Submission Thank you for your interest in sharing your program/project on the Healthy Foster Care America Web site! The goal of this Web site is to promote information sharing and networking. This resource is designed to promote information sharing and networking among members of the Council on Foster Care, Adoption, and Kinship Care to enter program information. Program/Project Name * Can you be contacted? Yes, individual can contact me No, do not display my contact information Are you willing to allow individuals to contact you directly for more information about your program/project? Email Address * Phone Number * Contact Name * Name of the contact to be listed on the website Affiliation Name Is your program/project affiliated with a university or organization? If so, what is the name of the affiliation? Website URL Model Type Model Type: Choose Option Evaluation Medical Home Preferred Provider Nurse Coordinator Mental Health / Developmental Health Special Needs / Multi-disciplinary Specify your own value: Which model best describes your program/project? Click below for a description of each: https://www.aap.org/_layouts/15/aap/forms/pages/HFCAModelDefinitions.htm Where does it provide services Locally-based County-based State-Wide Where does your program/project provide services? City State AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY State specific location Please be more specific regarding the location. (eg, private pediatric office, neighborhood health center, county health department, foster care agency, hospital-based clinic, etc) How is program/project funded? Federal Funding State Funding County Funding Foundation Funding Health Insurance Specify your own value: How is your program/project funded? (Check all that apply) Describe how it's funded Rich text editor Describe how it's funded What services does it provide Entry to care health assessment Comprehensive health assessment Standardize screening (developmental, mental health) In-clinic mental health evaluation Subspecialty referrals Ongoing primary care/medical home Specify your own value: Description of program/project Rich text editor Description of program/project Provide a brief description of the program/project. How are patients tracked? Commercial electronic medical record? Specialized database for your program Paper-based records Specify your own value: How does your program/project track patients? Which one? (Commercial EMR) Provide special focus No special focus Fetal Alcohol Spectrum Disorders Teen pregnancy prevention Substance use and abuse Developmental delay/issues Mental health Developmental Issues Children in family foster care Youth in group home/residential care Young Children Adolescents Specify your own value: Does your program/project have a special focus? Check all that apply Program/Project strengths Rich text editor Program/Project strengths Describe the strengths of the program/project. If possible, include how the program/project communicates with other professionals as well as how the health plan integrated into permanency planning for the child. (1 paragraph) Program/Project challenges Rich text editor Program/Project challenges Describe any challenges and/or barriers as well as tips for others who may be interested in replicating the program/project. (1 paragraph) Captcha BotDetect CAPTCHA Feature for SharePoint