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Family Service of Rhode Island, the Roger Williams University Justice System Training and Research Institute and the Institute for Intergovernmental Research will create a Center for Trauma-Informed Policing to improve outcomes for traumatized children encountered on crime scenes. A state-of-the-art, virtual law enforcement training program will be developed and the FSRI Go Team police/mental health partnership program will be formally evaluated. A Project Advisory Committee including child trauma experts, law enforcement, clinicians, and family with lived experience will advise on all project activities. Following a New England-based pilot to test the initial training and technical assistance program and two Learning Communities involving police departments across the country to improve upon and refine the program and related intervention products, the final trauma-informed law enforcement Learning Management System (LMS) will be launched and broadly disseminated. Project goals and objectives: 1. Develop a best practice Trauma-Informed Policing training curriculum for law enforcement to respond to the needs of children impacted by traumatic stress (informed by a nationwide law enforcement survey, LMS design and build out, pilot testing, and two Learning Communities. 2. Evaluating FSRI's Go Team program to assess its efficacy in reducing child trauma symptomology as a promising addition to the inventory of evidence-based practices (including a point-in-time-self study, stakeholder survey, key informant interviews, Go Team service recipient focus groups, service utilization data, and measures for post intervention child trauma symptomology synthesized into a comprehensive evaluative report for journal publication. 3. Evaluation of overall project impact resulting in a Project Evaluation Report. 4. Dissemination of the Trauma-Informed Policing training program, LMS, intervention products, and evaluative findings (as promoted through project partner, SAMHSA, and NCTSN networks and presented at regional and national law enforcement and child mental health conferences, regional meetings, and other relevant venues. The Center for Trauma-Informed Policing or "TIP Center" will serve as an ongoing resource for law enforcement interested in becoming trauma-informed, implementing best practice response approaches, and developing or enhancing partnerships with community-based mental health organizations to mitigate the short- and long-term effects of childhood trauma exposure and reduce the risk of revictimization. Ten diverse police departments at various stages of trauma-informed readiness are expected to participate in the Year two pilot and 20 are expected to participate in the Year three and four Learning Communities. A total of 3,000 law enforcement professionals, community-based mental health professionals, and other key stakeholders are expected to benefit from TIP Center training, technical assistance, consultation, and intervention products across the five year project period.

Health disparities and systemic inequities cause child traumatic stress to have a disproportionate impact on marginalized communities. Addressing these disparities requires a diverse, skilled, well-supported, and resilient workforce. The proposed project, titled the "Center for Equity and Resilience in Trauma-Responsive Organizations," will create a Treatment and Service Adaptation Center to develop and implement a comprehensive approach to addressing these issues. Secondary traumatic stress is a major contributor to turnover in the helping professions, and it impedes the ability of providers to respond effectively to the children and families they serve. A lack of diversity in the workforce contributes to mental health disparities, lack of treatment engagement, and attrition among Black, Indigenous, and People of Color. Supporting a diverse workforce and preventing and addressing secondary traumatic stress are upstream approaches that can reach multitudes of children and families by improving the workforce’s ability to provide good care. The Center will be a partnership between the University of Denver Butler Institute for Families, and the University of Colorado Kempe Center for the Prevention and Treatment of Child Abuse and Neglect. Butler and Kempe have developed an approach with promising initial evaluation. With the support of this funding opportunity, the Center will expand, evaluate, refine, and disseminate this approach to build a diverse, skilled, well-supported, and resilient workforce among across child-, youth-, and family-serving systems in Colorado and nationwide. The central activities for the project include the development, implementation, and dissemination of the comprehensive approach which will strengthen the resilience and well-being of the workforce (Goal #1) and support a diverse workforce by advancing equity and addressing race-based traumatic stress in the workplace (Goal #2). These efforts will be complemented by improving the knowledge and skills of the workforce to care for children and families impacted by trauma with a lens of equity (Goal #3). Additionally, the project will develop materials addressing the above outcomes for national dissemination in partnership with the NCTSN (Goal #4). The comprehensive approach will be evaluated using equitable evaluation principles and refined to ensure effectiveness. Measurable objectives include the following: 1) at least 500 people complete the 16-hour Strengthening Resilience to Prevent and Address STS training series and 80% of those will show decreases in rates of burnout and STS; 2) at least 200 supervisors in the behavioral health, education, and child-, youth-, and family-serving systems complete Trauma-Informed Supervision training; 3) 100 supervisors and administrators and 200 staff complete the From Historical Trauma to Modern Oppression: Understanding Racism, Race-Based Traumatic Stress, and Cultural Healing module; 4) 20 agencies participate in a Zoom-facilitated Community of Practice and coaching and 80% of those agencies will show improvements in workplace equity and increases in staff intent to stay, particularly among BIPOC staff; 5) materials for all 4 Strengthening Resilience modules and the Historical Trauma training are transcreated and piloted with native Spanish speakers; and 6) two asynchronous web-based trainings (one in Spanish) are developed.

The Alaska Child Trauma Center at Alaska Behavioral Health is proposing a Rural Child Trauma Center to raise the standard of care and improve access to evidence-based treatments for rural children impacted by child trauma. The Center will provide training in rural communities to improve identification of child trauma and training to mental health professionals to improve the quality and accessibility of child trauma treatment in rural areas. The Rural Child Trauma Center will use four strategies; (1) rural community training on child trauma to improve local awareness, identification and responsiveness to child trauma (2) training and ongoing professional consultation on evidence-based treatments to mental health professionals serving rural areas (3) training on the provision of child trauma treatments using telehealth, to extend services to areas with mental health professional shortages (4) rural child trauma-focused Learning Communities to improve professional and organizational rural-service competency (5) an annual Rural Child Trauma Institute to disseminate best practices in rural child trauma treatment nationwide. The Rural Child Trauma Center will provide training to over 10,000 persons living in, or serving, rural areas over the project period. The sought outcomes of the Center are increased identification of child trauma in rural areas, improvement in the availability of evidence-based trauma treatments in rural areas and improvement in access to those services for children and families in rural communities.

The Coalition for Compassionate Schools (C2S) draws upon long-standing local partnerships between city agencies, the NCTSN Project Fleur-de-lis, Tulane University, and community organizations to support transformative change in New Orleans schools through the implementation and sustainment of a healing-centered, multitiered trauma-informed schools service approach to improve the psychological, behavioral, and educational outcomes of youth exposed to trauma and to prevent new exposure in schools. The C2S will address critical gaps in the trauma-informed schools service approach by integrating social justice and racial equity into our training content, tools, and implementation strategies; employing a multi-year strategy grounded in implementation science to increase the capacity of the K-8 education workforce in the TIS-SA; and expanding our approach into afterschool programs and other youth service systems. We will partner with the NCTSN Center for Safe Supportive Schools (Maryland) and the NCTSN Cullen Center (Ohio) to disseminate and replicate our implementation model, filling the need for a schools-focused NCTSN Category II Center in the Southern/Central region of the US. Our goals are to: 1) Increase the capacity of New Orleans K-8 public schools to implement and sustain a TIS-SA to improve outcomes for youth exposed to trauma and prevent new exposure in schools; 2) Expand implementation of TIS-SA to afterschool programs and coordinate training and consultation across service systems to support service providers and youth affected by traumatic events; and 3) Develop additional products to support a TIS-SA and provide training, consultation, and implementation support for the replication and dissemination of our TIS-SA to schools across the country.

The Stronger Together: Attachment, Resilience, & Support (STARS): Helping Children and Youth Reach Their Full Potential project seeks to promote resilience of children impacted by trauma by expanding the EBT workforce through training, consultation, and TA in EBTs (PSB-CBT; PCIT; TF-CBT) to ameliorate the behavioral sequelae of trauma with advanced trainings to fill identified gaps in standard training. Notably, 75 clinicians will receive training in PSB-CBT with an additional 12 clinicians receiving training in PCIT through the STARS training team. Further, to increase providers' understanding of trauma, all therapists will complete the NCTSN on-line Core Concepts of Trauma training. Advanced training in PCIT-PSB (up to 20 clinicians) and TF-CBT-PSB (up to 180 clinicians) will allow the cross-pollination of provider skills in EBT with interventions to treat behavioral sequelae of trauma. As part of the project, we additionally seek to enhance resilience of our EBT workforce through management and reduction of secondary traumatic stress (STS) by providing specialized training to up to the 400 clinicians and supervisors in the Components for Enhancing Clinician Experience and Reducing Trauma (CE-CERT) model. STARS will further facilitate sustainability of EBT within agencies through the provision of trainer training or advanced clinical populations in EBT for behavioral sequelae of trauma for up to 32 PSB-CBT providers. A total of 319 therapists will be trained in EBT and up to 400 will receive training to address STS as a result of the award with countless families and community members impacted and served. In addition to clinical training, the STARS project seeks to address systemic racism and inequities in agencies responding to problematic sexual behavior of youth and enhance engagement of families in EBT through culturally congruent communication and therapy practices. To this end, we will develop the STARS Equity Workgroup with PSB-CBT, PCIT, and TF-CBT leads, our existing PSB Youth Partnership and Parent Partnership Boards, and partners across the country including EBT trained clinicians. The workgroup will assess our current programming, develop a plan to address equity, and create and disseminate resources for equity practices and policies through the course of the project. The STARS team is composed of EBT and module developers, nationally recognized trainers, and consultants who have made significant impacts in their areas of expertise. The OUHSC STARS team also has extensive expertise in service provision to children and families impacted by trauma with infrastructure to conduct large-scale trainings, implementation, technical assistance and rigorous evaluation. Members will participate fully in NCTSN activities and works groups to further the Network's mission. Through the STARS program the outcomes of children who have experienced trauma can be brighter.

Implementing Multi-system Programs to Strengthen Attachment in Children and Families Affected by Trauma (IMPACT) serves children ages 1-7 and their families impacted by trauma and at risk for, or are involved with, the child welfare system in marginalized communities in East Tennessee. Our goals are to increase awareness and community engagement around trauma, decrease traumatic stress symptoms and disruptive behavior in young children, and decrease caregiver stress by improving their ability to parent children with trauma histories. We will increase identification of young children with trauma by partnering to provide a web-based trauma screening training product for the young children’s system of care and increase implementation of trauma screening instruments for young children with community mental health partners. We will coordinate dissemination efforts with community mental health centers to implement Parent-Child Interaction Therapy (PCIT) and two modifications to target trauma symptoms and emotion regulation. PCIT-Trauma Directed Interaction adds a trauma component to PCIT to help caregivers manage trauma reactions. PCIT with Toddlers supports caregivers of children ages 12-24 months with behavior and emotion dysregulation to help their child better regulate their feelings and behavior by strengthening attachment. We will work with foster parents, relative caregivers, and kinship placements through the Resource Parent Curriculum—Child-Adult Relationship Enhancement (RPC-CARE), in concert with the Center for Children and Families (CCFH), to educate and support families of young children to better understand the impact of trauma on children’s behaviors, and give them specific skills to successfully parent. IMPACT will expand workforce capacity to support families by working with case workers and other non-clinical staff in the CARE model, which will be implemented in outpatient and in-home settings. We will also support providers working with families to address secondary traumatic stress with Reflective Supervision and Consultation (RS/C) workshops followed by monthly reflective consultation groups. Reflective consultation gives providers the space to reflect on their work with families, consider cultural and contextual elements of their work, and mitigate the effects of secondary traumatic stress. IMPACT will engage the community and families by partnering with Tennessee Voices for Children and forming an Advisory Board to meet semi-annually to guide the IMPACT project. The Advisory Board will guide project personnel on services accessibility, review and provide input to address implementation barriers, assist with achieving cultural sensitivity to materials and engagement strategies and advise on sustainability. We anticipate serving at least 30 people the first year of the grant, then increasing that capacity to 74 families per year for a total of at least 300 families over five years.

The Center for Trauma Recovery and Juvenile Justice (CTRJJ) brings together juvenile justice (JJ) and mental health services experts with lived and professional experience to increase the capacity nationally to deliver culturally responsive evidence-based trauma treatment (EBTT) and trauma informed (TI) services to JJ-involved youth (JJIY) and youth at risk (JJAR), families, and JJ staff, and to increase traumatized JJIY/JJAR access nationally to TI services and EBTT's. Since 2012, CTRJJ partnered with NCCTS to form an NCTSN JJ Coordinating Committee and has created an array of trainings, educational products and presentations, and programmatic/ policy consultation for, and in collaboration with, leading national JJ advocacy organizations, professional societies, justice-related federal agencies and >75 municipal or regional juvenile justice systems in 25 states/territories. CTRJJ faculty have done >2,000 presentation/trainings for to more than 40,000 multidisciplinary providers, JJ personnel, attorneys, and judges, and school, child welfare, law enforcement, homelessness, family preservation, violence prevention, and health care services providers who serve >75,000 JJIY/JJAR, in collaboration with >20 Category II and >30 Category III NCTSN Centers/Affiliates, while producing >25 peer review publications and >50 educational products such as Working Together in the Pandemic for Trauma Informed Juvenile Justice and Trauma-Informed Services for Unaccompanied Minors. Over the five-year funding period, CTRJJ will provide training and technical assistance to more than 2500 youth/family serving programs and 10,000 professional/peer service providers to enable them to adapt, deliver, and evaluate EBTT's validated for JJIY/JJAR (TARGET and TGCTA) and a unique TI services curriculum for front-line staff (Think Trauma) and effectively serve > 50,000 traumatized JJIY/JJAR and their families. CTRJJ will continue partnering with the NCTSN National Center to lead and coordinate NCTSN JJ initiatives, and with Category II and III Centers to produce 500 public and professional TIJJ training and education products and presentations. CTRJJ will add faculty with unique expertise on racial/ethnic, identity-related, and historical trauma, implementation science, and JJ systems, in order to launch 2 major initiatives: (1) a TI JJ System Enhancement Academy (SEA) designed to guide 25 multi-constituency multi-disciplinary teams anchored by NCTSN Category III Center/Affiliates in developing coordinated TI enhancements of their local JJ services to prevent and reduce JJ involvement, increase youth and staff safety and prevent re-traumatization, and, increase involvement of parents and family members as partners while also reducing the adverse effects of secondary traumatic stress on JJ personnel and providers; (2) a Core Skills Consortium (CSC) of 15 NCTSN Category II Centers, that will identify core skills for TI/EBTT training, assessment, intervention, collaborative multi- disciplinary multi-system services planning and coordination, and service system transformation. Together, the SEA and CSC will create a framework for, and serve as first steps toward, a long-term initiative to integrate and sustain TI services within and across JJ and related systems.

Clayton County Juvenile Justice Fund doing business as Clayton County System of Care is applying for the NCTSI-II grant opportunity to build out the infrastructure of our Clayton County School Justice Partnership. Our Clayton County model often referred to as the “Teske” model, is recognized as the first of its kind and renown in utilizing a School Justice Partnership to promote early intervention, enhance mental health and prevent long term consequences of Adverse Childhood Experiences or trauma. Since our inception in 2004, we have been promulgating best practices by providing Technical Assistance (TA) through our in-house Progressive Assistance for Change and Empowerment (PACE) partnership to establish and sustain a trauma informed SJP to provide early trauma intervention that promotes health and wellness by increasing academic achievement and reducing unnecessary juvenile court referrals that lead to adult incarceration. PACE has lifted up Clayton County’s model which received recognition for serving as a national model and ideal solution to excessive school suspension and expulsions (Edleman, 2017, Howell et al. 2014, and NCJFCJ, 2015). Under the leadership of Judge Teske, PACE uses our national platform to provide training and technical assistance to forty-one different sites across twenty-three states and several of our sites have gone on to establish an SJP and have reported positive outcomes. Despite our nation’s progress towards implementing SJP’s many jurisdictions continually fail to realize the prevalence of ACEs among youth in the juvenile justice system. Jamieson (2019) notes that 90% of youth in the juvenile justice system have reported exposure to at least one ACE. The CCSJP will enhance national access to our dual in-person and remote platforms to help jurisdictions broker community buy-in and establish and sustain a trauma-informed School Justice Partnership. Moreover, our comprehensive approach includes data guidance and technical assistance to assist jurisdictions in collaborating across systems and agencies to measure and monitor their data driven needs and success. The incorporation of the data assistance will help overcome the current gaps of knowledge that jurisdictions struggle with when seeking to replicate the Clayton County School Justice Partnership (NCJFCJ, 2015). Lastly our unique marketing and resource assessment and technical assistance coordination allows jurisdictions to mobilize and sustain their School Justice Partnership. By providing services through our comprehensive CCSJP helpdesk we aim to replicate efficacious trauma informed School Justice Partnerships across the nation to embolden healthy future outcomes for children, families and communities.

Spurwink ShifaME Trauma Systems Therapy for Refugees uses Trauma Systems Therapy adapted for refugees (TST-R), an evidence-based practice, to provide culturally appropriate mental health services to refugee children, adolescents, and their families in six communities in Southern Maine who have or at risk for mental health issues due to trauma. TST-R addresses a child's trauma system from a social ecological perspective, working within the unique ecology of each child and family, and building systems of prevention and community resilience building, targeted skill-building, and stress reduction interventions for at-risk youth, and intensive therapeutic intervention for refugee youth with significant psychological distress. The ShifaME model includes community engagement, school-based groups, and home-based family treatment interventions. All tiers are delivered by mental health clinicians in partnership with cultural brokers who are members of the refugee community they are serving and trained in TST-R, and who assist the clinical team and the community in creating cross-cultural understanding and change. The program will serve up to 250 individuals through community and parent outreach and 297 individuals in Year 1; 387 people in Year 2; 477 in Year 3; and 567 in Year 5; for a total and 2,175 over five years, with 514 in direct care, 678 in behavioral health homes, and 736 in school groups. Project goals include increasing access to effective trauma-focused treatment and services by refugee youth and families by providing TST-R treatment and decreasing barriers to mental health services; improving school functioning for refugee youth; and improving mental health and overall functioning for refugee youth with significant trauma-related mental health symptoms. ShifaME will maximize community impact by expanding its breadth of services, cultural competency, and sustainability, and establish the program as a regional hub for TST-R expertise by developing a train-the-trainer model and curriculum for TST-R training. ShifaME will increase awareness of the need for mental health services and acceptance of services by providing linguistically and culturally responsive care facilitated by cultural brokers, improving mental health and school functioning.

The AMIkids NCTSI – III Community Treatment and Service Center Project will expand the provision of highly effective trauma screening, assessment, care management, therapy and prevention for youth and families by developing a NCTSN Category III Center. By providing licensed clinical professionals at three juvenile justice residential programs, this project will increase access to effective trauma-focused treatment for youth and families receiving delinquency services through the South Carolina Department of Juvenile Justice (SCDJJ). The population of focus for this project is juvenile justice involved youth through age 21 and their families who reside throughout the state of South Carolina. The majority of these youth come from low-income families, are youth of color, and have behavioral issues in school and in the home. These youth have typically experienced multiple arrests, family dysfunction, violence, substance abuse, and trauma. This project will expand trauma-focused treatment services in South Carolina by adding licensed clinical professionals in AMIkids residential programs located in the following geographic catchment areas: Bennettsville, Columbia, and Jonesville. This project will serve 100 individuals in the first year, and 125 in each of years 2 through 5, for a total of 600 individuals served. By leveraging and expanding the existing collaboration with a NCTSI – Category II, Treatment and Service Adaptation Center and its partnership with the SCDJJ as the only nonsecure residential provider in the state, AMIkids Inc. will engage AMIkids Behavioral Health to provide direct trauma treatment and services to juvenile-justice involved youth and increase participation of families in treatment at the locations identified. Services will include the use of validated trauma screening, assessment, and evidence-based trauma treatments such as Structured Psychotherapy for Adolescents Responding to Chronic Stress, Trauma Focused Cognitive Behavioral Therapy, and Eye Movement Desensitization and Reprocessing. Measurable objectives of the project include: (1) Within 7 days of admission, 100% of youth enrolled at three AMIkids residential programs will receive orientation and informed consent for trauma screening and treatment by an AMIkids Behavioral Health licensed clinical staff; (2) Within 7 days of informed consent acceptance, 100% of youth will receive trauma screening utilizing the UCLA-PTSD-RI-5 administered by licensed clinical staff; (3) Within 21 days of informed consent acceptance, 100% of youth enrolled at three AMIkids residential programs who have risk factors for trauma based on intake screening information including the UCLA-PTSD-RI-5 and ACE scale will receive a comprehensive mental health assessment administered by licensed clinical staff; (4) Within 30 days of informed consent acceptance, 100% of youth assessed as requiring trauma treatment will receive an individualized treatment plan outlining trauma treatment services to be delivered; (5) 100% of youth receiving trauma treatment services will be offered an evidence-based intervention matched to the assessed need, and 75% of adolescents and youth engaged in trauma treatment services will successfully complete the evidence-based intervention assigned; and (6) 100% of youth receiving trauma treatment services will be offered family therapy if indicated as a need based on comprehensive assessment and age, and 75% of eligible families will successfully complete family therapy goals as prescribed on the individualized treatment plan and measured by at least 60% dosage completion.

The MetroWest Evidence-based Trauma-Informed Referral & Treatment Initiative for Children (METRIC) will increase access to trauma-focused, evidence-based services for children and adolescents ages 2 to 18, and their families, in school and community-based settings in Waltham and surrounding MetroWest communities. Based at the Baker Center Waltham (BCW), a division of the Judge Baker Children's Center, this initiative will provide trauma-focused services to a projected 2,350 children and adolescents and their families during the five-year grant-period. The METRIC initiative includes collaboration among BCW expert staff, the Waltham Public Schools and NCTSI-II Centers, including the Child Trauma Training Center at UMass Medical Center. METRIC will include comprehensive screening; assessment, evidence-based trauma-focused treatment, training for school and outpatient clinicians, and referral systems to strengthen the infrastructure supporting the long-term needs of the community. METRIC's multilingual clinical staff will be trained in four evidence-based practices to meet the needs of children and adolescents impacted by traumatic stress. Throughout the five-year project, we will engage MetroWest stakeholders including schools, early care and education providers, pediatric providers, hospitals, child welfare staff, faith-based organizations, and other child-serving organizations through educational outreach, development of screening and referral mechanisms, and consultation. Metric will also employ a new Family Support Coordinator (FSC) at the Baker Center Waltham to assist parents and caregivers in navigating the treatment process and refer caregivers to needed community-based, culturally competent services. The FSC will also help families enroll in MassHealth (Medicaid) or private insurance as needed in order to ensure access to care. METRIC will add to the knowledge base of both the National Child Traumatic Stress Initiative network and ongoing trauma-focused initiatives in Massachusetts such as the Childhood Trauma Task Force. We will work collaboratively with local and state leadership to promote high quality trauma-focused care for vulnerable children and families and derive important lessons learned from this initiative that can be applied across our Commonwealth. The METRIC initiative will positively impact thousands of underserved children and adolescents in Waltham and the MetroWest region of Boston. METRIC will improve the quality of trauma-focused care, further develop a trauma-informed system of care, and increase access for underserved populations including economically disadvantaged, Black and Latinx children and teens and LGBTQ+ youth. This five-year initiative will provide much needed support to vulnerable families for many years to come and through METRIC we will establish the necessary infrastructure and mechanisms to sustain this work into the future.

The purpose of this project is to create the Juvenile Justice Trauma Informed Systems Program (Project JUSTIS) within the Child Trauma and Resilience Assessment Center (CTRAC) at Colorado State University (CSU). Project JUSTIS will serve Larimer and Denver county youth (ages 8-18) and their families who have experienced trauma and demonstrate risk for involvement in the juvenile justice (JJ) system. Childhood trauma is associated with higher levels of post-traumatic stress, deficits in regulation, and poorer experiences in school, all of which can contribute to higher risk of delinquent behavior. Unsurprisingly, youth in JJ have higher trauma exposure than their peers. Project JUSTIS aims to reduce entry into the JJ system and recidivism by increasing access to trauma-informed screening, services, and systems. Larimer County (8th judicial district) and Denver County (2nd judicial district) are home to a combined 90,000 of Colorado’s youth and together addressed close to 5,000 juvenile charges between 2017-2019. When a youth’s involvement in the JJ system escalates, risk for additional trauma exposure, separation from support systems, and obstacles to treatment increase, highlighting the need for coordination and provision of trauma-informed services for youth at-risk for JJ involvement. These risks are particularly salient for youth of color who are overrepresented in stricter levels of sentencing and detainment in both Larimer and Denver counties. Project JUSTIS aims to increase the capacity and expand delivery of trauma screening, assessment, and treatment for youth in the target population, train local professionals in trauma-informed care principles, and improve youth and caregiver well-being. To achieve these project goals, Project JUSTIS will deliver: (1) trauma screening; (2) comprehensive trauma assessments for youth and caregivers; (3) trauma-informed consultations; (4) evidence-based treatment; and (5) no-cost community training for organizations who engage with youth and families. Project JUSTIS will also engage with NCTSN network members to strengthen grant activities. Clinical teams will be trained in Trauma Focused Cognitive Behavioral Therapy (TF-CBT) and Alternatives for Families Cognitive Behavioral Therapy (AF-CBT) in collaboration with the NCTSI-II Center for Resilience and Well-being in Schools at the University of Colorado Boulder. Project JUSTIS also plans to engage in the System Enhancement Academies to support project implementation being proposed by the University of Connecticut Center for Trauma Recovery and Juvenile Justice in the upcoming NCTSI-II funding cycle. On a yearly basis, our team will screen between 115-375 youth and caregivers (increasing year over year) and train between 300-360 professionals. By the end of the project, we will have screened 1350 children, adolescents, and caregivers for complex trauma; and provided 1005 youth and caregivers assessments, consultations, and evidence-based trauma treatments. Additionally, our team will train 1680 staff from child-serving organizations in trauma screening and trauma-informed practices and train 50 graduate-level interns on trauma screening and assessment protocols.

The Center for Family and Adolescent Trauma Treatment (CFATT) will provide a wide array of community based, evidence based, trauma focused, and culturally informed treatments and services. Support provided via wrap around services and care coordinators will complement the three evidence-based practices (Trauma Focused CBT, Culturally Informed and Flexible Family Treatment for Adolescents: CIFFTA, and Trauma Assessment Pathway: TAP) that will be offered. The population of focus will be children and adolescents (11-18 years of age) who have experienced a traumatic event (e.g., sexual abuse, domestic violence, neighborhood or country of origin violence, natural disasters, immigration-related trauma). Adolescents will be identified/referred by community health workers, by our treatment partners (Center for Family and Child Enrichment and Citrus Family Care Network), and by community partners (e.g., local Care Coordinator/Natural Helper teams, Foster Care, Child Welfare, and Juvenile Justice). The diverse South Florida community requires treatments designed for complex presenting problems (e.g., cutting and self-harm, depression, and substance use), diverse populations (e.g., race, ethnicity, sexual orientation, and gender identity), and community contexts include powerful high risk factors. Four sets of Needs/Gaps have been identified. The first is the high rate of trauma documented in the South Florida area, partly because Black, Latino, and LGBTQ youth experience higher rates of victimization and trauma compared to the general population. The second is that despite the importance of family involvement and intervention, families tend to underutilize services and members may be difficult to engage into services without the use of specialized engagement strategies and interventions. The third is that it is difficult to change the practice in the youth serving systems without having an ongoing and sustained practice improvement relationship. The fourth is the devastating effects of COVID19. In response to these needs, the CFATT proposes a set of five goals. 1) To increase access and participation in services by youth/families exposed to traumatic events, through specialized outreach and engagement strategies. 2) To provide direct evidence based mental disorder treatment and comprehensive services (TAP, TF-CBT, CIFFTA, care coordination) to 85 youth/families per year (375 over 5 years) to decrease trauma-related and behavioral and mental health symptoms. 3) To provide training and workshops to child serving systems such as Child Welfare, Juvenile Justice, and Foster Care on trauma-informed practices. 4) To collaborate with the Allegheny CAT II TSA and Dr. Mannarino to enhance TF-CBT family engagement interventions and to enhance CIFFTA’s trauma intervention components. 5) To implement a rigorous project evaluation including a process and outcome evaluation.

Gateway Healthcare proposes to implement the “Scaling Up Access to Trauma-Focused CBT (TF-CBT) for Children in Rhode Island” project to increase access to effective, home-based trauma-focused treatment for children and adolescents, particularly those of color, and expand the network of trauma-competent providers in the state of Rhode Island. The project anticipates serving 1,100 unduplicated children and training a minimum of 65 clinicians in TF-CBT. The population of focus is children ages 5-18 in Rhode Island who have experienced significant trauma and are exhibiting symptoms such as anxiety, depression, self-harm, fear and avoidance, disruptions in eating and sleeping, physical ailments and/or co-occurring mental and substance use disorders. The project has a particular emphasis for families who are black, indigenous, and children of color (BIPOC) who have been traditionally underserved with trauma services. The project’s overarching goal is to increase the number of children in Rhode Island who have access to evidence-based trauma treatment, i.e., Trauma-Focused Cognitive Behavior Therapy (TF-CBT). The project’s measurable objectives are: 1) to train at least 65 clinicians in TF-CBT, including at least 10 clinicians who are BIPOC by the end of the project period; 2) to increase access to TF-CBT for 1,100 children in RI experiencing trauma, 45% of whom will be black, indigenous, or persons of color; and, 3) In years 1-3,to document specific modifications to the TF-CBT protocol for use in intensive home-based settings, including relevant cultural adaptations, and make them available to the broader mental health provider community in project years 4 and 5. Strategies and interventions to meet these goals and objectives include: 1) Providing evidence-based mental health trauma treatments and services to children in RI; 2) Growing the trauma resource in the state by bringing together organizations that support specific target populations, such as Latinx and Asian children or immigrants; 3) Expanding the number of clinicians in the state with both child expertise and training in evidence-based trauma techniques; and, 4) Documenting and distributing adaptations to the TF-CBT protocol that are effective with different population groups. Over the course of the project, 1,100 children will be treated and 65 clinicians will receive training, as follows: Year 1: 150 children and 32 clinicians; Year 2: 200 children and 15 clinicians; Year 3: 250 children and 10 clinicians; Year 4: 250 children and 8 clinicians; and Year 5: 250 children and 5 clinicians.

The population of focus for the COACHES Trauma-Focused High Fidelity Wraparound project (“COACHES” project) is children and transition-age youth (and their families) between the ages of 6 and 21, who have a serious emotional disturbance (SED) and those at risk for or with co-occurring substance use disorders (SUD) who have experienced one or more Adverse Childhood Experiences (ACEs). The geographic catchment area includes Putnam and St. Johns, two adjacent counties in Northeast Florida where the prevalence of children in grades K-12 with an emotional/behavioral disability has been increasing since 2018 despite stable levels among their peers in Florida. Over the 5-year grant period, the project will serve 230 unduplicated youth and families as follows: 30 the first year, and 50 each year thereafter. The population of focus includes children with a history of trauma and those served by the child welfare system who are at higher risk for out-of-home placement as demonstrated by repeated failures at less intensive levels of care, a history of two or more psychiatric hospitalizations, involvement with the Department of Juvenile Justice, and/or poor academic performance and/or suspensions. The goal of the program is to increase timely access to culturally competent, evidence-informed and evidence-based trauma treatment and services to prevent out of home placements or admission to inpatient/residential or juvenile justice programs. Two mobile teams, comprised of a trauma-trained clinician and a wraparound case manager, supported by a shared peer support specialist position will provide services in-person, in-home/on-site, as well as via telehealth and digital communication to address transportation barriers. Objective 1: By the end of the grant period, 80% of youth will remain in the community (defined as no involuntary psychiatric hospitalizations, residential placement, formal respite placement or incarceration) while participating in services. Objective 2: By the end of the grant period, 80% of youth will demonstrate an improvement in their social, cognitive, and role functioning as evidenced by CFAR/FARS or related assessment scores. Objective 3: By the end of the grant period, eligible youth will demonstrate 80% attendance of available school days while receiving services. Objective 4: By the end of the grant period, 80% of youth will not meet the HUD definition of homelessness while participating in services. Evidence-based practices will include Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Brief Strategic Family Therapy – Solutions Focused (BSFT), and High-Fidelity Wraparound. To implement the required activities, LSF Health Systems (LSF), a not-for-profit, behavioral health Managing Entity contracted by the State of Florida to manage the state-funded system of behavioral healthcare in Northeast Florida, will partner with St. Augustine Youth Services (SAYS), a leading not-for-profit behavioral health provider with more than 30 years of experience serving vulnerable children and families.

Over 5 years, Family Service of Rhode Island will trauma-screen 3,000 at-risk diverse children; provide evidence-based/informed practices (EBPs) to 1000+ children, with 250+ families receiving help with care barriers; add 64 therapists certified in EBPs; educate 3000 child-serving workers statewide on trauma-focused care/referrals; adapt/innovate 3 EBPs to improve outcomes; measure effectiveness; and sustain treatment. Project Name: Children’s Treatment and Recovery Center. Populations Served: 3,000 at-risk children (particularly victims of or witnesses to abuse, violent crimes, etc.) ages 2 to 18 and their families, particularly from Latinx and Communities of Color with a focus on low-income high-crime cities Providence, Centrals Falls and Pawtucket. In addition, 3000 child serving professionals statewide will be educated to foster understanding and referrals to trauma-focused evidence-based practices (EBPs) and increase the number of clinical providers certified in these treatments. Strategies/Interventions: EBPs will be Trauma-Focused Cognitive Behavioral Therapy (TF-CBT); Parent Child Interaction Therapy (PCIT); Trauma Systems Therapy (TST, evidence-informed). TF-CBT to be adapted to improve outcomes. Other interventions: measuring clinical effectiveness with Child Stress Disorder Checklist; assisting populations overcome care barriers; Resources provided to increase understanding of child-serving professionals of EBPs; Goals: 1) Expanded access to EBPs for diverse at-risk children and their families. 2) Providing direct services of aforementioned therapies; 3) Educate child-serving systems about trauma-informed resources and services to increase access and referrals to EBPs 4) Collaborate with Category II and III sites to adapt EBPs. 5) Measure treatment effectiveness. Overview of Objectives: 1) Trauma-screen 3000 children/youth for exposure to traumatic events; 2) Increase number of certified PCIT therapists by 4; TF-CBT by 60 (focus on bilingual, bi-cultural staff); 3) Treat 1000 children with EBPs; 4) Identify funding beyond SAMHSA for sustainability; 5) Outreach and care management for 250 families; 6) Emergency services for 100 youngsters; 7) Implement clinical measure Child Stress Disorder Checklist; 8) Deliver trauma-focused education/resources to 3000 child-serving professionals and measure knowledge gain; 9) With NCTSN Category IIs and IIIs, adapt TF-CBT, and foster increased number of PCIT clinicians and improve TST implementation;10) Measure effectiveness of Children’s Treatment and Recovery Center. Total People Served Annually: Year 1: 1200; Year 2: 1300; Year 3: 1500; Year 4: 1700; Year 5: 1800 Total People Served At End of 5 Years: 7500.

Memorial Hermann Health System (MHHS), is the largest, non-profit, integrated health system in Greater Houston, serving over 2 million patients across 320 sites in Southeast Texas. Our 14 hospitals, anchors within their respective communities, cover Houston’s Metropolitan Service Area with a population of 6.37 million. MHHS’ Behavioral Health Services (BHS) provides quality behavioral health services to children, adolescents, and adults through a continuum of programs that span 11 hospitals and over 13 community settings. Almost 50% of our patient population is uninsured and low-income. We offer trauma-informed care focusing on Medicaid, uninsured/low-income, at-risk children and adolescents living in our four county catchment area: Harris, Montgomery, Brazoria and Fort Bend. Our grant program provides a continuum of services from screening and comprehensive assessment to treatment and prevention to our target population. We capitalize upon the patient flow from our emergency departments, our Mental Health Crisis Clinics, and other BHS program. Grant-funded Trauma-focused Behavioral Health Clinicians will be embedded into our Mental Health Crisis Clinics, benefit from the existing interdisciplinary care team, to offer trauma-informed care to at-risk children and youth. We leverage technology to offer in-person or virtual care. Referrals will be generated from our partners, which include The Harris Center and Tri-County Behavioral Health (local mental health authorities) and three school districts (Humble, Spring Branch and New Caney ISDs). Our overall goal is to increase access to trauma-informed care for vulnerable children and adolescents and improve patient symptomology. Our grant objectives over the five year period are: 1) to screen 5,000 children and adolescents across our health system for current or historical trauma; 2) to enroll and treat 625 children and adolescents using Trauma Focused- Cognitive Behavioral Therapy (TF-CBT) or Trauma and Grief Component Therapy (TGCT) to reduce patient symptomology by 20%; and 3) to offer 2 educational sessions per year targeting parents at our partner schools to help them understand trauma and what steps they can take to prevent trauma in their children. We dedicate time for outreach and to engage new stakeholders to ensure our community is informed of this invaluable grant program.

In the collaboration of the Health Intervention Projects for Under-served Populations (HIPUP)/Public Health Institute (PHI) and Korean Community Center for the East Bay (KCCEB), Improving the Wellness for Asian Youth 2 (IWAY2) aims to provide trauma-informed treatment and other services [e.g., youth empowerment programs (YEPs)] to reduce psychological symptoms and behavioral problems and promote health and well-being for Asian children in Alameda County, CA. IWAY2, an expansion of our current successful IWAY project, will target Asian children (12 to 18 years old) and their families who have had traumatic experiences due to the COVID-19 related violence and harassment against Asians, refugee/immigration process, child abuse, and other traumatic events (e.g., exposure to war and disaster). In collaboration with stakeholders, local CBOs, including NCTSI Category II and III Centers, and the Public Health Department and other child-serving agencies, we will conduct community and online outreach and recruit the targeted Asian children who are suffering from trauma. Counselors and Health Educators will provide trauma-informed treatment and other services (e.g., YEPs) based on SAMHSA’s EBPs (IFACES and TF-CBT) and monitor the progress of clients. We will evaluate the efficacy of IWAY2 utilizing GPRA/SPARS and local measures. Based on the collaboration with local service providers, we will also facilitate system-level changes in child-serving systems to improve access, use, and outcomes of trauma-informed treatment and other services and improve behavioral health disparities. IWAY2 aims to attain the following measurable objectives: 1) 20,000 contacts through community and online outreach (3,200 in year 01; 4,800 each in year 02, 03, and 04; 2,400 in year 05); 2) 5,000 screenings for eligibility (800 in year 01; 1,200 each in year 02, 03, and 04; 600 in year 05); 3) 1,000 referral services to collaborating agencies (160 in year 01; 240 each in year 02, 03, and 04; 120 in year 05); 4) 250 Asian children enrolling in Counseling (TF-CBT) and YEPs (IFACES) (Counseling Program: 20 in year 01; 30 each in year 02, 03, and 04; 15 in year 05; YEPs: 20 in year 01; 30 each in year 02, 03, and 04; 15 in year 05); 5) 225 completion of the Counseling or YEPs and exit assessment (225 children: 36 in year 01, 54 each in year 02, 03, and 04, and 27 in year 05); 6) 200 completion of the 6-month follow-up assessment (32 in year 01, 48 each in year 02, 03, and 04, and 24 in year 05); 7) 20 trainings for service providers and county/state agencies (e.g., child protection agency) on trauma-informed treatment and other services (4 trainings in each project year); and 8) 10 collaboration projects with NCTSI-Category II TSA Centers. Results of the process and outcome evaluation will be reported to SAMHSA and the targeted communities through the project website, community forums, and newsletters. Through direct individual and system level interventions, IWAY2 will have a significant impact on increasing access, use, and outcomes of trauma-informed treatment and other services for Asian children and families who are suffering from trauma but have been neglected by mental health and other service providers.

Western Michigan University's Children's Trauma Assessment Center (CTAC), a thrice funded NCTSN site, proposes the Family Assessment and Specialized Trauma Treatment to Advance Resiliency in Children and Families (FASTER) Project. CTAC will partner with the Michigan Department of Health and Human Services (MDHHS) to develop, pilot, and implement a family resiliency-based trauma assessment model, in conjunction with an evidence-based trauma treatment, Trust Based Relational Intervention (TBRI), for children and families in the child welfare system. FASTER's overarching goals are to 1) increase permanency for children, and 2) improve child and family well-being. CTAC will partner with Texas Christian University's Karyn Purvis Institute, the home of TBRI, to implement TBRI to families receiving resiliency-based trauma assessments at CTAC. In subsequent years, CTAC will disseminate TBRI to its four trauma assessment center partners (Easter Seals of Michigan, Child and Family Services of Upper Michigan, Great Lakes Recovering Center of the Upper Peninsula, and Children's Trauma Assessment Group). In years 3-5 the assessment centers will provide statewide accessibility for family trauma assessment and TBRI. CTAC will initially (years 1-2) serve child welfare populations from Kent County (second largest urban population in Michigan) and Jackson County (a midsize county with double the statewide child maltreatment substantiation rates). Objectives include: 1) developing a replicable resiliency-based family trauma assessment product, 2) engaging families in family assessment, 3) MDHHS funding contracts for statewide family trauma assessments, 4) conducting TBRI family interventions, 5) collaborating with NCTSN sites, and 6) developing an Advisory Board of parents and youth formerly involved in child welfare. In Year 1, 175 people (100 children, 75 adults) will be served; Year 2, 228 individuals (130 children, 98 adults) will be served; Years 3 through 5, 508 individuals (250 children, 258 adults) will be served each year; with five year totals of 1927 individuals (980 children, 947 adults) being served. FASTER's evaluation will include process and fidelity measures for implementation, including an evaluation of how the family assessment is integrated across the assessment sites. Additionally, the evaluation includes a focus on outcomes, utilizing the NOMS measures as well as screening and assessment tools to examine the impact of TBRI. The evaluation design is descriptive and will add to the existing knowledge base for family-focused assessment, service planning, and interventions intended to address trauma.

Volunteers of America Southeast Louisiana (VOASELA) proposes a National Child Traumatic Stress Initiative-Category III (NCTSI-III) according to SM-21-010 requirements to increase access to effective trauma-focused treatment and services for children and adolescents ages six-18, and their families, who experience traumatic events specifically from exposure to violent crimes; domestic violence/substance abuse, and parent incarceration. Within this population, are youth of active military/veterans and those in child-serving systems (child-welfare and protective services, juvenile justice). The project will focus on service delivery within dual parishes of Greater New Orleans (GNO)—Jefferson Parish and Orleans Parish. Both parishes have at least a 20% youth population under age 18 living in parish communities with nearly 25% household poverty and among extreme neighborhood violence and crime--so extreme, that 98% of the nation’s cities are safer than GNO. Sixty-percent (60%) of youth are victims of or witnesses to physical or sexual, school, and/or neighborhood violence; nearly 40% have experienced one form of violence, and another 10% have experienced an excess of five instances of violence. Without intervention, this exposure to violence predisposes youth to adverse childhood experiences (ACEs) and child-trauma reactions. To mitigate the prevalence of child trauma in GNO, VOASELA will serve 300 youth over the grant period, (Y1=36; Y2=76; Y3=76; Y4=76; Y5=36), through the implementation of (1) a public awareness campaign for in-person community engagement (abiding COVID-19 precautions) and virtual communication with a strong presence on social media platforms and hosting community forums; (2) collaboration with a NCTSI-II TSA to provide consultation and staff training on evidence-based (EB) Trauma-Informed-Cognitive Behavioral Therapy (CF-CBT); (3) case management and therapeutic services using EB screening/assessment tools and clinical treatment plans with CF-CBT methodology; (4) support for child-serving agencies to identify youth with trauma-reactions and provide linkage to treatment/services, and engage key agency representatives to collaborate on policies to reduce violence and disparities affecting child and adolescent mental health; and (5) partner with experienced researchers (evaluators) to study the NCTSI-III proposed project effectiveness through a well-designed process and outcome evaluation. VOASELA respectfully requests SAMHSA funding for $2,000,000 to implement the five-year proposed NCTSI-III project to improve access for marginalized children, adolescents, and their families to EB trauma-focused treatment/services.

Philadelphia Alliance for Child Trauma Services: Fortifying the Future The intent of this application is to change the trajectory for trauma impacted youth and families by building an expanded, more responsive, and more nimble citywide trauma services infrastructure. We will accomplish this by building infrastructure support to expand and enhance the trauma providers’ networks and by ensuring access to universal trauma screening and treatment for youth and families. Our focus is on the most vulnerable youth, ages 3-21, who experience trauma and interpersonal or community violence, commercial sexual exploitation, and traumatizing racism and discrimination. We will assess 500 youth/year for trauma, totaling 2,500 in 5 years; and provide EBP trauma services to 500 youth/year, with a total of reaching 2,500 youth over 5 years. We will implement three EBPs. 1) Universal Screening using the Trauma History Questionnaire throughout all Philadelphia youth serving providers. 2) Trauma-Focused Cognitive Behavioral Therapy, an intervention used with youth and parents/caregivers to decrease the negative behavior patterns and emotional responses that occur as a result of sexual abuse, physical abuse and other traumas. 3)Stress-Less, an evidence-informed trauma intervention for clinicians who provide youth trauma services. Four major goals will guide our work. 1) Expand and build sustainability in the public mental health system’s capacity to provide evidence-based trauma treatment to underserved youth and families. 2) Increase parity of access and quality of services for LGBTQ+ identifying individuals and Black, Indigenous and people of color, youth and families impacted by trauma. Incorporating an anti-racism lens into our trauma-informed approach and specifically training clinicians to engage in culturally responsive and anti-racist evidence-based trauma care. 3) Develop youth and community trauma leadership through building on the power of social capital and the role that trusted individual community members and grassroots organizations play in building trust and reputation. We will build a network of grassroots partners and youth advocates to help re-shape the mental health system, while raising awareness and utilization of trauma screening, TF-CBT, Stress-Less and other EBPs. 4) Increase local and national partnerships by increasing our partnerships by 30%. The expansion will include youth serving agencies, such as the Children’s Hospital of Philadelphia and Philadelphia Child Welfare, to refine, strengthen and support the development of an effective referral process for trauma services and to provide trauma education opportunities. We will expand and develop new partnerships with NCTSN centers in order to contribute to product development and model adaptations.