Blueprint for change_presentation 1

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  • The Systems Committee of the GCSDV is comprised of individuals working to end sexual and domestic violence in various ways. Membership on the committee is voluntary and is determined in part by the particular question being addressed. During the period this blueprint was created, membership included representatives from “systems” across the state - hospitals, community-based organizations, domestic violence and sexual assault advocacy groups, Jane Doe Inc., and various state agencies. As such, there is not a guarantee of absolute representation of every interest on every topic. Although the authors of this blueprint represent a range of agencies and sectors, the committee members agreed that its’ expertise is more weighted towards domestic violence than sexual assault. The initial charge of the Committee was to identify and suggest systems-level opportunities to improve the state’s responsiveness to individuals and families experiencing (or who have in the past experienced) sexual and domestic violence.
  • Massachusetts has been a leader in applying government resources to prevent domestic and sexual violence, and to support those who are hurt by it, both directly and through education and public health measures. We have much to be proud of. Like much progress, there have been places and times where our efforts and successes have created unintended negative consequences that require further action and remediation. As such, the Committee was asked to respond to these key questions:  
  • The fragmentation of domestic violence and sexual assault within our systems (which is not reflective of how juxtaposed these issues in fact are in the lives of many survivors) must be addressed separately, deliberately and substantively. It is important to note that while many of the issues we identified and the recommendations in this blueprint impact survivors of both sexual and domestic violence, this blueprint is primarily focused on domestic violence, which includes sexual assault in the context of an overall partner relationship, but does not explicitly address sexual violence by strangers, trafficking, and other associated forms of violence and abuse. A separate review is needed to identify priorities and develop recommendations for meaningful systems change for sexual assault survivors and for the integration of domestic violence and sexual assault systems.
  • Section II describes the process employed to identify which of myriad possible concerns the Committee would examine. High importance : The issue negatively impacts a large number of survivors and/or dramatically impacts a smaller number of survivors in ways that are very difficult to work-around or that are extremely harmful. High feasibility: The issue can be addressed and stands a good chance of succeeding if well addressed. It doesn’t depend on significant other changes occurring, or on leveraging political will that is not present. Timely: A particular window of opportunity for addressing the issue exists. The issue capitalizes on changes that are already occurring—it can be tacked on to other areas where there is momentum, political will and attention. Low budget impact : The issue can be addressed without significant outlay of funds. Ideally, it has the potential of realizing cost savings to the Commonwealth in a relatively short time frame. Targeted : The issue is specific, and progress correlates to measurable benchmarks and outcomes. Highly actionable : The issue can be addressed in a few short steps that the Lieutenant Governor’s leadership could set in motion without requiring legislative approval or vote. Non-duplicative : The work raises and/or addresses issues and/or frames issues differently from work being undertaken by other working groups (e.g. there are already efforts underway to infuse trauma-informed practices across the EOHHS Secretariat and to integrate trauma services with the new regional homelessness centers).
  • Using the criteria on slide 6, we narrowed down a very large list to these three problems (read). In the reports you all have copies of, In Section III, we examine these; identify several existing initiatives that hold promise for addressing each problem; and make specific recommendations for action.
  • Scenario:   Jeanie’s son Max was diagnosed with a complex health condition, requiring regular doctor's visits and very limited contact with people other than immediate caregivers who are versed in his care. Fortunately, Jeanie lives near the hospital where Max is cared for. Recently her boyfriend, who is also Max’s father, has been escalating violence and threats, leading Jeanie to seek a restraining order and help in finding new housing where he will not know where to find her. DV specialists recommend moving out of the area where her boyfriend lives, which will make it harder to take the baby to the doctor. DTA finds placement for her in a group home, but the doctor has ordered that Max’s health will be compromised if he lives with other people. Jeanie risks 51A being filed if she fails to make the appointments or chooses to live with other people (who could also help with child care so she can work). Jeanie risks the judge vacating the 209A at 10 day hearing if she hears that Jeanie has not moved out of the area, assuming she over-stated her fear of the boyfriend. Meanwhile, the boyfriend has filed for visitation, and if granted, Jeanie will face the choice of putting herself and Max in danger by having contact, or violating a probate court order to allow visitation. If she chooses to move away and live alone, she faces both physical and emotional isolation not only from her boyfriend, but from her network of friends and family, whom she needs more than ever to help her juggle everything, difficulty in making doctor's and court appointments, risks returning to the boyfriend for child care and emotional support, etc. all of which could be used against her as signs that she does not care about protecting herself or the health of her baby. Sadly, this case gets more complicated, could add complexity here: a TANF work requirement, which makes it harder to move away from transportation and child care support, ability to attend court appearances, etc. Failing to show up in court risks losing custody, attending risks losing job, etc. Woven throughout is the isolation factor, and the way "safety" is often defined in limited and non-survivor-centered ways.
  • Systems can work at cross-purposes and decrease safety and/or family stability (e.g. revocation of probation and re-incarceration of a mother, children placed into foster care, loss of housing subsidies). The challenges and even harms that can result also require further state or state contractor involvement with a family (e.g., being forced to take an apartment in a different town may trigger a loss of a job, which may lead to a need for public benefits and publicly subsidized health care, as well as legal representation to address the conflict between systems). What this means for the Commonwealth: the state may incur increased expenses as new problems are created that then require additional case management and subsidies. Neither blanket confidentiality policies, or their reverse (generalized information sharing policies) increase safety and may undermine it.
  • In rec 2 remember to say includes consideration of waiving or amending riles, rpocedures when necessry for safety.
  • Scenario: Years of drugs, drinking and a bad habit of picking at her adolescent pimples left Monique with the skin of a 40 year old, but she’s only 22 She’s been on the streets for almost ½ of that. For the past five years, she’s been with T., who saved her from a mean pimp in New York. He’s mean, too, but he doesn’t make her hustle that much– only at the end of the month when his disability check is running out. In the summer, they live by the railroad tracks. In the winter, they stay at the wet shelter together. Sometimes, when they’re drunk, they fight and it gets bad with the bottles. The only wet shelter that will take them just has them stay in opposite dorms and keeps a close eye when they are fighting. She got a restraining order on him once, but then the shelter told her she couldn’t stay there because it made it unsafe for everyone else. When she called the domestic violence hotline, she explained she couldn’t stay at the homeless shelter, but didn’t really think he was really going to come after her that night… She couldn’t get in the DV program. Monique and T. both have felony convictions– forget public housing. The time she spent in MCI Framingham were the few months she was clean and sober and without him. And he was the only one glad to see her when she got out. She’s scared of him, but the staff at the shelter change so fast every time she’s almost ready to talk about it, there’s someone new. Encounter systems with two fundamentally different descriptions of the problem: a housing/resource problem (homelessness), or a relational problem (domestic violence). Each framing leads to dramatically different interventions and responses. Systems prioritize addressing domestic violence, even if that’s not the survivor’s priority. Survivors may not reveal their trauma in a homeless shelter for fear the shelter will not allow them to stay due to safety reasons; survivors may not be explicit about their homelessness prior to domestic violence in a DV program for fear of being seen as ‘simply’ trying to get shelter. Survivors’ experience of homelessness as a reinforcing trauma, as clearly documented by researchers, is not validated by the system. Those who face not only homelessness and domestic violence, but a range of other challenges, such as medical or mental health concerns, addiction or court involvement, who are youth, or in myriad other “non-traditional” categories may find it almost impossible to find services that can support the complexity of their situations. Neither system has fully embraced a mandate to work with those who are victimized on the streets, such as situations involving prostitution or trafficking, or the abuse of one person who is homeless by a partner who is also homeless; as a result, their needs remain largely unmet. The unit of service is either the family, or the children, or the adult survivor, often leading to conflicting demands on members (what is good for an adult survivor as a “unit” may not be the best thing for the family, or for her as a mother, but the system rarely recognizes these inherent tensions).
  • The Executive Office should direct DHCD (with input from staff at DTA), DCF and DPH to develop contracting streams that allow for organizations with demonstrated expertise in domestic violence, homelessness, and the intersection of the two (as a separate concern) to work in ways that do not require them, or their participants, to assume a ‘primary label’ of either homeless or domestic violence. The Executive Office should direct DHCD (with input from staff at DTA), DCF and DPH to compare eligibility-for-service and intake requirements to identify areas where the divide between homeless and domestic violence situations are reinforced, and to alter requirements, forms and process to reduce this divide. The Executive Office should create a working group including members of GCASDV to identify where access to state and federal benefits and services are markedly different depending on the label one chooses, and develop strategies to lessen these disparities.
  • Start with good news…. Many years ago Massachusetts led the country in making the connection between domestic violence and impact on children. ground breaking work = specialized domestic violence unit in DCF hospitals and health care centers & pediatric dept. with domestic violence advocates/programs specialised doemstic violence unit in DTA a network of child witness to violence programs We did a great job at educating the community about the fact that doemstic violence impact children…. This problem statement comes because of some unintended consequences of that work.
  • Julie is a mother of 3 children who fled here from New jersey after surviving years of abuse from the father of her children. He found her and moved back in. After a particularly brutal attack he was arrested and the police filed a child abuse report with DCF. While awaiting trial he was released and the children were removed from the custody of the parents. After another assault of Julie Nick was held without bail until his trial. Julie took this opportunity with the help from DCF and a Domestic Violence program to move to a safe location. Eventually Nick was found guilty on multiple charges and incarcerated for 6 years. Julie got custody of her children back and within 8 months her DCF case was closed. Not long after that her children began to show more and more signs of the trauma they experienced. While in DCF custody one of the children disclosed that her father had sexually abused her and they had all witnessed his violence. Julie knew her children needed help and found a program in her area that specialized in trauma recovery work. She met with the therapist and shared her story with them. After her oldest child's first visit, in which she disclosed some of the abuse she experienced the therapist filed a 51A report with DCF but did not inform Julie that this was going to happen. When the DCF screener called Julie she tried to explain that the information her daughter shared was old information that DCF had on record, that her case had been closed and that she had worked cooperatively with DCF. This did not change the course of the conversation and Julie was informed that an investigation was going to be opened. Julie became very upset and explained that she was just trying to get her children help. Eventually simply asked the screener to make sure that her ex-husband not be contacted because it would give him information about the general location of where she lived. The DCF screener informed her that it was agency policy to contact non-residential fathers.
  • Throughout the Commonwealth, in both government and in communities, we are surrounded by examples of the commitment and creativity in helping survivors leverage their strength to find safety, stability and supportive connections to others. We have come—collectively—to recognize that survivors’ needs are complex and fluid and that their strengths are extraordinary Although there is room for improvement, we have come a long way in recognizing that survivors are in all of our systems, not just the “survivor” services. At the same time, we must recognize that there is much that remains to be done, and it is urgent work. As the three issues identified in this blueprint illustrate, continued inattention to outdated systemic arrangements may lead to further harm for victims and their families and impose an extraordinary, unnecessary cost burden on the state. Here, we have outlined some starting points. These areas alone will not solve the problems, but will be steps forward. The changes we suggest are well within reach, and this time in history—when resources are short and the need is growing—is one uniquely suited to change. We further suggest that the implementation and effectiveness of the reforms suggested above will depend on the exercise of clear leadership from the Executive Office, and accountability by all parties. But to ensure that this process does not repeat the stripping of control and choice and voice many survivors and communities now seek to escape, those implementing the change must also be held to the following principles of practice and change: Participant-driven and community-focused Transparent to participants and communities Accountable to participants and communities The Lieutenant Governor, in his active stewardship of multiple interagency and advisory councils has demonstrated leadership that we hope he, the Executive Office, and all of us can capitalize on to move these recommendations forward.
  • Blueprint for change_presentation 1

    1. 1. Massachusetts Governor’s Council to Address Sexual and Domestic Violence Systems Change and Integration Committee Blueprint For Change in Domestic Violence August 27, 2009
    2. 2. Systems Change and Integration Committee <ul><li>Boston Medical Center </li></ul><ul><li>Department of Children and Families </li></ul><ul><li>Department of Developmental Services </li></ul><ul><li>Department of Public Health </li></ul><ul><li>Department of Transitional Assistance </li></ul><ul><li>Department of Youth Services </li></ul><ul><li>The Full Frame Initiative </li></ul><ul><li>Jane Doe Inc. </li></ul><ul><li>Matahari, Eye of the Day </li></ul><ul><li>Springfield College , School of Social Work </li></ul>
    3. 3. Outline of the Report <ul><li>Introduction </li></ul><ul><li>How We Identified Issues and Problems </li></ul><ul><li>Three Issues to Address </li></ul><ul><li>Recommendations for Change </li></ul><ul><li>Closing Thoughts </li></ul>
    4. 4. Introduction <ul><li>In February 2009, recognizing the lack of integration among government systems, the Lieutenant Governor charged the Systems Change and Integration Committee with identifying and suggesting systems-level opportunities to ensure victims of domestic violence contending with multiple issues are well served by government agencies. </li></ul>
    5. 5. Key Questions <ul><li>Where do systemic fragmentation, misalignment, and/or inaccessibility significantly impede survivors’ progress? </li></ul><ul><li>Where are the opportunities for government action to significantly mitigate or eliminate these impediments? </li></ul>
    6. 6. Criteria for Determining Issues and Recommended Actions <ul><li>High Importance </li></ul><ul><li>High Feasibility </li></ul><ul><li>Timely </li></ul><ul><li>Low Budget Impact </li></ul><ul><li>Targeted </li></ul><ul><li>Highly Actionable </li></ul><ul><li>Non-Duplicative </li></ul>
    7. 7. Three Issues to Deal With <ul><li>A. Conflicting requirements for victims involved with multiple systems often trigger new risks and harms. </li></ul><ul><li>B. Issue-tailored continuums of care for homelessness and domestic violence require survivors to assume a ‘primary issue’ that neglects the interconnections between these issues. </li></ul><ul><li>C. Inconsistent and unclear guidelines for mandated reporting of suspected child abuse/neglect in the context of domestic violence, and child welfare’s response to these reports, create new dangers and harms. </li></ul>
    8. 8. Problem A Conflicting requirements for victims involved with multiple systems often trigger new risks and harms
    9. 9. <ul><li>A Scenario </li></ul>
    10. 10. Conflicting Requirements What This Means for Survivors <ul><li>Systems can work at cross-purposes and decrease safety and/or family stability. </li></ul><ul><li>The challenges and even harms that can result also require further state or state contractor involvement with a family. </li></ul><ul><li>Safety can be compromised by either blanket confidentiality policies, or their reverse (generalized information sharing policies). </li></ul>
    11. 11. Conflicting Requirements Recommendations <ul><li>Ensure that survivors are not penalized for acting on one mandated plan that puts them in violation of another mandated plan. </li></ul><ul><ul><li>Require state agencies and vendors to develop policies and procedures for victims involved with multiple agencies. </li></ul></ul><ul><ul><li>Mandate interagency MOU’s to identify protocols for resolving such conflicts. </li></ul></ul><ul><li>Create an online resource for anonymous submission of examples of conflicting protocols. Analyze periodically for recommendations to systems and the executive office. </li></ul>
    12. 12. Problem B <ul><li>Issue-tailored continuums of care for homelessness and domestic violence require survivors to assume a ‘primary issue’ that neglects the interconnections between these issues. </li></ul>
    13. 13. A Scenario
    14. 14. Have to Choose an Issue What This Means for Survivors <ul><li>They are seen to either have a “resource problem” or a “relationship problem.” </li></ul><ul><li>Domestic violence, if identified, is the top priority, whether or not a survivor agrees. </li></ul><ul><li>Revealing too much can create problems in the system. </li></ul><ul><li>Multiple challenges are not dealt with effectively. </li></ul><ul><li>Violence on the streets is not dealt with by either system well. </li></ul>
    15. 15. Have to Choose an Issue Recommendations <ul><li>Develop joint contracting that recognizes homelessness/DV intersection expertise as a specific competency. </li></ul><ul><li>Conduct a policy review to assess: </li></ul><ul><ul><li>Where intake and eligibility for services/ benefits are different or conflicting based on what “label” is assigned. </li></ul></ul><ul><ul><li>Implement strategies to lessen the disparities. </li></ul></ul>
    16. 16. Problem C <ul><li>Inconsistent and unclear guidelines for mandated reporting of suspected child abuse and neglect in the context of domestic violence, and child welfare’s response to these reports, create new dangers and harms. </li></ul>
    17. 17. <ul><li>A Scenario </li></ul>
    18. 18. Unclear Mandated reporting What This Means for Survivors <ul><li>Under-filing may potentially leave children in volatile, dangerous situations </li></ul><ul><ul><li>However, more filing is not the solution. </li></ul></ul><ul><li>“ Over filing” may lead to unnecessary 51A reports and possible removal of children from parental custody. </li></ul><ul><ul><li>This often stems from an inaccurate generalization that all domestic violence situations are lethal. </li></ul></ul><ul><ul><li>Removals not only traumatize children but also alienate parents from DCF, and burden the state foster care system. </li></ul></ul><ul><li>Community members and agencies see filing as an “intervention” rather than a tool to increase safety. </li></ul>
    19. 19. Unclear Mandated reporting What This Means for Survivors <ul><li>Filing may increase the risk for survivors and children…. </li></ul><ul><li>It can inadvertently give the offender information about the survivors general location. </li></ul><ul><li>Adult victims are often named as a “abusers” when they are experiencing abuse. </li></ul><ul><ul><li>This often results in an antagonistic relationship with DCF which creates a cycles that gets the survivor labeled as “non-compliant” or “uncooperative.” </li></ul></ul><ul><li>51A reports are often filed without notification or collaboration with the adult survivor. </li></ul><ul><ul><li>This creates major challenges for DCF to effectively safety plan with the family and thus increases risk. </li></ul></ul>
    20. 20. Unclear Mandated Reporting Recommendations <ul><li>High level, public endorsement of the principles outlined in the DCF Brochure by the Executive Office and stewardship of its usage in training and policy development. </li></ul><ul><li>Support and provide technical assistance to DCF as it implements new policy and procedures, including differential response options in domestic violence cases. </li></ul><ul><li>Expand on the dissemination and training (particularly to new homeless centers) using the brochure as a foundation. </li></ul>
    21. 21. Conclusion <ul><li>Much has been accomplished in Massachusetts. We have a good track record and the capacity for more. </li></ul><ul><li>Gov systems have an important role to play in increasing safety and enhancing the lives of those affected by domestic violence. </li></ul><ul><li>Implementing this blueprint could be a critical step forward fulfilling that role. </li></ul>
    22. 22. Next steps <ul><li>Convene a meeting across Secretariats to brief and discuss recommendations. </li></ul><ul><li>Charge a multi-system task force with creating an implementation and oversight plan within 30 days. </li></ul><ul><ul><li>This group to include domestic violence experts from GCSDV, DCF, DTA, DHCD, DYS, Jane Doe Inc, etc </li></ul></ul>
    23. 23. <ul><li>Questions and Discussion </li></ul>

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