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The co-occurrence of substance use disorder (SUD) and trauma create a complex treatment profile that renders most treatment models ineffective. Family Centered Treatment Recovery (FCT-R) is designed to successfully navigate the complex interplay within the context of family, addressing the systemic dynamics of SUD and trauma exposure on the family unit. The SPARC Foundation (SPARC) proposes to expand its existing FCT-R pilot program in order to serve additional families while field testing and using program outcome data to further develop, validate, and scale the FCT-R model. SPARC will add two additional FCT-R teams to increase direct services in the service area, while also partnering with the Family Centered Treatment (FCT) Foundation, a current NCTSI Category II Treatment and Services Adaptation (TSA) provider, to scale up, implement, and evaluate the FCT-R model to additional FCT licensed agencies statewide and nationally. FCT-R consists of four distinct FCT treatment phases that encompass screening, assessment, care management, therapy, and prevention. Systemic trauma treatment and SUD treatment is provided throughout each of the four phases and supported by the evidence-based fidelity measures of FCT. FCT-R is designed to treat “cross-over” families involved with multiple systems (e.g., child welfare, etc.), or who are in crisis, facing forced removal of children from the home, or in need of reunification due to multi-generational trauma and SUD. Located in Western North Carolina in the Blue Ridge Mountains of Appalachia, the service area is home to 490,000 residents and more racially diverse than the state in general. The catchment area recorded 1,363 substantiated abuse and neglect claims in 2018, and in 2019 served 1,019 children in foster care. Over the five-year grant project, SPARC’s FCT-R project will serve 816 individuals from 272 families, and meet the following goals and objectives: Goal 1: Expand FCT-R trauma services into Buncombe, Polk, and Transylvania counties. Objective 1a: Execute agreements with four county partners. Objective 1b: Recruit, hire, and train 2 new FCT-R teams. Objective 1c: Deliver training to 210 county partners about trauma and the FCT-R model. Objective 1d: Begin FCT-R service delivery to expanded service area. Goal 2: Over the 5-year grant period, provide direct services to 312 individuals from 104 families in expanded service area. Objective 2a: 100% of families referred into the program will have a Family Relapse Prevention and Response Plan. Objective 2b: 100% of families referred will complete a screening meeting. Objective 2c: 80% of families will demonstrate an increase in cumulative number of abstinent days. Objective 2d: Develop, test, validate, and implement a new data-driven measure to gauge SUD treatment progress during FCT-R treatment. Objective 2e: 75% of families will complete all phases of FCT-R Treatment. Objective 2f: 80% of referred families will be reunified and/or preserved. Goal 3: Scale up and spread model to enable 7 FCT-certified agencies to implement the FCT-R model and serve at least 504 individuals from 168 families over five years. Objective 3a: Collaborate with the FCT Foundation to finalize FCT-R program manual, white paper, and training materials to be used for disseminating the model to external agencies. Objective 3b: Develop and finalize plan for training and scaling. Objective 3c: Collaborate with FCT Foundation to train 7 FCT-certified agencies to deliver FCT-R services. Objective 3d: Disseminate results of the project to one national conference audience.

Children’s Aid focuses its services on low-income communities in New York City (NYC), serving children, youth, and families. One of our central goals is to provide caregivers with the supports they need to keep their families strong, healthy, and safe. Since 2001, the Family Wellness Program (FWP) has provided comprehensive intimate partner violence (IPV) intervention and prevention services that help families heal from the trauma of violence and establish long-term safety. FWP, which specializes in working with child welfare involved families, is the only IPV program in NYC which serves every member of the family, including the person causing harm (PCH), with a primary focus on the well-being of the child. Our client population is largely immigrant families and families of color whose primary language is Spanish. FWP services are targeted in the high-needs NYC neighborhoods of Harlem, Washington Heights, and the South Bronx. FWP will offer underserved NYC families free, comprehensive IPV services aimed at helping them establish long-term safety and heal from the devastating effects of trauma and abuse. FWP services, offered in both English and Spanish, will include: crisis intervention and assessment; individual and group counseling; and case management and advocacy. These services will include the use of evidence-based and evidence-informed trauma treatment interventions, including Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Child-Parent Psychotherapy (CPP). The goals and objectives of our project are to: train all project therapists in evidence-based practices, including TF-CBT and CPP; reduce trauma reactions in children and adult survivors; strengthen the ability of adult survivors to keep themselves and their children safe; engage the PCH to increase their understanding of the impact of abuse, neglect, and exposure to IPV on their children and family; and reduce trauma reactions in the PCH. We aim to reach 450 clients over the life of the project, and will partner with the National Child Trauma Workforce Institute (NCTWI) at Silberman School of Social Work at Hunter College for training and consultation.

Refugee and Immigrant Center for Healing (RICH) - Trauma Systems Therapy for Refugee Youth Program Jewish Family Services of Western New York will implement the Trauma Systems Therapy for Refugees (TST-R) evidence-based model to assist local refugee and immigrant youth (ages 5-21) and their families from the Bhutanese, Somali, Congolese, Iraqi, and Syrian communities. The program aims to increase alignment and enhance collaboration among local resettlement agencies, public schools, ethnic and community-based organizations, and behavioral healthcare providers to serve 400 individuals annually, via a wide range of community-based and clinical interventions. This project will result in the development of a system of care that more effectively responds to the complex needs of refugee and immigrant youth impacted by trauma and their families by focusing on three (3) primary goals: 1) Development of a network of culturally responsive engagement and community-level mental health services; 2) Increased identification of mental health concerns and access to effective treatment for refugee and immigrant youth; and 3) Improved overall mental health and quality of life for refugee and immigrant youth and their families. Toward this end, TST-R will incorporate use of cultural brokers and train culturally-responsive clinicians to support youth and parent skill-building; reduce barriers to treatment through formal partnerships, referral systems, and culturally-responsive professional development; and provide appropriate care to those in need.

The GRowing Evidence-based Assessment and Treatment (GREAT) for Children project aims to increase access to and participation in evidence-based screening, assessment, treatment, and prevention services for children in Hampton Roads, Virginia, who have experienced traumatic stress. Providing these vital services for our diverse community of children ages 12 months - 18 years will reduce health disparities and increase child and family resilience. The population served by this project includes children ages 12 months - 18 years from across the eastern region of Virginia who are referred to the Children's Hospital of The King's Daughters Child Advocacy Center (CAC) for an allegation of maltreatment or concerns for traumatic stress, and children ages 7-18 who present at the hospital's Emergency Department (ED) for medical needs related to having experienced a traumatic event. Specifically, GREAT will support the CAC's clinical capacity to increase access to services and support for children ages 12-36 months, children ages 7-18 with problematic sexual behaviors, and Spanish-speaking children, while also providing evidence-based practices (EBPs) for our diverse population of at-risk children. GREAT aims to increase the capacity of clinicians to deliver Parent-Child Interaction Therapy - Toddler to expand access to services for children ages 12-36 months of age, a population currently unserved by our mental health services and underserved by clinicians in our community. Clinicians will also increase capacity to provide Advanced Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for problematic sexual behaviors (PSB) and PSB-CBT, EBPs effective in reducing PSBs in children ages 7-18 who are also currently underserved in Hampton Roads. Because the need for EBPs in our community for child traumatic stress is so great, clinicians from CHKD Mental Health Service Line will increase capacity to provide Child and Family Traumatic Stress Intervention (CFTSI) for children presenting at CHKD's Emergency Department following a traumatic experience. The project also aims to enhance the capacity of 1,000 key stakeholders and multidisciplinary partners (200 each project year) to identify, refer, and serve children who have experienced traumatic stress. We will collaborate with NCTSN Category I and II Centers on developing and implementing screening and assessment processes, implementing culturally and linguistically sensitive EBPs, and evaluating impact and child outcomes. GREAT project activities will result in 500-650 children being screened for trauma related symptoms and 150 children participating in mental health assessments each grant year. We anticipate serving 100 children per year using TF-CBT, PCIT, PCIT-T, Advanced TF-CBT for PSB, PSB-CBT, and CFTSI. By the end of the project, 3,050 children will be screened for the need for mental health assessment, and of those screened, 500 will complete trauma-focused mental health assessments. Of the children recommended for trauma treatment, 375 will participate with their caregiver(s) in the selected EBPs, and 225 children will participate in evaluation activities to inform our understanding of traumatic stress and the efficacy of EBPs in our community.

The University of Pittsburgh’s Theiss Complex Child and Adolescent Trauma (CCAT) Project expands access to evidence-based trauma treatment for children in Western Pennsylvania. It aims to improve service access and outcomes for high-need, underserved communities including racial/ethnic minority and low-income populations. It places an emphasis on children impacted by complex trauma, particularly those in the child welfare and juvenile justice systems. In collaboration with UPMC Western Behavioral Health and its Theiss Center for Child Trauma and Behavioral Health (Theiss), the CCAT Project’s primary goal is to increase access to trauma-related, evidence-based practices (EBPs) in Western Pennsylvania to remediate the impact of complex traumatic stress. This goal will be accomplished by: 1) expanding the age range of Theiss trauma services (up to age 18) through the incorporation of Integrative Treatment of Complex Trauma (ITCT, Child & Adolescent versions); 2) expanding the geographic reach of Theiss by leveraging UPMC’s Western Behavioral Health network throughout Western Pennsylvania for the implementation of evidence-based trauma treatments to support children impacted by complex trauma (including ITCT as well as Child Parent Psychotherapy-CPP); 3) facilitating trauma-related training and professional development for the mental health and related workforce (emphasizing the fields of child welfare/juvenile justice); and 4) serving as a resource for high-need, underserved communities by collaborating with local human service agencies to provide prompt clinical consultation and support to meet the complex needs of members of their community experiencing traumatic events. The CCAT Project will achieve the following primary goals/objectives by the end of the grant project period: screen 600 children/adolescents for trauma; support 5 programs/counties to implement EBPs; establish clinical consultation services with 15 community agencies/underserved communities; develop 15 additional new partnerships/collaborations; facilitate EBP training for 20 clinicians; and provide trauma-related professional development for 2,000 in the mental health and related workforce (500 of whom will represent child-serving systems such as child welfare and juvenile justice). Children and adolescents served will gradually increase each subsequent grant year (Year 1-40; Year 2-60; Year 3-80; Year 4-120; and Year 5-150). A total of 450 children and adolescents throughout Western Pennsylvania will receive EBPs through the Theiss CCAT Project. Seventy percent of children/adolescents who participate in CCAT Project EBPs will represent child-serving systems, and 80% will demonstrate improved functioning on TSCYC/TSCC and NOMs assessments (across racial/ethnic and socioeconomic backgrounds) upon completion of treatment. The CCAT Project will further address behavioral health disparities by maintaining a high percentage of children/adolescents served from racial/ethnic minority populations (at least 45% annually) and will increase the percentage of grant-served children and adolescents from new catchment areas to at least 25% by Year 5.

Puerto Rican Family Institute (PRFI) proposes to increase its capacity to provide trauma- informed services to Latinx children ages 2-21, their families and communities. This will be accomplished by training our clinicians in the evidence-based practices TF-CBT and CM-TFT, embedding the principles of a trauma-informed organization in PRFI and offering community trauma education, consultation and referral information to a diverse range of partners. The geographic catchment area is comprised of three New York City boroughs: Manhattan, the Bronx and Brooklyn, where PRFI maintains clinics and where we have strong current partnerships with schools and CBOs. Population(s) to be served: Adverse Childhood Experiences (ACE) disproportionately affect low-income children of color who are already at risk. Latinx children exposed to multiple ACEs are at risk for anxiety, withdrawal and aggression, obesity, and chronic health problems in the future. Strategies/interventions: Puerto Rican Family Institute proposes to serve these children by enhancing our clinical expertise in TF-CBT and CM-TFT, leveraging the trust PRFI has established in the NYC Latinx communities, and relying on the reputation we have for high-quality, culturally-informed services among our partners – schools, community coalitions, medical organizations and other community organizations. We will provide education to these organizations to understand a trauma-informed framework and perspective, prioritize practical and applied strategies that have immediate benefits for the well-being and healing for children, families and staff who work with traumatized populations. Goal 1: PRFI will increase access to evidence-based trauma treatment services for children and their families. Objective: 1.a. PRFI will create an ongoing system of outreach and engagement to at-risk children and vulnerable families. Measure: Develop referral agreements with at least 4 agencies in Year One and at least two a year in Years 2-5, a total of 12 in the grant period. Objective 1.b: PRFI will ensure that clinicians will be certified to provide TF-CBT. Measure: Certify 5 clinicians in Years 1-5 for a total of 25 in the grant period. Objective 1.c.: PRFI will provide TF-CBT trauma treatment. Measure: Year 1: 50 children; Years 2-5: 100 children and their families a year a total of 450 in the grant period Goal 2: PRFI will create awareness of trauma identification response and resources for treatment and support among our partnering agencies, communities and local organizations. Objective 2.a.: PRFI will provide free technical assistance on how create trauma informed cultures in their agencies. Measure: Technical assistance to 2 agencies (including schools) a year in Years 1-5, a total of 10 agencies in the grant period. Objective 2.b.: PRFI will address trauma-induced mental illness/emotional disturbance by general education of the prevalence of trauma and its treatment and support options. Measure: 4 informational sessions/forums a year to schools, other behavioral health agencies, and community agencies.

The Trauma Resiliency Project for Families in northern Utah and southern Idaho will continue to provide evidence-based and trauma-informed treatment to children and families. Participants will include children, ages 0-18, and their families who have suffered trauma. Outreach will be specifically extended to military, refugee, immigrant, LBGTQ+, and minority families because these groups are at higher risk for experiencing a traumatic event (CDC, Vital Signs, 2019). A focused outreach effort will also be made in the rural parts of our catchment area because fewer service providers are available to reach this population. The Child & Family Support Center of Cache County Inc. (CFSC or The Family Place, Utah) has a mission to strengthen families and protect children. The goal for this project is to continue to provide and increase access to effective trauma-focused treatment and service systems for children and their families who experience traumatic events throughout our community. We will build on our previously awarded SAMSHA Community Treatment and Services Category III grant by extending our evidence-based trauma treatments to children 0-18 (previously 0-11), and their families who have suffered trauma, and by diversifying the types of therapy models that can serve them. To achieve this goal, we will continue providing evidence-based and evidence-informed interventions in the following strategies: (1) a therapeutic child center (2) home visits, (3) group therapy, (4) individual therapy, and (5) community training and outreach to local leaders and community members. CFSC employees are trained annually in the Attachment, Regulation, and Competency (ARC) framework for trauma intervention. As we have worked closely with our community to prevent trauma and provide services to those who have experienced trauma, we have learned families need more therapy treatment options to effectively address the trauma they have faced. As we continue to use the expertise we have learned through ARC, we will add the Parent Management Training model (ADAPT), that has been modified for individuals who have faced trauma, and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) telehealth services provided in Spanish and English. The evidence-based Trauma-Focused Equine Assisted Psychotherapy (TF-EAP) approach, Natural Lifemanship, will also be provided to children and families who have experienced trauma. Measurable outcomes will include reduced trauma symptoms, an increase in trauma-informed services, stronger family relationships, and a more trauma-informed community. We anticipate screening 500 participants a year for trauma, with 225 of them receiving trauma-informed mental health assessments. During the 5-year program, approximately 2,500 individuals will be screened for trauma, and of those screened 1,125 will receive trauma-informed mental health assessments and treatment in their preferred modes, including trauma treatment in our therapeutic child center, parent-child relationship treatment in home visits, group and individual therapy where parents and children increase their coping skills, regulatory abilities, and recovery after trauma.

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.

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.

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.

Community Association of Progressive Dominicans' (ACDP) National Child Traumatic Stress Initiative -- Category III Program will provide evidence-based trauma treatment and prevention services to 400 adolescents and their families living in Washington Heights and surrounding neighborhoods in Upper Manhattan, New York City (NYC), with a focus on Latino and Black individuals, who make up 79% of the service area and the majority of ACDP's client population. Through this funding, ACDP will add a full range of trauma screening, prevention, and treatment services to their outpatient clinic using evidence-based programs (EBPs). Specifically, ACDP will: 1) implement universal screening trauma and suicide risk though validated screening tools, 2) implement comprehensive assessment inclusive of screening for adverse childhood experiences (ACEs) and behavioral health disorders, as indicated, 3) develop tailored service and treatment plans, and 4) provide a range of evidence-based prevention and treatment services that address a combination of immediate (safety planning) and long-term needs. ACDP will provide direct outpatient mental health treatment services and will leverage its own school-based and afterschool programs to recruit clients; and will leverage primary care and additional behavioral health services provided by La Casa De Salud Inc. (LCDS), and outpatient and residential mental health and substance use treatment services provided by Promesa, both of which are Acacia Network. Over the five-year program, ADCP will achieve the following: Objective 1: Serve 400 at-risk individuals and their families utilizing evidence-based practices at ACDP's Washington Heights Mental Health clinic. Objective 2: Among clients participating in the Supporting Students Exposed to Trauma (SSET) intervention, improve skills and techniques to reduce trauma-related stress by 75%. Objective 3: Reduce current tobacco use by 25% among at-risk youth enrolled in the tobacco cessation program. Objective 4: Increase the number of individuals scoring medium- or high-risk for toxic stress response or at risk for suicide accessing mental health treatment by 75%. The program will enroll 40 clients in each of Years 1 and 2, and 100 clients per year in Years 3, 4, and 5. ACDP will also implement the SSET intervention with 60 youth over the life of the program (12 per year).

The Rutgers Child Trauma Clinic (hereafter referred to as the CTC) at the Center for Psychological Services (CPS), will be a specialty clinic that will serve youth ages 3-18 that are impacted by trauma and represent a lower socioeconomic demographic group of families in need of low or no cost services. Youth served in the program will be those demonstrating increased risk as evidenced by their family involvement with the state child welfare system, school disciplinary team, or identified by a community organization or family member as having significant challenges that are linked to suspected or known trauma. CPS is the training clinic for the Graduate School of Applied and Professional Psychology at Rutgers and is a top ranked doctoral psychology program in the nation. In 2019, New Jersey (NJ) published a report about adverse childhood experiences in the state. The report, entitled “Adverse Childhood Experiences: Opportunities to prevent, protect against, and heal from the effects of ACEs in New Jersey,” shared that over 40% (approx.. 782,000) of children in New Jersey have experienced at least one adverse childhood experiences(ACE) and 18% have experienced multiple ACEs. Also, 27% and 22% of African-American and Hispanic children have experienced multiple ACEs, respectively, compared to 18% of their white counterparts. As a result of these findings, NJ identified five areas of opportunity to address childhood trauma in the state. Among these included support for parents and caregivers in receiving trauma-focused education and support, and providing evidence-based treatment for traumatized youth. (New Jersey Funders ACEs Collaborative, July 2019) Furthermore, Middlesex County, NJ, where the CTC will be located, continues to rank in the top three counties for new cases and deaths linked to covid-19, disproportionately affecting the traumatic loss exposure of ethnic minority communities. The CTC will offer several trauma-focused treatments to address the impact of trauma and loss, behavior management, sexual abuse and stress management for youth and their caregivers. Individual, family and/or group sessions utilizing trauma and attachment-informed treatment modalities will include Trauma Focused- Cognitive Behavior Therapy (TF-CBT), the Attachment, Regulation and Competency (ARC) Framework, and Game-Based CBT. The CTC will implement the Core Curriculum on Child Trauma as the foundational approach for the selection and process of treatment modalities and will ensure CTC providers are also trained in Psychological First Aid in order to assist as community responders if an event occurs that has a significant psychological impact on the community. The selected interventions have been demonstrated to be effective with these diverse populations, a critical factor for serving youth in the CTC catchment area of Middlesex County which is the 2nd most populous and most diverse county in NJ. In Year 1, we expect to start off serving 105 youth and caregivers and scale up to 163 individuals each year thereafter, ultimately serving 757 children and caregivers impacted by trauma by the end of the grant cycle.

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 Community Health & Resilience Initiative (CHRI) will increase access to effective trauma-focused treatment and prevention services for children, adolescents and families (ages 3 to 18) who have experienced trauma in Greene County Ohio. Over the life of the grant, this project will reach 4,075 individuals through direct treatment, prevention, promotion and outreach strategies. CHRI will embed trauma-focused mental health services into the crisis oriented child serving systems of child welfare, juvenile justice and law enforcement, reaching 1,875 youth through direct treatment by project end. The expansion of mental health treatment into these services systems puts access to care at the front door of system involvement for children, adolescents and families who have experienced trauma. The primary strategies are direct trauma treatment and trauma prevention and promotion. One goal of the project is to increase the use of EBPs in direct trauma treatment. EBPs selected for this project include: Trauma Focused Cognitive Behavioral Therapy, Child and Family Traumatic Stress Intervention, and The Attachment, Self-Regulation, and Competency Intervention. Prevention and promotion strategies will change over time the daily practices of key systems that are often the first points of formal contact for children and families in times of crisis and trauma. All partner system staff will be trained to administer trauma screenings and the project will provide trauma informed trainings to 200 of these system staff annually. To increase healthy coping skills and improve family functioning, prevention and promotion services will be provided directly to 200 children and families experiencing trauma per year, and 1,000 over the life of the grant. The final goal of the project is to use resources to increase understanding of trauma and build trauma focused and sensitive policies, procedures and practices in local child serving systems of child welfare, juvenile justice and law enforcement using real-time consultation (1,000 over the life of the grant) and Trauma-Informed Organizational Assessment.

The Championing Access to Trauma-informed-treatments to Achieve Lowcountry Youth Services Transformation (CATALYST) project aims to reduce the impact of trauma on children’s lives by providing and increasing access to effective trauma treatments and services for children and their families while also improving the quality of services by applying them with improved cultural and racial equity. A total of 6,644 unique individuals in the South Carolina Lowcountry will be served during the proposed project. The proposed project will achieve these aims by 1) providing outreach, engagement and prevention services with 500 children and 500 caregivers, 2) providing screening with 5,589 children and effective trauma treatments for 627 child victims of child abuse, and their families, in our service area, and 3) improving the quality of trauma treatment and services delivered and improve child outcomes by learning and applying EBPs from a cultural and racial equity lens. The CATALYST project will be headquartered at the Dee Norton Lowcountry Children’s Center, Inc. (“Dee Norton”), the only Accredited Children’s Advocacy Center (CAC) serving child trauma victims in Charleston County. Dee Norton is a specialty outpatient child maltreatment center that serves over 1,500 children each year. Child maltreatment is a public health problem with clearly documented negative physical and mental health effects for child victims (e.g., Felitti et al., 1998). Untreated childhood posttraumatic stress disorder is associated with other serious psychiatric problems in adolescence, including mood disorders, delinquency, anger management and impulse control difficulties, suicidal ideation and self-injury, and drug and alcohol abuse. These clinical correlates can persist and become exacerbated in adulthood (Danielson et al., 2006). Children of color are disproportionately represented in child welfare, yet because of systemic racism, families of color may distrust the legal, social welfare, and mental health systems (Office of the Surgeon General, 2001). Other cultural groups, such as sexual minorities (e.g., LGBTQ) are at high risk but similarly underutilize mental health services (Jee & Simms, 2006). There is a clear need to increase access to evidence-based trauma services and to ensure services are culturally sensitive. The proposed project will increase access to evidence-based treatments, with particular attention to improving the quality of and outcomes for children receiving treatment from diverse backgrounds, including racial and sexual minorities. To achieve service transformation, 55 child-serving professionals will be trained on quality improvements during the project. Further, the proposed project will directly impact children ages 2-17 by 5,889 children receiving trauma-informed screening and referral services. We further expect that 627 children will receive evidence-based, trauma-informed treatment, over the course of the proposed project.

Nationwide Children’s Hospital (NCH) “Expanding Access to Peritrauma and Trauma Treatment for Families in Central Ohio (APTT)” will increase capacity for and access to trauma services in Franklin ad Licking County. We will serve 1170 (Yr.1: 65, Yr. 2-5 approximately 277 on average) children and adolescents (ages 0 -17). We will prioritize services to black families in our urban poverty area who are overrepresented in public child serving systems, and rural families in a rapidly urbanizing county. APTT aims to decrease reliance on more intensive or complex trauma treatment by responding to child trauma early, or soon after a traumatic event. We will engage home visitation services, hospital emergency and acute services, and community organizations that represent these families. Goal One of our project aims to improve parent child attachment, reduce child trauma symptoms, and increase child protective factors by training 36 clinicians to provide Child Parent Psychotherapy (CPP) and/or the Perinatal adaptation (P-CPP) to 755 expectant and new mothers. Both services will be aligned with our home visitation program. Goal Two is to improve parent child communication and reduce posttraumatic symptoms in children after a recent traumatic event by training 25 clinicians to provide Child and Family Traumatic Stress Intervention (CFTSI) to 415 families in our hospital and with partners in a continuous county. Goal Three is to improve family engagement and satisfaction by improving our ability to provide integrated, family driven services congruent with cultural and linguistic backgrounds and preferences. APTT will provide CPP to 90 families in collaboration with Ethiopian Tewahedo Social Services, as well as care management to 125 families receiving services at NCH to address social determinants of health and tangible support needs, and provide advocacy to assist families to remain safely in services. A child trauma consultant will provide training and case consultation to reduce health inequities by addressing social and racial barriers to care, and increasing provider confidence to provide culturally relevant services. We will establish a trauma specific family advisory committee and align with their recommendations. Goal Four is to improve child trauma services by disseminating knowledge and building capacity to sustain efforts at the local and regional level, and contribute at the national level to the knowledge about effective trauma treatment with diverse populations. APTT will support CPP Train the Trainer consultation, increasing access to training to support service sustainability. We will provide training utilizing NCTSN material to at least 300 service providers, with a priority on community health workers and prevention services providers. Throughout the grant, staff will support Early Trauma Treatment Network’s effectiveness research with our local, diverse population by providing data and analytic support, and participate in the NCTSN Intimate Partner Collaborative to develop and disseminate one resource by grant year 5.

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.

Healing Hurt People (HHP): Integrating Peer Services (PS) with Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for violently injured (VI) racial and ethnic minority youth. HHP is a hospital and community-based violence intervention program providing peer support, trauma therapy, and case management to Philadelphia children (ages 8 to 18) who have been violently injured (shootings, stabbings, assaults) or witnessed such violence. Founded in 2007, HHP is part of Drexel University's Center for Nonviolence and Social Justice (CNSJ) in the College of Medicine and Dornsife School of Public Health. In 2020, 199 children were shot in Philadelphia, an increase of 83% from 2019. Physical assaults are also highly prevalent. The School District of Philadelphia reported 774 assaults in the 2018-2019 academic year. Many violently injured youths (VIY) are released from the hospital having received physical care, but no services related to their emotional suffering. Over 60% of VIY in Philadelphia experience PTSD symptoms. Untreated PTSD will potentially derail a child's healthy development and significantly increase the risk for substance abuse, suicidality, poor mental health, and impairing overall functioning at home, school, and in the community. Goal 1: Increase the number of violently injured children who access trauma-specific services via flexible/assertive outreach strategies. Objective 1.1: Staff will introduce services through bedside visits, phone outreach, and home-visits to 200 unduplicated children/families in Yr1; 220 in Yr2; 220 in Tr3; 220 in Yr4, and 220 in Yr5. Objective 1.2: 60% of those outreached each year will receive trauma psychoeducation. Objective 1.3: A brief acute needs assessment will be completed with 60% of participants outreached. Goal 2: Decrease traumatic stress symptoms/increase daily functioning in VIY by delivering PS with TF-CBT. Objective 2.1: 70% of children who receive PS with TF-CBT will report reduced trauma symptoms at discharge. Objective 2.2: 70% of children who receive PS and TF-CBT will report improved daily functioning at discharge. Goal 3: Increase coping skills/wellbeing among VIY through participation in a culturally relevant group therapy. Objective 3.1: 10 children will attend CYPHER group session in Yr1; 20 in Yr2; 30 in Yr3; 40 in Yr4; 50 in Yr5. Objective 3.2: 80% of those attending CYPHER will improve wellbeing as measured at discharge. Goal 4: Increase child serving organizations knowledge of trauma/impact on VIY to increase referrals to HHP and access to trauma services. Objective 4.1: Staff will provide in-service or "Trauma 101" presentations to 60 direct care professionals across child serving systems in Yr1; 80 in Yr2; 100 in Yr3; 120 in Yr4 and 140 in Yr5. 65% of attendees will exhibit increased knowledge of trauma and ability to use trauma-informed practices through post session evaluation surveys. Objective 4.2: Referrals to HHP from partner child serving organizations will increase 15% each year. Number of Unduplicated Individuals to be Served: Yr 1, 120; Yr 2, 132; Yr 3, 132; Yr 4, 132; Yr 5, 132; Total, 648.

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.

The proposed New York Center for Trauma-Informed Child Welfare Practice (NYCTICWP) will improve outcomes for children who have experienced trauma through the direct implementation of the evidence-based Trauma Systems Therapy (TST) model, the dissemination of evaluation findings and wider partnership with the NCTSI network, training provided to our partners throughout the child welfare system in New York City, and ultimately, policy and practice influence at the national level. The project will serve children between the ages of 5 and 21 residing in New York City who have been directly impacted by trauma, either as a victim or a witness, with a focus on those who are most at risk (families living in poverty, racial/ethnic minorities, and those living in communities with a high incidence of violence). In total, we expect that the NYCTICWP will support The Foundling in providing TST directly to 167 children and their families, and reaching 560 children and families through training in the TST model which our team will provide to an increasing number of partner agencies over the course of the grant period. The goals for the current project include (1) improving access to evidence based community treatment for children who have experienced trauma through direct implementation of TST, (2) further expanding access through training, consultation, and technical assistance in TST by NYCTICWP to partner agencies in child welfare; 3) development of additional intervention products including tele-mental health protocols and customizable electronic medical record (EMR) templates for service documentation and billing; and 4) the evaluation of TST and dissemination of findings within the broader partnership of the NCTSI network and to local, state and federal policy makers. We expect that 45-50% of youth who complete TST within the system or community will see a decrease in functional impairment as measured by Ages and Stages Questionnaire Social Emotional, Behavior Assessment System for Children – 3, Trauma Symptoms Checklist for Young Children or the Child PTSD Symptom Scale. The Foundling has engaged in partnerships with the NYU Center for Child Welfare Practice Innovation which is led by PI Glenn Saxe M.D. and is a NCTSN Category II site as well as the Haven Academy, a charter school in the Bronx that serves a majority population of child welfare involved youth, and Good Shepherd Services, a child welfare agency. The NYCTICWP also plans to develop additional partnerships during each year of the grant, which will gradually expand our capacity to impact the community as the project continues.

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.

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.

Serving Children and Adults in Need Inc. (SCAN) is proposing to implement its Border Traumatic Stress Response Center to increase access and the quality of effective trauma-focused treatment and service system in Webb County for children and adolescents, and their families who have experienced or witnessed a traumatic event. The project will provide access to all children and their families in Webb County, especially children living in underserved areas, adolescents with co-occurring trauma and substance use disorder and children of parents who are receiving substance use disorder treatment services. The project will serve a total of 750 children and their families (150 annually) for the duration of the project. SCAN will continue to foster the development of trauma-informed systems of care in Webb County through ongoing collaborations with community partners and NCTSN Category II sites. The projects goals are to: 1) Provide outreach and engagement strategies to increase access to and participation in trauma treatment and prevention services for children, adolescents, and their families who have experienced a traumatic event; 2) Provide a full continuum of evidence-based, trauma-focused, mental disorder treatment and services, including screening, assessment, care management, therapy, and prevention for diverse and at-risk children and adolescents; 3) Foster trauma-informed systems of care at local, regional, and state levels through education in trauma-informed practices for staff in child protective services, the foster care system, the juvenile justice system, and using SCAN's expertise and Network resources; 4) 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; 5) Implement a project evaluation, including process and outcomes evaluation, to be submitted to SAMHSA by the end of the project period; and 6) Staff will deliver culturally and linguistically competent evidence-based interventions with a high degree of fidelity. The project will collaborate with NCTSN TSA and CTS Centers on the development and enhancement of interventions for traumatized youth to make them more culturally and linguistically relevant. The project will utilize the following evidence-based practices: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT); Trauma Systems Therapy for Substance Abuse (TST-SA); Parent Child Interaction Therapy (PCIT) and Child-Adult Relationship Enhancement (CARE).

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).

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.