Form Event Description Event Description Event Description Form

National Cross-Site Assessment of Addiction Technology Transfer Centers (ATTC) Network

Attachment.1.Event.Description.Form

ATTC - Event Description Form

OMB: 0930-0216

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Event Code ________________

A

Form Approved

OMB No.: 0930-0216

Exp. Date 02/28/2013

See burden statement on next page


TTC Event Description Form


Please complete this form for each event implemented or sponsored by your ATTC.


Date: ___________________ Location: ________________ ATTC:_____________


Event Title: _____________ ______________ Event Code No.: ___________________


Co-sponsors: ______________________________________________________________


Total # of participants: ________ Total # of PREs collected: _________


# of participants consenting to follow-up: _________ Total # of Follow-up surveys sent: _____


A> TAP 21. Check all the TAP 21 competency areas that apply to this event:

____ 1 Transdisciplinary Foundations ____ 2.5 Counseling

____ 2.1 Clinical Evaluation ____ 2.6 Client, Family & Community Education

____ 2.2 Treatment Planning ____ 2.7 Documentation

____ 2.3 Referral ____ 2.8 Professional and Ethical Responsibilities

____ 2.4 Service Coordination


B1>SAMHSA Programs/Issues and other Special Topics. Is the event intended to focus on any of the following special topics? Check all that apply:


____ Co-occurring Disorders ____ Substance Abuse Treatment Capacity

____ Seclusion & Restraint ____ Strategic Prevention Framework

____ Children & Families

____ Mental Health Systems Transformation____ Suicide Prevention

____ Homelessness ____ Older Adults

____ HIV/AIDS/Hepatitis ____ Criminal & Juvenile Justice

____ Workforce Development

B2>SAMHSA Cross-Cutting Principles. Check all that apply:


____ Science to Services/Evidence-Based ____ Data for Performance Measurement &

Practices Management

____ Collaboration w/ Public & Private ____ Reducing Stigma & Barriers to Service

Partners

____ Cultural Competency/Eliminating ____ Community & Faith-Based Approaches

Disparities

____ Trauma & Violence ____ Financing Strategies/Cost-effectiveness

____ Rural & Other Specific Settings ____ Disaster Readiness & Response

C> Contact Hours How many contact hours is this event? _________________


NOTE: For academic credit-hour courses, multiply the number of credit hours assigned by 15 to calculate contact hours (e.g. 3 credit hours x 15 = 45 contact hours)


D> Is this a Training of Trainers (TOT) Event? ___ Yes ___ No


E> Event Format and Technology Characteristics

  • Which of the following best describes the event?:

__ Workshop __Instit./Conf. ___Univ./College Course ___Comm. Coll. Course

__ Technical Assistance ___ Meeting

  • Does the event occur in:

___ a concentrated period (e.g. one or more consecutive days) or

___ spread out over a length of time (e.g. a semester course)


  • Technology Format: (Select one)

______ Traditional Classroom Format

______ Practicum/Internship Experience

______ Distance Learning Format (Please specify):

______ Ground Mail Format

______ E-mail Format

______ On-line/ Web-based Format

______ Tele-video Format

______ Other; Please indicate: ______________________________________


Publication Use. Please record the TIPs, TAPs and other publications you used in this event.


The publications I used in this event were:

TIP #

USE

TAP#

USE

1: State Methadone Tx Guidelines

1: Approaches in Treat. of Adolescent

2: Pregnant, SA Women

2: Medicaid Financing

3: Screen and Assess Adolescents

3: Need, Demand, and Problem Asses.

4: Guidelines for Adolescents

4: Coordination of ADM Services

5: Drug Exposed Infants

5: Self-Run, Self-Supported Houses

6: Screening Infectious Diseases

6: Empowering Families

7: Screening & Assess in CJ

7: Methadone

8: Intensive Outpatient Tx

8: Relapse Prevention

9: Coexisting MI and SA

9: Funding Resource Guide

10: Cocaine and Methadone

10: Rural Issues

11: Simple Screening for Outreach

11: Opportunities for Coordination

12: Intermediate Sanctions

12: Narcotic Treatment Programs

13: Patient Placement Criteria

13: Confidentiality

14: State Outcomes Monitoring

14: Siting D and A Treatment Prog.

15: HIV-Infected Abusers

15: Forecasting Cost in Managed Care

16: Trauma Patients

16: Purchasing Managed Care Svcs.

17: Adults in Criminal Justice Sys

17: Rural and Frontier Treatment

18: Tuberculosis Epidemic

18: Confidentiality Compliance

19: Detoxification

19: Relapse Prevention for Offenders

20: Opioid Substitution Therapy

20: Excellence to Rural and Frontier

21: Diversion for Juveniles

21: Addiction Couns Competencies

22: LAAM of Opiate Addictions

21A: Clinical Supervision Comps

23: Drug Courts

22: Contracting for Services

24: Primary Care Clinicians

23: Women Offenders

25: Domestic Violence

24: Welfare Reform & Confidentiality

26: Older Adults

25: Impact of SA Tx on Employment

27: Comprehensive Case Manage

26: ID SA among TANF-elig Families

28: Naltrexone

27: Linking A&D Svcs. w/ Ch Welfare

29: Phys & Cognitive Disabilities

28: NRADAN Awards for Excellence

30: Continuity of Offender Treat

29: State Admin Records for Perf. Mgt

31: Screening Adolescents

30: Buprenorphine for Nurses

32: Treatment of Adolescents

31: Implementing Change

33: Tx for Stimulant Use Disorders



34: Brief Interventions & Therapies

Other Publications

USE

35: Enhancing Motivation

The Change Book

36: Child Abuse & Neglect Issues

Specify Other Titles:

37: SA Tx and HIV/AIDS


38: SA Tx and Vocational Svcs.


39: SA Tx and Family Therapy


40: Buprenorphene & Opioid Tx



41: SA Tx: Group Therapy



42: SA Tx for Co-occur. Disorders



43: Med-assted Tx for Opioid Addic



44: SA Tx in the CJ System



45: Detox and SA Tx



46: Admin Issues – Intensive Outpt.



47: Clinical Issues – Intensive Outp.



48: Managing Depressive Symptom



49: Inc. Alco. Pharm. Into Med Prac.



50: Addressing Suicidal Th./Behav.




Public reporting burden for this collection of information is estimated to average 15 minutes per response to complete the Contact Information Form and this questionnaire. Send comments regarding this burden estimate or any other aspect of this collection of information to the SAMHSA Reports Clearance Officer, Room 16-105, 5600 Fishers Lane, Rockville, MD 20857. An agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The control number for this project is 0930-0216.

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File Typeapplication/msword
File TitleEducation and Training Event Description Form
AuthorLisa M. Reboy-Woolery
Last Modified ByDHHS
File Modified2009-12-11
File Created2009-12-11

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