Presentation Application

OVERVIEW: This form lists the information required when submitting a proposal through the Call for Presentations. Complete this form in the way you want the information to appear on all conference material. Submit this completed form as a Word document with your resume and professional photograph to . All proposals with supporting documents must be submitted by Friday, May 27, 2016.

It is strongly recommended that you compose your responses in a separate document and then copy and paste your responses into the fields of your final document for submission. Please keep the original document for your records. Be sure to also save your online presentation application once you have completed it.

EVENT OVERVIEW:

Event: 2016 Fall Behavioral Healthcare Meeting

Date: Thursday, October 20, 2016

Location: Pines Manor in Edison, New Jersey

Format: Workshop will take place in the morning and afternoon. Each session will be 75 minutes in length. Presentations may include up to three speakers, but one or two are preferred.

PRESENTERS:

Presenters must have professional qualifications in good standing with their professional regulatory board, if applicable, and meet one or more of the following:

·  Be a faculty member of an undergraduate or graduate school of social work

·  Have received specialized graduate or postgraduate level training in the subject taught in the program

·  Have extensive experience to include no less than five years of practical application or research involving the subject taught in the course

·  Social work ethics courses must be presented/developed or co-presented/co-developed by a licensed social worker in good standing.

SESSION CONTENT:

The 2016 Fall Behavioral Healthcare Meeting is seeking educational sessions that highlight concrete programs, services, or initiatives that are practical, replicable, and relevant for the particular attendees of this conference. Conference attendees are the senior leaders of behavioral healthcare from community-based providers, behavioral healthcare systems, provider networks, county and regional authorities, and state associations of providers.

PRESENTER:

First Name:

Last Name:

Credentials:

Title:

Organization Name and Address:

Email Address:

Office Phone:

Fax:

Website, Twitter and/or Social Media links: (if applicable)

Social Work license #: (if not applicable, please put NA)

NASW member Id(s): (if not applicable, please put NA)

Brief biography:

CO-PRESENTERS: Each session may have up to 3 presenters. Please provide the information listed above for each co-presenter.

SESSION INFORMATION

Session Title:

Session Time: (Please indicate your first and second choice)

Morning Workshop
Afternoon Workshop

Topic Area: (Select from the list below or indicate otherwise)

·  Addictions and Co-occurring Disorders

·  Behavioral Health/Primary Care Integration

·  Certified Community Behavioral Health Clinics

·  Children and Youth

·  Clinical Practices

·  Community Partners

·  Criminal Justice

·  Crisis Response Services

·  Ethics

·  Finance and Payment Redesign

·  Health Information Technology

·  Health Promotion, Prevention, Peers, and Recovery

·  Healthcare Reform

·  Mental Health First Aid

·  Mobile Technology

·  Population Health

·  Prevention, Peers, and Recovery

·  Public Policy/Regulatory Issues

·  Special Populations

·  Treatment Planning

·  Trauma-informed Care

·  Other: ______

Target Audience: (e.g. Social Workers, Counselors, Management, Fiscal, etc. – specify all that apply)

Audience Target Levels: (Please specify all that apply)

Beginner
Intermediate
Advanced

Session Description: Complete a maximum 5-6 sentence description that addresses the following points:

·  Statement of the Problem: The first few sentences build the case for why the session is important by outlining a brief “statement of the problem” (i.e. scope). In other words, why is this session necessary?

·  This Session helps to Solve the Problem: The next sentence describes how the information in the session helps the learner to manage the problem(s) described in the first few sentences.

·  Course Topics: The next few sentences briefly describe the content in the session; this is generally a re-hash of the major section headings and the topics in the learning objectives.

·  Target Audience: The final sentence clearly spells out who the intended target audience is for the course.(1 paragraph):

Learning Objectives: What are the 3 BIG IDEAS that attendees must know when leaving your session in order to do their job better?

Tips for capturing your top 3 learning objectives or BIG IDEAS:

·  From the Learner’s Perspective: Each learning objective should address what professional gains you want to learner to be able to complete when they leave your session.

·  Measureable: Each learning objective needs to be framed using a measurable and behaviorally observable verb like: define, classify, calculate, debate, and analyze. Stay away from vague verbs like: learn, understand, and demonstrate knowledge.

·  Brief: Each learning objective should be brief and not include more than one “and.”

·  Connect to Practice: If relevant for your session, include a learning objective that specifically addresses how the new knowledge obtained by the attendee can be used professionally to benefit their practice and/or clients. (Demonstrating a concrete connection from organizational-level change to individual practice and clients is required for some CEs.)

The learner will leave the session being able to:

1.

2.

3.

Bibliography: List 3 to 5 current references (within the past 5 years) as evidence of supporting research (bibliography). This is a required field. Bibliography must be in American Psychological Association, (APA) format and at least half of the references must be current sources within the last 5 years. (For APA Guide, see References here: http://owl.english.purdue.edu/owl/resource/560/05/)

Describe how course content reflects current literature/materials:

Indicate the appropriate type of credits this session is appropriate:

___Clinical ___Non-clinical ___Ethics ____Social and Cultural Competence

Course Content: Use your outline as a starting point to develop this list and/or compile from your course description and objectives.

PRESENTER(S) EVENT SPECIFICS

Presenter

Name
Phone
Cell
E-Mail
Questions / Response / Please circle or list special comments here
Do you plan to stay for lunch? / Yes No
Do you have special dietary needs? / Yes No / Vegetarian / Kosher
Gluten Free / Lactose Free

Co-Presenter

Name
Phone
Cell
E-Mail
Questions / Response / Please circle or list special comments here
Do you plan to stay for lunch? / Yes No
Do you have special dietary needs? / Yes No / Vegetarian / Kosher
Gluten Free / Lactose Free

Co-Presenter

Name
Phone
Cell
E-Mail
Questions / Response / Please circle or list special comments here
Do you plan to stay for lunch? / Yes No
Do you have special dietary needs? / Yes No / Vegetarian / Kosher
Gluten Free / Lactose Free

AUDIO VISUAL

Audio Visual Requirements / Response / Please circle or list special comments here
Microphone? / Yes No / Please circle the type of mic you prefer to use.
Podium / Handheld / Lavaliere
Are you presenting a PowerPoint? / Yes No / PLEASE EMAIL YOUR PRESENTATION BY
FRIDAY, OCTOBER 7, 2016
Do you require internet access or sound for your presentation? / Yes No / Please circle all that apply.
Internet Access / Sound
Will you bring your own laptop?
Is it a Mac? / Yes No
Yes No / PLEASE NOTE: We will provide a LCD Projector and can preload your presentation on our laptop.
Do you require Flipchart & Markers? / Yes No

This form lists the information required when submitting a proposal through the Call for Presentations. Complete this form in the way you want the information to appear on all conference material. Submit this completed form as a Word document with your resume and professional photograph to .

All proposals with supporting documents must be submitted online by Friday, May 27, 2016.

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