State of New Jersey NEW JERSEY TASK FORCE ON CHILD ABUSE AND NEGLECT PO BOX 700 TRENTON, NJ 08625-0700 (609) 292-0888 NEW JERSEY CHILD SEXUAL ABUSE TRAINING INSTITUTE 13 JAMES STREET MORRISTOWN, NJ 07960 (973) 829-6800 Dear Applicant: As you may be aware, we have created a Certificate Program in "Advanced Studies in Child Maltreatment with a specialization in Child Sexual Abuse." This program is a funded initiative of the New Jersey Task Force on Child Abuse and Neglect, and is also being supported by a University Consortium for Training in Child Maltreatment, represented by Montclair State University, Rowan University, Rutgers School of Social Work, and Seton Hall University. You have been identified as a potential candidate for the Certificate Program, because of your interest and your completion in our first year, Child Sexual Abuse Case Consultation Project. To complete the Certificate Program, two years of supervised experience are required in addition to the completion of basic graduate training and specialized courses related specifically to child sexual abuse (please see our enclosed brochure for a complete description of the program) The Child Sexual Abuse Case Consultation counts as the first year of the required supervised practicum experience. We are anticipating beginning the second year of supervised practicum experience of the Certificate Program in October 2006. At this time, we are able to offer the second yearsupervised experience, free of charge. In future years, participants will have to pay for the second year of supervision. Enclosed is our brochure detailing the program, an application form for the second year practicum, and an application for the Certificate Program. Both the second year application and application for the Certificate Program must be completed by July 1st, 2006. Please note that this is an invitation to apply and does not guarantee acceptance. We hope you will take this opportunity to apply and look forward to hearing from you. If you have any questions, please contact Tamara Beckman (973 829-6800). Sincerely, Marsha Heiman, Ph.D. Clinical Director Child Sexual Abuse Case Consultation Project NJ CHILD ABUSE TRAINING INSTITUTE 2006/07 Certificate Program in Child Maltreatment Application Form- 2nd Year Group Name: Home Address: County of Residence: Home Phone Number: Business Address: County of Business: __________________________ Business Phone #: Agency Affiliation: Position: Degree: License or Certifications: E-mail: ________________________ FAX #: Professional Organization Affiliation: ______________________________________________ Year attended the 1st year of the Child Sexual Abuse Case Consultation Project:_____ Name of group facilitator: _________________________________ Please read & initialize, indicating that you understand the below requirements: ____ I have treated at least 10 cases of child sexual abuse (if assessments are included then applicant needs at least 7 treatment cases) Case Documentation Forms will be required following acceptance into the 2nd year program. ____ I understand to receive the Certificate, I will be required to treat 10 additional cases. ____ I understand to receive the Certificate, I will be required to complete the identified core graduate courses and specialized courses. ____ I understand that during this 2nd year of training, I will be required to produce videotapes of treatment sessions with child sexual abuse victims and their families. NOTE: PLEASE ATTACH A COPY OF YOUR RESUME AND MAIL TO: Anthony V. D’Urso, Psy.D., 13 James Street, Morristown, New Jersey 07960 ATTN: Certificate Program or FAX to (973) 829-6804 NEW JERSEY CHILD ABUSE TRAINING INSTITUTE APPLICATION FOR CERTIFICATE: ADVANCED STUDIES IN CHILD MALTREATMENT WITH A SPECIALIZATION IN CHILD SEXUAL ABUSE Last Name________________________ First Name__________________ MI____ Address______________________________________________________________ City_____________________________ State______ E-mail_______________________________ Zip__________ Tel______________________________ Fax____________________________ 1) HIGHEST DEGREE OBTAINED (MA, M.D., MSW, Ph.D., Psy.D.., etc.)___________ Institution where received_______________________________Date____________ 2) LICENSE/CERTIFICATION Attach a copy of your License or Certification to practice independently. Mental Health Profession__________________________ID#___________________ State Issued_____________________________________________ If you do not have a license, but are working in an agency, then provide a letter from your supervisor that you are working in a clinical capacity and receiving supervision from a licensed clinician. 3) OFFICIAL TRANSCRIPT FROM GRADUATE SCHOOL Please be advised that upon acceptance into the program, an official transcript will be required. 4) GRADUATE COURSE COMPETENCIES Please check off the graduate courses you have completed: Child Development Assessment Techniques Child Psychopathology Family Systems Theory Professional Ethical Issues 5) SPECIALZED ACADEMIC COMPETENCIES Please check off the courses you have completed (either through graduate credits or continuing education credits/workshops) Upon acceptance into the program, you will need to provide certificates/transcript that demonstrates the completion of these courses: Trauma Theory Human Sexuality Assessment & Treatment of Juvenile Sex Offenders Legal and Ethical Issues in Child Maltreatment 6) CASE DOCUMENTATION FORM Enclosed is the sample Case Documentation Form. You are required to submit 20 cases. Please note if any of your cases are already on file. ______________________________ SAMPLE CASE DOCUMENTATION FORM Age/Gender of identified child patient _6 year old female, only child living with both parents_ Number of sessions provided ___6______ Year Treated: 2002 Modality used (check all that apply): Group Referral Source: ________ DYFS ___X___ Parent ________ Other ___X_ Individual ___X___ Family ______ ________ School ________Other Clinician Method (check all that apply): ______ Evaluation Only ______ CBT ______ Play Therapy __X___ Eclectic __X___ EMDR ______ Art/Movement ______ Other: _Family Therapy____________ Presenting Problem: _X__ Sexual Abuse _____ Sexual Abuse discovered in course of treatment _____ Behavior/Mood problem was the presenting problem, with sexual abuse as a past issue and not the focal point of treatment, although sexual abuse was addressed in treatment sessions Outcome: __X___ Successfully completed ____ Family dropped out of treatment _____ Unable to deal directly with the sexual abuse issues due to a variety of other pressing problems ______ Case remains ongoing due to severity of issues Brief Summary of the Case (May be taken from discharge summary) Please disguise client’s identity: C. was abused by her paternal grandfather who babysat after school, while both parents worked. Upon disclosure, parents believed C. and immediately took protective steps. The event was reported and an arrest was made. Legal proceedings were pending at the time of treatment. C. was treated due to symptoms of PTSD, specifically flashbacks and nightmares. She was more withdrawn and clinging and refused to sleep in her own bed. School reported that C. had been less assertive and confident, and "didn't seem happy." A combination of techniques (EMDR, play, and art) combined with individual and family therapy were used. At the end of treatment, C. stated "I'm back to my old self," and all PTSD symptoms and regressive symptoms were resolved. C. had a better understanding of the problem, "he did some bad things to me and I didn't do any thing to him." In addition, both parents were supported and provided information regarding abuse. The issue of focus for the parents was the stress they were receiving from other family members to drop the case. Both parents remained committed to protecting their daughter and doing what was in her best interest.
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