(To Send) CCO Survey

Coordinated Care Organization Survey: Social-Emotional Health Services for Children, Ages 0 to 5
Hello, and thank you for taking the time to complete this survey for InterCommunity Health Network Coordinated Care Organization (IHN-CCO). You are receiving this survey because your organization was identified as providing social-emotional health services for IHN-CCO members, ages 0 to 5. This survey is designed to assess providers of social-emotional services for children, ages 0 to 5.

This assessment is a requirement of all CCOs by the Oregon Health Authority. The Oregon Health Authority requires an assessment of providers of social-emotional services for children, ages 0 to 5, in four areas:

1) Location;

2) Service capacity;

3) Language/s spoken in service provision; and

4) Race/ethnicity.

This assessment is intended to identify potential gaps in service capacity and language and cultural needs for IHN-CCO members, ages 0 to 5. This survey ought to take 10 to 30 minutes based on the number of providers of social-emotional health services for children, ages 0 to 5, in your organization. Again, thank you for taking the time to help IHN-CCO understand and improve social-emotional health services for our youngest members.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
What is the name of your organization?
What is the location of your clinic? If there are multiple clinic locations, please list each.
What cities or towns does your clinic serve? Please choose each applicable answer.

CorvallisMonroePhilomathAlbanyLebanonSweet HomeHarrisburgNewportLincoln CityWaldportOther
What counties does your clinic serve? Please select all that apply.

Lincoln CountyLane CountyBenton CountyOther Oregon County/CountiesOther State(s)Linn CountyOther
Please Note for the Following Section:

Providers are highly encouraged to enter their demographic data, but it is optional. The data provided in this survey will be used to understand the gaps in culturally responsive care for our IHN-CCO members and will not be shared publicly.
Please add the following information for each provider providing services to children between the ages of 0-5.*
If you answered "OTHER" for any provider, please give their name and describe the reason (EX: Jane Smith, Language: French)
What is the total number of appointment slots for clients, ages 0 to 5, of social-emotional services in the next two months?
What is the number of OPEN appointment slots for new referrals or appointments for clients, ages 0 to 5, of social-emotional service in the next two months?
Additional thoughts and comments:
Thank you for your time to help IHN-CCO understand and improve social-emotional services for our youngest members. If you would like to learn more about how this information will be used, please reach out to:

Katie Walsh
Population Insight Program Manager
Phone: (971) 388-2048
Email: kwalsh@samhealth.org (preferred method of contact)
Should be Empty:

Coordinated Care Organization Survey: Social-Emotional Health Services for Children, Ages 0 to 5