BIRCH Program Modules Request

Thank you for your interest in BIRCH (Bundles of Interventions, Resources, and Cultural Hub) Program Modules!

This space will gather the intended use of BIRCH Program Modules to help us continually improve content. After you complete the questions below, you will receive the BIRCH Program Modules via email from birch@thunderbirdpf.org within 5-10 business days.

You will be contacted within 3-6 months about your use of BIRCH and for general feedback. Your personal information will never be shared or published; any feedback reported will be done in aggregate.

*Remarque* : Les modules du programme BIRCH en français sont maintenant disponibles sur demande. Cliquer ici pour soumettre votre demande et y accéder.

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* 1. Name:

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* 2. What treatment centre or community organization are you affiliated with?

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* 3. What is your role within the centre/ organization?

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* 4. How many years have you worked in mental wellness or substance use treatment?

0-1

2-5

6-10

more than 10

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* 5. How did you hear about the BIRCH program?

From Thunderbird Partnership Foundation communication (social media, newsletter, emails, Community Wellness Hub, etc.)

From the BIRCH Website (birchbundle.ca)

From another mental wellness or treatment staff member

From a community health worker/ organization

Other (please describe):

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* 6. What aspects of the BIRCH program do you intend to use?

Printable BIRCH Program Modules

Electronic BIRCH Program Modules

Practitioner Guide for Implementation

Individual worksheets

PowerPoint Slides for Facilitation

eHealth Guide

Skill Teaching Videos

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* 7. How do you think you will use the BIRCH program content?

As part of client residential treatment programming

As part of a virtual treatment program

In community presentations or workshops

As part of client continuing care/after care programming

For my own individual learning, skillset, and knowledge

To share substance use treatment knowledge with community members

As an additional resource to share with clients after treatment

As an additional resource to share with staff

To provide to clients who are currently wait listed for treatment

To track client progress with BIRCH worksheets

To support the development of client treatment plans

Not sure yet - I just want to review the content

Other (please describe):

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* 8. Do you intend to modify the Program Modules content (e.g., to support community, centre, or regional context)?

Yes

Not Sure

BIRCH Program Modules Request

Question Title

* 1. Name:

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* 2. What treatment centre or community organization are you affiliated with?

Question Title

* 3. What is your role within the centre/ organization?

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* 4. How many years have you worked in mental wellness or substance use treatment?

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* 5. How did you hear about the BIRCH program?

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* 6. What aspects of the BIRCH program do you intend to use?

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* 7. How do you think you will use the BIRCH program content?

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* 8. Do you intend to modify the Program Modules content (e.g., to support community, centre, or regional context)?

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* 9. If yes, can you please describe anticipated modifications?

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* 10. Please provide an email address for us to send you BIRCH Program Modules and supporting content: