Lena M. Lundgren, Ph.D.
“LaVoz Homeless Treatment Project: Focusing on HIV/AIDS, Housing and Substance Abuse Treatment for Homeless Latino Substance Abusers.”
Funded by SAMHSA/CSAT
Principal Investigator: Lena Lundgren, Ph.D. Co-Investigator: Luz Lopez, Ph.D.
Amount for research: $400,000
The Boston University Center for Addictions Research and Services (CARS) has been awarded a three-year grant to conduct a study funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT). This study will examine the effectiveness of an intervention implemented by Tapestry Health/LaVoz to conduct a door-to-door HIV testing outreach campaign to reduce HIV risk among Latinas residing in Western Massachusetts. This project will recruit hard to reach Latina women through a targeted neighborhood outreach campaign (n = 2600) and provide 200 Latinas who are at-risk for or living with HIV, who may have experiences of violence and trauma which impact their exposure to HIV, substance use disorders (SUD) and mental health disorders (MH), with clinical addiction treatment, trauma-recovery treatment provided by a trauma specialist, and HIV risk reduction and prevention education, including HIV, STI, and pregnancy testing.
“Outcome Evaluation of Tu Bienestar – HIV Prevention and Mental Health Services to Latino Substance Users”
Funded by SAMHSA/CSAT
Principal Investigator: Lena Lundgren, Ph.D. Co-Investigator: Maryann Amodeo, Ph.D.
Amount for research: $435,000
The Boston University Center for Addictions Research and Services (CARS) has been awarded a 5 year grant for an outcome study funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT). The outcome study will assess the effectiveness of Tu Bienestar (your wellness), an HIV prevention and drug relapse prevention program by one of the Center’s longtime collaborators, Casa Esperanza. The intervention will be provided to 575 Latina/o substance abusers and their families. The CARS outcome study will, through a quasi-experimental research design examine whether program participation increased: 1) testing rates for HIV, STIs Hepatitis A, B, and C among hard-to-reach, isolated, at-risk substance using Latinos and their family 2) entry into medical, mental health, and substance abuse treatment services, and 3) mental well-being of those with co-occurring disorders. It will also examine whether program participation reduced HIV risk-behaviors for the target population.
“La Voz: A Needs Assessment and Prevention Project for HIV and Substance Abuse Prevention for Latinos”
Funded by SAMHSA/CSAP
Principal Investigator: Luz Lopez, Ph.D. Co-Investigator: Lena Lundgren, Ph.D.
Amount for research: $383,000
The Boston University Center for Addictions Research and Services (CARS) has been awarded a 5 year grant funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP) to develop an HIV and substance abuse prevention project for Latino adults. CARS will work with Tapestry Health, a multi-service health and human service organization in Springfield Massachusetts and long time community-based collaborator, to conduct a community needs assessment to enhance the capacity of local planning and service infrastructures to address the substance abuse, HIV, and hepatitis prevention needs of Latinos. Results of the community needs assessment will be shared with stakeholders to generate the development of a comprehensive strategic plan. Proposed services will be adjusted in accordance with the findings from the needs assessment. To ensure that La Voz meets its goals and objectives, and is able to use process and outcome monitoring data to conduct ongoing program development, CARS will conduct ongoing participatory program evaluation to oversee data related effort.
“Pathways to Recovery: A Comprehensive Continuum of Care for Latinos”
Funded by SAMHSA/CSAT
Co-Investigator: Jordana Muroff, Ph.D.
This longitudinal study will assess the effectiveness of Pathways to Recovery, a recovery-oriented system of care for treating co-occurring substance abuse and mental health disorders with the Center for Addictions Research and Services (CARS) long-time collaborator, Casa Esperanza, based in Roxbury, MA. The program will provide intensive case management, increased access to medical screening, mental health services, family intervention services and supported employment services. In addition, aspects of the intervention will be modified to better serve the Latino/a community. The CARS outcome study will assess the effectiveness of adding these expanded and culturally modified integrated dual diagnosis services to an already existing residential substance abuse treatment program for Latino/a individuals.
“Factors Associated With Adopting Evidence-Based Substance Abuse Treatment Practices in Community Organizations Funded through Federal Program Efforts: A National Study”
Funded by the Robert Wood Johnson Foundation
Co-Investigator: Maryann Amodeo, Ph.D.
The Boston University Center for Addictions Research and Services conducted a national study of 500 community-based organizations (CBOs) funded (2003-2007) by Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), examining factors that facilitated and/or impeded the implementation of their proposed evidence-based treatments (EBTs). CSAT is the major federal funder of substance abuse treatment in the U.S. Recent CSAT funding requirements mandate that CBOs applying for treatment services grants implement EBT approaches. Yet there is often a disconnect between the real world of CBO treatment and the EBTs promoted by the federal government.
Methods: Quantitative and qualitative research methods were used to explore the relationship between organizational and staff factors and the capacity to implement proposed EBTs. The data collection phase included two steps: (1) phone interviews with the director (n=500) and two front-line staff (n=1000) of the grantee organizations, and (2) a web-based survey with the same individuals. The study utilized Lehman, Greener, & Simpson’s (2002) measurements of organizational readiness of change (TCU ORC-S, TCU ORC-D) and controlled for other confounding organizational and program staff factors not included in the TCU scores.
Aim: The overall aim of the study was to identify results that will be used to improve federal and state substance abuse policies promoting the use of EBTs among CBO treatment providers. Given the extensive attention and funding that the federal government is directing to the development and implementation of EBTs, data is needed on the extent to which funded programs with the mandate to implement such practices are actually doing so, and the factors influencing implementation. Specific policy recommendations were developed in the areas of (2) organizational readiness for change and EBT implementation efficacy, (2) training utilization and needs and EBT implementation efficacy; and (3) staff attributes and EBT implementation efficacy.
“Outcome Study: The Relapse Prevention Initiative: Trauma Counseling Services To Drug Users”
Funded by Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA)
Funds for this project include: (1) Award to Casa Esperanza of Boston, Massachusetts, to provide enhanced residential drug treatment services including trauma counseling services to recovering substance abusers and, (2) Award to Boston University School of Social Work (BUSSW) to conduct a five year study examining the effectiveness of the Casa Esperanza effort. The purpose of the study is to measure the effectiveness of adding Trauma Recovery Group Treatment and comprehensive Aftercare Services to existing Casa Esperanza residential drug treatment services. The study will identify whether the intervention resulted in: (1) reduced client drug and alcohol relapse rates (as measured through a drug and alcohol use scale from the CSAT GPRA Client Outcome Measures for Discretionary Programs; (2) increased number of clients domiciled; (3) improved psychological and emotional well-being (ASI mental health score and the Dissociative Experiences Scale score will be used); and (4) increased family stability.
“La Voz: HIV Mobile Prevention and Clinical Care for Latino Injection Drug Users”
Funded by SAMHSA/CSAT
Co-Investigator: Maryann Amodeo, Ph.D.
This new intervention will provide mobile HIV outreach, education, testing and mental health counseling services in the Western Massachusetts ’ region provided by one of the Center’s long time collaborators, Tapestry Health. The Western Massachusetts geographic area has one of the highest HIV incidence rates related to injection drug use in the nation and the Latino population is disproportionately affected by the epidemic. Through this new effort, La Voz will acquire and adapt a van to serve as a mobile program facility. Outreach workers, trained in motivational interviewing techniques, will provide HIV risk avoidance education and supplies, as well as referrals to van medical and mental health staff and to substance abuse treatment services. A trained nurse on the van will conduct HIV testing, and STI and Hepatitis testing. A full time mental health counselor will also be on the van to provide mental health screening, counseling and referrals to psychiatric care. The Center for Addictions Research and Services team will over a five year time period both conduct a comprehensive outcome evaluation of this effort and train La Voz mobile van workers on using evidence based-services.
“Outcome Evaluation: Men’s HIV Prevention Health Project”
Funded by Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA)
This study examined the enhancements in treatment effectiveness and efficiency that results from adding intensive prevention case management to standard outreach activities when providing services to men having sex with men (MSM) who are substance abusers. A quasi-experimental research design with a comparison group was used to examine whether adding an intensive, culturally-sensitive prevention case management (PCM) component to standard community outreach health prevention services increases the likelihood that a population of adult MSMs will have: (1) no past month use of alcohol or illegal drugs; (2)no or reduced alcohol or illegal drug consequences; (3) improved self-sufficiency through employment, other legal income or public assistance; (4) improved social support and functioning including improved family and social relationships, no or reduced involvement with the criminal justice system and permanent housing in the community; (5) good or improved health and mental health status; and (6) improved treatment efficacy including appropriate service utilization, improved program retention and increased program completion. In addition, data were gathered that will allow for the testing of outcomes that are more specific to this target population. Data will be used to determine whether the intervention increased the likelihood that study participants would have HIV testing, HCV testing, STI testing, enter mental health and substance abuse treatment, enter job training, and increase condom use. Data were also gathered that lead to increased understanding of the nature and variety of substances used by the target population (e.g., methamphetamines, club drugs) as well as research into the role of race/ethnicity and sexual identity in substance use.
“Outcome Evaluation Of Project La Voz, An HIV Prevention”
The purpose of this five year outcome evaluation funded by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), was to examine the impact of adding intensive prevention case management to standard outreach activities provided by Tapestry Health, Inc. and targeted to a population of Latino Injection Drug Users (IDUs) residing in Springfield, Massachusetts. Specifically, 787 Latino drug users received intensive, culturally-sensitive prevention case management including outreach, mental health and health services Provided services included (1) HIV testing, Hepatitis C testing, STD testing, (2) needle risk and sexual risk behaviors prevention counseling, (3) referral to drug treatment, and (4) transportation, housing, and other daily living assistance activities. An examination of intake and six month follow up data among Latino injection drug users who had been sharing needles at intake (n = 202) showed that having more than seven encounters with the culturally competent staff reduced the likelihood of sharing needles at the six month follow up. A paper describing these results, The Association Between Number of HIV Prevention Service Encounters and a Reduction in Sharing Works for a Sample of Latino/Latina Injection Drug Users, has been submitted for review to the Journal of Health Care for the Poor and Underserved.
“Drug Treatment Paths And HIV Outcomes Of Injection Drug Users”
This three year study funded by the Substance and Mental Health Administration (SAMHSA, Center for Substance Abuse Treatment (CSAT) determined which types of substance abuse treatment services lead to the best outcomes for IDUs. This study included both male and female IDUs and focused on two ethnic/racial groups, African Americans and Latino/as. Two annual interviews were conducted with 200 African American and 200 Latino/a IDUs. These interviews focused on changes in clients’ drug use, HIV risk behaviors, employment and housing, and perceived barriers to treatment. Furthermore, information was elicited from female IDUs who have children in order to identify treatment patterns and barriers specific to mothers.
“Research On HIV Service And Substance Abuse Treatment Needs Of African-American And White Injection Drug Users”
This five year project funded by the Robert Wood Johnson Foundation tracked changes in substance use and HIV-risk behaviors through in-person interviews with 300 male IDUs recruited at needle exchange programs over a period of three years. 150 White IDUs in Western Massachusetts and 150 African-American IDUs in Cambridge participate in 2 annual interviews. The major research question addressed in this study was to determine what substance abuse treatment paths are associated with reduced substance use and reduced HIV risk behaviors among IDUs over a period of three years.
“Service Gaps, HIV, And Substance Abuse Treatment Needs Of African-American And White Injection Drug Users: A Longitudinal Study”
The primary focus of this four year longitudinal study funded by the Substance and Mental Health Administration (SAMHSA), Centers for Substance Abuse Treatment (CSAT) was to identify adult injection drug users’ substance abuse treatment and other service needs, including job training and parental supports services. The study primarily analyses data on 45,000 heroin users in the State of Massachusetts who either entered substance abuse treatment or a needle exchange program between 1996-2001. The study also included qualitative interviews with forty injection drug users exploring their perceived barriers to using services such as substance abuse treatment or job training.
“Outcome Evaluation To Assess The Effectiveness Of Project Safeplace: An Effort To Reduce HIV/AIDS Rates Among Hard-Core Drug Users”
Project SafePlace, under the direction of the Boston Public Health Commission, is designed to provide community outreach to IDUs, link them with a comprehensive resource and drop-in center, the Addicts Outreach and Resource Center (AORC), and provide links to substance abuse treatment. This outcome evaluation assessed whether project SafePlace facilitated access to substance abuse treatment and reached the goals of increasing entry and length of stay in treatment. In summary, the evaluation effort identified that (1) SafePlace clients over all had a high level of knowledge about HIV and AIDS and about the possible consequences of engaging in high risk activities such as sharing needles and not using condoms when engaging in sexual activity; (2) this knowledge level increased after participation in the program, and (3) there was a positive association between high utilization of pretreatment services provided by the drop-in center and entry into detoxification for the main population utilizing SafePlace, African-American IDUs. Hence, the more often pre-treatment services were utilized, the greater the likelihood of multiple treatment entries.
“Dual-Earner Families And Reduced-Hours Career Paths In The Medical Profession”
This three-year study funded by the Alfred P. Sloan Foundation explored the consequences of working a reduced hour schedule in medicine from the perspectives of the reduced-hour physicians, their spouses, and the managed health care organization. Results indicated that reduced-hours physicians show higher levels of satisfaction compared to peers in academic medicine; yet, a reduced-hours career track is perceived to close certain career advancement options and reduced-hours physicians experience stigma about their career choice. Reduced-hours career tracks in medicine are seen by both male and female full time physicians as choices primarily available to women physicians. Further, they are understood and often assumed to be career paths undertaken in order to spend more time with children. Specifically, a large number of physicians do not have a full-time clinical practice. There are instead a wide variety of practice models. For example, some work reduced-hours in two practices, some work reduced hours and also do research, some work reduced-hours clinical practice and have an administrative position. Yet, most full time and reduced-hours physicians seem to believe that reduced clinical schedules will result in limited career options, and that even within primary clinical practice the progression up the career ladder is slowed. Hence, there is a difference between working fewer clinical hours for work-family or other personal reasons, and clinical hours reduced in order to take on other kinds of medical work.
“Reduced-Hours Work in Medicine: The Full-time Physicians Perspective”
This one-year qualitative research effort examined full-time physicians’ perspectives on reduced-hours careers in medicine. Comparative analysis show that in many ways work characteristics identified as problematic are the same for both full time and reduced-hours physicians. These include workload issues, particularly related to managed care (i.e., more patients in less time, more paperwork, more negotiation with insurance providers on behalf of patients); the fact that they all described a lack of administrative support, and all need more of it; and, that both groups of physicians stated that full-time medical practice seems inevitably to produce high levels of stress and pressure with regard to family time.
Maryann Amodeo, Ph.D., M.S.W.
“Technology To Enhance Addiction Counseling And Helping (TEACH) CBT”
Funded by the National Institute on Drug Abuse, National Institutes of Health through a grant to the New England Research Institutes, Inc., and Subcontract to the Boston University School of Social Work
This study, TEACH CBT, designed and tested a web course to supplement the often limited continuing educational opportunities available for substance abuse counselors. The web course presents the techniques of Cognitive-Behavioral Therapy (CBT) with content developed by experts from several institutions and based on many sources including NIDA’s CBT treatment manual. The course (a) is composed of 8 modules inclusive of 16 hours of on-line training and off-line assignments, (b) is available to counselors 24 hours/day, 7 days/week, (c) provides numerous handouts and access to a discussion board, (d) engages the user with interactivity and exercises, and (e) presents material in multiple formats, resulting in a unique learning opportunity for counselors. A randomized controlled trial with 120 counselors from substance abuse treatment agencies in New England is assessing the effectiveness of this web course design in comparison to manual-based CBT training alone on several outcomes: a) knowledge of CBT, b) attitudes towards using evidence-based practices and CBT interventions, and, c) specific CBT counseling strategies utilized (assessed from audio-tapes of client sessions).
“Predicting Resilient Outcomes From Childhood Stresses And Resources: Black Women And White Women With And Without Alcoholic Parents”
Funded by the Greater Boston Council on Alcoholism
This study aimed (1) to determine whether black women and white women from families with and without alcoholic parents differ in adult psychosocial outcomes and (2) to identify stresses and resources in childhood that account for different adult outcomes by parental alcoholism status and race in a community sample of 300 women. Subjects were blind to the purpose of the research, responding to flyers that advertised a “family study” and participating in a screening interview that did not disclose the specific purpose of the research. Subjects completed standardized questionnaires and participated in a face-to- face interview. The final sample was balanced by race, parental alcoholism status, and socioeconomic status. Unique aspects of the study included women varied in age, race, and socioeconomic background; subjects recruited from the community rather than treatment populations; childhood risk factors and adulthood outcomes examined together rather than in isolation from one another; a range of risk factors including childhood sexual and physical abuse and parental psychopathology; a range of adulthood outcomes such as psychosocial adjustment, life satisfaction, self-esteem and coping methods in addition to substance abuse. Data on childhood family environment and parental behavior was also collected from siblings as a reliability check on subject reports.
“Introducing Evidence-Based Practices In Addiction Settings Using Organization Development Methods”
Funded by the National Institute on Drug Abuse through a grant to Boston Medical Center and Subcontract to the Boston University School of Social Work
Although federal agencies have made dissemination of evidence-based practices (EBPs) in addiction settings a major national priority, gaps remain in technology transfer to community agencies. We collaborated with four urban addiction treatment programs to facilitate the introduction of EBPs using Organization Development (OD) methods. The OD approach is based on the theory and technology of applied behavioral science, including action research, to bring about change. In effect, it engages the system in an organizational assessment, an organizational diagnosis, and an organization-specific treatment plan. In this study, employee work teams, with the authors as consultants, identified areas for treatment improvement, developed change strategies, and implemented change plans with the overall explicit goal of introducing EBPs into their addiction treatment setting. We are examining changes in organizational policies and procedures and improvements in practitioner skills. The introduction of EBPs may be premature for some addiction programs as addressing more fundamental aspects of client-clinician interaction and agency treatment philosophy may first be required. Preliminary findings are that the OD approach is complementary to other technology transfer efforts by being: (a) “organization-centered,” engaging practitioners at all levels; (b) “needs-focused,” addressing issues identified by the particular organization; (c) flexible in its responsiveness to a range of organizations at various stages of readiness for change; and (d) relatively affordable.
“Clinical Addiction Research And Education (CARE): Chief Resident Immersion Training Program”
Funded by the National Institute on Drug Abuse and sponsored by the Section of General Internal Medicine, Boston Medical Center. The purpose of this project is to train physicians in evidence- based practices including brief intervention methods, and to evaluate effectiveness of this training method. Annually, cohorts of 25 Chief Residents are recruited from around the country for a four-day intensive substance abuse training program. Chief Residents come from Internal Medicine, Family Medicine and Emergency Medicine. They commit themselves to teach substance abuse to residents in their hospital and medical settings and implement action plans for continued institutional commitment to this issue. Knowledge and behavioral outcomes of Chief Residents who complete the program are compared with outcomes from Chief Residents who applied but were not accepted for the program. Dr. Amodeo served as a faculty member and advisor for this training and evaluation project. (PI: Jeffrey H. Samet, MD, MPH, BUMed).
“Evaluation Of National Child Welfare Training Initiative: Youth Transitioning From Care”
Funded by the Children’s Bureau, Administration on Children, Youth and Families, U.S. Department of Health and Human Services, the purpose of this project was to evaluate the nature, role, and impact of a cluster of Child Welfare training grants provided to nine institutions across the country. These grants trained Child Welfare workers, supervisors, community providers, and others working with youth who are transitioning from foster care. Products of this Evaluation Project, still in production, include a Case-Study Report of the experiences of the nine sites, a comprehensive literature review on the State of Child Welfare Training, a survey of state training directors on the national role of Child Welfare training and federal training funds, and a survey of schools of social work on a similar topic. Dr. Amodeo, Co-PI of the project, assisted with all aspects of the project. (PI: Mary E. Collins, Ph.D., BUSSW).
“Training In Youth Development For Public Child Welfare”
This purpose of this grant from the Children’s Bureau, Administration on Children, Youth and Families, U.S. Department of Health and Human Services, was to design a curriculum and implement statewide training for child welfare workers focused on youth development principles. A team of faculty from the Boston University School of Social Work, in collaboration with the Massachusetts Department of Social Services (DSS), designed and delivered a curriculum emphasizing a Positive Youth Development approach to working with youth who are transitioning out of foster care. Training included group skills, substance abuse skills and cultural competency skills. Training was delivered to DSS youth workers and workers in youth residential programs across the state. The project also provided tuition stipends for students specializing in the child welfare field. Dr. Amodeo was the Co-PI and served as a curriculum designer and trainer. (PI: Mary E. Collins, Ph.D., BUSSW).
“Interdisciplinary Faculty Training Program In Substance Abuse For Health Care Professionals: Project MAINSTREAM”
Funded by the Health Resources and Services Administration, U.S. Department of Health and Human Services, and directed by the Association for Medical Education and Research in Substance Abuse (AMERSA), the purpose of this national initiative was to recruit and train interdisciplinary teams of faculty from across the country, equipping them with substance abuse skills to train students in a range of health professions. Health professional faculty in the project came from Social Work, Nursing, Psychology, Medicine, Public Health, Pharmacology and Allied Health Professions, among others. A published curriculum and mentoring was provided.
Outcomes included degree of substance abuse curriculum integration at the home institution, number of students taught by these faculty teams and equipped with substance abuse skills, and faculty publications, research, grant funding and professional presentations on substance abuse. Dr. Amodeo served on the Executive Fellowship Committee, advising on curriculum content, recruitment and selection of participants, evaluation measures and methods, and serving as a liaison with federal funding agencies. (PI: Richard Brown, M.D., University of Wisconsin, Madison).
Melvin Delgado, Ph.D.
“Minority Institutions Drug Abuse Research Program”
Funded by the National Institute on Drug Abuse, this multi-year project provided research training on drug abuse to social work researchers interested in studying ethnic and racial minority populations. Participants were faculty from a variety of universities and colleges from around the country. Instructors were leaders in substance abuse research with expertise in epidemiology, longitudinal research, analysis of national data bases, health services research, culturally-responsive research methods, prevention, intervention and state-of-the-art methodologies in social work research. Approaches to partnering with communities of color to conduct research was a pervasive theme. Goals were to equip faculty to design studies that would move the field forward in developing effective interventions for underserved populations. Participants presented research proposals to senior faculty and fellow participants who provided guidance on refining the design, operationalizing the concepts, and implementing the study.
Ruth Paris, Ph.D.
“Evaluation of Project BRIGHT (Building Resiliance through Intervention: Growing Healthlier Together)”
Funded by SAMHSA
Principal Investigator: Ruth Paris, PhD.
Boston University School of Social Work Assistant Professor Ruth Paris in conjunction with the Center for Addictions Research and Services will lead an evaluation study of Project BRIGHT. Funded by SAMHSA, Project BRIGHT is designed to address traumatic stress in children ages birth to five and their parents in recovery from Substance Use Disorders (SUD) and Co-Occurring Disorders (COD), at eight Family Residential Treatment (FRT) programs across Massachusetts. The Institute for Health and Recovery (primary grantee) will collaborate with BUSSW, Jewish Family and Children’s Services Center for Early Relationship Support and Boston Medical Center’s Child Witness to Violence Project. Dr. Paris and the Center for Addictions Research and Services will evaluate program activities, interventions, methods, and implementation to assess effectiveness.
The FRT programs provide intensive SUD treatment to families who seek recovery from the devestating effects of substance abuse, mental illness, and trauma, rebuilding shattered lives while raising young children. Appropriate interventions for such young children require support of the parent-child relationship in order to be effective and sustained, and BRIGHT will therefore offer Child-Parent Psychotherapy (CPP), developed specifically to address the impact of traumatic experiences on young children and their parents. This specialized intervention offers therapeutic support to children and their parents in building new understandings and behaviors that promote developmental progress, resilience, and emotional stability. It will be adapted to address the specific needs of families in treatment for substance abuse.
During the 3-year project, trained clinicians will provide CPP to families on site at the FRT programs, simultaneously training FRT staff in the practices and strategies critical for addressing children’s trauma histories with the goal of supporting parent-child relationships.
The intervention objectives to be measured include: child’s decreased trauma response symptoms; child’s increased capacity for emotional regulation; child’s developmental progress; parent’s decreased mental health symptoms; parent’s increased awareness of trauma impact on child; and parent’s increased capacity to provide safety and protection for child (including understanding child’s intentions and communications). Local evaluation data will be entered into the Core Data Set in order to participate in the National Cross-site Evaluation conducted by the National Child Traumatic Stress Network. By pooling data from many sites across the country researchers and clinicians will learn more about the impact of trauma on children and contribute to the development of effective evidence-based practice models.