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Summary: Vision for Children at Risk (VCR) proposed to work collaboratively with community based organizations to promote the wellness of young children, from 0-8 years of age, by addressing social, emotional, cognitive, physical, and behavioral aspects of development. Major partners include safety net behavioral health and health providers, the public school district, and an organization that provides training and consultation to professional care givers. Project name: Saint Louis Project LAUNCH (STL-PL) Populations: STL-PL will focus on children ages 0-8, their parents/guardians, and professional caregivers. Professional caregivers will include staff at unlicensed childcare providers and early childhood staff in the public school. Strategies: STL-PL will impact system coordination by increasing provider use of Ages and Stages Questionnaire (ASQ) as the primary screening tool to build a regional understanding of child development needs. Health care providers will be encouraged to use the ASQ to identify behavioral and developmental needs of children. Parent training will provide both group and individual interventions to build knowledge and protective factors of low-income and minority families. Unlicensed child care providers and early childhood staff at the public school district will receive behavioral health consultation to increase their capacity to respond to emotional and behavioral health needs of children. Goals/objectives: Goal 1: Improve coordination and collaboration across family and child serving system. Objective 1.1: Increase organizational use of ASQ Data Hub to 25 child serving sites by year 5. Objective 1.2: Increase the integration of behavioral health into primary care at two safety net health providers. Objective 1.3: Increase access to existing behavioral health resources through a linkage and referral system for use by parents and organizations. Objective 1.4: Engage at least 40 organizations as members of the Young Child Wellness Council by the end of year 3. Goal 2: Increase knowledge of parents of children 0-8 on topics of early childhood development and community resources. Objective 2.1: Increase knowledge of protective and wellness factors in 240 parents of children 0-8 annually. Objective 2.2: Increase connections to community resources for 240 families attending Cafes annually. Objective 2.3: Increase positive parenting behavior for at least 100 families through Triple P over 5 years. Objective 2.4: Engage at least 20 parents as members of a Parent Advisory Council over 5 years. Goal 3: Increase capacity of child care providers and early child educators on topics of early childhood development. Objective 3.1 Increase capacity of 2 medical providers, 45 Family Child Care Homes, and 65 Early Childhood staff at Saint Louis Public Schools to respond to the emotional and behavioral needs of children and families. STL-PL will serve 462 individuals annually, including children, parents/guardians, and professional care givers.

Family Service (San Antonio) will foster the healthy development of young children by: preparing child serving systems to identify and refer for screening and assessment children with developmental or behavioral differences; providing consultations to families and providers; educating parents about healthy, safe environments for children; and introducing co-located, integrated primary and behavioral health care for young children with developmental issues. Project Name: Project LAUNCH San Antonio Population to be served: Children ages birth to eight who are at-risk for or affected by early childhood mental health concerns and related developmental delays. Of the children assisted by Project LAUNCH, 77% are expected to be Hispanic, 8% Anglo and 11% African American. Three-quarters will be boys, 96% will be economically disadvantaged, and 55% will live with a single parent. Strategic Interventions: A) Screen children for mental health intervention needs. B) Provide or coordinate evidence-based early intervention services (mental health assessment, consultation and/or trauma-informed counseling). C) Provide workforce development training to early education providers to build knowledge of children’s mental health, developmental indicators, methods of fostering social and emotional learning, and methods of identifying children in need of assistance. D) Build capacity of four partners (Voices for Children, UHS, Baby Court, the San Antonio chapter of the Texas Association for the Education of Young Children) and early education providers (childcare centers, Head Start and Early Head Start programs, school districts, PreK4SA) to identify and effectively address children’s mental health concerns at the earliest possible point, reducing health disparities for at-risk populations. Project Goals and Objectives: The goal is to promote the wellness of children from birth to eight years of age by addressing the social, emotional, cognitive, physical and behavioral aspects of development and preparing them to thrive in school and beyond. Five year objectives are: 1. Improve the capacity of 1,800 childcare and early education providers to understand and support children’s mental health and developmental trajectories. 2. Provide mental health consultation and early intervention services to 970 children and their families. 3. Provide trauma-informed parenting training and support groups to increase the capacity and skills of 125 parents, guardians and family caregivers to promote healthy, safe and secure environments in which young children can learn and grow. 4. Deliver integrated, single site primary and behavioral health care and developmentally appropriate mental health services, in a public pediatric clinic. 5. Establish a Young Child Wellness Council (YCWC) to advise and provide support to Project LAUNCH. 6. Improve coordination and collaboration across child and family-serving systems. Project LAUNCH will assist 1,195 unduplicated children, 465 families and 1,800 childcare and early education staff across the five-year project period.

Through a cross-sector partnership, the Rochester Whole Child Health Initiative (Roc-WCH) will integrate child- and family-serving systems with the goal of preventing behavioral health concerns through early detection and intervention. Concurrently, the professionals who work with children will be better equipped with the knowledge and skills they need to support young children’s social and emotional development in partnership with families. This project targets those who work with low-income (i.e., Medicaid eligible) children ages 0-8 residing or receiving care in the city of Rochester, NY. Rochester ranks 1st in similar sized cities for child poverty and is the 5th poorest city in the US among the top 75 metropolitan areas (Johnson, Doherty, & Hebda, 2016). The city is ethnically and racially diverse: 16% Latino, 42% Black, 38% White, 3% Asian, and .5% American Indian and Alaska Native, and 4% multiracial and faces many of the challenges that similarly poor and diverse urban communities struggle with. According to a recent survey of high school students, 70% of Rochester area youth experienced at least one Adverse Childhood Experience (ACE) and 28% reported three or more traumatic life events (Monroe County Department of Public Health, 2017). A recent Greater Rochester Health Foundation (GRHF) report indicates that there are major gaps in children’s behavioral health services in our region to address this trauma (Scharf, et al., 2015). There is a particular shortage of providers with adequate training and expertise to work with young children with mental and behavioral health concerns. Our project addresses these gaps. Although the association between children’s experiences of poverty and their development and academic success has been well documented (Black, Hess & Berenson?Howard, 2000), a growing body of research shows that preventive interventions that strengthen relationships and promote early social-emotional competencies equip children academically and interpersonally (Domitrovich, Moore, & Greenberg, 2012; Dunlap & Fox, 2014). ROC-WCH will provide: 1) screening and assessment to ensure early identification of behavioral and developmental concerns annually for 3,834 children ages 0-8 in Rochester for a total of 16,002 (11,502 with LAUNCH funds, 4,500 with non-federal funds) children screened and 900 pre- and peri-natal women for a total of 2,700 (non-federal funds) women screened; 2) training, capacity building, and consultation services annually for 160 health care providers and 22 early care and education professionals for a total of 209 and 110 trained respectively; 3) referrals, consultation, and intensive support services to 533 parents/families of young children for a total of 1,739 (1,549 with LAUNCH funds, 190 non-federal) children served and 180 pre- and peri-natal women for a total of 900 (non-federal) women served; and 4) training annually for 56 parents/guardians focused on building strong relationships and creating healthy, safe, and secure environments for a total of 280 parents trained.

The Schenectady Community Action Program’s (SCAP’s) Project LAUNCH will contribute to the healthy development and wellness of at-risk young children in Schenectady County in New York State, preparing children from birth to age eight to thrive in school and beyond. Service components will include: assessment and screening, intervention and treatment, parent education and training, and professional development and support for staff in child-serving organizations. The Schenectady Coalition for a Healthy Community has identified Promoting Mental Health & Preventing Substance Abuse as a priority area requiring focus in this community. Risk factors are compounded for families experiencing economic challenges, limited education or employment opportunities, inexperience with positive parenting techniques, isolation, or physical or mental health issues. The primary area of focus for this project will be the City of Schenectady, where Schenectady County’s most at-risk children and families are found. In the city, populated by 65,705 people, 36.7% of children under age 18 live in poverty, with 41.3% of children under age five living poverty. Recent focus groups conducted by SCAP have identified mental health support as one of the greatest needs in Schenectady. SCAP’s Project LAUNCH goals include: Goal 1: Increased capacity of child-serving organizations to ensure early identification of behavioral and developmental concerns that hinder healthy development and wellness of young children from birth through age eight. Goal 2: Increased capacity of early care and education settings to address behavioral health issues to promote optimal learning environments for young children. Goal 3: Increased capacity of parents, guardians and family caregivers to provide healthy, safe and secure environments in which young children can learn and grow. The project will screen 500 individuals for mental health or related interventions annually (2,500 over project period), referring 300 (1,500 over project period) to mental health or related services with 250 receiving services (1,250 over project period). 75 individuals in the mental health and related workforce will receive training in related practices each year (150 over project period). Collaborative activities will result in extensive coordination among 15 child-serving organizations. SCAP will utilize multiple evidence-based practices to implement project components, including: Family Development, Head Start/Early Head Start, Pyramid Model, Positive Solutions for Families, FLIP-IT and Trauma Informed Care. Ellis Medicine, SCAP’s primary treatment partner, will use multiple evidence-based practices to provide screening and treatment support. Additional project partners include: * Early Learning Providers: Capital District Child Care Council, YWCA Northeastern NY, Schenectady Day Nursery, and two Group Family Day Care Providers * Schenectady County Public Health Services: Healthy Schenectady Families, Early Intervention and WIC * Hometown Health Centers: Federally Qualified Health Center (FQHC)

It is the mission of Western Idaho Community Action Partnership (WICAP) Project LAUNCH to provide education to child serving agencies and the greater community about child and family mental health and resiliency including its effects on child development across domains. This project provides direct and indirect services to increase access to mental health care for young children and their families. Project Launch is located in Southwestern Idaho. This area has experienced an increase in child abuse and neglect rates and highest rates of poverty and homelessness in the State of Idaho. These factors contribute to children's risk of developing Social Emotional Disturbance (SED). The population served by Project LAUNCH are children, ages birth to age 8, at risk of developing SED, and their caregivers. Participants are identified through screening events and a growing network of referral sources including Head Start, local public schools, and primary and mental health care agencies. Services are individualized, person centered, and culturally and linguistically appropriate to meet the needs of the child and their family across home and early education environments. Participants qualify for Project LAUNCH program services based upon ACES risk factors and screening results. Evidence based practices will be implemented over the five year period, and measured for increasing fidelity. The Region 3 Southwest Idaho area consists of mainly white non-Hispanic 75% and Hispanic families 25%. The region is a Mental Health Shortage Area (MHSA )due to rural location or population size. The more populated areas in Canyon County do not have enough Mental Health Professionals to adequately meet the needs of the population while the more rural counties such as Payette, Washington, and Owyhee do not have access due to their geographical remoteness. Population number for the initially targeted areas is 250,000 people with 20 to 25% living in poverty. The geographic location spans over 22,000 miles of land. All Project LAUNCH grantees implement five promotion and prevention strategies to increase preventative care and support the social emotional well being of infants, young children and their caregivers. The five strategies WICAP Project LAUNCH will implement include: Screening and Assessment: Increase the number of ASQ-3, ASQ-SE, and speech and language screening completed by early childhood serving agencies along with additional research based depression, substance abuse, and mental health screenings appropriate to the individual by 10% annually to assist in the early identification and resulting intervention of developmental concerns. Enhanced Home Visiting Through Increased Focus on Social and Emotional Well-Being: Increase Home Based Home Visitors trained in mental health Family/Peer Support and provide training to add additional certified Family Support providers receiving reflective supervision serving the target population. Family Strengthening and Parent Skills Training: In collaboration with stakeholders and participants select and implement an evidence based parenting program that fits the target population communities needs within the first year of the project and work toward increased fidelity. Provide ongoing training to early childhood educators and Family/Peer support in the selected Evidence Based Practice. Mental Health Consultation in Early Care and Education: Increase individual counseling services for children, parents, and caregivers by 10% annually working towards and embedded model and providing Early Childhood Positive Behavior Support consultation and support to early childhood educators and children. Integration of Behavioral Health Into Primary Care Settings: Establish a work-group consisting of primary and mental health care professionals, stakeholders and Project LAUNCH staff to increase collaboration and uncover barriers, needs, and discuss pathways to solutions.

Project Launch-Illinois Southland is a collaboration between Children's Research Triangle (CRT) and the Partnership for Resilience (PfR) to promote the wellness of young children by enhancing and expanding available services in the community. PL-IS will work with children ages 0-8 and their families from Chicago's Southland, the region of southern Cook County encompassing 70 municipalities. Children and families in this area are 47% African American, 34% Caucasian and 16% Hispanic and are impacted by high rates of unemployment and poverty. The Southland lacks comprehensive services to fully address the social, emotional, cognitive, physical, and behavioral needs of young children and their parents to promote healthy development and overall wellness. The goals for PL-IS include: improving cross-system collaboration, communication, joint decision making, and shared values; promoting the use of comprehensive screening and assessment in child serving agencies; improving behavioral health integration into primary care settings; increasing access and use of Early Childhood Mental Health Consultation (ECMHC); and implementing a comprehensive public awareness campaign. To meet these goals, PL-IS will implement a Young Child Wellness Council (YCWC) to conduct a comprehensive needs assessment and develop a 5 year strategic plan; the YCWC will guide the project's activities. PL-IS will train community partners, including primary care providers, to screen and refer at-risk children and families (15 primary care providers trained per year for a total of 75 for the grant). Community partners will screen children and parents using standardized measures (Year 1: 750, Year 2 1,200, Year 3: 1,650, Year 4: 2,100, and Year 5: 2,550 for a total of 8,250 parents and children screened) and refer at least 75% of at-risk children and parents for community-based assessment and treatment services. PL-IS will develop a workforce training initiative to increase education and skills in screening through a college-level seminar and internship program. Family Navigator Services will be implemented to assist community partners conducting screenings with linking children and parents to appropriate referrals. PL-IS will conduct ECMHC in Head Start, early education, early care, and home visiting programs and increase the availability of credentialed consultants in the Southland. PL-IS will increase the capacity and availability of credentialed consultants in the Southland. PL-IS will increase the capacity and availability of Triple P Positive Parenting Program by training 20 new providers each year on Triple P (100 providers for the grant), which will allow at least 120 parents per year to receive Triple P (600 for the grant) services. A mental health consultant will provide 60 children and parents with evidenced-based mental health interventions (300 for the grant) as well as professional training to increase capacity to work with young children (4 agencies per grant year for a total of 20 agencies). Finally, PL-IS will implement a multifaceted public awareness campaign to improve knowledge about early childhood development, screenings, and treatment and promote project activities.

Red Cliff Project LAUNCH supports the Red Cliff Band of Lake Superior Chippewas, a federally recognized tribe, to create a relationship-based, integrated early childhood system of care. The approach represents our belief that evidence-based models and cultural congruity, when thoughtfully integrated, result in a powerful change model. The project will result in measurable positive outcomes for children, families, providers and the community. Located on the shores of Lake Superior, the Red Cliff reservation is the smallest and poorest tribe in Wisconsin. The ongoing impact of historical trauma, however, is reflected in sobering demographics: 62% of Head Start children identified with or at risk for a mental health issue; 39% of ECE parents/caregivers have a mental health diagnosis; 17% of ECE caregivers report domestic violence; 12% of caregivers incarcerated and high rates of child abuse and neglect. Yet this data doesn’t define us, and Red Cliff’s rich cultural history and drive for self-determination provide a solid foundation for successful program development and implementation. The Young Child Wellness Council, with representation from families, the community, traditional healers, early childhood, public school, primary care, mental health, and substance misuse services will create a shared vision of child wellness. Culturally-congruent evidence-based practices will enhance existent service provision to 300 children and over 400 family members annually. Red Cliff Project LAUNCH goals are to 1) increase tribal and non-tribal agency collaboration in the Red Cliff early childhood system of care; 2) improve professional, parent and community member understanding of infant and early childhood mental health in relationship to child development and increase their capacity to provide nurturing social emotional supports; 3) reduce family stress and increase parent capacity to provide warm, nurturing environments to support strong family relationships, improved quality of life and overall resiliency; and 4) universal and targeted EBPs Head Start through 3rd grade result in measurable improvements in children’s social-emotional skills and competencies. Expected project outcomes include improved child health and school readiness; developmentally-appropriate screenings across settings; increased access to prevention and early intervention programs and pediatric and adult mental health services; increased connectedness between providers, families, and schools; increased integration of physical health, mental health and traditional wisdom and an integrated, effective system of care.

Building Early Connections is an application from Rush University Medical Center (RUMC) that seeks to improve early systems of care in Chicago for the most common childhood mental health concerns related to externalizing, internalizing, and social impairments. Building Early Connections capitalizes on exciting advances in behavioral science research demonstrating the power of early childhood psychosocial interventions to result in profound and lasting treatment effects during a period of the greatest neuroplasticity in development. By developing specialized promotion, screening and treatment services, we seek to shift community perspectives on “watchful waiting” to proactive solutions designed to alter developmental trajectories and strengthen families. The program will focus on children 8 years old and younger, and their families, in Chicago’s historically underserved West Side (WS) neighborhoods served by RUMC. We expect to reach a racially and ethnically diverse population (50% African American, 44.5% Latino, 13% foreign born) and to serve socioeconomically vulnerable individuals (75% of our population living in the lowest census income bracket). Building Early Connections will employ a multifaceted approach within RUMC, and across the WS of Chicago, to build a continuum of care and scalable service delivery, training, and consultation models. The proposed approach is designed to facilitate replicability and make a significant and enduring impact on mental health services and families in high-poverty communities. At RUMC, we will capitalize upon current clinical efforts to link mental health and developmental screening in primary care with timely access to appropriate evidence-based interventions and community supports. We will initiate a coordinated schedule of professional development activities to train 170 primary care providers and192 mental health providers, creating a cascading effect of expanding the pool of professionals who are using state of the art screening and intervention practices to empower caregivers, enhance the caregiver-child relationship, and alter developmental trajectories in a positive direction (Goals 1 & 2). It is anticipated that through Goals 1 and 2, we will be able to offer screening, consultation and/or evidence-based intervention to 20,000 children/families in our community. At a broad community level, we will collaborate with 28 community organizations and partners on the WS of Chicago for mental health consultation and healthy development promotional activities to reach 40,000 children and families on Chicago’s WS (Goals 3 & 4). Finally, Building Early Connections outcomes will be assessed via number of children served, number of Rush providers trained and number of community organizations partnered with for promotion and consultation.

Project Name: Project Launch Upper Valley: Promoting a healthy start for young children and their caregivers Population to be served and need: We aim to increase our community’s ability to identify, engage and serve at-risk and trauma-affected families with evidence-based early intervention services, with an eventual goal of influencing early childhood policy and practice in two Northern New England states. We will achieve this goal through our overarching vision of “meeting young children and families where they are,” whether it be the pediatrician’s office, school, child care center, or a caregiver’s place of work. The target population is children 0-8 and their caregivers in Grafton and Sullivan Counties in NH and Windsor County in VT (collectively, the “Upper Valley (UV)”). Many towns suffer from higher than average poverty and unemployment levels, and the targeted counties are in the midst of a devastating opioid crisis, with some of the highest rates in the county of infants born opiate-exposed. Numerous service sectors have observed an unprecedented increase in early childhood neglect and trauma and subsequent behavioral health (BH) needs of young children. For example, the number of children in out of home care has risen more than 50% since 2012, mostly accounted for by young children. Health, education and service providers are overwhelmed by the influx of needs in this population, and are unfamiliar with how to identify, triage and meet the BH needs of young children. Strategies/evidence-based practices: Project Launch UV will focus activities at four tiered levels. At our broadest, community-wide level (Tier 1), we will raise public awareness and decrease stigma for young children’s BH needs via local businesses, radio ads and social media campaigns. Tier 2 involves screening of children 0-8 and their caregivers in six primary care clinics, and providing trauma-informed care training to the workforce (e.g., early education and care, health, BH). Tier 3 will provide targeted supports to enhance engagement and increase access to care, and provide expert BH consultation for our professional workforce that serves young children and their caregivers. Finally, most intensive supports provided in Tier 4 will be delivery of two evidence-based parenting interventions: Circle of Security (COS) and Helping the Noncompliant Child (HNC). Goals and measurable objectives: Our goal is to increase identification and access to care for at-risk and trauma-affected families, and promote healthy development of children 0-8 by meeting them and their caregivers in naturalistic settings (e.g., primary care, early care and education, caregiver workplace) through a tiered approach. Our primary objectives are: to reach our community at large through a public awareness campaign with distribution of flyers, radio ads and social media posts; provide trauma informed training to 300+ professionals and staff from health, BH, education and business sectors; enhance screening, linkage and referral systems across 6 primary care clinics (reaching ~8500 children; ~1000 Year 1); provide 600+ BH consultations; deliver COS and HNC to caregivers (235 for COS and 335 for HNC); and create a Young Child Wellness Council.

Richmond University Medical Center, partnered with the Staten Island Partnership for Community Wellness, The Staten Island Performing Provider System and the Alliance for North Shore Families and Children will implement the Staten Island Project LAUNCH to improve outcomes for low income and high need children from birth to eight residing in the New York City (NYC) borough of Staten Island (SI)'s North Shore.

Children’s mental health services in Iowa are frequently described as inconsistent, fragmented and under-resourced. Iowa’s Project LAUNCH initiative seeks to accomplish two overarching goals: to provide coordinated and appropriate wraparound mental health supports to young children and their families within an at-risk demonstration site; and to strengthen Iowa’s infrastructure to support competent and well-trained early childhood mental health consultants. Results from Project LAUNCH will be shared statewide via the Early Childhood Iowa network to inform a well-designed and coordinated system for children’s mental health, supporting school readiness and seamless transitions into the K-12 system. POPULATION OF FOCUS: Iowa’s Project LAUNCH services will focus on supporting minority and low-income children, age birth through age five, enrolled in Drake University’s Head Start and Early Head Start programs in central Iowa. Families enrolled in this program experience multiple risk factors, including extreme poverty, trauma and racial inequities. This initiative seeks to provide comprehensive screening and assessment, followed by evidence-based mental health interventions for at least 25 identified children annually, in an effort to improve children’s social, emotional, physical and cognitive outcomes and reduce family stress. STRATEGIES/INTERVENTIONS: The purpose of Iowa’s Project LAUNCH will be to support development of a community-based approach to promoting young children’s social/emotional wellbeing. Project goals include 1) Implement comprehensive and coordinated screening and assessment processes that identify children most at risk for negative outcomes, 2) Deliver evidence-based mental health services to identified children and families, 3) Enhance community partnerships to better support young children’s social and emotional wellbeing, 4) Support statewide professional infrastructure to coordinate and strengthen early childhood mental health consultation, and 5) Inform Iowa’s newly established Children’s Behavioral Health State Board about benefits for investing in promotion, prevention and early intervention Numbers served by Iowa’s Project LAUNCH: Annually Children 0–6: 882 Children 6–8: 375 Parents: 60 Annual Total: 1,317 5-year Period Children 0-6: 4,410 Children 6-8: 1,875 Parents: 300 5-year Total: 6,585

The Responsive Early Access for Durham's Young children: A coordinated system to promote young child wellness (READY) project will foster the healthy development and wellness of all young children, preparing them to thrive in school and beyond. Our population of focus will be children ages 0-8 and their caregivers, including families who experience racial and ethnic disparities, parental substance use (e.g., opioids), homelessness, and parental deployment. Through READY, the Center for Child and Family Health (CCFH) and its community partners will serve a diverse population in Durham, NC (36% African American, 28% Hispanic, 4% Other). Moreover, many children served through READY will present with exposure to trauma and other early childhood adversities (e.g., parental mental illness, substance abuse) that interfere with their healthy development. The overall goals are to: 1) increase Durham's capacity to promote healthy social-emotional development and to identify and address young children's behavioral concerns that may contribute to long-term, serious emotional disturbances; 2) build the knowledge, skills, and resources of providers in primary care and early care and education settings to promote young children's social, emotional, and behavioral wellness and their caregivers' behavioral health; 3) increase collaboration and coordination in the Durham early childhood system of care; 4) raise public awareness and education related to early childhood development and mental health. The objectives are to: 1a) expand screening/assessment of young children and caregivers among funded partners by 15%; 1b) increase evidence-based prevention and mental health intervention by 15%; 1c) train providers in screening (305 providers), assessment (25), and evidence-based prevention and mental health intervention (31); 2a) increase capacity to provide an evidence-based integrated behavioral health intervention by 33%; 2b) train 80 primary care providers in a selected curriculum on children's behavioral health; 2c) increase the number of early childhood providers who receive mental health consultation and/or training related to behavioral and emotional concerns by 20%; 3a) establish a consistent Young Child Wellness Council with quorum of agencies and families at most quarterly meetings; 3b) increase knowledge, awareness, and collaboration factors of organizations and families in a system of care to sustain these public-private-family partnerships; 4a) increase knowledge of families and community through print and digital campaign and presentations; 4b) increase knowledge and skills of providers related to early childhood trauma and behavioral health through training; and 5a) develop and implement an evaluation plan, collecting, entering, and reporting required measures. Taken together, these READY activities will serve 858 unduplicated children and caregivers annually with prevention and mental health services (4,030 individuals served across 5 years), with an additional 1,400 screened (7,000 over 5 years). READY also will train 184 individuals annually (946 individuals trained across 5 years).

Columbia Wellness and Willapa Behavioral Health, nonprofit mental health agencies in southwest Washington state, partnered to create CARE: Coordinating Agencies’ Response to Early Childhood Needs. Our vision is a seamless birth to age 8 coordinated continuum of care that nurtures healthy development and wellness of children through the prevention, early identification, and treatment of mental, emotional, and behavior disorders with evidence-based practices. Targeting 1,800 unduplicated individuals annually and an estimated 9,000 throughout the lifetime of the project, we designed our continuum based on a catchment area with the greatest need. The CARE continuum is in partnership with primary and early child care providers, community-based organizations, and 4 elementary schools in 3 school districts. Demographics for targeted children are 70% Caucasian, 19% Hispanic, 6% multi-racial, 2% Asian, 1% Native Hawaiian/Pacific Islander, 1% African-American, and 1% Native American/Alaskan. Our median household income averages 44,984, substantially lower than the state 65,500, with an average free and reduced-price lunch rate of 66% in our target counties, compared to the state average of 43%. Clinical characteristics of our target population show a need for early identification, healthy and supportive environments, behavioral health services, and coordinated services. CARE has five key goals areas: (a) train and support early care, schools, and primary care providers in the use of tools for social and emotional development and caregiver screeners; (b) conduct family education initiatives to strengthen parenting skills that provide optimal, supportive environments for children; (c) equip primary care settings to address behavioral health through on-site consultation/training, screening, assessment, interventions, and referrals; (d) assist early care and education to create optimal learning settings and identify and address social, emotional, and behavioral concerns; and (e) ensure a coordinated continuum of care birth- age 8. Our proposal includes 18 measurable objectives. Implementation will be supported by grant funded staff (Project Director, Evaluator, 2 Nurse Navigators, 2 Early Interventionists, 2 School Therapists) and existing staff (Project Leads, WISe Therapists, Mental Health Specialists). Core strategies and interventions include: developing a strong momentum among stakeholders through a Young Child Wellness Council; designing a tri-county child wellness plan to empower coordination and collaboration; conducting a public awareness campaign to educate our community on the importance of promoting the wellness of young children by addressing their social, emotional, cognitive, physical, and behavioral development; using validated instruments to support universal screening of children and parents; providing services for children referred for interventions through evidence-based practices such as CBT+, TF-CBT, and a wraparound model through our state WISe initiative; implementing the EBP Incredible Years, to support parents, child care providers, and teachers in addressing social and emotional development; and providing community parenting classes based on common social, emotional, and behavioral issues identified by parents and caregivers.

Fairbanks Native Association (FNA), Alaska Center for Children and Adults (ACCA), and ThrivAlaska (Thriv) have partnered as a “community applicant” to serve children (ages birth eight) and their families, promoting wellness by addressing social, emotional, physical, cognitive, and behavioral development. By removing service silos, this partnership will provide simultaneous coordinated mental health and early childhood services. The proposed community-wide Fairbanks Young Child Wellness Project (Wellness Project) will serve all ethnicities in the Fairbanks North Star Borough (FNSB) of Alaska. All FNSB agencies (tribal and non-tribal) struggle with the same issue; service silos restrict service collaboration, integration, and rapid access to care, creating a need for systemic change rather than individual agency change. FNA’s Behavioral Health Department serves an equal number of Natives and non-Natives, so it is critical to FNA that the service system is accessible and collaborative to fully meet the needs of its service population. For these reasons FNA and has opted to partner with two community agencies and is applying as a “community” applicant.” According to the FNSB Early Childhood Development Commission, only 57% of FNSB children arrive to kindergarten with the tools they need to succeed in school. These children’s developmental screening scores are below state averages. Alaskan youth also have higher Adverse Childhood Experiences (ACEs) than the national average. ACES impair development in childhood. FNA, the required Mental Health provider and lead agency for the Wellness Project, has been a leader in FNSB behavioral health for over five decades. As there have been times FNA was the only provider of residential care, it has a history of serving all ethnicities. FNA will serve as the point of entry for the adult mental health services and will be the point of entry for adult services, including Behavioral Screening and Assessment (SBIRT), Mental Health Consultation and Family Behavioral Therapy, and referral to its continuum of behavioral health care. FNA will oversee coordination and collaboration among FNSB mental health and child-serving agencies and will coordinate the Young Child Wellness Council (YCWC). ACCA has been a community leader in Infant Learning and Infant/Early Childhood Mental Health for more than 20 years and has provided services in Alaska since 1956. ACCA will provide Early Intervention Services, Developmental Screening, Family Training and serve as point of entry for children ages 0-8 who have developmental, social, and/or emotional concerns. Thriv, 44 years early experience, will focus on augmenting family training through its existing family training program (in-kind) and children’s mental health for its early childhood programs. The Wellness Project will serve 755 unduplicated young children and 2307 family and staff members over the five year life of the project.

Serving Children and Adults in Need (SCAN) is proposing to implement its Border Project LAUNCH (Border PL) in Webb County, Texas situated on the Texas-Mexico border. Border PL will target underserved Hispanic children ages birth to eight years of age, and their caregivers, with a special focus on children with caregivers who suffer from behavioral disorders. The purpose of Border PL is to promote the wellness of young children by addressing the social, emotional, cognitive, physical and behavioral aspects of their development by disseminating effective and innovative early childhood mental health practices and services to improve outcomes for young children and their families The project proposes to serve a minimum of 4,500 unduplicated participants over the life of the project including caregivers, children and staff from child care settings and schools. The goals of the project are: 1) Screen, assess, and link children ages birth to 8 years of age and their caregivers to comprehensive behavioral health care to ensure the early identification of behavioral and developmental concerns in children as well as perinatal/maternal depression, traumatic stress, and opioid/substance misuse among caregivers; 2) Train parents, guardians and family caregivers on how to provide healthy, safe and secure environments in which young children can learn and grow; 3) Integrate behavioral health care into primary care settings to equip primary care providers with the knowledge, skills, and resources to address issues related to young children's and caregivers' behavioral health; 4) Provide mental consultation and training to staff in early child care and educational settings to ensure that young children's social, emotional, and behavioral concerns are identifies and addressed; 5) Establish a Webb County Young Child Wellness Council with membership from primary care, behavioral health, education, child care, Head Start, child welfare, and early intervention; 6) Improve coordination and collaboration across child and family serving systems and programs; 7) Raise public awareness and education related to early child development and mental health; 8) Foster the wellness of young children and their caregivers by achieving improved outcomes at discharge and 6-month follow-up; 9) Assure the project development is culturally and linguistically-informed so as to meet the specific cultural and linguistic needs of participants fro the border region. The Evidence Based Practices (EBPs) selected are: Parent Child Interaction Therapy (PCIT), SafeCare, and Positive Parenting Program (Triple P). The EBPs are part of a family-focused, holistic approach that is trauma and culture-informed and promotes the wellness of young children and their healthy attachment to caregivers. This approach supports healthy social, emotional, physical, and behavioral development through caregiver empowerment and services coordination to meet children's overall needs.

NATIVE HEALTH is a non-profit, Urban Indian Organization that provides services for American Indians/Alaska Natives that reside in the Phoenix Metropolitan Area. Phoenix Metro encompasses 25 communities throughout Maricopa County. The majority of the county has been urbanized with the exception of a few agricultural areas and five tribal communities. The target population includes high-risk American Indian and Alaska Native children birth up to 8 years and their families that reside in Phoenix or the suburbs. (Urban dwelling American Indians). The project will also include other high-risk minority children birth to 8 years. Five tribal communities are either fully or partially within the county resulting in many people that reside in the urban community. There are 21 federally recognized tribes in Arizona. The urban community has representation from all or most of these tribes. The project proposes to increase child resiliency through incorporating evidence based programming targeted to young children and parents. The program will enhance and expand an existing Home Visiting Program with added service delivery of in-home mental consultation and referral to treatment (in-home or in the clinic setting). The program will increase integration of services throughout the agency medical and behavioral health sites and will provide resources and opportunities for urban American Indian families as relative to early childhood development, family resources and capacity to support families with young children for school readiness. The program will develop a Youth Child Wellness Council to increase program coordination for the target population as well as develop policy for systems building. Evidence based programs to be implemented are Parents as Teachers Home Visiting Model, Positive Indian Parenting, and a range of Cognitive Behavioral Therapies. This program will deploy additional Home Visitors and Community Health Workers in the field while using a Licensed Clinical Social Worker to link and/or provide direct services to families being served. Various community needs assessments conducted in the local communities have identified that the local urban American Indian population has experienced numerous disparities in behavioral health, physical health, social and income disparities. Rates of family violence are greater than for other populations as are other behavioral health and substance abuse concerns. Rates for diabetes and obesity are alarmingly high. American Indian and Alaska Native women are more likely to receive inadequate prenatal care. Adverse pregnancy and birth outcomes are resultant. Families tend to be transient; moving from reservations to the urban center and returning as household circumstance change. Supportive services are especially helpful for families that experience a great deal of transition.