name of person completing application
* must provide value
I attest that I have read and agree to the expectations found within the CPP Information Sheet, CPP Implementation Overview, and CPP Agency Checklist on the ARBEST website:
* must provide value
Agency Director ( First and Last Name)
* must provide value
First and Last Name
Email
Clinical Supervisor ( First and Last Name)
* must provide value
First and Last Name
Email
Name of Agency Address Phone Number Agency Director Clinical Supervisor
Please email the completed application to:
* must provide value
Street Address
Street Address Line 2
City
Phone Number
Trainee Qualifications, Caseload, and Training Requirements There are two tracks within CPP trainings: Therapist and Supervisor. You will need to designate whether each trainee is on the Therapist track or the Supervisor track, as tracks have different training requirements and expectations. The Supervisor track consists of 3 monthly, 1-hour long video/phone calls and the completion of case requirements for two cases. The Therapist track consists of 2 monthly, 1-hour long video/phone calls and the completion of case requirements for four cases. Both tracks have the same requirements for virtual training attendance, reflective supervision, and case presentations.
Allowing and facilitating all trainees' time away from clinical and non-clinical duties to participate in virtual training, 13, half-day virtual trainings throughout the 18-month training period. Virtual trainings consist of a 5, half-day initial workshop followed by 4, half-day follow-up workshops at approximately 4 months and 10 months following the initial training. Of note, at this time we anticipate that the full 18-month training will occur virtually. Trainees will be given notice if activities must change to require in-person participation. Supporting Therapists' participation in full group video consultation calls with trainers (two, 1-hour video calls per month). Call Group 1: 2nd & 4th Mondays, and some 5th Mondays @ 12pm (Starting August 14th, 2023) Supporting Supervisors' participation in full consultation calls with trainers (two, 1-hour video calls per month) and Supervisor-only video calls with trainers (one, 1-hour video call per month). Supervisor Call: 3rd Mondays @ 12pm (Starting August 21, 2023) Allowing all trainees adequate time for preparation (e.g., completing the case presentation template and providing sample clinical material) for presenting on consultation calls. (Each trainee is required to present at least twice, either on the consultation calls or during virtual follow-up trainings, during the 18-month training period). Assisting trainees in receiving sufficient CPP-appropriate referrals to complete training requirements within 18 months (i.e., maintaining a CPP caseload of 3-4 cases seen weekly to optimize therapists' ability to treat 4 cases, two of which must be at least 16 sessions). Allowing trainees to prioritize accepting CPP referrals and allowing trainees to prioritize the birth through age 5 age group within their caseload. Engaging in community outreach to referral sources (e.g., pediatricians, early childhood education settings) to ensure trainees have adequate numbers of referrals. If applicaple, allowing all trainees adequate time to complete activities that support meaningful collaboration with the courts (e.g., completing case update letters for court, attending family-team meetings, and/or providing court testimony). Supporting therapists and supervisors in conducting bimonthly reflective supervision, at minimum, without a trainer present. This typically occurs among trainees within the same agency, or within a small group established by trainers and may occur in-person or via phone/video call.
IMPORTANT: These calls are in addition to the twice monthly calls.
Infrastructure Needs If treating clients in clinic: Creating or repurposing a fully or partially dedicated CPP therapy room (could be the trainee's office): A safe, relatively low-stimulation room for a caregiver and a child to engage in play with a small selection of toys. If treating clients in clinic: Developing an observation room: a room allowing a CPP trainee to see and hear the caregiver and child playing and be out of the child's sight and hearing. CPP observation can be conducted through a live video feed or by using a one-way mirror. Please indicate below which option your agency is pursuing:
Briefly describe how the CPP room and observation room will look and function in your clinic:
If treating clients remotely: CPP clinicians must be able to see parent-child interactions and families must be able to see the CPP clinician. Therefore, remote CPP must be conducted via secure video platform and the clinician must have access to a webcam so that the family can see the clinician during sessions. Briefly describe how virtual CPP sessions and observation will function in your clinic:
Supplies and Resources Having ability for trainees to easily make copies of assessment and/or fidelity measures, some of which are online. Purchase and/or maintain a supply of appropriate CPP toys, such as: trauma, creative, toys that encourage non-directive play. CPP trainers will discuss appropriate CPP toys during the training period. Enable access to UAMS Box online resource. Depending on agency internet protections, this may include facilitating help from IT to ensure trainees are able to access resources and submit case presentations.
Trainee qualifications, caseload, and training requirementsThere are two tracks within CPP trainings: Therapist and Supervisor. You will need to designate whether each trainee is on the Therapist track or the Supervisor track, as tracks have different training requirements and expectations. The Supervisor track consists of 3 monthly, 1-hour long video/phone calls and the completion of case requirements for two cases. The Therapist track consists of 2 monthly, 1-hour long video/phone calls and the completion of case requirements for four cases. Both tracks have the same requirements for in-person training attendance, reflective supervision, and case presentations.
* must provide value
I understand the need to designate trainees into either Therapist or Supervisor tracks and the requirements for each track
I am unable to designate my trainees into the Therapist or Supervisor tracks
I understand the need to designate trainees into either Therapist or Supervisor tracks and the requirements for each track
I am unable to designate my trainees into the Therapist or Supervisor tracks
Allowing and facilitating all trainees' time away from clinical and non-clinical duties to participate in virtual training, 13, half-day virtual trainings throughout the 18-month training period. Virtual trainings consist of a 5, half-day initial workshop followed by 4, half-day follow-up workshops at approximately 4 months and 12 months following the initial training. Of note, at this time we anticipate that the full 18-month training will occur virtually. Trainees will be given notice if activities must change to require in-person participation.
Supporting Therapists ' participation in full group video consultation calls with trainers (two, 1-hour video calls per month).
Call Group 1: 1st & 3rd Mondays @ 12pm (Starting August 16th)
* must provide value
Supporting Supervisors ' participation in full consultation calls with trainers (two, 1-hour video calls per month) and Supervisor-only video calls with trainers (one, 1-hour video call per month).
Supervior Call: 2nd Tuesdays @ 12pm (Starting September 14th)
* must provide value
Allowing all trainees adequate time for preparation (e.g., completing the case presentation template and providing sample clinical material) for presenting on consultation calls. (Each trainee is required to present at least twice, either on the consultation calls or during virtual follow-up trainings, during the 18-month training period).
* must provide value
Assisting trainees in receiving sufficient CPP-appropriate referrals to complete training requirements within 18 months (i.e., maintaining a CPP caseload of 3-4 cases seen weekly to optimize therapists' ability to treat 4 cases, two of which must be at least 16 sessions). Allowing trainees to prioritize accepting CPP referrals and allowing trainees to prioritize the birth through age 5 age group within their caseload. Engaging in community outreach to referral sources (e.g., pediatricians, early childhood education settings) to ensure trainees have adequate numbers of referrals.
* must provide value
Allowing all trainees adequate time to complete activities that support meaningful collaboration with the courts (e.g., completing case update letters for court, attending family-team meetings, and/or providing court testimony).
* must provide value
Supporting therapists and supervisors in conducting bimonthly reflective supervision, at minimum, without a trainer present. This typically occurs among trainees within the same agency, or within a small group established by trainers and may occur in-person or via phone/video call.
* must provide value
If treating clients in clinic: Creating or repurposing a fully or partially dedicated CPP therapy room (could be the trainee's office): A safe, relatively low-stimulation room for a caregiver and a child to engage in play with a small selection of toys.
If treating clients in clinic: Developing an observation room: a room allowing a CPP trainee to see and hear the caregiver and child playing and be out of the child's sight and hearing. CPP observation can be conducted through a live video feed or by using a one-way mirror.
Please indicate below which option your agency is pursuing:
Observation room with a one-way mirror
Observation room created through the use of video feed
Other
Observation room with a one-way mirror
Observation room created through the use of video feed
Other
Briefly describe how the CPP room and observation room will look and function in your clinic:
If treating clients remotely: CPP clinicians must be able to see parent-child interactions and families must be able to see the CPP clinician. Therefore, remote CPP must be conducted via secure video platform and the clinician must have access to a webcam so that the family can see the clinician during sessions.
Briefly describe how virtual CPP sessions and observation will function in your clinic:
Having ability for trainees to easily make copies of assessment and/or fidelity measures, some of which are online.
* must provide value
Purchase and/or maintain a supply of appropriate CPP toys, such as: trauma, creative, toys that encourage non-directive play. CPP trainers will discuss appropriate CPP toys during the training period.
* must provide value
Enable access to UAMS Box online resource. Depending on agency internet protections, this may include facilitating help from IT to ensure trainees are able to access resources and submit case presentations.
* must provide value
All Trainees that I have listed in this application are aware that I, as their supervisor/agency director, will receive information pertaining to their progress throughout CPP training.
* must provide value
Yes
No
Trainee(s) Information IMPORTANT: Please list a good contact email for each trainee. If accepted, this is how we will notify them of their acceptance.
Trainee #1 Information Primary Office Location Intends to complete CPP as a: Answer these next set of questions to the best of your ability (Yes / No / Unsure). Master's degree or higher in a mental health field? Independently licensed (or under supervision of licensed MHP who is also participating in the CPP training)? Actively treating children ages 0-5 with mental health, attachment, and/or behavioral problems? Ability to include parents in weekly sessions? Experience working with infants or young children? Evidence-based treatment experience? Ability to be reimbursed by Medicaid? Completed DC:0-5 training? Completed Infant Mental Health Certification? Prior experience with treating children in foster care? Prior experience collaborating with courts (e.g., attended staffings, wrote treatment update letters, provided court testimony)?
Trainee #2 Information Primary Office Location Intends to complete CPP as a: Answer these next set of questions to the best of your ability (Yes / No / Unsure). Master's degree or higher in a mental health field? Independently licensed (or under supervision of licensed MHP who is also participating in the CPP training)? Actively treating children ages 0-5 with mental health, attachment, and/or behavioral problems? Ability to include parents in weekly sessions? Experience working with infants or young children? Evidence-based treatment experience? Ability to be reimbursed by Medicaid? Completed DC:0-5 training? Completed Infant Mental Health Certification? Prior experience with treating children in foster care? Prior experience collaborating with courts (e.g., attended staffings, wrote treatment update letters, provided court testimony)?
Trainee #3 Information Primary Office Location Intends to complete CPP as a: Answer these next set of questions to the best of your ability (Yes / No / Unsure). Master's degree or higher in a mental health field? Independently licensed (or under supervision of licensed MHP who is also participating in the CPP training)? Actively treating children ages 0-5 with mental health, attachment, and/or behavioral problems? Ability to include parents in weekly sessions? Experience working with infants or young children? Evidence-based treatment experience? Ability to be reimbursed by Medicaid? Completed DC:0-5 training? Completed Infant Mental Health Certification? Prior experience with treating children in foster care? Prior experience collaborating with courts (e.g., attended staffings, wrote treatment update letters, provided court testimony)?
Trainee #4 Information Primary Office Location Intends to complete CPP as a: Answer these next set of questions to the best of your ability (Yes / No / Unsure). Master's degree or higher in a mental health field? Independently licensed (or under supervision of licensed MHP who is also participating in the CPP training)? Actively treating children ages 0-5 with mental health, attachment, and/or behavioral problems? Ability to include parents in weekly sessions? Experience working with infants or young children? Evidence-based treatment experience? Ability to be reimbursed by Medicaid? Completed DC:0-5 training? Completed Infant Mental Health Certification? Prior experience with treating children in foster care? Prior experience collaborating with courts (e.g., attended staffings, wrote treatment update letters, provided court testimony)?
Trainee #5 Information Primary Office Location Intends to complete CPP as a: Answer these next set of questions to the best of your ability (Yes / No / Unsure). Master's degree or higher in a mental health field? Independently licensed (or under supervision of licensed MHP who is also participating in the CPP training)? Actively treating children ages 0-5 with mental health, attachment, and/or behavioral problems? Ability to include parents in weekly sessions? Experience working with infants or young children? Evidence-based treatment experience? Ability to be reimbursed by Medicaid? Completed DC:0-5 training? Completed Infant Mental Health Certification? Prior experience with treating children in foster care? Prior experience collaborating with courts (e.g., attended staffings, wrote treatment update letters, provided court testimony)?
Email (If accepted into the training, this is how we will notify trainees)
* must provide value
Primary office location (City, County).
* must provide value
Intends to complete CPP as a:
* must provide value
Therapist Supervisor
Master's degree or higher in mental health field?
Yes No Not Sure
Master's degree or higher in mental health field?
Yes No Not Sure
Master's degree or higher in mental health field?
Yes No Not Sure
Master's degree or higher in mental health field?
Yes No Not Sure
Master's degree or higher in mental health field?
Yes No Not Sure
Yes No Not Sure
Yes No Not Sure
Yes No Not Sure
Yes No Not Sure
Yes No Not Sure
Actively treating children ages 0-5 with mental health, attachment, and/or behavioral problems?
Yes No Not Sure
Actively treating children ages 0-5 with mental health, attachment, and/or behavioral problems?
Yes No Not Sure
Actively treating children ages 0-5 with mental health, attachment, and/or behavioral problems?
Yes No Not Sure
Actively treating children ages 0-5 with mental health, attachment, and/or behavioral problems?
Yes No Not Sure
Actively treating children ages 0-5 with mental health, attachment, and/or behavioral problems?
Yes No Not Sure
Yes No Not Sure
Yes No Not Sure
Yes No Not Sure
Yes No Not Sure
Yes No Not Sure
Experience working with infants or young children
Yes No Not Sure
Experience working with infants or young children
Yes No Not Sure
Experience working with infants or young children
Yes No Not Sure
Experience working with infants or young children
Yes No Not Sure
Experience working with infants or young children
Yes No Not Sure
Evidence-based treatment experience
Yes No Not Sure
Evidence-based treatment experience
Yes No Not Sure
Evidence-based treatment experience
Yes No Not Sure
Evidence-based treatment experience
Yes No Not Sure
Evidence-based treatment experience
Yes No Not Sure
Ability to be reimbursed by Medicaid
Yes No Not Sure
Ability to be reimbursed by Medicaid
Yes No Not Sure
Ability to be reimbursed by Medicaid
Yes No Not Sure
Ability to be reimbursed by Medicaid
Yes No Not Sure
Ability to be reimbursed by Medicaid
Yes No Not Sure
Completed DC:0-5 training
Yes No Not Sure
Completed DC:0-5 training
Yes No Not Sure
Completed DC:0-5 training
Yes No Not Sure
Completed DC:0-5 training
Yes No Not Sure
Completed DC:0-5 training
Yes No Not Sure
Completed Infant Mental Health Certification
Yes No Not Sure
Completed Infant Mental Health Certification
Yes No Not Sure
Completed Infant Mental Health Certification
Yes No Not Sure
Completed Infant Mental Health Certification
Yes No Not Sure
Completed Infant Mental Health Certification
Yes No Not Sure
Yes No Not Sure
Yes No Not Sure
Yes No Not Sure
Yes No Not Sure
Yes No Not Sure
Prior experience collaborating with courts (e.g., attended staffing's, wrote treatment update letters, provided court testimony)
Yes No Not Sure
Prior experience collaborating with courts (e.g., attended staffing's, wrote treatment update letters, provided court testimony)
Yes No Not Sure
Prior experience collaborating with courts (e.g., attended staffing's, wrote treatment update letters, provided court testimony)
Yes No Not Sure
Prior experience collaborating with courts (e.g., attended staffing's, wrote treatment update letters, provided court testimony)
Yes No Not Sure
Prior experience collaborating with courts (e.g., attended staffing's, wrote treatment update letters, provided court testimony)
Yes No Not Sure
Email (If accepted into the training, this is how we will notify trainees)
Primary office location (City, County).
Intends to complete CPP as a:
Therapist Supervisor
Email (If accepted into the training, this is how we will notify trainees)
Primary office location (City, County).
Intends to complete CPP as a:
Therapist Supervisor
Email (If accepted into the training, this is how we will notify trainees)
Primary office location (City, County).
Intends to complete CPP as a:
Therapist Supervisor
Email (If accepted into the training, this is how we will notify trainees)
Primary office location (City, County).
Intends to complete CPP as a:
Therapist Supervisor
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