The Center for Trauma-Informed Adolescent Suicide, Self-Harm, and Substance Misuse Treatment and Prevention (ASAP) trains health and mental health care professionals in state of the art trauma-informed treatments for self-harm, suicide prevention, substance abuse, and depression with the aim of empowering children, adolescents, young adults, and their families to recover from mental health problems and build lives they want to live. The UCLA-Duke ASAP Center provides national expertise on adolescents affected by trauma, emphasizing services for trauma-affected youth with suicidal/self-harm behavior and substance misuse, and those from underserved marginalized groups. By providing training and information on evidence-based care for trauma, suicide/self-harm, and substance misuse, the Center comprises a national resource, with potential to decrease morbidity and mortality associated with traumatic stress, suicidal/self-harm behavior and substance misuse. We provide trainings on brief evidence-based interventions for acute care and stabilization. These include: 1) SAFETY-Acute (A), a trauma-informed emergency/acute care intervention for suicidal and self-harm behavior (also called Family Intervention for Suicide Prevention), which aims to link youth to trauma-focused or other evidence-based treatments once safety is established; 2) the related 12-week SAFETY intervention for youth requiring additional stabilization after a suicidal/self-harm episode; and 3) motivational interviewing plus cognitive-behavior therapy for substance using adolescents. The ASAP Center also collaborates with other organizations within the National Child Traumatic Stress Network and other SAMHSA initiatives to strengthen national capacity and expand and train the workforce for responding to child traumatic stress and reduce risk of associated suicidal behavior, self-harm, and substance use.

Over the past five years, we collaboratively developed PATTeR (Pediatric Approach to Trauma, Treatment and Resilience) as a successful foundation for transforming pediatrics into a trauma-informed and responsive system of care. PATTeR is a partnership of the University of California Los Angeles (UCLA), the University of Massachusetts Medical School (UMass), and the American Academy of Pediatrics (AAP). Guided by its National Advisory Board (NAB) and the National Child Traumatic Stress Network, PATTeR incorporated the latest science from multiple fields (resilience, attachment, parenting, neuroscience, evidence-based trauma-informed mental health interventions) into an evidence-based and practical curriculum for pediatricians.  PATTeR developed, implemented and evaluated a novel trauma-informed care (TIC) curriculum for pediatricians; adapted the curriculum to resident education; and piloted a learning collaborative focused on implementing TIC into pediatric practice. PATTeR has introduced 30,000 professionals to TIC and provided in-depth training to 800 physicians, including >100 residents. Completers of in-depth training reported an average increase in proficiency of 1.8 levels on a scale of 1 to 6 on TIC elements (eg, serve and return, predictable compassionate availability, co-regulation).  We continue to seek funding to continue the work.

The Pediatric Approach to Trauma, Treatment and Resilience (PATTeR) is a multi-site project. The three project sites include the American Academy of Pediatrics, the University of Massachusetts Medical School and UCLA's Section on Developmental Studies. The focus of PATTeR is to develop curricula focused on trauma and resilience specifically for pediatricians who are the first child professionals family encounter and the most frequent gate-keepers to subspecialty care, including trauma-informed mental health care, and to supportive community-based services. During year one, we will focus on developing two levels of curricula: Trauma Aware and Trauma Informed. Through the AAP, which is the professional home of over 60,000 pediatricians across the United States, we will recruit pediatricians serving children and families in a variety of settings but focus on those serving certain high risk groups: those living in poverty, involved with child welfare or social services, those living in resource-poor areas and military families. Case-based learning designed to lead to practice change will occur in a group on-line format (using ECHO Technology) with an expert panel. Trauma Aware training will occur over 6 sessions. Pediatricians seeking to become trauma training resources in their own communities or AAP chapters will complete the more detailed Trauma-Informed training over 12 sessions. We will also recruit residency program leaders through the Academic Pediatrics Association to engage in both curricula since they are the educators who will transform pediatric residency education. We will also infuse curricula into multiple AAP education venues and anticipate reaching thousands of pediatricians during the grant cycle.

The University of Chicago Medicine REACT Program: Recovery and Empowerment After Community Trauma represents a response to Chicago's greatest ongoing public health challenge: violence. Based in an urban children's hospital, UCM REACT provides African American patients affected by community violence with brief trauma-focused intervention, as well as access to trauma-informed psychiatric and psychological services and ongoing trauma-focused therapy. UCM REACT builds on Healing Hurt People - Chicago (HHP-C), a partnership between UCM Comer Children's Hospital and the John H. Stroger Jr. Hospital of Cook County. HHP-C offers hospital-based violence intervention services to young patients who have been shot or suffered other violent injuries. The REACT Program, linked to the Comer Children's emergency department and PICU, provides trauma screening, support, psychoeducation, and intervention to Comer patients of all ages who have been affected by community violence, whether or not they have sustained violent injuries. The REACT Clinic, co-directed by a trauma psychologist and a child psychiatrist, provides trauma-informed psychological and psychiatric needs assessments patients identified by REACT and HHP-C. REACT and HHP-C clinicians receive training in and utilize the Child & Family Traumatic Stress Intervention (CFTSI). Finally, REACT and HHP-C clients have access to ongoing therapy services through provider partnerships with clinicians/programs with expertise in serving urban African American families, complex trauma, Child-Parent Psychotherapy, and ARC (Attachment, Regulation, & Competency).