Mental Health Provider Questionnaire
The COVID-19 pandemic has deepened already existing racial inequalities and traumas in our society. Current data show that Black, Latinx and Native American communities are suffering from disproportionate infection and mortality rates. Asian Pacific American communities are experiencing a sharp spike in racialized harassment and violence carried out by those would scapegoat them as the source of the pandemic. A group of us working in Austin/Travis county organizations have developed an incident form to track these racialized incidents (hyperlink form). We will follow-up on reported incidents and want to provide support to those who need it.

In order to provide support, we are identifying mental health professionals of color in Texas who are trained or have experience in providing services—in both individual and group settings—related to racial trauma and healing and have knowledge in culturally-grounded, social justice centered practices. Please fill out the following questionnaire if you are interested in supporting this effort and we will follow-up with you. Thank you!
Name (First, Last) *
Contact Phone Number *
Contact Email Address *
Brief Bio (you or your practice)
Fees/Rate *
Accepted Insurance *
Do you offer sliding scale? *
Languages Spoken *
Would you be interested in providing a mental health virtual training/webinar for the community? *
If so, what topics could you present on or facilitate?
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This form was created inside of AACHI - Austin Asian Community Health Initiative. Report Abuse