Michigan Association of CMH Boards 2017 Annual Winter Conference

February 6, 2017 Pre-Conference Institute; February 7 & 8, 2017 Full Conference

Radisson Plaza Hotel, Kalamazoo, Michigan

Presentation Submission Form: Deadline Friday, December 3, 2016

Purpose of this form: Training program planners at MACMHB use the information requested in this form for several things – to assure appropriateness of content; to assess whether the presentation meets criteria for social work “Continuing Education Clock Hours,” and/or substance abuse professional certification “Contact Hours”; to develop program description and learning objectives for the brochure. Description and learning objectives may be edited and formatted for inclusion in program brochure.

·  Complete this form [electronically] and save it as a document.

·  Required to Send: 1) completed submission form and 2) a resume for each presenter.

·  Return via email to by Friday, December 3, 2016.

·  We allow for a maximum of 3 presenters during a workshop.

·  Workshops are generally 90 minutes; a small number of double sessions may be considered.

·  Presenter Compensation: The conference budget will not provide honorariums for workshop presenters. Presenters will receive a complimentary conference registration for the day of their presentation. Due to the high cost of travel, MACMHB is not able to reimburse workshop presenters for mileage. If presenters are not able to participate due to lack of reimbursement, special arrangements may be made with MACMHB when you are notified of your accepted proposal.

Proposed Time:
Check all your availability / Pre-Conference Institute: February 6 9am – 4:00pm; or 1pm – 4pm
February 7 Morning (10:00am – 11:30am)
February 7 Afternoon (1:30pm – 3:00pm)
February 7 Afternoon (3:30pm – 5:00pm)
February 7 Morning (10:30am – 12:00pm)
Target Audience: / Clinical Board Members
Administrative/Executive Leadership
Check all that apply: / Targeted Experience Level: Entry Level Intermediate Advanced
Social Workers: Macro [administrative] Micro [clinical]
Presentation Title to be Listed in Brochure:
Presentation Description – Please provide a brief description (5-7 sentences) of the proposed presentation that we may use for promotional purposes.
Description: Limit of 175 words.
QUANTIFIABLE LEARNING OBJECTIVES [include a MINIMUM of 3 - MAXIMUM of 4]
Use such words as: define, memorize, repeat, record, list, recall, name, relate, specify, cite, recount, restate, summarize,
discuss, describe, recognize, explain, express, identify, translate, exhibit, solve, apply, employ, use, demonstrate, illustrate, operate, calculate, show, experiment, interpret, classify, differentiate, group, compare, organize, contrast, examine, categorize
EXAMPLE – Participants will be able to 1) identify a working definition of Trauma; 2) Repeat 2 common reactions of Trauma in each of 5 life domains;3) list 4 standards for Trauma Informed services for your organization; 4) describe the 3 Stages of Healing; and 5) list the 4 steps in every session.
Participants will be able to:
1.
2.
3.
You MUST select ONE track that your proposed workshop best fits.
o  Emerging and Evidence-Based Practices
o  Integrated Care Initiatives
o  Healthcare Reform
o  Consumer Integration and Relationship Building, Empowerment and Peer Services
o  Recovery-Oriented Care
o  Public Policy Advocacy
o  Clinical Care Assessment: Quality, Cost, Fidelity Integrity, and Outcomes Dimensions
o  Children/SED/Autism Practices
o  Board Member Development, Governance and Leadership
o  Developmental Disabilities Practices
o  Substance Use Disorders
o  Advocacy Training and Support for Consumers/Families
What are the topics / sections to be covered?
Topics:
Bibliography: Please identify where material for this presentation is drawn from. You may attach a separate bibliography or use additional pages if necessary.
Bibliography:
References – Please identify presentations you have previously delivered on this or related topics unless included on your resume:
Previous Trainings:
Primary Presenter Information:
Name:
Degrees/Credentials:
Title:
Organization:
Address:
Phone Number: / Fax Number:
Email Address:
Co-Presenters Information (if applicable):
Name:
Degrees/Credentials:
Title:
Organization:
Address:
Phone Number: / Fax Number:
Email Address:
Continue to add Presenter Information as Needed.

The conference budget will support modest honorariums for plenary speakers; however we do not provide honorariums for workshop presenters. Presenters will receive a complimentary conference registration for the day of their presentation. Due to the high cost of travel, MACMHB is not able to reimburse workshop presenters for mileage. If presenters are not able to participate due to lack of reimbursement, special arrangements may be made with MACMHB when you are notified of your accepted proposal.

Submit all materials by December 2, 2016 to Chris Ward at