KUMC Project ECHO Series Registration

Welcome to the ______ series ______.

Please register by providing the following information. Agendas, didactic and case presentation slides will be sent in advance of each session to the e-mail address you provide.

If you have any questions, please contact projectecho@kumc.edu.

Thank you!

iECHO ID

Data Management: Completion Status

Registration Complete

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Course 1 Attended

Yes

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Course 2 Attended

Yes

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Course 3 Attended

Yes

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Course 4 Attended

Yes

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Course 5 Attended

Yes

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Course 6 Attended

Yes

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Course 7 Attended

Yes

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Course 8 Attended

Yes

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Course 9 Attended

Yes

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Course 10 Attended

Yes

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Course 11 Attended

Yes

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Course 12 Attended

Yes

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Number of Sessions/Courses in this Series

Short Series Title for this ECHO

NOTE: This is the Final Title's categorical information preceding the ":" e.g., OD2A SUD 2023 ECHO
NOTE: If course is one session only, then the Series Title = Session Title

Series Schedule for this ECHO

NOTE: This is Final Series Schedule of (timeframe, weekday and duration): "" e.g.,
noon - 1 pm each Thursday, February 15 through March 14, 2024

Duplicate Record - If this is a duplicate registrant, designate if this is a duplicate or primary record

duplicate secondary record

duplicate primary record

Audit Trail

Audit Trail

Audit Trail

Administrative Notes

NOTE: For each note, please add the most current at the top of this field with a date and initials of the recorder

e.g.
2020 11-04 jw note goes here

2020 10-29 jl note goes here

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FAQ 1

Must participants individually register or can an entire group be registered administratively (e.g. project echo/other proxy registrant)?

Response:
We look forward to the participation of your practice with our SUD 2022 ECHO. Because the Project ECHO learning platform allows all ECHO participants to interact with the specialty team and other learners during the live event, our program does require each participant to complete a brief registration form, which includes participation agreements and a disclosure statement. Additionally, our team needs the individual registrations to assist with attendance verification for our CE department.

Without these individual registrations, we are not able to meet our credentialing requirements. We have designed our registration to be a simple process that collects this information as efficiently as possible, and we look forward to your practice's participation.

Per:
Shawna Wright, Ph.D., LP, Associate Director, KU Center for Telemedicine & Telehealth
Clinical Assistant Professor (vol.), Dept. of Psychiatry and Behavioral Sciences

FAQ 2

Why didn't I receive a registration confirmation email? (or Why did projectecho@kumc.edu receive a failed message notification?)

Response:
Sometimes the registrant has a typo in their email field. Correct it and send an email to the new address per

Subject Line:

KUMC Project ECHO Registration Confirmation

Message Body:

Thank you FIRST NAME LAST NAME for registering for the KUMC SUD 2022 ECHO series.

We will send you reminders and documents to this email address before each course. If you prefer correspondence directed to another email address please notify us at projectecho@kumc.edu.

As a reminder: Your registration covers all courses of the series, so there is no need to re-complete this survey for each course.

ALL ECHO Roles = Registrant/Participant UNLESS indicated here

Please check ALL Roles this Registrant fulfills during this project/series

Planning Team Member

ECHO Staff

Continuing Education

Funder

Specialty Team Member/Expert

Guest Speaker

Facilitator

Observer

Lived Experience Contributor

Something Else

Is this your first ECHO?

* must provide value

Yes

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How examples

How did you hear about this ECHO Series? Please check all that apply.

* must provide value

KUMC/AHEC email announcement

KUMC Project ECHO Webpage

Recommended by a friend or colleague

Partner agency or organization

Social media

Blog or publication

Search engine (e.g. Google, Yahoo, etc.)

Poster/printed posted announcement

Something else

Please describe why you selected "something else" here

First Name

* must provide value

Last Name

* must provide value

Email address

* must provide value

Secondary email address

Work Phone Number

Mobile Phone Number

What is your position/title?

* must provide value

Organization Name: Please provide the name of your primary health care delivery/work site.

* must provide value

Organization Address: Please provide the street address of your primary health care delivery/work site.

* must provide value

Organization City: Please provide the name of the city of your primary health care delivery/work site.

* must provide value

Organization State, Tribal Nation/Territory

Please select ALL that apply

* must provide value

Kansas (KS)

Tribal Nation Serving Kansans

Not Kansas

Please Specify the Tribal Nation Serving Kansans

* must provide value

The Iowa Tribe of Kansas and Nebraska

The Kickapoo Tribe in Kansas

The Prairie Band Potawatomi Nation

The Sac and Fox Nation of Missouri in Kansas and Nebraska

The Kaw Nation

Something else

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Please describe why you selected "something else"

* must provide value

Organization County: Please select your primary health care delivery/work site county in Kansas.

* must provide value

2024 Kansas Fights Addiction County Index Ranking

* must provide value

This field indicates when a county is in the Kansas Fights Addiction (KFA) 5th Quintile

Indicators used to determine county index rankings include: overdose emergency department visits per capital, overdose fatalities per capita, percentage of households below poverty, and percentage of adult frequent mental health distress.

Source: https://sunflowerfoundation.org/wp-content/uploads/2024/03/KFA-County-Index-Map-2024.pdf

2024 Kansas Fights Addiction County Index Ranking

* must provide value

View equation

2024 Kansas Fights Addiction County Index Ranking

* must provide value

2024 Kansas Fights Addiction County Index Ranking

* must provide value

Organizational Location: United States (US), US Territory or Other Country

* must provide value

US State or Territory Organization (outside Kansas)

* must provide value

Organization County: Please select your primary health care delivery/work site county (outside Kansas).

* must provide value

Organization Zipcode: Please provide the zip code of your primary health care delivery/work site.

* must provide value

Country Other Than US: Please select the country in which you deliver health care/work. (outside of US)

* must provide value

Please select your primary practice/work activity.

* must provide value

Please select your professional role.

* must provide value

Please describe why you chose "something else."

* must provide value

Participation is the Key to ECHO's success.

Unlike a webinar, participants and facilitators learn from each other fostering a more engaging and interactive learning experience. Participation brings a community of learning together.

Please download the attached file for your calendar appointment(s).

Attachment:Kansas Fights Addiction 2025 ECHO Advancing Centers of Excellence .ics

Have you worked with clients/patients who are at risk of, or have a substance use disorder, and believe you could benefit from additional resources or consultation with specialists?

Briefly describe:

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Have you experienced barriers or obstacles to screening for, testing for, or treating substance use disorders in your clinic or community and believe you could benefit from additional resources or consultation with specialists?

Briefly describe:

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A 52-year-old male with chronic back pain has been on long-term opioid therapy as prescribed by his physician. He reports experiencing sweating, restlessness, and mild nausea when he accidentally misses a dose. He does not run out early, request early refills, ask to increase his dose, or have any other complications with his treatment. What is the most appropriate classification of his symptoms?

* must provide value

Opioid Use Disorder

Pseudoaddiction

Physical Dependence

Drug-Seeking Behavior

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A 38-year-old female with a history of knee surgery has been prescribed oxycodone for post-operative pain. She frequently calls for early refills, reports losing prescriptions, and becomes angry when the provider refuses. She continues requesting opioids despite improvements in her pain. This behavior is most consistent with which of the following?

* must provide value

Opioid Use Disorder

Physical Dependence

Tolerance

Withdrawal

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Rates of overdose from which drugs have contributed most to the increase of overdose deaths in Kansas over the last 2 years?

* must provide value

Heroin and cocaine

Heroin and methamphetamine

Fentanyl and methamphetamine

K2 and spice

Prescription opioids and benzodiazepines

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How much training is required for prescribers to obtain the ability to treat up to 30 patients with buprenorphine for opioid use disorder?

* must provide value

8 hours for physicians and 24 hours for nurse practitioners, physician assistants, and other advance practice providers

No training-all prescribers are allowed to prescribe buprenorphine without restriction

No training, but prescribers must complete notification of intent through SAMHSA

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The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain do not apply to pain management related to sickle cell disease, cancer-related pain treatment, palliative care, or end-of-life care.

* must provide value

True

False

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Are you a prescribing provider?

* must provide value

Yes

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When working with an individual diagnosed with substance use disorder (SUD), which of the following statements reflect your thoughts or approach? (Select all that apply.)

* must provide value

Patients with SUD are responsible for their condition and should be able to stop using if they really want to.

Treating SUD is frustrating because patients often return to use, making it feel like progress is minimal.

The medical aspects of SUD require long-term management, similar to diabetes or hypertension.

Patients with SUD are frequently more manipulative than other patient populations.

Medications for opioid use disorder (MOUD) are just replacing one addiction with another.

People with SUD deserve the same level of care and empathy as those with other chronic illnesses.

I have felt uncomfortable treating patients with SUD due to concerns about whether their requests for opiates or other controlled substances were legitimate.

Which of the following concerns influence your willingness to treat patients with substance use disorder (SUD)? (Select all that apply.)

* must provide value

Patients with SUD are often ambivalent and difficult to engage in treatment.

I worry that treating SUD patients will put my practice at risk of having to deal with disruptive behaviors.

I believe people with SUD deserve compassionate care, but I don't feel well-equipped to provide treatment.

I am concerned about the risk of legal or regulatory issues when prescribing medications for SUD.

I have seen patients with SUD successfully recover with appropriate treatment.

Managing SUD feels outside my professional role or expertise.

I believe addressing SUD is an essential part of my clinical responsibilities.

Which of the following best describes your utilization of the strategy:

**Outcome/Change #3**

* must provide value

Would you and/or your practice be interested in taking the next step toward driving meaningful practice change by joining an ECHO Centers of Excellence cohort focused on implementing insights from the Kansas Fights Addiction 2025 ECHO?

Participants will receive a stipend along with additional resources, including marketing and promotional support, as well as access to advanced training and mentorship programs to elevate your practice.

Yes

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By selecting "I agree," you understand and agree to the following:

Project ECHO sessions will be recorded
Recordings and images may be used for marketing purposes
First and last names are required to be displayed during ECHO sessions to claim continuing education credit
Following HIPAA guidelines is a requirement of ECHO participation
Project ECHO will communicate all ECHO information via email (these communications can be opted out of at any time)
Promotion or sale of products, services, or personal business interests during ECHO sessions is strictly prohibited

The data collected during registration and ECHO sessions is kept strictly confidential and is not shared with any third parties. It is used only for deidentified reports, quality assurance, research and future programming.

* must provide value

I agree

In the past 24 months, have you and/or your spouse or partner had, or do you have, a financial relationship(s) with any ineligible companies?
Ineligible companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

* must provide value

Yes

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Please click "Add Signature" and sign with your mouse or finger.

* must provide value

Add signature

Please take a moment to strengthen and grow our community of practice for substance use disorder treatment by sharing this registration link/QR code with your ENTIRE TEAM: Primary care providers and clinic administrators, physicians, advanced practice clinicians, nurses, behavioral health clinicians, licensed addiction counselors, peer support workers, recovery specialists, community health workers, faith-based recovery community members.

Simply forward the announcement you've received or copy this link to share!

Register at:

https://bit.ly/KFA2025ECHO

Please share any additional comments you have for the KUMC Project ECHO team.

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