Fall 2009
Dear Mental/Behavioral Health Provider:
The MS Chapter of the American Academy of Pediatrics is a membership organization for pediatricians across the state of Mississippi, currently representing some 345+ pediatricians.
In 2008, our organization has received a small grant to address mental/behavioral health services for children. One major component was to assess the services currently available for children in the central MS (particularly the metro-Jackson, MS) area. Since 2008, we have chosen to branch out and collect information on services outside the metro-Jackson, MS area. Ultimately, understanding the availability of services and working toward improvements in communications between pediatricians and mental/behavioral health pro viders will help to improve children’s access to and utilization of these services.
Attached you will find a brief survey. Will you please take time to complete the survey and return it to us? Your response will be greatly appreciated.
Sincerely,
Susan Buttross, MD, Project Director
Behavioral and Developmental Pediatrician
UMC Child Development Clinic
601/984-5240
Email: sbuttross@ped.umsmed.edu
Gretchen Mahan, Project Coordinator
Chapter Executive Director
MS Chapter AAP
601/605-6425
Email: msaap@integrity.com

The following information is being requested in order to provide correct information to pediatricians and others who provide referrals for children needing mental and behavioral health services. Thank you for completing this brief survey.
Your Name (please print) :____________________________________________________
Name of Your Organization/ Practice
__________________________________________________________________________
Address __________________________________________________________________
__________________________________________________________________________
Counties served: ____________________________________________________________
Do you serve children/adolescents? ______ yes _____ no
(If no, survey ends here)
Phone number and contact name to accept referrals: ________________________________
Ages Served Birth to 5 years ______ 6 to 12 years ______ 13 to 19 years ______
Areas of Competency and service to children: (please circle all that apply):
ADHD Mood Disorders Family Issues Anxiety
Oppositional/Defiant Behavior Conduct Disorder
Academic Difficulties/Learning Disabilities Sleep Problems
Speech/Language Problems Developmental Delay (including Autism/Asperger's)
Social Problems Substance Use/Abuse
Child Abuse/Neglect
Psychosis
Eating DO/Obesity/Nutrition
Tic DO/Tourette's
Other disorders treated (please list): ___________________________________________
________________________________________________________________________
Type of Payment Accepted (yes/no): Private insurance? ___________________________
Medicaid? ____________________________________________
Self-pay? _____________________________________________
Other (please list)? _____________________________________
Please email completed survey to msaap@integrity.com
, fax to 601.605-8367, or mail to: MS Chapter AAP,
P O Box 4725 Jackson, MS 39296-4725