Supporting Young Children Exposed to Violence: The Erie Safe Start Promising Approaches Program

1. Supporting Young Children Exposed to Violence: The Erie Safe Start Promising Approaches Program Birth to Three National Conference Washington, DC June, 2007

2. Presenters Elena Cohen, MSW Safe Start Center Kristen Kracke, MSW Office of Juvenile Justice and Delinquency Prevention (OJJDP) Judy Smith, PhD Erie Safe Start Promising Approaches Program

4. Effects of Exposure on Children • Immediate and long term • Physiological and neurological reactions that can lead to alterations in brain development and function

5. Witnessing Violence Can Affect a Child’s: • Ability to trust adults to keep him safe • Ability to learn • Social and emotional development • Self-esteem • Ability to be a child

6. How a Child Reacts to ViolenceCan Depend on: • Nature of the violence (closeness, intensity, frequency) • Risk and protective factors • Age and developmental stage of the child

7. How a Child Reacts to ViolenceCan Depend On: • Elapsed time since exposure • Gender • Temperament • Presence of child physical or sexual abuse

8. Common Reactions Birth - 5 • Fussiness, uncharacteristic crying and neediness • Generalized fear • Startle response to loud or unusual noises • Regressive symptoms • Somatic symptoms • Helplessness—lack of usual reponsiveness • Confusion • Difficulty talking about event

9. Common Reactions (6-11 years) • Feelings of reponsibility and guilt • Repetitious play and retelling • Nightmares and other sleep issues • Concerns about safety • Aggressive behavior

10. Common Reactions (Birth – 5) • Somatic symptoms (stomachaches headaches) • Helplessness—lack of usual responsiveness • Confusion • Difficulty talking about event

11. Common Reactions (6-11 years) • Withdrawal, school avoidance • Worry and concern for others • Anxiety and fearfulness • Regression • Separation anxiety • Distractability

13. Protective Factors Characteristics that protect children from the damaging effects of negative life circumstances and events and build resiliency.

14. Risk Factors Characteristics and experiences that make it more challenging for a child to grow and develop skills that lead to success in life.

15. Resiliency The ability to recover readily or “bounce back” from adversity and stressful events.

16. Building Resiliency • We can’t always control the “nasty weather” children might have to endure. • We can work to build resiliency by promoting protective factors and reducing risk factors.

17. The Need to Feel Safe • When children feel safe and secure they are free to grow and explore their world. • When children are exposed to violence, the sense of safety is threatened • Children learn that the world is a safe place through the messages they receive from their parents or primary caregivers.

18. Early Childhood Programs Role • Prevention/building resiliency • Increasing awareness • Screening/Identification • Access to early intervention and treatment • Integrated systems of care • Enhancing assessment

19. Identification • Gain information from a variety of sources: -Parents and extended family members -Observations of the child -Teachers, child care staff, other caregivers -Community partners

20. Identification • Consider the physical, emotional, cognitive, and social strengths of the child, as well as the concerns. • Partner with the non-abusing parent to get child’s history as well as current circumstances.

21. Identification • Each child responds differently depending on a variety of factors; same for reactions to violence. • Information gained is to develop goals that responds to each child.

22. Challenges to Addressing Exposure • Lack or awareness about impact of exposure and interventions • Fragmentation of services • Lack of capacity in early care and school programs • Inadequate supply of trained providers • Inadequate attention to cultural competency

23. Safe Start Initiative Purpose of the Safe Start Initiative is to prevent and reduce the impact of family and community violence on children and their families.

24. Safe Start Definition of Exposure to Violence Being a direct victim of abuse, neglect, or maltreatment or a witness to domestic violence or other violent crime in the community.

25. National Safe Start Initiative Framework Sphere of Influence and Support

26. Components • Practice innovation • Research • Evaluation • Training and technical assistance • Information and resource development

27. Practice Component: Phase I—Demonstration Sites • Baltimore, MD; Bridgeport, CT*; Chatham County, NC; Chicago, IL*; Pinellas County, FL*; Spokane, WA*; Pueblo of Zuni, NM; San Francisco, CA; Sitka Tribe of Alaska; Rochester, NY; Washington County, ME;

28. Phase II—Promising Approaches Bronx, NY; Chelsea, MA; Dallas, TX; Dayton, OH; Erie, PA; Kalamazoo, MI; Miami, FL; New York City, NY; Oakland, CA; Pompano Beach, FL; Portland, OR; Providence, RI; San Diego, CA; San Mateo, CA; Toledo, OH

29. Phase I—Strategies and Practices • Increased awareness professionals and public: two award-winning public service announcements • Change in policies and procedures—memoranda of understanding • New protocols for CPS/DV • Expand pathways of referrals

30. Phase I: Strategies and Practices • Improved existing mental health services by funding specialized training • Increased sustainability by creating funding streams through tax base and strong coordinating bodies of governance.

31. Phase I Strategies and Practices • Creation of multiple point of entry • Modified infrastructure of local service delivery systems by creating centralized access and by developing partnerships that expedited linkages

32. Phase I—Strategies and Practices • Utilized data-based decision making • Developed screening procedures and protocols • DV protocol for the Department of Children and Families • Coordinated case review • Home-based therapy and cell phone distribution

33. Phase II—Diversity of Approaches • Home Visitation • Domestic Violence Shelter-Based Service • Motivational Interviewing • Kinship care /dyad therapy • Child Welfare-Domestic Violence Integrated Services • After School Support/Kids Club

34. Phase II: Diversity of Approaches • Parent Child Interactive Therapy (PCIT) • Child Parent Psychotherapy (CPP-DV) • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) • Trauma Assessment Pathway (TAP) • Dyadic Therapy

35. Phase II—Diversity of Approaches • In-home, family-centered services • Integrated case management (mental health/social services, family support) • Trauma-focused curriculum for teachers and parents • Medical home • Child advocacy center

36. What is a Children’s Advocacy Center (CAC) ? • Child-friendly location • Investigators bring child with allegation of abuse to CAC • Forensic interview • Interviewer with specialized training • Multidisciplinary team present • Regular case review

37. Medical exam Case management Therapy Family Advocacy Education of Professionals Community Education NOTE: CAC’s differ in what services are offered beyond a forensic interview. All CAC’s refer children/family to needed community services Other Possible CAC Services

38. Non-profit Free standing Department of Hospital Program of a social service organization Part of prosecutor’s office or police department CAC Models

39. History of CACs • 1982, Bud Kramer establishes first CAC in Huntsville, Alabama • CAC’s begin to proliferate • National Children’s Alliance established through Department of Justice funds/now provides accreditation • Over 500 CACs nationwide

40. Benefits of CAC Model • Reduction of secondary trauma for children • Children more likely to be seen by all disciplines • Children more likely to receive a medical exam • Children more likely to receive a counseling referral

41. Benefits (continued) • Cost per case is lower • Case more likely to result in prosecution • Most coordination between disciplines • Establishment of protocols and expected quality of service

42. CAC in Erie, PA • Opened its doors in June 2001 • Nonprofit organization; fully accredited • Established out of a community planning process • Totally funded by grants, donations, fundraisers • Receives about 400 referrals a year

43. CAC-Erie • Accepts children as young as two if verbal • Only interviews age 18 and over by special request when developmental delay or MR • Provides forensic interview using CornerHouse model • Multidisciplinary staffing every two weeks • Case management

44. CAC-Erie • Crime Victim/Center Advocacy sees each family to set up counseling services • Staff of CAC consists of ED, assistant district attorneys, detectives from DA and police, forensic interviewer, case managers, secretary, and office coordinator • Provides education in community – Shaken Baby Syndrome

45. Accomplishments • Most important: Make a difference one child at a time • Established Child Abuse Protocol for Erie County (CAP) • CAP increased speed of all investigative steps • Education of professionals and community

46. Safe Start - Erie • CAC – lead agency with partners • Partners: Achievement Center, Crime Victim Center, Edinboro University, Office of Children and Youth • Children age 8 and under • Eligibility criteria

47. Safe Start- Erie • Majority of referrals from CAC; others from partner agencies, Head Start, Social Service • All Safe Start children receive a developmental assessment once every six months for two years • About half of the families are randomly assigned to an integrated treatment program

48. Safe Start - Erie • Developmental Clinic includes questionnaires for the parent, subtests of the Woodcock Johnson, the Battelle Screening, and Vineland • Treatment program consists of about 25 hours of treatment including home & office visits and a parent group

49. Challenges • Families are often “system wary” or focused on daily survival which presents recruitment/retention challenges • Program visibility and long-term commitment

50. Benefits • Quick, integrated responses • Developmental findings lead to early referrals • Mobile therapy allows us to reach families that would have gone un-served • Coordination between providers • Ability to follow over time