Please fill out the application below and attach all required materials. Applications will be accepted on a rolling basis. Please allow CFHA staff 2 weeks to review your application after submission. Step 1 of 3 33% DESIRED QUALIFICATIONS: Five + years of applied experience in either academic or clinical integrated behavioral health settings Two+ years of experience as consultant in identified areas of expertise Evidence of scholarship in behavioral health integration – research/publication/presentations Demonstrated experience or accomplishments in identified areas of expertise CFHA Membership REIMBURSEMENT PLAN: CFHA will offer a reimbursement rate of $1200-$1800 per day or $150-$225 per hour, plus reasonable travel, lodging and per diem.Name:* First Last Email:* Phone:*Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current role / job title:* Organizational affiliation:*Employer / University / Department, etc. Field of study:* Highest degree attained:* Please attach current CV / Vitae / Resume:*Accepted file types: pdf, doc, docx, rtf, Max. file size: 50 MB.Are you willing to accept our proposed reimbursement rate of $1200-$1600 per day or $150- $200 per hour + reasonable travel, lodging and per diem?* Yes Brief summary of clinical experience:*Please include populations served, type of clinical settings, years of experienceBrief summary of scholarship:*Research / Publications / PresentationsBrief descriptive summary of your prior consulting experience:*Please include description of strategies used to engage practice in implementation and adoptionReferences*Please provide 3 references references from past consulting clients (Name, Project- including scope of work, contact information)Accepted file types: pdf, doc, docx, rtf, Max. file size: 50 MB.Please identify which position you would like to be considered for:* Speaker Consultant Both Areas of ExpertisePlease select all areas of expertise for which you would like to be considered as a speaker or consultantGeneral IBH topics:Select all that apply Implementation Assessment and/or Program Evaluation Quality Improvement and Data Analytics Business and Financial Strategies for sustainability of IBH practice (contracting, billing coding) Ethical Considerations in Integrated Practices Health Information Technology Population based tools and screening strategies The Role of Psychiatry in Integrated Care Building an IBH Team in your Practice (Steps in hiring and training successful BH staff) Clinician Well-being (burnout prevention) Workforce Development and Inter-professional training Practice Management (i.e. managing a provider panel, patient flow...etc) Other IBH Areas Other IBH Areas Designs and strategies of behavioral health integration:Select all that apply PCBH Model SBIRT Medical Family Therapy Collaborative Care (IMPACT) Other Other designs and strategies areas: Individual patient assessment and intervention in:Select all that apply Chronic Pain and Opioids (MAT Implementation) Pediatric BH Disorders Common Medical Conditions (i.e. Diabetes, Hypertension, Sleep) Common Behavioral Health Conditions (i.e. Depression, Anxiety, PTSD) Common Substance Misuse Conditions (i.e. Prescription Medications, Alcohol, Illicit Drugs) Prevention and Health Behavior Change (i.e. Exercise Promotion, Tobacco Cessation, Eating/Nutrition) Other Other individual patient assessment: Specific clinical populations:Select all that apply Geriatric Pediatric Obstetric Seriously Mentally Ill Inpatient/Specialty Care Clinically Complex Patients Other Other specific clinical population: Clinical skill development in:Select all that apply Motivational Interviewing Acceptance and Commitment Therapy in PC Mindfulness-Based Interventions Psychopharmacology Solution Focused Therapy Cognitive Behavioral Therapy Group Interventions Other Other clinical skill development: Other areas of expertise not listed: NameThis field is for validation purposes and should be left unchanged.