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Initial Collaboration: Child Wh Wit Children Who Witness
Violence ProgramViolence Program
Rainbow Babies and Children’s Hospital form Task Force to study rates of exposure to violence among Force to study rates of exposure to violence among children in 1997 after noticing sharp increase of child exposure to violence in ERp
Task Force convened of community leaders from the religious safety forces government physicians and religious, safety forces, government, physicians and citizens to conduct study of issue and develop plan
S d f h 1999Start date set for March 1999.
K D i iKey Decisions
Law enforcement will be the only referent
Program available 24/7 365 days per yearProgram available 24/7 365 days per year
Crisis Response
Aggressive outreach efforts
Evaluation thru out every aspect of project
I l t tiImplementation
Education on impact of trauma on children provided to police officers during roll calls utilizing training films of local experts and in person question and answer
CWWV Director conducted roll call trainings around new protocol in each of five districts, every roll call around the clock
Referrals begin to pour in prior to official start date of b g p p d 3/1/99
Children Who Witness Vi l PViolence Program
Hallmarks of ServiceHallmarks of Service
Provide crisis services to children and families impacted by domestic violence community impacted by domestic violence, community violence, and self inflicted violence
W ll b l d f ll Will be voluntary and free to all participants
Services will be delivered in home to reduce impediments to receiving service
Clinicians will ACCEPT and MEET women where Clinicians will ACCEPT and MEET women where they are at in their journey to a violence free life
CWWV P t lCWWV Protocol
Keep it Simple
Officer on scene of DV becomes aware of children present
Offi t t C i i T 623 6888Officer contacts Crisis Team 623-6888
24/7/365 availability from trained clinicians who take demographic information
Crisis team alerts CWWV Program ManagerCrisis team alerts CWWV Program Manager
Aggressive outreach protocol begins
O t h P t lOutreach Protocol
CWWV staff contacts family by phone immediatelyy
Family responds to call explains h DCFS program, insures who we are not DCFS sets
first appt.
No response on phone following steps to engage are takenengage are taken
Clinician team drives to home
Explains services, offer services
P t lProtocol
Clinician team drives to home
Explains services, offer services E p a s serv ces, o er serv ces
Family has no phone or , not home, crisis worker leaves handwritten note in envelope with brochure leaves handwritten note in envelope with brochure requesting call
CWWV staff does second drive by within 24 CWWV staff does second drive by within 24 hours, continues calling
CWWV staff sends letter to home requesting call CWWV staff sends letter to home requesting call from family, provides number
S i P id dServices Provided
Safety Planning
Crisis Intervention shelter relative’s home immediate Crisis Intervention: shelter, relative s home, immediate needs addressed
Psycho social education: Impact of violence on children development, short and long term impact, Cycle of violence violence,
Rapport building
Cli i l I t tiClinical Interventions
CBCL, DOSE, PEDS, TSCC
Linkage to Witness Victim Services / Domestic Linkage to Witness Victim Services / Domestic Violence Project
Linkage to agencies providing ongoing trauma services to children
Education about impact of trauma on children and adolescent’s
Referrals for DV ongoing support for victim
B fit t Vi tiBenefit to Victims
Immediate response to family after trauma
S d l d h / l bServices delivered in home/ eliminate barriers
Services are without cost to familyServices are without cost to family
Services provided to children and caregiver
Clinicians are Master’s prepared, many independently licensedindependently licensed
Access to both child and adult psychiatry p y y
24 hour availability to project 365 days per year
B fit t OffiBenefits to Officers
Confident when they leave scene that family will be contacted and have opportunity for high quality mental health services brought to victims at no cost to them
Receive letter from CWWV, thanking them for r f rr l p t C mm nd r g int referral, copy to Commander goes into personnel file
Officers updated in roll call 3-4 times per year about project and project activitiesp j p j
B i / L L dBarriers/ Lessons Learned
Families concerned we are linked to DCFS
F l d l b f l Families are in denial about impact of violence on children
Crisis period resolves family “ wants to move on” forget eventon forget event
Families do not respond to aggressive outreach efforts
Children Exposed to Intimate pPartner Homicide
Understanding Issues and Enhancing Response to these Children and Familiesp
Some Facts of Living in the gUnited States
4 Women per day are killed by Intim t P rtn r r EIntimate Partner or Ex
8 Children per day essentially left 8 Children per day essentially left orphaned
Mom is dead, Dad in jail or has d dcommitted suicide
SilSilence
“ When the headlines fade, why do we hear so little about this we hear so little about this population of children?”D h f h h b k d Despite the fact that they outnumber kids affected by leukemia--- a condition familiar to most Americansto most AmericansIVP affected 4,150 children in 2000
Leukemia impacted est. 3,500 children
P h it iPerhaps it is:
Stigma associated with family violence
Our current fragmented social service systemsOur current fragmented social service systems
Culture of difficulty addressing issues of death and dying especially deaths resulting from an intentional act versus an accident or illness
Our own feelings of inadequacy at finding the right words to talk about the “ unspeakable” acts
I ti t P t H i idIntimate Partner Homicide
Bureau of Justice Assistance defines an intimate partner to include: spouse ex-intimate partner to include: spouse, ex-spouse, boyfriend or girlfriend
Homicide= Act of killing another human being: not always an illegal act ex Death being: not always an illegal act ex. Death penalty. Self defense, accidental d h ili ideaths, military action
Affili t d TAffiliated Terms
Criminal Homicide= Murder
Mariticide= Killing one’s spouseMariticide= Killing one s spouse
Uxoricide= Killing one’s wife
Femicide=Killing of women
Familicide=Killing entire or portion of family
Suicide= Killing one’s self
Bl S i id C lli P li Blue Suicide=Compelling Police to use deadly force
I ti t P t H i idIntimate Partner Homicides
United States 2007
1,800 per year
64 529 IP H i id 1976 200564,529 IP Homicides 1976-2005
5 400 attempted 3 times actual rate of 5,400 attempted 3 times actual rate of homicides completed in this category
32,637 suicides
750,000 completed suicides
Gender Difference in Overall Homicide Rates
Men more likely to murder then m n 10 1women 10:1
Men are more likely to be murdered Men are more likely to be murdered 4:1
IPV: Gender Difference Suicide Gender Differences
Women most likely to be killed by intimate Women most likely to be killed by intimate partner
33 3 vs 3%33.3 vs. 3%
32,637 in 2005
Men 25,907
Women 6,703
Wh t D it MWhat Does it Mean
You are more likely to lose your Mother at the hands of your Fatherat the hands of your Father
You are more likely to lose your primary y y p ycaregiver
Because men more likely to also commit suicide following an IPV murder, you g , ymay also lose your Dad
For children who do not lose their Dad, they are likely to go to jail/prison
Impact of IPV Homicide in 121 pFemicide cases in 2004
35% children witnessed the h mi idhomicide
62% witnessed attempted homicide 62% witnessed attempted homicide previously
37% discovered body
A f I t ChildAreas of Impact on Children
Physical Injury and Death
Trauma and mental health issues
C l i f d M l i l lComplex grief and Multiple losses
Criminal Justice System implicationsCriminal Justice System implications
Custody and Other legal issuesy g
Social Challenges
Unknown
T d M t l H lthTrauma and Mental Health
Risk of PTSD
Sleep Disturbance
H /A l A iHyper/Arousal Anxiety
Long term risk of DepressionLong term risk of Depression
Behavioral– Extreme aggression/ gg /passivity
Psychosomatic Disorders
C l G i fComplex Grief
Loss of Parent ( physical and emotional)
Complex grief related to the nature and manner of Co p e gr e re ated to the ature a d a er o death and chronic exposure to domestic violence prior to homicide
Parental incarcration
Sibling Seperation ( physical and thru loyalty Sibling Seperation ( physical and thru loyalty conflicts)
Extended Family ( conflict between victim/offender Extended Family ( conflict between victim/offender families)
C l G i f Complex Grief
Home ( Crime Scene or permanent move and destruction)and destruction)
School, Neighborhood, Peers ( , g , (Relocation/ Shunning)
“ The length of time it takes to kill i h l di ti t someone is hugely disproportionate
to it’s ramifications.”
Esther Levy age 20, witnessed father kill her mother at age 5mother at age 5
Vi l L R TViolence Loss Response Team
RFP issued by Office of Victim’s of Crime
MHS meets with CPD Chief Michael McGrath MHS meets with CPD Chief Michael McGrath discusses RFP
MHS h H d U M MHS meets with Homicide Unit Management Team
MHS meets with homicide detectives, gathers reactions, responds to questions and concerns
Witness Victim invited to join as partner
G t S b i iGrant Submission
MHS takes lead in writing the proposal after receiving input from two partnersg p p
CPD provides strong letter of support and all necessary statistics
Witness Victim brings impactful letters from Witness Victim brings impactful letters from Cuyahougha County Prosecutor's to support applicationapplication
City officials provide numerous letters of support
Excellent proposal submitted
A dAward
One grant awarded in the country
Cl l d l l dCleveland proposal selected
Two primary goals:Two primary goals:
Provide intensive case management services to victims of homicides families and friends
Replicate this project in another cityReplicate this project in another city
Service Utilization and Homicide Survivors
Among those who do need treatment, only a small percentage get needed treatment.
Numerous barriers exist to initiating treatment and remaining in treatment in the general population.g g p p
Numerous barriers for survivors residing in rural areas
VLRT P t lVLRT Protocol
Homicide, occurs in the City of Cleveland
H d D 623 6888 Homicide Detectives contact 623-6888 24/7/365
Crisis Social workers take demographics, next of kin information brief synopsis of of kin information brief synopsis of homicide, needs of detective
On-call VLRT Program Manger or Associate Director Trauma Services responds immediately
H i id i Cl l d OhiHomicides in Cleveland, Ohio
2005 – 114
2006 1192006 – 119
2007 – 1342007 134
2008 – 102
2009 – 120
2010 – 72
2011 58 d2011 – 58 to date
Vi l L R C ll b iViolent Loss Response Collaborative
Mental Health Services, Inc.
Cl l d D f P l H d UCleveland Division of Police, Homicide Unit
Witness Victim Service CenterWitness Victim Service Center
Recent Addition to Collaborative
Cornerstone of Hope
P f th C ll b tiPurpose of the Collaborative
The Collaborative offers comprehensive services that address both the practical services that address both the practical and psychological needs of family
b ft th i l t l f l d members after the violent loss of a loved one.
Mental Health Services, Inc.,Violent Loss Response Team
Received the federal grant to provide intensive case management to co-victims of homicide in gan urban setting
C l h l h h Community mental health agency with established 24 hour hotline for crisis response requests
Established history of providing community Established history of providing community and home based services
MHS – Violent Loss Response Team p(continued)
Licensed mental health workers are available 24 hours a day to respond to new referrals and y pto assist families in crisis and with ongoing needs
Goal of immediate response to families
MHS – Violent loss Response Team p(continued)
Initial interventions may includeAssistance with notificationAssistance with notificationPersonal safety issuesB i d hi h i l d id if i Basic needs which may include identifying where families can stay, getting food and
if d d b i water if requested, advocacy to obtain medication, obtaining items the family feels h d b bl they need but are not able to get
themselves, arrangements for pets
MHS – Violent Loss Response Team p(continued)
Initial interventions continued:Obtaining information regarding questions g g g qthey have about what happened to their loved oneAssistance with funeral planningCrime Scene clean up informationpIntroduction of Victims of Crime Compensation
MHS – Violent Loss Response Team p(Continued)
Initial Interventions continued:Assistance with needs of childrenAssistance with needs of children
Filings for guardianship / custody
Coordination with the Department of Children and Family Services
Enrollment in school / day care
MHS – Violent loss Response Team p(continued)
Ongoing / Long term interventionsOngoing grief supportOngoing grief supportSupport through criminal justice processT i iTransportation to appointmentsAssistance with estate and property issues of the deceasedLinkage to community resources based on needs the survivor identifies
MHS – Violent Loss Response Team p(continued)
Addressing mental health needsCrisis and/ or full diagnostic assessments completed when necessarywhen necessaryLinkage to emergency psychiatric services with MHS doctorsCrisis intervention services/ Psychological First AidPsycho education on trauma and lossLinkage to ongoing therapy for grief or other Linkage to ongoing therapy for grief or other conditionsCapacity to provide Trauma Focused Cognitive B h i l Th hildBehavioral Therapy to children
Cleveland Division of Police, ,Homicide Unit
Referral source for the Violent Loss Response Team
Briefly explain services to survivors and provide brochureC ll 24 h h l d b Call to 24 hour hotline to provide basic information and where response should be mademadeOngoing collaboration as requested by families with VLRT so appropriate information can be V pp pshared
Wit Vi ti S i C tWitness Victim Service Center
Victim advocates are available to:Assist with Victims of Crime application processCommunicate with detectives and prosecutors about case status and keep families informedabout case status and keep families informedEducate survivors about the criminal justice process and their rights as a crime victimAccompany survivors to hearings and trial datesAssist with formation of victim impact t t tstatement
C t Of HCornerstone Of Hope
Received a grant from local foundation to provide more accessible grief counseling to p g ginner city survivors of traumatic loss
VLRT ff f d l d VLRT staff refer directly to an experienced therapist who is willing to have initial linkage
h h d f ll ff sessions in the home and follows up at offices within the city. Groups specific for survivors of h i id il bl llhomicide are available as well.
P t lProtocol
At the scene of a Homicide, the detectives identify family members, close friends, and / or y y , , /witnesses that may need assistance
Th f d f h d The survivors are informed of the program and brochures are given. The detectives then call h 24 h h l f MHS d the 24 hour hotline of MHS to provide
demographic info and where the response h ld b d should be made to
P t l ( ti d)Protocol (continued)
VLRT staff receive the referral and prepare for as close to immediate response as called for or pas appropriate
F f h d Face to face outreach attempts are made to address provided by police
Services are briefly introduced and families can decide if this is a good time to meet or not –decide if this is a good time to meet or not their wishes are always honored
P t l ( ti d)Protocol (continued)
Initial informal needs assessment is conducted at first contact with familyy
Survivors receive concrete information on the types of practical needs VLRT may be able to types of practical needs VLRT may be able to assist with and identified needs are then addressedaddressed
P t l ( ti d)Protocol (continued)
To ensure collaboration from the beginning:Witness Victim also forwards the Witness Victim also forwards the information they get on survivors to VLRT
Homicide Unit Lieutenant forwards a copy f h i f h h i id VLRT of the synopsis of the homicide to VLRT
staff as soon as available
P t lProtocol
Quarterly meeting are held with the Collaborative members and other stakeholders
Protocols are reviewed and alterations are made as needed made as needed
C b i d h Cases may be reviewed to ensure that involved agencies all have same information
S i P id dServices Provided
On-Scene response for family members/ friends
If requested by homicide detectives assistance h fwith notification
Coroner identification of bodyCoroner identification of body
Immediate crisis intervention for family/friends
Funeral planningFuneral planning
Media management
S i C ti dServices Continued
Financial assistance
V f C lVictims of Crime applications
Liaison to Homicide DetectivesLiaison to Homicide Detectives
Grief Support/ Education
Linkage to on-going therapy
Camp Bridges
O i h k i ’On going check in’s
S i C ti dServices Continued
Assistance in obtaining basic needs, housing, food, clothing, g, , g
Linkage to spiritual counseling
Linkage to Witness Victim: who act as advocates for victim’s during prosecutionadvocates for victim s during prosecution
Social Security information
Wh h it W k d?Why has it Worked?
Homicide detectives are outstanding, willing to engage with us, acknowledge time limitations g g , gthey have to respond to families
MHS h h ff CWWV PMHS history with officers CWWV Project
Quickly recognized assistance MHS could Quickly recognized assistance MHS could provide to them and the bereft families
Observed MHS clinicians, do exactly what they said they would do, every time, we are very committed to this project
Responded to all request always gave it our
Wh ti dWhy continued
Willing to learn from the detectives
NEVER f h h NEVER interfere with the investigations
Homicide Unit leadership encouraged to join Homicide Unit leadership encouraged to join us presenting at national conferences
Constant communication
Th U t dThe Unexpected
Dealing with infant deaths
Number of suicidesNumber of suicides
West 89th
Imperial Avenue
Media
Community relationsCommunity relations
Politics
Cold cases
St ff I d S l ti Staff Issues and Solutions
Vicarious trauma
V l dVary caseload
Develop vicarious trauma group with our Develop vicarious trauma group with our medical director, Cynthia Vrabel M.D. meets every other week to discuss how work impacts every other week to discuss how work impacts them
Flexible schedule
Keep close eye on number of hours workingKeep close eye on number of hours working
C ti dContinued
Open Door Policy
A k l d h d ff l k Acknowledge how difficult work is
Accompany them on callsAccompany them on calls
Continuing Education opportunities provided
Encourage creativity
Involvement at macro level
P li A i t d R f lPolice Assisted Referrals
Response to families and individuals residing in CMHA Housingresiding in CMHA Housing
Similar to CWWV Model however includes referrals with issues other then domestic violencedomestic violence
Initiated 2 years ago y g
PPurpose
Address the social problems p ri n d b CMHA r id nt experienced by CMHA residents
quickly
Bring services to them
Overcome barriers
P t lProtocol
Utilize CWWV aggressive Outreach ProtocolProtocol
24 hour responsep
Master’s prepared clinician’s
Where and when families want services
Ch ll t PARChallenges to PAR
Families Scared
“ Might lose m place” Might lose my place
“ You are DCFS”
“ Don’t want people knowing my business”business
“ That’s the way it is women get y gwhooped down here”