodate.
Feedback
Where did you hear about this training event?
(Required)
Thank you for being as specific as possible.
Pre-Survey
Thank you for participating in the Clarkson Regional Health Services-sponsored "Bridges to Mental Health" workforce expansion program! Program leaders are interested in understanding more about those participating in the program for future planning efforts and to better understand the impact the program is having on access to care. Please respond to the questions below, which should take ~5 minutes.
How old are you?
(Required)
<35 years old
35-44 years old
45-54 years old
55-65 years old
>65 years old
What is your gender identity?
(Required)
Female
Male
Non-binary / Third gender
Prefer not to say
What is your practice specialty?
(Required)
Family Medicine
General Internal Medicine
General Pediatrics
Internal Medicine Subspecialty (please list your subspecialty in the next question)
OB/GYN, Women's Health
Pediatrics Subspecialty (please list your subspecialty in the next question)
Psychiatry or Psychology
Other (please list in the question below)
If applicable, please list your Subspecialty and/or "Other" practice specialty.
How many years have you practiced in this specialty?
(Required)
<5 years
5-10 years
11-20 years
>20 years
What is your professional degree(s)? Click all that apply.
(Required)
MD/DO
NP
PA
MPH
MBA
PhD
Other (please list in the field below)
If you selected "Other" professional degree(s), please list here.
Where is your practice location (zip code)?
(Required)
How many years have you practiced at this location?
(Required)
<5 years
5-10 years
11-20 years
>20 years
What health professional school did you attend?
(Required)
What is the compensation model of your practice?
(Required)
Purely productivity based
Fixed salary
Salary plus incentive
If your salary includes an incentive, what is the incentive based on?
(Required)
N/A based upon previous response
Productivity
Quality
Both
Other (please indicate in the field below)
If you selected "Other" incentive in the preceding question, please list here.
Timely access to clinical experts for the mental/behavioral care needs of my patients is...
(Required)
Always adequate
Usually adequate
Often inadequate
Completely inadequate
What is your experience with integrated behavioral health models?
(Required)
For reference, these are models in which mental/behavioral health staff are commonly co-located within a primary care clinic, and a psychiatrist has dedicated time to provide direct consultation in managing the mental/behavioral health care of patients in that clinic.
I currently practice in one of these models.
I have previously practiced in one of these, but not at present.
I am aware of these models, but have no firsthand experience.
I am only vaguely aware of these models.
I have not previously heard of these models.
At present, I am comfortable assessing and managing the following conditions:
Please select for each condition below.
Depression
(Required)
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
Anxiety
(Required)
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
Bipolar disorder
(Required)
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
OCD
(Required)
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
Post traumatic stress disorder (PTSD)
(Required)
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
Substance use disorder
(Required)
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
Suicidal ideation
(Required)
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
New onset psychosis
(Required)
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
Consent
I agree to participate in an evaluation of the impact of this program on access to mental/behavioral health care for Nebraskans. I understand that all data will be kept secure and HIPAA compliant, with no individual patient level data examined at any time. Additionally, my data will remain anonymized in all data analysis and reporting.
(Required)
Yes
No
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Bridges to Mental Health
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