Providers

Mental health provider directory application

Thank you for your interest in joining the Bend Resilience Project Provider Directory!

Our goal is to connect children, families, and community members affected by traumatic events with qualified mental health professionals who have training and experience in evidence-based treatments (EBTs).

Please complete this brief application. Submissions will be reviewed for relevant qualifications before inclusion in the directory.

Fields marked are required.

Provider information

The number alone, as your Oregon board writes it: C and the number for counselors, T for marriage and family therapists, L for social workers, and the number alone for psychologists. We check it with the board.

Credentials (check all that apply)

For example, certifications or other degrees. Shown on your profile page.

Populations served

Age range of clients you treat 
Populations served (check all that apply)

Evidence-based trauma treatment

Which of the following treatments are you formally trained in and currently provide? (Check all that apply.) 

About how many hours of training or continuing education have you completed in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)? 

Count only training in this treatment. General trauma or PTSD education does not count.

About how many clients have you treated with Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)? 

Count clients you treated with this approach, not ones you assessed or referred elsewhere.

About how many hours of training or continuing education have you completed in Cognitive Processing Therapy (CPT)? 

Count only training in this treatment. General trauma or PTSD education does not count.

About how many clients have you treated with Cognitive Processing Therapy (CPT)? 

Count clients you treated with this approach, not ones you assessed or referred elsewhere.

About how many hours of training or continuing education have you completed in Prolonged Exposure (PE)? 

Count only training in this treatment. General trauma or PTSD education does not count.

About how many clients have you treated with Prolonged Exposure (PE)? 

Count clients you treated with this approach, not ones you assessed or referred elsewhere.

About how many hours of training or continuing education have you completed in Eye Movement Desensitization and Reprocessing (EMDR)? 

Count only training in this treatment. General trauma or PTSD education does not count.

About how many clients have you treated with Eye Movement Desensitization and Reprocessing (EMDR)? 

Count clients you treated with this approach, not ones you assessed or referred elsewhere.

About how many hours of training or continuing education have you completed in Child-Parent Psychotherapy (CPP)? 

Count only training in this treatment. General trauma or PTSD education does not count.

About how many clients have you treated with Child-Parent Psychotherapy (CPP)? 

Count clients you treated with this approach, not ones you assessed or referred elsewhere.

About how many hours of training or continuing education have you completed in Written Exposure Therapy (WET)? 

Count only training in this treatment. General trauma or PTSD education does not count.

About how many clients have you treated with Written Exposure Therapy (WET)? 

Count clients you treated with this approach, not ones you assessed or referred elsewhere.

About how many hours of training or continuing education have you completed in Narrative Exposure Therapy (NET)? 

Count only training in this treatment. General trauma or PTSD education does not count.

About how many clients have you treated with Narrative Exposure Therapy (NET)? 

Count clients you treated with this approach, not ones you assessed or referred elsewhere.

Include relevant formal training, certification, supervised clinical experience, or consultation.

Areas of clinical expertise

Which concerns do you have experience treating? (Check all that apply.)

Availability and services

Are you currently accepting new clients? 

Priority access for Silver Rail families

Are you willing to prioritize referrals from Silver Rail Elementary families affected by the tragedy, including offering expedited appointments or making exceptions to your usual waitlist when possible?

Language accessibility

Are you able to provide clinical services in Spanish?
Services offered (check all that apply)

Insurance and payment

Payment options accepted (check all that apply)

Professional attestation

Have you ever had a professional license restricted, suspended, revoked, surrendered, or subject to disciplinary action? 
By submitting this application, I confirm that: 

Type your full name. It serves as your signature.

DateToday’s date, added when you send

Submission does not guarantee inclusion in the Bend Resilience Project Provider Directory. Applications will be reviewed to help ensure that listed clinicians have qualifications appropriate to the populations and services they offer.