Medical facility grant application-Due November 10, 2013 at 5pm

Posted 10/16/13 (Wed)


Depression and Suicidal Ideation Screening Grant          
1.) Please describe the need for this type of grant within your community (Community and patient population). Please describe the specific suicide problem within your community.
2.) Please describe where you intend to implement this program (clinics, Emergency Departments, Primary care, etc.). Who will be the contact person for this project? How many patients do you anticipate to screen monthly?
3.) Please provide a description of the need for training in order to implement this program. Who do you expect to train and what type of training do you expect to use (on-line, in person, data entry, how to talk to a suicidal patient, Applied Suicide Intervention Skills training, etc.)?
4.) Please provide a detailed timeline for development of a suicide screening policy, education of staff, and implementation of patient screenings.
5.) How will staff be educated on the depression and suicide screening policy and how will it be implemented?
6.) Screening for depression is important, equally important is how and where patients are referred for follow up care. Please describe what types of interventions you plan on using for patients (examples are: physician counseled, referred to social worker, referred to private counselor, referred to phone case management, etc.). Please describe the process your facility will use when making referrals.
7.) Because this is a grant funded activity there is no guarantee that funds will be continued next year, please describe your sustainability plan to keep the depression screening going after this grant year expires.
8.) Do you have an electronic medical record? If yes, do you plan to incorporate the PHQ2 or PHQ9 into your record?
9.) Funds from this grant are available for client services only that are currently not covered by other funding. Do you currently receive funding for depression screening and referrals from other sources, including private insurance?
10.) Do you have the ability to provide reports including de-identified data on age, sex, race of patients as well as where they were referred to after screening for this project?
11.) Please attach the completed budget with this application.
Agency Name:
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