Virginia Association of Infant Mental Health

An Affiliate of the World Association for Infant Mental Health

Membership Application for Year July 1, 2013 through June 30, 2014

Name: ______Date: ______

Professional Title: ______

Organization: ______

Work Address: ______

Office Phone Number: ______

E mail Address: ______

Home Address: ______

Home Phone Number: ______

_____ Check here if you do not want your name, position, agency and email included in the VAIMH Directory.

Mail this form and a check for $25.00 to:

VAIMH 13695 Van Doren Road Manassas, Virginia 20112

Attn: Terry Erlichman

7/28/12 Each VAIMH member is asked to assist the organization by serving on one of four work groups. Please select one of the following VAIMH work groups of interest to you:

Early Childhood Mental Health Professional Development/Parent Support Develops and oversees the Early Childhood Mental Health Training Plan including Train the Trainer events related to the social-emotional development of young children, training related to clinical work and the infant mental health endorsement, screening and assessment and parent education and support; Develops presentation and display tool kits and coordinates presentation requests; Establishes and maintains a list of qualified trainers; Assists with statewide training including securing national trainers for VAIMH events; Works collaboratively to develop a social emotional development website portal to house resources and mini-lessons.

Virginia Infant Mental Health Endorsement Implementation Oversees the development of the Virginia Association for Infant Mental Health Competency and Endorsement System including developing a process for full implementation by 2013; Coordinates endorsement training efforts with the ECMH Professional Development/Parent Support Work Group; Ensures endorsement candidates are assigned a qualified Advisor; Oversees the scheduling of the Endorsement Exam for Levels III and IV; Provides support to Endorsement candidates and maintains the list of persons endorsed in Virginia.

Virginia Association for Infant Mental Health Expansion Develops & oversees the Plan for how to grow the World Association for Infant Mental Health State Affiliate in Virginia including: Revising the By-Laws; Electing Officers; Planning and implementing the Annual Meeting; Developing local VAIMH chapters; Issuing the VAIMH newsletter; Planning state & local VAIMH events; and Developing the necessary forms and public awareness materials for recruiting new members that includes a cross representation of early childhood providers, mental health professionals, the medical community, families/ caregivers and students.

Early Childhood Mental Health Policy/Public Awareness Develops the Public Awareness & Policy Plan for the VAIMH including recruiting key early childhood policy makers and technology experts to serve on the work group; Plans for regularly scheduled Policy Summits; Develops public awareness materials including coordinating requests for displays; Coordinates policy and public awareness efforts with the Early Childhood Advisory Council (ECAC) and Smart Beginnings; and Oversees the development of the VAIMH website and procedures for keeping the website updated on a regular basis.

PLEASE NOTE: The Facilitator for the work group selected will contact you with information related to meetings, current projects etc. Your name will be added to the work group selected. Work group meetings are scheduled by the Work Group Facilitator, are held as needed in between the regularly scheduled quarterly meetings of the VAIMH and are routinely held by conference call so travel is not necessary. Thank you!

7/28/12