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Through the Expanding Comprehensive School Mental Health Systems in Northeast Ohio project, school districts and partners will improve educational and health outcomes for K-12 students in at least four Greater Cleveland school districts by collectively establishing trauma- informed learning environments for all students and targeted/intensive supports and interventions for students experiencing significant trauma responses and mental health challenges. This project focuses primarily on school children and youth ages 5-18 in the Cleveland Metropolitan School District and the 16 school districts serving Cleveland’s First Ring suburbs. Collectively, these school districts serve 60,000 students, 60% of whom qualify as economically disadvantaged. Slightly more than half of these students (53%) are African-American, 37% are White, 7 % are Latinx, and 2% are Asian/Pacific Islander, and 1% are Native American. Regional data demonstrates significantly growing numbers of these students experiencing symptoms of depression, anxiety, and suicidality consistent with national data revealing a youth mental health emergency that has been intensified by the Covid-19 pandemic. Confounding factors for these youth include repeated exposure to violence and subsequent trauma at home, in school, and in the community, systemic racism, gender-based marginalization, homophobia, elevated number of Adverse Childhood Experiences (ACEs), and the complex narrative of multigenerational chronic stress, adversity and trauma. Under the leadership of the Educational Service Center of Northeast Ohio (ESC NEO), Local Educational Authorities and local trauma-informed primary care and mental health service providers will solidify and disseminate a promising comprehensive school mental health system initiated in 2017 in the first ring Lakewood City Schools, using evidence-based and promising educational and clinical practices. This system leverages established interagency relationships and local healthcare providers who already serve the district population, expanding access to trauma-informed educational environments as well as high-quality screening, referral, and treatment support services to students and families who have experienced significant trauma and/or mental health challenges. Through the ongoing development of comprehensive school mental health systems in Lakewood and at least three other districts, approximately 3,000 students (non-duplicated) will be screened for trauma responses and mental health needs over the four years of the grant period, and approximately 1,400 of these students will receive additional services (beyond screening). In order to accomplish the goals of the project at least 400 educators and 80 health care professionals will participate in professional development supporting improved practice in relation to student trauma and mental health challenges. A customized family and community engagement plan will lead to increased awareness of trauma and mental health challenges among children and youth, along with the ability to connect students and families with needed supports. Over the course of the project, the partners will establish a regional community of practice in order to maximize quality, sustainability, and continuous expansion of comprehensive school mental health systems in Northeast Ohio.

Wyoming Trauma-Informed Services in Schools will partner with two LEAs (Sweetwater County School District #1 and Sweetwater County School District #2) and one Behavioral Health Partner (Wyoming Behavioral Institute) to deliver trauma-informed services primarily within the student population aiming to serve 300 unique students annually. The 300 student estimate is based on 4% of the total student population of the districts of approximately 7500 students. Tier 1 services will not be counted unless SAMHSA requests this counting. There will be processes developed that will impact the entire student population.

The Camden County Educational Services Commission (CCESC), in coordination with Behavioral Health provider Oaks Integrated Care (Oaks), is seeking to develop and implement School Based Trauma Informed Support Services and Mental Health Care in Camden County, New Jersey, to serve Pre-K through 12th Grade students in public, charter, renaissance, nonpublic schools, state facilities, and private schools for the disabled. CCESC and Oaks provide a variety of overlapping school based services in Camden County; therefore, the proposed proactive programmatic services will include all municipalities and educational institutions within the County, and the proposed targeted reactive programmatic services embedded within various districts will include those municipalities and schools with the highest rates of referrals to the County's Crisis Center and Children's Mobile Response (CMR) services. A prominent issue at the forefront of youth mental health treatment in Camden County sees school districts defaulting to sending youth to the Emergency Department (ED) for discharge and clearance to return to school following a mental health crisis. Without the proper linkage and referral to treatment services, which is beyond Crisis service's capacity and scope, treating the school clearance as a simple "Check-mark" for the student greatly exacerbates any current and future mental health issues and challenges. The current system passes liability from one entity to another, resulting in the "revolving door" phenomenon of individuals cycling in and out of the public health system. The goal of the proposed School-Based project is to provide services to address the unmet behavioral and mental health needs of the target population by increasing accessibility to services and strengthening collaboration between schools, their faculty, families of students, and mental health services providers. CCESC and Oaks will serve a total of 125 individuals in Year 1, and 250 individuals annually in year 2 through 4, for a total level of service of 875 unduplicated individuals through the 4 year project period. This number is based on actual trends of referrals and admissions served in Oaks' Crisis Center and CMR programs.

The Rhode Island Department of Education (RIDE), in partnership with Bradley Hospital and Family Service of RI proposes to increase student access to evidence-based and culturally responsive and sustaining trauma support services and mental health care by developing innovative statewide initiatives to raise awareness among school personnel and the broader school community on the prevalence and effects of trauma on youth mental health and school performance particularly in the context of the COVID 19 pandemic. RIDE, in collaboration with key partners, will provide more intensive support to 5 Local Education Agencies (LEA’s) to strengthen schools’ capacity to provide culturally relevant evidenced-based trauma support services and mental health care using a Multi-tiered System of Supports (MTSS) framework. LEAs will be selected based on need and readiness to change. The impact of the COVID-19 pandemic on RI’s youth is unprecedented. During the 2021-2022 school year, amid the pandemic, the number of emergency responses to youth experiencing serious mental health problems increased. Impressions of serious mental health concerns included anxiety, depression, bipolar disorder, mania, emotional state issues, suicide or homicidal actions or ideations and others (RIDOH, 2022). Further, school level data from SurveyWorks underscore RI's need for statewide efforts to help schools cultivate safe and secure school climates that are culturally responsive and grounded in principles of trauma-informed care so all youth can feel comfortable and supported reaching out to adults for help. The following goals will guide the work. 1. Build capacity of the SEA and partners to support increase student access to evidence-based and culturally responsive and sustaining trauma support services and mental health care by developing innovative initiatives, activities, and programs to link local school systems with local trauma-informed support and mental health systems. 2. Build LEA capacity to develop and operationalize a school-based trauma informed support and mental health services implementation plan. 3. Build LEA capacity to support and provide trauma informed, culturally responsive mental health care through professional development and training of all school-based staff. 4. Increase capacity at the LEAs to connect families, schools, and communities to increase engagement and involvement in planning and implementing to increase awareness of the impact of trauma on children and youth. 5. Foster partnerships at the state level among State Department partners with a role in behavioral health for children and youth. RIDE expects over 42,000 RI school age children will benefit from this effort over the course of the Co-Operative Agreement. Culturally competent and trauma-informed considerations will be interwoven into all aspects of the evaluation and serve as the foundation for monitoring progress, measuring outcomes, and sharing findings that are timely, relevant, and of use to stakeholders.

Collingswood Public Schools have experienced a significant rise in the number of students requiring therapeutic support, mainly due to the massive disruption of the COVID-19 pandemic. Analysis of multiple data points, as well as input from administrators, school support staff, teachers, students and families, overwhelmingly support this statement. Oftentimes, these therapeutic supports are outside the typical scope of school services. As a result, Collingswood Public Schools is in need of a Wellness Center that houses highly qualified staff, including clinical social workers, a nurse practitioner and BCBA, so that students and families who need Tier II and Tier III supports and interventions have a safe, welcoming space to begin the healing process. Collingswood Public Schools also need coaches and additional resources, so that all students and families receive the Tier I support necessary to implement systemic changes that support trauma-informed care within our schools. This grant will enable us to make these goals attainable.

Burlington County Institute of Technology (BCIT) is a four-year countywide vocational-technical public high school serving 2,100 students in 9th through 12th grades. Located on two campuses, the student body is far more racially and ethnically diverse, as well as economically disadvantaged, than Burlington County (the geographic catchment area). As reported by BCIT professionals, and confirmed by a 2020 Rutgers University County Needs Assessment, the COVID-19 pandemic with its resulting isolation, illness/deaths and financial downturns, created and exacerbated traumas experienced by students and families, including but not limited to, bullying, disasters, early childhood trauma, community violence, sexual abuse/assault in and outside the home, domestic terrorism and violence, and traumatic grief. The Study found behavioral and mental health services for youth to be a prioritized urgent need, especially given the lack of services, and difficulties accessing existing services, and additional barriers impeding access by Black/African American and other historically underrepresented racial and ethnic minorities, and LGBTQIA students and their families. The Project will enable students and their families to better identify and successfully navigate access to available trauma resources, specifically addressing transportation and financial barriers, and systemic and historic barriers negatively affecting participation by LGBTQIA and Black/African American and other historically underrepresented racial and ethnic students/families. These goals will be achieved by working with three Local Partners in achieving a number of objectives (measurable in both time and level of participation) to include: the creation, dissemination and successful communication of a database of available trauma based resources; developing working teams with each Local Partner to navigate access and entry into available programs; assisting those specific students/families where transportation and financial access have been a barrier to accessing trauma based resources by additionally working with County and community resources; implementing cultural competency and implicit bias training for the entire staff (enhancing identification practices in teachers and staff to construct pathways and linkages to build connections with providers prior to students encountering mental health crises); and implementing culturally appropriate educational and therapeutic youth school events, all the while addressing systemic barriers that have limited access to trauma based resources by Black/African American and other historically underrepresented racial and ethnic and LGBTQIA, students and their families. Over a four-year period, this Project will disseminate information services to 2,100 students, provide direct services to 650 students, provide 40 with direct assistance seeking to overcome financial/economic barrier, and provide training for 600 BCIT teachers and staff and events for 480 students.

The Board of Education of the City of Chicago, District 299, Chicago Public Schools (CPS) proposes to expand its current trauma-informed mental health services to include those which focus on substance use prevention and intervention. The population of focus is the district’s school communities, including students and their families and caregivers, staff, and educators. The year one geographic catchment areas are High School Networks 14 and 16. However, youth and their families regardless of enrollment in CPS or residence in these networks or of high school age, will have access to developmentally and culturally appropriate trauma-informed mental health services for substance use. We plan to expand the project to networks 15 and 17 by the project’s end in 2026. These networks encompass communities of color, of which, most are historically disinvested. Research shows that over 80% of high-school youth in Chicago have been exposed to violence in their lifetime and that this violence is concentrated in communities with high rates of disinvestment (Gorman-Smith et al., 2014). Data from Chicago’s 2019 CDC Youth Risk Behavior Survey (YRBS) demonstrates students experience high rates of emotional distress (35%) and suicide attempts (10%). The YRBS data also reflects an increase in the number of high school students who report feeling sad and hopeless (28% in 2005, 38% in 2019). Student substance use is rising in tandem with the rise in students feeling sad and hopeless. Instances of substance use infractions increased by 59% in SY19. According to the YRBS, 26% of surveyed students report currently drinking alcohol, and 23% of students report currently using marijuana. Possessing or using substances in school is a violation of the Student Code of Conduct (SCC 4-14) and 2,011 infractions were recorded across the district in SY20. The project is organized across five activity areas to provide effective prevention education and responsive screening and interventions to impact youth substance use behaviors in Chicago Public Schools across a multi-tiered system of supports (MTSS). 1. Prevention/Education (Tier 1) 2. Responding to Substance Use Behaviors: Engaging Students & Families (Tiers 2-3) 3. Responding to Substance Use Behaviors: Substance Use Resources & Interventions (Tiers 2-3) 4. School-Based Substance Use Intervention Supports (Tiers 2-3) 5. Community-Based Substance Use Intervention Supports (Tiers 2-3) Proposed number individuals served: STUDENTS: YEAR 1: 150 YEAR 2: 500 YEAR 3: 7,400 YEAR 4: 10,500 EDUCATORS/STAFF/ADMINISTRATORS: Y1: 350 Y2: 400 Y3: 450 Y4: 500 PARENTS/CAREGIVERS: Y1: 100 Y2: 200 Y3: 300 Y4: 400

Students in the Ketchikan Gateway Borough School District (KGBSD) experience trauma at extremely high rates due to region specific social, economic, and cultural conditions. Child sexual abuse, child abuse and neglect, exposure to domestic violence, intergenerational trauma, and bullying are all concerns within the KGBSD. A dedicated focus on trauma-informed capacity building district wide is needed to assure the successful support of students in the school system and build capacity to prevent trauma and promote healing in the community. The proposed project would allow the school district to collaborate with partner Women In Safe Homes (WISH): 1. Increase the accessibility of trauma-informed mental health services and student support; 2. Expand the capacity of the KGBSD to fully integrate trauma-informed policies and practices through staff training; 3. Operationalize the use of a common framework for trauma-engaged schools; and 4. Increase administrative oversight to assure compliance with best practices for trauma-informed and culturally responsive school systems. The KGBSD and WISH have historically partnered to provide trauma-informed and culturally responsive services for students and training to educator. KGBSD and WISH currently partner to provide mental health support services available to students who have experienced domestic violence. The proposed program would greatly expand the number of students able to access mental health services, and expand the capacity of the district to provide social work services, educator training, and fully-realize being a trauma-engaged school district. Goals for the program are to 1. Expand the Ketchikan Gateway Borough School District’s relationship with organizational partner WISH and other local mental health service providers and service agencies better identify, refer, and provide services to students impacted by trauma and their families; 2. Increase the capacity of the school district to identify students impacted by trauma and mental health struggles and provide them with access to comprehensive, low barrier supports and services to improve their social, emotional, and academic outcomes over the lifespan; 3. Operationalize a district wide administrative plan based on the Alaska Department of Education and Early Development’s Transforming Schools: A Framework for Trauma-Engaged Practice in Alaska, and 4. Implement a comprehensive training and oversight plan. The program will utilize Transforming Schools: A Framework for Trauma-Engaged Practice in Alaska (TSF), developed by the Alaska Department of Education and Early Development in 2019. The evidence-based framework is a roadmap for effectively integrating components to fully-realize becoming a trauma-informed school system through improvements in the domains of: 1. Deconstructing trauma; 2. Relationship building; 3. Policy considerations; 4. Planning and coordination of schoolwide efforts; 5. Planning and coordination of schoolwide efforts; 6. Professional learning; 7. Schoolwide practices and climate; 7. Skills instruction; 8. Support services; 9. Cultural integration and community co-creation; 10. Family partnership; and 11. Self-care for staff. The proposed project includes specific activities at the direct service, administrative, and school-policy levels to assure full realization of a trauma-engaged school, as described in the implementation plan. The result of implementing TSF is a school-district that builds on existing efforts to fully integrate trauma-informed and culturally responsive practices in all aspects of operations. The program will hire a Program Director, Evaluator, Three School Social Workers and Three School-Based Mental Health Counselors to carry out program services including student support services, school staff training and development, enhance community partnerships, and engage KGBSD families in activities that support student health, wellness, and achievement.