Call for Presentations Submission Deadline: Friday, March 13, 2015 to Steve Wiland at [email protected] This conference offers behavioral healthcare professionals the opportunity to: • • • • Share new clinical academic knowledge with practicing health professionals Share practice knowledge and experience addressing complex recovery challenges Provide an inter-professional educational opportunity eligible for continuing education credits Showcase Wayne County as a leader in inter-professional collaboration as an important element in Community Mental Health (CMH) system transformation 1 Who should submit workshop presentations? • • • • Researchers whose findings can contribute to the improvement of the CMH system University faculty with practice knowledge to enhance the competencies of the CMH workforce Experienced practitioners with specific expertise in effective program or practice models Experienced managers or administrators with specific expertise in effectively developing/ implementing program or practice models Presentations focusing on the following topics are invited: 1) Co-occurring Mental Health and Substance Use Disorders 2) Trauma and Posttraumatic Stress Disorder 3) Better Serving Homeless Populations 4) Better Serving Military Veterans 5) Behavioral Addictions 6) Integrated Behavioral and Physical Healthcare 7) Mental Health First Aid 8) Interfacing with the Criminal Justice System (Specialty Courts, Jail Diversion, etc.) 9) Effective Behavioral Health Crisis Response 10)Using Data/Outcomes to Drive System Improvement 11)Adolescent Suicide Prevention 12)Mental Illness and Youth 13)Cross-System Partnerships (which could encompass a number of the above) The DWMHA Interdisciplinary Mental Health Conference encourages the following types of submissions: Research Papers - Completed research papers in any of the topic areas listed above or related areas. Abstracts - Abstracts of completed or proposed research in any of the topic areas listed above, or related areas. The abstract for proposed research should include the research objectives, proposed methodology, and a discussion of expected outcomes. Case Studies - Case studies in any of the topic areas listed above, or related areas. Work-in-Progress Reports or Proposals for Future Research - Incomplete research or ideas for future research in order to generate discussion and feedback in any of the topic areas listed above, or related areas. Reports on Issues Related to Teaching - Reports related to innovative instruction techniques or research related to teaching in any of the topic areas listed above or related areas. 2 Format of Presentations: Paper sessions will consist of three to four presentations in a 75 minute session. The session will be divided equally between the presenters. Workshop presentations will be given a full 75 minute session. Panel sessions will provide an opportunity for three or more presenters to speak in a more open and conversational setting with conference attendees. Submissions for these 75 minute sessions should include the name, department, affiliation, and email address of each panelist in addition to a description of the presentation and the title page. Poster sessions will last 75 minutes and consist of a large number of presenters. Poster sessions allow attendees to speak with the presenters on a one-to-one basis. The following supplies will be provided for poster sessions: • Easel • Tri-fold display board (48 x 36 inches) • Markers • Push pins • Tape • Round table • Chairs Selection Process: A limited number of presentation spaces are available and will be reviewed by the conference committee. All completed proposals must be received by Friday, March 13, 2015. Proposals received after the deadline or that are incomplete will not be considered. Presenter Information and Agreement: In submitting this presentation proposal, I understand and agree to the following on behalf of all presenters participating in this workshop • The conference budget does not provide honorariums for workshop presenters. • All presenters will receive complimentary conference registration. • Due to the high cost of travel, we are not able to reimburse for travel, lodging, mileage or other expenses related to presenting at this conference. • If presenters are not able to participate due to lack of reimbursement, special arrangements may be made with the conference committee if requested. • If using handouts, the presenter is responsible for providing a master copy and agrees to allow the handouts to be made available online in a pdf format. • I will not promote a specific product or service for personal gain during my presentation. 3 Questions and Submissions: Submit your completed application and all required attachments to the conference planning committee via Steve Wiland at [email protected]. Incomplete submissions will not be considered for the conference. Receipt of submissions will be acknowledged via email within 48 hours. There is a limit of two contributed submissions per lead author. 4 First Annual DWMHA Interdisciplinary Mental Health Conference: Raising the Bar Presentation Proposal Application Please complete this application – Type directly on document Do NOT change the font, change the color or formatting 1. Presenter Information: Enter the information below for each presenter in your workshop. The first (lead) presenter will be the main contact and responsible for communicating all conference related information to other presenters. There are a maximum number of three presenters allowed. Lead Presenter Name and Credentials: ___________________________________________________________ Organization Affiliation: __________________________________________________________ Discipline: ______________________________ Job Title: _______________________________ Email Address: __________________________________________________________________ Mailing Address: ________________________________________________________________ Phone Number: _________________________ Cell Phone: ______________________________ Name and Credentials: ___________________________________________________________ Organization Affiliation: __________________________________________________________ Discipline: ______________________________ Job Title: _______________________________ Email Address: __________________________________________________________________ Mailing Address: ________________________________________________________________ Phone Number: _________________________ Cell Phone: ______________________________ Name and Credentials: ___________________________________________________________ Organization Affiliation: __________________________________________________________ Discipline: ______________________________ Job Title: _______________________________ Email Address: __________________________________________________________________ Mailing Address: ________________________________________________________________ Phone Number: _________________________ Cell Phone: ______________________________ 2. Presenter Experience: Identify presentations the LEAD Presenter has previously delivered on this or related topics: A. Presentation Title:________________________________________________________ Type of Event and Date:____________________________________________________ B. Presentation Title:________________________________________________________ Type of Event and Date:____________________________________________________ C. Presentation Title:________________________________________________________ Type of Event and Date:____________________________________________________ Do you have any recorded presentations that are available for review online? If yes, please list the website(s)/direct link:__________________________________________________________ 3. Lead Presenter References: Identify at least two presenter references: Full Name:___________________________________Title:______________________________ Email: ______________________________________ Phone:____________________________ Relationship: _________________________________ 5 B. Full Name:___________________________________Title:______________________________ Email: ______________________________________ Phone:____________________________ Relationship: _________________________________ Format of presentation: 4. Schedule for workshop – Check all of your availability: _____ Monday AM _____ Monday PM _____ Tuesday AM _____ Tuesday PM 5. Would you be willing to present your workshop more than once at this conference? ____ Yes ____ No 6. Title of Presentation: 7. Abstract - description of your workshop that includes the theoretical and/or empirical background of the presentation and the ways in which the presentation will inform either clinical, applied practice or empirical research. This should be a description of the presentation content and a maximum of 250 words. Insert abstract below: 8. Choose the topic your presentation will focus on (select all that apply) _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ Co-occurring Mental Health and Substance Use Disorders Trauma and Posttraumatic Stress Disorder Better Serving Homeless Populations Better Serving Military Veterans Behavioral Addictions Integrated Behavioral and Physical Healthcare Mental Health First Aid Interfacing with the Criminal Justice System (Specialty Courts, Jail Diversion, etc.) Effective Behavioral Health Crisis Response Using Data/Outcomes to Drive System Improvement Adolescent Suicide Prevention Mental Illness and Youth Cross-System Partnerships (which could encompass a number of the above) 9. Each presentation must provide at least three (3) measurable learning objectives. Use such words as: define, identify, assess, describe, recognize, demonstrate, show, explain, examine. These will be used in the registration brochure and need to fit the workshop content. Learning Objective 1:__________________________________________________________ Learning Objective 2:__________________________________________________________ Learning Objective 3:__________________________________________________________ 6 10. Indicate the presentation format (check all that apply): _____ _____ _____ _____ Interactive Research/Evaluation Panel Discussion Other (please specify): _____ Case Study/Case Presentation _____ Lecture _____ Small Group Discussion 11. Please indicate the target audience level: _____ Entry Level _____ Intermediate Social Workers: _____ Macro _____ Advanced ______ Micro 12. Each presentation must provide a minimum of three bibliographic references. At least ONE reference must be current within the last five years. Reading 1: __________________________________________________________ Reading 2: __________________________________________________________ Reading 3: __________________________________________________________ 13. Choose the audio-visual and training equipment needed – select all that apply: _____ Speakers _____ Whiteboard and markers _____ Internet Access _____ Other – please specify: Attach the following information for each presenter: a) Resume/CV (electronic submission only) b) Brief biographical sketch (used for conference marketing and introductions) c) CME Wayne State University School of Medicine Disclosure of Commercial Relationships Form 7 Wayne State University School of Medicine Continuing Medical Education DISCLOSURE OF COMMERCIAL RELATIONSHIPS Activity Title: Activity Date(s): Name:        The Wayne State University School of Medicine Division of Continuing Medical Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) as a provider of continuing medical education. Wayne State University School of Medicine requires that all presentations at CME activities be fair, balanced, free of commercial bias, and fully supported by scientific evidence. Everyone who is in a position to control the content of an education activity must disclose relevant financial relationships with any commercial interest. A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Providers of clinical service directly to patients are not considered commercial interests. Planning committee members, moderators, planners and presenters are required to list all financial arrangements or affiliations with companies or organizations having a relationship to the subject of this educational activity. Please note: The ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner. Individuals who refuse to disclose are disqualified from CME planning and implementation. I. Check one: I have no relevant personal financial relationships with commercial interests within the past 12 months I have relevant personal financial relationships within the past 12 months with the following commercial interests: Type of Personal Financial Relationship Name of the Company(s) Whose Products Will Be Addressed Consultant Speaker’s Bureau Grant/Research Support (Principal Investigator) Stock Shareholder (Self-managed) Other: (must specify) 1. I agree that all the recommendations involving clinical medicine will be based on evidence accepted within the profession of medicine as adequate justification for their indications and contraindications in patient care. 2. I agree that all scientific and clinical research used to justify patient care recommendations will conform to generally accepted standards of experimental design, data collection and analysis. 3. I agree to provide a balanced presentation that is free from commercial bias or financial interest for or against any commercial product or service. II. Off-Label: Will your presentation or participation involve comments or discussion concerning an FDA nonapproved use of a pharmaceutical or medical device? Yes No Not Applicable (Planner) If “Yes”, how will you inform the audience that the FDA has not approved this use? Signature: Date: Activity Director or Reviewer: III. Resolution: If current conflicts of interest are present, the person overseeing CME content completes this section. To assure independence and balance of content, current conflicts of interest were resolved by the following process (check one): Pre-review of presentation slides by Activity Director Other (describe): Signature (no relevant relationships): 2013 Pre-review of ppt. slides by CME department Role: Date: