GNOCC Member Agreement

Contact Information

Organization Name *

Executive Director/CEO: *

First

Last

Application Contact Name *

First

Last

Contact Title: *

Contact Email *

Contact Phone *

Organization Information

Organization Type: *

Other:

Does your organization work statewide OR is your organization an affiliate of a statewide organization OR part of a statewide network of similar organizations? *

Yes
No

In 50 words or less, explain the mission/purpose of your work within child welfare. *

Does your organization provide direct services to children and/or families within the DCFS Orleans or Covington Region (Orleans, Jefferson, St. Bernard, Plaquemines, St. Tammany, Tangipahoa, Livingston, Washington, St. Helena): *

Yes
No

How many children do you serve annually in these parishes?

Of these, approximately what percent are in foster care?

How many families do you serve annually in these parishes? For example, a family served by multiple programs should only be counted once. (Please provide unduplicated number served).

Of these, approximately what percent are foster and/or adoptive families or prospective foster and/or adoptive families?

Approximately what percent are biological families who have, have had, or at risk of having a child removed from the home?

Do you have current staff, volunteers, and/or families who have participated in some level of TBRI training? *

Yes
No

Which other child trauma treatment models do you train volunteers, staff and/or families on? (please select all that apply) *

If other training is provided, please specify model used:

Southeast Louisiana

For the following questions, if your organization serves more than Southeast Louisiana, please only provide information for your operations in the parishes in the DCFS Orleans and Covington Regions (Orleans, Jefferson, St. Bernard, Plaquemines, St. Tammany, Tangipahoa, Livingston, Washington, and St. Helena).

How many current staff in your organization have attended the week-long TBRI® Practitioner training? *

In addition to staff who have attended the Practitioner training, how many other people in or affiliated with your organization have been trained in TBRI^®?

Staff *

Volunteers *

Families (bio, foster, adopt, kinship) *

Member Engagement and Expectations

What benefits of being a member in the GNOCC does your organization see as being most impactful/useful? (Please check all that apply). *

If other please specify

The ability of the GNOCC to achieve its goals is dependent on member organizations agreeing to support and participate in the following collaborative activities.

Please indicate if you are able and willing to commit to the following activities:

INCREASING THE NUMBER OF HEALING FAMILIES

As your staff builds capacity for TBRI® training, you will train foster, adoptive, biological, and/or kinship families on TBRI® and provide the tools, coaching, and oversight necessary to promote fidelity to the model. *

Yes
No
Not Applicable

ENSURING EACH CHILD RECEIVES CONSISTENT TRAUMA-INFORMED CARE FROM EVERY PART OF THE SYSTEM

Evaluate policies and practices with a TBRI® lens and adopt and implement policies and practices that are trauma-informed. *

Yes
No

Train staff, volunteers, and families on trauma-informed practices. *

Yes
No

Participate in an annual check-in or site visit to provide feedback on trauma-informed implementation challenges and successes. *

Yes
No

ENSURING SUSTAINABLE, HIGHLY-COORDINATED AND EFFECTIVE COLLABORATION

Participate in cross-organization and cross-sector gatherings to share information and develop coordinated action steps for improving services and the child welfare system. *

Yes
No

Gather and share data with GNOCC leadership and other member organizations that inform decision-making. *

Yes
No

Help engage the full spectrum of individuals and organizations in the child welfare system to further strengthen and advance collaboration *

Yes
No