Screen Reader Mode Icon
The Missouri Children's Trauma Network is working to create a list and map of Missouri clinicians trained in evidence-based mental health practices.

According to our records, you are rostered with the Missouri Academy of Child Trauma Studies (MoACTS) or have attended one of the Evidence-Based Practices the MOCTN provided in the previous years. We want to put your agency’s name, address, and phone number on the MO Children’s Trauma Network website so that child welfare workers and families coping with trauma can find clinicians trained in evidence-based trauma treatments.

Please take a few minutes to complete the following survey.

Question Title

* 1. First and Last Name:

Question Title

* 2. Address of the office where services are provided: 

Question Title

* 3. County of the office where services are provided

Question Title

* 4. What agency are you affiliated with:

Question Title

* 5. Phone number for intakes: 

Question Title

* 6. Website URL (if applicable):

Question Title

* 7. Population Served (age) - Select all that apply:

Question Title

* 8. Do you serve any special populations:

Question Title

* 9. Education (Psychology, Social work, LPC, etc.):

Question Title

* 10. Licensed:

Question Title

* 11. Evidence-Based Practice you are certified in - please select all that apply:

  Completed and fully trained Completed and fully certified
Eye Movement Desensitization and Reprocessing (EMDR) trained
Eye Movement Desensitization and Reprocessing (EMDR) certified
Problem Sexual Behavioral - Cognitive Behavioral Therapy (PSB-CBT)
Parent Child Interaction Therapy (PCIT)
Trauma Focused-Cognitive Behavioral Health Therapy (TF-CBT)
Motivational Interviewing trained
Motivational Interviewing Certified (MINT)
Supportive Parenting for Anxious Childhood Emotions (SPACE)
Attachment and Biobehavioral Catch-up (ABCs)
Solution-focused brief therapy (SFBT)

Question Title

* 12. How do you provide each of the Evidence-Based Practices? (Select all that apply)

  Telehealth Office Home
Eye Movement Desensitization and Reprocessing (EMDR) trained
Eye Movement Desensitization and Reprocessing (EMDR) certified
Problem Sexual Behavioral - Cognitive Behavioral Therapy (PSB-CBT)
Parent Child Interaction Therapy (PCIT)
Trauma Focused-Cognitive Behavioral Health Therapy (TF-CBT)
Motivational Interviewing trained
Motivational Interviewing Certified (MINT)
Supportive Parenting for Anxious Childhood Emotions (SPACE)
Attachment and Biobehavioral Catch-up (ABCs)
Solution-focused brief therapy (SFBT)

Question Title

* 13. Please Select all that apply regarding payment for services:

Question Title

* 14. Are there other clinicians in your network/agency we should reach out to, to include on our list?

Question Title

* 15. Is there anything else you think we should know about you, your agency, or your services?

Question Title

* 16. Are there any specific Evidence-Based Practices you are currently interested in being trained or certified in?

0 of 16 answered
 

T