Henry Ford Health System (HFHS) aims to increase its capacity and service provision of trauma-focused treatment via the development of a Child Trauma Specialty Service. To do so, we will implement two trauma-focused treatments, the Attachment, Regulation and Competency Framework (ARC) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and increase identification of and referral to treatment for child traumatic stress within pediatric primary care. This project, Implementing Trauma-Focused Treatment for Underserved Children in Detroit, MI, seeks to implement trauma-focused, evidence-based treatments across 5 outpatient pediatric behavioral health and 10 integrated care clinics in HFHS serving 3 counties in southeast Michigan (Wayne, Oakland and Macomb). This catchment area services a racial and ethnically diverse, urban (Detroit) and suburban (metro-Detroit) population of children and families with large proportions (>36% of Detroit residents) living under the poverty line. Children ages 4-17 years with traumatic stress (including diagnoses of PTSD, acute stress disorder and other complex or chronic stress and trauma conditions which causes impairments in social, emotional and behavioral functioning) will be served through this project and will be identified and referred for grant services through screening at both well visits and behavioral health care appointments. As our goal is to become the central hub for treatment of child trauma in Detroit, the outlined goals of this project include 1) establishing a leadership team with expertise in clinical service provision, training, and implementation of services for traumatized and vulnerable youth, 2) increasing awareness, knowledge, and training on child trauma across pediatric primary care, behavioral health clinics, and community partners, 3) implementing the Attachment, Regulation and Competency Framework through training, consultation, supervision, and establishing a train-the-trainer model, 4) expanding the number of pediatric treatment providers trained in TF-CBT, and 5) developing a high-fidelity and sustainable Child Trauma Specialty Service through iterative quality improvement using the Plan-Do-Study-Act method. This project will serve over 14,000 youth (beginning at 1,000 annually in year 1 of the grant and expanding to 4,000 annually by year 5) through enhanced screening for traumatic stress at primary care visits as well as through referrals from our school-and community-based healthcare clinics. Given the high prevalence rates of traumatic stress in the surrounding communities and high levels of unmet trauma-informed treatment needs in the health system, we anticipate identifying, referring, and engaging in treatment minimum of 580 of children (beginning at 80 youth annually in year 1 of the grant and expanding to 150 annually by year 5) by the end of the 5-year period of the grant.