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Learning Collaborative Application: Healing-Centered Approaches to Adolescent Relationship Abuse and Trafficking 2022-23

Thank you for your interest in our learning collaborative on Healing-Centered Approaches to Addressing Adolescent Relationship Abuse and Human Trafficking! Please complete the following form to apply for the learning collaborative.
This question requires a valid email address.
Each participant and their supervisor must read the Program Description and sign this form. Space is limited, so please complete and submit the complete survey ASAP. 

Please note: To share this survey link with other applicants and supervisors, or to finish completing it at later date, click the ‘Save and Continue Later’ link in the upper right-hand corner and fill-in your name and email address. A unique link will be emailed to you and you may share this application link with others. 
8. Administrator/Operations *This question is required.
9. Primary care provider *This question is required.
10. Behavioral health provider *This question is required.
11. Community-based partner participant (OPTIONAL)
12. Additional participant (OPTIONAL)
13. FOR EACH APPLICANT
I have read the Learning Collaborative description and understand that I am applying for a program that has the following requirements:
  • Participate in a brief virtual meet-and-greet with SBHA/Health Partners on IPV + Exploitation;
  • Participate in six 90-minute learning sessions, over three months, by engaging in learning collaborative activities and discussions (1pm - 2:30pm Eastern time on October 4; October 18; November 1; November 15; November 29; December 13);
  • Participate in two 30-60-minute coaching calls with SBHA/Health Partners on IPV + Exploitation throughout the learning collaborative
  • Share learned information with colleagues;
  • Create and implement an action plan to address adolescent relationship abuse in their school-based health center;
  • Complete periodic surveys to help improve learning collaborative activities for clinicians and other partners; and
  • Participate in a 30-minute 90-day follow-up call in spring 2023.
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14. FOR EACH APPLICANT’S SUPERVISOR

I have read the Learning Collaborative description and my health center and I agree to support the participation of all listed applicants in the Healing-Centered Approaches to Adolescent Relationship Abuse and Trafficking Learning Collaborative by allocating the necessary time and resources for their full participation in the program.
  • I understand that applicants will be asked to complete several evaluative surveys in order to understand and identify areas of improvement.
  • I understand that the School-Based Health Alliance and Health Partners on IPV + Exploitation are not providing remuneration to the applicant or SBHC, but are providing the training at no cost.
  • I understand that the SBHC is responsible for ensuring the applicant has a quiet place available during the learning collaborative sessions and the appropriate computer and web internet connectivity.
*This question is required.
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15. Does each participant have access to the system requirements outlined in the application guidance? *This question is required.
While this learning collaborative aims to assist your SBHC with building capacity related to adolescent relationship abuse (ARA) and human trafficking (HT), you might already incorporate some aspects of the work. The purpose of this tool is to help us understand how your SBHC currently serves adolescents.
16. Is your SBHC open year round? *This question is required.
18. Which services does your SBHC offer? (Check all that apply.) *This question is required.
19. What grades does your SBHC serve? (Check all that apply.) *This question is required.
20. Who is on staff at your SBHC?
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25. Please complete the grid below to help us understand your SBHC's partnerships.
  *This question is required.
Space Cell Have not implemented strategies at this timeConsidering implementing strategies within the next six monthsMaking plans to implement strategies within the next monthActively implementing one or more strategies for less than six monthsFully implemented one or more strategies for at least six months
Strong communication, coordination/collaboration exist between SBHC staff and school/district health staff
SBHC participates in the development and implementation of school health policies and programs (i.e., nutrition, health fairs, school staff wellness, school improvement plans, and school/district wellness)
Convenes an SBHC advisory council/committee to assist with program planning and implementation, ensure that the services meet the health needs of the youth served by the SBHC, coordinate across partners
Engages youth voices on the SBHC advisory council, a youth advisory council, and/or another formalized mechanism for youth development.
26. Please complete the following grid to help us understand your SBHC's clinical processes related to ARA and HT.

Please note that applicants at all levels are welcome to participate in this learning collaborative - you do NOT need to have adolescent relationship abuse/ human trafficking processes in place to be eligible to participate.
  *This question is required.
Space Cell Have not implemented strategies at this timeConsidering implementing strategies within the next six monthsMaking plans to implement strategies within the next monthActively implementing one or more strategies for less than six monthsFully implemented one or more strategies for at least six months
SBHC staff receive regular training on adolescent relationship abuse, human trafficking, and/or healthy relationship promotion
SBHC staff routinely inform patients about confidentiality and mandated reporting requirements
SBHC staff offer universal education about relationship abuse and/or trafficking to every adolescent patient
SBHC staff offer information about relationships to patients so they can help others
SBHC staff know how to reach out to victim service advocates to offer additional support
SBHC staff use a screening tool to assess for relationship violence
SBHC staff follow a clinic policy that all patients are seen alone for part of the visit
SBHC staff create “safer plans” with students when appropriate
The SBHC promotes individual practices to support provider wellness (e.g., Mindfulness-Based Interventions)
The SBHC implements clinic-wide practices to support provider wellness (e.g., reflective practice groups)
27. Please complete the following grid to help us understand your SBHC's partnerships related to ARA and HT.

  *This question is required.
Space Cell Have not implemented strategies at this timeConsidering implementing strategies within the next six monthsMaking plans to implement strategies within the next monthActively implementing one or more strategies for less than six monthsFully implemented one or more strategies for at least six months
The SBHC maintains an up-to-date list of community resources related to adolescent relationship abuse/trafficking
The SBHC has an informal relationship with a local domestic violence program
The SBHC has a memorandum of understanding with a local domestic violence program
The SBHC partners with a local domestic violence program on bidirectional referrals for services, consultation, prevention education, culture change campaigns, peer support programs, and/or some other type of programming
The SBHC refers students to domestic violence hotlines when appropriate
For students experiencing relationship abuse, SBHC team coordinates care with school staff when appropriate (reporting, referrals, and other supports)
The SBHC collaborates with school staff to educate students and/or families about healthy relationships, relationship abuse, and/or human trafficking
The SBHC has a youth advisory council
The SBHC has youth representation on SBHC advisory committee
The SBHC creates opportunities for youth to provide feedback on services and experience
The SBHC offers SBHC shadowing or internships
The SBHC facilitates peer education and mentoring
The SBHC supports youth in utilizing media to facilitate discussions with peers about relationships
The SBHC supports youth in implementing culture change campaigns
The SBHC supports youth in implementing advocacy activities