JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Q1 SBIRT Progress Report: FY21-22
Please complete this form by October 29, 2021.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
Position/Job Title
*
Your answer
Agency
*
Choose
Kids First Health Care
Metro Community Provider Network/STRIDE
Montrose
Mountain Family
Regents-Sheridan
Rocky Mountain/ECP
Southwest Open Schools
Summit Community Care Clinic
In this new school year, does your school-based health center(s) have school-based health center staff or sub-contractor staff who would have a role with SBIRT implementation at your school-based health center(s) that need to complete the Initial SBIRT training? (CDPHE SBIRT-SBHC Project Contract Statement of Work - Standards and Requirements Item 25)
*
Yes
No
If you answered yes to the above question, please provide staff member names, job titles, and name(s) of SBHC site(s) that they work at.
Your answer
Please respond to the following question regarding FY20-21 end-of-year data snapshots: Based on reviewing your final end-of-year data snapshot from Apex, what were your key takeaways?
*
Your answer
Please respond to the following question regarding FY20-21 end-of-year data snapshots: What contextual factors should we be aware of that help explain your data?
*
Your answer
As you are likely aware, the first SBIRT-SBHC five-year grant cycle will be coming to a close this year and CDPHE is currently planning for the final year of evaluation. What would you most like to know about the implementation of the first cycle?
*
Your answer
What do you plan to work on this year to help sustain SBIRT as a standard of care after the first grant cycle ends?
*
Your answer
Please provide any general feedback/comments/suggestions you would like to share with staff at CDPHE.
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of State.co.us Executive Branch.
Report Abuse
Forms
