TA Request Form | BPHC-BH TA

Requestor First Name

Requestor Last Name

Requestor Organization Name

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Here is a list of common TA requests on integrating behavioral health care services in the primary care setting:

Support planning, implementing, or sustaining an integrated care model
Building an effective integrated care team
Integrated care workforce retention, resiliency, & burnout prevention
Maternal Child, Pediatric, & Adolescent behavioral health
Evidence-based integrated care practices (e.g. SBIRT, MI, etc.)
Integrated care delivery: screening, workflows, billing, telehealth, psychiatric medication prescribing practices, etc.)
Integrated behavioral health care delivery: substance use treatment, OUD treatment, suicide prevention
SDoH, integrated care, & health equity
Understanding value-based payments

Please describe the area(s) of TA you would like to receive.

Briefly describe your health center and patient population.

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Telephone Number

What is your preferred method of contact?

A member of our team will reach out to you within two business days.

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