Application Information: Optimize Infant and Toddler Feeding for Obesity Prevention

This is the application survey for pediatric practices/clinics for the Optimize Infant and Toddler Feeding for Obesity Prevention project, focused on improving early feeding counseling and obesity prevention for children under age 2 during well visits.  

If you need additional information or if you have specific questions about the project or your team’s eligibility, please review the project information packet or contact Stephanie Womack at or 630-626-6612, before proceeding.

This survey can be completed by the Lead Clinician or other designee from the pediatric practice. The survey will take you five to ten minutes to complete. If you are unable to finish the survey in one sitting, you may return to the survey at a later time, if your computer accepts cookies. You may preview the survey questions here.   

To be eligible, you must:  
-Be a primary care pediatric practice/clinic
-Have support from organizational leadership to participate in the project
-Have identified core quality improvement (QI) team members for your practice that include two to four individuals, capable of fulfilling the following four roles
         1) Lead Clinician (MD/DO/NP/PA site champion)
         2) Clinical or Office Support Person (i.e., staff who participate in conducting assessments, collecting assessment information, or making or tracking community referrals, etc.)
         3) Office Manager (i.e., staff with knowledge of clinic flow issues and authority to facilitate practice-level changes)
         4) Data Coordinator (i.e., staff with skills to ensure the accurate & timely submission of clinical data, including appropriate sampling of patient data).

-Have core QI team members who are willing to commit to: 
         *Working on this project together for its duration 
         *Meeting regularly as a team regarding the project
         *Submitting required data for the project
         *Participating on a brief call to verify team eligibility (if requested) 
Note: Only responses to questions related to the above criteria will be used to verify eligibility. We will also be looking to recruit a diverse group of practices/clinics (e.g., group or solo practices, Community Health Centers/Federally Qualified Health Centers, medical school-affiliated, government, non-government, or non-profit clinics, etc.). Responses to other questions (e.g., EHR capabilities, experience, etc.) will help inform collaborative procedures and training. 
To complete this survey, you’ll need to have handy: the contact information for your practice (address, phone, and (if available) fax) and for the Lead Clinician for your practice’s core QI team (Name, e-mail address, telephone number, and (if available) fax. Information about the type and capabilities of your EHR would also be helpful. Once accepted, practices will be asked to submit contact information for other team members.

Please contact Stephanie Womack (; 630-626-6612) with any questions. 
11% of survey complete.