2020 EBP Symposium - Presentation/Panel Proposal Form

California Institute for Behavioral Health Solutions and California Department of Health Care Services Presents
10th Annual Evidence-Based Practices Symposium:
Building a Life Beyond Homelessness
June 16-17, 2020 | Sacramento, CA

Proposal Form for Professional Presentation or Panel Discussion

Submission Deadline (EXTENSION): March 12, 2020 at 11:59 p.m. PST

Call For Proposals: http://bit.ly/37mtWhr

Please contact Shirley Chan sychan@cibhs.org for questions about submitting a proposal.

1. Select Submission Type *This question is required.

2. Select the Amount of Time for Presentation *This question is required.

3. Presenter A - Name and Contact Information *This question is required.

	First Name
	Last Name
	Official Title
	Agency/Organization Affiliation
	Address
	Email Address
	Work Phone Number
	Cell Phone Number
	ADA/Special/Dietary Needs

4. Presenter A - What is your role? Please select the one that best describes your role. *This question is required.

5. Presenter B - Name and Contact Information

Leave blank if not applicable.

	First Name
	Last Name
	Official Title
	Agency/Organization Affiliation
	Address
	Email Address
	Work Phone Number
	Cell Phone Number
	ADA/Special/Dietary Needs

6. Presenter B - What is your role? Please select the one that best describes your role.

Leave blank if not applicable.

7. Presenter C - Name and Contact Information

Leave blank if not applicable.

	First Name
	Last Name
	Official Title
	Agency/Organization Affiliation
	Address
	Email Address
	Work Phone Number
	Cell Phone Number
	ADA/Special/Dietary Needs

8. Presenter C - What is your role? Please select the one that best describes your role.

Leave blank if not applicable.

9. Title of Your Presentation (maximum 15 words)

Use mixed-case letters (upper-case for the first letter of all words with 4 or more letters and lower-case letters for the remainder of the words) and appropriate punctuation.
*This question is required.

10. Abstract (maximum 50 words)

Enter a brief description of your professional presentation or panel discussion. This description will appear in the symposium program. *This question is required.

11. Presentation Summary

Please enter a detailed summary of your presentation. We recommend a 750-word summary; please use as many words desired for your presentation summary. The presentation summary may include: a detailed description of an evidence-based, promising, emerging, or community-defined practice; target population; characteristics of individuals served; outcomes for homelessness, housing, and/or behavioral health; and findings or impact of practice on outcomes.

Your proposal must adhere to the definition of continuing education (e.g., improve service to the public, enhance contributions to the profession). Your summary must demonstrate its relevance to the professional education of the intended audience, their advanced level of training, and their contribution to consumer care. In your summary, please be sure to include these elements where appropriate and where they support the learning objectives. A list of the topics that are planned to be covered and how you plan to deliver them is insufficient as a detailed summary of your presentation.

This section serves as the bridge linking the Learning Objectives and the Subject Matter References. It should outline how the learning objectives will be achieved utilizing the information planned to be presented and should tie in the sources of the information provided. It should prove that the content being presented is grounded in an evidence-based approach. *This question is required.

12. Educational Objectives

Enter 3 educational objectives.

Objectives are not a list of the topics to be covered but must clearly define what the participant will know or be able to do as a result of having attended the program, and these objectives must be stated in measurable terms. They are used to measure the efficacy of the instructor making the clear connection between the content being delivered and application of the content within the learner’s professional context. Refer to Pages 9-11 as a guide to helping you choose the correct verbs for your learning objectives. All objectives must start with “As a result of attending this training, participants will be able to...” then utilize at least one of the approved verbs.

Here are examples of learning objectives:

Practice example:
Participants will be able to apply three or more principles of trauma-informed care to improve the therapeutic milieu of STRTPs and promote positive outcomes among youth placed in congregate care.

Quality Improvement example:
Participants will be able to construct three metrics for monitoring access and timeliness of care to improve quality of service delivery in the public behavioral health system. *This question is required.

	Objective 1
	Objective 2
	Objective 3

13. Subject Matter References

Enter at least three references for each submission.

Subject Matter References are needed to demonstrate the knowledge base(s) being utilized as the foundation of the training. Include relevant references for addressing the empirical support of the evidence-based content by either established research or peer-reviewed, published support for your topic.

Here is are examples of the format we are looking for:

Online reference:
Exercising while Learning Boost Test Scores, study finds, http://health.usnews.com/health-news/family-health/brain-andbehavior/ articles/2011/05/02/exercising-while-learning-boosts-testscores-study-finds. Established Research.

Published text reference:
Gendreau, P., Goggin, C., and Smith, P. (2000). The forgotten issue in effective correctional treatment: Program implementation. International Journal of Offender Therapy and Comparative Criminology, 43, 180-187. Peer Reviewed. *This question is required.

	Reference 1
	Reference 2
	Reference 3

14. Biography

Each presenter needs to submit a brief biography consisting of a paragraph of no more than 250 words. This biography will be incorporated into a listing of the Professional Bios with those from the other presenters and distributed to attendees at the conference as well as used to introduce you.

Enter "N/A" if your proposal does not include additional presenters. *This question is required.

	Presenter A
	Presenter B
	Presenter C

15. Presenter A - Resume or CV File Upload

Each presenter’s resume or CV file must be in Adobe PDF format. Each presenter’s resume or CV will be used to verify their education level and/or the experience level of the presenter in the subject matter in which they will be presenting. *This question is required.

File: {{filename}} delete

16. Presenter B - Resume or CV File Upload

Each presenter’s resume or CV file must be in Adobe PDF format.

File: {{filename}} delete

17. Presenter C - Resume or CV File Upload

Each presenter’s resume or CV file must be in Adobe PDF format.

File: {{filename}} delete

18. Handouts (Optional) - this is not required.

The deadline for sending your presentation and handouts to CIBHS is June 1, 2020.

File: {{filename}} delete

19. Audio Visual Needs

CIBHS will provide all the audio-visual equipment for the meeting. The meeting rooms will be set with the appropriate audio-visual equipment depending on the format of the presentation. The standard set up will include a screen, LCD projector, laptop, lectern/podium and microphone. If you will need sound for your presentations or you will be watching a DVD, you will need to request an audio patch. Panel presentations will include a head table. In larger rooms, there will be a riser and additional microphones as needed.

Please select all boxes that apply to your presentation.

Confirm that you do not need any audio-visual equipment and do not need internet.
If you require additional audio-visual equipment, please list your specific needs.

*This question is required.

I do not need Internet or any audio-visual equipment.
I need Internet for my presentation (e.g., showing an online video during your presentation or using Vimeo).
I need additional audio-visual equipment. Please list your specific needs: Please enter an 'other' value for this selection.

20. Special Accommodations

If you need accommodations such as a sign-language interpreter or other services, please let us know so that we can better respond to your needs. Please select one: *This question is required.

Please enter an 'other' value for this selection.

21. Taping and Publications

If you are selected, will you grant permission for taping (audio or video) of your session? *This question is required.

Please read and review your responses before clicking "Submit".

After the submission deadline, March 12, no revisions can be made.