Complex Trauma Treatment Network
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    • Cycle 1: 2009-2012
    • Cycle 2: 2013-2016
    • Cycle 3: 2016-2021
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Cycle 1: 2009-2012

Learn About  Year 1
Learn About Year 2
Learn About Year 3
 
Year 1
In the CTTN’s first year of operation, five learning communities in the Northeast formed to address distinct goals and developments effort in a range of service systems. The learning communities included a lead agency that coordinated a core team of representatives from agencies and units relevant to the local goals. This Core Team provided local planning and implementation supports representing multiple agencies or sectors of the identified system of care.

The 5 Northeast CTTN Learning Communities Included:

Connecticut Department of Children & Families (Lead TA: Kristine Kinniburgh) 
The Connecticut Department of Children & Families established the use of complex trauma theory, assessment, and treatment principles to support common staff training in a longer term strategic planning process. The goal was to effect practice in the entire state system which included five bureaus: child welfare, juvenile justice, behavioral health, and prevention. Program goals were to create the conceptual and practice infrastructure to support longer term system development.

Massachusetts Office HIV/AIDS
 (Lead TA: Joseph Spinazzola)
The Massachusetts Office HIV/AIDS provided internal training using train-the-trainer principles for state program staff to in turn provide training and support for contracted agency staff with the goal of improving trauma-informed service in this statewide contract system. As part of this effort, CTTN supports adoption of a trauma-informed agency assessment tool to be implemented by statewide contracted agencies serving traumatized youth at risk for HIV/AIDS.

Massachusetts Children's Behavioral Health Initiative Cape & Islands
 (Lead TA: Julian Ford)
The Massachusetts Children's Behavioral Health Initiative Cape & Islands is a system of care supporting adolescents with extensive service histories as they transition to adulthood. This learning community is adapting a specific trauma model (TARGET) to develop and deliver a mentoring curriculum for care coordinators working with the teens transitioning to adulthood in supported job internships and job skills programs.

Vermont Department of Mental Health
 (Lead TA: Margaret Blaustein)
The Vermont Department of Mental Health worked to increase overall trauma awareness and sensitivity in addition to adapting a trauma response promising practice (the ARC Model) to improve services in the state's consolidated early intervention/therapeutic daycare programs. The goal of this initial effort is to support statewide expansion of trauma sensitive and trauma informed care in outpatient clinic settings serving young children.

Year 1 Conference Materials
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Year 2
For Year 2 of CTTN, the focus has been in the three Pacific Northwest states and in public education ranging from early learning public systems through Grade 12.
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Rationale for System Focus in Public Education
We are building a natural alliance between schools and trauma experts to create a new conceptual framework for understanding child risk, school consequences, and the necessary evolution in our approaches to supporting children’s optimal social and academic outcomes. Schools serve as one the principal identification and intervention systems for trauma exposed children. Schools are the principal provider of mental health services to children in the United States with 70-80% of services delivered in school-based programs (Burns et al., 1995). As school specific interventions or in coordination with community partners, schools offer a potential potent access and influence point for increased trauma knowledge and response capacity. As part of the overall development effort, the five learning communities are integrating system-wide social emotional learning development as a universal goal for children, strategies for trauma-informed response in classroom instruction, and identification and individualized response to trauma-exposed children in need of more intensive services.

The Five Pacific Northwest Learning Communities
Five learning communities involving large geographic areas in three Pacific Northwest states participate in CTTN’s Year 2 implementation. These five learning communities represent a high level of diversity with respect to types of communities (tribal, rural/frontier, suburban, and urban). There are three learning communities in Washington State, one in Alaska, and one in Montana. In Washington, the three communities are comprised of Educational Services Districts in partnership with multiple school districts. Montana and Alaska learning communities are structurally distinct and reflect both readiness and unique structural aspects of these very rural states.
 
The CTTN effort in Year 2 addresses dissemination of information and systems development that may affect nearly 500,000 students and a teacher workforce of more than 26,000. The leadership in each of the learning communities employs a two track strategy of systems level change and small pilot efforts to begin to build models for intervention in school buildings. With full recognition of the modest resources available in the CTTN effort, the potential scale of influence in this year’s work is significant because of the partners in the learning communities. This scale of system influence raises some potentially important learning opportunities about how influence and information can progress in complex systems.

The 5 Pacific Northwest CTTN Learning Communities Included:

Anchorage Alaska School District (Lead TA: Josh Arvidson)
The Anchorage School District (ASD), which serves nearly 50,000 students (40% of all the state of Alaska’s enrolled students) annually, is one of the 100 largest districts in the United States. ASD is a highly diverse district with 53% of the student body representing ethnically and racially diverse populations. ASD is an exceptionally large geographic district with more than 100 schools at all levels. In 2010, there was a certificated teacher workforce of 3,086 teachers. As a result,  though ASD is only a single district, it makes up a large distributed system.(Learning Community Lead: Ann Bryson; CTTN TA Lead: Josh Arvidson).

Montana Learning Community
 (Lead TA: Bessel van der Kolk)
The Montana CTTN learning community represented a collaborative with the NCTSN Category III ‘National Native Children's Trauma Center’ at the University of Montana. The focus of the CTTN learning community was a group of 10 schools representing five Missoula area schools and five sovereign tribal schools. This work was closely aligned with a long-term development discussion that included the Montana State Department of Education, which had been assessing an increasing trauma and social emotional learning emphasis for some time.

Responding to secondary trauma in professionals, secondary trauma’s impact on practice and development of more effective responses to trauma exposed children in schools is the principal focus of this learning communities development work. Culturally-centered and culturally-endorsed responses for Native American communities represented a companion primary focus of this work. The ARC Model was being adapted as a significant part of this development effort to supplement previous work with the CBITS in Montana schools. This effort was aligned with but complemented and extended the current Category III award for the National Native Children's Trauma Center. (Learning Community Lead: Rick VanDenPol; CTTN TA Lead: Bessel van der Kolk).

Western Washington Learning Community
 (Lead TA: Julian Ford)
Like the other two Washington learning communities, the Western Washington CTTN learning community
 was organized around Educational Service Districts (ESDs). ESDs are independent partners of local school districts with responsibility for organizing curricular, student support, and professional development services to geographically defined groups of school districts. In Western Washington, two ESDs collaborated in this work. The first, ESD 189, serves the Northwestern communities including a mix of urban, suburban, and very rural districts. Their partner, ESD 113, serves middle-southwestern Washington State - small urban, suburban, and rural districts. Both ESDs serve small isolated low-income districts dependent on fishing and timber industries. Combined, the 79 districts of the Western Washington learning community served 236,337 students in the 2009-2010 school year. The region’s student body is moderately diverse (30% diverse race and ethnic groups) and 40% of students live in poverty (based on free and reduced meal eligibility).  The certificated teacher workforce is estimated as 12,000 full time equivalent staff positions based on 2003 data.
 
A challenge to note was that the two ESDs are not geographically contiguous but rather divided by the Seattle metropolitan area. However, there are strong traditions of shared efforts across the ESDs that minimized this distance concern. (Learning Community Lead: Maurene Stanton; CTTN TA Lead: Julian Ford).

Central Washington Learning Community
 (Lead TA: Bradley Stolbach)
Two ESDs (105 and 171) were partners in this learning community comprising the middle third of Washington State. This learning community supported 53 school districts with a 2009-2010 enrollment of 101,442. The region has a majority diverse student body (58% race and ethnic group diversity) with Latino and Native American students being most common. The area includes a significant migrant farm workforce with associated challenges of cross-cultural communication and the vulnerability of undocumented families. Poverty in this largely rural area is high with 66% of enrolled students qualifying for free and reduced meals. The certificated teacher workforce is estimated at 5,300 full time equivalent staff positions.(Learning Community Lead: Ann Allen; CTTN TA Lead: Bradley Stolbach).

Eastern Washington Learning Community
 (Lead TA: Kristen Howard)
Washington State’s ESD 101
 served as the community lead organization with assistance from Washington State University staff. The regional area served is most of the extreme eastern third of Washington. In addition to the entire ESD 101 area, we included the Spokane WA city schools (District 81) and Walla Walla, WA school district (part of ESD 123) in the learning community. Within this broad region, a core group of five school districts (the five largest districts in the region) was the first adopter group for practice and policy change. These core team members included four Spokane WA school districts (Spokane Public Schools, Central Valley School District, Mead School District, and East Valley School District) and the Walla Walla School District.

The schools in the Eastern Washington learning community served 98,955 students in the 2009-2010 school year. The region is principally rural with the exception of the Spokane metropolitan area which serves about half of the regions students. The student population is primarily Caucasian and often poor (45% free and reduced meal eligible for the learning community coverage area). The certificated teacher workforce in the area is estimated as in excess of 5,200.

The Eastern Washington learning community included existing shared work addressing trauma and an expansion to a larger geographic area because of the CTTN opportunity. The composition of the learning community reflected a regional set of development partnerships that have included Washington State University’s Area Health Education Center working closely with multiple districts and ESD 101 in development of a public health response model to promote social emotional learning and trauma response in schools. This local work in Spokane, WA included two multi-year demonstration research programs funded by the Bill and Melinda Gates Foundation and the US Department of Justice - Safe Start program. Both projects moved from planning to implementation in Fall 2011. In these two funded programs, the ARC Model is being adapted as a focus for school practice. (Learning Community Leads: Sandra Szamblen and Natalie Turner; CTTN TA Lead: Kristen Howard).
Year 2 Conference Materials
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Year 3
In year 3, the focus was on Gulf Coast states and territories, working with 5 learning communities located in Texas, Louisiana, and Puerto Rico that serve children and families involved in child welfare/protective services. The goals of this project were to 1) educate service providers on understanding and treatment of complex trauma, 2) enhance access and quality of services for children and families impacted by complex trauma. Systemic change and dissemination of complex trauma assessment and treatment was facilitated through a learning collaborative model in which service providers 1) identify discrete working goals and 2) are supervised by complex trauma specialists over the course of a year in achieving their goals. Regional “learning communities” are comprised of state- or multi-county-wide leadership and service providers from child protective services, juvenile justice, community health, foster and residential care, outpatient mental health, acute crisis care school systems and consumer constituents. 

Efforts Included:

Trauma Informed Practice: (Lead TA:  Kristine Kinniburgh) A statewide initiative by the TX Department for Children & Family Services to reform its child welfare system

Tarrant County Trauma-Informed Learning Community: (Lead TA: Joseph Spinazzola) County-wide continuum of care initiative impacting the greater Fort Worth area

Puerto Rico LC: (Lead TA: Julian Ford and Rocio Chang) Initiative to enhance CT sensitivity and response across a consortium of MH and CW agencies hosted by the Universidad Central Del Caribe

Southeastern Louisiana CT LC: (Lead TA: Margaret Blaustein) ARC-based cross-systems collaboration aimed at raising awareness of the impact of CT on children and adolescents

DePelchin Children’s Services:  (Lead TA: Robert Hartman) ARC-focused CT treatment model dissemination across residential, outpatient clinic and community-based programs

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