SM-21-010 Individual Grant Awards 2021

The Alaska Child Trauma Center at Alaska Behavioral Health is proposing to expand behavioral health services by developing an outreach program to identify and engage children who have experienced trauma in Alaska and provide exceptional services to improve lives. We propose to build a collaboration with schools, a youth drop-in center and a statewide resource and referral network to identify children and families in need of trauma-focused services. This project will provide specialized, evidence-based trauma services by partnering with these service systems, increasing access to care and reducing barriers to engagement in treatment. This model of service delivery will assist in the early identification of behavioral health challenges and engage children and families who are not able to participate in traditional clinic-based services. Our population of focus is Alaskan children age 3 to 18 years who have experienced trauma. We will serve a diverse group of individuals including a high proportion of Alaskan Native children and children involved in the child protection system. We will provide a variety of trauma-focused evidenced-based practices to children and families, including ARC treatment, Trauma-Focused Cognitive Behavioral Therapy, Child Parent Psychotherapy and Parent-Child Interaction Therapy. This collaboration with service systems will help identify and engage children in behavioral health services, improve outcomes for children and support their ongoing development. There is an immense need for specialized services in Alaska, through this project, the Alaska Child Trauma Center will serve 300 children in the first year, and 400 annually in Year 2-5 for a total of 1900 children over the project period.

The Fairbanks Native Association (FNA) Child, Youth and Young Adults Services (CYYA Services) division is applying for support from the FY 2021 National Child Traumatic Stress Initiative. Our project is aptly named “Healing the Hurts” as it seeks to address both trauma and the intergenerational trauma experienced by American Indian and Alaska Native (AI/AN) people that has resulted in disproportionate trauma events across generations. Healing the Hurts focuses on trauma events, defined by the National Institute of Mental Health as follows: A traumatic event is a shocking, scary, or dangerous experience that can affect someone emotionally and physically. Experiences such as natural disasters, acts of violence as well as car crashes and other accidents. Healing the Hurts will focus on acts of violence – child abuse and neglect, sexual violence, and suicide – all of which AI/AN experience at disproportionate rates. The purpose of Healing the Hurts is to provide and increase access to effective trauma-focused treatment services in the Fairbanks North Star Borough for AI/AN children, adolescents, and the families who experience trauma events. Project objectives, in alignment with required services, include the following: • Overarching Goal: To provide support and direct trauma services for children, adolescents and their families • Goal 1: To provide outreach, engagement and prevention strategies to increase participation and access to trauma services • Goal 2: To provide evidence-based outpatient trauma treatment for at-risk children and adolescents • Goal 3: To provide services to the population of child and adolescent serving service system on trauma informed practices using local resources • Goal 4: To collaborate with NCTSI II centers • Goal 5: To provide process and outcome evaluation quarterly, annually, and at project completion Project services include outreach, trauma screening, Trauma Prevention Workbooks for adolescents and family members, office-based and home-based Outpatient Treatment, training on trauma-informed care, collaboration with National Child Traumatic Stress Centers, and process and outcome evaluation. Evidence-based screening, assessment, and treatment practices will guide services. Healing the Hurts is supported by the leadership of the Interagency Child, Adolescent & Young Adult Behavioral Health Council (BH Council), an AI/AN behavioral health coalition of 18 members. The BH Council plays a key role in all projects, providing the leadership and infrastructure to support services. The BH Council supports programs through various plans including Sustainability, Trauma-Informed Care, Cultural Competence, and Access to Care.

This proposed project, Parents and Children Together (PACT) is an initiative to fill a trauma-specific services gap for children of substance abusing women in Northwest Arkansas. PACT will enhance services for clients through case management and connection to clinical and community resources. This collaborative effort between UAMS, County Drug Courts, Ozark Guidance, Inc. and community agencies will link children to evidence-based treatments to treat past trauma and prevent future trauma. The target population is children of parents who have a substance use disorder (SUD), or co-occurring SUD/mental illness (COD), have experienced trauma, and who are at high risk for trauma continued inter-generational trauma. PACT will enroll participants in Benton, Washington and Madison Counties in Northwest Arkansas (NWA). PACT will serve 335 children and their families throughout the lifetime of the project. Goals of the project are to: 1) Increase access and engagement of services among the target population; 2) Improve system capacity and infrastructure to provide effective, evidence based, culturally appropriate trauma services; and 3) Improve child/family outcomes in NWA and reduce health disparities among historically disadvantaged populations. UAMS will facilitate infrastructure development to expand and enhance access to a comprehensive and trauma-informed continuum of care and connection to resources for our population of focus. By utilizing evidence-based practices and strategies like Trauma Focused Cognitive Behavioral Therapy (CF-CBT), CPP, CPIT, quality childcare, home visiting programs, social-emotional learning and parenting education, PACT will enhance and continuously improve the delivery of evidence-based and culturally appropriate services that are effective in preventing childhood trauma and treating existing trauma symptoms. Participant Outcomes will be measured through baseline and follow-up assessments of decreased child trauma symptoms, decreased school disciplinary occurrences, improved parenting self-efficacy, decreased parental SUD/COD symptoms, and improved family relationships/family functioning. The PACT project will provide for an imminent need in filling a gap in trauma treatment and trauma informed system service delivery for a vulnerable population at risk intergenerational trauma that has been even greater exasperated by the COVID-19 epidemic.

Family Involvement Center (FIC), a family-run, community service agency (CSA) and licensed behavioral health outpatient clinic, providing services in Arizona for over 18 years acknowledges trauma is not simply a “now” issue, it is longstanding. SAMHSA funding will serve 2,100 children who have experienced trauma and provide 400 hours of innovative trauma informed training. Being Family-Run is our foundation to expand trauma informed, holistic health services statewide. Our Family Driven Trauma Informed Program (FDTIP) will serve children age 0-17 who have experienced traumatic events. A survey by America's Health Rankings determined over 30% of Arizona’s children, ages 0-17, have two or more adverse childhood experiences (Overcoming Adverse Childhood Events, Arizona Adverse Childhood Experiences-ACE Consortium), which lead to toxic stress affecting their long-term health and well-being. The effects of not receiving treatment are evidenced by roughly 100 percent of children entering foster care require mental health support due to trauma. (Arizona Department of Corrections, 2019). FIC will address these challenges incorporating three key programs all of which utilize a family-centered approach, to include: individual and group counseling, parent peer support and youth services. As biological, adoptive, foster, kinship, multicultural, multigenerational, and other diverse families come to trust us to help navigate their path to unity, trauma past and present are often barriers. Trauma Informed Care (TIC) involves recognizing, understanding, and responding to the effects of trauma on all family members throughout their lifespan. “To help the child, you often need to help the parent first.” – Jane Kallal, FIC Founding Mother We will outreach, engage, and assess children who have experienced traumatic events to offer services, connect to resources and educate on the effects of trauma and the healing pathways available. We will assist with access, eligibility, and service referrals, as well as provide services based on Trauma Based Relational Interventions (TBRI), Neurosequential Model of Caregiving (NMC), and other appropriate evidence based practice (EBP) as identified by the needs of the child and parent/primary caregiver. Our training department has a long history of training EBP’s Parenting Wisely and Triple P. These EBPs are foundational to our family driven approach promoting a safe, stigma- free environment for children and families who experienced trauma and may not otherwise have opportunities like these for healing. FIC will build trauma informed resources through training using certified ACE, NMC, and TRBI trainers as well as partnering with Arizona Trauma Institute to expand capacity for future trauma service provision.

The Native American Health Center’s (NAHC) NCTSI-III project will provide an integration of behavioral health evidence based and community defined best practices to serve American Indian/ Alaska Native, Indigenous, and underserved youth, ages 12-18, who have been exposed to trauma or who are at-risk for trauma exposure residing in and around NAHC’s clinics located in East Oakland, California within multiple settings: clinical, school and community based. The proposed project will serve 350 members annually and 1,750 members over the 5 year project period. Goals and measurable objectives are as follows: Goal 1. Increase participation in, and access to, trauma treatment and mental health prevention services for children and adolescents ages 12-18, and their families who have experienced traumatic events through the implementation of culturally-competent, trauma-informed, community defined practices in NAHC’s clinic neighborhoods. Objectives: 1. Strengthen NAHC’s Traditional Health model by providing culturally based prevention services to 30 AIAN youth per project year 2. Provide school-based psycho-educational workshops to 30 youth per project year. 3. Provide school-based trauma-focused self-defense training to 30 youth, and/or their families per project year. 4. Implement a youth led tobacco/vaping cessation social media campaign that will reach 100 youth per project year. Goal 2. Increase access to direct evidence-based mental disorder treatment and services (including prevention, screening, assessment, care management, and therapy) for diverse and at-risk children and adolescents through culturally-competent services for children and adolescents ages 12-18 residing in NAHC’s clinic neighborhoods. Objectives: 1. Provide substance use and wellness screening and assessment to 30 AIAN youth per project year. 2. Provide school-based mental health screenings to 100 youth per project year. 3. Provide culturally modified outpatient mental health to 20 youth and their families per project year. 4. Provide school-based mental health interventions to 20 youth and their families per project year. Goal 3. Increase awareness and adaption of the importance of culturally appropriate and trauma-informed practices by providing locally developed AIAN History or other Network training services to populations of child-serving service systems, such as child welfare, child protective services, law enforcement and courts, and the juvenile justice system Objectives: 1. Provide locally developed culturally responsive trainings on AIAN History (addressing historical trauma) to representatives of 4 child serving systems per project year. 2. Collaborate with San Francisco Unified School District to develop a needs assessment that includes the pilot of school-based, trauma-informed prevention groups for at-risk youth residing in San Francisco by the end of Year 2 of the proposed project. 3. Collaborate with NCTSI - Category II Treatment and Service Adaptation (TSA) centers to develop, advance, or adapt interventions to improve engagement and outcomes for traumatized youth by the end of Year 1. 4. Implement a project evaluation to be submitted to SAMHSA by the end Year 5.

Special Service for Groups, Inc. (SSG) proposes BRIGHT (Build Resiliency, Inspire Growth, & Heal Trauma) to address the unmet need for trauma-informed mental health services for youth and their families in southern regions of Los Angeles County. SSG proposes to provide and evaluate evidence-based, trauma-focused mental health services for youth ages 13-25 and to build local system capacity to support youth impacted by trauma. The Occupational Therapy Training Program (OTTP) division of SSG will conduct outreach, treatment using the Seeking Safety model, care management, and prevention services for youth who experience a high rate of risk for trauma-related mental health disorders due to poverty, homelessness, school delinquency, and community violence. SSG/OTTP will also train professionals from youth-serving systems, as well as local parents/caregivers, in Youth Mental Health First Aid (YMHFA) to increase their capacity to support youth experiencing mental health issues. Additionally, SSG/OTTP will conduct ongoing performance measurement and evaluation and share the results with various stakeholders, including but not limited to collaboration with NCTSI - Category II sites. The BRIGHT project will serve 100 youth in year 1 and 125 youth years 2 to 5, for a total of 600 youth served, as well as will train 30 individuals each year for a total of 150 trained. The project also seeks to achieve the following goals and objectives: Goal 1: Provide and improve access to evidence-based treatment and services for youth impacted by trauma. By the end of year five, the project: (a) will provide information to 1250 community members to increase awareness of youth trauma; (b) will have conducted trauma screenings for 750 unduplicated youth; (c) will have provided 600 unduplicated youth Seeking Safety groups; (d) will have provided support/enrichment groups to 300 unduplicated youth; and (e) will demonstrate a 40% decrease in the severity of traumatic stress symptoms reported by Seeking Safety participants. Goal 2: Increase the capacity of parents and local youth-serving systems to implement trauma-informed practices and provide referrals for trauma-focused services. By the end of year five, the project: (a) will have provided YMHFA training to 75 professionals from youth-serving systems; (b) will have provided YMHFA to 75 parents/guardians from the community; (c) demonstrate at least 85% of YMHFA training participants who report increased confidence in performing actions to support youth with mental health challenges; (d) will have secured new referral relationships with at least five new partners from youth-serving systems. Goal 3: Enhance the available data on best practices for serving trauma-impacted youth. By the end of year five, project: (a) will have developed 5 presentations/ reports to disseminate findings; (b) will have published five annual program updates in a publicly accessible format; (c) will have held 10 meetings to collaborate with NCTSI - Category II sites.

The proposed project, entitled “A Tiered Approach to Trauma- and Grief-Focused Evidence- Based Practice Delivery in Residential and Intensive Programs,” is focused on increasing and improving identification and direct service delivery to the disproportionate number of trauma-exposed and bereaved youth Hathaway-Sycamores Child and Family Services (HSCFS) serves in our residential and community-based intensive programs (CBIPs) across six of the eight service areas in Los Angeles County (LAC). Youth in these programs have had limited access to trauma-and grief-focused evidence-based assessments (EBAs) and evidence-based practices (EBPs) largely due to funding and policy barriers, despite representing the most vulnerable youth across our geographic catchment area (i.e., disproportionately Black [10-79%] and Hispanic [33-68%] populations, low socioeconomic status [18-40% below poverty line], underserved communities in terms of access to care). HSCFS is a large, non-profit community mental health center located in Los Angeles County (LAC), California. HSCFS serves a highly diverse youth population, with 9 locations spanning six of the eight service areas across LAC. Our residential and CBIPs serve many youth who are involved in child welfare and/or juvenile justice systems, and the degree of trauma exposure and grief/loss experiences in this population is substantial and represents a significant service gap. The proposed project includes a sustainable, tiered plan for increasing and improving identification, assessment, and treatment of youth in our population of need by implementing (a) trauma- and grief-focused screening instruments, (b) comprehensive assessment measures, (c) two trauma- and grief-focused EBPs (Trauma and Grief Component Therapy for Adolescents [TGCT-A]; Trauma-Focused Cognitive Behavioral Therapy [TF-CBT]), (d) training for all staff roles across our residential and CBIPs in trauma-informed care (TIC) foundational models to develop shared, trauma-informed language, awareness, and case conceptualization for direct service. In addition, technology-based tools will also be developed and implemented to enhance identification and tracking efforts of youth receiving our services. Predicted measurable outcomes include (a) increased identification and linkages of youth who screen positive for trauma and grief/loss reactions with comprehensive trauma and grief assessments, (b) increased youth enrollment in trauma- and grief-focused EBPs, (c) reduction in traumatic stress and bereavement symptoms as measured by clinical outcome measures, and (d) improved attitudes and practices related to TIC organizational principles. Approximately 755 unduplicated youth will be served by the constellation of services included in the proposed project across the life of the grant.

The Community Counseling Center (CCC) at Azusa Pacific University (APU) offers community based mental health and psychological assessments across the San Gabriel Valley (SGV) in Azusa, California. Data from the Los Angeles County Department of Public Health and the Greater San Gabriel Valley Hospital Collaborative indicates that SGV families experience high rates of stress, poor health, economic burdens, domestic violence, and social isolation. APU will offer interdisciplinary, trauma-informed therapeutic trainings and services, outreach and stigma reduction campaigns, coordinated resource sharing, and aftercare. APU will utilize the National Standards for Culturally and Linguistically Appropriate Services (CLAS) to ensure the needs of vulnerable populations are addressed throughout project planning and implementation. A minimum of 500 individuals will be served annually, leading up to a total of 3000 throughout the lifetime of the project. Goal one is to enhance the quality and capacity of trauma informed mental health services to effectively prevent, assess and treat traumatic symptoms and experiences for at-risk children, adolescents, and families. Objective 1: Train 80% of clinicians in a trauma-informed evidence based practice by September 29, 2022, and every project year thereafter. Objective 2: Provide trauma-informed assessments, treatment, case management, crisis response, outreach and aftercare to at least 500 youth and families by September 29, 2022, and every project year thereafter. Objective 3: Develop a data tracking system to capture and evaluate trauma-informed service numbers and outcomes by September 29, 2026. Goal two is to increase access to services and resources by activating and implementing community-integrated outreach and engagement in collaboration with regional cities and child and family service agencies in the San Gabriel Valley. Objective 1: By September 29, 2022, project staff will partner with the Cities of Azusa, Glendora and Duarte to develop and offer 2 annual community presentations or webinars on identifying, responding to, and coping with traumatic events and experiences. Objective 2: By September 29, 2023, project staff, in collaboration with San Gabriel Valley child and family service agencies will participate in 2 outreach events annually to exchange information with youth, parents and providers on trauma-informed treatment resources. Objective 2.3: Develop a directory of trauma-focused resources to share with clients and stakeholders for enhanced access to care by September 29, 2025.

The YMCA of San Diego County (YMCA) will expand trauma-focused treatment for youth (ages 3-18) and their parents/caregivers through "Finding Youth Resilience" (FYR) that will provide Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) to youth throughout San Diego County who have experienced and exhibit symptoms of trauma. FYR will also offer trauma training to youth-serving personnel to increase their knowledge and awareness of the effects and symptoms of trauma on youth. San Diego County has over 714,000 youth under the age of 18; 43.3% report having experienced at least one Adverse Childhood Experience (ACE), while 14.4% report experiencing two or more ACEs that can lead to trauma. In San Diego County, one in 13 children has an emotional disturbance that limits participation in daily activities, and only 25-35% of affected youth access treatment due to the lack of mental health providers relative to demand for treatment (1:270). There is also an elevated incidence of mental health distress among the nearly 25% of individuals who are foreign-born. Specific FYR program goals and measurable objectives include: 1. Goal: Increase access to effective trauma-focused treatment and services to under-resourced youth and families. Objective: 1a. Screen 200 youth annually (100 in Year 1) for history of exposure to trauma and/or ACEs and distress levels. 1b. 100% of those who meet eligibility criteria will be referred to project services or linked to other appropriate services. 1c. Enroll a minimum of 75 (50 in Year 1) in TF-CBT or EMDR. 2. Goal: Decrease trauma symptoms in youth. Objective: A minimum of 75% of enrolled youth will complete at least five sessions of TF-CBT or EMDR, and 75% of those completing at least 8 sessions will demonstrate decreases in trauma symptoms. 3. Goal: Increase coping and self-regulation skills in youth. Objective: 75% of youth completing at least six sessions will demonstrate increased coping skills. 4. Goal: Increase parent/caregiver knowledge of trauma and appropriate co-regulation skills. Objective: 100% of parents/caregivers who attend a treatment session will receive evidence-informed psycho-education on childhood trauma symptoms and co-regulation, and 75% of parents/caregivers attending at least one parent psycho-education group session will report an increase in knowledge of childhood trauma and its symptoms. 5. Goal: Increase understanding of trauma for youth-serving systems. Objective: 100% of King-Chavez Neighborhood of Schools personnel and Girl Scouts San Diego staff and volunteers who receive trauma training will have a greater understanding and increased knowledge of trauma and its effects on children. FYR will utilize TF-CBT and EMDR to increase knowledge of trauma and trauma symptomatology in youth and their parents/caregivers, and will increase appropriate parenting practices and trauma-related emotional distress through psycho-education. 75 youth and their parents/caregivers will receive TF-CBT or EMDR treatment annually (50 in Year 1), totaling 350 youth and their parents/caregivers throughout the five-year project term. FYR will also provide trauma training to approximately 150 school-based personnel, 80 Girl Scouts staff and volunteers, and 45 YMCA ELP staff annually, for a total of approximately 1,375 adults trained over five years.

Olive View Medical Center – Los Angeles County (OVMC-LAC) proposes implementing a broad range of traumatic stress services to increase access and quality of care. This includes the implementation of a Care Process Model for Trauma (CPMT) of effective evidence-based trauma screening and trauma and trauma-reminder focused interventions for adolescents with posttraumatic stress disorder (PTSD) and their families in North Los Angeles County (LAC) and within schools, other child-serving systems, pediatric and psychiatry clinics, and psychiatry emergency rooms. This project will expand and enhance the capacity of OVMC-LAC to deliver more effective and linguistically/culturally competent trauma screening and treatment to underserved adolescents with PTSD and their families, especially among minorities (e.g., Hispanic, and African American youth, LGBTQ youth, and veteran families.) This proposal is to adopt CMPT, and trauma-reminder focused interventions, including Trauma and Grief Component Therapy for Adolescents (TGCTA), a Family Intervention for Suicide Prevention (FISP), and a Reminder Focused Positive Psychiatry intervention (RFPP) - in collaboration with NCTSN Category II Centers for adolescents with PTSD and their families. We will provide direct service and supervisory consultation using the NCTSN Core Curriculum to providers at OVMC-LAC. Clinicians and nurses at Pediatric Clinics, Los Angeles Unified School District (LAUSD), and Barry J. Nidorf Juvenile Hall mental health clinics will achieve trauma-informed skillset and competency to implement. Trauma-informed screening: CMPT will be primarily implemented in pediatric and mental health clinics, screening 1,500 at-risk adolescents for PTSD per year for a total of 7,500 adolescents. Adolescents at risk for PTSD will be evaluated using the Pediatric Traumatic Stress Screening Tool, and based on the adolescent's trauma symptom severity and the presence of functional impairment in the adolescent's life, adolescents with PTSD will be assigned to one of three treatment interventions, including protective– for mild symptoms, - resilient – for moderate symptoms - or restorative – for severe symptoms. Trauma Reminder Interventions: FISP, TGCTA, and RFPP interventions will be implemented at OVMC-LAC, as a hub, with direct service and ongoing consultation in designated psychiatry clinics. The project will provide evidence-based interventions to 210 youth with PTSD and their families per year for a total of 1,050 youth. The population of focus is trauma-exposed adolescents 9 to 18 years old. This includes children of military families, children involved in the child welfare system, children in pediatric clinics, and adolescents with co-morbid substance use disorders across north LAC, including minorities and underserved populations. Enhancing the skillset and competency of staff who provide CPMT and delivering trauma-focused treatment (Core Curriculum on Childhood Trauma, TGCT-A, FISP, and RFPP) at OVMC-LAC will be done in collaboration with NCTSN Category II centers in Houston, Los Angeles, and Salt Lake City. Reports regarding data collection and progress will be provided to SAMHSA.

Abstract: The purpose of this project is to provide systematic trauma screening and an adaptation of a 7-week evidence-based parenting intervention to biological parents and their young children (aged 1-10 years) in the process of reunification after an out of home placement, helping parents and children adjust to this disruption, and giving resource parents tools to support this process. Population to be Served: Young children (1 – 10 years of age) in foster care are considered at risk for adverse outcomes because of maltreatment, prenatal exposure to drugs and alcohol, and poverty. The experience of maltreatment is widely considered to put children at greater risk for maladaptive social, psychological, and psychobiological functioning. Research has shown that children with externalizing behaviors are significantly less likely to successfully reunify with their parents and at greater risk for future placement instability and psychopathology. Strategies: Children 1-10 years of age beginning supervised visits with biological parents will be invited to participate in PC-CARE, a brief evidence-based parenting intervention that can be delivered in a visitation center in 7 sessions. In addition to adaptating PC-CARE for biological parents during supervised visits, we will provide consultation to resource parents on supporting the child and family during these visits and create an online PC-CARE resource to promote caregivers’ learning and generalization of skills. Project Goals: The overall goals of this project will be to improve 1) public awareness of issues related to child trauma, 2) trauma screening for 1-10-year-old children in supervised visits, 3) successful reunifications; children’s behaviors problems by implementing PC-CARE during supervised visits and evaluating its effectiveness, 4) create an online PC-CARE resource for caregivers and the child-serving workforce. Measurable Objectives: The specific objectives of this project by October 2026 include: Goal 1a) conduct at least four outreach presentations per year; Goal 2a) conduct trauma screening of 625 1-10-year-old children; Goal 3a) provide PC-CARE to 625 children during supervised visits and as a result of participation in PC-CARE: b) decrease the likelihood of foster care re-entry, c) improve biological parents’ perceptions of the children’s behavioral strengths, d) reduce children’s trauma symptoms, e) decrease biological parents’ parenting stress, f) increase biological parents use of PC-CARE skills, g) increase caregivers’ perceptions of children’s behavioral strengths; Goal 4) a) launch an online PC-CARE resource, pilot test it, and b) integrate into treatment process by January 2023, c) provide support to 485 caregivers, with increases in users’ knowledge and satisfaction, d) 150 members of the child-serving workforce will use the online PC-CARE resource, demonstrating increases in knowledge and satisfaction.

Comorbid trauma and psychosis are common yet under-recognized in juvenile justice (JJ), child welfare (CW), and community mental health (CMH) settings; and recognized youth do not receive appropriate services. The Trauma and Adolescent Mental Illness (TAMI) Services Project triples the capacity of service providers in Sacramento County, CA, to provide evidence-based services for youth (age 12-22) with comorbid trauma and psychosis in JJ, CW, and CMH settings. Project goals are: 1) Increase capacity of child-serving systems to identify and appropriately link youth experiencing trauma and psychosis symptoms by implementing a universal screening and referral protocol in Sac County JJ and CW settings; 2) Increase the capacity of Sac County CMH services to provide evidence-based trauma-focused care for youth with comorbid trauma and psychosis by implementing a curriculum that addresses the training needs of CMH providers. Key measurable objectives include: implement universal screening for trauma and psychosis in JJ (yr 1+) and CW (yr 3+); implement comprehensive assessment and linkage to appropriate services for youth who screen positive for trauma and/or psychosis (yr 2+); train CMH partners in evidence based practices (EBPs) for comorbid trauma and psychosis (yr 1-2); support ongoing training needs via bi-monthly consultation calls (yr 2+) and biannual trainings (yr 3+). TAMI services comprise Trauma-Informed Cognitive Behavioral Therapy for Psychosis (TI-CBTp; Folk et al., 2019), developed in collaboration by the UC Davis (UCD) SacEDAPT clinic and UCD CAARE Center. We implemented TAMI services in the SacEDAPT clinic in 2014, have provided care to over 65 youth, and built capacity for 25 cases per year. Unfortunately, an estimated 100 system-involved youth need TAMI services annually in Sac County, and SacEDAPT is the only Sac County provider of TAMI services. This project will increase TAMI service capacity in Sac County by expanding to 6 additional CMH sites. Our team is uniquely positioned carry out this work: the SacEDAPT clinic and CAARE Center have an established partnership and are nationally recognized leaders in the development and implementation of EBPs for youth with trauma and psychosis in diverse settings. Over the 5-year project we anticipate screening a total of 1,365 individuals across JJ and CW settings; we estimate conducting 369 comprehensive assessments with youth who screen positive for psychosis or trauma; and we estimate 185 youth will receive TAMI services over the course of the project. By the end of the project, we will have increased TAMI service capacity from 25 to 80 individuals annually, tripling Sac County capacity to provide evidence-based trauma-focused care to system-involved youth with comorbid trauma and psychosis. This project will also build the necessary screening, assessment, and training infrastructure to support ongoing expansion of TAMI services in Sac County and beyond.

Project Name and Summary: Aurora Community Mental Health Center, d/b/a Aurora Mental Health Center (AuMHC) proposes funding through the National Child Traumatic Stress Initiative - Category 3 to expand and enhance the Trauma Resilience Youth Program (TRYP) to provide treatment needs specific to cultural adaptations and implementation in a service system that effectively engages and retains refugee, immigrant, and asylee populations in Colorado. Population to be Served: Children and families who are immigrants, refugees, and asylee who are in need of effective, culturally competent and linguistically accessible therapeutic services to recover from trauma and re-engage in activities that support health development. Strategies and Interventions: We will integrate best practices for refugee and immigrant populations to elevate our standard of care, building our staff experience, evidence-based treatment modalities, and population health management capacity. Key activities include: providing outreach and engagement strategies to increase participation in and access to treatment and prevention services; providing direct evidence-based mental disorder treatment and services including screening, assessment, case management, therapy, and prevention; collaborating with other NCTSI centers to improve engagement and outcomes for youth that have experienced trauma; provide services to populations of child-serving systems; and conduct a program evaluation to TRYP which will be submitted and shared with SAMHSA by the end of the project period. Project Goals and Measurable Objectives: Goal 1 is to increase TRYP capacity to deliver culturally and linguistically appropriate therapeutic services to improve the mental and physical health of refugees and immigrants in the Aurora community. TRYP will hire two new clinicians, identify enhancements for the electronic health record to improve documentation, monitoring, and client outcomes, and will develop a sustainable financial plan for Health Navigator services. Goal 2 is to increase capacity for an implementation of the Trauma Systems Therapy for Refugees (TST-R) including meeting fidelity in each of the four Tiers. TRYP will collaborate with Boston Children's Hospital to train TRYP Clinicians in TST-R, develop and offer TST-R trainings to AuMHC staff and partners, and establish fidelity of each TST-R Tier. Goal 3 is to develop and pilot a collaborative Two-Generation (2Gen) approach to enhance family well-being by intentionally and simultaneously working with refugee and immigrant children and their caregivers. This will include assessing feasibility of implementing a 2Gen model, identifying treatment options through a family systems approach, integrating an adult refugee-serving clinician to the TRYP team, and piloting the model with up to 10 families, evaluating its effectiveness and capacity.

The Resilient Communities: Building a Trauma-Responsive System of Care project will serve children and families from all backgrounds who have been impacted by any type of trauma with the aims of increasing access to evidence-based treatments, reducing health disparities, improving quality of life, and building community-wide resilience. Target subpopulations include children involved in the child welfare system or in foster/kinship care, as well as marginalized underserved populations (e.g., low-income, LGBTQIA+, Latinx, Limited English/monolingual Spanish speakers). The geographic catchment area includes Boulder and Broomfield Counties in Colorado. The project aims to serve a total of 13,345 children and families over the 5-year project period. Key goals include: (1) Increase protective factors and reduce risk factors for children, youth, and families experiencing trauma or adversity by implementing sustainable, evidence-based, culturally responsive prevention services; (2) Improve behavioral health outcomes, including trauma symptoms, for children, youth, and families by implementing and sustaining culturally responsive trauma-focused evidence-based practices (TF-EBPs); and (3) Improve access to care and multisystem coordination for children, youth, and families by providing services to service systems, building efficient referral pathways, and ensuring culturally responsive systems. There is a clear need to increase access for families to the evidence-based treatments that directly link to positive youth outcomes, including targeted prevention and outreach efforts for marginalized populations. And because clients often present with multiple, co-occurring forms of behavioral health challenges, clinicians must be equipped with the transdiagnostic approaches and core set of competencies proposed in this project that are empirically linked to clinical benefit to effectively help clients reduce risk, mobilize protective factors, and achieve positive outcomes. The targeted outreach and engagement strategies described in this proposal will promote the protective factors (e.g., parental support and warmth, responsivity, coping skills, social support), and reduce the risk factors that have far-reaching impact, including downstream prevention. This project will also take advantage of the rich opportunity to better meet community need by improving cross-system expertise through learning opportunities, community building, and strong referral pathway development for children- and family-serving partners. Resilient Communities includes development of an innovative Trauma-Focused Community Health Worker role to lead outreach, engagement, and stigma reduction activities that will build community and break down access barriers for marginalized populations.

The Wendt Resilient Scholars community-based, family-focused project (RSP) addresses barriers to mental health care faced by at-risk children and adolescents in Washington, DC, by increasing access to evidence-based treatment services. RSP serves children, adolescents, and families from DC's lowest-income Wards. The project implements three evidence-based practices to address untreated trauma, increase protective factors within families, and improve child/adolescent emotional wellbeing and health. The Wendt Center for Loss and Healing is the leading provider of trauma-informed mental health care in the Washington, DC, region, sharply focused on improving access to treatment for under-resourced communities. The children, adolescents, and families served through RSP reside in DC's most impoverished neighborhoods with the highest rates of health disparities and exposure to chronic stressors. Participants will be low-income, minority families who have experienced trauma and/or traumatic loss (community violence, poverty, discrimination, incarceration loss, etc.). The project incorporates a dual individual and systems-level approach, allowing more children/adolescents to directly access treatment while equipping the systems in which they spend their time (their families, schools, communities) to provide supportive environments that promote emotional wellbeing and health. In addition to direct treatment services, RSP provides training on trauma-informed practices to school staff and community members who serve and interact with trauma-impacted young people. RSP will serve 50 new families annually for the first three years of the grant and 45 families annually for the final two years, reaching approximately 720 individuals. RSP will train 70-75 school personnel and 45-50 community members annually. Collectively, 1,320 individuals will be served over the life of the grant. The project goal is to increase the impact and reach of mental health services for low-income, minority DC children/adolescents and their families who are suffering the adverse consequences of exposure to trauma and/or traumatic loss through a holistic, community-based program of evidence-based interventions. Objectives include: 1) Strengthen RSP infrastructure to provide accessible and effective services through the project's community-based, family-focused interventions; 2) Provide 50 news families (Years 1-3; 45 new families for Y4-5) impacted by trauma with access to evidence-based mental health services per year, with 70% of family members demonstrating decreased mental health symptoms, 65% increasing coping skills and functioning, and 65% improving family communication upon treatment completion; 3) Expand the ability of schools and community members to meet the needs of trauma-impacted children/adolescents through the provision of training to 75 school personnel (68 for Y4-5) and 50 community members (45 for Y4-5) per project year' 4) Effect systemic change to improve community understanding of, and response to, children/adolescents impacted by trauma through participation in 2-4 DC City Council hearings and 20-25 additional relevant forums on a yearly basis; and 5) Review and evaluate effectiveness of program and services in close collaboration with NCTSN.

Our proposed project PACTT (Providing Adolescents and Children Trauma Focused Treatment) will provide trauma services in Miami Dade County FL, one of only a few counties in the US with a racial/ethnic "minority majority" population. While PACTT will serve a countywide catchment area, it will heavily focus on two communities experiencing disproportionate traumatic events with corresponding impacts on children and families: (1) Homestead (South Dade); and (2) Overtown. These catchment areas share common denominators such as poverty reflecting stark racial dimensions, frequent incidences of violent crimes, including gang violence, poor quality schools, and other social and economic inequity. Among Miami-Dade youth, 15.2% report four or more adverse childhood experiences (ACEs), which also contribute to high depression rates (FYSAS 2020). Over the five year project period, we will provide Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) to approximately 107 children (5-11), and 249 adolescents (12-17) and their families who experience, or are at-risk for experiencing, traumatic events such as community violence, family violence, sexual abuse, physical abuse, bullying, and including poly-victimization (multiple types of victimization). Age wise, about 17% will be 5-9 years of age, 19% 10-12 years old, 41% 13-15 years old, 23% will be 16-17 and 65% will be female. The racial/ethnicity breakdown is expected to be as follows: Homestead - 15,434 Hispanic 67%; Black 21%, and White 12%; and Overtown = 1,173 Black 75%; Hispanic 20%, and Other 5%. Project PACTT will be implemented by Jewish Community Services of South Florida, Inc (JCS). Founded in 1920, JCS has provided behavioral health and social services to our Miami Dade community for more than 100 years. We provide a single high-quality standard of care for all clients seeking services independent of race, religion, identity, and gender. Moreover, we manage the 2-1-1 Help Line 24 hours a day, 7 days a week in all languages to provide information and referral services to individuals, families, and the community when they are in crisis and/or do not know where else to turn. We will leverage our 5+ year evaluation partnership with the University of Miller (UM) Miller School of Medicine's Department of Epidemiology and Public Health in the field of trauma-related mental disorders to provide effective trauma-focused treatment. Our overarching PACTT Goal is to: Provide and increase access to effective trauma-focused treatment and services systems for 375 children, adolescents, and their families who experience traumatic events in Miami-Dade and particularly in Overtown and Homestead. We are successfully wrapping up a SAMHSA Child Traumatic Stress initiative and, with SAMHSA's help, look forward to continuing this lifesaving work until we are able to sustain these efforts without federal assistance, a goal that was adversely affected by COVID's economic toll on our community.

Project Intersect: Trauma-focused Treatment and Services for Youth and Families who have Experienced Commercial Sexual Exploitation and Trafficking, will increase access to effective trauma-focused evidence-based treatment and services systems for youth and their families who have experienced Commercial Sexual Exploitation and Trafficking (CSET) and who are at high risk of CSET in Georgia. Youth who have experienced CSET (Y-CSET) have very rates of trauma exposure and impacts, with especially high rates of Post-Traumatic Stress Disorder and symptoms as well as anxiety, depression, and substance use problems. There are a number of health disparities associated with CSET. Youth of color, youth from low-resource families and communities and LGBTQ youth are significantly over-represented among Y-CSET. There is limited availability of services adapted to meet the needs of Y-CSET in GA. Services are needed that specifically target key gaps and clinical needs: Access to trauma-focused evidence-based treatment, especially in rural areas; treatment to address intersecting trauma impacts and substance use problems; treatment adapted to address racial trauma; Y-CSET caregiver (foster caregiver/ parent) training and support; trauma-informed CSET-aware congregate care/residential treatment (CC), and services for youth at high risk of CSET (YHR), who often have comparable trauma histories and service needs. To address these gaps. project goals/objectives are as follows: (1) Increase access to trauma-focused evidence-based treatment adapted to meet the needs of Y-CSET and their families (2) Increase access to evidence-based treatment that targets both trauma and substance use problems, tailored and adapted to meet the needs of Y-CSET; (3) Increase access to trauma-focused evidence-based treatments adapted for youth who have experienced Racial Trauma (RT) (4) Improve Foster Care knowledge of traumatic stress, trauma-informed care, trauma-focused treatment, CSET to better identify and achieve safe, supportive, and sustained placements for Y-CSET (5) Improve systems professional workforce knowledge and skills regarding traumatic stress, trauma-informed care, trauma-focused treatment, and CSET to better respond to the needs of Y-CSET in CC, particularly youth in CSET-specific programs (6) increase access to trauma-focused evidence-based treatments and interventions for YHR. To accomplish these goals, community outreach, awareness and service delivery will be conducted throughout the state (13 DFCS regions, 900 individuals), including Trauma-focused Cognitive Behavioral therapy (TF-CBT) adapted for Y-CSET (225 youth), TF-CBT adapted for youth who have experienced RT (40 youth), Risk Reduction through Family Therapy adapted for Y-CSET (150 youth),TF-CBT with YHR (225 youth) In addition, NCTSN Resource Parent Curriculum adapted for CSET will be delivered to 220 caregivers in all 13 regions, and Think Trauma adapted for Y-CSET and CC will be delivered to 105 staff of 3 CSET specialized CC settings. In all, 1825 youth and service systems professionals will be served (170 Y1, 350 Y2, 435 Y3-5).

The "Serving Underserved Populations in Rural Settings: Targeting Treatment and Adolescent Resilience Together" (SUPRSTART) Project will bring evidence-based mental health services to seven rural, underserved Georgia counties by training therapists in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and telehealth provision. It will expand child maltreatment (CM) prevention awareness by training 760 community leaders in two evidence-informed programs. CM is associated with an increased risk of deleterious outcomes such as post-traumatic stress, major depression, substance use, and revictimization. It is critically important that abused children have access to evidence-based treatment. Yet, families in the seven target counties must travel in excess of 27 miles to obtain services. SUPRSTART will bring telehealth TF-CBT services to youth victims ages 3-18 years in Burke County, and the Toombs Circuit, circumventing major geographic barriers to care. Among youth seeking services in the region, more than 60% are under 12 years of age, and almost 70% identify as female. Fifty percent of youth are African American. Importantly, the increased recognition of CM impact on health has led to state-level efforts enforcing evidence-informed prevention training among adults in close contact with youth to improve recognition of CM occurrences in community settings. However, less than 5% of adults in the rural Georgia Counties are trained to date. SUPRSTART will address CM service gaps in Burke County and the Toombs Circuit by 1) expanding the network of trained therapists in telehealth TF-CBT, TF-CBT for commercially sexually exploited youth, and treatment for youth victims struggling with suicidal ideation; 2) creating a sustainable telehealth delivery model using local Georgia Family Connection Partnership county offices, and 3) expanding the dissemination of the evidence-informed Stewards of Children and Connections Matter CM prevention curricula to pediatric residents at the Medical College of Georgia, and community leaders across the seven counties. These goals will be met under the guidance of an Advisory Committee comprised of local and national experts. In Years 1 and 2, we will train two cohorts of 15 community therapists each in TF_CBT, and telehealth delivery. In Year 3, these cohorts will receive advanced training, TF-CBT+, to address complex trauma among sexually exploited youth. Additionally, therapists will receive training in a trauma-informed self-harm risk reduction model (SAFETY-A) in Years' 2 and 3. We anticipate an annual increase in youth to be served via SUPRSTART: Year 1 n=20, Year 2 n=30, Year 3 n=40, Year 4 n=50, Year 5 n=60, for a total of 200 youth. Each year, at least 12 pediatric residents (total 60) and 20 community leaders per county (total 700) will receive prevention training. The Advisory Committee will perform continuous program evaluation across implementation and service delivery goals to ensure seamless telehealth treatment provision in these rural regions, and positive health outcomes among youth.

WestCare Pacific Islands’ (WPI) proposed “Ma’lak na Ha’åni” (CHamoru for Bright Futures) program will provide culturally responsive treatment for trauma-related mental health issues for male and female youth ages 11-17 living on the U.S. territory of Guam, specifically focusing on the island’s CHamoru, Filipino, Asian, and other Pacific Island subpopulations. The current availability of mental health treatment on Guam comes nowhere near to meeting the need for services. According to the 2019 Youth Risk Behavior Survey for all high school youth in Guam’s public school system, 46.9% of respondents reported feeling prolonged sadness and hopelessness; 11.3% reported experiencing sexual violence; and 11.1% reported feeling unsafe at or on their way to and from school. More alarming are the respondents’ reports on suicide with 23.8% having seriously considered attempting suicide; 24.4% made a plan about how they would attempt suicide; 16.5% had attempted suicide; and 3.7% made a suicide attempt that resulted in the need for medical intervention. These statistics illustrate a dire need to address the effects of traumatic stress for Guam’s youth. WestCare Pacific Islands (WPI), in collaboration with cross-sector community partners, proposes to step into this unmet need and provide critical, culturally relevant mental health support and treatment services for children and families impacted by trauma. WPI proposes to provide evidence-based, developmentally appropriate, trauma-informed mental health services and coordinated linkages to other needed supported services in the community. The project will also deliver a series of community events and trainings to increase awareness and understanding of trauma-related mental health issues among parents, community members, youth-serving agencies, and others who interact with children, deepening and expanding community relationships to better serve the children and families of Guam. WPI’s Ma’lak na Ha’åni program proposes to serve 75 unduplicated participants per year for a total of 375 unduplicated participants served over the five-year grant term. The program’s proposed goals, each with measurable objectives, are to 1) Increase the screening, diagnosis, treatment and referral of mental health issues for male and female youth ages 11-17 years and their families on the pacific island of Guam in order to improve the well-being of youth who have experienced trauma; and 2) Increase the awareness and capacity on the pacific island of Guam to provide trauma-informed mental health clinical services to male and female youth ages 11-17 years, parents/guardians, and community members to better detect and respond to mental health issues. In pursuing these goals, WPI will apply evidence-based practices including Cognitive Behavioral Therapy (CBT), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Seeking Safety, and Motivational Interviewing (MI).

The Service-partners Promoting Awareness, Resilience, and Knowledge-based Solutions (SPARKS) project proposed by the Pediatric Stress and Anxiety Disorders Clinic (PSADC) at the University of Illinois at Chicago (UIC) aims to increase access and provision of evidence-based trauma services for youth in the Chicagoland area by expanding the capacity of the Colbeth Child Adolescent Psychiatry Clinic for serving youth in clinic and community settings. The high levels of traumatic stress, community violence exposure, co-occurring behavioral health challenges, chronic socio-economic adversity, and the COVID-19 pandemic crisis have combined to expose the scarcity of trauma informed services among youth and families residing in the identified catchment areas (e.g., Chicago and its adjacent communities especially the Park Forest suburb). Consequently, the SPARKS project aims to provide a comprehensive, coordinated, and collaborative set of evidence-based trauma informed services to address this multiplicity of clinical care needs among targeted Chicagoland youth and families. In particular, SPARKS adopts the following goals and related measurable objectives: 1) increase access to care for youth and families impacted by trauma in Chicago and surrounding communities by reaching 1,735 total youth and families for the 5-year period) by a) utilizing evidence-based outreach and engagement strategies (520 youth/families total), b) administering evidence-based trauma screening and assessment tools (660 youth total), and c) providing trauma-focused prevention and intervention services (555 youth/families annually); and 2) engage in local and national partnerships to increase staff expertise and contribute to services adaptations to reach youth in school, community, and law enforcement systems by a) sustaining implementation of evidence-based, trauma-focused prevention and treatment services and increasing staff cultural competence in collaboration with NCTSN national training partners with minimum 80% training participation, b) expanding the reach of PSADC by ensuring between 20%-50% of proposed SPARKS program services are delivered at local partner outreach sites for key child-serving systems, and c) contributing to the coordination of services across child-service systems and the development of products, webinars, trainings, and resources in collaboration with NCTSN sites and local partners (minimum 4 collaborative activities annually). Through these goals and activities, SPARKS will increase evidence-based strategies for outreach, engagement, screening, assessment, prevention, and intervention strategies along with supporting continued protocol implementation, increased cultural competence, child service system coordination and resource exchange in the Chicago metropolitan and suburban areas.

La Rabida Children’s Hospital’s Chicago Child Trauma Center (CCTC) serves traumatized children and families living in low-income Black communities on Chicago’s South Side and southern suburbs with trauma assessment and therapy, case management, and trauma screenings and consultation. CCTC’s clinical expertise, staff development, commitment to excellence in care, and institutional knowledge make it an essential resource for children on Chicago’s South Side. CCTC’s goals include serving 300 clients each year, 225 of which will engage in long-term psychotherapy essential to treating complex trauma yet rarely offered. Given the multi-year treatment plan necessary for most clients, we hope to serve at least 700 unique clients over the course of the entire project. CCTC is one of the only agencies in Chicago that specializes in trauma-focused assessment and therapy for the full range of potentially traumatic events experienced by children. In the past 3 years of service, 79% of clients served identified as African American, 11% as multi-racial, and 9% as Caucasian. CCTC has maintained affiliate status with the National Child Traumatic Stress Network (NCTSN) after being funded as a Community Treatment and Services site (CTS). Our emphasis on resiliency and expertise in child trauma place CCTC in a unique position to increase and enhance the services available to traumatized children in the Chicago area and to continue to make valuable contributions to the NCTSN. Grant funding will enable CCTC to increase delivery of trauma-related services to community referrals—children not involved in the child welfare system—who have high levels of exposure to community violence, complex trauma, and COVID-19 related traumatic separation and grief. It will also assist the center in attaining consultation and support to better serve our clients and integrate into our community to assure we are meeting their needs. CCTC’s goals include (1) increasing our capacity to provide direct evidence-based trauma-focused treatment and case management services to high-needs children in the community who are not involved in the child welfare system; (2) Maintaining education and consultation in EBPs for complex trauma, particularly for those exposed to community violence; (3) developing structured approaches to increase cultural responsivity in treatment and systems processes, working to embed a more robust anti-racist and racial equity lens; (4) better integrating CCTC into the community, building stakeholder trust, gaining and integrating community feedback, and improving client engagement; and (5) expanding collaboration and knowledge sharing with local and national networks in order to improve the assessment and treatment of complex trauma in children.

Promoting Recovery and Resilience in Traumatized Children and Youth through Community Partnerships. Abstract- Children and youth in the Metro Louisville region are at risk for developing and are experiencing trauma and associated symptomology due to abuse and neglect, homelessness, domestic violence, economic distress, discrimination, racism, family separations, loss and grief, COVID-19 pandemic, and other traumatic and adverse life events. There is not enough professional capacity to keep up with the number of children and youth who are in need of trauma focused mental health assessment and treatment, particularly related to the events that have unfolded in the last year. To promote the recovery and resilience of traumatized children and youth, the University of Louisville’s Kent School of Social Work will partner with Metro Louisville region’s mental health service organizations to increase the number of mental health personnel trained in evidence-based trauma informed interventions, engage the community in mental health promotion education, provide treatment to traumatized children and youth, and assess impact of these efforts through process and outcome evaluation. It is expected that by through this partnership, 70 service providers will have been trained in evidence- based trauma focused interventions, 1000 persons from the community will have been engaged in mental health promotion and education, and 600 children and youth will have received trauma focused treatment to promote their recovery and resilience.

Mountain Comprehensive Care Center (MCCC), a current NCTSI-III grantee, will continue the Hope Initiative to increase access to and provide evidence-based and trauma-focused treatment and services for children/adolescents birth to age 17 and their families who experience traumatic events within the 8 adjacent counties of Breathitt, Floyd, Johnson, Knott, Magoffin, Martin, Perry and Pike counties located in eastern KY and Central Appalachia. Population: The population of focus is children/adolescents birth to age 17 and their families who experience traumatic events within the 8 targeted counties. The population will be rural and includes at-risk populations, LGBTQ and those with complex trauma (e.g., exposure to parental behavioral health issues, domestic violence, child abuse, parental deployment or incarceration), and demographically will mirror the general public. Based on data from the current project, it is anticipated that 35% of youth may be male, 63% female, and 2% transgender or gender fluid. All counties are rural, “distressed,” and among the nation’s worst 10% for economic inequities. Interventions: MCCC will use the evidence-based practices of Trauma-Focused Cognitive Behavioral Therapy, Cognitive Behavioral Therapy, and Child-Parent Psychotherapy as well as ensuring a trauma-informed care approach to all services. MCCC will conduct comprehensive, culturally-appropriate outreach and training for child-serving systems and community partners to increase access to trauma-focused care as well as provide direct outpatient evidence-based and trauma-focused treatment and services including therapy, care management, prevention, wraparound services and follow-up for up to 6 months post discharge to ensure ongoing stability. Goals/Objectives: The project will serve 150 youth in Year 1 and 200 annually in Years 2-5 for a total of 950 over the 5-year period. Goals are to increase access to effective trauma-focused treatment and services systems for children/adolescents (0-17) and their families who experience or witness traumatic events; improve provision of effective trauma-focused treatment and services systems; and maintain effective project implementation and evaluation by conducting CQI activities. Objectives include: training 5 local, regional and/or state services systems and community partners annually about trauma, services, identification, and referral protocols; collaborate quarterly with NCTSI Centers to develop, advance and adapt interventions to improve engagement/outcomes for traumatized youth; conduct 150 screenings and assessments in Year 1, and 200 annually in Year 2-5, to identify participants in need of treatment/services and connect to the appropriate care; provide direct evidence-based outpatient mental disorder treatment, care management, therapy, prevention, advocacy, wraparound services so that 70% of clients served show an improvement in their social and/or behavioral functioning; provide and/or coordinate training in evidence-based practices for 10 project staff; and conduct quarterly Project Management Team meetings to monitor outcomes, and ensure CQI. Morehead State University will conduct an independent project evaluation including process and outcomes evaluation.

Project Fleur-de-lis (PFDL), a program of Mercy Family Center, began as an intermediate and long-term school-based mental health service model for youth exposed to traumatic events in the Greater New Orleans area following Hurricane Katrina. PFDL has evolved to provide evidence-based treatment to youth, families, and communities who have been impacted by community violence, grief, complex trauma, and suicide to enhance personal and community resilience. PFDL’s population of focus is low-income, urban, Black youth ages 5-21 who are underserved in the Greater New Orleans (GNO) area (Orleans, Jefferson, St. Tammany, St. Bernard, and Plaquemines Parishes (counties)) who have been adversely impacted by community violence, complex trauma, suicide, and grief. Project Fleur-de-lis (PFDL) proposes the following goals and objectives: Goal 1: Increase access for trauma-exposed, culturally diverse youth and their families to culturally responsive, evidence-based trauma treatment. Objective 1A: By the end of the five-year project, PFDL and partnering school and community mental health professionals will provide CBITS, Bounce Back, and SPARCS to a minimum of 375 youth and families. Objective 1B: Upon completion of treatment, youth will report a 30% decrease in PTSD symptoms as measured by the Child PTSD Symptom Scale (CPSS). Goal 2: Increase access for youth and their families to culturally responsive, evidence-based bereavement and traumatic bereavement treatment. Objective 2A: By the end of the five-year project, PFDL and partnering school and community mental health professionals will provide TGCT and MGT to a minimum of 200 youth and families. Objective 2B: Youth will report a 30% decrease in maladaptive grief reactions on the Persistent Complex Bereavement Disorder (PCBD) checklist upon completion of treatment. Goal 3: Establish a trauma-, bereavement-, and suicide-informed community for youth by building the capacity of mental health professionals, community members, and youth with lived experience in PFDL’s geographical catchment area. Objective 3A: After the five-year grant cycle, PFDL, partnering school and community mental health professionals will have used SAFETY-Acute with a minimum of 250 youth at risk of suicide and report a 25% increase in collaborative safety plans with youth and families. Objective 3B: A minimum of 250 youth-serving professionals, school staff, and community members will demonstrate an increase in knowledge of childhood trauma as evidenced by the CCCT evaluation measure. Objective 3C: PFDL will provide education on bereavement-informed care and suicide prevention to a minimum of 500 youth-serving professionals and school staff. Objective 3D: A minimum of 100 youth with lived experience will participate in community-building circles to increase feelings of belonging, to reduce stigma, and to assist PFDL with incorporating their voices into our trainings and programming. PFDL will serve 450 individuals in Year 1, 500 in Year 2, 550 in Year 3, 600 in Year 4, and 650 in Year 5, serving a total of 2,750 unduplicated individuals across the five-year grant period.

The Culturally Relevant Tiered Trauma Treatment Program will address trauma, PTSD and severe depression in school age Black, Indigenous, and People of Color (BIPOC) youth living in Rhode Island's diverse, high poverty urban core cities. This culturally relevant, community-based program will also engage and train the systems and the adults who care for youth in these communities including parents, mental health professionals and public systems. With 90% of urban core youth screening positive for one or more traumatic exposures in Rhode Island, this project will address an urgent need for increased access to effective trauma-focused treatment and services systems for children and adolescents and their families, particularly in communities of color that have been disproportionately impacted by the pandemic. The Children and Youth Cabinet of Rhode Island (CYC) will serve as the lead intermediary organization for this project in partnership with licensed trauma-focused clinicians, implementation teams and evaluators affiliated with The Providence Center (TPC), Brown University, and the Culture and Evidence Based Practice Research Center at DePaul University. A key focus will be on understanding and addressing the mental health disparities of youth of immigrant, ethnic and linguistic minority backgrounds. STEAM Box, a youth-led nonprofit, will serve as an innovative youth engagement and outreach partner through podcasts, skills training and social-personal development and enrichment. CYC and its partners will implement two Tier 2 evidence-based programs, Cognitive Behavioral Intervention for Trauma in Schools (CBITS) and Act and Adapt. We will also implement the Tier 3 evidence-based therapeutic practice Cognitive Behavioral Therapy (CBT) and disseminate trauma systems trainings based on the data from universal trauma screening. The program will engage public systems including schools, child welfare and juvenile justice agencies; recruit, train and build leadership pipelines for clinicians, artists and educators who are BIPOC with shared lived experiences that mirror the student population; and create continuous consumer feedback loops to improve practice. Each year, the program will serve 275 children and youth in CBITS, Act and Adapt and CBT programs, and train 450 parents, educators and mental health professionals. Altogether the program will serve 3,625 unduplicated individuals over five years Tier 2 outcomes will include improvements in youth wellbeing and a reduction in PTSD symptoms among 80% of youth participants. Tier 3 outcomes will include improved indicators of overall mental health by 30% on average.