DEPARTMENT OF HEALTH AND HUMAN SERVICES

**Substance Abuse and Mental Health Services Administration**

**Center for Mental Health Services**

**Request for Applications (RFA) No. SM 03-011**

**Part I - Programmatic Guidance**

**Cooperative Agreements To Expand the National Child Traumatic Stress
Initiative**

**Short Title: Child Traumatic Stress Initiative**

**Intervention Development and Evaluation Centers**

Application Due Date**:**

**[August]{.underline}** **[7, 2003]{.underline}**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Gail P. Hutchings, M.P.A. Charles G. Curie, M.A., A.C.S.W.

Acting Director Administrator

Center for Mental Health Services Substance Abuse and Mental Health

Substance Abuse and Mental Health Services Administration

Services Administration

Date of Issuance: June 25, 2003

Catalog of Federal Domestic Assistance (CFDA) No. 93.243

Authority: Section 582 of the Public Health Service Act and subject to
the availability of funds.

**Table of Contents**

Agency 3

Purpose of this Announcement 3

Who Can Apply? 4

Application Kit 4

How To get an Application Kit 5

Where To Send the Application 5

Application Due Date 5

How To Get Help 6

Cooperative Agreements 6

Award Criteria 7

Post-award Requirements 7

Program Overview 7

What To Include in Your Application 10

Face Page 10

Abstract 10

Table of Contents 10

Budget Form 10

Project Narrative and Supporting Documentation 10

Appendices 11

Assurances 12

Certifications 12

Disclosure of Lobbying Activities 12

Checklist 12

Project Narrative 12

Rural/Tribal/Frontier (RTF) Intervention Development and Evaluation
(IDE) Center Project Requirements 14

Confidentiality and SAMHSA Participant Protection 20

Special Considerations and Requirements 23

Service Systems Models (SSM) IDE Center Project Requirements 24

Confidentiality and SAMHSA Participant Protection 31

Special Considerations and Requirements 34

Traumatic Stress and Substance Abuse (TSSA) IDE Center Project
Requirements 35

Confidentiality and SAMHSA Participant Protection 42

Special Considerations and Requirements 45

Appendix A: Background 46

Appendix B: References and Resources 49

Appendix C: NCTSN Background, Structure, and Mission 52

Appendix D: National Child Traumatic Stress Network Centers Descriptions
54

Appendix E: National Child Traumatic Stress Network Identity Description
68

Appendix F: NCTSN Organizational Chart 75

Appendix G: National Child Traumatic Stress Network Organization 76

Appendix H: Functional Cores and Planned Collaborative Groups 80

Appendix I: National Child Traumatic Stress Network Collaborative
Activities 81

Appendix J: National Child Traumatic Stress Network Data Collection
Domains 86

[Number range CHAPTER**Agency**]{.underline}

U.S. Department of Health and Human Services (DHHS), Substance Abuse and
Mental Health Services Administration.

Number range CHAPTER**[Purpose of this Announcement]{.underline}**

The Substance Abuse and Mental Health Services Administration (SAMHSA),
Center for Mental Health Services (CMHS) is accepting applications for
fiscal year 2003 cooperative agreements to expand the National Child
Traumatic Stress Initiative (NCTSI). Funds are available under Section
582 to local mental health providers for the purpose of developing
knowledge of best practices and providing mental health services to
children and youth suffering from post-traumatic stress as a result of
having experienced or witnessed a traumatic event. It is expected that
approximately **\$1.8 million** will be available to fund **three** new
centers in the **Intervention Development and Evaluation Program** of
the National Child Traumatic Stress Network (NCTSN). Number range
CHAPTERAnnual awards may be up to \$600,000 in total costs (direct and
indirect) for each year for up to 4 years. **Cost sharing is not
required in this program.** Actual funding levels will depend on the
availability of funds. Second, third, and fourth project-year funding
may be supplemented by SAMHSA for activities that fall within the scope
and intent of this RFA.

**Applications with proposed budgets that exceed \$600,000 will be
returned without review.**

Applicants **must** request support for 4 years and provide a separate
budget for each year. While SAMHSA's intent for this program is to fund
the full four year period requested, continued funding is contingent on
availability of funds.

Number range CHAPTERThe purpose of the NCTSI is to improve treatment and
services for all children and adolescents in the United States who have
experienced traumatic events or witnessed such events. A network of
centers, the NCTSN, has been established to promote the development and
use of effective treatments and services, to develop resources on trauma
for professionals, consumers, and the public, and to develop
trauma-focused public education and professional training and other
field development activities.

Number range CHAPTERThis RFA solicits applications for three specific
types of child and adolescent traumatic stress Intervention Development
and Evaluation (IDE) centers that will facilitate the NCTSI achievement
of its overall goals of improving access to and quality of services for
child and adolescent traumatic stress:

-   

-   Rural/Tribal/Frontier (RTF) Intervention Development and Evaluation
    Center

-   

-   Service Systems Models Intervention Development and Evaluation
    Center

-   Traumatic Stress and Substance Abuse Intervention Development and
    Evaluation Center

The Rural/Tribal/Frontier (RTF) IDE Center will support development of
child and adolescent traumatic stress treatment and service programs in
rural, frontier and tribal areas and development of distance
learning/consultation approaches for service delivery in such areas.

The Service Systems Models (SSM) IDE Center will support the
identification, standardization, implementation, evaluation, and
dissemination of promising trauma-informed service system intervention
models in youth-serving service systems.

The Traumatic Stress and Substance Abuse (TSSA) IDE Center will support
development, evaluation, and dissemination of interventions for
adolescents with co-occurring traumatic stress and substance abuse
problems.

[Number range CHAPTER**Who Can Apply?**]{.underline}

The following domestic public and private nonprofit entities are
eligible to apply:

-   Community-based and faith-based organizations;

-   Outpatient clinics;

-   Public or private universities;

-   Psychiatric or general hospitals;

-   Units of State or local governments;

-   Indian tribes and tribal organizations; and

-   Partnerships of multiple clinical centers, programs, and/or
    community service providers applying as a single center (in which
    case one of the participating organizations must be designated as
    the applicant organization).

Number range CHAPTER**Applicant organizations may apply for the
Intervention Development and Evaluation Centers (this RFA) and/or the
Community Treatment and Services Centers (RFA SM-03-012). A separate,
complete application is required for each category.** An organization
that is selected for funding in both grant programs will receive funding
only for its proposed Intervention Development and Evaluation Center.

**Organizations that are currently grantees of the NCTSI are not
eligible to apply as the applicant organization under this RFA.**

**Applicant organizations must apply for one of the specific IDE
centers---**Rural/Tribal/Frontier; Service Systems Models; or Traumatic
Stress and Substance Abuse**---**and address the requirements for that
specific center in the application. Applicant organizations may submit
separate applications for more than one of the specific IDE centers.

[Number range CHAPTER**Application Kit **]{.underline}

To submit an application for the Intervention Development and Evaluation
Centers program, include the following:

**1. *PHS 5161-1 ****(revised July 2000)*---Includes the Face Page,
Budget forms, Assurances, Certifications, and Checklist.

**2. *PART I*** of the Request for Applications (RFA) includes
instructions for the specific grant or cooperative agreement
application. This document is Part I.

**3. *PART II*** of the Request for Applications (RFA) provides general
guidance and policies for SAMHSA grant applications. The policies in
Part II that apply to this program are listed in this document under
"Special Considerations and Requirements."

**You must use all of the above documents of the kit in completing your
application.**

![](media/image1.wmf){width="9.305555555555556e-2in"
height="9.305555555555556e-2in"}**[How]{.underline}** **[To Get an
Application Kit:]{.underline}**

To get a complete application kit, including Parts I and II, you can:

-   Call the SAMHSA Mental Health Information Center at (800) 789-2647
    Monday through Friday, 8:30 a.m. to 5:00 p.m., EST

TDD: (301) 443-9006

Fax: (301) 984-8796

P.O. Box 42490

Washington, DC 20015

-   Download **Part I, Part II, and the PHS 5161-1** of the application
    kit from the SAMHSA web site at
    [www.samhsa.gov.](http://www.SAMHSA.gov./) Click on "Grant
    Opportunities" and then "Current Grant Funding Opportunities."

**[Where]{.underline}** **[To Send the Application]{.underline}**

Send the signed original and two copies of your grant application to:

Mr. Ray Lucero, Review Branch

Substance Abuse and Mental Health Services Administration

## Parklawn Building, Room 17-89

5600 Fishers Lane

## Rockville, MD 20857

**ATTN: Announcement SM03-011**

If you require a phone number for delivery, you may use (301) 443-9917.

**All applications MUST be sent via a recognized commercial or
governmental carrier. Hand-carried, faxed or e-mailed applications will
not be accepted.** **You will be** **notified by letter that your
application has been received.**

**Be sure to identify the specific IDE center being applied for,** in
Item Number 10 on the face page of the application form (SF 424) by
indicating:

-   

-   "SM-03-011, National Child Traumatic Stress Initiative:
    Rural/Tribal/Frontier IDE Program," or

-   "SM-03-011, National Child Traumatic Stress Initiative: Service
    Systems Models IDE Program," or

-   

-   "SM-03-011, National Child Traumatic Stress Initiative: Traumatic
    Stress and Substance Abuse IDE Program" in Item Number 10 on the
    face page of the application form.

[Number range CHAPTER**Application Due Date**]{.underline}

**Your application must be [received]{.underline} by**

**August** **7, 2003.** Applications received after this date will only
be accepted if they have a proof-of-mailing date from the carrier no
later than 7 days before the due date.

Privately metered postmarks [are not acceptable]{.underline} as proof of
timely mailing. Late applications will be returned without review.

**It is anticipated that funding decisions related to this RFA will not
be made before September 2003.**

**[How]{.underline}** **[To Get Help]{.underline}**

**For questions on program issues, contact:**

Malcolm Gordon, Ph.D.

Division of Prevention, Traumatic Stress, and Special Programs

Room 17C-17

Center for Mental Health Services

The Substance Abuse and Mental Health Services Administration (SAMHSA)

5600 Fishers Lane

Rockville, MD 20857

\(301\) 443-2957

E-mail: <mgordon@samhsa.gov>

**For questions on grants management issues, contact:**

Stephen Hudak

Division of Grants Management

Substance Abuse and Mental Health Services Administration

Rockwall II, 6^th^ Floor

5600 Fishers Lane

Rockville, MD 20857

\(301\) 443-9666

E-mail: shudak@samhsa.gov

**[Number range CHAPTERCooperative Agreements]{.underline}**

All awards are being made as cooperative agreements because they are
complex and may require substantial Federal staff involvement.

**Awardees** **must:**

-   Comply with the terms of the cooperative agreement award as
    specified in the requirements of this RFA and the Notice of Grant
    Award.

-   Participate in collaborative activities with other NCTSN centers and
    other collaborative network activities.

-   Participate in grantee meetings.

-   Accept guidance and respond to requests for data from CMHS.

-   Participate in policy steering groups and other work groups to help
    accomplish project goals.

-   As appropriate, author or co-author publications on project results
    for use by field staff.

-   Participate in post-award, cross-site process and outcome evaluation
    activities.

-   Implement specified activities, data collection, and quality control
    and complete required SAMHSA reports.

**SAMHSA Staff** **will:**

-   Consult with the National Center, Intervention Development and
    Evaluation Centers, and Community Treatment and Services Centers
    Project Directors on all phases of the project to ensure
    accomplishment of the goals of the NCTSI.

-   Review critical project activities for conformity to the goals of
    the NCTSI.

-   Have overall responsibility for monitoring the conduct and progress
    of the NCTSI programs.

-   Make recommendations regarding continued funding.

-   Provide feedback on project design and components.

-   Participate in selected policy and steering groups or related work
    groups.

-   Review quarterly reports and conduct site visits, if warranted.

-   Provide support services or recommend outside consultants, if
    needed.

-   Author or co-author publications on program findings.

-   Provide technical assistance on ways to help disseminate and
    implement products of collaborative activities.

**[Number range CHAPTERAward Criteria]{.underline}**

Decisions to fund a grant are based on:

1.  The strengths and weaknesses of the application as indicated by a
    Peer Review Committee and approved by the CMHS National Advisory
    Council.

2.  Availability of funds.

3.  The experience of the applicant organization in the field of
    trauma-related mental disorders.

4.  Geographic distribution among regions of the country and among urban
    and rural areas.

**[Post-award Requirements]{.underline}**

##  [Reports Required]{.underline}

-   

-   Quarterly progress reports (the Government Project Officer \[GPO\]
    will suggest the format for these reports).

-   

-   Annual report (in place of fourth quarterly report).

-   Final report at the end of the project period summarizing project
    progress, accomplishments, problems, alterations in approaches used,
    and lessons learned.

2\. Grantees must inform the Project Officer of any publications based
on the grant project.

3\. Grantees must provide information needed by SAMHSA to comply with
the Government Performance and Results Act (GPRA) reporting
requirements.

GPRA mandates accountability and performance-based management by Federal
agencies, focusing on results or outcomes in evaluating the
effectiveness of Federal activities and on measuring progress toward
achieving national goals and objectives. Grantees must comply with GPRA
data collection and reporting requirements.

GPRA measures related to this RFA are not yet determined. Following the
awards, SAMHSA will be working with grantees to finalize the GPRA
measures and obtain necessary clearances.

4\. [Grantee]{.underline} [meetings]{.underline}: All awardees must
attend an annual 3-day meeting of the centers funded under this
Initiative. Costs related to this requirement must be provided for in
the project budget. All NCTSI awardees should plan for three project
staff to attend.

[Number range CHAPTER**Program Overview**]{.underline}

**The overall goals of the NCTSI are to**:

1.  Number range CHAPTERImprove the quality, effectiveness, provision,
    and availability of therapeutic services delivered to all children
    and adolescents who experience traumatic events.

2.  Develop a national network of centers, programs, and constituencies
    dedicated to improving the identification, assessment, treatment,
    and services to children and adolescents who have experienced
    traumatic events.

3.  Further the understanding of the impact on individuals, families,
    and communities of child and adolescent traumatic stress and of
    effective therapeutic interventions to prevent the occurrence of
    serious negative consequences of childhood and adolescent trauma.

4.  Reduce the frequency and severity of negative consequences of
    traumatic events on children and adolescents through greater public
    recognition and understanding of the sequelae of childhood trauma,
    and support improved prevention and treatment services.

Number range CHAPTERThe NCTSI consists of three types of centers: the
National Center for Child Traumatic Stress, Intervention Development and
Evaluation Centers, and Community Treatment and Services Centers. **This
RFA solicits applications for new Intervention Development and
Evaluation Centers.**

Number range CHAPTEREach type of center has primary responsibility for a
set of functions under the Initiative. **It is critical to the success
of the NCTSI that the NCTSN of collaborative centers develop effective
ways of engaging in substantial joint activities to achieve the goals of
treatment/services improvements for children and adolescents who have
experienced trauma**. All centers are expected to collaborate with other
centers in the NCTSN and perform other network-related activities deemed
essential to achieve the goals of the Initiative. Descriptions of the
component centers, organizational structure, and collaborative
activities of the NCTSN are provided in the appendices of this RFA.

[Number range CHAPTER**National Center for Child Traumatic
Stress**]{.underline}

Number range CHAPTERThe National Center provides the vision, national
leadership, and overall organizing and coordinating expertise to move
the NCTSI toward its goals through the following:

-   Number range CHAPTERProviding leadership for a national network of
    centers for knowledge development and treatment and clinical
    services improvement and evaluation in the area of child traumatic
    stress.

-   Establishing a national capacity for training and technical
    assistance in implementing effective treatment and service delivery.

-   Supporting collaboration and coordination within the NCTSI and
    providing technical assistance to participating centers.

-   Developing a National Child Traumatic Stress Resource Center to
    develop and disseminate informational resources and other products
    on child and adolescent traumatic stress to professionals, policy
    makers, and the public.

[Number range CHAPTER**Intervention Development and Evaluation
Centers**]{.underline}

Number range CHAPTERIDE centers are responsible for developing,
delivering, and evaluating improved treatment approaches and service
delivery models within the NCTSI by doing the following:

-   

-   Number range CHAPTERUsing their specialized expertise to identify
    and evaluate existing therapeutic approaches and develop more
    effective approaches.

-   

-   Developing the NCTSN as a national network of treatment and service
    centers and providing their expertise in support of the NCTSN.

-   

-   Establishing a specialized capacity for training, evaluation, and
    technical assistance to support effective treatment and services for
    traumatized children and their families.

-   Using clinical and service information on child trauma cases to
    improve understanding of treatment and service needs; treatment and
    service delivery effectiveness; and availability, access, and
    disparity in service delivery; and to inform planning and decision
    making of the NCTSI treatment centers.

-   

-   

-   Participating in the development of a national child traumatic
    stress resource center, by serving in the role as a nationally
    recognized expert resource in specific areas of child traumatic
    stress. In their defined area of national expertise, IDE centers
    would serve as a resource for training, consultation, and technical
    assistance on effective treatment and services.

-   Providing expertise in support of the NCTSI Resource Center's
    publication and electronic dissemination of information to
    professionals and the public on those child trauma issues.

[Number range CHAPTER**Community Treatment and Service
Centers**]{.underline}

Number range CHAPTERCTS Centers are service organizations or programs
that primarily provide treatment and services in their community or in
specialty child service settings, for children and their families who
have experienced trauma. They are expected to help the NCTSI achieve its
goals by:

-   Number range CHAPTERCollaborating with other NCTSI centers to
    identify, improve, develop, and implement improved child trauma
    services and treatments that are effective in their community or in
    different specialty service contexts to which they have access,
    which might include hospitals, schools, inpatient psychiatric
    treatment centers, juvenile justice detention facilities, refugee
    centers, or child welfare/child protective service systems.

-   Number range CHAPTERParticipating in NCTSN efforts to develop
    protocols for collecting information on client characteristics,
    services received, and treatment outcomes for children and
    adolescents who receive trauma services that the NCTSN deems
    necessary to fulfill the Network's goals.

-   Expanding identification, assessment, treatment, and services for
    traumatized children and adolescents in the local community or in
    child and adolescent service sectors and improving trauma-focused
    services and outreach activities.

-   Participating in activities to develop knowledge regarding the
    availability of and access to effective child trauma services in
    communities and in child and adolescent specialty service settings.

-   Providing training, consultation, and other outreach efforts to
    local service sectors or service providers that can identify and/or
    provide access or services to children and adolescents who have
    experienced trauma.

-   Establishing liaison with some of the local service systems which
    provide services to children and adolescents who have experienced
    trauma. Such systems might include school systems, state/county
    mental health services, child welfare, protective services,
    rehabilitative services for children with physical and developmental
    problems, juvenile justice system, emergency medical services,
    disaster services, and refugee services.

Organizations applying to participate as one of the component centers
under this Initiative will be required to document their intention of
collaborating within the NCTSN in developing and evaluating treatment
and services.

[Number range CHAPTER**Collaborative Framework**]{.underline}

**The National Center** (1) has developed the framework and
organizational procedures for communication and collaboration among
NCTSI funded centers, (2) is supporting NCTSN efforts to develop
procedures to document and monitor collective activities and
experiences, and (3) is providing support for joint center activities to
achieve the goals of treatment/services improvements for children.

The National Center chairs a Steering Committee representing all the
NCTSI centers. The Steering Committee will provide leadership for the
activities of the NCTSN, prioritize efforts by the centers in
identifying, implementing, improving, and/or developing child and
adolescent trauma treatment and services; finalize plans for NCTSI-wide
activities, reports, protocols, and standards; and will also establish
an **NCTSI Advisory Board**.

The Advisory Board may include representatives from the corporate
community, foundations, parent and consumer groups, media and
advertising, education, and State and Federal government, as well as
leaders from the broader scientific community. The Advisory Board will
help create positive public awareness for the issue of child traumatic
stress, establish priorities related to NCTSI financial stability and
sustainability, and provide and promote access to political and business
leaders.

[What]{.underline} [To Include in Your Application]{.underline}

In order for your application to be **complete and eligible**, it must
include the following in the order listed. Check off areas as you
complete them for your application.

***1. FACE PAGE***

Use Standard Form 424. Follow instructions contained in Appendix A, Part
II, rather than the instructions that accompany the form itself. In
signing the face page of the application, you are agreeing that the
information is accurate and complete.

***2. ABSTRACT***

Your total abstract should not be longer than 35 lines. In the first 5
lines or less of your abstract, write a summary of your project that can
be used in publications, reports to Congress, or press releases.

The abstract should summarize the major goals of the project, the
type(s) of trauma or populations of child trauma victims that are the
focus of project efforts, types of treatment and service approaches to
be used (if applicable), and the major actions or activities to be
engaged in.

***3. TABLE OF CONTENTS***

Include page numbers for each of the major sections of your application
and for each appendix.

***4. BUDGET FORM***

Standard Form (SF) 424A, which is part of the PHS 5161-1, is to be used
for the budget. Fill out sections B, C, and E of the SF 424A. Follow
instructions in Appendix B of Part II of the RFA.

***5. PROJECT NARRATIVE***

***AND SUPPORTING DOCUMENTATION***

**These sections describe your project.** The program narrative is made
up of Sections A through D. Sections A-D **may not be longer than 30
pages.**

The sections in the Project Narrative are:

-   

-   Section A- Organizational Qualifications and Experience

-   

-   Section B - Implementation Plan

-   

-   Section C - Monitoring/Evaluation

-   Section D - Project Management

**Section A of your project must receive a score of at least 25 points
by the peer review committee to be considered for priority funding**.
This means that only proposed centers with sufficient prior expertise
and experience in child traumatic stress are likely to be eligible for
funding under this cooperative agreement. Applicants that score below 25
points in Section A may be considered for funding based on the needs of
the NCTSI and the availability of funds.

The supporting documentation for your application is made up of Sections
E through H. There are no page limits for these sections, except for
Section G, the Biographical Sketches/Job Descriptions.

**Section E** **-** Literature Citations

> This section must contain complete citations, including titles and all
> authors, for any literature you cite in your application.

**Section F -** Budget Justification, Existing Resources, Other Support

You **must** provide a narrative justification of the items included in
your proposed budget, as well as a description of existing resources and
other supports you expect to receive for the proposed project. **(See
Part II of the RFA, Grant Announcement, Example A, Justification.)**

**Section G** **-** Biographical Sketches and Job Descriptions

-   Include a biographical sketch for the project director and for other
    key positions. Each sketch must not be longer than 2 pages. If the
    person has been identified but not hired, include a letter of
    commitment from him/her along with a biographical sketch.

-   Include job descriptions for key personnel. They should not be
    longer than 1 page.

-   Sample sketches and job descriptions are listed in Item 6 in the
    Program Narrative section of the PHS 5161-1.

**Section H** **-** SAMHSA's Participant Protection. The elements you
need to address in this section are outlined after the Project Narrative
description in this document.

***6. APPENDICES 1 THROUGH 4***

-   Use only the appendices listed below.

-   **Do not** use appendices to extend or replace any of the sections
    of the Project Narrative unless specifically required in this RFA
    (reviewers will not consider them if you do).

```{=html}
<!-- -->
```
-   **Do not** use more than **30** pages (plus all instruments) for the
    appendices.

> **Appendix 1:**
>
> Schedules and Timelines of Activities, Reports, and Products

**Appendix 2:**

> Letters of Agreement, Memoranda of Understanding, or other
> documentation of collaboration with other potential centers or
> programs

**Appendix 3:**

> Letter to Single State Agency
>
> **Appendix 4:**
>
> Sample Consent Forms

***7. ASSURANCES***

> Non-construction Programs. Use Standard form 424B found in PHS 5161-1.
> See Part II, page 9.

***8. CERTIFICATIONS***

> See Part II, page 9. A list of certifications is included in the PHS
> form 5161-1. See Part II, page 9.

***9. DISCLOSURE OF LOBBYING***

***ACTIVITIES (See form in PHS 5161-1)***

Appropriated funds, other than for normal and recognized
executive-legislative relationships, may not be used for lobbying
Congress or State legislatures. Federal law prohibits the use of
appropriated funds for publicity or propaganda purposes or for the
preparation, distribution, or use of the information designed to support
or defeat legislation pending before Congress or State legislatures.
This includes "grass roots" lobbying, which consists of appeals to
members of the public suggesting that they contact their elected
representatives to indicate their support for or opposition to pending
legislation or to urge those representatives to vote in a particular
way. (Please read **Part II** of the RFA, General Policies and
Procedures for all SAMHSA applications for additional details.)

***10. CHECKLIST** (found in the PHS 5161)*

**You must complete the Checklist.** See Part II Appendix C of the RFA
for detailed instructions.

**[Project Narrative]{.underline}**

#### **Sections A through D**

In developing your application, use the instructions below that have
been tailored to this program. These are to be used in lieu of the
"Program Narrative" instructions found in the PHS 5161 on page 21.

**Sections A through D are the Project Narrative of your application.**
These sections describe your organization and what you intend to do with
your project. Detailed information on how to respond to Sections A
through D for each specific IDE center follows. **Be sure to respond to
Sections A through D under the IDE** **center for which you are
applying.** Sections A through D [may not]{.underline} be longer than
***30*** pages.

-   

-   Your application will be reviewed and scored against the
    requirements described below for Sections A through D. These
    sections also function as review criteria.

-   

-   A peer review committee will assign a point value to your
    application based on how well you address **each** of these
    sections.

-   

-   The number of points after each main heading shows the maximum
    number of points a review committee may assign to that category.

-   Bullet statements do not have points assigned to them; they are
    provided to draw attention to important areas within the criterion.

Reviewers also will be looking for evidence of cultural competence **in
each section** of the Project Narrative. Points will be assigned based
on how well you address cultural competency aspects of the review
criteria. SAMHSA's guidelines for cultural competence are included in
Part II of the RFA, Appendix D.

NOTE: Although the budget for the proposed project is not a review
criterion, the Review Group will be asked to comment on the
appropriateness of the budget after the merits of the application have
been considered **Number range CHAPTERRural/Tribal/Frontier/ (RTF)
Intervention Development and Evaluation (IDE) Center Project
Requirements**

Although children living in rural, tribal, and frontier (RTF) areas tend
to have the same amount of exposure to traumatic events as children
living in urban and suburban areas, they are less likely than their
urban and suburban counterparts to receive mental health treatment for
their trauma exposure. This may be attributed to a lack of recognition
of the occurrence or impact of trauma exposure on RTF children and
adolescents, stigma-associated reluctance of RTF populations to seek
mental health services, the scarcity of specialty mental health
providers in RTF areas, or other reasons. Children who experience
trauma-related mental health problems may receive services from service
providers, such as primary care physicians, school counselors, mental
health workers, and/or child protective caseworkers, who provide
services in a large but sparsely populated geographical area.

The goals of the proposed IDE center for rural, tribal, and frontier
areas are to develop, implement, and evaluate strategies to improve
access to and availability of trauma-related mental health treatment and
services in RTF areas of the United States for children and adolescents
who have experienced traumatic events. The IDE center will be required
to focus on improving access---the potential and actual entry of
children, adolescents, and their families---to child traumatic
stress-related treatment and services in RTF areas of the NCTSN. The IDE
center also will provide high-quality traumatic stress-related treatment
and services to children and adolescents in its own specified RTF
area(s). The center's activities should seek to address the unique
challenges of service delivery in RTF areas such as distance, isolation,
poverty, and stigma. The center's activities should result in a variety
of flexible service delivery options and strategies for implementation
in RTF areas within the NCTSN and potential exportation to other RTF
settings and populations throughout the country. As such, this center
will conduct the following activities:

-   

-   Assist and support NCTSN committees, task forces, and workgroups in
    identifying promising child and adolescent trauma interventions that
    have been developed by NCTSN centers and non-Network sites for RTF
    children and adolescents.

-   

-   Support development/improvement, implementation/expansion, and
    evaluation of various RTF service delivery strategies for child and
    adolescent trauma by current NCTSN centers or by other programs.

-   

-   Assess the feasibility of implementing model, promising, and/or
    effective service delivery strategies in RTF areas.

-   

-   

-   Support adaptation and adoption of service delivery strategies in
    additional NCTSN centers with RTF populations and in RTF communities
    outside the NCTSN.

-   

-   Develop and support dissemination of instructional materials and
    training on planning, implementation, management, delivery, and
    evaluation of model, promising, and/or effective service delivery
    strategies for RTF areas and populations in collaboration with other
    NCTSN centers and the National Resource Center for Child Traumatic
    Stress.

Number range CHAPTER**Section A: Organizational Qualifications and
Experience (35 points)**

**Section A of your project must receive a score of at least 25 points
by the peer review committee to be considered for priority funding**.
This means that only proposed centers with sufficient prior expertise
and experience in child traumatic stress are likely to be eligible for
funding under this cooperative agreement. Applicants who score below 25
points in Section A may be considered for funding based on the needs of
the NCTSI and the availability of funds.

**Number range CHAPTER1. Operational and Collaborative Experience (25
points) (RTF)**

**Operational**

-   Briefly describe your organization's most significant activities in
    providing, implementing or evaluating mental health and/or trauma
    services in terms of the following:

    -   Clinical interventions, supportive services, training,
        education, and consultation.

    -   The settings in which you provide services (e.g., outpatient,
        inpatient, hospital, school, or juvenile justice settings).

    -   Indicate the number of children who receive intervention
        services from your organization each month or who directly and
        substantially benefit via service programs for which you provide
        training, consultation, or other trauma-focused or mental
        health-oriented assistance.

    -   Describe the evidence base for the interventions that you use
        (outcome assessments, clinical followup, use of empirically
        supported standardized intervention models, use of interventions
        endorsed by authoritative clinical guidelines or best practice
        reviews, etc.).

-   Discuss how your organization reaches out to the community in the
    following areas:

    -   Identifying and providing trauma services to children and
        families who do not seek services.

    -   Training community providers in child trauma services.

    -   Developing or monitoring trauma services appropriate to the
        race/ethnicity/culture/ ge of the community's service
        population.,

    -   Educating the community on child trauma issues.

    -   Educating and training staff in specialty child service systems,
        such as juvenile justice, emergency medical services, or child
        protective services.

    -   Describe the specific tangible products (e.g.,
        publications---scientific or otherwise, screening or assessment
        instruments, training manuals, white papers, manualized
        treatments, information systems for trauma-related services) of
        these outreach efforts.

-   

-   Briefly describe your organization's (and partnering organizations')
    significant current training/consultation activities with RTF
    service providers or other professionals. Indicate the number of RTF
    providers of children's services that are typically trained or
    provided with consultation each year.

-   Briefly describe your organization's past or current involvement in
    conducting multisite intervention development or clinical research
    studies at RTF sites.

    -   Describe the types of clinical information currently collected
        at your center and how it is used.

    ```{=html}
    <!-- -->
    ```
    -   Indicate the products that resulted from such studies, such as
        reports, articles, or other types of study results.

**Collaborative**

-   Describe the extent to which your organization is---

    -   Partnering with other institutions or programs whose primary
        function is to deliver care in RTF areas.

    -   Collaborating with local child service systems, such as schools,
        primary health care, protective service, child welfare, and
        juvenile justice.

    -   Developing linkages with professional and client groups in the
        community.

    -   Developing community-wide initiatives.

    -   Provide documentation of any formal collaborative arrangements
        (e.g., Letters of Agreement) in Appendix 2.

    -   Describe the concrete results or products of these
        collaborations.

1.  

2.  **Personnel (10 points) (RTF)**

-   Identify the individual who will function as Project Director (i.e.,
    the individual with primary oversight for the development of project
    goals and objectives and responsibility for ensuring the success of
    the project) and describe his/her qualifications for assuming this
    leadership role in terms of the following:

    -   Contributions to the published literature in RTF mental health
        issues.

    -   Familiarity with and experience in trauma treatment and
        providing mental health services in RTF communities.

    -   Prior leadership and administrative experience.

    -   Connection to key clinical, practice, and research leaders and
        national organizations concerned with RTF mental health and
        child and adolescent trauma.

-   Identify a minimum of three additional staff or consultants who will
    participate at least 0.2 FTE in the activities of the IDE center.

    -   Describe their qualifications and experience in RTF mental
        health and child trauma.

    -   Describe their involvement with national/regional/State
        organizations and programs that provide or advocate for RTF
        mental health programs.

Number range CHAPTER**Section B: Implementation Plan (35 points)**
**(RTF)**

Number range CHAPTERIn this section you are asked to describe your plans
for activities in your community of concern and how you will translate
your success into lessons and benefits for the larger community (county,
State, Nation). Please make sure to address each function thoroughly and
label your narrative responses under separate headings that match the
function headings. To adequately address some of the requirements in
this section, it is important to be familiar with current NCTSN centers
and collaborative activities. This information can be obtained in the
Appendices to this RFA, on the NCTSI Web site
([[www.nctsnet.org]{.underline}](http://www.nctsnet.org/)), and from
contact you might have with NCTSN centers, which are listed in Appendix
D. As an IDE center, your efforts will be concentrated both on
activities that you can carry out with your partners and populations
locally and on activities that you will undertake in association with
the resources and partners of the NCTSN.

**1. Network Participation (RTF)**

-   Provide a statement indicating the willingness of your organization
    and its staff to participate in the following NCTSI activities:

    -   Participating in the NCTSN committees, workgroups, and
        taskforces.

    -   Implementing consensus decisions of the NCTSI Steering
        Committee.

    -   Collaborating with other NCTSN centers in (a) multisite
        treatment/services studies; (b) development of clinical data and
        evaluation data collection protocols; and (c) development of
        professional training and community education programs in areas
        of child trauma.

    -   Playing a leadership role in promoting improved access to and
        quality of trauma-related services in RTF areas through NCTSN
        collaborative activities.

-   Number range CHAPTERThe NCTSN currently conducts network activity
    through a number of venues (committees, workgroups, and taskforces)
    (see Appendix I).

    -   Identify the existing venues in which staff at your center have
        the experience and expertise.

    -   Propose any potential new committees that are relevant to your
        expertise and interest in child and adolescent trauma services
        in RTF areas, if applicable.

-   Describe how your current clinical and services data collection
    could be adapted to incorporate an NCTSN-wide clinical and services
    data protocol (see Appendix J) that has the aim of collecting
    information across NCTSN centers on client characteristics and
    services provided.

-   Provide a brief preliminary plan for participating in the structure
    and function of the NCTSN, and in efforts to improve its
    effectiveness.

```{=html}
<!-- -->
```
-   Describe a set of activities (no more than four) to carry out the
    plan.

-   Identify the main obstacles to the success of your plan.

-   Describe the means for overcoming the obstacles you have described.

**2. Community Engagement (RTF)**

-   Discuss your plan to improve access to and quality of treatment and
    services for children and adolescents exposed to traumatic events in
    your RTF community with NCTSI grant resources.

    -   Describe a set of objectives and activities to carry out the
        plan. These objectives should be feasible and practical to
        evaluate.

    -   In your plan, identify the number of children who will receive
        services or who will directly and substantially benefit via
        service programs for which you provide training, consultation,
        or other trauma-focused assistance.

    -   Discuss how the race/ethnicity/cultural diversity of children
        and their families and the developmental stage of children will
        be addressed in your plan.

    -   Describe the tangible products of these activities (e.g.,
        publications---scientific or otherwise, screening or assessment
        instruments, training manuals, white papers, manualized
        treatments, information systems for trauma-related services,
        etc.).

    -   Discuss how what you do in your community will contribute to the
        overall NCTSI goals of improving the quality of and access to
        treatment and services throughout the country for children and
        adolescents who experience trauma.

    -   Describe how collaborating with other NCTSI centers or using the
        resources of the NCTSN will enhance the success of your proposed
        activities and the effectiveness of bringing your success to the
        larger community.

    -   

**3. Network Collaboration (RTF)**

-   Discuss your preliminary plan(s) to engage in joint activities with
    other NCTSN centers and network organizational components to improve
    access to and quality of treatment and services for RTF children and
    adolescents exposed to traumatic events.

```{=html}
<!-- -->
```
-   Describe a set of objectives and activities for carrying out the
    plan. These objectives should be feasible and practical to evaluate.

-   Describe how achievement of these objectives may impact the child
    trauma field with respect to trauma type, service settings, target
    population, or type of interventions or other aspects of the field
    you believe will be bettered.

-   Describe resources in your center that can be devoted to these
    collaborative activities. Describe how the plan will make effective
    use of the human and other resources of the NCTSN. Identify the
    indicators you will use to assess your collaboration.

-   Identify the products that will result from achievement of these
    objectives that will support the overall goals of the NCTSI.
    Describe how these products will serve the Nation.

**(NOTE: It is expected that this preliminary plan may be modified
during the course of the project because of additional input from NCTSN
partners, outcomes of implemented activities and programs, and other
events and situations that arise within the project or the Network.
Funded projects can make changes to their plans with prior approval from
the Government Project Officer assigned to oversee their grant.)**

-   Provide a brief preliminary plan for strengthening your linking,
    networking, collaborating and coordinating with other NCTSN partners
    to improve traumatic stress treatment and increase access to
    services for traumatized children.

```{=html}
<!-- -->
```
-   Describe a set of objectives and associated activities (no more than
    four) to carry out the plan.

-   Identify the main obstacles to success of your plan.

-   Describe the means for overcoming the obstacles you have described.

**4. National and Network Resource (RTF)**

IDE centers collaborate with the National Resource Center for Child
Traumatic Stress (NRC-CTS) and other NCTSN centers in developing
resources related to their area(s) of child traumatic stress expertise.
The RTF IDE center is expected to serve as the primary resource for
product development, training, consultation, and technical assistance on
effective treatment and services and other related issues in RTF areas.

-   Describe your plan for serving as a national and Network resource
    with the support of the NRC-CTS.

```{=html}
<!-- -->
```
-   Explain how you will provide expert technical assistance through
    consultation, reference, resources, and other assistance to
    providers of treatment and services to traumatized RTF children and
    adolescents.

-   Provide a preliminary plan for a national program to educate
    professionals about child and adolescent trauma treatment and
    services in RTF areas.

-   Provide a preliminary plan to educate the public and other key
    populations on child trauma in RTF areas.

-   Describe how the treatment or services that you find effective could
    be documented, standardized, evaluated, and disseminated to other
    service programs outside your community.

```{=html}
<!-- -->
```
-   Describe collaborations, consultations, and/or other interactions
    with additional organizations or constituencies that will be
    employed to develop the resource capacity.

-   In addition to your proposed plan, state two short-term (over the
    first 2 years of your project) and three long-term (up to 4 years)
    objectives for working with the NRC-CTS to provide a national and
    Network resource in your program's area of expertise and activity.
    These goals should be feasible and practical to evaluate.Number
    range CHAPTER

**Section C: Monitoring/Evaluation** **(15 points) (RTF)**

**Intervention Development and Evaluation Centers must budget a minimum
of 10** **percent** **and a maximum of 15%percent** **of total costs for
monitoring/evaluation activities.**

-   Provide a preliminary plan to evaluate the functioning of your RTF
    IDE center in achieving objectives you have proposed for each
    functional area in the Implementation Plan (Section B). Please
    specify the following:

    -   A proposed set of indicators for completion or success of
        activities under each function.

    -   Methods that will be used to collect data on indicators of
        activities; both qualitative and quantitative methods may be
        used.

    -   Ways that results of the evaluation will be used in goal
        setting, decision making, activity planning, and monitoring.

-   Describe a timetable for evaluation reports and outline the
    structure and content of such reports.

-   Describe the qualifications and experience of the project's
    evaluation staff. If the evaluation staff has not yet been selected,
    position description(s) listing the minimum qualification and
    experience requirements should be attached in Section G.

-   Describe procedures to obtain input from consumer constituencies,
    especially youth and families, in developing the evaluation plans,
    collecting data, and reporting results.

```{=html}
<!-- -->
```
-   **Section D: Project Management - Organizational,
    Equipment/Facilities, Other Support,** **and Sustainability (15
    points) (RTF)**

```{=html}
<!-- -->
```
-   Provide a project schedule and an activity centered timeline to
    reflect the 4-year project length. Please attach as Appendix 1.

-   Describe a staffing pattern that is appropriate and adequate for the
    project, reflects the diversity of the target population, and is
    sensitive to age, gender, race/ethnicity, and other cultural factors
    related to the target population and to the community to be served.

-   Describe the management plan, project organization, and other
    resources that are appropriate for carrying out all aspects of the
    proposed project. Discuss how they reflect the diversity of the
    target population and are sensitive to age, gender, race/ethnicity,
    and other cultural factors related to the target population and to
    the community to be served.

-   Provide information about the adequacy and availability of
    facilities and equipment.

-   Describe the key components of your plan for sustaining your
    proposed activities beyond or supplementing NCTSI grant funding
    (consider components such as resource mapping activities, financing
    strategies, coalitions/partnerships with other child-serving
    agencies to improve resource availability or access to funding
    streams, key stakeholders and community support), use of outcomes
    evaluation data to inform potential funders or to mobilize key
    constituent support and marketing plans.

    -   Discuss aspects of your project that you would wish to sustain
        in the long term.

    -   Describe your short- and long-term approach for this sustenance.

    -   Explain how intra-NCTSN partnerships could provide opportunities
        for funding and sustainability.

**[SAMHSA's Participant Protection Requirements]{.underline}**

Part II of the PA/RFA provides a description of SAMHSA's Participant
Protection Requirements and the Protection of Human Subjects
Regulations.

The evaluation requirements as described in the "Project Narrative"
section of this RFA are subject to the SAMHSA Participant Protection
(SPP) provisions. However, applicants that propose to implement more
indepth evaluation activities may be subject to the Federal provisions
at 45 CFR Part 46 (Protection of Human Subjects). In accordance with
these provisions, evaluation approaches designed to conduct the
systematic collection of data on individual clients require review and
approval by an Institutional Review Board (IRB). These requirements
apply whether SAMSHA funds or funds from other sources are used to carry
out the evaluation activities.

SAMHSA will place restrictions on the use of funds until all participant
protection issues are resolved. Problems with participant protection
identified during peer review of your application may result in the
delay of funding. See Part II of the RFA for more information on
participant protection.

You [must]{.underline} address each element regarding participant
protection in your supporting documentation. If all or any one of the
elements is not relevant to your project, you must document the reasons
that the element(s) does not apply.

This information will do the following:

1.  Reveal if the protection of participants is adequate or if more
    protection is needed.

2.  Be considered when making funding decisions

    Projects may expose people to risks in many different ways. In this
    section of your application, you will need to do the following:

-   Identify and report any possible risks for participants in your
    project.

-   State how you plan to protect participants from those risks.

-   Discuss how each type of risk will be dealt with or why it does not
    apply to the project.

    Each of the following elements [must be discussed]{.underline}:

    [Protect Clients and Staff]{.underline} [From Potential
    Risks]{.underline}

```{=html}
<!-- -->
```
-   Identify and describe any foreseeable physical, medical,
    psychological, social, legal, or other risks or adverse affects.

-   Discuss risks that are due either to participation in the project
    itself or to the evaluation activities.

```{=html}
<!-- -->
```
-   Describe the procedures that will be followed to minimize or protect
    participants against potential risks, including risks to
    confidentiality.

-   Give plans to provide help if there are adverse effects to
    participants.

-   Where appropriate, describe alternative treatments and procedures
    that may be beneficial to the participants. If you do not decide to
    use these other beneficial treatments, provide the reasons for not
    using them.

    [Fair Selection of Participants]{.underline}

```{=html}
<!-- -->
```
-   Describe the target population(s) for the proposed project. Include
    age, gender, and racial/ethnic background and note if the population
    includes homeless youth, foster children, children of substance
    abusers, pregnant women, or other groups.

-   Explain the reasons for including groups of pregnant women,
    children, people with mental disabilities, people in institutions,
    prisoners, or others who are likely to be vulnerable to HIV/AIDS.

-   Explain the reasons for [including or excluding]{.underline}
    participants.

```{=html}
<!-- -->
```
-   Explain how you will recruit and select participants. Identify who
    will select participants.

    [Absence of Coercion]{.underline}

```{=html}
<!-- -->
```
-   Explain if participation in the project is voluntary or required.
    Identify possible reasons why it is required. For example, court
    orders requiring people to participate in a program.

-   If you plan to pay participants, state how participants will be
    awarded money or gifts.

-   State how volunteer participants will be told that they may receive
    services even if they do not complete the study.

    [Data Collection]{.underline}

```{=html}
<!-- -->
```
-   Identify from whom you will collect data; for example, participants
    themselves, family members, teachers, others. Describe the data
    collection procedure and specify the sources for obtaining data; for
    example, school records, interviews, psychological assessments,
    questionnaires, observation, or other sources. Where data are to be
    collected through observational techniques, questionnaires,
    interviews, or other direct means, describe the data collection
    setting.

-   Identify what type of specimens (e.g., urine, blood) will be used,
    if any. State if the material will be used just for evaluation or if
    other use(s) will be made. Also, if needed, describe how the
    material will be monitored to ensure the safety of participants.

```{=html}
<!-- -->
```
-   Provide in Appendix 4, "Data Collection Instruments/Interview
    Protocols," copies of [all]{.underline} available data collection
    instruments and interview protocols that you plan to use.

    [Privacy and Confidentiality:]{.underline}

```{=html}
<!-- -->
```
-   Explain how you will ensure privacy and confidentiality. Include who
    will collect data and how it will be collected.

-   Describe the following:

```{=html}
<!-- -->
```
-   How you will use data collection instruments.

-   Where data will be stored.

-   Who will or will not have access to information.

-   How the identity of participants will be kept private; for example,
    by using a coding system on data records, limiting access to
    records, or storing identifiers separately from data.

    **NOTE:** If applicable, grantees must agree to maintain the
    confidentiality of alcohol and drug abuse client records according
    to the provisions of **Title 42 of the Code of Federal Regulations,
    Part II.**

    [Adequate Consent Procedures:]{.underline}

```{=html}
<!-- -->
```
-   List what information will be given to people who participate in the
    project. Include the type and purpose of their participation.
    Include how the data will be used and how you will keep the data
    private.

-   State---

```{=html}
<!-- -->
```
-   Whether or not their participation is voluntary.

-   Their right to leave the project at any time without problems.

-   Possible risks from participation in the project.

-   Plans to protect clients from these risks.

```{=html}
<!-- -->
```
-   Explain how you will get consent for youth, the elderly, people with
    limited reading skills, and people who do not use English as their
    first language.

    NOTE: If the project poses potential physical, medical,
    psychological, legal, social or other risks, you **must** get
    [written]{.underline} informed consent.

```{=html}
<!-- -->
```
-   Indicate if you will get informed consent from participants or from
    their parents or legal guardians. Describe how the consent will be
    documented. For example, will you read the consent forms? Will you
    ask prospective participants questions to be sure they understand
    the forms? Will you give participants copies of what they sign?

-   Include sample consent forms in your Appendix 4, titled "Sample
    Consent Forms." If needed, give English translations.

    NOTE: Never imply that the participant waives or appears to waive
    any legal rights, may not end involvement with the project, or
    releases your project or its agents from liability for negligence.

```{=html}
<!-- -->
```
-   Describe if separate consents will be obtained for different stages
    or parts of the project. For example, will they be needed for both
    participant protection in treatment intervention and for the
    collection and use of data?

-   Additionally, if other consents (e.g., consents to release
    information to others or gather information from others) will be
    used in your project, provide a description of the consents. Will
    individuals who do not consent to having individually identifiable
    data collected for evaluation purposes be allowed to participate in
    the project?

    [Risk/Benefit Discussion:]{.underline}

    Discuss why the risks are reasonable compared to expected benefits
    and importance of the knowledge to be gained from the project.

    **[Special Considerations and Requirements]{.underline}**

    []{.mark}

    SAMHSA's policies, special considerations and requirements related
    to grants and cooperative agreements are found in **Part II** of the
    RFA/PA. The policies and special considerations that apply to this
    program are the following:

```{=html}
<!-- -->
```
-   Population Inclusion Requirement

-   Government Performance Monitoring

-   Healthy People 2010

-   Consumer Bill of Rights and Responsibilities

-   Promoting Nonuse of Tobacco

-   Supplantation of Existing Funds

-   Single State Agency (SSA) Coordination

-   Intergovernmental Review (E.O. 12372)

-   Public Health System Reporting Requirements

-   Confidentiality/SAMHSA Participant and Human Subject Protection

**Number range CHAPTERService Systems Models Intervention (SSM)
Development and Evaluation (IDE) Center Project Requirements**

Most children who experience traumatic events do not receive clinical
services for their trauma exposure in specialty trauma treatment
clinics. Either they are not identified as experiencing trauma-related
difficulties and receive no services, or they receive other types of
nontrauma focused services in other youth serving settings, such as
schools, the juvenile justice system, community mental health programs,
medical settings, child welfare, child protective services, and refugee
mental health or resettlement systems. Usually youth-serving systems do
not recognize either the occurrence of trauma exposure or the impact of
trauma exposure on children and adolescents in their service population.
Some of the services provided in youth service systems might be in
response to exposure to potentially traumatic events (e.g., police
response to incidents of community or domestic violence involving
children and adolescents, medical treatment of acute injuries or chronic
diseases, or forensic interviewing of children who are court referred
for sexual abuse at a children's advocacy center). Other services might
be interventions for difficulties resulting from the effects of
unrecognized trauma exposure (e.g., treatment of children for behavioral
or emotional problems that are the sequelae of \[unrecognized\]
traumatic stress reactions at community mental health centers,
educational or psychological counseling in schools for children
experiencing academic problems as a result of their trauma exposure,
incarceration or other juvenile justice processing of chronically
trauma-exposed adolescents who engage in status or criminal offenses).

Although the development of individual, group, and family clinical
treatment models for children and adolescents who experience serious
trauma-related mental health problems is a major goal of the NCTSI,
improvement in access to and quality of trauma-informed services in
other youth service systems, such as schools, community mental and
social services programs, law enforcement, courts, child welfare, child
protective services, acute and chronic medical care, and refugee
resettlement systems, is equally important. Trauma-informed services in
these other youth serving settings can do the following:

-   Triage children and adolescents to more intense levels of trauma
    assessment and intervention based on indicators of the impact of
    their trauma exposure.

-   Provide less clinically intense supportive services (e.g.,
    psycho-educational, family support, brief crisis interventions, peer
    support) to children with less severe trauma-related mental health
    sequelae.

-   Identify and refer for treatment and assessment children who show
    impairment in important functional areas (e.g., schools, peer
    relations) in which prior, unrecognized trauma exposure plays a role
    in the etiology or exacerbation of the functional difficulties.

-   Provide acute trauma-informed services at the time of exposure that
    might reduce the risk of subsequent intense and chronic traumatic
    stress reactions.

-   Decrease the potential for trauma resulting from events such as
    medical procedures, removal from the home by child welfare, juvenile
    justice arrest, and incarceration procedures.

Many current NCTSN centers have developed specific procedures for
providing or developing trauma-informed services in many of these youth
service sectors. Often these protocols include strategies for
successfully interfacing with youth service systems and for developing a
trauma-informed response protocol for use by service providers in the
specific service system. These procedures often have the following
components: (1) training or education of service providers (e.g.,
police, child protective service workers, health care workers) in the
impact of traumatic events on children and adolescents and in
recognizing signs of trauma-related problems displayed by children and
adolescents, (2) trauma-informed intervention procedures that are
congruent with the operational procedures of the service system
practitioners (e.g., police officers or medical staff) and that are
acceptable to the service providers, (3) screening or identification of
trauma-exposed children and adolescents who are in need of more intense
services, (4) provision of followup intensive clinical services for
exposed children and adolescents who evidence significant traumatic
stress reactions, and (5) followup of trauma-exposed children and
adolescents with whom the practitioners had contact to assess the
adequacy of the trauma-informed services received. Many of these
protocols for trauma-informed service system responses include
standardized procedural manuals, written protocols, or training
materials that would allow dissemination to other community sites
interested in implementing trauma-informed services in targeted youth
service sectors. Additional service systems protocols that are not yet
standardized could have such manuals or training materials developed by
systematically recording their service intervention procedures and
developing training materials to assist in implementing the protocol at
other sites.

The proposed Service Models Intervention Development and Evaluation
center will conduct the following activities:

-   Assist and support NCTSN committees, task forces, and workgroups in
    identifying promising child and adolescent trauma interventions that
    have been developed by NCTSN centers and non-Network sites for use
    with children and adolescents in youth-serving systems, especially
    in youth service systems that provide services to large numbers of
    children and adolescents who have been exposed to traumatic events.

-   Support development of various trauma-informed service delivery
    strategies in youth-serving service systems that have been developed
    by NCTSN centers so that such strategies can be implemented at other
    sites (e.g., by development of training materials or implementation
    manuals).

-   Assess the feasibility of implementing potentially effective
    trauma-informed service delivery strategies in youth-serving service
    systems.

-   Support adaptation, implementation, and evaluation of
    trauma-informed service delivery strategies in youth-serving service
    systems in the center's own community, in communities served by
    additional NCTSN centers, and in communities outside the NCTSN.

-   Develop and support dissemination of instructional materials and
    training on planning, implementing, and evaluating promising and/or
    effective trauma-informed service delivery strategies for various
    youth-serving service systems in collaboration with other NCTSN
    centers and the National Child Traumatic Stress Resource Center.

Number range CHAPTER**Section A: Organizational Qualifications and
Experience (35 points)**

**Section A of your project must receive a score of at least 25 points
by the peer review committee to be considered for priority funding**.
This means that only proposed centers with sufficient prior expertise
and experience in child traumatic stress are likely to be eligible for
funding under this cooperative agreement. Applicants who score below 25
points in Section A may be considered for funding based on the needs of
the NCTSI and the availability of funds.

**Number range CHAPTER1. Operational and Collaborative Experience (25
points) (SSM)**

**Operational**

-   Briefly describe your organization's (and partnering organizations')
    most significant activities in providing, implementing, or
    evaluating mental health and/or trauma services in various youth
    service systems (e.g., school systems, state/county child mental
    health services, community health centers or other health settings,
    social and youth services, juvenile justice, and child welfare and
    protective services) in your community or in other communities, in
    terms of the following:

```{=html}
<!-- -->
```
-   Clinical interventions, supportive services, training, education,
    and consultation.

    -   The youth service system settings in which you provide services
        (e.g., community health/mental health clinic, hospital, social
        services, school, or juvenile justice settings).

    -   Indicate the number of children in various youth-serving service
        systems who receive intervention services from your organization
        each month or who directly and substantially benefit via service
        programs for which you provide training, consultation, or other
        trauma-focused or mental health-oriented assistance.

    -   Describe the evidence base for the interventions that you use in
        these various youth-serving service systems (outcome
        assessments, clinical followup, use of empirically supported
        standardized intervention models, use of interventions endorsed
        by authoritative clinical guidelines or best practice reviews,
        etc.).

```{=html}
<!-- -->
```
-   Describe your organization's (and partnering organizations') past or
    current involvement in conducting intervention development, clinical
    research, or intervention evaluation studies:

    -   Describe the types of clinical information that is currently
        collected at your center and how it is used.

    -   Indicate the products that resulted from such studies including
        reports, articles, or other types of study results.

-   Describe your organization's experience and expertise in adapting
    and standardizing mental health or trauma service delivery protocols
    for use in various youth service systems.

-   Describe your organization's (and partnering organizations')
    significant current training/consultation activities with service
    providers or other professionals in various youth-serving service
    systems. Indicate the number of providers of children's services
    that are typically trained or provided with consultation each year.

**Collaborative**

-   Describe the extent to which your organization is---

    -   Partnering with other institutions or programs that provide
        mental health or other services in various youth-serving
        systems.

    -   Developing linkages with professional and client groups in
        various youth-serving service systems.

    -   Developing services, training, or other initiatives that could
        affect youth-serving service systems in entire communities,
        regions, or States.

    -   Provide documentation of any formal collaborative arrangements
        (e.g., Letters of Agreement) in Appendix 2.

    -   Describe the concrete results or products of these
        collaborations.

**2. Personnel (10 points) (SSM)**

-   Identify the individual who will function as Project Director (i.e.,
    the individual with primary oversight for the development of project
    goals and objectives and responsibility for ensuring success of the
    project) and describe his/her qualifications for assuming this
    leadership role in terms of the following:

```{=html}
<!-- -->
```
-   Experience in developing, adapting, and evaluating mental health
    interventions in youth-serving service systems.

-   Familiarity with trauma treatment and providing mental health
    services in communities and in various youth service systems.

-   Prior leadership and administrative experience.

-   Connection to national professional organizations concerned with
    service sectors, such as education, law enforcement, medical care,
    and child protection and community mental health.

```{=html}
<!-- -->
```
-   Identify a minimum of three additional staff or consultants who will
    participate at least 0.2 FTE in the activities of the IDE center:

```{=html}
<!-- -->
```
-   Describe their qualifications and experience in developing, adapting
    or evaluating service system interventions in youth-serving systems
    settings and in training service providers.

    -   Describe their involvement with national/regional/State
        organizations and programs that provide or advocate for
        youth-serving service systems.

Number range CHAPTER**Section B: Implementation Plan (35 points)**
**(SSM)**

Number range CHAPTERIn this section you are asked to describe your plans
for activities in your local community or in a wider range of
communities that you are engaged in and how you will translate your
success into lessons and benefits for the larger community (County,
State, Nation). Please make sure to address each function thoroughly and
label your narrative responses under separate headings that match the
function headings. To adequately address some of the requirements in
this section, it is important to be familiar with current NCTSN centers
and collaborative activities. This information can be obtained in the
Appendices to this RFA, the NCTSI Web site
([[www.nctsnet.org]{.underline}](http://www.nctsnet.org/)), and contact
you might have with NCTSN centers, which are listed in Appendix D. As an
IDE Center, your efforts will be concentrated both on activities that
you can carry out with your partners and populations locally and on
activities that you will undertake in association with the resources and
partners of the NCTSN.

**1. Network Participation (SSM)**

-   Provide a statement indicating the willingness of your organization
    and its staff to participate in the following NCTSI activities:

    -   Participating in the NCTSN committees, workgroups, and
        taskforces.

    -   Implementing consensus decisions of the NCTSI Steering
        Committee.

    -   Collaborating with other NCTSN centers in (a) multisite
        treatment/services studies; (b) development of clinical data and
        evaluation data collection protocols; and (c) development of
        professional training and community education programs in areas
        of child trauma.

    -   Playing a leadership role in promoting improved access to and
        quality of trauma-related services in youth-serving service
        systems through NCTSN collaborative activities.

-   Number range CHAPTERThe NCTSN currently conducts network activity
    through a number of venues (committees, workgroups, and taskforces)
    (see Appendix I).

    -   Identify the existing venues in which staff at your center have
        the experience and expertise to participate.

    -   Propose any potential new committees that are relevant to your
        expertise and interest in child and adolescent trauma services
        in RTF areas, if applicable.

-   Describe how your current clinical and services data collection
    could be adapted to incorporate a NCTSN-wide clinical and services
    data protocol (see Appendix J) that has the aim of collecting
    information across NCTSN centers on client characteristics and
    services provided.

-   Provide a brief preliminary plan for participating in the structure
    and function of the NCTSN, and in efforts to improve its
    effectiveness.

```{=html}
<!-- -->
```
-   Describe a set of activities (no more than four) to carry out the
    plan.

-   Identify the main obstacles to the success of your plan.

-   Describe the means for overcoming the obstacles you have described.

**2. Community Engagement (SSM)**

-   Discuss your plan for using NCTSI grant resources to improve access
    to and quality of treatment and services for children and
    adolescents exposed to traumatic events in your community or in the
    wider range of communities in which you are engaged and who receive
    services in youth-serving service systems (e.g., schools, the
    juvenile justice system, community mental health programs, medical
    settings, child welfare, child protective services, and refugee
    mental health or resettlement systems).

    -   Describe a set of objectives and activities to carry out the
        plan. These objectives should be feasible and practical to
        evaluate.

    -   In your plan, identify the number of children who will receive
        services or will directly and substantially benefit via service
        programs for which you provide training, consultation, or other
        trauma-focused assistance.

    -   Discuss how the race/ethnicity/cultural diversity of children
        and their families receiving services in youth-serving service
        systems and the developmental stage of children will be
        addressed in your plan.

    -   Describe the tangible products of these activities (e.g.,
        publications---scientific or otherwise, screening or assessment
        instruments, training manuals, white papers, manualized
        treatments, information systems for trauma-related services,
        etc.).

    -   Discuss how what you do in your community will contribute to the
        overall NCTSI goals of improving the quality of and access to
        treatment and services throughout the country for children and
        adolescents who experience trauma.

    -   Describe how collaborating with other NCTSI centers or using the
        resources of the NCTSN will enhance the success of your proposed
        activities and the effectiveness of bringing your success to the
        larger community.

    -   

**3. Network Collaboration (SSM)**

-   Discuss your preliminary plan(s) to engage in joint activities with
    other NCTSN centers and network organizational components to improve
    access to and quality of treatment and services for children and
    adolescents exposed to traumatic events who receive services in
    various youth-serving service systems.

```{=html}
<!-- -->
```
-   Describe a set of objectives and activities to carry out the plan.
    These objectives should be feasible and practical to evaluate.

-   Describe how achievement of these objectives may affect the child
    trauma field with respect to trauma type, service settings, target
    population or type of interventions, or other aspects of the field
    you believe will be bettered.

-   Describe resources in your center that can be devoted to these
    collaborative activities. Describe how the plan will make effective
    use of the human and other resources of the NCTSN. Identify the
    indicators you will use to assess your collaboration.

-   Identify the products that will result from achievement of these
    objectives that will support the overall goals of the NCTSI.
    Describe how these products will serve the nation.

**(NOTE: It is expected that this preliminary plan may be modified
during the course of the project because of additional input from NCTSN
partners, outcomes of implemented activities and programs, and other
events and situations that arise within the project or the Network.
Funded projects can make changes to their plans with prior approval from
the Government Project Officer assigned to oversee their grant.)**

-   Provide a brief preliminary plan for strengthening your linking,
    networking, collaborating and coordinating with other NCTSN partners
    to improve traumatic stress treatment and increase access to
    services for traumatized children.

```{=html}
<!-- -->
```
-   Describe a set of objectives and associated activities (no more than
    four) to carry out the plan.

-   Identify the main obstacles to success of your plan.

-   Describe the means for overcoming the obstacles you have described.

**4. National and Network Resource (SSM)**

IDE centers collaborate with the National Resource Center for Child
Traumatic Stress (NRC-CTS) and other NCTSN centers in developing
resources related to their area(s) of child traumatic stress expertise.
The SSM IDE Center is expected to serve as a primary resource for
product development, training, consultation, and technical assistance on
effective treatment and services approaches in youth service systems and
other related issues and to collaborate with other NCTSN centers in
developing such resources.

-   Describe your plan for serving as a national and Network resource
    with the support of the NRC-CTS.

```{=html}
<!-- -->
```
-   Explain how you will provide expert technical assistance through
    consultation, reference, resources, and other assistance to
    providers of treatment and services to traumatized children and
    adolescents in various youth-serving service systems.

-   Provide a preliminary plan for a national program to train
    professionals in youth-serving service systems about child and
    adolescent trauma treatment and services.

-   Provide a preliminary plan to educate the public and other key
    populations on the prevalence and impact of child trauma in various
    youth service systems.

-   Describe how the treatment or services that you find effective could
    be documented, standardized, evaluated, and disseminated to other
    service programs outside your community.

```{=html}
<!-- -->
```
-   Describe collaborations, consultations, and/or other interactions
    with additional organizations or constituencies that will be
    employed to develop the resource capacity.

-   In addition to your proposed plan, state two short-term (over the
    first 2 years of your project) and three long-term (up to 4 years)
    objectives for working with the NRC-CTS to provide a national and
    Network resource in your program's area of expertise and activity.
    These goals should be feasible and practical to evaluate.Number
    range CHAPTER

**Section C: Monitoring/Evaluation** **(15 points) (SSM)**

**Intervention Development and Evaluation Centers must budget a minimum
of 10** **percent** **and a maximum of 15%percent** **of total costs for
monitoring/evaluation activities.**

-   Provide a preliminary plan to evaluate the functioning of your SSM
    Intervention Development and Evaluation Center in achieving
    objectives you have proposed for each functional area in the
    Implementation Plan (Section B). Please specify:

    -   A proposed set of indicators for completion or success of
        activities under each function.

    -   Methods that will be used to collect data on indicators of
        activities; both qualitative and quantitative methods may be
        used.

    -   How results of the evaluation will be used in goal setting,
        decision making, activity planning, and monitoring.

-   Describe a timetable for evaluation reports and outline the
    structure and content of such reports.

-   Describe the qualifications and experience of the project's
    evaluation staff. If the evaluation staff has not yet been selected,
    position description(s) listing the minimum qualification and
    experience requirements should be attached in Section G.

-   Describe procedures to obtain input from consumer constituencies,
    especially youth and families, in developing the evaluation plans,
    in collecting data, and reporting results.

```{=html}
<!-- -->
```
-   **Section D: Project Management - Organizational,
    Equipment/Facilities, Other Support and Sustainability** **(15
    points) (SSM)**

```{=html}
<!-- -->
```
-   Provide a project schedule and an activity centered timeline to
    reflect the 4-year project length. Please attach as Appendix 1.

-   Describe a staffing pattern that is appropriate and adequate for the
    project, reflects the diversity of the target population, and is
    sensitive to age, gender, race/ethnicity, and other cultural factors
    related to the target population and to the community to be served.

-   Describe the management plan, project organization, and other
    resources that are appropriate for carrying out all aspects of the
    proposed project. Discuss how they are reflective of the diversity
    of the target population, sensitive to age, gender, race/ethnicity
    and other cultural factors related to the target population and to
    the community to be served.

-   Provide information about the adequacy and availability of
    facilities and equipment.

-   Describe the key components of your plan for sustaining your
    proposed activities beyond or supplementing NCTSI grant funding
    (consider components such as resource mapping activities, financing
    strategies, coalitions/partnerships with other child-serving
    agencies to improve resource availability or access to funding
    streams, key stakeholders and community support), use of outcomes
    evaluation data to inform potential funders, or to mobilize key
    constituent support, and marketing plans.

    -   Discuss aspects of your project that you would wish to sustain
        in the long term.

    -   Describe your short- and long-term approach for sustaining the
        project.

    -   Explain how intra-NCTSN partnerships could provide opportunities
        for funding and sustainability.

**[SAMHSA's Participant Protection Requirements]{.underline}**

Part II of the PA/RFA provides a description of SAMHSA's Participant
Protection Requirements and the Protection of Human Subjects
Regulations.

The evaluation requirements as described in the "Project Narrative"
section of this RFA are subject to the SAMHSA Participant Protection
(SPP) provisions. However, applicants that propose to implement more
in-depth evaluation activities may be subject to the Federal provisions
at 45 CFR Part 46 (Protection of Human Subjects). In accordance with
these provisions, evaluation approaches designed to conduct the
systematic collection of data on individual clients require review and
approval by an Institutional Review Board (IRB). These requirements
apply whether SAMSHA funds or funds from other sources are used to carry
out the evaluation activities.

SAMHSA will place restrictions on the use of funds until all participant
protection issues are resolved. Problems with participant protection
identified during peer review of your application may result in the
delay of funding. See Part II of the RFA for more information on
participant protection.

You [must]{.underline} address each element regarding participant
protection in your supporting documentation. If any one or all of the
elements is not relevant to your project, you must document the reasons
that the element(s) does not apply.

This information will---

-   

-   Reveal if the protection of participants is adequate or if more
    protection is needed.

-   Be considered when making funding decisions.

    Projects may expose people to risks in many different ways. In this
    section of your application, you will need to---

-   Identify and report any possible risks for participants in your
    project.

-   State how you plan to protect participants from those risks.

-   Discuss how each type of risk will be dealt with or why the risk
    does not apply to the project.

    Each of the following elements [must be discussed]{.underline}:

    [Protect Clients and Staff]{.underline} [From Potential
    Risks]{.underline}

```{=html}
<!-- -->
```
-   Identify and describe any foreseeable physical, medical,
    psychological, social, legal, or other risks or adverse effects.

-   Discuss risks that are due either to participation in the project
    itself or to the evaluation activities.

```{=html}
<!-- -->
```
-   Describe the procedures that will be followed to minimize or protect
    participants against potential risks, including risks to
    confidentiality.

-   Give plans to provide help if there are adverse effects to
    participants.

-   Where appropriate, describe alternative treatments and procedures
    that may be beneficial to the participants. If you do not decide to
    use these other beneficial treatments, provide the reasons for not
    using them.

    [Fair Selection of Participants]{.underline}

```{=html}
<!-- -->
```
-   Describe the target population(s) for the proposed project. Include
    age, gender, and racial/ethnic background and note if the population
    includes homeless youth, foster children, children of substance
    abusers, pregnant women, or other groups.

-   Explain the reasons for including groups of pregnant women,
    children, people with mental disabilities, people in institutions,
    prisoners, or others who are likely to be vulnerable to HIV/AIDS.

-   Explain the reasons for [including or excluding]{.underline}
    participants.

```{=html}
<!-- -->
```
-   Explain how you will recruit and select participants. Identify who
    will select participants.

    [Absence of Coercion]{.underline}

```{=html}
<!-- -->
```
-   Explain if participation in the project is voluntary or required.
    Identify possible reasons why it is required; for example, court
    orders requiring people to participate in a program.

-   If you plan to pay participants, state how participants will be
    awarded money or gifts.

-   State how volunteer participants will be told that they may receive
    services even if they do not complete the study.

    [Data Collection]{.underline}

```{=html}
<!-- -->
```
-   Identify from whom you will collect data; for example, participants
    themselves, family members, teachers, others. Describe the data
    collection procedure and specify the sources for obtaining data; for
    example, school records, interviews, psychological assessments,
    questionnaires, observation, or other sources. Where data are to be
    collected through observational techniques, questionnaires,
    interviews, or other direct means, describe the data collection
    setting.

-   Identify what type of specimens (e.g., urine, blood) will be used,
    if any. State if the material will be used just for evaluation or if
    other use(s) will be made. Also, if needed, describe how the
    material will be monitored to ensure the safety of participants.

```{=html}
<!-- -->
```
-   Provide in Appendix 4, "Data Collection Instruments/Interview
    Protocols," copies of [all]{.underline} available data collection
    instruments and interview protocols that you plan to use.

    [Privacy and Confidentiality:]{.underline}

```{=html}
<!-- -->
```
-   Explain how you will ensure privacy and confidentiality. Describe
    who will collect data and how it will be collected.

-   Describe the following:

```{=html}
<!-- -->
```
-   How you will use data collection instruments.

-   Where data will be stored.

-   Who will or will not have access to information.

-   How the identity of participants will be kept private; for example,
    through the use of a coding system on data records, limiting access
    to records, or storing identifiers separately from data.

    **NOTE:** If applicable, grantees must agree to maintain the
    confidentiality of alcohol and drug abuse client records according
    to the provisions of **Title 42 of the Code of Federal Regulations,
    Part II.**

    [Adequate Consent Procedures:]{.underline}

```{=html}
<!-- -->
```
-   List what information will be given to people who participate in the
    project. Include the type and purpose of their participation.
    Include how the data will be used and how you will keep the data
    private.

-   State the following:

```{=html}
<!-- -->
```
-   Whether or not their participation is voluntary.

-   Their right to leave the project at any time without problems.

-   Possible risks from participation in the project.

-   Plans to protect clients from these risks.

```{=html}
<!-- -->
```
-   Explain how you will get consent for youth, the elderly, people with
    limited reading skills, and people who do not use English as their
    first language.

    NOTE: If the project poses potential physical, medical,
    psychological, legal, social, or other risks, you **must** get
    [written]{.underline} informed consent.

```{=html}
<!-- -->
```
-   Indicate if you will get informed consent from participants or from
    their parents or legal guardians. Describe how the consent will be
    documented; for example, will you read the consent forms? Will you
    ask prospective participants questions to be sure they understand
    the forms? Will you give the participants copies of what they sign?

-   Include sample consent forms in your Appendix 4, titled "Sample
    Consent Forms." If needed, give English translations.

    NOTE: Never imply that the participant waives or appears to waive
    any legal rights, may not end involvement with the project, or
    releases your project or its agents from liability for negligence.

```{=html}
<!-- -->
```
-   Describe if separate consents will be obtained for different stages
    or parts of the project; for example, will they be needed for both
    participant protection in treatment intervention and for the
    collection and use of data.

-   Additionally, if other consents (e.g., consents to release
    information to others or gather information from others) will be
    used in your project, provide a description of the consents. Will
    individuals who do not consent to having individually identifiable
    data collected for evaluation purposes be allowed to participate in
    the project?

    [Risk/Benefit Discussion:]{.underline}

    Discuss why the risks are reasonable compared to expected benefits
    and importance of the knowledge from the project.

    **[Special Considerations and Requirements]{.underline}**

    []{.mark}

    SAMHSA's policies, special considerations, and requirements related
    to grants and cooperative agreements are found in **Part II** of the
    RFA/PA. The policies and special considerations that apply to this
    program follow:

```{=html}
<!-- -->
```
-   Population Inclusion Requirement

-   Government Performance Monitoring

-   Healthy People 2010

-   Consumer Bill of Rights and Responsibilities

-   Promoting Nonuse of Tobacco

-   Supplantation of Existing Funds

-   Single State Agency (SSA) Coordination

-   Intergovernmental Review (E.O. 12372)

-   Public Health System Reporting Requirements

-   Confidentiality/SAMHSA Participant and Human Subject Protection

Number range CHAPTER**Traumatic Stress and Substance Abuse (TSSA)
Intervention Development and Evaluation (IDE) Center Project
Requirements**

Studies indicate increased substance (alcohol and drug) use and abuse in
populations of individuals who have experienced traumatic events. There
are two types of substance use problems: *substance abuse* refers to
continued use of alcohol or drugs that results in problems with family
and/or friends, impairment in school or job performance, intoxication in
situations that are dangerous, and arrests or other problem with the law
due to this use; *substance dependence* refers to a pattern of alcohol
or drug use that results in a need for increased amounts of drugs or
alcohol to achieve an adequate drug/alcohol effect, withdrawal symptoms
to drug/alcohol desistance, difficulty controlling amount of
drugs/alcohol consumed, unsuccessful attempts to reduce or stop
drug/alcohol consumption, an obsession with obtaining access to the
abused substance, interference with important activities or
responsibilities because of the substance use, and continued use in
spite of knowledge that it is harmful.

Use of alcohol and drugs usually begins in early adolescence. Illegal
use of alcohol and drugs is highly prevalent among adolescents, and drug
and alcohol intoxication becomes relatively common in high school. Abuse
and dependence can become problematic in early to mid-adolescence.

Substance abuse problems are prevalent in populations that have
significant posttraumatic stress symptoms and, similarly, exposure to
traumatic events occurs often in individuals receiving treatment for
substance abuse problems. Co-occurrence of trauma and substance abuse
might be due to the following:

-   Trauma-exposed individuals might use or abuse drugs and alcohol to
    relieve sleep disturbance and trauma symptoms, such as
    re-experiencing depression.

-   Individuals who engage in high-risk behaviors are more prone to use
    and abuse alcohol and drugs and also are at high risk of being
    exposed to trauma because of their high-risks lifestyle.

-   Individuals who do not have effective coping styles are more likely
    to use alcohol and drugs as a coping strategy and also to use less
    effective coping strategies if exposed to traumatic events and thus
    to develop severe traumatic stress reactions.

More research is needed to understand the functional relationship
between trauma symptoms and substance use and abuse, especially with
adolescents.

Individuals who have both significant traumatic stress reactions and
drug and alcohol use problems often will have other medical and mental
health problems, have a greater range of social and interpersonal
impairments, have higher rates of adverse treatment outcomes for
substance abuse, including higher relapse rates, lower rates of
aftercare, poor response to treatment, and greater use of additional
treatment services.

Substance abuse problems can be a significant trauma-related issue at
NCTSN sites that provide services to substantial adolescent populations.
At this time there are no published controlled clinical trials of
integrated treatment for traumatic stress and substance abuse in
adolescents. The traditional approach in substance abuse treatment has
been to defer treatment of trauma related issues until the patient has a
substantial period of abstinence. The traditional mental health
treatment program for adolescents with substance abuse problems has been
to refer the adolescent for separate substance abuse treatment before
mental health issues are addressed. Several promising strategies for
joint treatment of traumatic stress and substance abuse have been
proposed and preliminarily tested, such as phased approaches to
intervention in which the same clinician or team of clinicians provide
treatment for both problems at the same time, cognitive-behavior therapy
that focuses on dysfunctional cognitions that maintain both traumatic
stress symptoms and substance abuse, and training in coping strategies
that provide effective ways to manage trauma-related dysfunctional
behaviors, including substance abuse, by recognizing triggers for
exacerbation of trauma symptoms that result in substance use and other
dysfunctional behaviors.

Developing integrated interventions for adolescents with traumatic
stress and substance abuse problems will require modifications to
trauma-specific and substance abuse-specific treatment programs. These
modifications could include the following:

-   Routine screening for trauma in substance abuse treatment programs
    and routine screening for substance abuse problems in adolescent
    trauma victims.

-   Issues relating to victimization being addressed in interventions
    for substance abuse treatment among adolescents.

-   Recognition of substance abuse and other dysfunctional behaviors as
    a potential consequent of trauma exposure in adolescent mental
    health programs and development of early intervention for traumatic
    stress reactions following trauma exposure to reduce the likelihood
    of dysfunctional behaviors as a sequela of trauma exposure.

-   Recognition of the importance of adolescent peer relationships as a
    potential therapeutic resource for both trauma and substance abuse
    treatment but also as a potential source for trauma exposure and for
    support for initiation and maintenance of substance abuse problems.

-   Recognition of adolescent gender differences in trauma exposure,
    traumatic stress reactions and the co-morbidity of traumatic stress
    and substance abuse and the relevance of these differences for
    trauma and substance abuse treatment.

The TSSA IDE center will conduct the following activities:

-   Assist and support NCTSN committees, task forces, and workgroups in
    identifying promising interventions that have been developed by
    NCTSN centers and non-Network sites for adolescent trauma and
    substance abuse treatment.

-   Support development, improvement, implementation, and evaluation of
    treatment strategies for co-occurring trauma and substance abuse
    problems of adolescents.

-   

-   Assess the feasibility of implementing promising substance abuse and
    trauma interventions in NCTSN centers with large adolescent service
    populations and in other non-NCTSN programs.

-   Support adaptation, implementation, and evaluation of substance
    abuse and trauma intervention strategies in additional NCTSN centers
    and in communities outside NCTS Network.

-   Develop and support dissemination of training materials for
    intervention approaches for co-occurring substance abuse and trauma
    in adolescents in collaboration with other NCTSN centers and the
    National Resource Center for Child Traumatic Stress.

Number range CHAPTER**Section A: Organizational Qualifications and
Experience (35 points)**

**Section A of your project must receive a score of at least 25 points
by the peer review committee to be considered for priority funding**.
This means that only proposed centers with sufficient prior expertise
and experience in child traumatic stress are likely to be eligible for
funding under this cooperative agreement. Applicants who score below 25
points in Section A may be considered for funding based on the needs of
the NCTSI and the availability of funds.

**Number range CHAPTER1. Operational and Collaborative Experience (25
points) (TSSA)**

The Traumatic Stress and Substance Abuse (TSSA) IDE center will be
expected to demonstrate expertise in the areas identified below to meet
the needs of adolescents with co-occurring traumatic stress and
substance abuse presentation and their families. When responding to the
sections below, keep in consideration that the use of "TSSA" represents
this emphasis on addressing the interface of traumatic stress and
substance abuse concerns.

The term "substance abuse" refers here to the broad spectrum of
problematic uses of substances of abuse. In other words, it refers to
conditions that both would and would not qualify as substance use
disorders. The term "adolescent" is used because the great majority of
the individuals in which serious traumatic stress and substance abuse
co-occur will be in this developmental stage. However, it is recognized
that, to a lesser degree, pre-adolescents and even younger children may
be so affected and should be considered, as appropriate, in service
design and delivery.

**Operational**

-   Briefly describe your organization's (and partnering organizations')
    most significant activities in developing, implementing and
    providing services to TSSA adolescents in terms of the following:

    -   Clinical interventions, supportive services, training,
        education, and consultation.

    -   The settings in which you provide services (e.g., outpatient,
        inpatient, hospital, school, or juvenile justice settings).

    -   Indicate the number of adolescents who receive intervention
        services from your organization each month or who directly and
        substantially benefit via service programs for which you provide
        training, consultation, or other trauma-focused or mental
        health-oriented assistance.

    -   Describe the evidence base for the interventions that you use
        (outcome assessments, clinical followup, use of empirically
        supported standardized intervention models, use of interventions
        endorsed by authoritative clinical guidelines or best practice
        reviews, etc.).

-   Briefly describe your organization's (and partnering organizations')
    past or current involvement in conducting multiple-site intervention
    development, clinical research, or intervention evaluation studies
    with TSSA populations and any other activities that demonstrate your
    capacity to design and implement program and service evaluation
    projects for this population.

    -   Describe the types of clinical information that is currently
        collected at your center and how is it used.

    -   Indicate the products that resulted from such studies such as
        reports, articles, or other types of study results.

-   Describe the ways your organization reaches out to the community in
    the area of TSSA with respect to the following:

    -   Identifying and providing TSSA services to adolescents and
        families who do not seek services.

    -   Training community providers in TSSA services.

    -   Developing or monitoring trauma services appropriate to the
        race/ethnicity/culture/age of the community's service
        population, .

    -   Educating the community on child trauma issues.

    -   Educating and training staff in specialty child service systems,
        such as juvenile justice, emergency medical services, or child
        protective services.

    -   Describe the specific, tangible products (e.g.,
        publications---scientific or otherwise, screening or assessment
        instruments, training manuals, white papers, manualized
        treatments, information systems for trauma-related services,
        etc.) of these outreach efforts.

-   Describe your organization's (and partnering organizations')
    significant current training/consultation activities with TSSA
    service providers or other professionals. Indicate the number of
    TSSA providers of children's services that are typically trained or
    provided with consultation each year.

**Collaborative**

-   Describe the extent to which your organization is---

    -   Partnering with other institutions or programs whose primary
        function is to deliver care to TSSA populations.

    -   Collaborating with local child service systems, such as schools,
        primary health care, protective service, child welfare, and
        juvenile justice.

    -   Developing linkages with professional and client groups in the
        community.

    -   Developing community-wide initiatives.

    -   Provide documentation of any formal collaborative arrangements
        (e.g., Letters of Agreement) in Appendix 2.

    -   Describe the concrete results or products of these
        collaborations.

**2. Personnel (10 points)**

-   Identify the individual who will function as Project Director (i.e.,
    the individual with primary oversight for the development of project
    goals and objectives and responsibility for ensuring success of the
    project) and describe his/her qualifications for assuming this
    leadership role in terms of the following:

    -   Contributions to the published literature in mental health,
        traumatic stress, and substance abuse issues.

    -   Familiarity with and experience in trauma and substance abuse
        treatment, especially when the two are co-occurring.

    -   Prior leadership and administrative experience.

    -   Connection to key clinical, practice, and research leaders and
        national organizations concerned with mental health and child
        and adolescent trauma and substance abuse.

-   Identify a minimum of three additional staff or consultants who will
    participate at least 0.2 FTE in the activities of the IDE center.

    -   Describe their qualifications and experience in the areas of
        mental health, child trauma, and substance abuse.

    -   Describe their involvement with national/regional/State
        organizations and programs that provide or advocate for child
        and adolescent mental health and substance abuse programs.

Number range CHAPTER**Section B: Implementation Plan (35 points)**

Number range CHAPTERIn this section you are asked to describe your plans
for activities in your community of concern and how you will translate
your success into lessons and benefits for the larger community (county,
State, Nation). Please make sure to address each function thoroughly and
label your narrative responses under separate headings that match the
function headings. To adequately address some of the requirements in
this section, it is important to be familiar with current NCTSN centers
and collaborative activities. This information can be obtained in the
Appendices to this RFA, the NCTSI Web site
([[www.nctsnet.org]{.underline}](http://www.nctsnet.org/)), and contact
you might have with NCTSN centers, which are listed in Appendix D. As an
IDE center, your efforts will be concentrated both on activities that
you can carry out with your partners and populations locally and on
activities that you will undertake in association with the resources and
partners of the NCTSN.

**1. Network Participation (TSSA)**

-   Provide a statement indicating the willingness of your organization
    and its staff to participate in the following NCTSI activities:

    -   Participating in the NCTSN committees, workgroups, and
        taskforces.

    -   Implementing consensus decisions of the NCTSI Steering
        Committee.

    -   Collaborating with other NCTSN centers in (a) multisite
        treatment/services studies; (b) development of clinical data and
        evaluation data collection protocols; and (c) development of
        professional training and community education programs in areas
        of child trauma and substance abuse.

    -   Playing a leadership role in promoting improved access to and
        quality of TSSA services through NCTSN collaborative activities.

-   Number range CHAPTERThe NCTSN currently conducts network activity
    through a number of venues (committees, workgroups, and taskforces)
    (see Appendix I).

    -   Identify the existing venues that staff at your center have the
        experience and expertise to participate in.

    -   Propose any potential new committees that are relevant to your
        expertise and interest in child and adolescent trauma services
        in RTF areas, if applicable.

-   Describe how your current clinical and services data collection
    could be adapted to incorporate a NCTSN-wide clinical and services
    data protocol (see Appendix J) that has the aim of collecting
    information across NCTSN centers on client characteristics and
    services provided.

-   Provide a brief preliminary plan for participating in the structure
    and function of the NCTSN and in efforts to improve its
    effectiveness.

```{=html}
<!-- -->
```
-   Describe a set of activities (no more than four) to carry out the
    plan.

-   Identify the main obstacles to the success of your plan.

-   Discuss the means for overcoming the obstacles you have described.

**2. Community Engagement (TSSA)**

-   Discuss your plan to improve access to and quality of treatment and
    services for TSSA adolescents in your community with NCTSI grant
    resources.

    -   Describe a set of objectives and activities to carry out the
        plan. These objectives should be feasible and practical to
        evaluate.

    -   Identify how many adolescents will receive services or will
        directly and substantially benefit via service programs for
        which you provide training, consultation, or other TSSA focused
        assistance.

    -   Explain how the race/ethnicity/cultural diversity of TSSA
        children and their families and the developmental stage of
        adolescents will be addressed in your plan.

    -   Describe the tangible products of these activities (e.g.
        publications---scientific or otherwise, screening or assessment
        instruments, training manuals, white papers, manualized
        treatments, and information systems for trauma-related services,
        etc.).

    -   Discuss how what you do in your community will contribute to the
        overall NCTSI goals of improving the quality of and access to
        treatment and services throughout the country for children and
        adolescents who experience trauma.

    -   Describe how collaborating with other NCTSI centers or using the
        resources of the NCTSN will enhance the success of your proposed
        activities and the effectiveness of bringing your success to the
        larger community.

**3. Network Collaboration (TSSA)**

-   Discuss your preliminary plan(s) to engage in joint activities with
    other NCTSN centers and network organizational components to improve
    access to and quality of treatment and services for TSSA
    adolescents.

```{=html}
<!-- -->
```
-   Describe a set of objectives and activities to carry out the plan.
    These objectives should be feasible and practical to evaluate.

-   Describe how achievement of these objectives may affect the child
    trauma field with respect to trauma type, service settings, target
    population or type of interventions, or other aspects of the field
    you believe will be bettered.

-   Describe resources in your center that can be devoted to these
    collaborative activities. Describe how the plan will make effective
    use of the human and other resources of the NCTSN. Identify the
    indicators you will use to assess your collaboration.

-   Identify the products that will result from achievement of these
    objectives that will support the overall goals of the NCTSI.
    Describe how these products will serve the Nation.

**(NOTE: It is expected that this preliminary plan may be modified
during the course of the project because of additional input from NCTSN
partners, outcomes of implemented activities and programs, and other
events and situations that arise within the project or the Network.
Funded projects can make changes to their plans with prior approval from
the Government Project Officer assigned to oversee their grant.)**

-   Provide a brief preliminary plan for strengthening your linking,
    networking, collaborating, and coordinating with other NCTSN
    partners to improve traumatic stress treatment and increase access
    to services for traumatized children.

```{=html}
<!-- -->
```
-   Describe a set of objectives and associated activities (no more
    than 4) to carry out the plan.

-   Identify the main obstacles to success of your plan.

-   Describe the means for overcoming the obstacles you have described.

**4. National and Network Resource (TSSA)**

IDE centers collaborate with the National Resource Center for Child
Traumatic Stress (NRC-CTS) and other NCTSN centers in developing
resources related to their area(s) of child traumatic stress expertise.
The TSSA IDE center is expected to serve as the primary resource for
product development, training, consultation, and technical assistance on
effective prevention, treatment and services, and other related issues
in TSSA areas.

-   Describe your plan for serving as a national and Network resource
    with the support of the NRC-CTS.

```{=html}
<!-- -->
```
-   Explain how you will provide expert technical assistance through
    consultation, reference, resources, and other assistance to
    providers of treatment and services to TSSA adolescents.

-   Provide a preliminary plan for a national program to train
    professionals about TSSA treatment and services.

-   Provide a preliminary plan to educate the public and other key
    populations on TSSA issues.

-   Describe how the treatment or services that you find effective could
    be documented, standardized, evaluated, and disseminated to other
    service programs outside your community.

```{=html}
<!-- -->
```
-   Describe collaborations, consultations, and/or other interactions
    with additional organizations or constituencies that will be
    employed to develop the resource capacity.

-   In addition to your proposed plan, state two short-term (over the
    first 2 years of your project) and three long-term (up to 4 years)
    objectives for working with the NRC-CTS to provide a national and
    Network resource in your program's area of expertise and activity.
    These goals should be feasible and practical to evaluate.Number
    range CHAPTER

**Section C: Monitoring/Evaluation** **(15 points) (TSSA)**

**Intervention Development and Evaluation Centers must budget a minimum
of 10** **percent** **and a maximum of 15%percent** **of total costs for
monitoring/evaluation activities.**

-   Provide a preliminary plan to evaluate the functioning of your TSSA
    Intervention Development and Evaluation Center in achieving
    objectives you have proposed for each functional area in the
    Implementation Plan (Section B). Please specify the following:

    -   A proposed set of indicators for completion or success of
        activities under each function.

    -   Methods that will be used to collect data on indicators of
        activities; both qualitative and quantitative methods may be
        used.

    -   How results of the evaluation will be used in goal setting,
        decisionmaking, activity planning, and monitoring.

-   Describe a timetable for evaluation reports and outline the
    structure and content of such reports.

-   Describe the qualifications and experience of the project's
    evaluation staff. If the evaluation staff has not yet been selected,
    position description(s) listing the minimum qualification and
    experience requirements should be attached in Section G.

-   Describe procedures to obtain input from consumer constituencies,
    especially youth and families, in developing the evaluation plans,
    collecting data, and reporting results.

**Section D: Project Management - Organizational, Equipment/Facilities,
Other Support,** **and Sustainability (15 points) (TSSA)**

-   Provide a project schedule and an activity-centered timeline to
    reflect the 4-year project length. Please attach as Appendix 1.

-   Describe a staffing pattern that is appropriate and adequate for the
    project, reflects the diversity of the target population, and is
    sensitive to age, gender, race/ethnicity, and other cultural factors
    related to the target population and to the community to be served.

-   Describe the management plan, project organization, and other
    resources that are appropriate for carrying out all aspects of the
    proposed project. Discuss how they reflect the diversity of the
    target population and are sensitive to age, gender, race/ethnicity,
    and other cultural factors related to the target population and to
    the community to be served.

-   Provide information about the adequacy and availability of
    facilities and equipment.

```{=html}
<!-- -->
```
-   Describe the key components of your plan for sustaining your
    proposed activities beyond or supplementing NCTSI grant funding
    (consider components such as resource mapping activities, financing
    strategies, coalitions/partnerships with other child-serving
    agencies to improve resource availability or access to funding
    streams, key stakeholders and community support,) use of outcomes
    evaluation data to inform potential funders or to mobilize key
    constituent support, and marketing plans.

    -   Discuss aspects of your project that you would wish to sustain
        in the long term.

    -   Describe your short- and long-term approach for sustaining the
        project.

    -   Explain how intra-NCTSN partnerships could provide opportunities
        for funding and sustainability.

**[SAMHSA's Participant Protection Requirements]{.underline}**

Part II of the PA/RFA provides a description of SAMHSA's Participant
Protection Requirements and the Protection of Human Subjects
Regulations.

The evaluation requirements as described in the "Project Narrative"
section of this RFA are subject to the SAMHSA Participant Protection
(SPP) provisions. However, applicants who propose to implement more
in-depth evaluation activities may be subject to the Federal provisions
at 45 CFR Part 46 (Protection of Human Subjects). In accordance with
these provisions, evaluation approaches designed to conduct the
systematic collection of data on individual clients require review and
approval by an Institutional Review Board (IRB). These requirements
apply whether SAMSHA funds or funds from other sources are used to carry
out the evaluation activities.

SAMHSA will place restrictions on the use of funds until all participant
protection issues are resolved. Problems with participant protection
identified during peer review of your application may result in the
delay of funding. See Part II of the RFA for more information on
participant protection.

You [must]{.underline} address each element regarding participant
protection in your supporting documentation. If any one or all of the
elements is not relevant to your project, you must document the reasons
that the element(s) does not apply.

This information will do the following:

1.  Reveal if the protection of participants is adequate or if more
    protection is needed.

2.  Be considered when making funding decisions.

    Projects may expose people to risks in many different ways. In this
    section of your application, you will need to do the following:

-   Identify and report any possible risks for participants in your
    project.

-   State how you plan to protect participants from those risks.

-   Discuss how each type of risk will be dealt with or why it does not
    apply to the project.

    Each of the following elements [must be discussed]{.underline}:

    [Protect Clients and Staff]{.underline} [From Potential
    Risks]{.underline}

```{=html}
<!-- -->
```
-   Identify and describe any foreseeable physical, medical,
    psychological, social, legal, or other risks or adverse affects.

-   Discuss risks that are due either to participation in the project
    itself or to the evaluation activities.

```{=html}
<!-- -->
```
-   Describe the procedures that will be followed to minimize or protect
    participants against potential risks, including risks to
    confidentiality.

-   Give plans to provide help if there are adverse effects to
    participants.

-   Where appropriate, describe alternative treatments and procedures
    that may be beneficial to the participants. If you do not decide to
    use these other beneficial treatments, provide the reasons for not
    using them.

    [Fair Selection of Participants]{.underline}

```{=html}
<!-- -->
```
-   Describe the target population(s) for the proposed project. Include
    age, gender, and racial/ethnic background and note if the population
    includes homeless youth, foster children, children of substance
    abusers, pregnant women, or other groups.

-   Explain the reasons for including groups of pregnant women,
    children, people with mental disabilities, people in institutions,
    prisoners, or others who are likely to be vulnerable to HIV/AIDS.

-   Explain the reasons for [including or excluding]{.underline}
    participants.

```{=html}
<!-- -->
```
-   Explain how you will recruit and select participants. Identify who
    will select participants.

    [Absence of Coercion]{.underline}

```{=html}
<!-- -->
```
-   Explain if participation in the project is voluntary or required.
    Identify possible reasons why it is required; for example, court
    orders requiring people to participate in a program.

-   If you plan to pay participants, state how participants will be
    awarded money or gifts.

-   State how volunteer participants will be told that they may receive
    services even if they do not complete the study.

    [Data Collection]{.underline}

```{=html}
<!-- -->
```
-   Identify from whom you will collect data; for example, participants
    themselves, family members, teachers, others. Describe the data
    collection procedure and specify the sources for obtaining data; for
    example, school records, interviews, psychological assessments,
    questionnaires, observation, or other sources. Where data are to be
    collected through observational techniques, questionnaires,
    interviews, or other direct means, describe the data collection
    setting.

-   Identify what type of specimens (e.g., urine, blood) will be used,
    if any. State if the material will be used just for evaluation or if
    other use(s) will be made. Also, if needed, describe how the
    material will be monitored to ensure the safety of participants.

```{=html}
<!-- -->
```
-   Provide in Appendix 4, "Data Collection Instruments/Interview
    Protocols," copies of [all]{.underline} available data collection
    instruments and interview protocols that you plan to use.

    [Privacy and Confidentiality:]{.underline}

```{=html}
<!-- -->
```
-   Explain how you will ensure privacy and confidentiality. Include who
    will collect data and how it will be collected.

-   Describe---

```{=html}
<!-- -->
```
-   How you will use data collection instruments.

-   Where data will be stored.

-   Who will or will not have access to information.

-   How the identity of participants will be kept private. For example,
    through the use of a coding system on data records, limiting access
    to records, or storing identifiers separately from data.

    **NOTE:** If applicable, grantees must agree to maintain the
    confidentiality of alcohol and drug abuse client records according
    to the provisions of **Title 42 of the Code of Federal Regulations,
    Part II.**

    [Adequate Consent Procedures:]{.underline}

```{=html}
<!-- -->
```
-   List what information will be given to people who participate in the
    project. Include the type and purpose of their participation.
    Include how the data will be used and how you will keep the data
    private.

-   State---

```{=html}
<!-- -->
```
-   Whether or not their participation is voluntary.

-   Their right to leave the project at any time without problems.

-   Possible risks from participation in the project.

-   Plans to protect clients from these risks.

```{=html}
<!-- -->
```
-   Explain how you will get consent for youth, the elderly, people with
    limited reading skills, and people who do not use English as their
    first language.

    NOTE: If the project poses potential physical, medical,
    psychological, legal, social, or other risks, you **must** get
    [written]{.underline} informed consent.

```{=html}
<!-- -->
```
-   Indicate if you will get informed consent from participant's or from
    their parents or legal guardians. Describe how the consent will be
    documented; for example, will you read the consent forms? Will you
    ask prospective participants questions to be sure they understand
    the forms? Will you give them copies of what they sign?

-   Include sample consent forms in your Appendix 4, titled "Sample
    Consent Forms." If needed, give English translations.

    NOTE: Never imply that the participant waives or appears to waive
    any legal rights, may not end involvement with the project, or
    releases your project or its agents from liability for negligence.

```{=html}
<!-- -->
```
-   Describe if separate consents will be obtained for different stages
    or parts of the project. For example, will they be needed for both
    participant protection in treatment intervention and for the
    collection and use of data?

-   Additionally, if other consents (e.g., consents to release
    information to others or gather information from others) will be
    used in your project, provide a description of the consents. Will
    individuals who do not consent to having individually identifiable
    data collected for evaluation purposes be allowed to participate in
    the project?

    [Risk/Benefit Discussion:]{.underline}

    Discuss why the risks are reasonable compared to expected benefits
    and the importance of the knowledge gained from the project.

    **[Special Considerations and Requirements]{.underline}**

    []{.mark}

    SAMHSA's policies, special considerations and requirements related
    to grants and cooperative agreements are found in **Part II** of the
    RFA/PA. The policies and special considerations that apply to this
    program are the following:

```{=html}
<!-- -->
```
-   Population Inclusion Requirement

-   Government Performance Monitoring

-   Healthy People 20101110

-   Consumer Bill of Rights and Responsibilities

-   Promoting Nonuse of Tobacco

-   Supplantation of Existing Funds

-   Single State Agency (SSA) Coordination

-   Intergovernmental Review (E.O. 12372)

-   Public Health System Reporting Requirements

-   Confidentiality/SAMHSA Participant and Human Subject Protection

**APPENDIX A**

**Background**

The term "trauma" has both a medical and a psychiatric definition.
Medically, trauma refers to a serious or critical "bodily injury, wound,
or shock" (Neufeldt, 1988). In psychological terms, trauma assumes a
different meaning, referring to a "painful emotional experience, or
shock, often producing a lasting psychic effect" (Neufeldt, 1988).

Various adverse events experienced in childhood and adolescence can have
a detrimental effect on the health, well-being, and development of
affected children and adolescents (Brooks-Gunn and Duncan, 1997; Rutter,
1999). Traumatic events often involve a life-threat, severe physical
injury, threat to psychological control or physical or psychological
integrity, loss of a primary caretaker, or loss of one's community or
social environment. Traumatic events may occur as episodes of (a)
physical and sexual abuse or assault, (b) natural or man-made disasters
and catastrophes, (c) physical injuries or incapacitation, such as from
motor vehicle or bicycle accidents, animal attacks, or other serious
accidents, (d) chronic, severe, or painful medical conditions or
invasive or painful medical procedures, (e) witnessing or experiencing
family or community violence, (f) traumatic loss of family members,
friends, and other significant attachment figures, and (g) exposure to
war, terrorism, kidnappings, political oppression, and forced
displacement. Traumatic events can be single or repeated events or
chronic exposure to or experience of a condition. Many types of trauma
include both acute and longer term components (e.g., acute physical
injuries, such as burns, that result in chronic pain, disfigurement, or
disability or repeated episodes of childhood abuse.

Exposure to traumatic events is common in children and adolescents. In
1998 an estimated 200,000 children were victims of physical child abuse,
100,000 were victims of sexual abuse, and 225,000 were victims of
multiple forms of child maltreatment (U.S. Department of Health and
Human Services, 2000a). Each year approximately 140,000 children and
adolescents receive treatment for bicycle-related head injuries; almost
20,000 children are hospitalized because of burns, and 5 of every
100,000 children, aged 0-10, are hospitalized for dog bites (Sosin, et
al., 1996; Sacks, Kresnow, and Houston, 1996; Quinlan and Sacks, 1999).

During the event and its immediate aftermath, traumatic events can
produce feelings of panic, helplessness, and uncontrollable fear or
terror and can lead to a range of both acute and chronic traumatic
stress reactions. The American Psychiatric Association's *Diagnostic and
Statistical Manual for Mental Disorders* (DSM-IV) recognizes a number of
psychiatric syndromes associated with exposure to stressful and
traumatic events including Post Traumatic Stress Disorder, Acute Stress
Disorder, and Adjustment Disorder. The impact of trauma on the
functioning of children and adolescents can be pervasive. Effects of
trauma can include dysphoric emotional states and emotional
dysregulation, such as depression, anxiety, and chronic or impulsive
outbursts of anger; suicide attempts; behavior problems, such as
antisocial behavior and substance abuse; cognitive and motivational
distortions, including hopelessness, chronic shame or guilt; learning
and academic problems resulting from learning, memory, and attentional
difficulties; and interpersonal problems (Leavitt and Fox, 1993; Briere,
et al., 1996; Eckenrode, Laird, and Doris, 1993; Gunnar, 2000; Perry and
Pollard, 1998; Pollack, Cicchetti, and Klorman, 1998; Shonk and
Cicchetti, 2001; Trickett and Schellenbach, 1998). A number of other
serious syndromes and pervasive personality distortions are associated
with exposure to serious or chronic stress and trauma, including
Dissociative Disorders and Borderline Personality Disorder. And yet,
many children and adolescents are able to cope effectively with the
aftereffects of their trauma exposure through their own resilience and
with support of family and others and may even derive positive benefits
from their experiences.

The severity and chronicity of the stress reactions following exposure
to traumatic events can vary greatly. Of particular significance to
children and adolescents are the effects on development (Cichetti and
Toth, 1997; Kaufman and Henrich, 2000; Garbarino, Eckenrode, and Powers,
1997; Pynoos, et al., 1999). Exposure to trauma can delay, distort or
arrest normal developmental processes in children and adolescents.
Developmental effects are a function of the age at which a child is
exposed to traumatic events, the developmental issues that they are
addressing at the time, the significance of the type of trauma for
current and later developmental stages, and how this exposure may affect
resources needed for later developmental tasks.

Considerable progress has been made in understanding the prevalence,
characteristics, risk factors, and consequences of trauma in children
and adolescents. However, knowledge is unevenly developed across areas
of child trauma, and many fundamental questions have not been adequately
addressed, such as which children will experience the most detrimental
effects of trauma exposure, the impact of trauma on developmental
processes across the stages of development, and determination of the
underlying biological, psychological, and social processes that must be
targeted by effective interventions (Pfefferbaum, 1997).

Intervention in the aftermath of trauma is one of the most significant
clinical issue in child and adolescent mental health. Promising
interventions for child trauma have been identified (James, 1989; Cohen,
Berliner, and March, 2000; Deblinger and Heflin, 1996; March, et al.,
1998; Lieberman, Silverman and Pawl, 2000; Marmar, Weiss, and Pynoos,
1995; Pynoos, et al., 1998), but much needs to be done to provide these
services to children and their families. The scientific evidence base is
not strong on many critical intervention issues, such as what types of
interventions maximize trauma recovery, which children and which types
of trauma exposure are effectively treated by different types of
intervention approaches, and how intervention approaches should best
address developmental issues.

Of particular concern for receipt of intervention services are children
in child service systems with high rates of trauma exposures, such as
the child welfare and child protective services systems, the juvenile
justice system, hospitals and emergency clinics, child rehabilitation
services, and service systems for refugee children. (Rosenfeld, et al.,
1997; Dubner and Motta, 1999; Clausen, et al., 1998; Crimmins, et al.,
2000; Erwin, et al., 2000). These systems provide services to large
numbers of children. In 1998, more than 1.8 million reports of child
abuse and neglect were investigated by child protective services and
900,000 children were categorized as victims of abuse and/or neglect or
at risk for maltreatment (U.S. Department of Health and Human Services,
2000a). Every day in the United States.

nearly 600,000 children and adolescents are in the child welfare system,
with almost half in nonrelative foster care and almost 10 percent in
institutional care (U.S. Department of Health and Human Services,
2000b). In 1997, approximately 125,000 juveniles were in detention
(Gallagher, 1999). Approximately 100,000 refugees are admitted into the
United States every year; many are families arriving from war zones,
fleeing political oppression, or victims of torture (U.S. Department of
Health and Human Services, 2000c).

In addition to these specialty child service systems, schools are the
largest child service system, and in every school there will be children
whose ability to perform competently is compromised by unrecognized and
untreated traumatic stress. Some progress has been made in developing
procedures to identify children affected by exposure to traumatic events
and provide trauma-focused treatment in school settings (Muris, et al.,
2000; McNally, 1996; March, et al., 1998). Development and
implementation of effective identification, assessment, and treatment
approaches in these child service settings would have a significant
impact on the mental health of children.

The National Child Traumatic Stress Initiative is designed to address
these child trauma issues by providing Federal support for a national
effort to improve treatment and services for child trauma, to expand
availability and accessibility of effective community services, and to
promote better understanding of clinical and research issues relevant to
providing effective interventions for children and adolescents exposed
to traumatic events.

######## APPENDIX B

**References and Resources**

Briere, J., Berliner, L., Bulkley, J.A., Jenny, C., and Reid, T. (1996)
[The APSAC Handbook on Child Maltreatment]{.underline}. Thousand Oaks,
Cal: Sage Publications.

Brooks‑Gunn, J. and Duncan,G. J. (1997) The effects of poverty on
children. [Future of Children]{.underline}. 7, 55‑71.

Cicchetti, D. and Toth, S. L. (Eds.) (1997) [Developmental Perspectives
on Trauma: Theory, Research, and Intervention]{.underline}. Rochester,
NY: University of Rochester Press.

Clausen, J. M., Landsverk, J., Ganger, W., Chadwick, D., and Litrownik,
A. Mental health problems of children in foster care. [Journal of Child
and Family Studies]{.underline}, 7, 283‑296.

Cohen, J. A., Berliner, L. and March, J. S. (2000) Treatment of children
and adolescents. In

E.B. Foa, T. M. Keane, et al. (Eds.) [Effective Treatments for PTSD:
Practice Guidelines from the International Society for Traumatic Stress
Studies]{.underline}. New York: Guilford, 330‑332.

Crimmins, S. M., Cleary, S.D., Brownstein, H.H., Spunt, B.J., and
Warley, R. M. (2000) Trauma, drugs and violence among juvenile
offenders. [Journal of Psychoactive Drugs]{.underline}, 32, 43‑54.

Deblinger, E. and Heflin, A.H. (1996) [Treating Sexually Abused Children
and Their Nonoffending Parents: a Cognitive Behavioral
Approach]{.underline}. Thousand Oaks, Cal: Sage Publications.

Dubner, A.E. and Motta, R.W. (1999) Sexually and physically abused
foster care children and posttraumatic stress disorder. [Journal of
Consulting and Clinical Psychology]{.underline}, 67, 367‑373.

Eckenrode, J., Laird, M., and Doris, J. (1993) School performance and
disciplinary problems among abused and neglected children.
[Developmental Psychology]{.underline}, 29, 53‑62.

Erwin, B.A., Newman, E., McMackin, R.A., Morrissey, C. and Kaloupek,
D.G. (2000) PTSD, malevolent environment, and criminality among
criminally involved male adolescents.

[Criminal Justice and Behavior]{.underline}, 27, 196‑215.

Gallagher, C.A. (1999) Juvenile Offenders in Residential Placement,
1997. Washington, D.C.: U.S. Department of Justice, Office of Juvenile
Justice and Delinquency Prevention, OJJDP Fact Sheet #96.

Garbarino, J., Eckenrode, J., and Powers, J. L. (1997) The maltreatment
of youth. In J. Garbarino and J. Eckenrode (Eds). [Understanding Abusive
Families: an Ecological Approach to Theory and Practice]{.underline}.
San Francisco: Jossey‑Bass, 145‑165.

Gunnar, M. R. (2000) Early adversity and the development of stress
reactivity and regulation.

In C.A. Nelson (Ed) [The Minnesota Symposia on Child Psychology, Vol 31:
The Effects of]{.underline} [Early Adversity on Neurobehavioral
Development. Minnesota Symposia on Child Psychology; V. 31]{.underline}.
Mahwah, N.J.: Erlbaum, 163‑200

James, B. (1989). [Treating Traumatized Children: New Insights and
Creative Interventions]{.underline}.

Lexington, Mass.: Lexington Books/D. C. Heath.

Kaufman, J. and Henrich,C. (2000) Exposure to violence and early
childhood trauma.

In C.H Zeanah (Ed.) [Handbook of Infant Mental Health. Second
Edition]{.underline}. New York: Guilford Press, 195-207.

Leavitt, L. A. and Fox, N. A. (1993) [The Psychological Effects of War
and Violence on Children]{.underline}. Hillsdale, N.J.: Erlbaum.

Lieberman, A. F., Silverman, R., and Pawl, J. (2000) Infant‑parent
psychotherapy: Core concepts and current approaches. In C.H Zeanah,
(Ed). [Handbook of Infant Mental Health. Second Edition]{.underline}.
New York: Guilford Press, 472‑484.

March, J. S., Amaya‑Jackson, L., Murray, M.C., and Schulte, A. (1998)
Cognitive‑behavioral psychotherapy for children and adolescents with
posttraumatic stress disorder after a single‑incident stressor. [Journal
of the American Academy of Child and Adolescent Psychiatry]{.underline},
37, 585‑593.

Marmar, C.R., Weiss, D.S., and Pynoos, R. S. (1995) Dynamic
psychotherapy of post‑traumatic stress disorder. In M. J. Friedman, J.
Matthew, D.S. Charney, et al. [Neurobiological and Clinical]{.underline}

[Consequences of Stress: From Normal Adaptation to Post‑traumatic Stress
Disorder]{.underline}. Philadelphia: Lippincott Williams & Wilkins,
495‑506.

McNally, R. J. (1996) Assessment of posttraumatic stress disorder in
children and adolescents.

[Journal of School Psychology]{.underline}, 34, 147‑161.

Muris, P., Merckelbach, H., Koerver, P. and Meesters, C. (2000)
Screening for trauma in children and adolescents: The validity of the
Traumatic Stress Disorder scale of the Screen for Child Anxiety Related
Emotional Disorders. [Journal of Clinical Child Psychology,]{.underline}
29, 406‑413.

Perry, B.D. and Pollard, R.H. (1998) Homeostasis, stress, trauma, and
adaptation: A neurodevelopmental view of childhood trauma. [Child and
Adolescent Psychiatric Clinics of North America]{.underline}, 7, 33‑51.

Pfefferbaum, B.P. (1997) Posttraumatic stress disorder in children: A
review of the past 10 years.

[Journal of the American Academy of Child and Adolescent
Psychiatry]{.underline}, 36, 1503‑1511.

Pollak, S., Cicchetti, D. and Klorman, R. (1998) Stress, memory, and
emotion: Developmental considerations from the study of child
maltreatment. [Development and Psychopathology]{.underline}, 10,
811‑828.

Pynoos, R.S., Goenjian, A. K. and Steinberg, A. M. (1998) A public
mental health approach to the postdisaster treatment of children and
adolescents. [Child and Adolescent Psychiatric Clinics of North
America]{.underline}, 7, 195‑210.

Pynoos, R.S., Steinberg, A. M., and Piacentini, J.C. (1999) A
developmental psychopathology model of childhood traumatic stress and
intersection with anxiety disorders. [Biological
Psychiatry,]{.underline} 46, 1542‑1554.

Quinlan K.P. and Sacks J.J. (1999) Hospitalizations for Dog Bite
Injuries \[letter\] [Journal of the American Medical
Association]{.underline}, 28, 232‑233.

Rosenfeld, A.A., Pilowsky, D.J., Fine, P., et. al. (1997) Foster care:
An update. [Journal of the American Academy of Child and Adolescent
Psychiatry]{.underline}, 36, 448-457.

Rutter, M. L. (1999) Psychosocial adversity and child psychopathology.
[British Journal of Psychiatry]{.underline}, 174, 480‑493.

Shonk, S. M. and Cicchetti, D. (2001) Maltreatment, competency deficits,
and risk for academic and behavioral maladjustment. [Developmental
Psychology,]{.underline} 37, 3‑17.

Singer, M.I., Anglin, T.M., Song, L. and Lunghofer, L. (1995)
Adolescents\' exposure to violence and associated symptoms of
psychological trauma. [Journal of the American Medical
Association]{.underline}, 273, 477‑482.

Sosin, D.M., Sacks J.J., and Webb K.W. (1996) Pediatric head injuries
and deaths from bicycling in the United States.
[Pediatrics]{.underline}, 98, 868‑70.

Sacks J.J., Kresnow M., and Houston B. (1996) Dog bites: how big a
problem? [Injury Prevention]{.underline}, 2, 52‑4.

Trickett, P. K. and Schellenbach, C. J. (1998) [Violence Against
Children in the Family and the Community]{.underline}. Washington, D.C.:
American Psychological Association.

U. S. Department of Health and Human Services, Children's Bureau (2000a)
[Child Maltreatment 1998: Reports from the States to the National Child
Abuse and Neglect Data System]{.underline}.

U. S. Department of Health and Human Services, Children's Bureau (2000b)
[Adoption and Foster Care Analyis and Reporting System: Report Number
4.]{.underline}

U. S. Department of Health and Human Services, Office of Refugee
Resettlement (2000c) [Fact Sheet.]{.underline}

**ADDITIONAL RESOURCES AVAILABLE**

**AT** [http://www.nctsnet.org](http://www.nctsnet.org/)

######## APPENDIX C

+-----------------------------------------------------------------------+
| **National Child Traumatic Stress Network:**                          |
+-----------------------------------------------------------------------+
| ###### Background,                                                    |
| structure, and mission of the National Child Traumatic Stress Network |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| Treatment centers from all over the United States have come together  |
| to form a new coalition, the National Child Traumatic Stress Network  |
| (NCTSN). The Network, which currently consists of 37 centers, is      |
| being funded by the [Center for Mental Health                         |
| Services](http://www.samhsa.gov/centers/cmhs/cmhs.html), [Substance   |
| Abuse and Mental Health Services                                      |
| Administration](http://www.samhsa.gov/), US Department of Health and  |
| Human Services through a Congressional initiative, the [Donald J.     |
| Cohen National Child Traumatic Stress                                 |
| Initiative](http://www.nctsnet.org/nccts/nav.do?pid=abt_hist). This   |
| Congressional initiative recognizes the profound, destructive, and    |
| widespread impact of trauma on American children\'s lives. Its        |
| purpose is to improve the quality, effectiveness, provision, and      |
| availability of therapeutic services delivered to all children and    |
| adolescents experiencing traumatic events. The Network will develop   |
| and disseminate effective, evidence-based treatments; collect data    |
| for systematic study; and help to educate professionals and the       |
| public about the effects of trauma on children.                       |
|                                                                       |
| Over the past 20 years significant advances have been made in the     |
| field of child traumatic stress. This Network is a groundbreaking     |
| effort that blends the academic best practices of the clinical        |
| research community with the wisdom of front-line community service    |
| providers. The work of Network members ranges across settings,        |
| disciplines, age groups, and trauma types, delivering high-quality    |
| services to large numbers of children and their families. The Network |
| is committed to addressing the full spectrum of child trauma from a   |
| developmental and family-centered perspective and to helping children |
| from every ethnic, sociocultural, and economic background.            |
|                                                                       |
| The Network is made up of three components:                           |
|                                                                       |
| **National Center for Child Traumatic Stress (Category I)**           |
|                                                                       |
| Designated to lead the NCTSN as the National Center for Child         |
| Traumatic Stress (NCCTS), the UCLA David Geffen School of Medicine    |
| and the Duke University School of Medicine have individually and      |
| collectively provided leadership in the developmental understanding   |
| of child traumatic stress, have pioneered evaluation and treatment of |
| children, families, and communities, and are at the forefront in      |
| developing public mental health strategies to reach the large         |
| population of children, families, and communities affected by         |
| traumatic events. The National Center for Child Traumatic Stress, as  |
| a joint program of UCLA and Duke University, is supported by the vast |
| resources of two of the country\'s preeminent learning institutions,  |
| their medical schools, and departments of psychiatry and              |
| university-level programs.                                            |
|                                                                       |
| **Intervention Development and Evaluation Centers (Category II)**     |
|                                                                       |
| Intervention Development and Evaluation (IDE) centers are charged     |
| with identifying, supporting, improving, and developing treatment and |
| service approaches for different types of child and adolescent        |
| traumatic events. IDE centers emphasize developmentally appropriate   |
| trauma evaluation and intervention for children and adolescents of    |
| all ages, as well as the identification, assessment, and appropriate  |
| treatment of children in specialty child service sectors, such as     |
| schools, the juvenile justice system, the refugee service system, and |
| the child welfare and protective service systems.                     |
|                                                                       |
| **Community Treatment and Services Centers (Category III)**           |
|                                                                       |
| The third category of grantees, Community Treatment and Services      |
| Centers, will implement and evaluate effective treatment and services |
| in community settings, collect clinical data on traumatized children  |
| receiving treatment, develop expertise related to effective           |
| practices, financing, and other service issues, and provide           |
| leadership and training on child trauma for service providers in the  |
| community and staff in a range of child service sectors.              |
|                                                                       |
| **NCTSN Mission:**                                                    |
|                                                                       |
| o raise theTTo raise the standard of care and improve access to       |
| services for traumatized children and their families and communities  |
| throughout the United States.                                         |
+-----------------------------------------------------------------------+
| **NCTSN Vision**                                                      |
|                                                                       |
| -   The NCTSN will raise public awareness of the scope and serious    |
|     impact of child traumatic stress on the safety and healthy        |
|     development of our Nation\'s children and families.               |
|                                                                       |
| -   We will improve the standard of care by integrating developmental |
|     and cultural knowledge to advance a broad range of effective      |
|     services and interventions that will preserve and restore the     |
|     future of our Nation\'s traumatized children.                     |
|                                                                       |
| -   We will work with established systems of care, including the      |
|     health, mental health, education, law enforcement, child welfare, |
|     and juvenile justice systems, to ensure that there is a           |
|     comprehensive continuum of care available and accessible to all   |
|     traumatized children and their families.                          |
|                                                                       |
| -   We will be a community dedicated to collaboration within and      |
|     beyond the Network to ensure that widely shared knowledge and     |
|     skills create a national resource to address the problem of child |
|     traumatic stress.                                                 |
|                                                                       |
| **Web site link: http://www.nctsnet.org/nccts/nav.do?pid=abt_main**   |
+-----------------------------------------------------------------------+

**APPENDIX D**

#### National Child Traumatic Stress Network Center Descriptions

+-----------------------------------------------------------------------+
| **Alabama**                                                           |
|                                                                       |
| **National Children\'s Advocacy Center**\                             |
| \                                                                     |
| The National Children\'s Advocacy Center will focus on treatment and  |
| services for children who are victims of child abuse or neglect and   |
| their families. This will include identifying gaps in the field and   |
| the best practices and emerging practices that will meet those needs, |
| evaluating those practices, and disseminating the information to the  |
| field through a variety of training and technical assistance methods  |
| and in collaboration with the National Child Traumatic Stress         |
| Network. As a partner of the National Child Traumatic Stress Network, |
| the NCAC plans to develop new training and technical assistance       |
| projects for therapists new to the field of child abuse; expand and   |
| conduct research on the Family Advocate Model; expand research on the |
| Forensic Evaluation Model, particularly for preschool child sexual    |
| abuse victims; and provide curriculum enhancements to universities    |
| that train professionals working in the field of child abuse.\        |
| Contact: JoAnn Plucker\                                               |
| Phone: (256) 533-0531\                                                |
| Email: <jplucker@ncac-hsv.org>\                                       |
| Web: [http://www.NationalCAC.org](http://www.NationalCAC.org/)        |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **California**                                                        |
|                                                                       |
| **Chadwick Center for Children and Families Trauma Counseling         |
| Program**\                                                            |
| \                                                                     |
| The Trauma Counseling Program within the Chadwick Center at           |
| Children\'s Hospital San Diego, is a large trauma-focused treatment   |
| program with offices throughout the county of San Diego. It will use  |
| its large and culturally diverse community service environment to     |
| explore the most effective treatment methods across childhood trauma  |
| types. The focus will be on the treatment of children. The trauma     |
| types include child abuse, witness to intimate and community          |
| violence, accident related trauma, and painful medical procedures.    |
| The Chadwick Center will examine the most effective clinical pathways |
| for connecting children from the initial medical and/or legal system  |
| contacts to trauma treatment. The center will draw from is culturally |
| diverse staff and client base and location as a border community to   |
| examine the issues of ethnicity, culture, and degrees of              |
| acculturation in the healing process. As part of the National Child   |
| Traumatic Stress Initiative, the Chadwick Center will partner with    |
| the NIMH-funded Child and Adolescent Services Research Center at      |
| Children\'s Hospital to support scientific integrity in its research  |
| on effective treatment methods.\                                      |
| Contact: Barbara Ryan\                                                |
| Phone: (858) 966-4011\                                                |
| Email: <beryan@chsd.org>\                                             |
| Web: <http://www.charityadvantage.com/chadwickcenter/home.asp>        |
|                                                                       |
| **Children\'s Institute International, Central L.A. Child Trauma      |
| Treatment Center**\                                                   |
| \                                                                     |
| Children\'s Institute International (CII), Central L.A. Child Trauma  |
| Treatment Center is a community agency serving metropolitan Los       |
| Angeles in two clinic sites, as well as in schools and through        |
| home-based services. CII\'s mental health programs serve children who |
| have been abused or neglected, sexually abused, and /or exposed to    |
| domestic violence as well as to violence at school or in their        |
| community. One goal of the Trauma Center is to create a Child Trauma  |
| Council in Central Los Angeles, composed of multiple agencies serving |
| children. Another special focus will be an evaluation of their        |
| multidisciplinary approach to serving children and families in their  |
| domestic violence treatment program.\                                 |
| Contact: Becky Gaba\                                                  |
| Phone: (213) 385-5100\                                                |
| Email: <rgaba@childrensinstitute.org>\                                |
| Web:                                                                  |
| [h                                                                    |
| ttp://www.childrensinstitute.org](http://www.childrensinstitute.org/) |
|                                                                       |
| **Early Trauma Treatment Network**\                                   |
| \                                                                     |
| Early Trauma Treatment Network (ETTN) is a unique collaboration       |
| between the University of California, San Francisco (UCSF), the Child |
| Violence Exposure Program at Louisiana State University Health        |
| Sciences Center, the Child Witness to Violence Project at Boston      |
| Medical Center, and Tulane University/Jefferson Parish Human Services |
| Authority Infant Team at Tulane University Medical Center. The ETTN   |
| is focused on providing Child-Parent Psychotherapy, a manualized,     |
| multimodal, relationship-based treatment for infants, toddlers, and   |
| preschoolers exposed to interpersonal traumas, including domestic     |
| violence, child abuse, community violence, and traumatic loss. They   |
| are implementing and evaluating this innovative treatment approach in |
| ethnically and culturally diverse populations across the four sites.\ |
| Contact: Chandra Ghosh Ippen\                                         |
| Phone: (415) 206-5312\                                                |
| Email: <chandra@itsa.ucsf.edu>                                        |
|                                                                       |
| **L.A. Unified School District Community Practice Center**\           |
| \                                                                     |
| The Los Angeles Unified School District Community Practice Center is  |
| designed to expand knowledge, services, training, and education for   |
| early trauma interventions in schools, including treatment, crisis    |
| response, and seamless linkages to other community services and       |
| followup care. It is developing school services specifically for      |
| ethnic minority and underserved children, including immigrant         |
| populations, and doing outreach to diverse communities affected by    |
| trauma to reduce stigma and increase awareness of the impact that     |
| trauma can have on children. Also is expanding upon the cognitive     |
| behavioral therapy treatment model it has been piloting in schools.   |
| The Center will focus on children who have been exposed to a wide     |
| range of community violence.\                                         |
| Contact: Marleen Wong\                                                |
| Phone: (818) 997-2640\                                                |
| Email: <mwong1@lausd.k12.ca.us>                                       |
|                                                                       |
| **Miller Children\'s Abuse and Violence Intervention Center**\        |
| \                                                                     |
| Miller Children\'s Abuse and Violence Intervention Center (MCAVIC) is |
| an outpatient evaluation and treatment program in Long Beach,         |
| California. The Center collaborates closely with community agencies   |
| and schools to provide culturally sensitive, trauma-specific, and     |
| developmentally appropriate services to children, adolescents, and    |
| their families. MCAVIC provides coordinated investigative, medical,   |
| and mental health services to children, adolescents, and families who |
| have experienced child abuse, family violence, neighborhood violence, |
| parental substance abuse, medical trauma, and community disasters.    |
| MCAVIC provides coordination of services for immediate intervention,  |
| as well as long-term services, support, and community outreach.       |
| MCAVIC\'s school-based program is designed to increase the            |
| availability of evaluation and treatment services to school-age       |
| children who have experienced child abuse, domestic violence,         |
| community violence, and parental substance abuse.\                    |
| Contact: Laura Benson\                                                |
| Phone: (562) 933-0590\                                                |
| Email: <lbenson@memorialcare.org>\                                    |
| Web: [http://www.memorialcare.org](http://www.memorialcare.org/)      |
|                                                                       |
| **National Center for Child Traumatic Stress**\                       |
| \                                                                     |
| Designated to lead the NCTSN as the National Center for Child         |
| Traumatic Stress (NCCTS), the UCLA David Geffen School of Medicine    |
| and the Duke University School of Medicine have individually and      |
| collectively provided leadership in the developmental understanding   |
| of child traumatic stress, have pioneered evaluation and treatment of |
| children, families, and communities, and are at the forefront in      |
| developing public mental health strategies to reach the large         |
| population of children, families, and communities affected by         |
| traumatic events. The National Center for Child Traumatic Stress, as  |
| a joint program of UCLA and Duke University, is supported by the vast |
| resources of two of the country\'s preeminent learning institutions,  |
| their medical schools, and departments of psychiatry and              |
| university-level programs.\                                           |
| Contact: Jenifer Wood\                                                |
| Phone: (310) 235-2633\                                                |
| Email: <jlwood@mednet.ucla.edu>\                                      |
| Web: [http://www.nctsnet.org](http://www.nctsnet.org/)                |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **Colorado**                                                          |
|                                                                       |
| **Aurora Mental Health Center**\                                      |
| \                                                                     |
| Aurora Mental Health Center is a nonprofit community mental health    |
| center that serves Aurora, Colorado, a city of 275,000 that includes  |
| parts of three counties of metropolitan Denver. Currently 315 paid    |
| employees and 82 volunteers aid more than 5,000 people annually.      |
| Services are provided in eight counseling and specialized service     |
| centers, seven residential facilities, 25 public schools, two county  |
| departments of human services, in homes, foster homes, and at other   |
| community locations. In 1999, the Aurora Mental Health Center was     |
| named the best community mental health center in Colorado by State    |
| Mental Health Services and has consistently ranked in the top three.  |
| The Center helps abused and neglected children and children who have  |
| witnessed interpersonal violence. The Center\'s Intercept program     |
| works with children with mental illness and developmental             |
| disabilities, an underserved population with an extremely high        |
| prevalence of abuse.\                                                 |
| Contact: Frank Bennett\                                               |
| Phone: (303) 617-2305\                                                |
| Email: <FrankBennett@aumhc.org>\                                      |
| Web: [http://www.aumhc.org](http://www.aumhc.org/)                    |
|                                                                       |
| **Mental Health Corporation of Denver\'s Family Trauma Treatment      |
| Program**\                                                            |
| \                                                                     |
| Mental Health Corporation of Denver\'s Family Trauma Treatment        |
| Program provides access for low-income children and families to       |
| community mental health services through a network of more than 30    |
| locations throughout the Denver area. The program\'s goal is to       |
| improve services and treatment for children who have experienced      |
| trauma by implementing and evaluating evidence-based interventions in |
| a variety of community settings including schools, shelters, juvenile |
| detention centers, day care centers, and neighborhood clinics.\       |
| Contact: Karen Mallah\                                                |
| Phone: (303) 504-6565\                                                |
| Email: <kmallah@mhcd.com>                                             |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **Connecticut**                                                       |
|                                                                       |
| **Childhood Violent Trauma Center**\                                  |
| \                                                                     |
| Childhood Violent Trauma Center (CVTC) represents a collaboration     |
| between the interdisciplinary faculty and staff at the Yale Child     |
| Study Center and the University of Connecticut Health Center.         |
| Together, the CVTC seeks to develop innovative and comprehensive      |
| responses to children and adolescents who have been acutely           |
| traumatized by violence in their communities and homes, with an       |
| emphasis on collaboration with local entities, especially law         |
| enforcement.\                                                         |
| Contact: Steven Berkowitz\                                            |
| Phone: (203) 785-7047\                                                |
| Email: <steven.berkowitz@yale.edu>\                                   |
| Web: [http://www.nccev.org](http://www.nccev.org/)                    |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **District of Columbia**                                              |
|                                                                       |
| **La Clinica del Pueblo, Inc.**\                                      |
| \                                                                     |
| La Clinica del Pueblo, Inc., is an outpatient bicultural, bilingual,  |
| nonprofit, community-based organization that provides a variety of    |
| services to an immigrant population, mainly Latino, in Washington,    |
| DC. The mission of La Clinica is \"To provide free, culturally        |
| sensitive and comprehensive health care and education services to the |
| Latino community and any others in need. La Clinica promotes          |
| community participation and empowerment through professional care,    |
| advocacy, and a vision of health as a basic human right.\" La Clinica |
| provides medical, HIV, mental health, social work, and interpreters   |
| services to nearly 6,000 unduplicated clients of all ages annually.   |
| Most patients/clients speak little or no English, have no health      |
| insurance, are immigrants from Central America (mainly El Salvador),  |
| and have never completed secondary school. The child and adolescent   |
| trauma victims seen at La Clinica suffer from exposure to domestic    |
| violence and/or substance abuse in the home, physical abuse, sexual   |
| abuse or assault, and medical trauma. Many have lost loved ones in    |
| natural disasters or through torture and the experience of being      |
| immigrants. The long-term goal of La Clinica\'s project is to develop |
| a well-integrated medical/mental health model for early               |
| identification and treatment of Latino children and adolescents       |
| suffering from trauma.\                                               |
| Contact: Darleen Joyce\                                               |
| Phone: (202) 462-4788\                                                |
| Email: <djoyce@lcdp.org>\                                             |
| Web: [http://www.lcdp.org](http://www.lcdp.org/)                      |
|                                                                       |
| **Wendt Center for Loss and Healing**\                                |
| \                                                                     |
| The Wendt Center for Loss and Healing is a 28-year-old nonprofit      |
| agency that provides mental health services to children and families. |
| The Wendt Center serves people throughout the Washington, D.C.,       |
| metropolitan area who have experienced the death of a loved one or    |
| are living with life-threatening illness. Individual counseling,      |
| grief support groups, a summer grief camp for children, and training  |
| for mental health professionals are the heart of the Wendt Center     |
| services. Three years ago the Wendt Center created the only program   |
| in the United States that provides on-site grief counseling to        |
| families who must visit the city morgue to identify a body; through   |
| this work the Wendt Center has developed an expertise in working with |
| children from families who have experienced a traumatic death.\       |
| Contact: Susan Ley\                                                   |
| Phone: (202) 624-0010\                                                |
| Email: <sley@lossandhealing.org>\                                     |
| Web: [http://www.lossandhealing.org](http://www.lossandhealing.org/)  |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **Florida**                                                           |
|                                                                       |
| **Healing the Hurt, Directions for Mental Health, Inc.**\             |
| \                                                                     |
| Directions for Mental Health, Inc., is a community mental health      |
| center in Clearwater, Florida, currently serving children and         |
| adolescents, aged 0-18, who present with mental health symptoms and a |
| history of trauma. Healing the Hurt is a partnership with Hospice of  |
| the Florida Suncoast and Family Service Centers, two community        |
| organizations that have traditionally provided intervention to        |
| children and adolescents who have recently experienced trauma related |
| to death or serious illness of a family member, or from sexual        |
| assault. Healing the Hurt works closely with the local school board,  |
| Safe Start Initiative, and the juvenile justice system and            |
| participates in a replication of the Child Development-Community      |
| Policing program. The agencies will be developing protocols for our   |
| services and implementing best practices as recommended by the        |
| National Center. In addition to expanding services and improving      |
| access, Healing the Hurt will focus on increasing community awareness |
| of the effects of trauma on children and on training other providers  |
| in the region.\                                                       |
| Contact: Ann Kelley\                                                  |
| Phone: (727) 547-4566\                                                |
| Email: <ann.kelley@directionsmh.org>                                  |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **Illinois**                                                          |
|                                                                       |
| **Family, Adolescent, and Child Enhancement Services (FACES)**\       |
| \                                                                     |
| Family, Adolescent, and Child Enhancement Services (FACES ) is a      |
| program of Chicago Health Outreach, a community-based health          |
| organization providing services to disenfranchised individuals and    |
| families in Chicago. The program enhances the quality of life for     |
| refugee children, adolescents, and families by providing culturally   |
| and linguistically appropriate, comprehensive mental health services  |
| for individuals suffering from trauma-related distress or emotional   |
| stress exacerbated by the refugee experience. Direct services include |
| psychiatric assessment and treatment, individual and family           |
| counseling, psychotherapy, occupational, art and dance/movement       |
| therapy, theater work, case management typically provided by a case   |
| manager from the child\'s country of origin, and outreach programs to |
| sensitize the children\'s wider communities to their needs. All       |
| services are available in the home, school, community, and on site.\  |
| Contact: Joan Liautaud\                                               |
| Phone: (773) 751-4054\                                                |
| Email: <jaywon@aol.com>\                                              |
| Web:                                                                  |
| [h                                                                    |
| ttp://www.heartland-alliance.org](http://www.heartland-alliance.org/) |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **Maine**                                                             |
|                                                                       |
| **Mid-Maine Child Trauma Network**\                                   |
| \                                                                     |
| The Mid-Maine Child Trauma Network (MCTN) will strengthen the         |
| infrastructure of rural community services to children who have       |
| experienced traumatic stress and their families. Building on a        |
| successful triage assessment and outcome evaluation protocol serving  |
| physical and psychosocial needs of abused and neglected children in   |
| foster care, the MCTN will (1) identify community resources, needs,   |
| and coordination opportunities among foster care, domestic violence,  |
| emergency health care, mental health, and terrorism/disaster response |
| services; (2) pilot triage assessment and outcome evaluation          |
| protocols in the above areas; (3) provide training and consultation   |
| to increase trauma assessment and intervention resources; (4)         |
| facilitate interagency development and coordination of child trauma   |
| services; and (5) collaborate with the National Child Traumatic       |
| Stress Network and regional networks in resource development and      |
| dissemination.\                                                       |
| Contact: Stephen Meister\                                             |
| Phone: (207) 621-2304\                                                |
| Email: <smeister@mainegeneral.org>\                                   |
| Web:                                                                  |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **Massachusetts**                                                     |
|                                                                       |
| **Center for Medical and Refugee Trauma, Boston University Medical    |
| Center**\                                                             |
| \                                                                     |
| Center for Medical and Refugee Trauma, Boston University Medical      |
| Center is working to develop and evaluate interventions and services  |
| for children and adolescents who experience medical trauma, including |
| burns, injuries, and invasive medical procedures. The Center also has |
| an emphasis on work with children and families who have experienced   |
| war, displacement, and resettlement stress. Activities of the Center  |
| include the investigation of risk factor profiles and the development |
| of culturally informed, social-ecologically valid interventions for   |
| children who have experienced trauma; examination of the impact of    |
| trauma on physical and mental health outcomes; consideration of acute |
| preventative interventions for injured children; and improvement of   |
| interventions for pain in medically hospitalized children.\           |
| Contact: Daphne McCampbell\                                           |
| Phone: (617) 414-7531\                                                |
| Email: <daphne.mccampbell@bmc.org>\                                   |
| Web: <http://www.bmc.org/childpsychiatry>                             |
|                                                                       |
| **The Trauma Center, Massachusetts Mental Health Institute**\         |
| \                                                                     |
| The Trauma Center, Massachusetts Mental Health Institute provides     |
| community crisis intervention, trauma treatment, clinical training,   |
| and treatment outcome research for traumatized children and their     |
| caregivers. The Center focuses on specialty trauma service delivery,  |
| education, and training to assist children exposed to physical and    |
| sexual abuse, neglect, and community and political violence. It is    |
| affiliated with multiple community agencies, including clinics,       |
| universities, schools, youth groups, homeless shelters, church groups |
| and the Boston police department, which partner with the Center to    |
| serve children in the Greater Boston area as well as in rural and     |
| remote areas of New England.\                                         |
| Contact: Joseph Spinazzola\                                           |
| Phone: (617) 782-6460\                                                |
| Email: <spinazzola@traumacenter.org>\                                 |
| Web: [http://www.traumacenter.org](http://www.traumacenter.org/)      |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **Missouri**                                                          |
|                                                                       |
| **Kansas City Metropolitan Child Traumatic Stress Center**\           |
| \                                                                     |
| Kansas City Metropolitan Child Traumatic Stress Program is sponsored  |
| by the University of Missouri-Kansas City. It is a partnership among  |
| the University, a multi-service children\'s agency called The         |
| Children\'s Place, and a large community collaborative of             |
| family-serving organizations in the metro-Kansas city area convened   |
| by PROCOMM and UMKC. Goals of the KC Metro program are to promote     |
| identification, assessment, and treatment for traumatized children    |
| and adolescents in the Kansas City area and to increase public        |
| awareness and promote the utilization of trauma treatments and        |
| services to underserved populations, including those in specialty     |
| service settings. KC Metro plans to emphasize policy and advocacy at  |
| the local and State levels.\                                          |
| Contact: Sharon Portwood\                                             |
| Phone: (816) 235-1064\                                                |
| Email: <portwoods@umkc.edu>                                           |
|                                                                       |
| **The Greater St. Louis Child Traumatic Stress Program**\             |
| \                                                                     |
| The Greater St. Louis Child Traumatic Stress Program is a             |
| collaborative project between the Children\'s Advocacy Services of    |
| Greater St. Louis and the Center for Trauma Recovery of the           |
| University of Missouri-St. Louis. The Program provides assessment and |
| therapy free of charge for children and adolescents for a variety of  |
| traumatic events including sexual and physical abuse, assault,        |
| accidents, homicide, domestic violence, and community violence.       |
| Services include individual, family and group therapy, forensic       |
| interviews and medical exams, abuse prevention education, research,   |
| consultation, and professional education and training programs.       |
|                                                                       |
| [http://www.umsl.ed                                                   |
| u](http://www.umsl.edu/divisions/artscience/psychology/CTRHome.html)\ |
| Contact: Jeffrey Wherry\                                              |
| Phone: (314) 516-7342\                                                |
| Email: <wherry@msx.umsl.edu>\                                         |
| Web: [http://www.safekidsmo.org](http://www.safekidsmo.org/)          |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **New Mexico**                                                        |
|                                                                       |
| **New Mexico Alliance for Children with Traumatic Stress**\           |
| \                                                                     |
| New Mexico Alliance for Children with Traumatic Stress is a           |
| collaboration between nonprofit, State government, and tribal         |
| organizations committed to improving New Mexico\'s capacity to        |
| identify, treat, and serve children who experience traumatic stress,  |
| from diverse cultural and ethnic backgrounds, living in both urban    |
| and remote rural areas. In addition to creating a network of highly   |
| trained service providers, the Alliance also seeks to document and    |
| disseminate information to local and national audiences about         |
| promising interventions for the unique populations they serve.\       |
| Contact: Sarthak Das\                                                 |
| Phone: (505) 603-0056\                                                |
| Email: <newmacts@yahoo.com>\                                          |
| Web: [http://www.tacinc.org](http://www.tacinc.org/)                  |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **New York**                                                          |
|                                                                       |
| **Children\'s Trauma Consortium of Westchester**\                     |
| \                                                                     |
| The Children\'s Trauma Consortium of Westchester is a partnership     |
| between the Behavioral Health Center at Westchester Medical Center,   |
| Julia Dyckman Andrus Memorial, The Center for Preventive Psychiatry   |
| and Fordham University Graduate School of Social Service. The         |
| Children\'s Trauma Consortium will provide a continuum of care for    |
| children who have experienced or been exposed to community violence,  |
| domestic violence, sexual abuse and assault, physical abuse, and      |
| assault. The focus will be on children at a high risk of being        |
| removed from their homes, schools, and communities.\                  |
| Contact: Maralee Walsh\                                               |
| Phone: (914) 493-7071\                                                |
| Email: <walshm1@wcmc.com>                                             |
|                                                                       |
| **Jewish Board of Family and Children\'s Services - Center for Trauma |
| Program Innovation**\                                                 |
| \                                                                     |
| The Jewish Board of Family and Children\'s Services - Center for      |
| Trauma Program Innovation (JBFCS) will develop, improve, and          |
| systematize trauma-focused assessment and treatment services for      |
| traumatized children from low-income and racially diverse             |
| neighborhoods. Children served have been exposed to a full range of   |
| interpersonal and community violence and present with both acute and  |
| chronic traumatic stress consequences. JBFCS is a large,              |
| decentralized network of mental health and social service programs    |
| throughout New York City. Two major goals of the Center are (1) to    |
| develop psycho-educational modules and a treatment manual for the     |
| Sanctuary trauma treatment program; and (2) to introduce              |
| research-grade data collection and treatment protocols to screen for  |
| trauma exposure, systematize trauma assessment, and implement         |
| trauma-focused treatment approaches.\                                 |
| Contact: Robert Abramovitz\                                           |
| Phone: (212) 632-4665\                                                |
| Email: <RAbramovitz@jbfcs.org>\                                       |
| Web: [http://www.jbfcs.org](http://www.jbfcs.org/)                    |
|                                                                       |
| **Mount Sinai Adolescent Health Center**\                             |
| \                                                                     |
| Mount Sinai Adolescent Health Center is dedicated to the coordinated  |
| and integrated provision of comprehensive adolescent health care      |
| services within a single setting that maintains complete patient      |
| confidentiality and provides care to adolescents regardless of their  |
| ability to pay. AHC staff work to engage adolescents in treatment,    |
| using a holistic approach and personally tailoring care to each       |
| individual\'s medical, mental health, family planning, and health     |
| education needs. Located in New York City, AHC serves a culturally    |
| and ethnically diverse population that has experienced a wide range   |
| of traumatic experiences including physical and sexual abuse/assault, |
| domestic, gang, and community violence, and homelessness.\            |
| Contact: Sabina Singh\                                                |
| Phone: (212) 423-2900\                                                |
| Email: <sabina.singh@msnyuhealth.org>                                 |
|                                                                       |
| **North Shore University Hospital Adolescent Trauma Treatment         |
| Development Center**\                                                 |
| \                                                                     |
| North Shore University Hospital Adolescent Trauma Center is based at  |
| a not-for-profit tertiary care hospital that has a commitment to      |
| providing mental health services to children and adolescents in the   |
| Long Island Region who have experienced physical abuse, sexual abuse, |
| neglect, or other types of interpersonal trauma. The Center           |
| specializes in developing interventions to address and raise          |
| awareness about the unique impact of exposure to trauma during        |
| adolescence.\                                                         |
| Contact: Victor LaBruna\                                              |
| Phone: (516) 562-3245\                                                |
| Email: <vlabruna@nshs.edu>                                            |
|                                                                       |
| **Parsons Child and Family Center**\                                  |
| \                                                                     |
| Parsons Child and Family Center provides residential treatment        |
| services to children and adolescents in Northeastern New York State.  |
| The Parsons treatment continuum includes residential and foster care, |
| outreach to schools and day care centers, mental health, and          |
| prevention services for children who have been physically and         |
| sexually abused and/or exposed to domestic and community violence.    |
| The Parsons Child Trauma Study Center will use its participation in   |
| NCTSN to disseminate information about best practice assessments and  |
| treatments of traumatized children and adolescents to its extensive   |
| collaborative network as well as to improve the treatment provided at |
| Parsons\' own treatment programs. Research and Evaluation for the     |
| grant activities will be coordinated by Dr. John Hornik and           |
| associates at the Advocacy for Human Potential (AHP) agency.\         |
| Contact: Joseph Benamati\                                             |
| Email: <benamaj@parsonscenter.org>\                                   |
| Web: [http://www.parsonscenter.org](http://www.parsonscenter.org/)    |
|                                                                       |
| **Safe Horizon---St. Vincent\'s Child Trauma Care Initiative**\       |
| \                                                                     |
| Safe Horizon-St. Vincent\'s Child Trauma Care Initiative offers a     |
| unique and comprehensive continuum of outreach and treatment services |
| for child trauma victims and their families. Programs range from      |
| community-based prevention to inpatient treatment and provide         |
| effective, trauma-focused care to thousands of children and youth     |
| each year. The project is the result of a collaboration between Safe  |
| Horizon, the Nation\'s leading nonprofit victim assistance            |
| organization, and Saint Vincent Catholic Medical Center, one of the   |
| largest behavioral healthcare providers in New York City. By pooling  |
| resources and expertise, the Initiative creates a system of extensive |
| outreach, services, treatment, consultation, and referrals that       |
| enables children and youth affected by trauma to access the most      |
| appropriate level of care at any given time. The overarching goal is  |
| to increase the options for and improve the quality of trauma-focused |
| services and treatment for all youth who have experienced trauma.     |
|                                                                       |
| Contact: Carrie Epstein\                                              |
| Phone: (212) 577-3871\                                                |
| Email: <cepstein@safehorizon.org>\                                    |
| Web: [http://www.safehorizon.org](http://www.safehorizon.org/);       |
| [http://www.svcm.org](http://www.svcmc.org/)                          |
|                                                                       |
| **The Institute for Trauma and Stress, NYU Child Study Center**\      |
| \                                                                     |
| The Institute\'s specific aims are the assessment and treatment of    |
| traumatized children, as well as the development and dissemination of |
| effective trauma treatments for children and their families. The      |
| Institute treats all types of urban trauma, including physical and    |
| sexual abuse, domestic and community violence, and traumatic          |
| bereavement and exposure to the 9-11 terrorist attack. The            |
| Institute\'s programs and goals include the training of clinicians in |
| empirically based trauma assessment and treatment, the evaluation of  |
| the effectiveness of these treatments in the community and the        |
| development of new treatments that are sensitive to the child and     |
| youth\'s trauma history, cultural and community context. There is     |
| extensive outreach and education to those who work regularly with     |
| children, about the psychological, social, and biological impacts of  |
| traumatic events. The Institute pioneers individual, group, parent,   |
| and family cognitive behavioral therapies, as well as                 |
| psychopharmacological and medical services. Services are offered      |
| through its affiliate outpatient and inpatient clinics, as well as    |
| school-based programs and foster care.\                               |
| Contact: Lena Kessler\                                                |
| Phone: (212) 263-2775\                                                |
| Email: <lena.kessler@med.nyu.edu>\                                    |
| Web: [http://www.aboutourkids.org](http://www.aboutourkids.org/)      |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **North Carolina**                                                    |
|                                                                       |
| **National Center for Child Traumatic Stress**\                       |
| \                                                                     |
| Designated to lead the NCTSN as the National Center for Child         |
| Traumatic Stress (NCCTS), the UCLA David Geffen School of Medicine    |
| and the Duke University School of Medicine have individually and      |
| collectively provided leadership in the developmental understanding   |
| of child traumatic stress, have pioneered evaluation and treatment of |
| children, families, and communities, and are at the forefront in      |
| developing public mental health strategies to reach the large         |
| population of children, families, and communities affected by         |
| traumatic events. The National Center for Child Traumatic Stress, as  |
| a joint program of UCLA and Duke University, is supported by the vast |
| resources of two of the country\'s preeminent learning institutions,  |
| their medical schools, and departments of psychiatry and              |
| university-level programs.\                                           |
| Contact: Jenifer Wood\                                                |
| Phone: (310) 235-2633\                                                |
| Email: <jlwood@mednet.ucla.edu>\                                      |
| Web: [http://www.nctsnet.org](http://www.nctsnet.org/)                |
+-----------------------------------------------------------------------+
| **Ohio**                                                              |
|                                                                       |
| **Cullen Center for Children, Adolescents, and Families**\            |
| \                                                                     |
| Cullen Center for Children, Adolescents, and Families combines the    |
| treatment capabilities of the Toledo Children\'s Hospital and the     |
| front-end delivery strengths of the Lucas County Children\'s Advocacy |
| Center. Together, both entities provide group, individual, and family |
| counseling, advocacy, and other support services to children and      |
| teens who experience violence, abuse, and other traumatic events.     |
| Building on the Lucas County Safe Kids Safe Streets Initiative, the   |
| Center will involve the community in all project components and       |
| widely disseminate information and treatment protocols.\              |
| Contact: Kristine Buffington\                                         |
| Phone: (419) 291-7919\                                                |
| Email: <Kris.Buffington@Promedica.org>                                |
|                                                                       |
| **The Children Who Witness Violence Program**\                        |
| \                                                                     |
| The Children Who Witness Violence Program provides immediate 24-hour  |
| trauma response services to children and families who have been       |
| referred by police officers in participating communities in the       |
| greater Cleveland area. The program is administered by Mental Health  |
| Services, Inc., a community mental health service provider. Police    |
| officers refer families who are involved in domestic or community     |
| violence by calling the Mental Health Services crisis line. A crisis  |
| intervention specialist is assigned to the family, makes contact with |
| them within an hour or two, and schedules an initial visit. The goals |
| of the initial response are to (1) stabilize the crisis situation and |
| provide immediate trauma intervention; (2) assure the safety of the   |
| child witness and the family; and (3) begin a comprehensive           |
| assessment of the child and family system. After the initial          |
| intervention and assessment phase, the child and family may be        |
| referred to an appropriate agency for up to 6 months of followup      |
| services.\                                                            |
| Contact: Sarah McGuire\                                               |
| Phone: (216) 623-6555\                                                |
| Email: <sarah@mhs-inc.org>                                            |
|                                                                       |
| **Trauma Treatment Replication Center**\                              |
| \                                                                     |
| The Trauma Treatment Replication Center is part of the Mayerson       |
| Center for Safe and Healthy Children, a child abuse evaluation,       |
| treatment, and research center located in Children\'s Hospital        |
| Medical Center, Cincinnati. The Trauma Treatment Replication Center   |
| is focused on acquiring expertise in the replication of child         |
| treatment models in community settings. Its goal is to transfer       |
| evidence-based child and adolescent trauma treatments from their      |
| developers to community-level providers.\                             |
| Contact: Frank Putnam\                                                |
| Phone: (513) 636-7001\                                                |
| Email: <frank.putnam@chmcc.org>\                                      |
| Web:                                                                  |
| <http://www.cincinnatichildrens.org/svc/prog/child-abuse/default.htm> |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **Oregon**                                                            |
|                                                                       |
| **Intercultural Child Traumatic Stress Center of Oregon**\            |
| \                                                                     |
| The Intercultural Child Traumatic Stress Center of Oregon has two     |
| major components. The first is a 6-month education program for        |
| service providers and others who work with refugee and immigrant      |
| children, focusing on the issue of child traumatic stress. The        |
| education program will train ethnic mental health counselors and      |
| school personnel, among others, to identify refugee and immigrant     |
| children who may be suffering the effects of traumatic stress. The    |
| education program will also publicize the availability of culturally  |
| appropriate treatment through the center. The second major component  |
| is direct treatment of refugee and immigrant children who suffer the  |
| effects of traumatic stress. Individual, family, and group therapy is |
| available for children from any of the 15 or so ethnic/language       |
| groups regularly encountered by the Intercultural Psychiatric         |
| Program, with a special emphasis on Asians and Hispanics.\            |
| Contact: Thomas Argent\                                               |
| Email: <argentt@ohsu.edu>                                             |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **Pennsylvania**                                                      |
|                                                                       |
| **Allegheny General Hospital Center for Traumatic Stress in Children  |
| and Adolescents**\                                                    |
| \                                                                     |
| Allegheny General Hospital Center for Traumatic Stress in Children    |
| and Adolescents is an urban, outpatient treatment program with a      |
| strong commitment to community involvement, based in Pittsburgh, PA.  |
| The center treats children exposed to many types of trauma, but has a |
| particular focus on developing, modifying, and disseminating          |
| effective interventions for child physical and sexual abuse,          |
| traumatic loss, and posttraumatic stress disorder. The Center has     |
| developed trauma-focused individual, group, and family cognitive      |
| behavioral interventions and has completed several randomized trials  |
| using these interventions with abused children and adolescents. Also  |
| it has recently established an NCTSN Task Force on Childhood          |
| Traumatic Bereavement.\                                               |
| Contact: Judith Cohen\                                                |
| Phone: (412) 330-4321\                                                |
| Email: <JCohen1@wpahs.org>                                            |
|                                                                       |
| **Center for Pediatric Traumatic Stress**\                            |
| \                                                                     |
| The Center for Pediatric Traumatic Stress (CPTS) at The Children\'s   |
| Hospital of Philadelphia develops and evaluates empirically based     |
| interventions for children who have experienced traumatic stress due  |
| to medical illness or injury and for their families. This includes    |
| developing manualized \"best practice\" protocols for preventing and  |
| treating traumatic stress, and establishing service delivery models   |
| to integrate prevention and treatment into health care and            |
| school-based systems. Current areas of intervention development focus |
| on traumatic stress related to life-threatening illness, acute        |
| injury, and critical care. CPTS is guided by an experienced team of   |
| clinicians from Psychology, Critical Care Medicine, Emergency         |
| Medicine, Nursing, Oncology, Pediatrics, and Surgery, and             |
| collaborates with health care providers nationwide to address         |
| critical issues regarding the prevention and treatment of traumatic   |
| stress in medical and primary care health settings. CPTS is also in   |
| the process of establishing an education and training center for      |
| disseminating state-of-the art-information and protocols about        |
| traumatic stress related to pediatric illness and injury.\            |
| Contact: Stephanie Schneider\                                         |
| Phone: (267) 426-5205\                                                |
| Email: <schneiderst@email.chop.edu>                                   |
|                                                                       |
| **Children\'s Crisis Treatment Center\'s Project Tamaa**\             |
| \                                                                     |
| Children\'s Crisis Treatment Center (CCTC) intends to expand its      |
| current trauma services by developing and implementing an innovative, |
| community and school-based, multimodal treatment program to assist    |
| the large and growing number of West African refugee children and     |
| their parents/caregivers who have relocated to the Southwest area of  |
| Philadelphia, Pennsylvania. Our new program, titled Project Tamaa, is |
| designed to target and serve those West African refugees from         |
| Liberia, Guinea, and Sierra Leone who have witnessed and experienced  |
| traumatic events, such as civil war and conflict-related atrocities   |
| in their homelands and in refugee camps and who are also struggling   |
| with acculturation issues. Project Tamaa\'s school-based components   |
| include children\'s therapy/support groups and teacher educational    |
| seminars, while the community-based components include caregiver      |
| education/support groups, case management services, and multicultural |
| social events.\                                                       |
| Contact: Anne Holland\                                                |
| Phone: (215) 496-0707 x1427\                                          |
| Email: <Aholland@cctckids.com>\                                       |
| Web: [http://www.cctckids.com](http://www.cctckids.com/)              |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **Utah**                                                              |
|                                                                       |
| **Child Trauma Treatment Network-Intermountain West Primary           |
| Children\'s Medical Center**\                                         |
| \                                                                     |
| Child Trauma Treatment Network Intermountain West Primary Children\'s |
| Medical Center seeks to improve treatment and services for children   |
| who experience trauma related to abuse and who live in the            |
| Intermountain West states of Arizona, Idaho, Montana, Nevada, South   |
| Dakota, Utah, and Wyoming. The program is developing a regional       |
| network of child therapists from all seven States who will            |
| participate and collaborate in training and consultation. Teams of    |
| therapists will work to create a network of professionals to serve    |
| the Intermountain West by raising the standard of care for children   |
| traumatized by abuse and by working to ensure that underserved        |
| populations of children have access to care.\                         |
| Contact: Susan Stewart\                                               |
| Phone: (801) 265-3180\                                                |
| Email: <wcsstewa@ihc.com>\                                            |
| Web: <http://www.ihc.com/xp/ihc/primary>                              |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **Virginia**                                                          |
|                                                                       |
| **International C.H.I.L.D., Center for Multicultural Human Services   |
| (CMHS)**\                                                             |
| \                                                                     |
| The Center for Multicultural Human Services (CMHS) helps people from  |
| ethnically diverse backgrounds succeed by providing comprehensive,    |
| culturally sensitive mental health services and by conducting         |
| research and training to make such services more effective and widely |
| available. Based in the Washington, DC, metropolitan area, this       |
| nonprofit agency provides a broad range of services through a         |
| multilingual (over 30 languages) interdisciplinary staff utilizing a  |
| social-ecological, team treatment approach. Under NCTSN funding, CMHS |
| is refining and documenting developmentally, clinically, and          |
| culturally appropriate treatment strategies for children who have     |
| experienced war, displacement, and refugee-related trauma. This past  |
| year, CMHS developed and evaluated an innovative community outreach   |
| and treatment program targeted to child survivors of war from Sierra  |
| Leone, \"Leaders of Tomorrow.\" Thirty children, ages 7-15,           |
| participated in a 4-week intensive summer program, and those most in  |
| need of intervention and support receive ongoing case management and  |
| group tutorials. CMHS developed and performed a play titled           |
| \"Children of War\" in an effort to educate the public about the      |
| impact of war, displacement, and abuse on children and to explore the |
| therapeutic value of using trauma narratives as part of the healing   |
| process. CMHS also provided training and consultation to programs     |
| across the United States on strategies for developing mental health   |
| services in refugee and immigrant communities.\                       |
| Contact: Dennis Hunt\                                                 |
| Phone: (703) 533-3302 x111\                                           |
| Email: <dhunt@cmhsweb.org>\                                           |
| Web: [http://www.cmhsweb.org](http://www.cmhsweb.org/)                |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **Washington**                                                        |
|                                                                       |
| **Harborview Center for Sexual Assault and Traumatic Stress**\        |
| \                                                                     |
| The Harborview Child Traumatic Stress Program is located at the       |
| Center for Sexual Assault and Traumatic Stress (HCSATS), a specialty  |
| program of the Harborview Medical Center, a University of Washington  |
| teaching hospital. The Center serves children and adults affected by  |
| child maltreatment, rape and violent crime, and other traumatic       |
| events. The Center will, as part of the NCTSN, increase capacity to   |
| deliver evidence-based interventions at HCSATS, improve mechanisms    |
| for identifying and linking affected children served within the       |
| medical center to services, create a collaboration with specialized   |
| community providers serving victims in diverse settings to increase   |
| identification, access and the availability of culturally specific    |
| treatments, develop and evaluate an empirical components based        |
| treatment training program, construct and manage a Web site distance  |
| learning and clinical resource for practitioners across the State,    |
| and collect qualitative and quantitative data on practice, child      |
| outcomes and systems.\                                                |
| Contact: Lucy Berliner\                                               |
| Phone: (206) 521-1800\                                                |
| Email: <lucyb@u.washington.edu> :                                     |
|                                                                       |
| ##### web site link: http://www.nctsnet.org/nccts/nav.do?pid=abt_ntwk |
+-----------------------------------------------------------------------+

**APPENDIX E**

**Number range CHAPTERNATIONAL CHILD TRAUMATIC STRESS NETWORK**

**The Story of the National Child Traumatic Stress Network**

The problem of child traumatic stress has been evident for many years,
but recently the Federal government elevated the problem to the national
stage. The Donald J. Cohen National Child Traumatic Stress Initiative
was established in 2001 to improve access to care, treatment, and
services for children and adolescents exposed to traumatic events, and
to encourage and promote collaboration between service providers in the
field, through a series of grants totaling more than

\$30 million.

A series of Federal grants were awarded by the U.S. Department of Health
and Human Services under the auspices of the Substance Abuse Mental
Health Services Administration (SAMSHA), and the Center for Mental
Health Services (CMHS) to establish the National Child Traumatic Stress
Network consisting of The National Center for Child Traumatic Stress
(Category I Center) established as a joint effort of the UCLA David
Geffen School of Medicine and the Duke University Medical Center to
provide coordinating leadership of the National Child Traumatic Stress
Network; Intervention Development and Evaluation Centers (IDE Category
II Centers), which will use the grant funds to identify, support,
improve, and develop effective treatment and service approaches;
Community Treatment and Service Centers (CTS Category III Centers),
which will use their funds to provide direct community-level service and
treatment. (While the grants for the Network centers were made within
these guidelines, it should be noted that many organizations within the
Network actually do work that crosses categorical boundaries.)

In making the announcement, Secretary of Health and Human Services Tommy
G. Thompson said, "the attacks of September 11 remind us how essential
these programs are to help our children deal physically and emotionally
with traumatic events. We are committed to substantially improving
mental health services for children and adolescents and supporting the
valuable services of the grantees of the Donald J. Cohen Initiative."

In choosing to name this initiative after Donald J. Cohen, M.D., the
Government honored a person who spent his entire professional career in
the mental health field as a tireless advocate for children. He was a
well-respected and world-renowned physician and teacher. Over the course
of his career, he held many faculty positions at the Yale University
School of Medicine. As Director of the Child Study Center at Yale School
of Medicine, Dr. Cohen championed traumatized children and their
families, advocating that more resources be dedicated for research and
service innovation. In his remarks to the Senate when he announced that
this program was being named for Dr. Cohen, Senator Joseph Lieberman
said, "I can think of no better tribute to this great man than to name
the very program he envisioned so many years ago in his honor."

The Scope of Child Traumatic Stress

THE PROBLEM

Trauma is woven into the fabric of daily life. Child abuse and neglect,
domestic violence, community violence, medical trauma, traumatic loss,
accidents, injuries, terrorism, natural disasters, and human-caused
catastrophes all affect the lives of children and their families and
communities throughout the United States. The prevalence of exposure to
traumatic events is alarming. In a nationally representative survey of
12- to 17-year-old youth, 8 percent reported having been sexually abused
at some time in their lives, 17 percent were physically assaulted, and
39 percent had been eyewitnesses to violence. In a landmark study in
North Carolina, a comprehensive child and adolescent survey indicated
that fully 25 percent of the children and youth interviewed had
experienced at least one traumatic event by age 16.

THE IMPACT

We have learned that some children who are either direct victims or
witnesses of trauma experience severe and persistent posttraumatic
stress reactions, such as unwelcome trauma pictures coming back to mind,
not feeling as close to others, and feeling jumpy or nervous. We

also have learned about the powerful influence of trauma reminders in
the daily lives of children and how these reminders can affect family
and peer relationships. In addition, traumatic stress can have an
insidious impact, disturbing many domains of normal child development,
as well as affecting a child's pro-social behavior and citizenship at
school and in the community.

*Biological studies among children and adolescents are demonstrating
that trauma reactions may interfere with development and are rooted in
the basic biology of fear and danger.*

There is evidence that traumatized children show and disturbances in
startle reactions and persistent alterations in their levels of stress
hormones such as cortisol, putting them chronically "on alert." These
biological accompaniments of post traumatic stress have a significant
impact on academic and social functioning. Human-perpetrated violence
can cause profound changes in the basic building blocks of interpersonal
life, including disturbances in attachment and extreme feelings of
loneliness.

*Manifestations include irritability, oscillations in behavior, from
aggressiveness with peers and adults to excessive passivity and
avoidance; reckless behavior;* *and, in adolescence, substance*

*abuse, high-risk sexual behavior, gang participation, disturbances in
academic performance and motivation, and difficulties in moral
decisionmaking.*

Social-ecological issues are equally serious. Traumatic experiences
(e.g., being shaken as a baby or surviving a motor vehicle accident)
produce physical disabilities that create functional challenges to
interacting with people and in completing basic tasks needed to survive.
These adversely alter expectations and beliefs about interpersonal
situations. The impact of traumatic events for infants and young
children can be exacerbated or mitigated by the response of the parents
and caregivers in the child's life. It is important to note that
traumatic events often help identify kids who are "at risk" for further
trauma unless support is provided to the family. The seriousness of the
problem of traumatic stress cannot be overstated. It is real and made
more poignant with greater public awareness by the events of September
11. As a result, significant additional bilateral congressional support
has extended the Network's sites to include many

more communities throughout the United States. This increased support
comes at a time when the field of child traumatic stress is on the cusp
of major advances in improving access to services and the care of
traumatized children and their families

(Please see references in Appendix B).

The Composition of the National Child Traumatic Stress Network

(Category I, II, and II, Centers)

As of September 2002 the Donald J. Cohen National Child Traumatic Stress
Initiative funded 37 sites of excellence, dedicated to establishing the
National Child Traumatic Stress Network---NCTSN. The Network's mandate
is to improve treatment and services for child trauma and to expand
availability and accessibility of effective community services to
children and adolescents exposed to traumatic events. The Network aims
to promote better understanding of clinical and research issues relevant
to providing effective interventions for use in community practice
settings.

*This Initiative creates a true national resource that* *allows many of
the leaders in the field of Child Traumatic Stress (CTS) to work
individually and collectively across disciplines and settings to effect
integrated and sustained change.*

The Initiative is made up of three components:

CATEGORY I CENTER

Designated to lead the NCTSN as the National Center for Child Traumatic
Stress (NCCTS), the UCLA David Geffen School of Medicine and the Duke
University Medical Center have individually and collectively provided
leadership in the developmental understanding of CTS, have pioneered
evaluation and treatment of children, families, and communities, and are
at the forefront in developing public mental health strategies to reach
the large population of children, families, and communities affected by
traumatic events.

The National Center for Child Traumatic Stress (NCCTS), as a joint
program of UCLA and Duke University, is supported by the vast resources
of two of the country's preeminent learning institutions, their medical
schools, and departments of psychiatry and university-level programs.

THE NETWORK

Over the past 20 years significant advances have been made in the field
of CTS. This Initiative and the Network represents the first time that a
true integration platform has been developed to blend the academic best
practices of the clinical research community with the wisdom of
front-line

community service providers. The work of Network members ranges across
settings, disciplines, age groups, and trauma types, delivering
high-quality services to large numbers of children and their families
who have experienced trauma.

CATEGORY II CENTERS\--INTERVENTION DEVELOPMENT AND EVALUATION

PROGRAMS

By funding the Intervention Development and Evaluation Programs
(Category II Centers) in the Network, SAMHSA is funding the
establishment or continuing efforts of centers that will identify,
support, improve, or develop treatment and service approaches for the
following:

-   Different types of child and adolescent traumatic events, including
    witnessing or experiencing interpersonal violence or life threat,
    traumatic loss of family, sexual assault and abuse, medical trauma
    including injuries from accidents and invasive procedures, natural
    and human-caused disasters, war and terrorism, and displacement and
    refugee trauma.

-   Developmentally appropriate trauma evaluation and intervention for
    children and adolescents of all ages.

-   Identification, assessment, and appropriate treatment and services
    for children in specialty child service sectors, such as schools,
    the juvenile justice system, the refugee service system, the child
    welfare and protective service system, and services for vulnerable
    children including the disabled.

CATEGORY III CENTERS\--COMMUNITY TREATMENT AND SERVICE PROGRAMS

The third category of grantees, Community Treatment and Service
Programs, will establish or continue community practice centers. These
centers will implement and evaluate effective treatment and services in
community settings, collect clinical data on traumatized children
receiving treatment and services, provide expertise on effective
practices, service financing, and other service issues, and develop and
provide leadership and training on child trauma for service providers in
the community and staff in child service sectors.

The Mission of the National Child Traumatic Stress Network--- NCTSN

The Mission of the National Child Traumatic Stress Network is to raise
the standard of care and improve access to services for traumatized
children and their families and communities throughout the United
States.

The Vision of the NCTSN

The NCTSN will raise public awareness of the scope and serious impact of
child traumatic stress on the safety and healthy development of our
Nation's children and families. We will improve the standard of care by
integrating developmental and cultural knowledge to advance a broad
range of effective services and interventions that will preserve and
restore the future of our Nation's traumatized children.

We will work with established systems of care, including the health,
mental health, education, law enforcement, child welfare, and juvenile
justice systems, to ensure that there is a comprehensive continuum of
care available and accessible to all traumatized children and their
families. We will be a community dedicated to collaboration within and
beyond the Network to ensure that widely shared knowledge and skills
create a national resource to address the problem of child traumatic
stress.

The Identity of the National Child Traumatic Stress Network--- NCTSN

*The purpose of the Network is to unite the efforts of a wide range of
independent organizations focusing on child trauma and to provide a
model for expansion and growth. In no way, though, is the NCTSN being
developed to supplant or supersede the identity of any individual
members of the Network. It is meant, instead, to add value to the
identities of all members and provide a national framework to highlight
their experience, expertise, and success, which form the real strength
of the Network as a whole.*

# Network Identity

*The Network provides the unique opportunity to integrate the strengths
of academic centers,* *which are* *dedicated to developing the most
scientifically supported interventions and the people to deliver them,
and community-based treatment and service centers, with their wisdom
about providing effective care.*

The Network can ensure the development of a comprehensive, integrated,
evidence-based system of care for traumatized children, their families
and communities throughout the United States.

The Network is able to look ahead to the future to ensure that all
possible steps are taken to address the problem of childhood traumatic
stress.

TANGIBLE BENEFITS

What does the Network offer its constituents in tangible, quantifiable
terms?

-   Dedicated and informed expert staff who are leaders in the field.

-   Reliable, state-of-the-art and state-of-the-science information.

-   Effective, informed educators.

-   Comprehensive knowledge base of best practices and emerging
    evidence-based protocols.

-   An effective networking framework.

-   Shared visions, values, and purpose.

-   The critical scale to effectively discover, design, and deliver
    services to children who have experienced traumatic stress and to
    their families and communities.

-   A national voice representing the members of the Network.

CULTURAL IMPERATIVES

Members of the NCTSN have identified certain key imperatives that they
wish to have embedded in the culture of the Network. These include the
following:

-   Respect for the individual and respect for cultural diversity.

-   Integrity.

-   Collegiality.

-   Collaboration.

-   Commitment to effective communication.

-   Fair dealing, and balance.

-   Transparency.

-   Compassion and courage.

-   Expertise.

NETWORK PERSONALITY

If the Network were a person, how would that person be described?

-   Intelligent, creative, professional.

-   Energetic, resourceful, pragmatic.

-   Discriminating, responsible, trustworthy.

-   Compassionate, empathetic, responsive.

-   Dedicated, competent, resilient.

-   Multi-faceted, culturally diverse, culturally competent, socially
    aware.

-   Contemporary, curious, adventuresome.

-   Modest, generous.

NETWORK VALUES

What does the Network stand for? What does it believe in? What would it
make a stand on?

-   Selflessness and dedication.

-   Fostering the development of new generations of professionals.

-   Using a scientific, developmentally sound approach.

-   Innovation.

-   Responsiveness to individuals, families, and communities.

-   Objectivity.

-   Professional development, care, and support.

-   Respect for cultural diversity.

-   Recognition that the Network whole is greater than the sum of the
    parts and has the advantage of being able to move the field ahead to
    provide care to traumatized children and their families and
    communities more quickly than could any individual center.

NETWORK CONDUCT

Our collective activities must be informed by a common set of
principles:

-   To develop and deliver services to children who have experienced
    traumatic events and to their families.

-   To give reliable, accurate information.

-   To encourage collaboration and collegiality.

-   To be consistent in presentation, tone, and manner.

-   To be courteous and professional.

-   To be respectful of diverse cultures.

-   To be encouraging and enthusiastic.

-   To be courageous and resolute.

-   To be dedicated to developing and inspiring future generations of
    caregivers for traumatized children and their families and
    communities.

APPENDIX F

NCTSN ORGANIZATIONAL CHART

######## APPENDIX G

##### 

##### NATIONAL CHILD TRAUMATIC STRESS NETWORK ORGANIZATION

**NCTSN Steering Committee**

The Steering Committee of the National Child Traumatic Stress Network
(NCTSN) guides the development of a national network of centers to raise
the standard of care and improve access to services for traumatized
children and their families and communities throughout the United
States. Specifically, the Steering Committee provides oversight and
guidance to the Network to ensure that plans and activities are
consonant with the mission and vision of the NCTSN, reviews the progress
of Network activities, and provides recommendations to the National
Center to promote the success of NCTSN activities. Five representatives
from Intervention Development and Evaluation Centers and five
representatives from the Community Treatment and Services Centers are
appointed to the Steering Committee for terms ranging from 1 to 3 years.

**NCTSN Terrorism and Disaster Branch**

The NCTSN has a variety of unique resources and activities geared to
improve the national and local response to children exposed to trauma.
The Terrorism and Disaster Branch (TDB) is a specialized unit of the
National Center for Child Traumatic Stress (NCCTS) recently established
to develop models, services, and partnerships to address the impact of
terrorism and disasters on the Nation\'s children, families, and
communities and to improve care and services related to these events.
The TDB's mission is to promote the well-being of children and families
by strengthening our Nation's preparedness and response to terrorism and
disaster. TDB staff have extensive experience responding to a range of
events including the Oklahoma City and American Embassy bombings, the
September 11 attacks, mass school violence, war, earthquakes,
hurricanes, tornadoes, and wild fires.

**National Resource Center**

## **[Mission]{.underline}**

The mission of the National Resource Center for Child Traumatic Stress
(NRC-CTS) is to support the goals, activities, and mission of the NCTSN
by providing relevant, practical information and resources to members of
the NCTSN, professionals in the field, and the public, including
survivors of trauma and their families and communities.

### Vision

The NRC-CTS will be the leading national resource for professionals, the
public, and the community of people who are affected by CTS via the
acquisition, coordination, and management of existing materials in the
field of CTS, the stewardship and facilitation of certain new
initiatives within the NCTSN, including training, technical assistance,
social marketing, and media relations; and the development of effective
distribution methods of the services and products of the NCTSN.

**Advisory Board**

#### Mission

The mission of the Advisory Board of the NCTSN is to raise the national
visibility of the issue of child traumatic stress and enhance the
capacity of the Network to identify its priorities for action.

#### Purpose

The NCTSN Advisory Board (NAB) will communicate and promote across the
Nation the vision, goals, programs, and accomplishments of the NCTSN,
and provide independent, broad advice and counsel to the NCTSN Steering
Committee related to strategic priorities and direction for the NCTSN.

**Data Core**

## **[Overview]{.underline}**

The Data Core is broadly concerned with data collection, analysis, and
dissemination and includes key members from the National Center,
including UCLA, Duke, and the Duke Clinical Research Institute (DCRI).
DCRI will serve as a repository for Network data. In addition to the key
members from the National Center, the Data Core has three working
committees: **Measures, Data Operations, and Design and Analysis**.
These working committees are comprised of members from the Data Core
National Center leadership and Category II and III sites.

[Mission]{.underline}

To collect and report data that document the progress of the NCTSN in
meeting its goals of expanding availability and access to care and
enhancing the quality of care to traumatized children and their families
across the United States.

**Learning** **From Research and Clinical Practice Core**

## **[Overview]{.underline}**

The Learning from Research and Clinical Practice Core is broadly
concerned with gleaning vital information about clinical practice in the
area of child traumatic stress, from both the clinical field and the
research literature, that can be used both to improve practice and to
inform research. This will involve careful review and synthesis of the
literature and devising a method for documenting clinical practice in
the field. The process for achieving these efforts will be both
iterative and interactive.

**[Mission]{.underline}**

To learn about effective interventions for childhood trauma from
research and clinical practice and to disseminate such learning to
policymakers, practitioners, and children and families.

**Training Core**

# [Overview]{.underline}

The Training Core is dedicated to developing, supporting, and providing
state-of-the-art, multiplatform, effective training to enhance the
quality of clinical assessment, treatment, and services for traumatized
children, and adolescents, their families and communities. Training
programs will incorporate advances in development knowledge, cultural
competencies and ecological frameworks. The Core will identify critical
training needs and resources within the Network, promote
training-related linkages between Network partners, and provide
centralized training opportunities for Network members in essential
knowledge and skill areas. In addition, the Core will work closely with
the other Cores to prioritize, coordinate and integrate training
functions within the Network and to provide specific training programs
to meet Network needs. Through the National Resource Center, training
materials and programs will be disseminated for professional and public
use.

# [Mission]{.underline}

To enhance the care of traumatized children, adolescents, families, and
communities through development and provision of the highest quality of
education and training.

**Policy Core**

## **[Mission]{.underline}**

To develop and advance a strategic policy agenda for the NCTSN aimed at
improving the visibility and understanding of the problem of child
traumatic stress and strengthening the infrastructure, funding, and
public will to address it.

## **[Vision]{.underline}**

-   Addressing child traumatic stress is a high priority for funders,
    policy makers, opinion leaders, and a number of key constituency
    groups.

-   Services are organized, delivered, and funded so that they
    adequately respond to the scope and seriousness of child traumatic
    stress.

-   Policies at the local, State and Federal levels support the delivery
    of services to all traumatized children and families who need them.

**Service Systems Core**

#### Overview

The Service System Core encompasses Network activities aimed at
improving access to services for traumatized children, raising the
standard of care that children receive within various service systems,
and improving the integration of services for traumatized children.
Activities focus on identifying unserved or under-served populations,
determining barriers to service access, measuring unmet need, and
promoting strategies to improve the access, the nature, and the
coordination of services delivered to traumatized children by various
systems. The goal is to ensure that there is a comprehensive continuum
of care available and accessible to all traumatized children and their
families. Network activities within the Service System Core are directed
toward the health system, mental health and substance abuse systems, law
enforcement, court system, childcare system, education system, and
victims' assistance, child welfare, and juvenile justice systems.

# [Mission]{.underline} 

To promote the access of traumatized children and their families to an
effective and integrated array of developmentally and culturally
appropriate, evidence-based interventions.

![](media/image2.jpeg){width="3.8333333333333335in"
height="0.7763888888888889in"}

**APPENDIX I**

## NATIONAL CHILD TRAUMATIC STRESS NETWORK (NCTSN)

## COLLABORATIVE ACTIVITIES

## TYPES AND DESCRIPTIONS

## 

## **What range of collaborative activities can be undertaken by Network members?** 

Network members are encouraged to engage in a broad range of
collaborative activities aimed at furthering the goals of the NCTSN. In
fact, collaborative opportunities are limited only by the time and
resources of participating Network members and the National Center.
Collaborative activities can involve only a few centers or can involve
multiple centers working together through a task force or committee.

## **What types of collaborative groups exist in the Network?**

While collaborative activity may be initiated informally between two or
three centers, much of the collaborative work of the Network takes place
through formal or informal groups or committees composed of multiple
centers. The Network has five basic types of collaborative groups
available to Network centers.

######### Working Committees

Working committees are planned and launched by the National Center and
are permanent groups overseeing issues that span trauma types and
settings and are central to achieving the NCTSN mission. The membership,
terms of service, and operating procedures for working committees are
usually fairly formal, and they are usually chaired, at least on an
interim basis, by a professional from the National Center.

######### Task Forces

Task forces are driven by Network interests or developed in response to
emerging needs. They are more flexible in their size, structure, and
organization than are working committees and are usually chaired or
co-chaired by Network members. They may be time limited and focused
around a particular project, trauma type, or product.

######### Working Groups

Most interest groups within the Network start out as small working
groups. These groups may later develop broader participation of Network
members and do more formal planning. They eventually may develop into a
task force.

######### Advisory Groups

Advisory groups advise the National Center regarding its core functions,
such as developing the National Resource Center or monitoring and
evaluation.

Collaborative Activities -- Brief Descriptions

As of March, 2003

[DATA CORE]{.underline}

+-----------------------------------------------------------------------+
| MEASURES COMMITTEE                                                    |
|                                                                       |
| The mission of the Measures Committee is to assist the Network in     |
| planning and implementing clinical and service measurements needed to |
| accomplish the goals of the National Child Traumatic Stress           |
| Initiative. The Measures Committee is currently working on a Needs    |
| Assessment Tool for the Network, which they began piloting at the     |
| beginning of March 2003. This committee has also developed a Measure  |
| Review Sheet to evaluate measures used in practice by Network members |
| in order to create an information database for the Network. The next  |
| project planned for this group is a Measures/Data Consultation        |
| Service that will impart advice and expertise on the use,             |
| reliability, and effectiveness of reviewed data collection tools.     |
+-----------------------------------------------------------------------+
| DATA OPERATIONS COMMITTEE                                             |
|                                                                       |
| The Data Operations Committee mission is to assist and advise the     |
| Data Core and Network in the collection, management, and              |
| dissemination of Network data. The focus of the Data Operations       |
| Committee is working with the NCCTS Data Core, the Duke Clinical      |
| Research Institute (DCRI), the UCLA Center for Health Services (CHS), |
| and the Center for Community Health (CCH) to develop the Network Data |
| Repository which will house quantitative survey data, administrative  |
| site details, individualized data on every client seen by Network     |
| members, and aggregate data summaries. The target date for beginning  |
| pilot data input from the Network is in the second quarter of 2003.   |
+-----------------------------------------------------------------------+
| #                                                                     |
|                                                                       |
| #                                                                     |
|                                                                       |
| # [LEARNING FROM RESEARCH AND CLINICAL PRACTICE CORE]{.underline}     |
|                                                                       |
| CHILD TRAUMATIC GRIEF TASK FORCE                                      |
|                                                                       |
| One focus of the Child Traumatic Grief Task Force is to collect       |
| epidemiological data from sites that will inform the Network and our  |
| field on factors related to child traumatic grief. This group has     |
| done work to define \"traumatic grief\" as it relates to the          |
| posttraumatic stress disorder (PTSD) field. Treatment manuals,        |
| trainings on interventions, and treatment guidelines for young        |
| children are some of the past accomplishments of this task force. The |
| task force currently has two subgroups working on educational fact    |
| sheets for various audiences on child traumatic grief and a Network   |
| survey of epidemiological work in the field.                          |
+-----------------------------------------------------------------------+
| SEXUAL ABUSE TASK FORCE                                               |
|                                                                       |
| The Sexual Abuse Task Force is committed to enhancing the quality and |
| access to treatment services for those affected by child sexual       |
| abuse. Currently planned work includes surveys, checklists, and focus |
| groups of Network clinicians in the area of child sexual abuse. The   |
| information gathered will include clinician level of awareness and    |
| knowledge of trauma-focused treatment, knowledge of cognitive         |
| behavioral treatments for trauma, and attitudes about manualized      |
| treatment.                                                            |
+-----------------------------------------------------------------------+
| COMPLEX TRAUMA TASK FORCE                                             |
|                                                                       |
| The initial focus of the Complex Trauma Task Force is to better       |
| describe the nature of complex trauma and the range of developmental  |
| adaptations associated with it. The Task Force has developed a        |
| clinician survey to gauge the perceived scope of the problem of       |
| complex trauma and is developing a white paper that will define the   |
| phenomenon of complex trauma, describe emerging interventions, and    |
| outline recommendations for the field.                                |
+-----------------------------------------------------------------------+
| FORENSIC MEDICAL EXAMINATION WORKING GROUP                            |
+-----------------------------------------------------------------------+
| The Forensic Medical Examinations Working Group is dedicated to       |
| development and implementation of therapeutic strategies during       |
| forensic medical examinations for suspected child maltreatment that   |
| will help children and parents cope with traumatic experiences and    |
| successfully resolve them. The group has begun an important           |
| exploratory project to interview Network sites on their current       |
| practices during forensic medical exams. A near-term product will be  |
| an information pamphlet that reconceptualizes these exams as an early |
| point of therapeutic contact with restorative and preventive          |
| functions.                                                            |
+-----------------------------------------------------------------------+
| FAMILY INTERVENTIONS WORKING GROUP                                    |
|                                                                       |
| The Family Interventions Working Group has identified a need for      |
| evidence-based models for family-based interventions and a lack of    |
| good resources for those who may need to conduct family-based         |
| interventions. This group\'s first activity is to survey the Network  |
| regarding current interventions used for traumatized children and     |
| their families. This group will also conduct a literature review      |
| which will identify effective family interventions that may be        |
| currently used or intended for other types of problems, but may be    |
| appropriate for translation to trauma-focused work. This work will    |
| result in a report that will be disseminated throughout the Network.  |
+-----------------------------------------------------------------------+
| PSYCHOPHARMACOLOGY WORKING GROUP                                      |
|                                                                       |
| The Psychopharmacology Working Group has just recently become         |
| established with the aim to develop a research effort to inform the   |
| use of psychopharmacological agents in the field of child trauma      |
| treatment. Very little empirical research exists in the field and     |
| plans are under way to conduct a multisite Network study on the use   |
| of medications in child trauma treatment. The group plans to evaluate |
| whether psychopharmacological interventions are effective in treating |
| the neurobiological alterations that occur with childhood PTSD.       |
+-----------------------------------------------------------------------+
| LEARNING FROM RESEARCH AND PRACTICE ADVISORY GROUP                    |
|                                                                       |
| The Learning from Research and Practice Advisory Group was developed  |
| to inform the work of the National Center\'s Learning from Research   |
| and Clinical Practice Core. This Core will disseminate learning about |
| evidence-based interventions by reviewing current literature and      |
| practice and making recommendations to clinical practice settings.    |
| The Advisory Group hopes to begin building an evidence base for       |
| promising practices and model programs and is beginning with a review |
| of the literature.                                                    |
+-----------------------------------------------------------------------+
| ## SERVICE SYSTEMS CORE                                               |
|                                                                       |
| SCHOOL INTERVENTIONS WORKING GROUP                                    |
|                                                                       |
| The School Interventions Working Group operates alongside the School  |
| Crisis and Intervention Unit and the Terrorism and Disaster Branch,   |
| but it is focused more specifically on intervention protocols for     |
| school-aged children. The group is working on developing a crisis     |
| response package of educational materials in collaboration with the   |
| U.S. Department of Education. A project is also under way to develop  |
| a grid of core/critical components necessary for a school-based       |
| intervention program.                                                 |
+-----------------------------------------------------------------------+
| JUVENILE JUSTICE WORKING GROUP                                        |
|                                                                       |
| The Juvenile Justice Working Group mission is to improve the          |
| identification, assessment, and treatment of traumatized children and |
| youth within the juvenile justice system. The group has begun to look |
| at existing evidence-based practices for youth in the juvenile        |
| justice system. A primary focus has been a review of existing data on |
| the prevalence of trauma among youth in the juvenile justice system,  |
| as well as identification/adaptation of instruments for assessing     |
| trauma exposure in this population.                                   |
+-----------------------------------------------------------------------+
| ADAPTED TREATMENT STANDARDS FOR DISABILITIES WORKING GROUP            |
|                                                                       |
| The mission of this working group is to develop adapted trauma        |
| treatment standards for children with various types of disabilities.  |
| The group intends to offer not only \"aspirational\" standards but    |
| also to define ethical and legal standards where possible. The group  |
| will address a wide range of disabilities over time, but their        |
| immediate plans include fact sheets on deafness and developmental     |
| disabilities.                                                         |
+-----------------------------------------------------------------------+
| REFUGEE TRAUMA WORKING GROUP                                          |
|                                                                       |
| The mission of the Refugee Trauma Working Group is to promote the     |
| identification, development, and adaptation of psychometrically,      |
| developmentally, ecologically sound and culturally appropriate        |
| assessment measures and intervention services for traumatized child   |
| and adolescent refugee and immigrant populations and their families.  |
| This group is currently planning a Network site survey of activities, |
| measures, information sources, and interventions used when working    |
| with child and adolescent refugees and their families. A short report |
| will follow that will include a listing of measures used,             |
| commonalities in interventions, and recommendations on practices for  |
| working with these populations. The group also has developed a white  |
| paper on refugee trauma to give an initial focus to its collaborative |
| work.                                                                 |
+-----------------------------------------------------------------------+
| SYSTEMS INTEGRATION WORKING GROUP                                     |
|                                                                       |
| The mission of the Systems Integration Working Group is to explore    |
| the role and coordination of concurrent services and systems that     |
| directly affect how children process and recover form crime-related   |
| traumatic events. This group was recently established and has been    |
| developing a logic flowchart model to identify and prioritize a few   |
| elements of the child trauma treatment system to focus on from an     |
| integration standpoint.                                               |
+-----------------------------------------------------------------------+
| MEDICAL TRAUMA WORKING GROUP                                          |
|                                                                       |
| The Medical Trauma Working Group addresses health outcomes related to |
| traumatic stress, acute trauma interventions, and medical trauma. The |
| group recognizes that these issues contain separate elements and      |
| areas of overlap. The group will produce multiple products, each      |
| geared toward a different area; for example, their planned projects   |
| include a white paper on Medical Traumatic Stress and another on      |
| Crisis Intervention and Treatment.                                    |
+-----------------------------------------------------------------------+
| ## TRAINING CORE                                                      |
|                                                                       |
| TRAINING COMMITTEE                                                    |
|                                                                       |
| The mission of the Training Committee is to assist the Network in     |
| planning and implementing clinical and service training needed to     |
| accomplish the goals of the National Child Traumatic Stress           |
| Initiative. This committee is determining the current state of        |
| training in the Network by analyzing data from two assessment tools   |
| they have developed: a Training and Materials Survey and a Training   |
| Needs Assessment Tool.                                                |
+-----------------------------------------------------------------------+
| EARLY CHILDHOOD TRAINING TASK FORCE                                   |
|                                                                       |
| The Early Childhood Training Task Force has been established to focus |
| on the training needs of caregivers in early childhood settings who   |
| work with children affected by trauma. One subgroup is planning to    |
| conduct eight focus groups to assess caregiver needs in this area.    |
| Other subgroups are working on a review of existing training          |
| materials and identification of possible funding opportunities for    |
| creating educational materials for teachers and childcare providers.  |
+-----------------------------------------------------------------------+
| JUDGES TRAINING WORKING GROUP                                         |
|                                                                       |
| The Judges Training Working Group is still in early stages of         |
| development and will be developing a mission and set of objectives.   |
| The group is interested in educating and training judges regarding    |
| issues related to child traumatic stress, and they plan to seek a     |
| partnership with the National Council of Juvenile and Family Court    |
| Judges. The group hopes to compile and review State-specific          |
| requirements for judges' training.                                    |
+-----------------------------------------------------------------------+

## **APPENDIX J**

# 

# NCTSN DATA COLLECTION DOMAINS

Center Service Utilization and Activities (assessed quarterly and
annually)

-   Direct clinical services for children

-   Other client related services for children

-   Activities that promote cultural competence

-   Training provided

-   Products developed such as training materials or clinical service
    manuals

-   Knowledge dissemination and transfer

-   Trauma types addressed

-   Development and use of evidence-based interventions and treatment
    models.

Center Network and Collaborative Activities (assessed quarterly and
annually)

-   Committee and working group participation

-   Technical assistance, training, and/or evaluation provided or
    received.

Core Clinical Characteristics/ Client and Treatment Outcome Data

-   Baseline assessment of types, history, and extent of trauma
    exposure, such as assessed through the NCTSN data core assessment

-   Trauma symptoms (such as assessed in the Briere Trauma Symptom
    Checklist)

-   Traumatic stress symptoms (such as assessed in the UCLA PTSD
    Reaction Index --Pynoos, et al.)

-   Child behaviors (such as assessed in the Achenbach Child Behavioral
    Checklist)

-   Type and severity of child's problems (qualitative)

-   Child's symptoms and problems that are focus of attention.