The co-occurrence of substance use disorder (SUD) and trauma create a complex treatment profile that renders most treatment models ineffective. Family Centered Treatment Recovery (FCT-R) is designed to successfully navigate the complex interplay within the context of family, addressing the systemic dynamics of SUD and trauma exposure on the family unit. The SPARC Foundation (SPARC) proposes to expand its existing FCT-R pilot program in order to serve additional families while field testing and using program outcome data to further develop, validate, and scale the FCT-R model. SPARC will add two additional FCT-R teams to increase direct services in the service area, while also partnering with the Family Centered Treatment (FCT) Foundation, a current NCTSI Category II Treatment and Services Adaptation (TSA) provider, to scale up, implement, and evaluate the FCT-R model to additional FCT licensed agencies statewide and nationally. FCT-R consists of four distinct FCT treatment phases that encompass screening, assessment, care management, therapy, and prevention. Systemic trauma treatment and SUD treatment is provided throughout each of the four phases and supported by the evidence-based fidelity measures of FCT. FCT-R is designed to treat “cross-over” families involved with multiple systems (e.g., child welfare, etc.), or who are in crisis, facing forced removal of children from the home, or in need of reunification due to multi-generational trauma and SUD. Located in Western North Carolina in the Blue Ridge Mountains of Appalachia, the service area is home to 490,000 residents and more racially diverse than the state in general. The catchment area recorded 1,363 substantiated abuse and neglect claims in 2018, and in 2019 served 1,019 children in foster care. Over the five-year grant project, SPARC’s FCT-R project will serve 816 individuals from 272 families, and meet the following goals and objectives: Goal 1: Expand FCT-R trauma services into Buncombe, Polk, and Transylvania counties. Objective 1a: Execute agreements with four county partners. Objective 1b: Recruit, hire, and train 2 new FCT-R teams. Objective 1c: Deliver training to 210 county partners about trauma and the FCT-R model. Objective 1d: Begin FCT-R service delivery to expanded service area. Goal 2: Over the 5-year grant period, provide direct services to 312 individuals from 104 families in expanded service area. Objective 2a: 100% of families referred into the program will have a Family Relapse Prevention and Response Plan. Objective 2b: 100% of families referred will complete a screening meeting. Objective 2c: 80% of families will demonstrate an increase in cumulative number of abstinent days. Objective 2d: Develop, test, validate, and implement a new data-driven measure to gauge SUD treatment progress during FCT-R treatment. Objective 2e: 75% of families will complete all phases of FCT-R Treatment. Objective 2f: 80% of referred families will be reunified and/or preserved. Goal 3: Scale up and spread model to enable 7 FCT-certified agencies to implement the FCT-R model and serve at least 504 individuals from 168 families over five years. Objective 3a: Collaborate with the FCT Foundation to finalize FCT-R program manual, white paper, and training materials to be used for disseminating the model to external agencies. Objective 3b: Develop and finalize plan for training and scaling. Objective 3c: Collaborate with FCT Foundation to train 7 FCT-certified agencies to deliver FCT-R services. Objective 3d: Disseminate results of the project to one national conference audience.

Spurwink's mission is to provide behavioral health and education services for children, adults, and families in Maine. The agency's vision is that people affected by behavioral health challenges including the impact of trauma and developmental disabilities live healthy, engaged lives in their communities. Spurwink recognizes the impact of traumatic events on youth, families and adults and in 2011 developed and implemented a trauma-informed clinical model and a Trauma-Informed System of Care. The agency's Trauma-Informed System of Care is comprehensive in its approach and includes: a definition of trauma, trauma as a co-occurring condition, a commitment and process to stay current with research and best practices, COA standards, staff training and supervision, physical and emotional safety, consumer choice, clear boundaries, empowerment and skill building, prevention of re-traumatization, and understanding difficult/challenging behaviors as a response to trauma. Trauma treatment models include Attachment, Regulation and Competence (ARC), Trauma Focused Cognitive Behavioral Therapy (TFCBT) and Trauma Systems Therapy adapted for Refugees (TST-R). Spurwink's services include a large array outpatient treatment programs serving children and families, evaluation services, foster care services and supports as well as educational and residential settings for youth. Spurwink is also part of a number of community collaborations to enhance services to children and families impacted by trauma.

The Terry Reilly Child Traumatic Stress program operates within the Behavioral Health Division through the Trauma and Resilience Centers. These centers provide community-based outpatient counseling and treatment programs dedicated to addressing sexual abuse, trauma, and adverse childhood experiences (ACEs), while also enhancing individual and family capacity for safety, stability, and healing. Terry Reilly began offering specialized trauma services in 1983 in response to the increasing awareness of the prevalence and severity of sexual abuse in the community. Today, Terry Reilly operates Idaho's largest outpatient counseling program dedicated to treating sexual abuse. Providers are state-licensed mental health professionals with master's degrees and specialized training in trauma and sexual abuse. They offer a variety of evidence-based clinical practices, including play therapy, cognitive behavioral therapy, and Eye Movement Desensitization and Reprocessing (EMDR), which has proven to be a powerful tool in recalling and relieving the deep trauma of abuse.

The Center for Family and Adolescent Trauma Treatment (CFATT) provides a wide array of community based, evidence based, trauma focused, and culturally informed treatments and services. Support provided via wrap around services and care coordinators will complement the three evidence-based practices (Trauma Focused CBT, Culturally Informed and Flexible Family Treatment for Adolescents: CIFFTA, and Trauma Assessment Pathway: TAP) that will be offered. The Center serves children and adolescents (11-18 years of age) who have experienced a traumatic event (e.g., sexual abuse, domestic violence, neighborhood or country of origin violence, natural disasters, immigration-related trauma). The diverse South Florida community requires treatments designed for complex presenting problems (e.g., cutting and self-harm, depression, and substance use), diverse populations (e.g., race, ethnicity, sexual orientation, and gender identity), and community contexts include powerful high risk factors.