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DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E <br /> resources. We will design the inventory to consist of provider information including, but not <br /> limited to: <br /> o Contact information <br /> ■ Primary Person to Contact with Follow-Up Questions <br /> ■ Phone Number <br /> ■ Email <br /> o Service Setting (Inpatient, Outpatient, Residential) <br /> o Types of Services provided (MH, SUD, IDD, Co-occurring diagnoses) <br /> ■ Evidence Based Programs provided <br /> o Special programs offered (e.g., homeless, LGBTQ, Veterans, immigrants, refugees, <br /> traumatic brain injury, criminal justice involved) <br /> o Languages (including deaf/hard of hearing) <br /> o Age group(s) served <br /> o Method(s) to access services <br /> ■ Referral source(s) (e.g. M.D. referral, walk-in, teacher referral) <br /> ■ Admission process (if there is a particular process required for admission) <br /> o Admission inclusion or restriction criteria (e.g., age, diagnosis, etc.) <br /> o Capacity for FY 16-17 <br /> o Utilization for FY 16-17 <br /> o Number of providers by type <br /> o Geographic location(s) <br /> o Funding sources <br /> ■ External funding support <br /> ■ Types of payment/insurance accepted <br /> ■ Can uninsured or indigent individuals/families access services? Through <br /> what means? <br /> o Hours of availability <br /> NRI will begin collecting this information by researching service providers online. Results of the <br /> online surveillance will yield a preliminary list of providers in the County that offer mental <br /> health, substance use, and/or intellectual and developmental disability services to individuals <br /> age 0-25. To fully populate the list of available providers, NRI will engage stakeholders through <br /> a focus group. The focus group will consist of representatives from Mental Health America of <br /> the Triangle, NAMI-Orange County, NC Families United, the school systems, providers and other <br /> youth-serving organizations. These stakeholders will likely be able to identify additional service <br /> providers that were not included in the on-line search. We will also allow focus group members <br /> to provide feedback on a Provider Survey tool. <br /> Once an exhaustive list of resources is created, we will distribute an electronic survey to each <br /> provider to solicit the types of information listed above. We propose using Google Forms to <br /> distribute the electronic Provider Survey. Google Forms provides a simple platform for survey <br /> Page 8 <br /> NRI ■ 3141 Fairview Park Drive ■ Suite 650• Falls Church, VA■ 22042 ■ 703-738-8160 ■www.nri-inc.org <br />