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FDT Pilot: Intent to Participate Survey

FDT Pilot: Intent to Participate

Please complete this brief form describing your agency's Intent to Participate in MCTAC's Family Driven Care Toolkit pilot. The Family-Driven Care Toolkit contains guidance, reference materials, and assessment tools to be utilized by behavioral health agencies and the families they serve to promote the use of family-driven practices. Participation in this pilot will involve creating a small, time-limited workgroup; attending three webinars; using the FDC Toolkit within your organization for at least the three-month pilot period; and providing feedback about your experience with the FDC Toolkit via webinar and/or survey.  Only one Intent to Participate form needs to be completed per agency.
 
1. Please identify the primary contact for your agency's team for the Family-Driven Care Toolkit pilot.
List additional members of your FDC Toolkit pilot workgroup. This workgroup will be responsible for attending the three webinars, facilitating use of the materials within your organization for at least for the three-month pilot period, and providing feedback about the tools.  We suggest your workgroup includes clinical supervisors, providers/clinicians, Family Peer Advocates, and family members.
2. Workgroup Member
3. Workgroup Member
4. Workgroup Member
5. Workgroup Member
6. Workgroup Member
7. We understand that participation in the Family Driven Care Toolkit pilot includes the following: *This question is required.
Space Cell Agree
Completion of the Family-Driven Care Organizational Self-Assessment
Webinar One: Introduction of toolkit, expectations of pilot agencies, distribution of materials, examples of how to use the materials.
Webinar Two: Interim feedback from professionals and participants regarding the use of the toolkit, support for continued use of tools.
Webinar Three: Final feedback from pilot participants.
Using the FDC Toolkit in my organization for at least the three-month pilot period.
Brief online feedback surveys