Clinical Services Integration (CSI)

Background

Trauma-Responsive Systems Change: The Clinical Services Integration (CSI) Initiative

Overview

From 2017 to 2023, the Institute for Child and Family Well-Being (ICFW) led the Clinical Services Integration (CSI) initiative to embed trauma-informed, evidence-based care into the daily work of child welfare, behavioral health, and family support systems.

CSI was not just a project. It was a strategy for transforming how public systems support families. Rather than bolting trauma care onto existing services, CSI aligned programs, practices, and people around a shared goal: creating systems that heal.

Why It Was Needed

In the early 2010s, most child welfare systems focused on safety and compliance. But well-being — especially trauma recovery, emotional stability, and economic security — was often overlooked. Inspired by national guidance and driven by local innovation, ICFW and Children’s Wisconsin launched CSI to close that gap.

The initiative began with one question: How can we deliver trauma-informed care from within the system, rather than outside it?

What We Did

CSI supported the design and integration of multiple trauma-responsive services and strategies, including:

• Parent-Child Interaction Therapy (PCIT) delivered in homes, groups, and via telehealth
• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for adolescents in foster care
• Well-Being Assessments that included caregiver stress and housing stability
• Mobility Mentoring® as a structured coaching tool embedded in family support
• After Action Reviews (PDF) and Outcome Harvesting (PDF) for adaptive evaluation
• Translating evidence-based interventions (EBIs) into the child welfare context, showing how programs like PCIT can be successfully adapted, embedded, and sustained within existing systems of care

Together, these efforts shifted practice from rigid compliance to flexible, trauma-informed engagement—without sacrificing fidelity or outcomes.

The Strategic Shift

Over time, CSI evolved into more than a collection of programs. It became a learning platform for systems change.

• Practitioners moved from monitoring to coaching
• Leaders used real-time learning to adapt strategies
• Data became a tool for improvement, not just accountability
• Systems began to ask new questions: “Are families better off—and how do we know?”

This shift marked a turning point. CSI helped redefine what public systems could be—responsive, reflective, and relational.

Voices from the Field

“PCIT in the home is beneficial for motivated families and it can be practiced to fidelity in the home environment.”
— CSI Therapist, After Action Review

“This was a family with high stress and a history of trauma. I saw major growth in the caregiver’s ability to manage her child’s behavior, which in turn increased her confidence in herself.”
— CSI Therapist, After Action Review (PCIT in-home case)

“Several teens have told me they wouldn’t have shown up for an appointment on a bad day, but in-home sessions provided opportunity for topical and thematic discussion, psychoeducation, and coping.”
— After Action Review, TF-CBT Case Example

“I learned I can recover from stuff and that it takes time and I can succeed. I just have to try hard and not give up.”
— Youth participant after EMDR treatment

Signals of Change

CSI led to measurable and strategic shifts across programs and partnerships:

• Trauma screening became clear best-practice across community mental health providers
• Staff trained through CSI became internal trainers and systems leaders
• Mobility Mentoring was embedded in prevention and child welfare services
• Evaluation tools like AARs and Outcome Harvesting reframed how we understand our systems change progress.
• Case planning started including caregiver stress, housing instability, and financial hardship
• Culture shifted from “checklist thinking” to shared learning and continuous improvement

Why It Matters Now

Today’s public systems face rising family needs, shrinking resources, and increasing pressure to deliver equitable outcomes. CSI shows what’s possible when systems are designed to learn, adapt, and center family well-being, not just focus on compliance.

At ICFW, we now bring the CSI approach to changemakers across the country, helping them:

• Align practice with healing
• Turn reflection into strategy
• Build the infrastructure for lasting systems change

Frequently Asked Questions

What was Clinical Services Integration (CSI)?
CSI was a multi-year initiative led by ICFW (2017–2023) to embed trauma-informed care into child welfare, behavioral health, and prevention systems through real-time learning and strategic integration.

What made this work different from typical trauma interventions?
Rather than refer families out, CSI brought therapy into homes, coached frontline teams, and aligned public systems to sustain trauma-informed practice.

What kinds of outcomes did CSI produce?
It improved access to care, increased caregiver stability, built shared infrastructure (like trauma screeners and evaluation tools), and changed how systems plan, respond, and measure impact.

Can this model be replicated?
Yes. ICFW now offers technical assistance and evaluation services to help partners design similar trauma-responsive strategies. Start here.

Explore the Full Story

Want to dig deeper? Read the full Clinical Services Integration Case Study for a detailed walkthrough of the strategy, outcomes, and lessons learned.

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