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What is ECHO?ECHO is an acronym that stands for E xtension for C ommunity H ealthcare O utcomes. ECHO is a virtual, interactive program that accelerates knowledge and information sharing through an "All Teach, All Learn" framework. ECHO programs have had great success in the healthcare, education, and public service industries.
What is ECHO Autism: Advocates?ECHO Autism: Advocates is a program that aims to develop a Network of well-equipped advocates, who are familiar with complex systems and passionate to connect people with autism and their families to high-quality, evidence-based resources, supports, and services.
When does ECHO Autism Advocates Occur?Virtual ECHO Autism: Advocate sessions occur on the 1st and 3rd Friday of each month from 10:00 AM to 11:30 AM central time. Sessions occur from Feburary through December each year.
Who can be part of the ECHO Autism: Advocates Program?The learning is geared towards people who live/work in the state of Missouri, but is open to anyone with an interest in being an advocate at any education level.
Autism experts lead the ECHO Autism: Advocates program. The lead content experts are parents of autistic children and/or professionals who have years of experience working in the autism field.
What can I expect during ECHO Autism: Advocates Sessions?Each session will start with a brief presentation by an autism expert, followed by a rich full group discussion where advocates are invited to present about the challenges that people with autism and their families face navigating systems, finding good resources, or advocating for themselves or loved ones. Sessions will end with the full group proposing solutions and sharing helpful resources. Topics that will be discussed will provide information about the medical system, educational system, state eligibility and funding, transition to adulthood and adult living, bolstering advocacy skills, and engaging your community. What if I need help?Please contact Michael Hansen at michaelhansen@health.missouri.edu with any questions.
First Name:
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Last Name:
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Email:
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What is your primary motivation for participation in ECHO Autism?
Because I want ...
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If other, please specify:
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Please select which option that best describes you.
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I am an autistic person
I am a spouse of an autistic person
I am the parent of a person with autism
I am a family member of a person with autism
I am a professional that works with autistic people
I am a student learning about autism
Other
Please describe:
* must provide value
What is your highest level of education?
* must provide value
High School / GCE A Levels / Secondary school
Associates
Bachelors
Masters
Licentiate
Doctorate
Other
(completed level of education)
Please list your highest level of education
* must provide value
What is your degree?
* must provide value
What is your degree?
* must provide value
What is your degree?
* must provide value
What is your degree?
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Please list your degree(s):
* must provide value
Which of these fields best categorizes the field you work in?We all have multiple roles and identities. Please consider your role (and field) as it relates to participation in this specific ECHO.
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Family/Self-Advocate
Community Support/Resource Navigation/Community Resource
Clinical intervention (ABA, OT, SLP, etc)
Clinical Health/Allied Health
Education
Law
Mental Health
Non-Clinical Health/Public Health/Research
Nursing
Nurse Practitioner
Oral Health
Pharmacy
Physician
Physician Assistant
Psychologist
Social Work
Student (Undergrad, Graduate, Medical, etc...)
Business
Other
Please list your field of work
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What is your role in that field?
* must provide value
Behavioral Implementer
Behavioral Specialist
Dietician
Occupational Therapist
Occupational Therapist Assistant
Physical Therapist
Physical Therapist Assistant
Speech Language Pathologist
Speech Language Pathologist - Assistant
Other
What is your role in that field?
* must provide value
Clinical Lab Worker/Med Technologist
Electroneurodiagnostic Technologist
EMT/Paramedic
Exercise Science Professional (trainer, physiologist)
Genetic Counselor/Genetic Assistants
Kinesiotherapist
Lactation Consultant
Magnetic Resonance Technologist (MRI)
Medical Assistant
Music Therapist
Phlebotomist
Radiologist
Respiratory Therapist
Other
What is your role in that field?
* must provide value
Certified Peer Mentor
Community Health Worker
Family Advocate
Family/Caregiver/Patient Navigator
Program Coordinator/Manager/Supervisor
Resource Specialist/Resource Navigator
Support Coordinator/Service Coordinator
Other
What is your role in that field?
* must provide value
Certified Peer Mentor
Higher Education (non-medical): Professor/Assistant Prof/Associate Prof/Adjunct Prof/Emeritus, etc.
Para Professional
School Administrator
School Principal
School Teacher
Other
What is your role in that field?
* must provide value
Caregiver
Certified Peer Mentor
Extended Family /Caregiver Support
Family Advocate
Foster Parent
Grandparent
Guardian
Kinship Foster Parent
Parent
Parent Partner
Self-Advocate
Other
What is your role in that field?
* must provide value
Law Student
Attorney
Guardian ad litem
Judge
Other
What is your role in that field?
* must provide value
Case worker
Clinician/Therapist/Counselor
Community Support Specialist
Provisional Clinician/Therapist/Counselor
Other
What is your role in that field?
* must provide value
Biostatistician
Quality Assurance/Compliance
Researcher/Analyst
Other
What is your role in that field?
* must provide value
Nurse
Nurse Aid
Other
What is your role in that field?
* must provide value
Family Medicine
Internal Medicine - General
Internal Medicine - Specialist
Internal Medicine - Pediatrics (Med-Peds)
Neurology
Nurse Practitioner
Pediatrics - General
Pediatrics - Specialist
Physician Assistant
Psychiatry - Child and Adolescent
Psychiatry - General
Other
What is your role in that field?
* must provide value
Dentist
Dental Hygienist
Dental Assistant
Other
What is your role in that field?
* must provide value
Pharmacist
Pharmacy Technician
Other
Intern
Resident
Fellow
Attending
What is your role in that field?
* must provide value
Family Medicine
Internal Medicine - General
Internal Medicine - Specialist
Internal Medicine - Pediatrics (Med-Peds)
Neurology
Pediatrics - General
Pediatrics - Specialist
Psychiatry - Child and Adolescent
Psychiatry - General
Other
Intern
Resident
Post-Doc/Fellow
What is your role in that field?
* must provide value
Clinical Psychologist
Counseling Psychologist
Neuropsychologist
School Psychologist
Other
What is your role in that field?
* must provide value
Case Manager/Coordinator
Clinician/Therapist/Counselor
Supervisor
Other
What is your role in that field?
* must provide value
Intern/In-training
Student - Undergraduate Study
Student - Graduate Study
Student - Post-graduate Study
Student - Medical
Other
What is your role in that field?
* must provide value
Chief Financial Officer
Chief Operating Officer
Compliance Manager
Risk Manager
Quality Assurance Coordinator
Chief Quality Officer
Data Analyst
Facilities Manager
Other
Please list your role
* must provide value
What are your credentials? (Select all that apply)
* must provide value
What are your credentials? (Select all that apply)
* must provide value
What are your credentials? (Select all that apply)
* must provide value
What are your credentials? (Select all that apply)
* must provide value
What are your credentials? (Select all that apply)
* must provide value
What are your credentials? (Select all that apply)
* must provide value
What are your credentials? (Select all that apply)
* must provide value
What are your credentials? (Select all that apply)
* must provide value
What are your credentials? (Select all that apply)
* must provide value
What are your credentials? (Select all that apply)
* must provide value
What are your credentials? (Select all that apply)
* must provide value
What are your credentials? (Select all that apply)
* must provide value
What is your area of study?
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Please list your credentials
Country:
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United States of America Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (the Democratic Republic of the) Congo Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czechia Cote d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands [Malvinas] Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati N. Korea S. Korea Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Moldova (the Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Republic of North Macedonia Romania Russian Federation Rwanda Réunion Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syrian Arab Republic Taiwan (Province of China) Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom of Great Britain and Northern Ireland United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Aland Islands
Do you complete your advocacy work within an organization?
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Yes
No
Organization name that is associated with the majority of your professional role:
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Organization Address:
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City:
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State:
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Alabama Alaska Arizona Arkansas American Samoa California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Trust Territories Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
County:
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Province/State/Region:
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Zip/Postal Code:
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Preferred Mailing Address Street:
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City:
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State:
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Alabama Alaska Arizona Arkansas American Samoa California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Trust Territories Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
County:
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Province/State/Region:
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Zip/Postal Code:
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Phone Number:
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Cell Phone Number:
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Do you help people with autism and/or their families get connected to services, supports, or resources?
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Yes
No
How many families are you currently working with?
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1-5
6-10
11-15
16-20
21-25
Higher than 25
Please select the option that best describes you.
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I help people with autism and their families on my own time.
I work for an organization/agency that helps people with autism and their families.
Other
Please describe:
* must provide value
EXPECTATIONS The overall aim of the ECHO Autism: Advocates program is to create a community of well-equipped advocates who understand support systems and best practices. While there are no requirements, we hope you will consider joining us for the entire series in this capacity:
Attend at least 50% of ECHO Autism: Advocates sessions Take place on 1st and 3rd Fridays of each month from 10:00 AM till 11:30 AM CT From February 2nd, 2024 till December 20th, 2024 Complete Pre-series, Mid-series, and End-of-series surveys
EXPECTATIONS The overall aim of the ECHO Autism: Advocates program is to create a community of well-equipped advocates who understand support systems and best practices. While there are no requirements, we hope you will consider joining us for the entire series in this capacity:
Attend at least 50% of ECHO Autism: Advocates sessions Take place on 1st and 3rd Fridays of each month from 10:00 AM till 11:30 AM CT From February 7th, 2025 through December 19th, 2025 Complete Pre-series, Mid-series, and End-of-series surveys
Missouri residents could be eligible for a $25 incentive in July and December of 2024 by attending 50% of sessions and being among the first 20 to complete Mid-series or End-of-series surveys
Missouri residents could be eligible for a $25 incentive (Amazon Gift Code) for completing a mid-year evaluation survey and a $25 incentive (Amazon Gift Code) for completing an end-of-year evalutation survey. Have you attended ECHO Autism: Advocates before?
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Yes
No
Will you join us for the virtual kick off event on January 26th, 2024 from 12:00 PM till 4:00 PM CT?
(Everyone who attends the kick off training will receive a FREE t-shirt)
* must provide value
Yes
No
Will you join us for the virtual kick off event on January 31st, 2025 from 8:30 AM - 12:30 PM CT?
(Everyone who attends will receive a token of appreciation from ECHO Autism Communities)
* must provide value
Yes
No
Notice Once you click submit below, you will redirected to the pre-survey that will take approximately 5 minutes. We appreciate the generosity of your time in completing the survey before attending your first session.
Notice Once you click submit below, you will redirected to the Pre-survey that will take apporoximatelty 5 minutes. After the Pre-survey is complete, you will then receive the virtual kick off event zoom registration.
To attend the kick off training on January 31st 2025, please complete the Pre-survey and Zoom registration.
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