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Getting An Agency License

In order to offer the Survivor Moms' Companion through your agency, an authorized agency administrator must obtain a license from The Sidran Institute. Fill out the form below and click Submit. The Sidran Institute will use your email address to send you license purchasing instructions and your agency code.

Make a record of your agency code after you receive it. Your tutors and supervisors will need this to record information regarding the clients they tutor under your supervision.

  • Agency Administration Commitments

    As the responsible administrator of an agency or organization delivering the SMC intervention, I commit to the following statements:

    We have engaged a licensed and experienced clinician to supervise tutors and serve as liaison to the Sidran Traumatic Stress Institute, which holds the license for this intervention program.

    We assure you that the supervisor has adequate capacity and authority to fulfill these roles, as outlined in the supervisor statement of commitment (appended).

    We select, train, and supervise only tutors who are licensed nurses and social workers (or psychologists, certified health educators, midwives, physicians), and have verified with our state’s registry that the tutor is duly licensed and in good standing.

    We assure you that the tutors have adequate capacity to fulfill their role, including the capacity to set tutoring appointments and facilitate referrals.

    We support completion and storage of SMC (electronic and/or paper) documentation, including forms pertaining to agency-level training, tutor training, supervision, remediation, and re-certification.

    We support on-line documentation (without personal health information) of client assessments, including intake, interim, and final scores on brief clinical measures and brief SMC evaluation questions. We are aware that our agency has a unique identifier as part of individual case numbers, so we can request individual client profiles for their medical record and annual aggregate data for our agency.

    We agree to have supervisors convey reports required to maintain our SMC end-user license agreement to Sidran via the secure website. This includes such documents as reports of trainings, tutor certification documents, fidelity audits, any remediation, and recertification requests.

    We have compiled, and will assist the supervisor to maintain, a list of referral resources appropriate to trauma-informed care including accessible
    1. intimate partner violence services,
    2. substance abuse services,
    3. specialist mental health services (i.e., psychiatrist, psychotherapist),
    4. child welfare services, and
    5. emergency care where psychiatric concerns can be addressed.

    We will facilitate the supervisor to deliver agency-level trainings to advance our services toward being fully trauma-informed. This will include use of in-service programs developed (and updated) as part of the SMC end-user license agreement:

    In start-up year
    1. Trauma-Informed Care and the SMC (1-hour, all-hands agency meeting),
    2. Advanced Introduction to Trauma-Informed Care and the SMC (2-hour, clinician-focused),
    3. and an optional SMC Journal Club (content for monthly meetings for tutors and any interested professional to discuss the SMC content and cases and to develop collaborations)

    In subsequent years
    1. Trauma-Informed Care (1-hour, all-hands meeting, refreshing and advancing capacity),
    2. Advanced Introduction to Trauma-Informed Care and the SMC (2-hour, clinician-focused refresher meeting for those not actively working as tutors),
    3. SMC Journal Club (content for monthly meetings for tutors and any interested professional to discuss pertinent research and clinical literature, cases, and collaborations).

    We understand that tutor fidelity to the manual is the best predictor of beneficial outcomes for manualized programs like the SMC (Bellg AJ et al., 2004, Moore GF et al., 2015), so tutors will
    1. use the process guide and fidelity checklist,
    2. discuss/assess learning outcomes and clinical outcomes of women I tutor,
    3. make use of clinical supervision for challenging or unique cases,
    4. aim for a high level of performance in terms of fidelity, high quality relationship and engagement by the mom, and appropriate referral, and safety; and
    5. accept remediation via further training or additional supervision if needed.

    We understand that the supervisor will audit clinical and fidelity by listening to the tutor side (only) of periodic tutoring sessions. The supervisor will document performance as
    1. true to the curriculum (>80% fidelity to the session checklists),
    2. of high quality in terms of the tutor-mom relationship (respect and rapport, attaining active participation from the mom, and
    3. safe, with appropriate case-finding and referral.

    We have read the attestations required of tutors and supervisors and agree to their scopes of work.

    We are aware that we can contact the SMC program staff (using website contact information) to get information, trouble-shooting, or consultation as part of the agency’s end-user license agreement.

    We are aware that the SMC is a licensed program, meaning that tutoring and supervision occurs in the setting of an agency or organization holding an end-user license agreement with the Sidran Traumatic Stress Institute and that the SMC curricula may not be used outside this context or at variance from the license agreement except by express written permission.

    References regarding fidelity:
    Bellg AJ, Borrelli B, Resnick B, Hecht J, Minicucci DS, Ory M, et al. Enhancing treatment fidelity in health behavior change studies: Best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol. 2004;23(5):443–51. doi: 10.1037/0278-6133.23.5.443

    Moore GF, Audrey S, Barker M, et al. Process evaluation of complex interventions: Medical Research Council guidance. The BMJ. 2015;350:h1258. doi:10.1136/bmj.h1258.
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