Thank you for your interest in our research study, Promoting Brain Health: A National Capacity-building Project for Aging Adults with Intellectual and/or Developmental Disabilities, Family Caregivers, and Service Providers. This study evaluates virtual education courses for adults with intellectual and/or developmental disabilities, their families, and service providers from across Canada. If you have any questions or would like help to fill out this form, please contact us at BrainHealthIDD@camh.ca or 437-328-6761. Please select the program session you are interested in attending:
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Spring 2024 (Cycle 1)
Fall 2024 (Cycle 2)
Spring 2025 (Cycle 3)
Fall 2025 (Cycle 4)
The virtual education courses will be offered for the following participants:
Adults with Developmental Disabilities (40 years of age and older)Social and Health Service Providers caring for clients with a developmental disability who are 40 years of age or older Family Caregivers 60 years of age and older caring for an adult with a developmental disability OR
Family Caregivers (any age) caring for an adult with a developmental disability who is 40 years of age or older The courses will be offered on the following dates:
Adults with developmental disabilities: Attend every Wednesday, Oct 2 to Nov 13 from 1:00-2:30pm Eastern time (7 sessions)Family members: Attend every Tuesday, Oct 29 to Dec 3 from 12:30-2:00pm Eastern time (6 sessions) Health and social service providers: Attend every Friday, Sept 20 to Oct 25 from 11:30am-1:00pm Eastern time (6 sessions) If selected to participate in this research study, you would agree to the following:
Carefully review and sign this Expression of Interest and Collaboration agreement; (Optional) Attend a 30-minute orientation session before the start of the course; For family caregivers and service providers:
Attend as many of the six 90-minute weekly sessions as possible; Complete a series of questionnaires before the start of the research, after the research is over (at 7 weeks), and at 14 weeks following the end of the course (week 20) For self-advocates:
Attend as many of the seven 90-minute weekly session as possible; Complete a series of questionnaires through an interview before the start of the research, after the research is over (at 8 weeks), and at 14 weeks following the end of the course (week 21). If you are interested in participating in this research, please answer the questions below. All information collected will remain confidential, and be used only for the purposes of this research study. An answer is required for all questions. Completion of the form is voluntary and you can stop filling out the form at any time and close your browser before submitting.
SAVE AND RETURN: You can save and return to the form at any time if you cannot complete it in one sitting. At the bottom of the page, there is a "save and return" button. When you click this, you will be provided with a return code, which you can use at a later date to return to your questionnaire. Once you are ready to return, click the "returning?" button on the top right hand side of the page and input your return code. If you have any questions about this, please contact us. If you have any questions or concerns regarding the questionnaire, please do not hesitate to get in touch with us at BrainHealthIDD@camh.ca or 437-328-6761.
I am:
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Adult with an intellectual and/or developmental disability
Family caregiver of an adult with an intellectual and/or developmental disability
Health and social service provider
Do you live in Canada?
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Yes
No
Are you 40 years of age or older?
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Yes
No
Are you 60 years of age or older caring for a family member with an intellectual and/or developmental disability?
OR
Have a family member with an intellectual and/or developmental disability 40 years of age or older?
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Yes
No
Do you have some clients with intellectual and/or developmental disabilities who are 40 years of age or older?
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Yes
No
Please specify your primary profession/role:
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First Name
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Last Name
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Email address:
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Re-enter email address:
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How old are you?
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How old is your family member with an intellectual and/or developmental disability?
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Telephone Area Code (three digits)
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Telephone (Seven Digits)
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Extension (if applicable)
First three digits of your postal code
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What province or territory do you live in?
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British Columbia
Alberta
Saskatchewan
Manitoba
Yukon
Northwest Territories
Nunavut
Ontario
Quebec
New Brunswick
Nova Scotia
Newfoundland & Labrador
Prince Edward Island
What city do you live in?
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How did you hear about this Brain Health-IDD study?
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Social Media (X/Twitter, Instagram, Facebook)
Organization Newsletter
Word of Mouth (Family, Friends, Colleagues)
Your health or social service provider
Other
Please specify the type of social media:
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Please specify what organization/newsletter:
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If other, please specify:
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Do you have a computer, tablet, or smartphone and internet access that would allow you to join a virtual course?
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Yes
No
Have you previously participated in a program offered by the Azrieli Adult Neurodevelopmental
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Yes
No
Would you like to attend a 30-minute orientation session to learn about WebEx, the videoconferencing program used to deliver the courses?
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Yes
No
Do you agree to fill out study questionnaires before the course, after the course is over (at 7 weeks), and 20 weeks after the start of the course (at 8 weeks and 21 weeks for self-advocates)?
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I agree
I agree but have questions
I cannot fill out the study questionnaires
What is your relation to your family member with IDD?
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Mother
Father
Sibling
Other
If other, please specify your relation:
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Name of developmental service agency you or your family member with intellectual and/or developmental disability is affiliated with:
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What is the name of your organization?
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What is your organization's postal code?
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ECHO Case PresentationsThe research course for health and social service providers is based on the Extension for Community Healthcare Outcomes (ECHO) Ontario Adult Intellectual & Developmental Disabilities (AIDD) program. Visit the ECHO website for more information: https://camh.echoontario.ca/programs-aidd/
An important part of the ECHO model is to discuss real, complex patient cases, collectively ask pertinent questions, and develop recommendations for care. All personal information must be de-identified. Before the launch of the ECHO course, we will work with participants who are interested on an agreed-upon date for a case presentation and will help to prepare and submit this anonymized client case through a case form. We hope that course participants will see this exercise as a helpful opportunity to share and receive feedback from the community of practice.
Please confirm the following:
Are you currently working in direct practice with clients?
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Yes
No
Do you have a case you would like to discuss during one of the ECHO sessions?
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Yes, I have someone in mind
No, I do not think I can present a case
ECHO Statement of Collaboration AgreementPlease review the ECHO Statement of Collaboration (SoC) below which outlines certain conditions that must be understood and agreed to in order to participate in any of our ECHO programs.
Carefully review and check to indicate your agreement to the following statements:
ECHO case presentations do not create or establish a provider-patient client relationship between any Hub clinician and a patient whose case is presented.
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I agree
I've read the SOC, but have questions. Please contact me. I understand that the ECHO team at CAMH will require my agreement to this item from the SoC prior to my attendance in the session.
Personal identifying information about patients/clients is not to be shared during ECHO sessions. If this inadvertently occurs, I will follow my own organization's policies and procedures to address the privacy breach.
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I agree
I've read the SOC, but have questions. Please contact me. I understand that the ECHO team at CAMH will require my agreement to this item from the SoC prior to my attendance in the session.
Recommendations from the Hub do not in any way replace my own diligence and professional expertise with respect to my patients or clients.
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I agree
I've read the SOC, but have questions. Please contact me. I understand that the ECHO team at CAMH will require my agreement to this item from the SoC prior to my attendance in the session.
My participation data will be shared with the funding agencies, ECHO Ontario Superhub, and ECHO Institute as outlined in the Statement of Collaboration.
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I agree
I agree to have my data shared with the funding agencies and ECHO Ontario Superhub, but want to opt out of sharing with ECHO Institute.
I've read the SoC, but have questions. Please contact me.
I have read and agree to the terms of the Statement of Collaboration with preferences as indicated above.
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I agree
I've read the SoC, but have questions and understand I will be contacted to discuss this prior to being enrolled in the study
I have read and agree to the terms of the Expression of Interest and Collaboration with preferences as indicated above.
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I agree
I agree but have questions and understand I will be contacted to discuss this prior to being enrolled in the research study
Please provide date:
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This Expression of Interest and Collaboration Form will be reviewed by our research staff and we will contact you as soon as possible to let you know if you are eligible to participate in the research.
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