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Kaplan, Sandra 1 Abstract By the end of adolescence, almost 40% of young people have experienced at least one traumatic event. This Center will dedicate the majority of its efforts to alleviating the impact of traumatic stress in adolescents, with particular attention to incorporating cultural sensitivity into all proposed interventions. This Center will focus on intervention development for chronic trauma exposure, resource development, and mass casualty response. Specific plans include: 1) The continued development, adaptation, and dissemination of interventions for chronically traumatized adolescent boys and girls. Current interventions do not focus on exposure to more chronic types of trauma nor treat the sequelae of repeated exposure to traumatic events. The proposed project describes plans to conduct an empirical evaluation of Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS). SPARCS has been developed for use with culturally diverse groups by our Center during its National Child Traumatic Stress (NCTSN) membership. It has been piloted across the U.S. in schools, and outpatient and residential facilities with adolescents who have experienced chronic exposure to traumatic events, including physical and sexual abuse, community violence, domestic violence, and prolonged medical trauma. Initial feedback has been encouraging and the proposed project will provide empirical support for the SPARCS Intervention. By the end of the proposed project, we will have submitted the SPARCS to the National Registry of Effective Programs and will have made several adaptations, including one for individual treatment. 2) An Adolescent Traumatic Stress Resource Center for professionals, teens, and families on adolescent trauma, development, and trauma interventions. We will continue to provide leadership for the Adolescent Consortium of the NCTSN. Efforts will include the development of a web-based resource for professionals, adolescents, and their families on adolescents’ development, mental health, traumatic stress, and trauma- specific assessment and intervention resources. The Center will also continue to reach hundreds of professionals and families each year through presentations and trainings. 3) The development of a national model for a health system/regional acute child, adolescent, and family disaster/terrorism Response Plan and supporting Toolkit. The acute intervention for this plan will be Psychological First Aid (PFA). Our Center will continue to collaborate with the NCTSN National Center and Terrorism and Disaster Branch efforts to develop this Plan and Toolkit. Together we will develop Toolkit applications for specific health system and regional sites serving children and families. This Plan and Toolkit will focus on the use of acute response interventions by pediatricians, first responders, Emergency Department staff, school personnel and mental health clinicians. Kaplan, Sandra 2 TABLE OF CONTENTS Section Page Face Page 1 Abstract 2 Table of Contents 3 Budget Forms 4-5 Budget Narrative 6-7 Project Narrative – Section A – Experience 8-17 Project Narrative – Section B – Proposed Approach 17-29 Project Narrative – Section C –Evaluation 29-31 Project Narrative – Section D –Management Plan and Staffing 31-32 Section E – Literature Citations 33-35 Section F – Budget Justification 36-38 Section G – Biographical Sketches and Job Descriptions 39-59 Section H – Confidentiality and Participant/Human Subjects Protections 60-62 Checklist APPENDICES Appendix 1 – Letters of Support (26) 63-88 Appendix 3 – Sample Consent Form 89-91 Appendix 4 – Letter to Single State Agency 92 Appendix 2 (Not included in 30 page limit for appendices) – Intervention Manuals & Data Collection Instruments 93 A. Background, Experience, and Need Our Center, located within the Division of Child and Adolescent Psychiatry, Department of Psychiatry, North Shore University Hospital, North Shore-Long Island Jewish Health System has more than 20 years of experience in developing child and adolescent trauma-focused clinical, training, and research programs. The primary focus of our Center has been on adolescents who have experienced chronic interpersonal violence, such as being the targets of intra-familial maltreatment (e.g. Kaplan et al., 1998) and/or having witnessed adult domestic violence (Pelcovitz, et al, 2000). We also have extensive experience with many other trauma types experienced by children of all ages and families, including exposure to disasters and terrorism. Our Center will concentrate on three areas for the proposed grant: 1. Developing and disseminating empirically supported treatment interventions for adolescent victims of chronic trauma 2. Developing resources for adolescents, parents and professionals on adolescent trauma, and on the relationship of trauma to adolescent development and adolescent mental health 3. The development of a national model for a health system/regional acute child, adolescent, and family traumatic stress disaster/terrorism Response Plan and supporting Toolkit. Experience with Interventions for Chronically Traumatized Adolescents When we were selected to join the National Child Traumatic Stress Network (NCTSN) in 2001, we identified chronically traumatized adolescents as a group with great need for mental health services. Since there were no published empirically-supported interventions for this group, our Center devoted significant resources to develop a group intervention now called “Structured Psychotherapy for Adolescents Responding to Chronic Stress” (SPARCS), which is Kaplan, Sandra 3 the first new intervention to result solely from the Network, using SAMHSA’s collaborative model of intervention planning, development, and piloting. SPARCS is considered to be a “Supported and Acceptable Practice” by the NCTSN for two primary reasons. First, SPARCS incorporates several empirically supported interventions, including Dialectical Behavior Therapy, which has been shown to significantly decrease emotional lability and self-injurious behavior in adolescents (Rathus & Miller, 2002). In addition, pilot testing of SPARCS at multiple NCTSN sites has provided encouraging results, including improvements in measures of interpersonal distress, somatic symptoms, interpersonal relations, social problems, behavioral dysfunction, posttraumatic cognitions, and social support. SPARCS has also been well-received by adolescents of diverse cultural backgrounds, including African- American and Hispanic adolescents from various socio-economic groups who have provided feedback that has been used to revise the intervention on a continuous basis. On a satisfaction survey completed by two groups of adolescents who received SPARCS, 80% felt they made progress in achieving goals, and all described the group as cohesive. Another group of teens approached their school principal to request a doubling of time allotted to the group sessions, and school staff at the same site reported fewer conflicts/physical fights among SPARCS group members. SPARCS was designed with several important features, including the following: • SPARCS is developmentally appropriate for diverse groups of adolescents and it is not simply an upward or downward revision of a child or adult intervention. This makes it more meaningful and relevant to teens and increases its generalizability to real-world situations. • Instead of being simply a script that clinicians must follow, SPARCS is a treatment guided by a manual that fosters clinical creativity and flexibility. This allows treatment to be tailored to the specific needs of diverse groups. Naturally occurring “crises” become opportunities to use coping strategies the intervention was specifically designed to teach. • SPARCS addresses comorbidity and impairment in functioning that stem from trauma but are not captured by a diagnosis of PTSD alone. Traumatized adolescents often do not meet the full criteria for PTSD but do show significant functional impairment. SPARCS is suitable for use with traumatized adolescents experiencing behavior problems, school refusal, substance use, early pregnancy, and other high-risk behaviors. Experience as an Adolescent Traumatic Stress Resource Center Our Center has become one of the primary education and training centers in the U.S. in the area of adolescent traumatic stress. Thousands of mental health clinicians, school personnel, and other community members are reached by our Center’s programs each year. These programs vary from presentations (1 to 3 hours in length) to in-depth multiple-day trainings. Table 1 describes the type and number of people attending our Center’s programs since we joined the NCTSN (and began tracking these statistics). Table 1. Number of People Reached by Our Training & Education Programs Since Entering the NCTSN M e ntal He alth Pare nts Adole s ce nts School Law /M e dical Cle rgy Total Ye ar Clinicians Pe rs onne l Profe s s ionals 2002 650 875 1,100 120 90 2,835 2003 1,065 1,600 500 650 150 100 4,065 2004 490 1,035 50 300 100 100 2,075 2005 Q1 150 2,100 200 190 70 2,710 Total 2,355 5,610 750 2,240 440 290 11,685 In addition to the educational and training activities listed above, our Center acts as a resource for a wide range of agencies and programs, which includes: • Nassau County (NY) Department of Social Services (DSS). Our Center is working with Nassau County Child Protective Services (CPS) to develop mental health training programs for CPS Kaplan, Sandra 4 workers who assess alleged maltreatment and determine service needs, and to help DSS better evaluate the services that it recommends and provides for teens residing either with their families or in foster care (and to their respective families). We have assessed the training needs of CPS, conducted five pilot trainings of CPS staff and received feedback. We have also begun planning a system with CPS staff that will allow collection of trauma exposure, mental health and academic information on maltreated preteens and teens (and their parents) to provide enhanced mental health, substance abuse, and educational referrals. • Schools. Our Center has a long history of acting as a resource for schools after traumatic events (e.g., suicides, fatal car accidents, sexual abuse incidents). Most recently, we provided consultation to a school district that received national attention after three students were sexually abused by peers as part of a hazing ritual. During 2004 we also planned and hosted a full-day conference, “Fostering Resilience in Schools: Curricula and Resources for Crisis Readiness and Response,” to help schools prepare for future small- or large-scale traumatic events. We meet regularly with school nurses, administrators, and mental health staff via our Health System’s School Health Committee and provide annual student and family traumatic stress workshops. We also provide consultation as schools enhance their disaster plans to comply with State requirements. • Legal & Law Enforcement Systems. We have successfully collaborated with judges to address the needs of traumatized children and adolescents in the legal system. We have completed a glossary of mental health terms for use by judges during child custody cases (submitted to NCTSN Resource Center), and our Director is on the NY State Office of Court Administration Parent Education Advisory Board, developing guidelines for parent education programs to reduce traumatic stress in children of divorce. Our Police Partnership also provides training to local police on evaluation and referrals for youth exposed to domestic violence. • Adolescent Consortium (AC). In 2003, with the National Center and the NYU Category II Center, our Center established and now co-leads the NCTSN’s Adolescent Consortium. The AC was “kicked off” with a two-day conference in Manhattan attended by 80 people from 15 NCTSN Centers. As part of the AC, our Center has reviewed over 30 adolescent measures for the NCTSN Measures Review Database, begun a concept paper on pathways to high-risk behaviors in adolescents, and completed annotated bibliographies on adolescent auto accidents and on the biological impact of trauma on development (updated every 3 months). Our Center also coordinated and participated in AC presentations at each of the last two All-Network Meetings. We also co-lead the NCTSN’s Tri-State NY Metropolitan Area (NY, NJ, and CT) Coalition’s Survey of Adolescent Services (described in later sections). • Our Center has also completed a bibliography of books on trauma and mental health for children and adolescents (submitted to the NCTSN for national dissemination). Regarding the cultural competence of our Resource Center activities, our Center is located in Nassau County, a culturally diverse county (according to the 2000 Census, 18% of residents being foreign-born and 23% of families speak foreign languages in their homes). We have presented to, and met with, leaders of schools, community agencies, and religious organizations which serve children, adolescents, and families from many cultures. We have requested and received feedback about the manifestations of traumatic stress in their specific cultures and their preferred ways of accessing traumatic stress support services. This feedback has been incorporated into our education and training programs provided to those listed in Table 1. Additional examples of cultural competence include our translation of materials into other languages (e.g. domestic violence educational materials for parents in our Police Partnership) and our staff having completed our Health System’s current cultural competence course. Experience with Disaster and Terrorism Response Another focus of our Center will be the development of a plan for, and “Toolkit” to support, an acute health system/regional mental health response to disasters and terrorism. Our Center Kaplan, Sandra 5 has a long history of responding to catastrophes, which began in 1985 when Avianca Flight 052 crashed on Long Island, leaving 85 survivors and 73 dead. Our staff provided immediate crisis counseling to survivors and to families of survivors and decedents. Longer-term group and individual treatment was provided to those in need. In subsequent years, we provided similar services to the families of victims of TWA Flight 800, which crashed off Long Island in 1998 and to families exposed to the 1993 bombing of the World Trade Center. Our most intensive work in this area followed the September 11th World Trade Center Attack, which necessitated an exponentially larger mental health response since 30% of the victims resided in regions served by our Health System. With consultation from the National Center we acted as a resource for the NY Metropolitan Area and accomplished the following: September 11th Response: Support for Schools • Presented a series of educational programs on terrorism and trauma for Long Island School Districts’ administrators and school mental health staff who oversee the education of several hundred thousand students in the NY Metropolitan Area. • Over 800 teachers and school mental health professionals attended additional presentations by our Center. • Conducted mental health consultations to schools, carried out in collaboration with the Nassau County Mental Health Association and the Nassau County Bureau of Cooperative Educational Services (BOCES) supported, in part, by a federal Project SERV grant. • Consulted to the Diocese of Rockville Centre Schools, which educate over 60,000 students in Long Island Catholic schools. Many of these schools were heavily impacted by 9/11 as a result of losing friends and relatives of students and faculty. September 11th Response: Training Mental Health Clinicians • In addition to providing direct crisis counseling services through the Project Liberty program, our Center also helped to train Project Liberty workers in Nassau and Suffolk Counties on interventions for traumatized children and adolescents. Our staff participated in five training sessions, reaching over 100 Project Liberty crisis counselors. • Our Center conducted approximately 20 additional trainings and lectures, attended by over 650 mental health professionals from the NY Metropolitan Area, in the year after September 11th on topics including state-of-the-art assessment and treatment of children, adolescents, and families impacted (directly or indirectly) by 9/11. September 11th Response: Support for the Community • In collaboration with Catholic Charities, our Center helped to create videos for Parents, Children, and Teachers for the Catholic Community (the community most heavily impacted by the 9/11 Attacks). These videos were honored with a 2002 Telly Award. • Beginning on 9/11, our staff began a relationship with the 300 EMTs employed by our Health System’s Center for Emergency Medical Services (CEMS) by providing crisis counseling services to EMTs returning from Ground Zero. The relationship has continued with our staff conducting focus groups to help determine how to best support EMT families before and after future disasters and terrorist attacks. In collaboration with EMTs, our Center also developed a parenting guide for EMTs to help them help their children cope with the specific stressors associated with this profession (see Appendix 2). This will be submitted to the NCTSN National Center for dissemination. • Based on our expertise in treating victims of disasters and terrorism, our Center was selected in 2003 to become an original member of the Child and Adolescent Trauma Treatment and Services (CATS) Consortium (supported by the NY State Office of Mental Health). We have worked to bring our expertise, and that of the NCTSN, to this Consortium, which currently uses two interventions from the NCTSN. CATS was designed to be appropriate for the multi- cultural population of the NY Metropolitan area. Assessments are available in Spanish and Kaplan, Sandra 6 our consents include a Spanish version. Through CATS, we have provided direct evidence- based services to over 100 families. More recently, our Center’s disaster and terrorism efforts have centered upon our collaboration with the National Center’s Terrorism and Disaster Branch (TDB). Our Director was an expert review panel member in last month’s Psychological First Aid (PFA) Meeting held by SAMHSA. We have also begun developing (with the National Center and TDB) applications for PFA at health system sites serving children, and begun collaborating on the TDB’s NIMH research training program to prepare for health system based rapid mental health response research efforts following disasters and terrorism. Our community agency collaborators, who serve ethnically diverse minority populations, have supported the cultural competence of our disaster response efforts by providing us with feedback that we have incorporated into our education/training presentations and treatment development efforts. In addition, we have utilized Spanish language handouts provided by the NCTSN Website and by Project Liberty, and bi-lingual staff to reach out to minority groups, in their communities, houses of worship, and schools. Current Status: Interventions for Adolescent Victims of Chronic Trauma Although there exist empirically supported interventions for adolescents who develop PTSD after exposure to traumas (e.g. Trauma Focused CBT—Cohen et al., 2004; Trauma-Grief Focused Psychotherapy—Layne et al., 2001; STAIR—Silva et al., 2003), there are fewer interventions focused on adolescents exposed to chronic forms of trauma who may not have developed PTSD. Although adolescents exposed to chronic stressors such as domestic violence, recurrent physical or sexual abuse or neglect, or community violence, may or may not develop PTSD, they often develop a constellation of long-lasting problems (van der Kolk & Fisler, 1996), including: Pervasive Problems with Affect Regulation including experiencing overwhelming emotional distress, engaging in impulsive or aggressive actions in response to minor provocations, suicidal ideation/attempts, self-mutilation, risky sexual behavior, and substance abuse. Alterations in Attention or Consciousness, particularly dissociative coping, may lead to numerous negative consequences, including problems focusing on and completing tasks and chronic numbing and depersonalization. Alterations in Self-Perception including feeling ineffective, damaged, ashamed and guilty, have a significant impact on mental health outcome (McGee, Wolfe & Olson, 2001). Alterations in Relations with Others lead to pervasive interpersonal problems that prevent the development of mature, supportive, and nonviolent interpersonal relationships, as well as disrupted peer and parent-child relationships. Problems with Somatization, in the absence of physical causes, have been reported in several studies with child and adolescent trauma survivors and are associated with impaired health functioning and increased healthcare costs (Hexel & Sonneck, 2002). Alterations in Systems of Meaning include a sense of a foreshortened future or loss of previously sustaining beliefs. Re-establishing meaning is viewed by many as a core ingredient in the process of recovering from trauma (Roth, Lebowitz, & DeRosa, 1997). Chronically traumatized children and adolescents are found throughout most service systems. By the end of adolescence, almost 40% of youth will be exposed to at least one serious traumatic event, and many will experience chronic exposure to trauma (Kilpatrick, et al., 2003), particularly those in minority, recent immigrant, and lower SES communities. Our Center has focused on chronically traumatized adolescents in specialized settings, such as residential treatment facilities, specialized outpatient clinics and school programs, and foster care programs. Adolescents in these settings typically have been living with ongoing extreme stress and have adapted in ways that helped them survive but can also put them at risk for multiple problems in the future including abusive and unstable relationships, school refusal, poor academic performance, substance abuse, and impulsive, self destructive behaviors that could significantly Kaplan, Sandra 7 alter their life course. A diagnosis of “simple” PTSD does not adequately address the needs of this population. Therefore, these programs have been receptive to a trauma-focused, present- oriented approach that addresses adolescents’ multiple current stressors. Adolescents with extensive trauma histories are also over-represented in the juvenile justice system, a setting in which we plan to introduce SPARCS. SPARCS incorporates the only other intervention, TARGET (Ford, et al., 2004), that is specifically designed to address this complex array of problems, for both male and female adolescents, with or without a diagnosis of PTSD. SPARCS has been standardized in the form of a written manual to guide clinicians, with accompanying color handouts for adolescents that facilitate therapeutic activities during sessions (see Appendix 2). SPARCS has been disseminated through the NCTSN to at least six CTS Centers, which are identified in Section B. In disseminating SPARCS within the NCTSN, we have become aware of a number of barriers to dissemination of interventions, which include initial training costs and staff time for training and ongoing consultation. Furthermore, staff morale and energy levels vary widely depending on their current responsibilities, resources and support. The stress and demands of learning new treatments, a mismatch of theoretical orientations, or lack of support from administrators can cause serious implementation problems. We look forward to continuing our collaborative approach to developing creative solutions for addressing the needs of chronically traumatized youth, which will address the above barriers. Some of these needs include developing interventions for individuals and groups, and distance training approaches to reach clinicians in rural areas or in areas that do not have easy access to specialized training. Our plan for developing these interventions and training delivery systems is addressed in Section B. Current Status of Adolescent Trauma Resources and Service Delivery Systems Information regarding traumatic stress and adolescents is scattered and not easily accessible. There is a need for web-based resources providing information on adolescent traumatic stress for professionals, educators, policy-makers, and consumers (adolescents and their families). Our review of websites on topics such as PTSD, anxiety/stress, child abuse, adolescent health, and suicidality, revealed no single site that addresses the full range of traumatic events to which adolescents are exposed or the mental health and behavioral correlates of trauma exposure. Further, there has been little or no attempt to tailor websites to culturally diverse groups. We also plan to address this issue in the proposed project. The Tri-State NY Metropolitan Area (NY, NJ, and CT) Coalition’s Survey of Adolescent Services is designed to obtain basic data on the range of adolescent mental health, substance abuse, and primary care services, including inpatient, residential, outpatient, emergency care, and community-based services, provided both within the 9 Regional Area NCTSN Centers and within their affiliated health systems. This collaborative effort is designed to identify the following: 1) regional services available to adolescents 2) the extent to which these services address traumatic stress and 3) the professionals and their students from these services available for future training. The survey will be important in determining the current status of resources available for traumatized adolescents and will also lead to the development of best-practices models for healthcare facilities to help traumatized adolescents. Current Status of Acute Disaster Response Intervention Plans & Service Delivery Systems Since the September 11th Attacks, there has been a renewed emphasis on preparations for future disasters and acts of terrorism. Historically, plans for mental health responses to large- scale events have been rudimentary. Initial crisis counseling services are provided by agencies including the Red Cross, Departments of Mental Health, and/or local community volunteers. Longer-term assistance is provided by community mental health professionals. More recently, response planners have begun to consider the roles of schools, pediatricians, first responders, and clergy in enhancing mental health after disasters and terrorism. To date, acute emergency response plans of health systems have focused on the physical health rather than the mental health needs of children and families. In 1996, the Federal Kaplan, Sandra 8 Emergency Management Agency (FEMA) published the “Guide for All-Hazard Emergency Operations: State and Local Guide,” which provided state and local leaders with guidelines for the acute response to disaster/terrorism events. Although this publication outlined a national approach to responding to disasters, it did not offer mental health response guidance for professionals. SAMHSA published the “Mental Health All-Hazards Disaster Planning Guidance” (2003), a reference to help state and local mental health leaders plan to incorporate mental health needs into states’ emergency management plans. This publication presents general recommendations to facilitate a mental health response, such as the types of incidents to prepare for and the types of community organizations to include in plans. However, the guide does not describe best practices for psychological interventions that can be utilized immediately following a disaster or terrorist event. In fact, only a few post-disaster acute mental health interventions currently exist, and most are comprised solely of educational materials rather than crisis counseling strategies and are geared primarily towards adults. Comprehensive training for mental health providers is rarely included in health system/regional emergency operations acute response intervention plans. Federal and State Mental Health Departments and the American Red Cross are authorized to provide acute (within days and weeks) crisis counseling and supportive post-disaster services. Psychological debriefing, such as Critical Incident Stress Debriefing (Mitchell, 1983) is a frequently used acute intervention for victims, their families, and first responders, immediately following a disaster. Unfortunately, recent reviews of the safety of psychological debriefing for adults have been mixed (Rose, et al., 2003), and its use with children and adolescents has not yet been studied; there is great need for acute interventions. A number of national and governmental organizations including, but not limited to, the Centers for Disease Control and Prevention (CDC), FEMA, the American Red Cross, and the NCTSN provide disaster/terrorism response materials for children and families. These educational materials, primarily web-based and accessible to the public, include disaster and terrorism typology, home and family safety procedures, and when to seek medical or mental health services following a disaster or terrorist act. However, they do not refer to specific acute interventions for use with children and families. Organizations such as the American Psychological Association, the American Red Cross, NCTSN, and International Society for Traumatic Stress Studies offer educational materials for professionals who work with children exposed to disasters and/or terrorist acts. These materials are specifically aimed at helping professionals and parents to identify childhood traumatic stress symptoms and to facilitate treatment referrals when appropriate. A number of evidence-based psychological interventions, both community and school-based, such as Healing After Trauma Skills (Gurwitch & Messenbaugh, 2001) and Trauma-Focused CBT (Cohen et al., 2004) treat the long-term effects of exposure to a disaster or terrorist attack. Significant barriers to disseminating acute disaster/terrorism response plans and interventions currently exist. While basic educational materials are available, first responders, healthcare providers and educators (who are frequently the first to have contact with children following a disaster) are often not trained to consider the mental health needs of children and adolescents. A Toolkit of materials, including assessments, interventions, and suggested operational plans would facilitate the implementation of rapid psychological interventions as a companion to a physical health emergency operations response by health systems and regions. The service delivery systems involved in rapid disaster and terrorism response are often not located in traditional mental health settings. Disaster and terrorism response includes a complicated interplay of activities by federal, state, and local governments, non-governmental organizations (e.g. Red Cross), as well as by local health systems. The North Shore-Long Island Jewish Health System will serve as the pilot site for the development of a model which will involve linkage of a child and family mental health response plan to a health system’s physical health emergency operations plan. This model will eventually Kaplan, Sandra 9 be disseminated nationally. Currently, the physical response by our Health System to a local disaster or terrorist event is led by and coordinated through our Health System’s Center for Emergency Medical Services (CEMS) which responds within the regional emergency operations. CEMS is the largest hospital-based ambulance service in the NY Metropolitan Area and is one of the largest in the United States. CEMS has unrestricted operating authority to work in the 2,200 square miles of NYC and Nassau and Suffolk Counties on Long Island. Home to the Regional Emergency Management Training Center, the CEMS employs more than 300 emergency medical technicians and paramedics. Recently, CEMS was awarded a certificate of full accreditation from the Commission on Accreditation of Ambulance Services (CAAS), the first and only ambulance service in the NY Metropolitan Area to receive this distinction. CEMS managers and instructors are accomplished emergency services professionals, some of whom have worked extensively with the FBI, NYPD, and various emergency management agencies. Staff instructors hold certifications and accreditations from HazMat for Healthcare, as well as from several governmental agencies. CEMS helps to lead regional healthcare disaster response and houses a training center to educate healthcare practitioners in and out of the System in emergency response. The Health System’s CEMS is an integral component of the regional emergency response to disaster and/or terrorism events, making it an ideal partner in this endeavor. Immediately following a local disaster or terrorist event, the relevant Federal, State, and County agencies inform CEMS, which then responds by initiating the Health System’s physical and mental health responses. Prior to our collaboration with the CEMS, the Health System’s physical health response plan for disaster/terrorism had not been directly linked to a mental health response plan. These pilot efforts will add the child mental health component to existing emergency operations of a large health system, and can be disseminated to and implemented by other sites throughout the U.S. Once incorporated into the physical health response of health systems, these plans can be sustained after NCTSN funding has ended. Community disaster/terrorism related trauma-focused mental health intervention services are coordinated at National, State, and local levels. Our Health System’s Emergency Response plans include collaboration with all of the NY Metropolitan Area Counties. Currently throughout the country, following a disaster or terrorist act, mobile crisis teams are deployed by federal, state, or local agencies to the disaster site. At the site, team members provide immediate crisis counseling to victims and family members. In addition, specialized teams, such as the Rapid Response Support Team (RRST), and American Red Cross mental health teams may be deployed to provide any of the following services: rapid triage and incident management, linkage with child and family systems of care, clinical child and family evaluation and assessments, and evidence-based acute, intermediate, and long-term trauma/grief focused interventions and specialized interventions (i.e. school-based, medical trauma focused, tailored for other special populations). The expertise of the service providers is variable and ranges from mental health volunteers (trained in crisis counseling) to mental health professionals. A comprehensive toolkit for professional training and education and public education regarding child, adolescent, and family acute response does not now exist for use by health systems. The following describes the experience and expertise of our key staff Sandra J. Kaplan, M.D. is Vice-Chairman, Department of Psychiatry for Child & Adolescent Psychiatry, North Shore University Hospital and Professor of Clinical Psychiatry, NYU School of Medicine. She directs our Hospital’s trauma-focused mental health services, research studies and training programs. She leads our NIMH funded research group on the mental health correlates of, and risk factors for, adolescent physical abuse. She has been appointed to the U.S. Department of State’s International Civilian Psychiatric Response Team, where she serves with Dr. Pfefferbaum, Director of the Terrorism and Disaster Branch of the National Center. Dr. Kaplan is a member of: the Executive Committee of the Interdisciplinary Forum on Mental Health and Family Law of the Bar of the City of NY and of the NY State Office Kaplan, Sandra 10 of Court Administration’s Parent Education Advisory Board. Her national leadership was recognized by the nation’s psychiatrists awarding her the American Psychiatric Association’s (APA) 2001 Agnes McGavin Prevention Award for her family violence prevention efforts. Her APA efforts have included membership on the Task Force on Psychiatric Aspects of Violence, the Committee on Family Violence and Sexual Abuse (which she chaired for 10 years) and the Council on Children and Families. She has been a member of the Steering Committee of the National Advisory Council on Family Violence (consisting of medical specialty organizations of the AMA) and recently represented the NCTSN as a speaker at the “Dare to Act” Conference in Baltimore, MD (sponsored by SAMHSA). She has also served as a member of the NCTSN’s Steering Committee, and helped to create and Co-Chairs the NCTSN Adolescent Consortium. David Pelcovitz, Ph.D. is Professor of Psychology at Yeshiva University; Attending Psychologist, North Shore University Hospital; and Clinical Professor of Psychology, NYU School of Medicine. He has been a clinician and researcher in the area of traumatic stress for over 20 years, with primary clinical and research interests in the area of PTSD and on understanding the complex emotional and behavioral sequelae of trauma in adolescents and is the co-lead author of the SPARCS intervention. He worked closely with other national leaders in the trauma field in developing the PTSD sections of the DSM-IV, and has lectured nationally and internationally on assessment and treatment issues regarding traumatized children and adolescents. He has also conducted studies of the impact of chronic illness (e.g. cancer, diabetes) on adolescents and their families, and continues to study, together with Dr. Kaplan and their colleagues, the long- term impact of physical abuse on adolescents. In addition to teaching courses on the treatment of child and adolescent abuse in NY Metropolitan Area doctoral psychology programs, Dr. Pelcovitz has also served as a chair or committee member of over 20 doctoral dissertations investigating various aspects of traumatic stress. He has frequently consulted with communities throughout the country regarding large-scale sexual abuse incidents. In addition, Dr. Pelcovitz teaches and regularly provides consultation to clergy regarding their roles in identifying and aiding victims of trauma. Ruth DeRosa, Ph.D. is Senior Psychologist, Department of Psychology, North Shore University Hospital. She is the lead author of the SPARCS intervention, and has provided intensive training on SPARCS to community providers in NY and across the country. She has also presented at regional and national meetings, both on SPARCS and on developing manualized interventions. Dr. DeRosa has served as coordinator of an NIMH funded pilot treatment study for survivors of sexual trauma, and participated in an NIMH rapid award grant investigating the impact of an industrial disaster in a rural community. She has additional treatment outcome research experience evaluating pharmacological interventions for PTSD, and is a certified Dialectical Behavior Therapy provider. She is a member of the NCTSN Data Core Committee and Complex Trauma Task Force, and was recently invited to be part of a select NCTSN “think tank” on incorporating “mindfulness” techniques into trauma treatments. Juliet Vogel, Ph.D. is Director of Child Psychology Training at North Shore University Hospital, and Assistant Professor of Clinical Psychology, NYU School of Medicine. She has extensive experience with traumatized children and adolescents that includes Chairing the American Psychological Association’s Task Force on Children’s Psychological Response to Disasters from 1989-1993 and authoring the reports from this Task Force (Vogel & Vernberg, 1993). Dr. Vogel has also led efforts to understand the long-term effects on children of the first World Trade Center bombing in 1993 (Vogel, 1995). She is also Director of the Child and Adolescent Trauma Treatment and Services Consortium (CATS), where she has obtained additional expertise implementing and evaluating empirically supported interventions for traumatized youth. Dr. Vogel currently serves on the NCTSN’s Measures Committee, as well as the Adolescent Development Subcommittee of the Adolescent Consortium. Suzanne Sunday, Ph.D. is Director of Research, Department of Psychiatry at North Shore University Hospital; Associate Professor of Psychology, NYU School of Medicine; Associate Kaplan, Sandra 11 Investigator in the Institute for Medical Research, North Shore-LIJ; and Coordinator of our NIMH funded adolescent physical abuse studies. Dr. Sunday, an American Psychological Association Fellow, has had extensive experience training and supervising clinicians in the use of semi- structured interviews, and has expertise in data collection, management and analysis for NIH and foundation grants, including several randomized control treatment outcome studies. She is a member of the Adolescent Development Subcommittee of the NCTSN’s Adolescent Consortium and participates on the NCTSN Measure Review Database Team. Victor Fornari, M.D. is Associate Chairman for Education & Training, Department of Psychiatry, North Shore University Hospital and Associate Professor of Clinical Psychiatry, NYU School of Medicine. Dr. Fornari has extensive experience in the psychotherapeutic and psychopharmacological treatment of victims of disasters and their families (including survivors of the Avianca Airlines Crash and families of TWA Flight 800). He has been appointed to the U.S. Department of State’s International Civilian Psychiatric Response Team. He is also a member of the Nassau County Critical Incident Response Team, and Disaster Task Force. Alan Cohen, M.D. is Clinical Director of Child & Adolescent Mental Health Services at North Shore University Hospital, as well as Director of the Families in Transition program for children and adolescents experiencing high-conflict divorce/separation. In addition to his experience treating victims of interpersonal trauma, Dr. Cohen also has extensive experience consulting to school systems, and is currently the clinical psychiatric consultant to several large school districts. Dr. Cohen is our Center’s liaison to the Hospital’s Disaster Committee, and mental health consultant to the Health System’s CEMS. Victor Labruna, Ph.D. is Research Coordinator of the Division of Child and Adolescent Psychiatry, North Shore University Hospital and Assistant Clinical Professor of Psychology, NYU School of Medicine. In addition to day-to-day coordination of our Center, Dr. Labruna has contributed to the development of the SPARCS intervention, as well as contributing to disaster and terrorism response plans. He also coordinates our Division’s Police-Mental Health Partnership Program for youth exposed to domestic violence. B. Proposed Approach. For the SPARCS intervention, the Adolescent Traumatic Stress Resource Center, and the Health System Disaster and Terrorism Response Plan and Toolkit, we will respond to the RFA in the following order: 1) Plan to Partner with NCTSN Centers and Develop Resources; 2) Plan to Partner with CTS Centers and Service Provider Organizations for Dissemination/Adoption; and 3) Sustainability. Interventions for Adolescent Chronic Traumatic Stress: SPARCS 1) Plan to Partner with NCTSN Centers to Develop Resources SPARCS was originally conceptualized, developed and piloted using the support of the NCTSN committees and the collaborative nature of the Network. Specifically, the Complex Trauma Working group contributed to outlining the areas of functioning that are targeted in the SPARCS treatment, the Expert Core contributed to the conceptualization and content, the Learning from Research and Clinical Practice Core contributed to the design of the training for clinicians and to addressing barriers to adoption and implementation, the Data Operations Committee contributed to the feasibility of flexible treatment components, and the National Center has been key in identifying Network partners. Our NCTSN partnerships, which include urban and suburban sites that span the U.S. and serve many ethnically diverse populations (including Hispanic, African-American, and recent immigrants), have provided valuable feedback that has enhanced the cultural competence of the manual. They will continue to work with us to further modify the treatment, handouts, and the style and language of our work. SPARCS was designed to be flexible and to allow clinicians to adapt the language and activities based on the cultural characteristics of their population. We believe that it is critical to continue to incorporate suggestions into the manual from sites that treat additional culturally diverse populations. For Kaplan, Sandra 12 example, we plan to work with the North Dakota collaborative that has expertise working with Native Americans and with the North Carolina CTS site to further modify the language in the handouts for lower SES, educationally deprived populations. As we have implemented SPARCS with our partners within the NCTSN, as well as with local community sites, we have received feedback requesting a variety of adaptations. We propose to work on four specific adaptations: the addition of a multi-family group to SPARCS, SPARCS for a juvenile justice population, SPARCS for adolescents with serious mental illness, and SPARCS for individual therapy. Sites, including Children’s Institute International, are now able to work with us to develop a multi-family group SPARCS component that would teach adolescents, with their families, coping and communication strategies. This will broaden the impact of the intervention by improving the adolescents’ family environment and providing additional support. We plan to continue our collaboration with Julian Ford (currently associated with the Yale NCTSN Center) who has successfully piloted his TARGET intervention in juvenile justice system that has prompted Connecticut to adopt this model to address the needs of teens in these settings, who have very high rates of trauma (57-92%, Wordes & Nunez, 2002). SPARCS includes components of TARGET as well as many additional therapeutic elements that we believe will be very useful for this population. Dr. Ford has agreed to work with us to further modify SPARCS for use with adolescents in the juvenile justice system. We will also collaborate with Dr. Rosenberg of the Dartmouth Trauma Interventions Research Center and the National Center for PTSD (applying to be a CTS center), as we adapt our intervention for adolescents suffering from serious and persistent mental illness. A majority of these adolescents have experienced traumatic stress, either before or after their diagnoses (Mueser, et al., 2002). Despite this, very few programs systematically assess the trauma exposure experienced by these adolescents, and there is currently no available empirically supported interventions for use when the traumas are identified. The skills taught by SPARCS are well-suited to help these chronically ill and stressed adolescents. The most frequent request, and the adaptation we plan to focus on for this proposal, has been to adapt SPARCS for use in individual treatment. For example, some agencies (rural agencies in particular) have mentioned having difficulty recruiting enough adolescents at one site to conduct a group. Other sites continually add teens to their programs throughout the year, thus they cannot offer SPARCS to many of their clients because the group is already in progress. Starting groups during the Spring and Summer months is also problematic because many sites report that some of their adolescents drop out of treatment or leave the agencies during the summer but clinicians could opt for individual therapy for clients continuing throughout the summer. Other NCTSN sites have reported that some adolescents are extremely uncomfortable participating in groups but would be willing to have individual therapy. In addition, individual work is better suited for special-needs adolescents, including those that cannot use the written materials used in the group. Finally, some clinicians are not experienced in group therapy and are more comfortable with individual treatment. Based on collaborations with NCTSN Centers and committees, we plan to modify the SPARCS protocol so that it can be used for traumatized adolescents in individual treatment with a high degree of flexibility. Although there are unique strengths to group treatment (e.g. provision of social support, reduction of feelings of isolation, interpersonal skills enhancement, and learning of group members from each other), there are also advantages to individual treatment. A primary advantage of individual therapy is increased flexibility for tailoring treatment to the individual needs of the client. As described previously, chronically traumatized youth often develop a constellation of long-lasting impairment in functioning including difficulty with regulating emotions, impulses, and attention, problems with dissociation, negotiating relationships, self- perception, physical complaints and systems of meaning. Each of these domains of functioning will be systematically assessed using an empirically based assessment (SIDES-A) during the first two sessions of the SPARCS intervention. All clients will receive the initial sessions that will Kaplan, Sandra 13 provide them with basic skills and education about trauma. Then, based on the information gathered during the initial sessions, clinicians will have the opportunity to tailor the treatment to the adolescents’ needs by selecting SPARCS sessions that are most relevant for their clients. Thus, if a teen is struggling primarily with interpersonal issues, interpersonal issues would be the focus of his/her treatment. Recent literature has suggested that this approach more accurately links interventions to specific problems (Hodges, 2004). Evidence suggests that interventions based upon clinical judgment alone can be less effective than interventions based upon assessment results (e.g., Ben-Porath, 1997; Grove & Meehl, 1996). There is also evidence that assessment in and of itself can be a powerful intervention because it can build a common understanding of the goals of treatment, help the client feel validated, lead to increase introspection and self-understanding, and standardized questions rather than open-ended discussion are often easier for the client (Finn & Tonsager, 1997). An assessment-based approach such as this is being used successfully in the NCTSN Network (e.g. Chadwick Center in CA). To accomplish the adaptation to an individual approach, we propose the following plan: 1. Work with the Learning from Research and Clinical Practice Core (LRCP) to survey sites interested in SPARCS for individuals by systematically gathering feedback and suggestions for adaptations, and identifying the needs of the sites and the adolescents they serve (such as types of chronic trauma, experience/training of clinicians, degree of family involvement, typical severity of symptoms/impairment in functioning, cultural factors, setting, preferred length of treatment, sources of funding, ability to conduct mastery vs. time-based treatment, and literacy and educational level of adolescents) 2. Consult with NCTSN committees including the Complex Trauma Working Group, the LRCP, the Adolescent Consortium, and the National Center’s Expert Core regarding specific techniques and adaptations to be included 3. Adapt the SPARCS manual to reflect needs of individual treatment and of the Network sites using the assessment guided approach described above 4. Distribute the adapted SPARCS manual for individual treatment for review by NCTSN Centers as well as by the committees listed above 5. Pilot SPARCS for individual treatment with collaborating NCTSN Centers 6. Systematically evaluate SPARCS for individuals (as described in detail in Section C). 7. Incorporate additional modifications based on the evaluation 8. Disseminate adapted SPARCS to other NCTSN sites and community mental health service providers in a standardized manner that will permit replication at many sites. These same steps will also be utilized for our other proposed adaptations to SPARCS discussed above. Our Center will also measure the following outcomes as outlined in the LRCP Core report, “How to Adopt & Utilize Trauma-Focused Evidence-Based Practices for Children:” • Clinical Efficacy - measured by changes in client assessments, client satisfaction, clinician’s experience of the process, and how family members and others experience the client after the treatment. The measures we are using are described in Section C. • Implementation Effectiveness - assessed by indicators of clinician’s fidelity to critical components of the treatment (adherence checklists). • Implementation Partner Satisfaction – including staff, administrators, consumers/families, and third party payor satisfaction with the new treatment. In our current collaborations with CTS Centers, we have identified a number of interviews and self-report questionnaires that assess areas of current functioning that are targeted in the SPARCS treatment. Each of the sites we have been working with have selected all or a subset of these assessments depending on the needs and resources of their site. Children’s Institute International and The Trauma Center (MA) have collected pre-treatment evaluations and will soon be collecting post-treatment data. Sites starting data collection in the Fall include: Andrus Kaplan, Sandra 14 Children’s Center, Mt. Sinai Adolescent Health Center, and the Mental Health Center of Dane County. Regarding implementation effectiveness, our Center has conducted weekly consultation meetings with clinicians at the CTS SPARCS implementation sites. These meetings include in- depth review and discussions of clinician’s experiences with, and adolescents’ reactions to, the SPARCS treatment and its materials and skill building activities. Based on CTS clinicians’ reports during these meetings, we complete a treatment adherence checklist, designed specifically for SPARCS, to quantify treatment fidelity. These checklists are used to guide clinicians’ adherence to the protocol and to assess overall implementation effectiveness at each site. During the conference calls, Network meetings, and SPARCS training sessions we discuss agency satisfaction with the SPARCS program including feedback from clinicians, teachers, teachers’ aides, administrators, consumers/families and support staff. Based on these ongoing evaluations, we have made major revisions to our intervention and to the training procedures. SPARCS has been adapted to foster greater creativity and flexibility on the part of the clinician. This “operationalized” flexibility allows the treatment to be tailored to the specific needs of each group. Therefore, when “crises” occur, rather than abandoning the current session, it provides an opportunity to use SPARCS coping strategies. Since clinicians reported being constrained by the manual’s scripted language, the manual now includes some suggested questions but does not contain significant verbatim language. SPARCS now offers brief session summaries that therapists can bring to group to guide the session’s activities separate from the manual. Based on principles of adult learning, the format of the manual was adapted to be more user-friendly and easier to read and follow. It is now more interactive with additional role-plays, small group learning, and more cultural diversity in examples and exercises. Clinicians participating in early trainings reported that 2 consecutive days of material was difficult to assimilate. Therefore, we began instituting one day of training (or 2 half days if feasible) followed by approximately one month before the second training day. This time frame allows clinicians more time to read all of the material and increases their ability to incorporate the skills into daily practice. We plan to continue this collaborative evaluation process for SPARCS and its adaptations and future products and trainings. Additional resources our Center plans to support SPARCS (and its adapted forms) include a package of resources that will be available on the NCTSN Website. These will be developed for a number of consumers including adolescents, families, mental health clinicians, social service workers, administrators, and school staff. Resources will include: • Readings on critical treatment components for chronically traumatized teens. • In partnership with the National Center, we will create organizational readiness checklists that describe the requirements for the clinicians, supervisors, and senior administrators planning to institute evidence-based practices for chronically traumatized adolescents. • Intervention evaluation packets (available by downloading from the Web) with explicit rationale and support for their clinical use. This will include developing training materials for the Disorders of Extreme Stress-Adolescent Version (SIDES-A), a clinical interview we designed to capture the impact of chronic trauma and to enhance treatment planning. • Partner with National Center and CTS sites to address challenges in evaluation of empirically based interventions and to support community sites’ ability to create HIPAA compliant and culturally appropriate SPARCS consent forms more easily. • Document how clinical and organizational problems have been overcome so that this knowledge is readily available to previous, current, and future SPARCS users. Partner with the National Center to support web-based consultation as part of the Learning Collaborative. • Develop a SPARCS therapist self-test for critical components of the intervention. 2) Plan to Partner with CTS Centers & Service Providers for Dissemination and Adoption In partnership with the NCTSN, we will be sponsoring an innovative model for the dissemination and adoption of interventions for traumatized youth. This Learning Collaborative, Kaplan, Sandra 15 developed by the Institute for Healthcare Improvement (IHI), was identified by the NCTSN as the most effective method for instituting change and sustaining improvements in healthcare systems. IHI’s model promotes skill building within a learning community that supports a partnership of trust and cooperation and allows participants across all agencies to learn from each other and invent new solutions as they work to establish lasting and meaningful change at their respective agencies. We have been selected by the NCTSN to host a Regional Learning Collaborative bringing together clinicians and supervisors from at least four other Centers interested in adopting SPARCS into their adolescent trauma programs. The typical learning collaborative includes these steps: 1) Development of a change package, which identifies specific critical components necessary for successful adoption of a promising practice; 2) A pre-work phase to help organizations and administrators to complete a readiness checklist to identify the agency’s strengths, anticipate organizational barriers, and to prepare clinicians with readings to prepare them for training; 3) Learning sessions that typically include 3 face-to-face meetings (2 days for each) over the course of a year; 4) Action Periods and Feedback that are the time periods between the learning sessions when participants study, test and implement the treatment, and give regular feedback describing their plans, actions taken, assessment of their actions in order to quickly and regularly capture challenges and successes; 5) Teamwork meetings that include monthly teleconferences across all sites with additional consultations with subgroups to discuss particular content areas or specific needs; and 6) Final Report and Evaluation to capture the process of change within the Collaborative itself as well as improvement in functioning among adolescents participating in the intervention. Our Center’s Learning Collaborative will incorporate many different modalities including pre-training materials and self-tests, advanced planning, face-to-face learning sessions, web- based feedback and videoconferences. However, establishing a Learning Collaborative with sites across the country faces several important barriers, particularly the substantial time commitments and travel costs on the part of participants. It is therefore, not always feasible for all participants from each site to travel three times over the course of a year. We propose to address these barriers in the SPARCS Learning Collaborative by incorporating long-distance videoconferencing into our proposed training program to allow live, interactive training sessions. This technology has been used before to effectively aid in psychotherapy training (e.g. Dudding & Justice, 2004; Rudestam, 2004) and is beginning to be used within the NCTSN. The National Center of the NCTSN has offered technical assistance to our Center regarding technology as we plan this videoconferencing capacity. For significantly less money than would be required for multiple face-to-face meetings, we will create a system for the Learning Collaborative that allows geographically diverse sites to learn the intervention, and to generate creative solutions to problems that interfere with successful implementation and sustainability. This approach requires that community sites support only the initial 2-day, in- person meeting (reducing financial costs), to foster partnerships and camaraderie among sites. All subsequent learning sessions will be scheduled flexibly, allowing staff at the community sites to participate in half-day learning sessions with less disruption to their schedules and responsibilities. We have also found that half-day learning sessions are more productive, focused, and conducive to the transfer of knowledge. The above proposed approach will allow more clinicians to participate, and has the potential to reach a greater number of rural CTS Centers who have more difficulty accessing training and support in evidence-based interventions compared to Centers in metropolitan areas. During the proposed grant, we will complete four to five separate Learning Collaboratives, each with four participating sites in geographically diverse areas serving diverse populations. We will ship the video-conferencing equipment to each site at the start of the collaboration; their only cost will be for the two monitors needed to utilize the equipment. When they have completed the Learning Collaborative (following completion of all group sessions), they will return the equipment to us to use with the next collaborative. We also plan to pilot one of the learning Kaplan, Sandra 16 collaboratives with no face-to-face meetings, with all training and collaborations to be conducted via video-conferencing. This will allow more sites to participate, particularly small rural sites or sites with limited funds that could not afford even one face-to-face meeting. The following sites have expressed interest in joining a SPARCS Learning Collaborative: Children’s Institute International (CA), the Mental Health Center of Dane County (WI), The Trauma Center (MA), Andrus Children’s Center (NY), and the consortium based in Fargo, ND (headed by Dr. Wonderlich and applying to become a CTS Center) which serves rural areas including a Native American reservation. More than six additional geographically and ethnically diverse sites (both current NCTSN Centers and sites applying to join the Network) have also expressed interest in participating in a future SPARCS Learning Collaborative. If any of the Centers identified above do not continue with the NCTSN, the National Center will help us identify additional funded NCTSN sites for the Learning Collaborative. In addition to using 21st Century technology to address the barriers to disseminating SPARCS within the Learning Collaborative, we also plan to work with Dr. Wonderlich to provide individual and/or group SPARCS therapy via telemedicine (includes interactive video technology). His group has pioneered the usage of telemedicine in rural areas (Mitchell et al., 2005; Myers et al., 2004). Using similar techniques, we would help them pilot the delivery of SPARCS to traumatized adolescents residing in remote rural areas (including Native American Reservations) of North Dakota and then work to disseminate the technique to other rural areas. We plan to partner with several service provider organizations both in our own immediate community, in state agencies, and across the country in order to support the implementation and adoption of SPARCS and to assess its suitability for different populations. Some of these sites include residential treatment centers, outpatient clinics, school-based and substance abuse programs. For example, as a result of our partnership, Madonna Heights, a local residential program, has already instituted significant changes in the way they organize their approach to treating adolescents; all traumatized teens entering the program first join a SPARCS group to learn new, and reinforce existing, adaptive coping strategies. The program has reported such success that another facility affiliated with Madonna Heights is requesting training and consultation in SPARCS in order to achieve a similar shift in treatment approach. This demonstrates the sustainability of the intervention. This is one of many examples of SPARCS not only “taking root” in a community agency serving ethnically diverse adolescents, but also expanding to neighboring agencies. Our potential community service providers include State Child Protective Services and state agencies providing treatment to juvenile offenders. The Domestic Violence Mental Health Policy Initiative in Illinois is interested in collaborating on a state-wide effort to effect change in their systems that treat children and adolescents with long- term exposure to domestic violence and other chronic interpersonal trauma. 3) Sustainability Planning The National Center has been very supportive of our intervention efforts over the past four years. It has acted as a liaison, identifying ideal NCTSN sites to implement our SPARCS intervention, identifying experts in adult learning to help us design appropriate training materials for clinicians, and providing additional support to help us adapt SPARCS so that it is more culturally appropriate for urban, Hispanic adolescents. As previously described, we have also recently begun working with the National Center on a SPARCS Learning Collaborative, which is aimed at helping SPARCS to become a self-sustaining intervention at Network and other community sites that will continue to use SPARCS regardless of external funding. Sustainability of SPARCS will be enhanced by our proposed adaptations and by extensive training during the grant period, which provides a “critical mass” of clinicians that will ensure an interest in its use regardless of additional funding. The video-conferencing capabilities included in this proposal will allow a larger number of Centers (and more staff at each Center) to be trained. Fortunately, we have found that SPARCS has been readily adopted as a best practice by the community Kaplan, Sandra 17 agencies where it has been piloted, and has therefore continued to be used even after our official training of the agencies has ended. Adolescent Traumatic Stress Resource Center 1) Plan to Partner with other NCTSN Centers to Develop Resources The increased use of the Internet has vastly increased the information available to the public and to professionals. According to the Pew Internet & American Life Project (2005), 83% of American teens currently use the Internet, and, while fewer minorities use the Internet, they make up the fastest growing group of users. The websites of national organizations, such as the American Academy of Pediatrics, American Medical Association, and American Academy of Child & Adolescent Psychiatry, offer tip sheets for caregivers of adolescents and links to other websites with information on adolescent health topics. Additionally, the CDC website provides information for adolescents and their families about topics such as adolescent risk-taking, substance use, and mental health. However, despite providing overviews of adolescent issues, none of these websites addresses the broad range of traumatic experiences to which adolescents are exposed, none have specific information on assessments and interventions, few are designed specifically for adolescents themselves, and even fewer address the needs of minority teens. A review of the top 15 adolescent-focused health websites (Mid-Hudson Library System, 2005) chosen by adolescents themselves indicates that information on broad topics related to anxiety and stress is available, but specific information on topics such as maltreatment, suicide, rape, grief and trauma symptoms is limited. Our Center will lead the effort of the AC to provide adolescent content for the NCTSN website. AC leaders have already begun working with the NCTSN National Resource Center’s Executive Editor to identify the major content needs of the NCTSN website. Major renovation and re-organization of the NCTSN website is being planned by the National Center, and we are pleased to have the opportunity to participate in this process. The 30 Centers participating in the AC possess a wide range of expertise in the area of adolescent traumatic stress, and working groups will develop specific website content. We will coordinate these working groups and will be participants in them as well. Our Center will lead the effort to develop a section of the NCTSN Website designed specifically for diverse groups of teens. This section will include links to hotlines, mentoring programs, specialized healthcare programs, and other community programs for traumatized adolescents. We hope that popular adolescent websites, including media, healthcare, and education sites, will provide links to the NCTSN adolescent-specific website. We also have the goal of providing professional NCTSN Website content on promising practices in assessment and treatment of adolescent traumatic stress. Content will include: fact sheets, concept papers, annotated bibliographies, surveys, actual assessment, intervention guides, and training materials. This content is intended for mental health professionals, as well as healthcare professionals, educators, child welfare workers, and juvenile justice staff on topics such as the causes and consequences of adolescent traumatic stress, psychopharmacology; new legislation relevant to adolescents; funding opportunities, and scholarship opportunities for researchers, clinicians, and students. Another resource we are developing is the Tri-State NY Metropolitan Area Survey of adolescent services affiliated with 9 Regional NCTSN Centers which will provide information about: the numbers of adolescents served in various types of healthcare settings and the number of regional professionals and students available for training in best-practice trauma-focused adolescent assessments and interventions. This information will be used to develop collaborative plans for improving assessment and treatment of traumatic stress at these sites and to provide a process for replication in other NCTSN regions. Developing an NCTSN Regional Learning Collaborative and seeking collaborative sources of funding will also be project goals. We will work with the National Center to develop a future “Breakthrough Series” (a national NCTSN learning collaborative) on adolescents emphasizing issues related to traumatic stress (e.g. assessment, treatment, education, public policy, & cultural competence). Kaplan, Sandra 18 Finally, we will continue and significantly increase our collaborative effort with the NCTSN National Resource Center to identify adolescent-specific content needs of the NCTSN Website. We will continue to coordinate the development of the above content needs, each of which will be carried out by working groups of staff members from two to three Adolescent Consortium Centers with relevant expertise. Editing and final submission of adolescent-specific content to the National Resource Center, as well as marketing of the newly-available web-based information to other NCTSN Centers, will be conducted by our Center staff. Specific indicators used to evaluate the success of the website are detailed in Section C. 2) Plan to Partner with CTS Centers & Service Providers for Dissemination One of the major contributions of this endeavor will be to disseminate information on training in and implementation of promising-practice adolescent traumatic-stress assessments and interventions. As stated above, the Tri-State NY Metropolitan Area Survey of Regional Adolescent Services will provide important information about the numbers and types of Regional professionals, students, and trainees to be trained in those assessments and interventions. The next step will be to develop training resources, applicable to working with diverse groups of adolescents, for the identified professionals, students, and trainees and to disseminate those resources among both NCTSN and adolescent healthcare service provider organizations affiliated with these NCTSN Centers. We will track the impact on adolescent services within the Region, and the impact on the training of healthcare professionals and trainees of these service sites. This process will serve as a prototype for the dissemination of best-practice adolescent traumatic-stress assessments and interventions in other Regions in the Country. Our Center will continue to partner with CTS and community service agencies on a variety of resource projects. The AC has nearly completed two review papers: “A Review of Interventions to Address High Risk Behavior and Trauma in Adolescent” and “Pathways Between Trauma and High Risk Behavior in Adolescents”. As the co-leader of the AC, our plan is to complete these reviews, and continue with plans to edit two reports on traumatized adolescents (one on assessment, the other on treatment). We have developed specific outlines for each, and identified potential authors within the NCTSN for each chapter. These products will be made widely available through national conferences, the NCTSN Website, and mental health training programs. The adolescent-specific web pages to be developed by us will be linked to popular adolescent websites, including healthcare, media and education sites. The Big Brother/Big Sister organization has already indicated to the NCTSN that they would agree to a link to their website. The collaboration of additional organizations that appeal to adolescents of multiple racial, ethnic, and religious backgrounds is already being sought. 3) Sustainability of Adolescent Resource Center Products Sustainability of the adolescent content for the NCTSN Website will require the initial investment of significant time and financial resources. However, once completed, the support needed to maintain the website will be greatly reduced, allowing the website to be sustained even if funding is decreased in the future. The Tri-State NY Metropolitan Area Coalition has chosen to focus on training as a means of sustainability, and its Survey of Regional Adolescent Services will form the backbone of the effort to develop a regional training model for healthcare professionals in best-practice adolescent traumatic-stress assessments and interventions. In addition, sustainability plans include a dedicated search for funding sources beyond the NCTSN. We have identified several foundations with a focus on adolescent health, including mental health (such as the W.T. Grant Foundation). The survey’s results will demonstrate to potential funding sources the significant regional resources provided by NCTSN Centers. Health System/Regional Disaster and Terrorism Response Plan and Toolkit 1) Plan to Partner with other NCTSN Centers to Develop Interventions and Resources Building upon our current collaborations with the National Center and its TDB efforts (led by Dr. Pfefferbaum), our Center will develop a health system/regional model of an acute child, adolescent, and family traumatic stress disaster/terrorism Response Plan. A “Toolkit” will be Kaplan, Sandra 19 developed to support the Response Plan by providing implementation materials to facilitate, education, training, and evaluation. Psychological First Aid (PFA), being developed by the National Center, will be the acute traumatic stress intervention utilized in our Plan and Toolkit. This acute response Plan, for which we will lead development and piloting, will be linked to existing emergency operation physical health response plans. Regarding currently existing resources in this area, Regional, State and National Emergency Operations Plans exist and disaster rehearsal drills are taking place across the U.S. However, these existing plans do not yet include evidence-informed acute traumatic stress interventions for children and families, such as the NCTSN’s PFA. The existence of these emergency operations plans and the participation of regional health systems in the implementation of such plans will provide resources to which our Center’s proposed traumatic stress response plans can be linked. Currently available educational materials (e.g. Healing After Trauma Skills (HATS: Gurwitch et al., 2001), Facing Fear (Red Cross, 2001) workbooks, and earlier versions of PFA) will need to be updated and PFA training materials, currently being developed by the National Center and NCTSN TDB efforts will be included. Training materials for use of the Toolkit (and PFA) at various healthcare sites do not now exist and will be developed. The proposed Toolkit will be comprised of three main components: 1. Educational and training materials for physical and mental healthcare providers, first responders, school staff (in conjunction with the NCTSN’s School Crisis & Intervention Unit), and chaplains on types of disaster/terrorism events, possible physical and mental health service sites, methods of assessing traumatic stress following disasters or terrorist attacks, and information on best-practice interventions for acute and longer-term mental health needs. Also included will be educational materials for dissemination to parents. 2. PFA training materials with modules to be used by crisis counselors (who are often not mental health professionals) and additional modules for trained mental health professionals. 3. Training programs for physical and mental healthcare providers to use the Toolkit, and particularly PFA, at specific health system sites serving children and adolescents. The educational and training materials disseminated will be specific to child and adolescent service sites (e.g. Emergency Department, schools), and to professionals (e.g. EMTs, physicians, nurses, clergy, teachers). In addition, the materials will be specific to trauma type, location of trauma, and to child’s developmental stage. Emphasis will be placed on methods to link child and family focused mental health response to physical health emergency response. The educational and training materials will be developed and disseminated in the form of handouts, CD-ROMs, DVDs and web-based materials, and will include the following: Educational and Training Materials (including PFA), for Physical and Mental Healthcare Professionals, Clergy and Teachers: • General information and fact sheets pertaining to disaster and terrorism • Fact sheets describing trauma-specific mental health issues/symptoms and common responses to disaster/terrorism • Flow charts outlining physical and behavioral response plans and systems of care for children according to disaster type • Fact sheets on developmentally appropriate intervention strategies for different age groups and different cultures • Handouts listing proposed mental health screenings to be used by health professionals • Descriptions of evidence-based interventions • PFA Operations Manuals and training DVDs (modules developed for use by specific type of professionals will be utilized in toolkits for those groups) • Lists of resources for referrals to trauma trained mental health professionals • Bibliographies of relevant research and clinical publications on traumatic stress Kaplan, Sandra 20 Additional Materials for School Personnel: • Guidelines for managing school crises (adapted for use by specific school personnel) • Descriptions of empirically supported school-based interventions Materials for parents: • Checklist on basic emergency plans • Fact sheets on common responses to disaster/terrorism and when to seek medical and/or mental health help (General information pertaining to disaster and terrorism) • Information sheets about what to expect if treatment at a hospital is required (general information about triage, decontamination, anxiety related to trauma) • Bibliographies on child traumatic stress • PFA materials appropriate for use by parents Psychological First Aid (PFA), an evidence-informed approach for helping people cope with typical, distressing thoughts, emotions, and physical reactions in the immediate aftermath (hours to weeks) of highly traumatic events, will be a major component of the proposed Toolkit. Through collaboration with Drs. Steinberg and Brymer (National Center), Layne (NCTSN Expert Core), and Pfefferbaum, (TDB and University of Oklahoma), our Center will serve as a pilot site for the dissemination, utilization, and evaluation of PFA. Our Center’s immediate access to children and families following a disaster or terrorist event, and the frequent disaster drills conducted at our Health System and in its communities, make us an ideal site to pilot PFA. In collaboration with regional first responders and with our Health System emergency department and security personnel, we will adapt our Parenting Guide for EMTs for use by these other professionals. This Guide will be included in the Toolkits for these professionals. The final component of the acute response intervention effort will be training programs for healthcare and school professionals in the use of the materials and interventions in the Toolkit. We will train first responders, teachers, chaplains, primary care providers, and mental health providers in its use. PFA will become an acute response companion to the physical health response plan. PFA-trained professionals will be able to use it currently in their capacities as emergency responders, thereby providing benefit to trauma exposed children and families. Parents will also be trained to utilize their version of PFA through parenting workshops to be offered in collaboration with schools, primary care providers and health educators. Our NCTSN partnerships will include collaboration with existing Network Committees. They will assist us in the development of the many components of the Response Plan and supporting Toolkit. Specifically, we will work with: the TDB Training and Risk Communication Task Forces as we develop curricula and training materials, the TDB Rapid Response Support Team Liaison Group to identify potential collaborators from other Network Centers located within health systems, and the TDB Data Task Force to assist in developing our evaluation strategies. Finally, we will use the TDB Service Systems Task Force to help us adapt the Toolkit for various health system child and adolescent service sites. 2) Plan to Partner with CTS Centers & Service Providers for Dissemination and Adoption Initially, the acute response intervention plans will be developed in collaboration with the NCTSN National Center and its TDB efforts. It will be piloted as the child and family mental health component of our Health System’s existing Emergency Operations Plan. As part of a large Regional Health System of 15 hospitals (and the largest ambulance core in the Northeast) serving 5.4 million residents (including 1.4 million children), our Center is an ideal location to develop a national prototype of a child, adolescent and family focused acute mental health response intervention plan and supportive toolkit. Physical and mental health care providers, who are integral members of the Health System’s Emergency Operations Plan, and chaplains will be trained to use the Toolkit and asked to participate in emergency drills. Trainings will be conducted to familiarize professionals with the contents of the Toolkit and to enable them to use PFA. We plan to disseminate the Toolkit throughout the Country using a “train the trainer” model Kaplan, Sandra 21 in which we will initially train individuals from NCTSN Centers located in, or affiliated with, health systems. These individuals will then train their colleagues to use the Toolkit with school personnel, healthcare providers and parents. We will provide the National Center with electronic versions of Toolkit components for placement on the NCTSN Website for national dissemination. Our Center will also utilize videoconferencing training capacity to provide ongoing consultation and training to NCTSN Centers across the U.S. that are utilizing the Toolkit. Our Center’s relationship with our Health System’s Center for Emergency Medical Services (CEMS) is critical to the successful dissemination of the planned acute response intervention toolkit. As mentioned earlier, CEMS houses a training center and is a leader in the Northeast in training healthcare providers and systems to respond to disasters and terrorism, particularly bioterrorism. Our collaboration with CEMS will not only ensure that the planned acute response interventions for children and families is embedded in our local region’s emergency operations response, but also that it will be made available to other regions and service provider organizations trained by CEMS. Our partnership with The HealthCare Chaplaincy will also facilitate dissemination. Chaplains are often considered first responders following a disaster or terrorist act but generally have little training in child mental health interventions (personal communication, Rev. G. Handzo, April 5, 2005). Chaplains, like other first responder groups, often have immediate access to children and families following disasters or terrorism, and are therefore an ideal group to help disseminate the proposed Toolkit. Through currently established relationships with our Health System’s Department of Professional & Public Health Education, our Center will disseminate the Toolkit to local school administrators and personnel. Specifically, this Department coordinates the System’s School Health Liaison Committee (of which we are a member). It is comprised of regional school administrators, nurses and mental health professionals and will facilitate the informing of these important consumers about the Toolkit. Over the past two years, our Center has also collaborated with our System’s Kiwanis Pediatric Trauma Center to deliver traumatic stress mental health training to regional school personnel and pediatric primary healthcare providers. The Kiwanis Center also supported our conference last year “Pediatric Intervention Models for Traumatic Stress” and has expressed interest in supporting the production and dissemination of some of the proposed terrorism and disaster response materials. Once the Toolkit is complete, our Center, along with the National Center and TDB, will disseminate the Toolkit to all NCTSN Centers affiliated with health systems and school systems. These Centers will provide consumer feedback and will participate in the evaluation of this effort. 3) Sustainability Planning for Disaster and Terrorism Response Since 9/11, the National Center and its TDB efforts have collaborated with us on the development of an acute Health System Regional Mental Health Response for children and families following disaster and terrorism. The proposed acute response Toolkit will also be developed with the National Center and its TDB efforts. Together, we will identify TSA and CTS Centers, which have relationships with health systems and schools. We will then work to disseminate our terrorism and disaster related products through these Centers. We will also work with the American Red Cross through its work with the National Center on the development and dissemination of PFA and make our Toolkit available to the Red Cross as well as to our County and State Departments of Mental Health. Once incorporated into these systems and linked to existing physical health response plans, the Toolkit will be sustainable beyond our individual grant. All of our proposed plans will be made compatible with existing physical health plans and will comply with Federal guideline on mental health response to disaster and terrorism. Sustainability of the Toolkit will also be dependent on our ability to disseminate it widely to community partner agencies and providers that will continue to exist beyond our grant. One such community group that has wide reaching membership, is the Kiwanis International with more than 300,000 members and several hundred thousand young people in a variety of high school and college clubs. Partnering with such organizations will provide our Center with the Kaplan, Sandra 22 ability to disseminate information on a national level through local “grassroots” organizations. We will inform professionals about the Toolkit via presentations at national meetings and through publications. Consumer Collaboration (for all proposed projects) Our Center has made great efforts to obtain consumer input, which has significantly improved the interventions we have developed. Our Center’s current Advisory Board consists of members of NCTSN Category III Centers and community agencies, and a survivor of domestic violence who is a single-parent of traumatized children. Our Center is in the process of expanding our consumer input by establishing two separate advisory boards that will review the projects and products of our Center to increase relevance and accessibility to traumatized adolescents, their families, and healthcare professionals. An adolescent advisory board will be made up of seven to ten adolescents, including students from a local alternative high school, peer leaders from local religious and civic youth organizations, and adolescent and/or young- adult survivors of trauma who have been successfully treated by our Center. An adult advisory board will consist of a similar number of consumers, including the founder of a charter school for inner city youth, a 9/11 survivor with a catastrophic injury, members of the Nassau Partnership for Healthy Communities and local members of the National Alliance for the Mentally Ill. We have commitments from all of the above cited persons and organizations, and will also include members from the NCTSN CTS Centers with which we are working. Our Boards will be culturally, racially and ethnically diverse. We will hold at least semi-annual meetings with each group, during which they will provide input regarding materials sent to them for review prior to these meetings. Frequent (between Advisory Group meetings) consumer feedback will also be sought for all projects. As we develop the acute response Toolkit, we will seek review of materials and feedback from child caregivers and first responders, including teachers, clergy, mental health and primary care providers, and emergency responders. In addition, we will also seek feedback from groups of September 11th survivors and their families regarding the Toolkit. Incorporation of Cultural and Social Diversity (for all proposed projects) We have consistently attempted to improve the cultural competence of all of our Center’s projects. We have systematically obtained feedback from adolescents and CTS Centers (most notably Safe Horizon and Children’s Institute International) where our SPARCS intervention has been piloted successfully with diverse groups including African-American and Hispanic adolescents living in poverty-stricken areas. This feedback has been invaluable in adapting and revising SPARCS to increase its relevance to these groups. For example, in addition to our regular feedback during weekly consultations, we hosted a CTS clinician for two days during which additional, alternative activities for recent immigrant Hispanic adolescents began to be developed. In addition, we have translated our SPARCS Handouts, given to adolescents during sessions, into Spanish, as well as the primary measure (SIDES-A) we developed to evaluate the broad array of symptoms associated with trauma exposure. We are disseminating the Spanish version of the SIDES-A to all sites involved in the evaluation of SPARCS that have Spanish- speaking clients. These materials, prepared by a member of our staff who recently emigrated from Latin America, are not simply word-for-word translations, but have been changed to incorporate culturally relevant concepts and examples. This staff member will continue to review all materials we produce to increase relevance to Hispanic populations and allow greater access to our interventions by Spanish speaking groups. We have also made conscious efforts during training activities to encourage clinicians to use culturally appropriate examples within SPARCS’ activities and discussions. Additional examples of cultural sensitivity include using human figures in session handouts selected to reflect diverse races, or to be racially ambiguous and working to make SPARCS sensitive to individual factors such as gender and literacy level. We will continue to address issues of literacy and diversity with the NCTSN Center for Child and Family Health (Durham, NC), and with the rural North Dakota site described previously. The SPARCS manual and Kaplan, Sandra 23 activities are designed to avoid heterosexism and can be used with gay and lesbian populations. We will continue to use the resources of the diverse NCTSN Centers to increase the utility of our interventions for a wide range of culturally and socially diverse populations. We will also consider religious diversity in future activities. Currently SPARCS is applicable to many different cultural groups, even when addressing clients’ systems of meaning (including religious beliefs) and we have been careful not to present or endorse any specific religious perspectives in our discussions of systems of meaning. We have been contacted by groups that serve traumatized adolescents within religious communities (e.g. Orthodox Jews, Evangelical Christians, observant Catholics and Muslims). These groups have expressed an interest in SPARCS, but have requested that some sessions consider religious beliefs, especially when addressing systems of meaning. To our knowledge, no manually-guided, evidence-based intervention has created ways to integrate optional religious components into trauma treatment. The incorporation of religious perspectives by faith-based mental health professionals into optional modules may make SPARCS more useful for traumatized adolescents in religious communities. To create these optional modules, we have begun to collaborate with the HealthCare Chaplaincy, which has representatives from most of the religions practiced in the U.S. This organization, which we have provided with trauma training in the past, has also agreed to review the SPARCS manual for religious sensitivity. The Healthcare Chaplaincy will also help us review and revise our terrorism and disaster response plans. We are aware that major components of our response plans will involve immediate support/assistance to families which have injured or deceased loved ones and outreach to groups that have been impacted by an event. To be effective and to be accepted, the Plan and Toolkit need to be sensitive to the customs, rituals, belief systems and sources of support as they pertain to traumatic experiences, healthcare, death/dying, and bereavement. C. Evaluation Protocols for Evaluating the SPARCS Intervention Our proven successful collaborations with many NCTSN Centers in the training and implementation of SPARCS provide a foundation for effective evaluation. We have worked closely with the CTS sites previously mentioned to address potential barriers in the following ways: 1) SPARCS treatment fidelity will be evaluated through adherence checklists completed by our staff during the weekly clinical consultations; 2) assessors at all sites will be extensively trained and provided with telephone consultation support as needed; and 3) a list of recommended questionnaires and interviews are provided to each site with detailed instructions for identification coding and copying of completed forms. We will assess the efficacy of the SPARCS intervention using two separate models based on the ability of the site to also include adolescents receiving “treatment as usual”: 1) comparing the pre- and post-treatment responses of the SPARCS group to those of the “treatment as usual” group, or 2) comparing pre- and post-treatment responses of the SPARCS group. The assessment measures described will be administered before and after the intervention. As indicated in the Goals and Objectives section, feedback from consumers and stakeholders has been, and will continue to be, an important part of our overall evaluation. Feedback will be requested from clinicians, teachers, administrators, and participants from each site where the intervention is implemented. This feedback will be used to evaluate the current intervention, and to revise the intervention and training program. We plan to submit SPARCS to NREP before the cessation of the proposed grant. Assessment Measures – The following is a typical package of assessment instruments for measuring change in chronically traumatized adolescents receiving interventions. As we have in the past, we will also use any measures required by the NCTSI, once they are finalized. Structured Interview for Disorders of Extreme Stress for Adolescents (SIDES-A; Pelcovitz, et al., 2005) is a clinical interview for adolescents based on the SIDES (Pelcovitz, et al., 1997). It assesses alterations in functioning in the following areas: 1) affect regulation, 2) attention & Kaplan, Sandra 24 consciousness, 3) self-concept, 4) interpersonal relationships, 5) somatization, and 6) systems of meaning. We have translated this interview into Spanish and include it in Appendix B. PTSD Module from SCID I (First et al., 1996) is considered the “gold standard” clinical interview to assess current and lifetime symptoms of Posttraumatic Stress Disorder. We have also translated this interview into Spanish. Measures of Perceived Social Support from Family (PSS-Fa) and Perceived Social Support from Friends (PSS-Fr) The PSS-Fa and PSS-Fr (Procidano & Heller, 1983) each consist of 20 items relating to the degree of intimacy and support provided by friends and family. Youth Outcome Questionnaire-Self Report (Y-OQ-SR) The Y-OQ-SR (Wells, Burlingame, & Rose, 1999) is specifically constructed to track progress and outcome of psychotherapy for children and adolescents (see Mosier et al., 2001). It is composed of 64 items that comprise six subscales and a Total, designed to tap Intrapersonal Distress (ID), Somatic (S), Interpersonal Relations (IP), Critical Items (CI), Social Problems (SP), and Behavioral Dysfunction (BD). Children’s Coping Strategies Checklist- Rev.1 (CCSC-R1; Ayers, et al, 1996). A 54-item questionnaire designed to assess coping strategies, including 1) Active (problem focused, positive reframing), 2) Distraction (e.g. physical release of emotions) 3) Avoidance (avoidant actions, wishful thinking), and 4) Support Seeking (support for actions, support for feelings). The Self-Satisfaction Survey (SSS) The SSS (Kochendorfer, 1974) is a 10-item self-report survey of general satisfaction with a group-related experience shown to be sensitive to clinical change in adolescent groups (Hoag, Primus, Taylor, & Burlingame, 1996). Trauma Symptom Checklist for Children (TSCC; Briere, 1996). A 54-items self-report measure of posttraumatic stress and related symptomatology. Includes 2 validity scales (Under- response & Hyper-response), 6 clinical scales (Anxiety, Depression, Anger, Posttraumatic Stress, Dissociation, and Sexual Concerns), and 8 critical items. Posttraumatic Cognitions Inventory (PTCI ; Foa, et al., 1999). A 36-item self-report instrument designed to measure trauma-related thoughts and beliefs related to the following domains: negative cognitions about self, negative cognitions about the world, and self-blame. Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003). A 15-item self-report measure assessing degree of attention/awareness of what is occurring in the present moment. Data Analysis All evaluation data from CTS sites will be coded and identified with unique numbers in order to protect confidentiality. For data collected by distant sites, it will be copied without identifiers and sent to the North Shore University Hospital where all data entry, cleaning, and analyses will be conducted. Statistical analyses will be conducted using SAS. Adolescent evaluation data will be analyzed by location with respect to gender, ethnicity and race using Chi Squares and with respect to age and SES using ANOVAs. Repeated measures (time) analyses will utilize PROC MIXED. Analyses will be conducted first across all locations with location dummy-coded and entered as a covariate. For sites where there is a waitlist comparison group, group (intervention vs. comparison) and the group by time interaction will also be entered into the PROC MIXED model. Analyses will be conducted on the following symptoms with Z scores computed on the summed measures which assess the symptom: Affective and Impulse Control (consisting of the YOQ Intrapersonal distress, Social Problems, and Behavioral Dysfunction subscales and the SIDES Affective and Impulse Control Scale), Attention/Consciousness (consisting of the SIDES Attention/Consciousness scale), Somatization (the YOQ Somatization subscale and the SIDES Somatization scale), Self-perception (the PTCI Self-Blame, the Negative Cognitions about Self subscale scores, and the SIDES Self-Perception score), Relations with Others (consisting of the YOQ-Interpersonal Relations, the PSS-Fr/PSS-Fa, and SIDES Relations with Others scale), Systems of Meaning (consisting of the PTCI Negative Cognitions about the World subscale score, and SIDES Systems of Meaning scale). We will also conduct pre-/post-intervention analyses on the MAAS and TSCC. Kaplan, Sandra 25 With respect to our analyses involving a comparison group, a total of at least 64 subjects completing intervention and comparison groups will give us a power of .80, α=.05, to detect a medium effect size. Missing data will be accounted for using several methods. With respect to attrition (participants who drop out before completion of the intervention), we plan to compare the baseline scores of these subjects with those who complete the intervention to look for a bias. Second, we will conduct a PROC MI (multiple imputation) analysis of the data. This is considered the state-of-the-art approach to dealing with missing data. Rather than substituting a single value for each missing value (simple imputation), multiple imputation replaces each missing value with a set of plausible values that represent the uncertainty about the right value to impute. These data sets are analyzed using standard procedures and the results are combined. Finally, the use of PROC MIXED as opposed to other GLM analyses allows for missing data. A secondary sensitivity analysis will compare the different methods. Evaluation of Adolescent Trauma Resource Center Activities The adolescent-specific website section of the NCTSN website will contain links to an anonymous survey that will ask questions about the accessibility, utility, and overall appeal of the survey layout and content. Staff members at our Center have already begun to familiarize themselves with evaluations of website use among American adolescents. Evaluation of the website section that will be developed for adolescents will be carried out via anonymous on-line surveys, electronic counters that report the number of website visitors, and regular monitoring, by our staff, of the ease of the site’s accessibility via popular search engines. Website visitors will also be able to write comments during their visits. Attention will be paid to using feedback to make the website useful for both male and female adolescents of multiple racial/ethnic backgrounds who live in rural, suburban, and urban areas. A similar evaluation will also be conducted for the professional sections of the website, consisting of web ”hits”, a survey of NCTSN sites concerning the usefulness of the site, and website visitor reviews. With respect to the Survey of Adolescent Services, our goal is to have all 9 Centers within the Tri-State New York Metropolitan Region complete the Survey (at least for adolescent-specific programs and services). Our Center will compare programs listed in the survey to the known programs at these Centers to ensure that information on all programs has been entered. Responses from sites will be compiled and made available to the Network in a detailed report. We will also continue to track people attending our Center’s public and professional education and training programs. Not only will we identify the number and type of people attending these programs, but we will attempt to maintain ongoing contact with them to determine the extent to which the training is incorporated into the clinical care provided by professionals. Ongoing contact will also allow us to determine the durability of any changes and allow these clinicians to provide ongoing feedback. Evaluation of the Acute Disaster and Terrorism Response Toolkit During 2004 our Center hosted two focus groups consisting of regional clinicians, researchers, and administrators for the purpose of thinking about methods of implementing and evaluating disaster response plans, and potential barriers (e.g. difficulty obtaining informed consent immediately after disasters) Based on these groups (and with their members as advisors) we will evaluate the Response Plan and Toolkit as follows: 1) Focus groups consisting of child healthcare professionals and first responders will be conducted to review the Toolkit materials, including the Health System/ Regional Acute Response Plan; 2) After being trained, consumers are trained in the use of the Toolkit, they will evaluate the training they received (consumer satisfaction surveys); 3) Healthcare providers and other consumers, trained in using the Toolkit, will apply their knowledge through “Tabletop Exercises”. During these exercises, they will be given disaster scenarios and will then discuss the usefulness and applicability of each of the components of the Toolkit. Evaluators will assess the groups’ knowledge and ability to appropriately implement different components of the Toolkit; 4) We plan to examine the use and efficacy of the proposed toolkit following incidents such as multi-victim mechanical or natural Kaplan, Sandra 26 disasters, and school based traumatic events; 5) Once incorporated into Regional and Health System emergency operations plans, the Toolkit will be evaluated during standard disaster drills. During such drills, observers will grade healthcare providers’ ability to access the Toolkit, to disseminate appropriate materials (e.g. fact-sheets) and to implement PFA. The PFA evaluation will consist of pre- and post-intervention measures of distress and clients’ satisfaction. Longer- term evaluation will consist of following-up with individuals who received PFA (and gave permission to be re-contacted) to invite them to participate in later evaluations. D. Staff, Management, and Relevant Experience The proposed project goals are broad and necessitate having skilled staff, each with multiple talents and experiences. Our staff consists of highly qualified professionals who have been working together closely for up to 25 years. Key Staff, Roles, and Percent of Effort Devoted to the Proposed Project Sandra Kaplan, M.D. (25% effort) will continue in her role as Project Director of our NCTSN Category II Center. She will be responsible for the overall leadership of the program and for the administration, direction and design of this project. She will also be responsible for the presentation and publication of findings, and assurance of the integrity of the project. David Pelcovitz, Ph.D. (10% effort) will continue in his role as Co-Director of our NCTSN Center. His responsibilities in the proposed program include continued modification of the SPARCS intervention, further work on fidelity measures, training of community sites in the intervention, and contributing to evaluation activities. Victor Labruna, Ph.D. (50% effort) will continue in his role as Coordinator of our Center. He will coordinate the following activities: monitoring progress towards goals/objectives; supervision of Center staff; communication with other Centers, SAMHSA representatives, and the National Center’s Network-wide evaluation initiatives; and completion of required reports. He will also contribute to decisions regarding assessment, data management, and statistical analyses. Ruth DeRosa, Ph.D. (50% effort) was instrumental in developing the SPARCS manual that is the focus of this proposal. She will lead, along with Dr. Pelcovitz, the adaptation and further development of interventions for chronically traumatized adolescents. She will coordinate and lead ongoing training and consultation of clinicians at collaborating CTS Centers and will select outcome, treatment fidelity, and process measures to assess interventions. Victor Fornari, M.D. (5% effort: in kind) will contribute his expertise on the treatment of adolescents exposed to natural and technical disasters to the proposed project, as well as his knowledge of interventions for school violence exposure. Alan Cohen, M.D. (10% effort) will lead the integration of our disaster and terrorism response interventions into the Health System’s Emergency Operation plans for piloting. He will also continue to work on interventions to support first responders and adapting the Parenting Guide for EMTs so that it is appropriate for other first responders. Juliet Vogel, Ph.D. (20% effort) will use her experience implementing manually-guided interventions in community settings to assist in planning the implementation and evaluation of interventions. She will also continue to work on materials for EMS workers and their families, and will continue as a member of the Measures Committee and the Adolescent Development Committee of the Adolescent Consortium. Suzanne Sunday, Ph.D. (20% effort) will be responsible for planning and conducting intervention evaluation analyses, including the impact of variables such as treatment fidelity, and cultural factors. She will support Network-wide data summarization and analyses, will also supervise training in clinical interviewing, and continue on the AC Adolescent Development Committee and continue to participate on the NCTSN Measure Review Database Team. One of our staff will be assigned to track data collection efforts at all sites that are implementing the SPARCS intervention and the disaster/terrorism Response Plan and Toolkit, and will manage our evaluation database, and will track treatment fidelity using measures we have developed. This staff member will also track professionals who receive training through our Kaplan, Sandra 27 Adolescent Traumatic Stress Resource Center programs and maintain ongoing contact with them. Our Center’s Director and Coordinator have already contributed to the content of the cross-site evaluation through conference calls with the group developing the evaluation. We will continue to participate fully in the development and implementation of the cross-site evaluation. Our Center staff includes professionals from many cultural backgrounds, including Hispanic, Asian, and Native-American, and languages spoken include Spanish, French, Italian, and Hebrew. Translation services are also available to us in over 150 different languages. Our Health System has also been a strong advocate for enhancing the cultural competence of healthcare in our region; it houses (and is a member of) the Nassau County Partnership for Health Communities, which includes over 20 physical and mental health agencies, and advocacy groups across Long Island (Nassau and Suffolk Counties). Member organizations, which have collaborative agreements in place with our Health System, include the Coalition to Eliminate Racial & Ethnic Disparities in Healthcare, the Hispanic Counseling Center, the Islamic Center of Long Island, the Long Island Minority AIDS Coalition, and ERASE (Education, Research, Advocacy, & Support to Eliminate) Racism. This Partnership is developing a cultural competence infrastructure for physical and mental health agencies, and developed a cultural competence self-assessment tool and a program to generate interest in pursuing health professions in minority youth. We will continue collaborating with the Partnership, which will review products of our Center and distribute them to member organizations for review and input. Products will then be adapted based on this feedback. Kaplan, Sandra 28 Section E. Literature Citations Ayers, T. S., Sandler, I. N., West, S. G., & Roosa, M. W. (1996). A dispositional and situational assessment of children's coping: testing alternative models of coping. Journal of Personality, 64, 923-958. Ben-Porath, Y.S. (1997). Use of personality assessment instruments in empirically- guided treatment planning. Psychological Assessment, 9, 361-367. Briere, J. (1996). Trauma Symptom Checklist for Children: Professional Manual. Florida: Psychological Assessment Resources Inc. Burlingame, G. M., Mosier, J. I., Wells, M. G., Atkin, Q, G., Lambert, M. J., Whoolery, M., et al. (2001). Tracking the influence of mental health treatment: the development of the Youth Outcome Questionnaire. Clinical Psychology and Psychotherapy, 8, 361-379. Cohen, J., Deblinger, E., Mannarino, A., Steer, R. (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 393-402. Dudding, C. & Justice, L. (2004). An E-Supervision Model: Videoconferencing as a Clinical Training Tool. Communication Disorders Quarterly. 25, 145-151. Federal Emergency Management Agency (1996). Guide for All-Hazard Emergency Operations: State and Local Guide. Washington, D.C. Foa, E. B., Ehlers, A., Clark, D. M., Tolin, D. F., & Orsillo, S. M. (1999). The Posttraumatic Cognitions Inventory (PTCI): development and validation. Psychological Assessment 11(3), 303-314. Ford, J. D., Kasimer, N., MacDonald, M., & Savill, G. (2001). Trauma Adaptive Recovery Group Education and Therapy (TARGET) Participant and Leader Manuals. Farmington, CT: University of Connecticut. Finn, S. & Tonsager, M. (1997). Information-gathering and therapeutic models of assessment: Complementary paradigms. Psychological Assessment, 9, 374-385. Grove, W. M., & Meehl, P. E. (1996). Comparative efficiency of informal (subjective, impressionistic) and formal (mechanical, algorithmic) prediction procedures: The clinical- statistical controversy. Psychology, Public Policy, and Law, 2, 293-323. Gurwitch, R.H., & Messenbaugh, A.K. (2001). Healing after trauma skills: A manual for professionals, teachers, and families working with children after trauma/disaster. Oklahoma City, OK: University of Oklahoma Health Sciences Center. Health Information Project, Mid-Hudson Library System (2005). Top Teen Picks: Web Sites [On-line]. Available: http://hip.midhudson.org/hip_websites2004.htm Hexel, M., & Sonneck, G. (2002). Somatoform symptoms, anxiety, and depression in the context of traumatic life experiences by comparing participants with and without psychiatric diagnoses. Psychopathology, 35(5), 303-312. Hodges, K. (2004). Using Assessment in Everyday Practice for the Benefit of Families and Practitioners. Professional Psychology: Research & Practice, 35, 449-456. Kaplan, S.J., Pelcovitz, D., Salzinger, S., Weiner, M., Mandel, F, Lesser, M. & Labruna, V. (1998). Adolescent physical abuse: risk for adolescent psychiatric disorders. American Journal of Psychiatry, 155, 954-959. Kilpatrick, D. G., Saunders, B. E., & Smith, D. W. (2003). Youth victimization. Research in Brief. U.S. Department of Justice: National Institute of Justice. Layne, C., Pynoos, R., Saltzman, W., Arslanagic, B., Savjak, N., Popovic, T., Durakovic, E., Music, M., Campara, N., Djapo, N., & Houston, R. (2001). Trauma/grief-focused group psychotherapy: School-based postwar intervention with traumatized Bosnian adolescents. Group Dynamics: Theory, Research and Practice, 5, 277-290. McGee, R., Wolfe, D., & Olson, J. (2001). Multiple maltreatment, attribution of blame, and adjustment among adolescents. Development and Psychopathology, 13, 827-846. Kaplan, Sandra 29 Mitchell, J., Myers, T., & Swan-Kremeier, L. (2005). Psychotherapy for bulimia nervosa delivered via telemedicine. Telehealth Report, in press. Mitchell, J. T. (1983). When disaster strikes...The Critical Incident Stress Debriefing. Journal of Emergency Medical Services, 8, 36–39. Mueser, K. T., Rosenberg, S. D., Goodman, L. A., & Trumbetta, S. L. (2002). Trauma, PTSD, and the course of severe mental illness: an interactive model. Schizophrenia Research, 53, 123-143. Myers, T., Swan-Kremeier, L., Wonderlich, S., Lancaster, K., & Mitchell, J. (2004). The use of alternative delivery systems and new technologies in the treatment of patients with eating disorders. International Journal of Eating Disorders, 36, 123-143. Pelcovitz, D., Kaplan, S., DeRosa, R., Mandel, F., Salzinger, S. (2000). Interparental Violence: Adolescents at Risk for Psychiatric Disorders. American Journal of Orthopsychiatry, 70, 360-369. Pew Internet and American Life Project (2005). Teenage Life Online: The rise of the instant-message generation and the Internet's impact on friendships and family relationships [On-line]. Available:http://www.pewinternet.org/PPF/r/36/report_display.asp Procidano, M. E., & Heller, K. (1983). Measures of perceived social support from friends and from family: three validation studies. American Journal of Community Psychology, 11, 1-23. Romano, S., Quinn, L., & Halmi, K., (2004). Cognitive-behavioral group psychotherapy for bulimia nervosa: Clinical considerations and group format. Eating Disorders: The Journal of Treatment & Prevention, 2, 31-41. Rathus, J. H. & Miller, A. L. (2002). Dialectical Behavior Therapy adapted for suicidal adolescents. Suicide & Life-Threatening Behavior, 32, 146-157. Red Cross (2001). Facing Fear. Washington DC: The American National Red Cross Rose S, Bisson J, Wessley S. (2003). Psychological debriefing for preventing post traumatic stress disorder (Cochrane Review). In: The Cochrane Library, Issue 1. Oxford: Update Software. (AI). Roth, S., Lebowitz, L., & DeRosa, R. (1997). Thematic assessment of post-traumatic stress reactions. In J. Wilson & T. Keane (Eds.). Assessing psychological trauma and PTSD: A handbook for practitioners. NY: Guilford Press. Rudestam, K. E. (2004). Distributed education and the role of online learning in training professional psychologists. Professional Psychology: Research and Practice, 35(4), 427-432. Silva, R., Cloitre, M., Davis, L, Levitt, J., Gomez, S, Ngai, I., & Brown, E. (2003). Early intervention with traumatized children. Psychiatric Quarterly, 74, 333-347. U.S. Department of Health and Human Services. (2003) Mental Health All-Hazards Disaster Planning Guidance. DHHS Pub. No. SMA 3829. Rockville, MD: Center for Mental Health Services, Substance Abuse Mental Health Services Administration. U.S. Census Bureau (2000). United States Census 2000. U.S. Dept of Commerce Van der Kolk, B.A., & Fisler, R. (1995). Dissociation and the fragmentary nature of traumatic memories: overview and exploratory study. Journal of Traumatic Stress, 8, 505-525. Vogel, J. M., Solanto, M. V., Morrissey, R. F., & Koplewicz, H. S. (April 1995). Predictors of persisting distress in elementary school children exposed to the World Trade Center disaster. Poster presented at the Biennial Meeting of the Society for Research in Child Development, Indianapolis. Vogel, J. M. & Vernberg, E. M. (1993). Children’s psychological responses to disasters. Journal of Clinical Child Psychology, 22, 464-484. Wells, M. G., Burlingame, G. M., & Rose, P. (1999). Manual for the Youth Outcome Questionnaire Self-Report. Wharton, New Jersey: American Professional Credentialing Service. Kaplan, Sandra 30 Wordes, M. & Nunez, M. (2002). Our Vulnerable Teenagers: Their victimization,its consequences, and directions for prevention and intervention. Report published by the National Council on Childhood Delinquency and the National Center for Victims of Crime. Kaplan, Sandra 31 Budget Justification Personnel Director – Is responsible for leading the entire project, serving on, and collaborating with, the NCTSI Steering Committee and is responsible for supervising all project staff. Co-Director – Is responsible for overseeing the development of specific treatments for traumatized youth Project Coordinator – Responsible for coordinating the following: the activities of key personnel, communication between this site and the other Centers, and data management (including statistical analyses and sharing of clinical/evaluation data with other Centers). Psychologist/Psychiatrist - will be responsible for developing, implementing, and evaluating new and innovative treatments for traumatized adolescents. Senior Statistician – is responsible for leading all research development, data management, and statistical analyses Fringe Benefits – The 28% Fringe rate consists of FICA, health insurance, pension contribution, malpractice insurance, workman’s compensation insurance. Equipment – Equipment for videoconferencing for our Center, as well as 4 other Centers has been included in the budget. This equipment will allow our Center to conduct weekly videoconferencing with the other sites. The equipment is transferable and will be given to new Centers after initial Centers are trained. Supplies – In addition to basic office supplies, we have requested support for photocopying/printing costs associated with the relatively large treatment manuals and handouts needed for treatment implementation Travel – A travel budget has been requested sufficient to ensure that the SAMHSA goals of collaboration between NCTSN Centers is achieved through frequent meetings. Other – A consultant (J. Ford) has been requested in the budget to assist in adapting our intervention for juvenile justice settings and to assist our Center in disaster and terrorism response. SubContracts – One subcontract has been included in the budget for the services of David Pelcovitz, Ph.D., to continue to serve as the Co-Director of our Center. Indirect Costs – Attached is a copy of the negotiated rate agreement for indirect costs. Although the negotiated indirect rate is over 60%, the requested amount for the current application has been reduced to 15%. Kaplan, Sandra 32 Section G. Bio Sketches and Job Descriptions BIOGRAPHICAL SKETCH NAME POSITION TITLE Sandra J. Kaplan, M.D. Vice Chairman, Department of Psychiatry for Child and Adolescent Psychiatry, North Shore University Hospital EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.) INSTITUTION AND LOCATION DEGREE YEAR(s) FIELD OF (if STUDY applicable) George Washington University, Washington, DC B.S. 1963 Zoology Temple University School of Medicine, Philadelphia, PA M.D. 1967 Medicine The Robert E. Wagner Graduate School of Public Service M.S. 1996 Health of the New York University Management Positions and Employment 1968-1969 Pediatrics Residency, St. Christopher’s Hospital for Children, Philadelphia, PA 1970-1971 Pediatric Neurology Fellowship, Children’s Hospital of Washington, DC 1971-1972 Child Psychiatry and Learning Disorders Fellowships, Children’s Hospital of Washington 1972-1974 Child Psychiatry Fellowship, Eastern Pennsylvania Psychiatric Institute, Philadelphia, PA 1974-1976 Adult Psychiatry Residency, Eastern Pennsylvania Psychiatric Institute, Philadelphia, PA 1977-1978 Forensic Psychiatry Fellowship, New York University School of Medicine 1986 -1996 Associate Professor of Clinical Psychiatry, Cornell University Medical College 1997 -1998 Associate Professor of Clinical Psychiatry, New York University School of Medicine 1998 -present Professor of Clinical Psychiatry, New York University School of Medicine 1990 -1996 Chief, Child & Adolescent Psychiatry, North Shore University Hospital, Manhasset, N.Y. 1996 -1998 Associate Chairman, Department of Psychiatry, North Shore University Hospital 1998 -present Vice Chairman, Dept of Psychiatry for Child & Adolescent Psychiatry, North Shore University Hospital 1987 -1993 & Chair, Committee on Family Violence and Sexual Abuse, American Psychiatric 1995–2002 Association 2002 to present Member, Council on Children and Families, American Psychiatric Association (APA) Other Experience, Professional Memberships, and Board Certifications 1975 American Board of Pediatrics 1977 American Board of Psychiatry and Neurology 1979 American Board of Child and Adolescent Psychiatry 2001 American Board of Psychiatry & Neurology Subspecialty Cert. in Forensic Psychiatry 1997 –2002 Member, Task Force on Violence, American Psychiatric Association 1993 –present Member, Steering Committee, AMA National Advisory Council on Violence and Abuse 2001- Present Member, United States Department of State Civilian Psychiatric Response Team Honors 2001 McGavin Award for Research Contributions to Primary Prevention in Child Psychiatry, APA Kaplan, Sandra 33 B. Selected peer-reviewed publications (in chronological order). 1. Kaplan, S, Pelcovitz, D, Ganeles, D, and Salzinger, S. (1983). “Psychopathology of Parents of Abused and Neglected Children.” Journal of the American Academy of Child Psychiatry,22, 238-244. 2. Kaplan, S, and Zitrin, A. (1983). Psychiatrists and Child Abuse I. Case Assessment by Child Protective Services.Journal of the American Academy of Child Psychiatry, 22, 253-256. 3. Kaplan, S, and Zitrin, A. (1983). Psychiatrists and Child Abuse II. Case Assessment by Hospitals. Journal of the American Academy of Child Psychiatry, 22, 257-26l. 4. Pelcovitz, D, Kaplan, S, Samit, C, Krieger, R. (1984). Adolescent Abuse: Family Structure and Treatment Implications. Journal of the American Academy of Child Psychiatry, 23, 85-90. 5. Salzinger, S, Kaplan, S. (1984). Mother’s Personal Social Networks and Maltreatment. Journal of Abnormal Psychology, 92, 68-76. 6. Salzinger, S, Kaplan, S, Pelcovitz, D, Samit, C, Krieger, R. (1984). Parent and Teacher Assessment of Children’s Behavior in Child Maltreating Families. Journal of the American Academy of Child Psychiatry, 23, 458-464. 7. Pelcovitz D, Kaplan S, Goldenberg B, Mandel F, Lehane J, Guarrera J. (1994). PTSD in physically abused adolescents. Journal of the American Academy of Child & Adolescent Psychiatry,33,305-312. 8. Kaplan, S., Pelcovitz, D., (1994). Editor, Child Abuse. Child & Adolescent Psychiatric Clinics of North America. 9. Kaplan, S, Pelcovitz, D, Weiner, M. (1994). Adolescent physical abuse. Child Psychiatric Clinics of North America, 3, 695-712. 10. Kaplan, S. (1995) Diagnostic and Treatment Guidelines on Family Violence and Mental Health. Chicago: AMA. 11. Kaplan, S. (1996). Editor, Family Violence: A Clinical and Legal Guide.Wash, D.C.:APA Press. 12. Kaplan, S. (1997). Editor, A Directory of Video Tapes For Clinical Interviewing and Case Management of Family Violence Victims. American Medical Association. 13. Kaplan, S, Pelcovitz, P, Salzinger, S, Mandel, F, Weiner, M. (1997). Physical abuse and adolescent suicide attempts. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 799-808. 14. Kaplan, S, Pelcovitz, P, Salzinger, S, Mandel, F, Weiner, M., Lesser, M., and Labruna, V. (1998). Adolescent physical abuse: Risk for adolescent psychiatric disorders. American Journal of Psychiatry, 155, 954-959. 15. Kaplan, S, Pelcovitz, D., Salzinger, S., Mandel, F., Wiener, M., and Labruna V. (1999). Adolescent abuse and risk for suicidal thoughts and behaviors. Journal of Interpersonal Violence, 14, 976-988. 16. Kaplan, S, Labruna V., Pelcovitz, D., Salzinger, S., Mandel, F., Wiener, M. (1999). Physically abused adolescents: Behavior problems, functional impairment, and comparison of informants’ reports. Pediatrics, 104, 43-49. 17. Kaplan, S, Pelcovitz, D., and Labruna V. (1999). Child and adolescent abuse and neglect research: A review of the past 10 years. Part I. Physical and emotional abuse and neglect. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1214-1222. 18. Pelcovitz, D., Kaplan, S., Salzinger, S., Weiner, M., Ellenberg, A.,Labruna, V., Salzinger, S. (2000). Adolescent physical abuse: Adolescent perception of family functioning and age at time of abuse. Journal of Family Violence, 15, 375-389 19. Pelcovitz, D., Kaplan, S., DeRosa, R., Mandel, F., Salzinger, S. (2000). Interparental Violence: Adolescents at Risk for Psychiatric Disorders. American Journal of Orthopsychiatry, 70, 360-369 20. Mandel, F, Weiner, M, Kaplan, S, Pelcovitz, D and Labruna, V. (2000). An examination of bias in volunteer subject selection: Findings from an in-depth child abuse study. Journal of Traumatic Stress, 3, 77-88 21. Kaplan, S., Pelcovitz, D., & Fornari, V. (2005). The Treatment of Children Impacted by the World Trade Center Attack, in Danieli, Y., Brom, D., & Sills, J. (Eds.) The Trauma of Terrorism: Sharing Knowledge and Shared Care An International Handbook. Binghamton, NY: The Haworth Maltreatment & Trauma Press. Kaplan, Sandra 34 BIOGRAPHICAL SKETCH Provide the following information for the key personnel in the order listed on Form Page 2. Photocopy this page or follow this format for each person. NAME POSITION TITLE David Pelcovitz, Ph.D. Professor of Education EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.) DEGREE YEAR(s) INSTITUTION AND LOCATION (if FIELD OF STUDY applicable) Brooklyn College B.A. 1973 Psychology Brooklyn College M.S. 1974 School Psycholgy University of Pennsylvania Ph.D. 1977 Psychological Services/ Professional Scientific RESEARCH AND PROFESSIONAL EXPERIENCE: 1978- Post-Doctoral Fellowship, Clinical Psychology, Devereux Foundation, Institute for Clinical Training 1989-1994- Co-Principal Investigator, 1989-1994, National Institute of Mental Health Grant 1R01MH 43772-01A1 1993-1994 National Institute of Mental Health, National Field Trials for DSM-IV Post Traumatic Stress Disorder, Co-Site Coordinator Academic and Administrative Appointments: 1982-1986 Clinical Instructor, Psychology in Psychiatry, Cornell University Medical College 1986-1993 Clinical Assistant Professor, Psychology, Cornell University Medical College 1993-1997 Clinical Associate Professor of Psychology, Cornell University Medical College 1997-present Clinical Professor, Psychology in Psychiatry, NYU School of Medicine 1980--present, Chief Psychologist, Child and Adolescent Psychiatry, North Shore University Hospital 1993-present, Director of Research, Department of Psychiatry, North Shore University Hospital 2000-2004, Director of Psychology, North Shore University Hospital 2004-present Attending Psychologist, North Shore University Hospital 2004-present Professor of Education, Yeshiva University Selected Publications B. Selected peer-reviewed publications (in chronological order). 1. Pelcovitz, D., Kaplan S., Samit C., Krieger R., & Ganeles D. (1994). Adolescent abuse: Family structure and implications for treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 23, 85-90. 2. Pelcovitz, D., Adler A., Packman, L., & Kaplan S. (1992). A failed school-based sexual abuse prevention effort. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 887-892. 3. Pelcovitz, D., Kaplan S., Goldenberg B., Mandel F., Lehane J., & Guarrera J. (1994). Post- traumatic stress disorder in physically abused adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 305-312. Kaplan, Sandra 35 4. Pelcovitz, D., & Kaplan S. (1994). Child witnesses of violence between parents: Psychosocial correlates and implications for treatment. Child and Adolescent Psychiatric Clinics of North America, 3, 745-758. 5. Pelcovitz, D., & Kaplan S. (1996). Post-traumatic stress disorder in children. Child and Adolescent Psychiatric Clinics of North America, 5, 449-469. 6. Najarian, L., Goenjian, A., Pelcovitz, D., Mandel, F., Najarian, B. (1996). Relocation after a disaster: Post-traumatic 7. stress disorder (PTSD) in Armenia after the earthquake. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 374-383. 8. Kaplan, S. J, Pelcovitz, D., Salzinger, S., Mandel, F. S. & Weiner, M. (1997). Adolescent physical abuse and suicide attempts. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 799-808. 9. Pelcovitz, D., van der Kolk, B., Roth, S., Mandel, F., & Kaplan S. (1997). Development of a criteria set and a structured interview for disorders of extreme stress. Journal of Traumatic Stress, 10, 3-16. 10. Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trial for post-traumatic stress disorder. Journal of Traumatic Stress, 10, 539-555. 11. Kaplan S., & Pelcovitz, D. (1997). Incest, DSM-IV sourcebook, Volume 3, Washington, DC: American Psychiatric Press. pp. 805-857. 12. Pelcovitz, D., Libov, B., Mandel, F., Kaplan, S., Weinblatt, M., & Septimus, A. (1998). Posttraumatic stress disorder and family functioning in adolescent cancer. Journal of Traumatic Stress, 11, 205-221. 13. Kaplan S., Pelcovitz, D., Salzinger, S., Weiner M., Mandel, F. S., Lesser, M.L., & Labruna, V.E. (1998). Adolescent Physical abuse: Risk for adolescent psychiatric disorders. American Journal of Psychiatry, 155, 954-959. 14. Kaplan, S, Pelcovitz, D., Salzinger, S., Mandel, F., Wiener, M., and Labruna V. (1999). Adolescent abuse and risk for suicidal thoughts and behaviors. Journal of Interpersonal Violence, 14, 976-988. 15. Kaplan, S, Pelcovitz, D., Salzinger, S., Mandel, F., Wiener, M., and Labruna V. (1999). Physically abused adolescents: Behavior problems, functional impairment, and comparison of informants’ reports. Pediatrics, 104, 43-49. 16. Kaplan, S, Pelcovitz, D., and Labruna V. (1999). Child and adolescent abuse and neglect research: A review of the past 10 years. Part I. Physical and emotional abuse and neglect. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1214-1222. 17. Pelcovitz, D. (In Press). Group therapy for victims of sexual abuse. In Boyd-Webb, N. (Ed.) Play Therapy with Children in Crisis. Second Edition, New York, Guilford. 18. Pelcovitz, D., Kaplan, S., DeRosa, R., Mandel, F., Salzinger, S. (2000). Interparental Violence: Adolescents at Risk for Psychiatric Disorders. American Journal of Orthopsychiatry, 70, 360-369. 19. Pelcovitz, D., Kaplan, S., Salzinger, S., Weiner, M., Ellenberg, A.,Labruna, V., Salzinger, S. (2000). Adolescent Physical Abuse: Adolescent perception of family functioning and age at time of abuse. Journal of Family Violence, 15, 375-389. Kaplan, Sandra 36 Biographical Sketch Provide the following information for the key personnel in the order listed for Form Page 2. Follow the sample format for each person. DO NOT EXCEED FOUR PAGES. NAME POSITION TITLE Suzanne Sunday Ph.D. Associate Professor of Psychology EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.) INSTITUTION AND LOCATION DEGREE YEAR(s) FIELD OF STUDY (if applicable) St. Lawrence University, Canton, NY B.S. 1973 Psychology and Chemistry Rutgers University, New Brunswick, NJ M.S. 1977 Psychology Rutgers University, New Brunswick, NJ Ph.D. 1981 Psychology A. Positions and Honors. Positions and Employment 1981-1988 Assistant Professor, Manhattanville College, Dept. of Psychology, Purchase, NY 1988-2002 Cornell University Medical College, Dept. of Psychiatry, White Plains, NY 2002- North Shore University Hospital, Dept. of Psychiatry, Manhasset, NY 2002- Associate Professor of Psychology in Psychiatry, New York University School of Medicine, New York, NY 2003- Associate Investigator, Institute for Medical Research North Shore- LIJ Health System, Manhasset, NY Professional Memberships and Elected Positions 1981- Fellow, American Psychological Association 1981- Fellow, Behavioral Neuroscience and Comparative Psychology Division, American Psychological Association 1997-1998 Membership Chair, Behavioral Neuroscience and Comparative Psychology Division, American Psychological Association 1974- Member, Eastern Psychological Association 1996-1997 Member, Eastern Psychological Association Board of Directors 1998-2001 Member, Eastern Psychological Association Board of Directors 1982- Member, Columbia University Appetitive Seminar 1987- Member, Society for the Study of Ingestive Behavior 1987 Co-Incorporator, Society for the Study of Ingestive Behavior 1997-2003 Secretary, Society for the Study of Ingestive Behavior 1991-1994 Treasurer, Society for the Study of Ingestive Behavior 1986-1987 Treasurer, Society for the Study of Ingestive Behavior 1996-1999 Member, Long Range Planning Committee, Society for the Study of Ingestive Behavior 1995- Fellow, Academy for Eating Disorders 1996- Member of Eating Disorders Research Society 2003- Member of the International Society for Traumatic Stress Studies 2003- Member of the New York University Bellevue Psychiatric Society B. Selected Peer Reviewed Publications (in chronological order). 1. Sunday, S.R., & Halmi, K.A. (1990). Taste perceptions and hedonics in eating disorders. Physiology & Behavior, 48, 587-594. Kaplan, Sandra 37 2. Sunday, S.R., Einhorn, A., & Halmi, K.A. (1992). The relationship of perceived macronutrient and caloric content to affective cognitions about food: Eating disordered, restrained and unrestrained subjects. American Journal of Clinical Nutrition, 55, 362-371. 3. Sunday, S.R., Halmi, K.A., Werdann, L., & Levey, C. (1992). Body size estimation and Eating Disorder Inventory scores in four subgroups of eating disorder patients. International Journal of Eating Disorders, 11, 133-149. 4. Sunday, S.R., Levey, C.M., & Halmi, K.A. (1993). Effects of depression and borderline personality traits on psychological state and eating disorder symptomatology. Comprehensive Psychiatry, 34, 70-74. 5. Braun, D.L., Sunday, S.R., & Halmi, K.A. (1994). Psychiatric comorbidity in patients with eating disorders. Psychological Medicine, 24, 859-867. 6. Mazure, C.M., Halmi, K.A., Sunday, S.R., Romano, S.J., & Einhorn, A.M. (1994). Yale-Brown- Cornell Eating Disorder Scale: Development, use, reliability, and validity. Journal of Psychiatric Research, 28, 425-445. 7. Sunday, S.R., Halmi, K.A., & Einhorn, A. (1995). The Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS): A new scale to assess eating disorder symptomatology. International Journal of Eating Disorders, 18, 237-245. 8. Heebink, D.M., Sunday, S.R., & Halmi, K.A. (1995). Anorexia nervosa and bulimia nervosa in adolescence; Effects of age and menstrual status on psychological variables. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 378-382. 9. Sunday, S.R. & Halmi, K.A. (1996). Micro- and macroanalyses of meal patterns in anorexia and bulimia nervosa. Appetite. 26, 21-36. 10. Sunday, S.R., Reeman, I.M., Eckert, E., & Halmi, K.A. (1996). Ten year outcome in adolescent onset anorexia nervosa. Journal of Youth and Adolescence, 25, 533-544. 11. Sunday, S.R. & Halmi, K.A. (1997). Eating behavior and eating disorders: The interface between clinical research and clinical practice. Psychopharmacology Bulletin. 33, 373-379. 12. Wiseman, C.V., Turco, R.M., Sunday, S.R., & Halmi, K.A. (1998). Smoking and body image concerns in adolescent girls. International Journal of Eating Disorders, 24, 429-433. 13. Sunday, S.R. & Halmi, K.A. (2000). Comparison of the Yale-Brown-Cornell Eating Disorders Scale in recovered eating disorder patients, restrained dieters and non-dieting controls. International Journal of Eating Disorders, 28, 455-459. 14. Halmi, K.A., Sunday, S.R., Strober, M., Kaplan, A., Woodside, D.B., Fichter, M., Treasure, J., Berrettini, W.H., & Kaye, W.H. (2000). Perfectionism in anorexia nervosa: Variation by clinical subtype, obsessionality, and pathological eating behavior. American Journal of Psychiatry, 157, 1799-1805. 15. Sunday, S.R., Peterson, C.B., Andreyka, K., Crow, S.J., Mitchell, J.E., & Halmi, K.A. (2001). Differences in DSM-III-R & DSM-IV diagnoses in eating disorder patients. Comprehensive Psychiatry, 42, 448-455. 16. Sunday, S.R. & Halmi, K.A. (2003). Energy intake and body composition in anorexia and bulimia nervosa. Physiology & Behavior, 78, 11-17 17. Caballero, A.R., Sunday, S.R., & Halmi, K.A. (2003). A comparison of cognitive and behavioral symptoms between Mexican and American eating disorder patients. International Journal of Eating Disorders, 34, 136-141. 18. Wiseman, C.V., Sunday, S.R., Peltzman, B., & Halmi, K.A. (2004). Risk factors for eating disorders: surprising similarities between middle school boys and girls. Eating Disorders: The Journal of Treatment and Prevention, 12, 315-320. 19. Wiseman, C.V., Sunday, S.R., Bortolotti, F., & Halmi, K.A. (2004). Primary prevention of eating disorders through attitude change: a two country comparison. Eating Disorders: The Journal of Treatment and Prevention, 12, 241-250. 20. Dancyger, I, Fornari, V, Scionti, L, Wisotsky, W, & Sunday, S. (2005). Do daughters with eating disorders agree with their parents’ perception of family functioning? Comprehensive Psychiatry, 46, 135- 139. Kaplan, Sandra 38 BIOGRAPHICAL SKETCH Provide the following information for the key personnel in the order listed on Form Page 2. Photocopy this page or follow this format for each person. NAME POSITION TITLE Victor Labruna, Ph.D. Coordinator, Adolescent Trauma Treatment Development Center EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.) DEGREE YEAR(s) INSTITUTION AND LOCATION (if applicable) FIELD OF STUDY Hamilton College, Clinton NY B.A. 1992 Psychology St. John's University, Queens, NY Ph.D. 1998 Clinical Psychology RESEARCH AND PROFESSIONAL EXPERIENCE: Concluding with present position, list, in chronological order, previous employment, experience, and honors. Include present membership on any Federal Government public advisory committee. List, in chronological order, the titles, all authors, and complete references to all publications during the past three years and to representative earlier publications pertinent to this application. If the list of publications in the last three years exceeds two pages, select the most pertinent publications. DO NOT EXCEED TWO PAGES. POSITIONS 1992-1994 Graduate Research Fellow, Department of Psychology, St. John's University. 1996-1997 Psychology Intern, Divisions of Child and Adolescent Psychiatry and Neuropsychology, North Shore University Hospital. 1997-1999 Grant Writer/Publications Coordinator, Division of Child and Adolescent Psychiatry, North Shore University Hospital 1999-presentResearch Coordinator and Clinical Psychologist, Division of Child and Adolescent Psychiatry, North Shore University Hospital 2001-present Assistant Clinical Professor of Psychology, NYU School of Medicine Publications Kaplan, S, Pelcovitz, P, Salzinger, S, Mandel, F, Weiner, M., Lesser, M. and Labruna, V. (1998). Adolescent Physical Abuse: Risk for Adolescent Psychiatric Disorders. American Journal of Psychiatry, 155, 954-959. Kaplan, S., Labruna, V., Pelcovitz, D., Salzinger, S., Mandel, F., Weiner, M. (1999). Physically abused adolescents: behavior problems, functional impairment, and comparison of informants' reports. Pediatrics. 104, 43-9. Pelcovitz, D., Kaplan, S., Ellenberg, A., Labruna, V., Salzinger, S., Mandel, F., Weiner, M. (2000). Adolescent physical abuse: Age at time of abuse and adolescent perception of family functioning. Journal of Family Violence. 15, 375-389. Mandel, F., Weiner, M., Kaplan, S., Pelcovitz, D., Labruna, V. (2000). An examination of bias in volunteer subject selection: Findings from an in-depth child abuse study. Journal of Traumatic Stress, 13, 77-88 Kaplan, S., Pelcovitz, D., Salzinger, S., Mandel, F., Weiner, M., Labruna, V. (1999). Adolescent physical abuse and risk for suicidal behaviors. Journal of Interpersonal Violence. 14, 976- 988. Kaplan, S., Pelcovitz, D., Labruna, V. (1999). Child and adolescent abuse and neglect research: A review of the past 10 years. Part I: Physical and emotional abuse and neglect. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 1214-1222 Kaplan, Sandra 39 BIOGRAPHICAL SKETCH RUTH R. DeROSA INSTITUTION AND LOCATION DEGREE YEAR(s) FIELD OF STUDY Duke University, Dept. of Psychology Ph.D. 1995 Clinical Psychology Duke University, Dept. of Psychology M.A. 1993 Clinical Psychology George Washington University B.A. 1989 Psychology PROFESSIONAL EXPERIENCE 2001-present Treatment Development, National Child Traumatic Stress Network (NCTSN), North Shore University Hospital, Dept. of Child and Adolescent Psychiatry, Manhasset, NY 1997-present Psychologist, Private Practice, Family Therapy Institute of Suffolk 1995-present Volunteer, Parent Education & Custody Effectiveness Project 2000-2002 Psychologist, Police-Mental Health Partnership for children living with domestic violence 1995-1997 Psychologist, Private Practice Institute for Behavioral Health 1994-1995 Clinical Psychology Internship (APA approved), Northport VA Medical Center 1990-1994 Clinical Assessment Counselor/Therapist, Duke Psychology 1993-1994 Intake Coordinator: Duke Psychology Clinic 1992-1994 Dialectical Behavior Therapy Team, Duke University Medical Center 1994 Interviewer, Multi-site project, Duke University, Research Triangle Institute, University of North Carolina, & Duke University Medical Center 1993-1994 Research Coordinator, Incest Survivors Treatment Study, Duke University Medical Center 1992-1993 Clinical assessments, Fluxetine Treatment Outcome Study, Duke University Medical Center 1991-1991 Clinical Research Assistant, DSM-IV PTSD Field Trial, Duke University Medical Center 1991-1991 Therapist, Inpatient Psychiatric Unit Duke University Medical Center, Affective Disorders Unit 1989- 1991 Inpatient assessment of DSM-III-R diagnoses, Cognitive Assessment Lab Duke University Medical Center HONORS AND AWARDS 1986-1989 Outstanding Academic Achievement Citations May 1988 Phi Beta Kappa May 1989 Bachelor of Arts, Special Honors in Psychology, summa cum laude PROFESSIONAL AFFILIATIONS American Psychological Association New York State Psychological Association International Society for Traumatic Stress Studies Suffolk County Psychological Association Kaplan, Sandra 40 SELECTED PUBLICATIONS Craighead, L. W., Allen, H. N., Craighead, W. E., & DeRosa, R. (1996). Effect of social feedback on learning rate and cognitive distortions among women with bulimia. Behavior Therapy, 27(4), 551-563. Krause, E. D., DeRosa, R., & Roth, S. (2002). Gender, trauma themes, and PTSD: Narratives of male and female survivors. In R. Kimerling, J. Wolfe, & P. Ouimette (Eds.), Gender and posttraumatic stress disorder. NY: Guilford. Pelcovitz, D., Kaplan, S., DeRosa, R., Mandel, F. S., & Salzinger, S. (2000). Interparental Violence: Adolescents at Risk for Psychiatric Disorders. American Journal of Orthopsychiatry, 70, 360- 369. Roth, S., DeRosa, R., & Turner, K. A. (1996). Cognitive-behavioral interventions for posttraumatic stress disorder. In E. Giller, Jr. & L. Weisaeth (Eds.), Emerging concepts in the treatment of post-traumatic stress disorder. London: Bailliere Tindall. Roth, S., Lebowitz, L., & DeRosa, R. (1997). Thematic assessment of post-traumatic stress reactions. In J. Wilson & T. Keane (Ed.), Assessing psychological trauma and PTSD: A handbook for practitioners. NY: Guilford Press. Turner, K., DeRosa, R., Roth, S., Batson, R., & Davidson, J. (1996). A multi-modal treatment for incest survivors: Preliminary outcome data. Clinical Psychology and Psychotherapy, 3(3), 208-219. Kaplan, Sandra 41 BIOGRAPHICAL SKETCH Juliet M. Vogel, Ph.D. Education: 1966 A.B. Summa Cum Laude (psychology) Smith College 1973 Ph.D. (developmental psychology; Harvard University minor in clinical psychology) 1986 Respecialization in clinical psychology Michigan State University Postdoctoral training: 1985-1986 Clinical psychology intern, Boston Children’s Hospital and Judge Baker Children’s Center, Boston 1987-88 Postdoctoral fellow, Department of Human Development and Family Studies, Cornell University, Ithaca, NY 1988-89 Clinical Psychology Postdoctoral Fellow, Department of Psychiatry, University of California San Francisco Academic Appointments: 1972-1973 Lecturer in psychology, Rutgers University 1973-1980 Assistant Professor of Psychology, Rutgers Univesity 1980-1985 Associate Professor of Psychology, Kalamazoo College 1981-1985 Adjunct Professor of Psychology, Michigan State University 1991-1997 Assistant Professor of Psychiatry, Albert Einstein College of Medicine 1993- Adjunct Professor of Psychology, Long Island University 1999- Clinical Assistant Professor of Psychology in Psychiatry, New York University School of Medicine Hospital Appointments 1989-1997 Staff psychologist, Long Island Jewish Medical Center, New Hyde Park, NY 1997- Director of Child Psychology Training, Department of Psychiatry, North Shore University Hospital, Manhasset, NY Awards and Honors: 1966 A.B. Summa Cum Laude 1966 Phi Beta Kappa 1966 Sigma Xi 1966 Woodrow Wilson Fellow Major Committee Assignments: 1989-1993 Chair, Task Force on Children’s Psychological Response to Disasters, Section on Clincal Child Psychology, Division of Clinical Psychology, American Psychological Association Publications: Vogel, JM, Teghtsoonian, M. The effects of perspective alterations on apparent size and distance scales. Perception & Psychophysics, 11, 294-298. Vogel, J. M. (1977). The development of recognition memory for the left-right orientation of pictures. Child Development, 48, 1532-1543. Kaplan, Sandra 42 Vogel, J. M. & Laughlin, K. A. (1978). Role of symmetry in the mirror-image confusions of preschoolers. Journal of Educational Psychology, 70, 894-903. Vogel, J. M. (1979). The effects of verbal descriptions vs. orientation codes on kindergartners’ memory for the orientation of pictures. Child Development, 50, 239-242. Vogel, J. M. (1980). Limitations on children’s short-term memory for left-right orientation. Journal of Experimental Child Psychology, 30, 473-495. Vogel, J. M. (1980). Getting letters straight. In F. Murray (Ed.), Some perceptual prerequisites for reading, monograph in the series, The development of the reading process. Newark, Delaware: International Reading Association. McKinney, J. P., & Vogel, J. M. (1987). Developmental theories. In V. B. Van Hasselt & M. Hersen (Eds.), The handbook of adolescent psychology (pp. 13-33). New York: Pergamon Press. Vogel, J. M. (1993). Children’s psychological responses to disasters. Youth Mental Health Update, 5(2), Division of Child and Adolescent Psychiatry, Schneider Children’s Hospital, Long Island Jewish Medical Center. Vogel, J. M. & Vernberg, E. M. (1993). Children’s psychological responses to disasters. Journal of Clinical Child Psychology, 22, 464-484. Vernberg, E. M. & Vogel, J. M. (1993). Intervention with children after disasters. Journal of Clinical Child Psychology, 22, 485-498. Vogel, J. M. (1995). After disasters, what about the children? [Review of Children and disasters]. Contemporary Psychology, 40, 319-320. Vogel, J. M., & Koplewicz, H. S. (1995). Trade Center bombing holds lessons for aftermath of Oklahoma tragedy. The Brown University Child and Adolescent Behavior Letter, 11(6), 1,4. Koplewicz, H. S., Vogel, J. M., Solanto, M. V., Morrissey, R. F., Abikoff, H., Alonso, C.M., Gallagher, R., & Novick, R. M. (2002). Child and parent response to the World Trade Center bombing. Journal of Traumatic Stress, 15, 77-85. Vogel, J. M. , Cohen, A.J. , Habib, M. S. & Massey, B. D. (2004). In the wake of terrorism: Collaboration between a psychiatry department and a center for emergency medical services to support EMS workers and their families. Family, Systems & Health, 22, 35-46. Agency Title Type & # Period Role Substance Abuse and Adolescent Trauma Treatment U79 SM54251 1/1/2002 Treatment Mental Health Development Center, National through Developer Services Child Traumatic Stress Network 9/31/2005 Administration (SAMHSA) Child and Adolescent Evidence-based Mental Health New York State 8/1/2002 Project Trauma Treatment and Treatments and Services for Office of Mental through Director Services Consortium Children and Youth affected by Health 6/30/2005 (CATS) the September 11th Terrorist Attacks New Yorkers for Supplement for CATS program to New York City 7/1/2004 Project Children enhance services for youth from Family Fund through Director Queens New York 6/30/2005 American Red Cross Youth Recovery and Resilience September 11 5/1/2005 Project Grant Recovery Fund through Director 6/30/2006 Kaplan, Sandra 43 Biographical Sketch VICTOR M. FORNARI, M.D. EDUCATION: June, 1974 Cornell University, Ithaca, New York B.S., Biology: Concentration in Anatomy and Physiology, with Distinction October, 1975 Columbia University, College of Physicians and Surgeons, Institute of Human Nutrition, New York, New York, M.A. in Human Nutrition May, 1979 State University of New York, Downstate Medical Center, Brooklyn, New York M.D., Medicine POSITIONS 1985 - 1986 Physician-in-Charge, Child Psychiatry Inpatient Unit, Schneider Children’s Hospital of Long Island Jewish Medical Center. 1990 - 1998 Director of Clinical Services, Division Child and Adolescent Psychiatry, Department of Psychiatry, North Shore University Hospital - New York University School of Medicine 1991- Director of Training, Division of Child and Adolescent Psychiatry, Department of Psychiatry, North Shore University Hospital - New York University School of Medicine. 1992-1998 Assistant Chairman for Training and Clinical Services, Child and Adolescent Psychiatry, Department of Psychiatry North Shore University Hospital-New York University School of Medicine. 1998- Associate Chairman for Education and Training, Director of Training in General Psychiatry, Department of Psychiatry, North Shore University Hospital, New York University School of Medicine. ACADEMIC APPOINTMENTS: July 1996 Associate Professor of Clinical Psychiatry New York University School of Medicine New York, New York 1991-present Member, Nassau County Critical Incident Response Team, Department of Mental Health, Mental Retardation and Developmental Disabilities 1991-present Member, Task force to address the needs of chronically ill children and their families, the Child Development Center, North Shore University Hospital- New York University School of Medicine Kaplan, Sandra 44 1991-present Member, Nassau County Mental Health Disaster Task Force SELECTED PUBLICATIONS AND PRESENTATIONS Fornari, V., Wlodarczyk-Bisaga, K., Matthews, M., ACSW, Sandberg, D., Ph.D., Mandel, F.S., Ph.D., Katz, J., M.D. “Perception of Family Functioning and Depressive Symptomatology in Individuals with Anorexia Nervosa or Bulimia Nervosa.” Comprehensive Psychiatry, 40, (6), 434-441, 1999 Fornari, V., Dancyger, I., Schneider, M., Fisher, M., Goodman, B., McCall, A. “Parental Medical Neglect in the Treatment of Adolescents with Anorexia Nervosa.”Int. J. of Eating Disorders 29, 358-362, 2001 Fornari, V., “A Child Surviving a Plane Crash,” Nine Years Later, in Children in Crisis; A Play Therapy Casebook, Webb, N. (Ed). Guilford Publications, Inc., New York, New York,1991. Douzinas, N., Fornari, V., Goodman, B., Sitnick, T., Packman, L., “Eating Disorders and Abuse” in Child and Adolescent Psychiatric Clinics of North America, Kaplan, S., and Pelcovitz, D., (eds) Saunders, Philadelphia,October, 1994 Fornari, V., Fuss, J., Hickey, J., Packman, L.,“The Avianca Airline Crash: Implications for Community Health Care Response,” Intense Stress and Mental Disturbance in Children, Pfeffer, (ed.) American Psychiatric Press, Inc.Washington, D.C., 1996. Fornari, V., Contributor, “Diagnostic Statitistical Manual for Primary Care, Children and Adolescent Version (DSM-PC)”, American Academy of Pediatrics, Elk Grove Village, Ill., 1996. Fornari, V. “A Child Surviving a Plane Crash,” Nine Years Later, in Children in Crisis:A Play Therapy Casebook, Webb, N. (Ed.) Guilford Publications, Inc., New York, New York, 1999, 2nd (ed) Fornari, V., “School Based Prevention and Intervention Strategies (i.e. Disasters, Suicide, Violence Prevention and Divorce.)” School Mental Health Partnerships: Planning for Tomorrow: The Raphel Sims Lakowitz Conference, North ShoreUniversity Hospital, May 29, 1998 Fornari, V., “The Aftermath of a Crisis in the School.” Mental Health Association of Nassau County, Hofstra University, April , 1995. Fornari, V., “Aftermath: Principles of Disaster Mental Health Intervention.” New York Council on Child and Adolescent Psychiatry, December 16, 1993 Fornari, V., Fuss, J., Hickey, J., Packman, L., Terr, L., Montero, G., “Team Treatment Approach for Disaster Survivors: Avianca Plane Crash,” American Academy of Child and Adolescent Psychiatry, San Francisco, October, 1991 Kaplan, Sandra 45 Biographical Sketch NAME POSTION TITLE Alan J. Cohen, M.D. Psychiatrist EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.) DEGREE INSTITUTION AND LOCATION (if applicable) Year(s) FIELD OF STUDY University of Rochester, College of Arts and Sciences B.A. 1981 University of Rochester, School of Medicine and M.D. 1985 Dentistry A. Positions and Honors. Positions and Employment 1985-1986 Internship, Pediatrics/Psychiatry Albert Einstein College of Medicine (AECOM) of Yeshiva University, Bronx, NY 1986-1989 Resident, Psychiatry, AECOM, Bronx, NY 1989-1991 Fellow, Child and Adolescent Psychiatry, AECOM, Bronx, NY 1989-1990 Consulting Psychiatrist, Fordham University Counseling and Career Services 1989-1990 Consulting Psychiatrist, Ferkauf Graduate School of Psychology, Yeshiva University, AECOM, Bronx 1991-1992 Attending Psychiatrist, Adult Psychiatry Inpatient and Consultation-Liaison Services, AECOM, BMHC, Bronx 1991-1992 Consulting Psychiatrist, Child and Adolescent Psychiatry Therapeutic Nursery Staff, AECOM,BMHC, Bronx 1991-1992 Attending Psychiatrist, AECOM, Bronx Municipal Hospital Center (BMHC), Bronx, NY 1991-1992 Instructor in Psychiatry, Albert Einstein College of Medicine 1992- Attending Psychiatrist, North Shore University Hospital (NSUH) Manhasset, NY 1992- Coordinator of Medical Student Education, AECOM, BMHC, Bronx 1992- Medical Director, Child and Adolescent Psychiatry, Ambulatory Services, NSUH, Manhasset,NY 1992- Physician-in-Charge, Families in Transition Program, NSUH, Manhasset 1992-1995 Instructor in Psychiatry, Cornell University Medical College 1995-1997 Assistant Professor in Psychiatry, Cornell University Medical College (CUMC) 1995-1997 Adjunct Assistant Professor of Psychiatry, NYU School of Medicine (NYU) 1996- Forensic Psychiatric Consultant to Courts 1997- Assistant Professor of Clinical Psychiatry, New York University School of Medicine Other Kaplan, Sandra 46 1998- Director of Clinical Services, Child and Adolescent Psychiatry 2000- Psychiatric Consultant to Sagamore Children’s Hospital, Dix Hills, NY Other Experience and Professional Memberships 1984- American Psychiatric Association 1989- American Academy of Child and Adolescent Psychiatry 1989- New York Council on Child and Adolescent Psychiatry 1990 Diplomate of the American Board of Psychiatry and Neurology (Adult Psychiatry) 1992 Diplomate of the American Board of Psychiatry and Neurology (Child and Adolescent Psychiatry) 1993- Interdisciplinary Forum of Nassau County 1995- Greater Long Island Psychiatric Society 1997-99 Family Committee, American Academy of Child and Adolescent Psychiatry 1997-99 School Committee, American Academy of Child and Adolescent Psychiatry 1998- Diplomate of the American Board of Psychiatry and Neurology (Forensic Psychiatry-Added Qualifications) 1998- American Academy Psychiatry and the Law 1998- Tri-State Chapter: American Academy of Psychiatry and the Law Honors 1988 Leo M. Davidoff Society Award Winner for Excellence in Teaching AECOM, Bronx, NY Publications Cohen, A., Adler, N., Kaplan, S., Pelcovitz, D., Mandel, F., “The Interactional effects of marital status and physical abuse on adolescent psychopathology” in Child Abuse and Neglect; Pergamon Press, 26 (2002) 277-288. Cohen, A., Adler, N., Mandel, F., Kaplan, S., Pelcovitz, D. Adolescent Responses to Divorce. In Leventhal, BL, Schwab-Stone, ME, eds. Scientific Proceedings, 42nd Annual Meeting of the American Academy of Child and Adolescent Psychiatry. New Orleans, October 17-22, 1995: 90. Cohen, A., Greenberg, D., Garfinkel-Cohen, R. Ambulatory Psychiatric Treatment of Physically Abused School-Aged Children, Adolescents and Their Families. In: Kaplan, S., Pelcovitz, D., eds. Child Abuse. Philadelphia: W.B. Saunders, 1994: 4:845-63 (Lewis, M., ed. Child and Adolescent Psychiatry Clinics of North America; vol. 3). Solidum, A., Fornari, V., and Cohen, A. Book Review of “Posttraumatic Stress Disorder” in Child and Adolescent Psychiatric Clinics of North America for the Journal of Child and Adolescent Psychopharmacology (in press, June 2004) Vogel, J., Cohen, A., Massey, B., and Habib, M. Supporting EMS Workers and Their Families In the Wake of Terrorism: Collaboration Between a Psychiatry Department and a Center for Emergency Medical Services (EMS) to Support EMS Workers and Their Families” in Families, Systems, & Health, 2004, Vol. 22, 35-46. Cohen, A., Adler, N., Kaplan, S., Pelcovitz, D., Mandel, F. The Interactional effects of marital status and physical abuse on adolescent psychopathology. Child Abuse and Neglect, 26, 277-288. Kaplan, Sandra 47 BIOGRAPHICAL SKETCH Provide the following information for the key personnel in the order listed for Form Page 2. Follow the sample format on next page for each person. DO NOT EXCEED FOUR PAGES. NAME POSITION TITLE Julian D. Ford, Ph.D. Associate Professor of Psychiatry EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.) INSTITUTION AND LOCATION DEGREE YEAR(s) FIELD OF STUDY (if applicable) University of Michigan, Ann Arbor, MI BA 1973 Psychology State University of New York at Stony Brook, New York Ph.D. 1977 Clinical Psychology Academic and Professional Appointments 1977 to 1979 Assistant Professor of Psychology, University of Delaware, Newark, DE 1980 to 1990 Clinical Assistant Professor of Psychiatry, UCLA Medical School, Los Angeles, CA 1990 to 1994 Adjunct Associate Professor of Psychiatry, Oregon Health Sciences University, Portland, OR 1994 to 1998 Deputy Executive Director, VA National Center for PTSD, White River Junction, VT 1994 to 1998 Assistant Professor of Psychiatry, Dartmouth Medical School, Hanover, NH 1998 to 2001 Assistant Professor of Psychiatry, University of Connecticut Medical School, Farmington, CT 2001 to present Associate Professor of Psychiatry, University of Connecticut Medical School, Farmington, CT Other Appointments 1982 to 1984 Consulting Editor, Behavior Therapy 1985 to 1989 Consulting Editor, Journal of Consulting and Clinical Psychology 1992 to 1994 Director, PTSD Residential Rehabilitation Program, Portland VA Medical Center 1996 to 2002 Consulting Editor, Journal of Consulting and Clinical Psychology 1998-to present Consulting Editor, Child Maltreatment 2000 to present Senior Academic Fellow, Child Health and Development Institute of Connecticut 2000-Present International Society for Traumatic Stress Studies Presidential Work Group on Complex Trauma 2001-Present Executive Committee, CT Center for Effective Practices in Children’s Behavioral Health Care 2003-Present Consulting Editor, Clinical Psychology: Science & Practice 2003-2006 Editorial Board, Journal of Aggression, Maltreatment and Trauma 2004 NIMH Child, Parenting and Family Special Emphasis Panel (ZMH1-NRB-G-07) 2004 National Council of Juvenile and Family Court Judges Peer Review Committee 2004 Substance Abuse and Mental Health Services Trauma Treatment Improvement Protocol 2004-Present Editorial Board, Journal of Trauma and Dissociation 2004-Present Editorial Board, American Journal of Health Behavior Honors and Awards 1973-1976: State University Chancellor’s Fellowship 1973: BA with Honors, University of Michigan Selected Peer-Reviewed Publications (in chronological order) Ford, J., Fisher, P., & Larson, L. (1997). Object relations as a predictor of treatment outcome with chronic PTSD. Journal of Consulting and Clinical Psychology, 65, 547-559. Ford, J., Greaves, D., Chandler, P. Thacker, B., Shaw, D., Sennhauser, S.,& Schwartz, L. (1997). Time-Limited psychotherapy with Operation Desert Storm veterans.Journal of Traumatic Stress, 10, 655-664. Ford, J., Shaw,D.,Chandler, P.,Thacker,B. ,Greaves,D., Sennhauser,S.,& Schwartz,L.(1998). Family systems therapy after Operation Desert Storm: European Theater veterans. Journal of Marital and Family Therapy, 24, 141-148. Ford, J., & Kidd, P. (1998). Early childhood trauma and disorders of extreme stress as predictors of treatment outcome with chronic PTSD. Journal of Traumatic Stress,111, 743-761. Ford, J. (1999). Disorders of Extreme Stress following warzone military trauma: Associated features of post traumatic stress disorder or comorbid syndrome? Journal of Consulting and Clinical Psychology, 67, 3-12. Kaplan, Sandra 48 Ford, J., Racusin, R., Daviss, W.B., Ellis, C., Thomas, J., Rogers, K., Reiser, J., Schiffman, J, & Sengupta, A. (1999). Trauma exposure among children with Attention Deficit Hyperactivity and Oppositional Defiant Disorders. Journal of Consulting and Clinical Psychology, 67, 786-789. Schnurr, P., Ford, J., Friedman, M., Green, B., Dain, B., & Sengupta, A. (2000). Predictors and outcomes of PTSD in World War II veterans exposed to Mustard Gas. Journal of Consulting and Clinical Psychology, 68, 258-268. Daviss, W.B., Racusin, R., Fleischer, A., Mooney, D., Ford, J. D., & McHugo, G. (2000). Acute stress disorder ymptomatology during hospitalization for pediatric injury. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 569-575. Daviss, W.B., Mooney, D., Racusin, R., Ford, J. D., Fleischer, A., & McHugo, G. (2000). Predicting post-traumatic stress after hospitalization for pediatric injury. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 576-583. Ford, J., Racusin, R., Ellis, C., Daviss, W.B., Reiser, J., Fleischer, A., & Thomas, J. (2000). Child maltreatment, other trauma exposure, and post traumatic symptoms among children with Oppositional Defiant & Attention Deficit Hyperactivity Disorders.Child Maltreatment, 5, 205-217. Mueser, K., Salyer, M., Rosenberg, S., Ford, J. D., & Fox, M. (2001). Psychometric evaluation of trauma and PTSD assessments in persons with severe mental illness. Psychological Assessment, 13, 110-117. Ford, J.D., Campbell, K., Storzbach, D., Binder, L., Anger, W. K., & Rohlman, D. (2001). Posttraumatic stress symptomatology is associated with unexplained illness attributed to Persian Gulf War military service. Psychosmoatic Medicine, 63, 842-849. Winston, F., Kassam-Adams, N., Vivarelli-O’Neill, C., Ford, J., Newman, E., Raxt, C, Stafford, P., & Cnaan, A. (2002). Acute stress disorder symptoms in children and their parents after pediatric traffic injury. Pediatrics., 109, e90-e96. Ford, J.. (2002). Traumatic victimization in childhood and persistent problems with oppositional-defiance. Journal of Trauma, Maltreatment, and Aggression, 11, 25-58. Fontana, A., Ford, J., & Rosenheck, R. (2003). A multivariate model of patients’ satisfaction with treatment for posttraumatic stress disorder. Journal of Traumatic Stress, 16, 93-106. Ford, J.., Schnurr, P., Friedman, M., Green, B., Adams, G., & Jex, S. (2004). Posttraumatic stress disorder symptoms and physical health outcomes fifty years after exposure to a toxic gas. Journal of Traumatic Stress, 17, 185-194. Ford, J., Trestman, R. L., Steinberg, K., Tennen, H., & Allen, S. (2004). Contribution of psychiatric and addictive disorders to high utilization of primary medical care. Social Science and Medicine, 58, 2145-2148 Jankowski, M. K., Schnurr, P., Adams, G., Green, B. L., Ford, J. D., & Friedman, M.J. (2004). A mediational model of PTSD in World War II Veterans Exposed to Mustard Gas. Journal of Traumatic Stress, 17, 303-310. Ford, J. D., Schnurr, P., Friedman, M., Green, B., Adams, G., & Jex, S. (2004). Posttraumatic stress disorder symptoms and physical health outcomes fifty years after exposure to a toxic gas. Journal of Traumatic Stress, 17, 185-194. Adams, M., Ford, J. D., & Dailey, W. (2004). Predictors of getting help among Connecticut adults after September 11, 2001. American Journal of Public Health, 94, 1596-1602. Kim, M., & Ford, J. D. (in press). Trauma and post-traumatic stress among homeless men: A review of the literature. Journal of Aggression, Maltreatment & Trauma. McDonagh-Coyle, A., Friedman, M. J., McHugo, G., Ford, J. D., Mueser, K., Sengupta, A., Fournier, D., Demment, C., Schnurr, P., & Descamps, M. (in press). Randomized trial of cognitive behavioral therapy for chronic PTSD in adult female survivors of childhood sexual abuse. Journal of Consulting and Clinical Psychology. Ford, J. D., Courtois, C., van der Hart, O., Nijenhuis, E., & Steele, K. (in press). Treatment of complex post- traumatic self-dysregulation. Journal of Traumatic Stress. *Ford, J. D., Russo, E., & Mallon, S. (in press). Integrating post-traumatic stress disorder (PTSD) and substance use disorder treatment. Journal of Counseling and Development. *Ford, J. D., Tennen, H., Trestman, R. L., & Allen, S. (in press). Depression, anxiety, and alcohol use disorders prospectively predict potentially problematic utilization of primary and specialty medical services. Social Science & Medicine. Kaplan, Sandra 49 Job Description Project Director Duties and responsibilities: The project director will spend a minimum of 20% of a 37.5 hour work week overseeing the clinical, research and educational components of the proposed program The director will meet on a weekly basis with the program’s administrative and clinical staff and work with the project coordinator in organizing the clinical, educational and collaborative efforts of the program. Qualifications: The director will be a licensed mental health professional who has a national reputation for leadership in the planning and implementation of clinical and educational services for the assessment and treatment of adolescent victims of trauma. This leadership should be demonstrated by the director having experience in designing innovative clinical and educational programs for this population as well as extensive evidence of publishing research on adolescent interpersonal trauma in peer reviewed publications. Evidence of extensive experience serving on national and regional committees on agencies serving the field of services for traumatized adolescents. Supervisory Relationships: The director will be responsible for the supervision of the duties carried out by the project coordinator, clinicians and service developers. Skills and Knowledge Required: Extensive training in the provision of psychotherapeutic services to traumatized children and adolescents. Thorough knowledge of research design and program evaluation and strong knowledge of administration and coordination of services in large health care system. Prior Experience Required: In the assessment and treatment of traumatized adolescents; designing and writing results of outcome studies and program evaluation; administration of adolescent mental health systems of care. Personal qualties:Flexibility, high energy; patience and ability to build consensus and team work within and between teams of mental health providers. Travel: Extensive travel requirements Salary Range: $160,000-$250,000 full time Hours: 15-20 hours per week Kaplan, Sandra 50 Job Description Project Co-Director Duties and responsibilities: The project co-director will spend a minimum of 15% of a 37.5 hour work week coordinating and directing the treatment component of the study. The Co-Director will work closely with the therapists and consultants on the provision of psychotherapy and other clinical services to traumatized adolescents. The co-director will meet on a weekly basis with the program’s clinical staff and work with the project director and coordinator in organizing the clinical, educational and collaborative efforts of the program. Qualifications: The Co-Director will be a licensed mental health professional who has a national reputation for leadership in the assessment and treatment of adolescent victims of interpersonal trauma. Demonstrated ability to design program evaluation studies, and work collaboratively with colleagues on a local and national level is required. Extensive publications in the field of assessment and treatment of adolescent trauma is required. Supervisory Relationships: The Co-Director, together with the Director, will be responsible for the supervision of the duties carried out by the project coordinator, clinicians and service developers. Skills and Knowledge Required: Extensive training in the provision of psychotherapeutic services to traumatized children and adolescents. Thorough knowledge of research design and program evaluation and strong knowledge of administration and coordination of services in large health care system. Prior Experience Required:Extensive clinical experience in the assessment and treatment of traumatized adolescents; designing and writing results of outcome studies and program evaluation; teaching mental health professional and graduate students skills in the assessment and treatment of PTSD. Personal qualties: Flexibility, high energy; patience and ability to build consensus and team work within and between teams of mental health providers. Travel: extensive travel requirements Salary Range: $90,000-120,000 Hours: 10-20 hours per week Kaplan, Sandra 51 Job Description Project Coordinator Duties and responsibilities: responsibility for coordinating the activities of key personnel, communication between this site and the other Centers, and data management (including statistical analyses and sharing of clinical/evaluation data with other Centers Qualifications: The coordinator will be a licensed mental health professional who has experience in coordinating complex inter-agency projects. Demonstrated skills in coding and organizing data as well as in coordinating professional activities are required Supervisory Relationships: The coordinator will supervise the projects psychology staff and will report to the project director and co-director Skills and Knowledge Required: Extensive training in data management. Research design and implementation in the study of trauma Prior Experience Required: Coordination of research studies, treatment of traumatized adolescents Personal qualties:Flexibility, patience and ability to organize personnel Travel: local travel to meet with community implementation sites, as well as attendance at regional and national NCTSN meetings. Salary Range: $60,00-90,000 Hours: 18-30 hours per week Senior Psychologist/Psychiatrist Duties and responsibilities: will be responsible for developing, implementing, and evaluating new and innovative treatments for traumatized adolescents. Will work with project consultants developing and implementing use of manualized interventions Qualifications: licensed mental health professional who has experience in delivering and supervising treatment to traumatized adolescents Supervisory Relationships: The psychologist/psychiatrist will supervise the clinicians delivering the clinical services and report to the project co-director. Skills and Knowledge Required: Extensive training in psychotherapy of trauma and clinical interventions with adolescents. Prior Experience Required: Supervision of mental health professionals providing psychotherapy to traumatized adolescents. Personal qualties: Flexibility, patience and ability to communicate ideas effectively Travel: local travel to meet with community implementation sites, as well as attendance at regional and national NCTSN meetings. Salary Range: $65-90,000 for Senior Psychologists $90,000-$200,000 for Psychiatrists Hours: 5-7 a week Kaplan, Sandra 52 Job Description Senior Statistician Duties and responsibilities: will be responsible for planning evaluation strategies for interventions and training programs, setting up and monitoring databases, and conducting statistical analyses. Qualifications: Doctoral degree in social sciences or statistics Supervisory Relationships: will supervise data entry and will report to the project Co-Director. Skills and Knowledge Required: Training in biostatistics and knowledge of measurement of mental health Prior Experience Required: Experience with evaluating outcome research and program evaluation. Experience with advanced statistical programs such as SPSS and SAS. Personal Qualties: Flexibility, patience and ability to communicate ideas effectively Travel: local travel Salary Range: $70,00-90,000 Hours: 3-8 per week Psychologist Duties and responsibilities: will be responsible for implementing interventions for traumatized adolescents, or assisting community sites in implementation, as well as responsible for background research to support intervention development, and assisting in development of intervention manuals. Qualifications: doctoral degree in clinical psychology. Supervisory Relationships: Assistant psychologists will report to the Project Coordinator. Skills and Knowledge Required: Training in psychotherapy of trauma and clinical interventions with adolescents. Knowledge of mental health assessments. Prior Experience Required: Experience providing mental health services to traumatized adolescents. Personal Qualties: Flexibility, patience and ability to communicate ideas effectively Travel: local travel to meet with community implementation sites Salary Range: $45,00-55,000 Hours: 18-40 hours/week Kaplan, Sandra 53 Section H: Confidentiality/Human Subjects Protections Risks from involvement in project or assessments Subjects will be informed that should they find the therapeutic intervention or the pre and post- tests in any way upsetting they will be free to withdraw without compromising the availability of any other services from our health system. Fair Selection of Participants Participants will be adolescents who have suffered traumatic experiences such as physical child abuse, sexual abuse, neglect, life-threatening illness, or exposure to domestic violence. Participants will be selected from adolescents being served at other Centers in the National Child Traumatic Stress Network, as well as local agencies such as Child Protective Services. Participation will be offered to pre-existing groups of adolescents at these agencies, or participation will be offered to individual adolescents and enrollment will continue until capacity to provide services is reached. Subjects will be enrolled without regard to race, ethnicity or physical disability. Absence of Coercion: Participation will be completely voluntary. Interventions will not include adolescents or their families who are court ordered into treatment, unless the additional participant protections for prisoners are met. Subjects will not be paid for their participation but, when agencies permit, participants may be offered compensation for their time to complete assessments. Data Collection: We will obtain data through a combination of standardized questionnaires (measuring emotional and behavioral functioning), structured interviews, and review of school records (see Appendix 3 for copies of assessments). Data collection will occur at the agency where services are being provided. Staff involved in data collection will either be clinical staff at the agency where services are provided, or staff from our Center. Privacy and Confidentiality Any research done at our site as part of this project will fully conform to local and federal guidelines for human subject protection. In addition, as a planning site we will be advising, and coordinating the research done at the community centers to insure that they are in full compliance with federal human subjects protections guidelines. All data will be kept in locked and confidential files located at our Center. Subject identifiers will be stored separately from the data so that no names will be attached to the files except through a master list that will only be available to the study director and coordinator. Data will not be made available to anybody in our institution or to outside sources without the written permission of the adolescent and their parent/s. We will respect the provisions of Title 42 of the Code of Federal Regulations, Part II regarding confidentiality of alcohol and drug abuse records. Adequate consent procedures:: Protection from potential emotional or legal risk: There are no known physical risks associated with the outcome measures that will be given before and after our therapeutic interventions. Subjects will be informed that they or their child may become somewhat fatigued due to the length of the interviews/questionnaires, and that they have the right to skip any questions that they might find to be distressing. They will have the right Kaplan, Sandra 54 to end the interview immediately should they find any part of the interview process upsetting, or should they become too fatigued to continue. They could then choose to continue or complete the interview on a later date. Our mental health staff will be available to all research participants to discuss any anxiety or concerns raised by the questionnaires or interviews. Subjects will also be informed orally, and in writing, that in accordance with New York State law, if, during any interview, information is obtained about instances of child maltreatment, this must be reported. We will also inform them that we have a duty to warn any person who is identified as an intended victim of violence. They will also be informed that the Institutional Review Board or SAMHSA may require access to their records relevant to their participation in this study. In accordance with Federal Regulations, all subjects will be informed about the North Shore-LIJ Health System policy in the event that physical injury occurs. Although no physical risks are anticipated subjects will be informed in writing that if, as a result of their participation they experience physical injury from known or unknown risks of the research procedures as described, immediate medical care and treatment, including hospitalization, if necessary, will be available. No monetary compensation, however, is available and subjects will be responsible for the costs of such medical treatment, either, directly or through their medical insurance and/or other forms of medical coverage. All information obtained in the course of the research and identified with the subjects will remain confidential and will be disclosed only with written permission. If the results of this study are published subjects will not be identified by name. All records will be kept in locked files accessible only to this project’s staff. If any school or medical records are requested, the agency to whom the request is made will be told only that the subject is participating in a research study. As noted earlier, the only exceptions are in life threatening situation where in accordance with New York State law, if, during any interview, information is obtained about instances of child maltreatment, this must be reported. Subjects will also be informed that we have a duty to warn any person who is identified as an intended victim of violence. Provision of help in cases of adverse reactions: Our mental health staff will be available at no charge to the subjects to discuss any anxiety or concerns raised by the questionnaire and interviews. If subjects want feedback, the clinical information from our pre and post treatment measures of the mental health needs of the subjects will be made available to them at no charge. Identifying any potential difficulties may enable early intervention and help subjects and their families with any emotional distress they may be experiencing. However, subjects will be informed that there are no guarantees that they or their child will receive any direct benefit from participating in this research. Subjects will also be informed that with their written permission, clinical information from the research will be shared with their therapist if they have one). Information regarding emotional concerns and family history could help clinicians to make more specific treatment decisions for the subjects. If requests for referrals for treatment are made such referrals will be made available. In any instance where an urgent need for treatment is deemed necessary by the senior clinicians involved in this study, this information will be shared with the subjects and treatment referrals will be provided. Adequate Consent Procedures Kaplan, Sandra 55 As noted earlier our consent form will contain all of the required elements of informed consent including the voluntary nature of participation, the right to leave the project at any time, and all potential risks and protection from risk. Written consent will be obtained from both the parent (or legal guardian) and written assent will be obtained from adolescents. The policy of our Health System’s IRB is to read each page of the consent form together with the subject and once we are assured that they understand to initial the bottom of the page (this is in addition to the witnessed full signature at the end of the consent). Copies of the consent will be given to both the adolescent and their parent. One consent will be used for the pre and post treatment stages of the project. As noted earlier treatment will be available to subjects who decline to participate in the research component of the study. Alternatives Subjects will be given written assurance that participation in the research portion of the study is strictly voluntary. They will still receive the benefits of the studies intervention (i.e. the psychotherapeutic intervention) even if they refuse participation in the study. Once the assessment has begun subjects can discontinue participation at any time without affecting their care at the North Shore – LIJ Health System. Are protections safeguards Adequate? Informed consent will be obtained from parents of minor subjects, and assent will be obtained from participants who are minors. Informed consent will be obtained from emancipated minors or participants over the age of 18. All research will be subject to approval by the Health System’s Institutional Review Board. The IRB requires that all staff involved in carrying out research are required to complete several tutorials, including ones on basic human subjects guidelines, HIPAA guidelines, and informed consent procedures. Staff are required to pass a test after the tutorials in order to be allowed to work on the project.
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