B. Provide information below on the 5-10 most significant technical assistance/collaborative activities in the past year. In the notes, briefly state why these were the most significant TA events. Title Topic of Technical Assistance/Collaboration Recipient of Intensity of TA Primary Target TA/Collaborator Audience Select one from list A and all that apply from List B. List A (select one) List B (select all that apply) Other Divisions/ One time brief Local Departments in a (single contact) Within State Clinical care University One time extended Another State Women’s/Reproductive/ related (including Perinatal Health Title V (MCH (multi-day contact Regional medical home) Early Childhood Health/ Programs) provided one time) National Cultural Development (birth to State Health Dept. On-going International Competence school age) Health Insurance/ infrequent (3 or Related School Age Children Organization less contacts per Data, Research, Adolescent Education year) Evaluation CSHCN/Developmental Medicaid agency On-going frequent Methods Disabilities Social Service Agency (more than 3 (Knowledge Autism Mental Health Agency contacts per year) Translation) Emergency Juvenile Justice or other Family Preparedness Legal Entity Involvement Health Information State Adolescent Health Interdisciplinary Technology Developmental Teaming Mental Health Disability Agency Healthcare Nutrition Early Intervention Workforce Oral Health Other Govt. Agencies Leadership Patient Safety Mixed Agencies Policy Respiratory Disease Professional Prevention Vulnerable Systems Populations* Development/ Racial and Ethnic Family and/or Improvement Diversity or Disparities Consumer Group Other Foundations Clinical Programs/ Hospitals Other (specify) 1 Example G- Policy 11- Oral Health E - Education 2 2 "Vulnerable groups," refers to social groups with increased relative risk (i.e. exposure to risk factors) or susceptibility to health-related problems. This vulnerability is evidenced in higher comparative mortality rates, lower life expectancy, reduced access to care, and diminished quality of life.
B. Provide information below on the 5-10 most significant technical assistance/collaborative activities in the past year. In the notes, briefly state why these were the most significant TA events. Title Topic of Technical Assistance/Collaboration Select one from list A and all that apply from List B. Recipient of TA/Collaborator Intensity of TA Primary Target Audience List A (select one) Clinical care related (including medical home) Cultural Competence Related Data, Research, Evaluation Methods (Knowledge Translation) Family Involvement Interdisciplinary Teaming Healthcare Workforce Leadership Policy Prevention Systems Development/ Improvement List B (select all that apply) Women’s/Reproductive/ Perinatal Health Early Childhood Health/ Development (birth to school age) School Age Children Adolescent CSHCN/Developmental Disabilities Autism Emergency Preparedness Health Information Technology Mental Health Nutrition Oral Health Patient Safety Respiratory Disease Vulnerable Populations* Racial and Ethnic Diversity or Disparities Other Other Divisions/ Departments in a University Title V (MCH Programs) State Health Dept. Health Insurance/ Organization Education Medicaid agency Social Service Agency Mental Health Agency Juvenile Justice or other Legal Entity State Adolescent Health Developmental Disability Agency Early Intervention Other Govt. Agencies Mixed Agencies Professional Family and/or Consumer Group Foundations Clinical Programs/ Hospitals Other (specify) One time brief (single contact) One time extended (multi-day contact provided one time) On-going infrequent (3 or less contacts per year) On-going frequent (more than 3 contacts per year) Local Within State Another State Regional National International 1 Example G- Policy 11- Oral Health E - Education 2 2 "Vulnerable groups," refers to social groups with increased relative risk (i.e. exposure to risk factors) or susceptibility to health-related problems. This vulnerability is evidenced in higher comparative mortality rates, lower life expectancy, reduced access to care, and diminished quality of life.
T72.2%20-%20DGIS%20Forms%20and%20PMs.docx