Losing a Loved One to HomicideWhat Do We Know From Research and Practice?

July 19, 2018

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AcknowledgementsThis webinar was produced by the Center for Victim Research (CVR) under grant number 2016-XV-GX-K006, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this webinar are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.

Presenters

Sara Bastomski, PhD Marina Duane, MID

Sara Bastomski is a Research Associate in the Justice Policy Center at the Urban Institute. She conducts basic and applied research on crime victimization and criminal justice policy. She holds a Ph.D. in Sociology from Yale University.

Marina Duane is a Research Associate in the Justice Policy Center at the Urban Institute. She researches multidisciplinary justice policies and provides technical assistance to local jurisdictions on implementing evidence-based practices. She holds an M.A. in International Development from the University of Pittsburgh.

Jeff Dion, JD

Jeff Dion is a is a homicide survivor and attorney with more than twenty years of experience in victim services. He currently serves as Executive Director of the National Compassion Fund. He holds his law degree from George Mason University.

Road Map for Today’s Talk

• Reviewing research & practice: Why? How?• Homicide co-victims: Definition? Who’s at risk? • Harms & consequences• Interventions & services • Where does the field need to grow?• Discussion/questions

Reviewing Research & Practice

Goals of CVR’s Reviews

System• Assess state of the field in victimization response• Systematically synthesize the best available evidence

from research and practice• Help service providers and researchers understand

what the field needs

Goals of CVR’s Reviews (cont.)

System

Modified from: Puddy, R. W. & Wilkins, N. (2011). Understanding Evidence Part 1: Best Available Research Evidence. A Guide to the Continuum of Evidence of Effectiveness, CDC

CVR Syntheses

Best Available Research

What We Know from

Practice

Context of What We

Know

Reviewed 147 research articles

on homicide co-victims!

Reviewed 172 practice sources

on homicide co-victims!

Questions to Answer

1. How many victims? (prevalence)2. Risk factors?3. Harms and consequences?4. Interventions and victim services?5. Policy, practice, and research implications?

Homicide Co-Victimization

Photo credit: PowerPoint “Bing” search

Definition

Homicide co-victims are people who have lost a loved one to homicide, including family,

members, kin, and friends of the deceased.

Note: We did not focus on loved ones lost to noncriminal causes, killed in the line of duty, mass violence, or attempted homicide.

Prevalence• Each year, 64,000 to 213,000 people in the U.S. lose a

loved one to homicide • During their lifetime, 9% to 18% of U.S. population

experiences homicide co-victimization• Rates are even higher in marginalized and disadvantaged

communities that experience high rates of homicide

Notes: Scholars state that each homicide impacts 3-10 loved ones, and in 2016 there were 21,250 homicides

Risk Factors

• Race is a key risk factor for homicide co-victimization• Black adults and adolescents, and Latinx adolescents face

heightened risks of homicide co-victimization• Black adults and adolescents, and Latinx adolescents are

overrepresented as co-victims of criminal homicide, but not vehicular homicide

Photo credit: Shutterstock image

Risk Factors (cont.)

• Native Americans report experiencing victimization at a higher rate than national average:• Advocates underscore that homicides among Native American

women are far higher than those of the national average

Photo credit: Indian Law Resource Center

Harms and Consequences

Harms Faced by Co-victims

• Psychological

• Physical health

• Social

• Economic

Four major categories of harms faced by co-victims:

Photo credit: PowerPoint “Bing” search

Audience PollIn your experience, which type of harms are the most common among homicide co-victims? Please think about co-victims you work with or study.

• Psychological (e.g. distress, mental health concerns)• Physical (e.g. trouble sleeping, heart conditions)• Social (e.g. negative impacts on relationships or community)• Economic (e.g. material hardships, trouble with expenses)

“[T]o this day when I hear this [knocks on table]—that’s how the police came to my door—you ring the doorbell I’m fine, when I hear somebody knock on the door um, I have an absolute panic attack for about half a second—much less than it used to be.”~ Mastrocinque et al. (2015)

Psychological Harms • Homicide co-victims often suffer PTSD, depression, or

prolonged grief as a result of the experience• As many as 1 in 4 homicide co-victims suffer from

prolonged grief due to the sudden and violent nature of loved ones’ deaths

• About 1 in 5 homicide co-victims suffer from PTSD• Psychological harms can lead to substance use disorders

Physical Harms • Homicide co-victims are at risk for harms to physical

health due to prolonged grief• Negative physical health outcomes include:

• Cancer, heart trouble, high blood pressure• Higher bodily pain and poor physical health among elderly• Elevated risk of suicidal ideation & suicidality

Social and Economic Harms • Co-victims may be stigmatized in family circle or

community, resulting in isolation• Media coverage can amplify social stigma

• Stress and trauma from violent loss impede social relationships & increase conflicts with family

• Loss of economic support loved ones had provided• Esp. when deceased was breadwinner or childcare provider

• Costs of funeral arrangements & time away from work

“If people don’t go through the situation that is happening at hand, you think that nobody can understand . . . because they weren’t in that predicament . . . those who live a hard life, don’t want to talk to anybody because they feel as though anyone else who does not live a hard life won’t understand.” ~ Sharpe (2008)

Secondary Victimization & Barriers to HealingHomicide co-victims often come into contact with criminal justice, media, social service, and health care systems

Actors in these systems may not be prepared to interface in a trauma-informed manner

Services and Interventions

Photo credit: Shutterstock image

Complex needs but rather disjointed services:

Lack of Wraparound Services

Addressing psychological harms

Participating in justice processes

Participating in justice processes

Dealing with media and society

Audience PollWhat types of services do co-victims tend to access? Please think about co-victims you work with or study.• Grief support groups• Self help groups (e.g., organically organized, usually led by

community leaders)• Individual or group counseling/therapy (e.g., Cognitive Behavior

Therapy – Trauma Focused group intervention)• Self care (e.g. stress reduction strategies, meditation)

Services for Psychological Harms

Strengths Limitations

Grief Support Groups

• Accessible; usually well-advertised• Cost-efficient• Peer-led• Mixed composition• Open enrollment (drop-in, drop-out)

• Mixed composition• Prompts to retell or relive the incident

multiple times• Lack of training in violent death dynamics• Lack of research

Self Help Groups

• Responsive to needs in the community• Led by invested peers and community

leaders• More targeted/focused on violent death

• Limited to those who are aware• Level of skill among facilitators unclear• Lack of training among facilitators• Can be difficult to sustain

Photo credit: Dougy Center, Oregon

Volunteers who lead grief support groups at the Dougy Center meet

regularly to debrief and prepare for future groups

SpotlightRestorative Retelling and Criminal Death Support Group

• Wraparound services including psychological treatment, trauma support, training on navigating media and criminal justice

• Studies show RR is effective for depression & PTSD, mixed for prolonged grief

Fairfax Police Grief Support Group• Led by law enforcement strengthens ties with community• Includes assistance in grieving, navigating the investigation, and spiritual or

religious advocates• Responsive to community needs

Services for Psychological HarmsStrengths Limitations

Individual or Group

Counseling

• Trained and skilled specialists• Tailored to individual needs• Can be trauma focused (e.g., TF-CBT)• Shown to reduce depression & anxiety

symptoms, PTSD, prolonged grief

• Inaccessible and cost-prohibitive• Lack of expertise to address violent death

reactions• Stigmatizing in some communities

Self Care

• Builds on innate resiliency• Quick to reduce ongoing stresses• Conducive to long-term coping skills• Varies by individual need

• Self-guided, which could be limiting• Difficult to undertake soon after death• Research on homicide co-victims is lacking

“[What] helped us survive and eventually thrive again [was] the rich mixture of all sources of support – from short simple conversations over coffee with a friend to sessions with our psychologist to whom we brought the most serious issues.”~ Grieving parents at Compassionate Friends, a grief support organization

Criminal Justice System

Police

1. First response and death notification2. Engagement through ongoing investigation3. Victim advocates

Prosecutors

1. Victim assistance units2. Victim impact statements & explaining the process3. Strained interactions if goals for case outcomes do not align

Courts, post conviction

1. Participation in parole reviews2. Myth of “closure”3. Death penalty decisions

1. Are we victim-centered?

2. How can we help co-victims avoid

secondary trauma?

Barriers to Accessing Services• Strained relationship with police• Uninsured/underinsured struggle to engage in counseling• Language barriers for people with Limited English Proficiency

(e.g., Bo’s place, San Diego grief support groups in Spanish)• Lack of cultural competency (e.g., Western concepts not

always conducive to healing concepts in Native communities)• Societal stigma

• Many co-victims do not access grief support groups right away, which practitioners and counselors say correlates with improved outcomes

Where the Field Needs to Grow

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Research

• Few studies have examined individual-, household-, and community-level risk factors for homicide co-victimization

• Up-to-date, national estimates of prevalence are not available• Lack of information on risks among vulnerable populations

(particularly, Native Americans)• Few studies on physical health and economic wellbeing

Practice

Lack of wraparound services to help victims heal and move forward

Evaluations on which services work and for whom are scarce

Remains unclear to what extent grief support groups are effective for those who lose a loved one to violent death as compared to natural causes

Services are lacking in socioeconomically disadvantaged communities, where homicide rates are disproportionately high

Policy

Variations in state policies mean loved ones can have different grieving experience depending on where they live

Expanding insurance coverage for counseling may improve access for low-income co-victims

Key Takeaways• 1 in 10 may become co-victims in their lifetime but up-to-date

prevalence estimates are lacking• Homicide co-victims experience psychological, physical, social

& economic harms. Prolonged grief is a particular concern • Wraparound services not readily available across the country• Access to services remains issue in communities with high

rates of homicides

Thank You www.victimresearch.orgTwitter @VictimResearchYouTube Center for Victim ResearchFacebook CenterVictimResearchLinkedIn Center-for-Victim-Research

Selected References• Amick-McMullan, A., Kilpatrick, D. G., & Resnick, H. S. (1991). Homicide as a risk factor for PTSD among surviving family members. Behavior Modification, 15(4),

545-559.

• Armour, M. P. (2002). Journey of family members of homicide victims: A qualitative study of their posthomicide experience. American Journal of Orthopsychiatry, 72(3), 372-382.

• Attig, T., Corless, I. B., Gilbert, K. R., Larson, D. G., McKissock, M., Roth, D., … & Worden, J. W. (2013). When does a broken heart become a mental disorder?Retrieved from https://www.dougy.org/news-events/news/when-does-a-broken-heart-become-a-mental-disorder/1487/

• Bandes, S. A. (2009). Victims, closure, and the sociology of emotion. Law and Contemporary Problems, 72(2), 1-26.

• Borg, M. J. (1998). Vicarious homicide victimization and support for capital punishment: A test of Black's theory of law. Criminology, 36(3), 537-568.

• Bo’s Place. (2017). Bo’s place programs and services [Educational brochure]. Retrieved from https://www.bosplace.org/wp-content/uploads/2017/04/Bos-Place-Brochure-English-digital-2017.pdf

• Columbia Center for Complicated Grief. (N.d). Complicated grief overview. Retrieved from https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/overview/

• Federal Bureau of Investigation. (2016). Crime in the united states, 2016. Retrieved from https://ucr.fbi.gov/crime-in-the-u.s/2016/crime-in-the-u.s.-2016/topic-pages/murder

• Indian Law Resource Center. (n.d.). Ending violence against native women. Retrieved from http://indianlaw.org/issue/ending-violence-against-native-women?page=4

• International Association of Chiefs of Police and Bureau of Justice Assistance. (2014). 10 things law enforcement executives can do to positively impact homicide investigation outcomes. Retrieved from http://www.theiacp.org/Portals/0/documents/pdfs/10%20Things_IACPHomicideGuide.pdf

• Mastrocinque, J. M., Metzger, J. W., Madeira, J., Lang, K., Pruss, H., Navratil, P. K., ... & Cerulli, C. (2015). I’m still left here with the pain: Exploring the health consequences of homicide on families and friends. Homicide Studies, 19(4), 326-349.

• Miller, L. (2009). Family survivors of homicide: I. Symptoms, syndromes, and reaction patterns. The American Journal of Family Therapy, 37(1), 67-79.

• National Center for Victims of Crime. (2013). Crime victim compensation. Retrieved from http://victimsofcrime.org/help-for-crime-victims/get-help-bulletins-for-crime-victims/crime-victim-compensation

• National Highway Safety Traffic Administration. (2017). Traffic safety facts, 2016 data. Retrieved from https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812450

• National Sheriff's Association, Justice Solutions, and National Organization of Parents of Murdered Children Inc. (2011). Serving survivors of homicide victims during cold case investigations: A guide for developing a law enforcement protocol. Retrieved from http://www.pomc.org/docs/guidefordevelopingalawenforcementprotocolaugust172011.pdf

• Parents of Murdered Children. (2000s). Murder is not entertainment (MINE). Retrieved from http://www.pomc.com/mine.html

• Penn State & Federal Bureau of Investigation. (n.d). We regret to inform you... [Online training] Retrieved from http://deathnotification.psu.edu/

• Prigerson, H. G., Bierhals, A. J., Kasl, S. V., Reynolds, C. F., Shear, M. K., Day, N., ... & Jacobs, S. (1997). Traumatic grief as a risk factor for mental and physical morbidity. American Journal of Psychiatry, 154(5), 616-623.

• Redmond, L. M. (1989). Surviving: When someone you know was murdered: A professional's guide to group grief therapy for families & friends of murder victims. Clearwater, FL: Psychological Consultations and Educational Services.

• Rheingold, A. A., Baddeley, J. L., Williams, J. L., Brown, C., Wallace, M. M., Correa, F., & Rynearson, E. K. (2015). Restorative retelling for violent death: An investigation of treatment effectiveness, influencing factors, and durability. Journal of Loss and Trauma, 20(6), 541-555.

• Rheingold, A. A., & Williams, J. L. (2015). Survivors of homicide: Mental health outcomes, social support, and service use among a community-based sample. Violence and Victims, 30(5), 870-883.

Selected References (cont.)

• Rheingold, A. A., Zinzow, H., Hawkins, A., Saunders, B. E., & Kilpatrick, D. G. (2012). Prevalence and mental health outcomes of homicide survivors in arepresentative US sample of adolescents: Data from the 2005 National Survey of Adolescents. Journal of child psychology and psychiatry, 53(6), 687-694.

• Roberta's House. (2017). Homicide transformation project. Retrieved from http://robertashouse.org/special-support-groups/

• Rynearson, E. K., Fanny C., & Tackacs, L. (2015). Accommodation to violent dying: A guide to restorative retelling and support. Fourth Revision. Separation and Loss Services. Virginia Mason.

• Rynearson, E. K., Favell, J., & Saindon, C. (2002). Group intervention for bereavement after violent death. Psychiatric Services, 53(10), 1340-1340.

• Saindon, C., Rheingold, A. A., Baddeley, J., Wallace, M. M., Brown, C., & Rynearson, E. K. (2014). Restorative retelling for violent loss: An open clinical trial. Death Studies, 38(4), 251-258.

• Sharpe, T. L. (2008). Sources of support for African-American family members of homicide victims. Journal of Ethnic & Cultural Diversity in Social Work, 17(2), 197-216.

• US Department of Veterans Affairs. (2017). Epidemiology of PTSD. Retrieved from https://www.ptsd.va.gov/professional/ptsd-overview/epidemiological-facts-ptsd.asp

• Vincent, N. J., McCormack, J., & Johnson, S. (2015). A comprehensive conceptual program model for supporting families surviving a homicide victim. Child and Adolescent Social Work Journal, 32(1), 57-64.

• White Bison. (2018). Introducing white bison's newest training program. Retrieved from http://blog.whitebison.org/blogenginenet_3/post/introducing-white-bison-s-newest-training-program

• Zinzow, H. M., Rheingold, A. A., Hawkins, A. O., Saunders, B. E., & Kilpatrick, D. G. (2009). Losing a loved one to homicide: Prevalence and mental health correlates in a national sample of young adults. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 22(1), 20-27.

Selected References (cont.)