Agency Name * Email (This will be your username for as long as you participate in SMC.) *
* Electronic Communications and Electronic Signatures *
You agree to be bound by any affirmation, assent, or agreement you transmit through this website, including but not limited to any consent you give to receive communications from Growing Forward Together solely through electronic transmission. You agree that when in the future you click on an “I agree,” “I consent,” or other similarly worded “button” or entry field with your mouse, keystroke, or other computer device, your agreement or consent will be legally binding and enforceable and the legal equivalent of your handwritten signature.
Agency Administration Commitments
As the responsible administrator of an agency or organization delivering the SMC intervention, I confirm that the following statements are true:
1. We have engaged a supervisor who will:
to the SMC staff. The supervision role includes:
Lead implementation of the SMC and serve as on-going liaison
Selecting, overseeing training process, monitoring fidelity, remediating, and arranging re-certification of tutors
Conducting an agency-wide in-service training about traumatic stress and the SMC intervention
Providing license-related forms and (for Early Adopters only) anonymized clinical documentation to the SMC staff
Provide clinical supervision, including case consultation, working through challenges, addressing vicarious trauma, or other needs, consistent with norms in behavioral health service settings. NOTE: If the selected supervisor is not an experienced, licensed clinician, then we also have engaged such a person to provide the clinical supervision. 2. The supervisor has adequate capacity and authority to fulfill these roles,
as outlined in the supervisor statement of commitment (appended). We understand the requirements of the SMC program, and make the following commitments:
3. We will facilitate an all-hands, agency-level training to advance our services toward being fully trauma-informed.
This is an in-service Trauma Informed Care (TIC) education program, developed by SMC and presented by the supervisor.
4. We have compiled, and will assist the supervisor to maintain, a list of referral resources
appropriate to trauma-informed care in the perinatal period, including:
Intimate partner violence services
Substance abuse services
Specialist mental health services (i.e., psychiatrist, psychotherapist)
Child welfare services
Emergency care where psychiatric concerns can be addressed
5. The supervisor will audit fidelity of all tutors
by periodically requesting fidelity checklists from tutor and client for the same session (i.e., “mirror image reports”). The supervisor also will periodically review a case file to verify that safety was monitored and referrals were appropriate. The supervisor will document tutor performance as:
True to the curriculum (>80% on the SMC fidelity guide/checklist)
Of high quality in terms of the tutor-client relationship (respect and rapport, attaining active participation from the mom)
Safe, with appropriate referral
6. We understand that, at the time of license renewal at the end of Year 2, the supervisor will also request and evaluate at least one case study
by each tutor (on the form provided) documenting knowledge of SMC’s use. The supervisor will recommend for or against re-certification of the tutor based on fidelity, quality, and safety.
1. We will select, train, and supervise only tutors who are certified or licensed professionals and paraprofessionals
(nurses, social workers, psychologists, midwives, physicians, doulas, health educators, community outreach workers, or other experienced staff).
If, in our state, paraprofessional health workers are not certified, we assure you that they are trained and experienced in their role. Furthermore, we understand that the SMC is not to be used as a peer-to-peer intervention.
2. We will ensure that the tutors have adequate capacity to fulfill their role,
including the capacity to set tutoring appointments and facilitate referrals.
3. We understand that tutor fidelity to the manual is the best predictor of effectiveness
for manualized programs like the SMC (Bellg AJ et al., 2004, Moore GF et al., 2015) *, so tutors will:
Use the “Each and Every Time” fidelity guide and fidelity checklist
Use the SMC tools for assessment, monitoring, and referral tracking
Make use of clinical supervision for challenging or unique cases
Strive for a high-quality tutor-client relationship because helping clients feel supported while they are learning skills is an essential intervention component
Accept remediation via further training or additional supervision if needed
1. We support completion and storage of SMC (electronic and/or paper) documentation as follows:
License-related documents, including forms pertaining to agency-level training, tutor training, fidelity monitoring, remediation, and re-certification, as well as documentation of availability and utilization of clinical supervision. 2. We acknowledge that conveying the license-related reports to SMC staff is required to maintain our SMC end-user license.
3. We understand that, at the time of license renewal, SMC staff will review the license-related documentation and discuss any impediments with the supervisor.
1. We have read the list of commitments required of tutors and supervisors and agree to their scopes of work.
2. We are aware that we can contact the SMC staff to get information, technical assistance, or consultation as part of the agency’s end-user license agreement.
3. We are aware that SMC
tutoring and supervision
occurs only in the setting of an agency or organization holding an end-user license agreement
and that the SMC curriculum and materials may not be used outside this context or at variance from the license agreement except by express written permission.
(If some aspect of these Commitments is impossible in your setting, please do not proceed, but contact us to discuss how we might accommodate your needs.)
Phone: (734) 773-1480
*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: 10.1037/0278-6188.8.131.523
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.
Commitment Agreement *