Indiana presentation ceipv


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This presentation examines 5 phases of the Family Violence Prevention Project's response to Children Exposed to Intimate Partner Violence.

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  • It was important to us that partners just didn’t feel like people sitting in chairs around a table. We wanted it to be engaging and win-win. Biggest surprise is that people looked forward to meetings—even orgs who don’t get $ contracts from us to implement services. For 9 years, excited has been maintained and that has been the biggest surprise to me. It speaks to mutual benefit—either in form of contracted services, leveraging funds in indiv org’s grant writing, or exposing orgs to new research and guest speakers (i.e. we brought in LIST THAT LADY FROM HARVARD) and we brought in Dr. Tom Boat to do presentaiton
  • Research resulted in need to address all forms of family violence Prohibited continuation in our community to operate in silos and increased collaborative environment
  • Spectrum of Prevention Implementation Model
  • 1,979 children are placed in custody About 500 people are arrested for intimate partner violence
  • Public health model—layering of services—connection between bullying, teen dating violence, community violence. Work in schools.
  • Lessons Learned: Never assume professionals truly understand impact of CEFV Evaluation of train-the-trainer model occurred right at the end of the program Participants may not have had time to reflect on the training and use it in the “real world.” Evaluating trainers’ mastery of curriculum & effectiveness in training others is time consuming. 0 Consulting or contracting with experts in this area is helpful in developing a valid measure of learning. Measuring systems impact is time consuming &requires significant expertise to implement
  • Chronic severe stress impedes brain development during critical periods in children aged 7 and younger. Enormous efforts have been expended to cope with the public health emergency of children’s lead exposure. Living with the terror of battering appears to be twice as toxic to kids.
  • (De Bellis et al, 1999)
  • Davidson et al., 2000, p 592
  • Many battered women stay for economic reasons. It is impossible to support a family on the minimum wage jobs available to many women. (Shipler, 2004) In one family violence shelter survey, over half the women reported that their partner had harmed or killed a pet. 21% reported that they did not seek shelter sooner in order to protect their pets. (Ascione & Arkow, 1999) Estimates of battering generally omit questions about the sexual and physical violence that takes place after separation and so may underestimate the prevalence. Court-ordered visitation exchanges with violent ex husbands can endanger women and subject children to further battering exposure.
  • KEYS TO SUCCESS: Develop solid “core” curriculum Feedback Forums Identify strengths & areas to improve Involve in process of adapting curriculum Re-train trainers Continuous technical assistance & communication with trainers/ needs
  • Two agencies have instituted a policy that all new employees receive training in CWWDV ProKids & JFS
  • Smaller target audience = greater concentration & eval of impact Put in how many trained and how many hours LESSONS LEARNED Allow time to build relationships (buy-in) with home visitation program supervisors Materials must be cultural competent Resources must be culturally accessible Emphasize safety planning for home visitor Develop products & pilot pre/post tests before training implementation
  • KEYS TO SUCCESS Build on success from Phase I Expert recommendations & time from CWWDV committee (8 organizations) Excellent evaluators Strong funder support
  • This approach is based on the research of Betsy McAlster Groves, Director of the Child Witness to Violence Project at Boston Medical Center[i]. While Phase I and II narrowed the gap in training Large gap still remained as many caregivers of CEFV do not access services provided by crisis intervention service providers. Obstacle: Securing school time for services Strategy: Focus conversation on benefits of peace education: decrease violence / increases time to teach / increases educational performance Lessons Learned Referral process: Work with Jobs & Family Services first and have JFS staff ask court system for referrals to program Do not have FVPP service providers first asking court to do referrals Reduce financial barrier to families by offering services free to families
  • As researchers Bancroft and Silverman contend, “the damage that family violence can cause to mother-child relationships may be the most serious cause of distress for children of battered women”[ii]. Treatment goals: Improvement in the quality of the parent-child relationship Decrease in child behavior problems with an increase in pro-social behaviors Increase in parenting skills, including positive discipline which leads to a decrease in parenting stress Trauma Treatment Training Center at Cincinnati Children's Hospital Medical Center The emphasis is on changing negative parent child patterns
  • Group processing beneficial for this cohort because teens learn best from peer behavior defining norms.
  • As Betsy McAlister Groves states, “such children feel trapped in the middle of intense and prolonged interparental conflict and experience confusing feelings of loyalty and respond with h eightened levels of stress, fear, and anger” Address lack of structure & stability for the children which creates an environment of anxiety and insecurity about what will happen to them and to their family members. sibility….groups can help these children to understand family members' roles in the separation and to develop their own perspectives on the conflict.” KEYS TO SUCCESS Offer diverse services in program model Not cookie cutter approach: referrals based on child’s specific needs Use well-known, well-respected community service providers Children’s Hospital Beech Acres Parenting Center
  • Discuss data from courts and anecdotal cases This intervention is mastery-based so we move the parent on when she has met mastery or is close to it ( eg., in 5 minutes of CDI with child , the parent can give 10 labeled praises, 10 reflections and 10 behavioral descriptions and no more than 3 questions, commands or negative talk).  PCIT is neat because the outcome data is part of the program. 
  • Outcomes all above 90%
  • Indiana presentation ceipv

    1. 1. End Abuse. Embrace Hope. Integrating Innovative Best Practices Cincinnati, Ohio
    2. 2. Collaborative Structure
    3. 3. Terminology <ul><li>Collaboration: </li></ul><ul><ul><li>Relationships that provide opportunities for mutual benefit and results beyond what any single organization or sector could realize alone. </li></ul></ul>* Drucker Foundation, Meeting the Collaboration Challenge
    4. 4. History <ul><li>HealthPath Foundation of Ohio released white paper identifying 2 greatest health concerns to Ohioans: </li></ul><ul><ul><li>Family violence </li></ul></ul><ul><ul><li>Oral health </li></ul></ul><ul><li>HealthPath Foundation of Ohio awarded grants to 5 Ohio communities to develop & implement collaborative and comprehensive approaches to prevent family violence </li></ul><ul><li>2001: Family Violence Prevention Project was awarded a 2-year planning grant ($150,000) and a 3-year implementation grant (250,000) </li></ul><ul><ul><li>Since then leveraged over $2.5 million </li></ul></ul>
    5. 5. History <ul><li>Lead Agency: YWCA of Greater Cincinnati </li></ul><ul><li>Lead Partner: United Way of Greater Cincinnati </li></ul><ul><li>Founding membership 28 agencies </li></ul><ul><li>Current membership 45 partners & champions </li></ul>
    6. 6. Mission Statement <ul><li>To prevent and eliminate all forms of family violence in our diverse and caring communities </li></ul><ul><li>Family violence includes: </li></ul><ul><ul><li>Child abuse </li></ul></ul><ul><ul><li>Children Exposed to Intimate Partner Violence </li></ul></ul><ul><ul><li>Bullying </li></ul></ul><ul><ul><li>Teen Dating Violence </li></ul></ul><ul><ul><li>Intimate partner violence </li></ul></ul><ul><ul><li>Abuse against persons with disabilities & Deaf people </li></ul></ul><ul><ul><li>Elder abuse/neglect </li></ul></ul>
    7. 7. Collaborative Partners <ul><li>FVPP collaborating partners represent multiple interests & perspectives: </li></ul><ul><ul><li>Advocates </li></ul></ul><ul><ul><li>Direct service providers </li></ul></ul><ul><ul><li>Funders </li></ul></ul><ul><ul><li>Academics </li></ul></ul><ul><ul><li>Business </li></ul></ul><ul><ul><li>Criminal justice </li></ul></ul><ul><ul><li>Faith community </li></ul></ul><ul><ul><li>Medical communities </li></ul></ul>
    8. 8. Framework: Prevention Spectrum Influencing Policy & Legislation Changing Organizational Practices Fostering Coalitions & Networks Educating Providers Promoting Community Education Strengthening Individuals Knowledge & Skills
    9. 9. Assessing Local Needs: Each Year in Cincinnati <ul><li>4,800 children are abused or neglected </li></ul><ul><li>7,846 reports of abuse or neglect are filed with children’s services </li></ul><ul><ul><li>1,979 children are placed in custody </li></ul></ul><ul><ul><li>Majority of cases involve domestic violence/IPV </li></ul></ul><ul><li>7,400 adults are physically abused by an intimate partner </li></ul><ul><li>1,697 people file petitions for civil protection orders </li></ul><ul><li>2,300 seniors are abused or neglected </li></ul><ul><li>300 reports of abuse or neglect are filed with adult protective services </li></ul>
    10. 10. Children Exposed to Intimate Partner Violence
    11. 11. Children Exposed to Intimate Partner Violence (CEIPV): Local Research <ul><li>Community Needs Assessment (2001 )revealed: </li></ul><ul><ul><li>Regional professionals were unaware of: </li></ul></ul><ul><ul><ul><li>Impact of exposure to intimate partner violence on children </li></ul></ul></ul><ul><ul><ul><li>The scope of the problem </li></ul></ul></ul><ul><ul><li>There were not enough qualified trainers to fill the demand for training on CWWDV. </li></ul></ul>
    12. 12. CEIPV: Local Response <ul><li>Creation of 5 phases of programming </li></ul><ul><ul><li>Phase I: Train the Trainer Program </li></ul></ul><ul><ul><li>Phase II: Home Visitation Focus </li></ul></ul><ul><ul><li>Phase III: Intervention Services Community Coordinated Response Model </li></ul></ul><ul><ul><li>Phase IV: School-Based Mental Health Providers & Nurses Collaborative </li></ul></ul><ul><ul><li>Phase V: Community Coordinated Response with Child Protective Services </li></ul></ul>
    13. 13. CEIPV: Collaborative Partners <ul><li>Beech Acres Parenting Center </li></ul><ul><li>Cincinnati Children’s Hospital </li></ul><ul><li>Mayerson Center for Safe and Healthy Children </li></ul><ul><li>Childhood Trust </li></ul><ul><li>Hamilton County Juvenile Court </li></ul><ul><li>ProKids </li></ul><ul><li>YWCA of Greater Cincinnati </li></ul><ul><li>Hamilton County Jobs & Family Services: Child Protective Services </li></ul><ul><li>Hamilton County Prosecutor’s Office </li></ul><ul><li>Hamilton County Public Defender’s Office </li></ul>
    14. 14. Phase I: Awareness & Education <ul><li>Train-the-Trainer program </li></ul><ul><li>Trained 35 professionals who trained 2,000+ professionals </li></ul><ul><li>Multi-part curriculum: </li></ul><ul><ul><li>Designed by national CEIPV and child maltreatment experts: </li></ul></ul><ul><ul><ul><li>Erna Olafson, PhD, PsyD </li></ul></ul></ul><ul><ul><ul><li>Barbara Boat, PhD </li></ul></ul></ul><ul><ul><ul><li>Frank Putnam, M.D. </li></ul></ul></ul><ul><ul><li>Focus: medical, psychological, social, and behavioral impacts of CEIPV . </li></ul></ul>
    15. 15. Phase I: Structure <ul><li>Trainer criteria : </li></ul><ul><ul><li>Conducted educational presentations & trainings as part of their job </li></ul></ul><ul><ul><li>Sound understanding of family violence </li></ul></ul><ul><ul><li>Organization committed to conducting 2 of 5 trainings pro bono </li></ul></ul><ul><li>35 Trainers </li></ul><ul><ul><li>Represent 16 different mental health, school-based, social service agencies </li></ul></ul><ul><li>Learning objectives: </li></ul><ul><ul><li>Understand impact of CEIPV </li></ul></ul><ul><ul><li>Recognize signs of exposure </li></ul></ul><ul><ul><li>Decrease risk factors children engaging in future acts of violence </li></ul></ul><ul><ul><li>Create supportive environment for CEIPV </li></ul></ul>
    16. 17. Animal Abuse & Intimate Partner Violence <ul><li>Victims of family violence are 5X more likely to have their pets harmed by batterers than non-victims. </li></ul><ul><li>Children with substantiated physical abuse, along with other inhabitants of the home, are 10X more likely to be bitten by the family dog. </li></ul><ul><li>Dog bites to children are the 3 rd leading cause of emergency room visits. </li></ul>
    17. 18. Exposure to Battering & IQ <ul><li>Children age 5 who were exposed to high levels of family violence had IQs that were, on average, 8 points lower than unexposed children. </li></ul><ul><li>Chronic lead exposure decreases children’s IQs on average 3 or 4 points. </li></ul><ul><ul><ul><li>(Koenen, et al, 2003; Putnam, 2003) </li></ul></ul></ul>
    18. 19. Abnormal Inter-Hemispheric Connections in Maltreated Children • Corpus Callosum - mid sagital region and areas 4, 5, 6, & 7 were smaller in maltreated children with PTSD • Decrease correlates with: Intrusive thoughts, avoidance, hyperarousal & dissociation • Effects boys > girls
    19. 20. Orbital Prefrontal Cortex Amygdala Ventral Prefrontal Cortex Trauma Impacts Key Structures Underlying Emotional Regulation Dorsolateral Cortex Anterior Cingulate
    20. 21. Why Do Some Battered Women Stay? <ul><li>Violence, stalking, & emotional abuse increases after women leave </li></ul><ul><ul><li>Greatest risk of being murdered when they leave </li></ul></ul><ul><li>Batterers often harangue, beat, or rape ex-partners during child visitation exchange </li></ul><ul><li>Homelessness </li></ul><ul><li>Women stay in order to keep the children alive </li></ul><ul><li>Many women stay in order to keep the pets alive </li></ul><ul><li>Batterer has threatened to sue for custody if they leave </li></ul><ul><ul><li>Batterers more likely to sue for custody than non batterers. When batterers do sue, family courts award batterers custody at same rates they award custody to non batterers. </li></ul></ul>
    21. 22. Traumatized Children: Social & Emotional Impact <ul><li>Affect dysregulation (depression, mood swings, panic attacks, affect liability) </li></ul><ul><li>Attentional problems (ADHD, impulsivity, hypervigilence) </li></ul><ul><li>Disturbances in sense of self and identity (suicidality, self-mutilation, low self-esteem, risk taking, alter personalities, depersonalization) </li></ul><ul><li>Impaired stress response : sensitivity to traumatic reminders, alterations in neuroendocrine stress response </li></ul><ul><li>Use and abuse of substances to regulate mood, sense of self, and behavior </li></ul><ul><li>Interpersonal and relationship problems (attachment disorders, social withdrawal, promiscuity, antisocial behavior, spouse abuse, parenting problems) </li></ul>
    22. 23. Phase I: Outcomes <ul><li>Data analyzed independently by a team of psychologists and staff members using SPSS 12.0 (Norusis, 2004) </li></ul><ul><li>Trainer effectiveness evaluated utilizing a workshop evaluation </li></ul><ul><li>Participant knowledge, attitudes, skills were assessed utilizing a pre-post test evaluation </li></ul>
    23. 24. Training Evaluation <ul><li>Kirkpatrick’s Model (Kirkpatrick, 1994) </li></ul><ul><ul><li>The majority of training evaluations adhere to Kirkpatrick’s model </li></ul></ul><ul><ul><li>Optimal evaluation of a training program occurs at 4 levels: (1) Reaction, (2) Learning, (3) Transfer of Learning, (4) Systems Impact </li></ul></ul>(Kirkpatrick, D.L. (1994). Evaluating Training Programs: The Four Levels. San Francisco, CA: Berrett-Koehler.)
    24. 25. Phase I: Outcomes 2005 Training Sessions <ul><li>29.3% of participants said they knew a lot about the topic or had a high level of understanding before the training </li></ul><ul><li>92.8% of participants said they knew a lot about the topic or had a high level of understanding before the training </li></ul>
    25. 26. Phase I: Outcomes Pre-Test: 54.4% agree; Post-Test: 94.6% agree
    26. 27. Phase I: Outcomes
    27. 28. Phase I: Outcomes
    28. 29. Phase II: Home Visitation <ul><li>Smaller group of trainers </li></ul><ul><li>2 Prong training </li></ul><ul><ul><li>Training #1: CEIPV 101 </li></ul></ul><ul><ul><li>Training #2: Role plays and resources </li></ul></ul><ul><li>Created simple, customized tools for home visitors to review with young mothers </li></ul><ul><ul><li>Healthy Relationship Discussion Flow-Chart </li></ul></ul><ul><ul><li>“ Red Flags/Green Flags” </li></ul></ul><ul><ul><li>United Way 211 Magnets </li></ul></ul><ul><ul><li>Recipes for a Happy Healthy Home Magnets </li></ul></ul>
    29. 30. Phase II: Outcomes <ul><li>Trained 130+ Home Visitors = 6,500+ clients annually </li></ul><ul><ul><li>Every Child Succeeds </li></ul></ul><ul><ul><li>Healthy Moms & Babes </li></ul></ul><ul><ul><li>Home Instruction for Parents of Preschool Youngsters </li></ul></ul><ul><ul><li>Health Department </li></ul></ul><ul><ul><li>Hamilton County Jobs and Family Services </li></ul></ul><ul><li>90%+ identified signs and symptoms of children exposed to intimate partner violence </li></ul><ul><li>90%+ identified appropriate resource and referrals for moms and children </li></ul><ul><li>100% of home visitation programs created systems based change mandating training on impact of children exposed to intimate partner violence </li></ul>
    30. 31. Phase III: CCR Structure <ul><li>Coordinated response models between 3 family violence organizations and child abuse agencies </li></ul><ul><ul><li>Parent-Child Interaction Therapy ( Cincinnati Children’s Medical Center ) </li></ul></ul><ul><ul><li>Amend Adolescent ( YWCA of Greater Cincinnati ) </li></ul></ul><ul><ul><li>Families in Transition Program ( Beech Acres Parenting Center ) </li></ul></ul><ul><li>Referrals made from legal system, child protective services, school system, hospitals, social service and community organizations. </li></ul>
    31. 32. Parent-Child Interaction Therapy: Cincinnati Children’s Hospital <ul><li>Evidence-based treatment model for traumatized children with complex needs </li></ul><ul><li>Highly specified, step-by-step, live-coached sessions with both parent and child. </li></ul><ul><li>Children lack coping mechanisms & bond with victimized mother is severely damaged. </li></ul><ul><li>Mothers learn skills through didactic sessions & using transmitter/receiver system in which the parent is coached in specific play with the child. </li></ul>
    32. 33. Parent-Child Interaction Therapy <ul><li>20 sessions on relationship-enhancing skills & positive discipline/ compliance skills </li></ul><ul><li>Parent is taught & coached in Praise, Reflection, Imitation, Description, and Enthusiasm (PRIDE) </li></ul><ul><li>Skills gradually expanded from structured implementation in treatment to structured sessions in home to more unstructured situations and finally to use in public situations </li></ul><ul><li>Skills observed & coached via one-way mirror </li></ul><ul><li>Behaviors coded & charted on graph & mothers provided with immediate feedback about progress and skill mastery. </li></ul><ul><li>Families participate in 1, 3, 6, and 12 month booster sessions </li></ul>
    33. 34. Amend Adolescent: YWCA of Greater Cincinnati <ul><li>10 week psycho/social educational group sessions </li></ul><ul><li>Utilized best practice curriculum: Aggression Replacement Training </li></ul><ul><li>11-17 year old high-risk adolescents </li></ul><ul><li>Session focus: </li></ul><ul><ul><li>CEIPV impact </li></ul></ul><ul><ul><li>Teen dating violence (interconnection) </li></ul></ul><ul><ul><li>Sexism </li></ul></ul><ul><ul><li>Abuse of power </li></ul></ul><ul><ul><li>Non-violent conflict resolution </li></ul></ul><ul><ul><li>Peer pressure </li></ul></ul><ul><ul><li>Positive coping skills </li></ul></ul><ul><li>Parents/guardians required to attend adult concurrent group sessions </li></ul>
    34. 35. Families in Transition: Beech Acres Parenting Center <ul><li>Children Group sessions: 5-17 years old </li></ul><ul><li>Role-play, art, writing activities, & group discussion </li></ul><ul><ul><li>Isolation reduction </li></ul></ul><ul><ul><li>Self-esteem enhancement </li></ul></ul><ul><ul><li>Coping skills </li></ul></ul><ul><ul><li>Feeling identification </li></ul></ul><ul><li>Adult Survivor Group Sessions: Role-play, video & discussion </li></ul><ul><ul><li>Impact on CEIPV </li></ul></ul><ul><ul><li>Communication skills </li></ul></ul><ul><ul><li>Support, counseling, and safety planning </li></ul></ul>
    35. 36. Phase III: Program Model Outcomes PCIT <ul><li>Parent masters skills of child-directed & parent-directed intervention </li></ul><ul><li>Parent rating of child on the Eyberg Child Behavior Inventory falls to normal levels </li></ul><ul><li>Scores on Parenting Stress Inventory change in a positive direction </li></ul><ul><li>100% </li></ul><ul><li>100% </li></ul><ul><li>100% </li></ul>Amend Adolescent <ul><li>Increase knowledge of power & control dynamics </li></ul><ul><li>Increase self-esteem & feelings of self-worth </li></ul><ul><li>Increased social competency and empathy </li></ul><ul><li>90% </li></ul><ul><li>85% </li></ul><ul><li>80% </li></ul>Families in Transition <ul><li>Increase awareness of community resources & impact of CEFV </li></ul><ul><li>Identify key indicators of healthy and unhealthy relationships </li></ul><ul><li>Learn to cope effectively w/stress associated w/family violence </li></ul><ul><li>Women in family violence situations report being able to set, manage and implement a safety plan for her and her children. </li></ul><ul><li>90% </li></ul><ul><li>90% </li></ul><ul><li>80% </li></ul><ul><li>70% </li></ul>
    36. 37. Phase IV: School-Based Mental Health Structure <ul><li>Strategic collaboration among school based mental health providers, nurses, and school leaders </li></ul><ul><li>FVPP trained school teams on impact of CEIPV </li></ul><ul><li>FVPP provides follow-up TA to discuss school cases and responses </li></ul><ul><li>FVPP funds wrap-around services to schools (i.e. Amend Adolescent ) </li></ul>
    37. 38. Phase V: Child Protective Services Training Structure <ul><li>Partnership between Hamilton County Jobs Family Services Child Protective Services and family violence workers </li></ul><ul><li>Revamped 10 year HCJFS policy and protocol manual for family violence & CEIPV </li></ul><ul><li>Launched training of all levels of staff </li></ul><ul><ul><li>2010 trained nearly 180 staff on family violence dynamics, impact on children, and trauma-informed response/referral system </li></ul></ul><ul><ul><li>2011 Slated to train 70-100 new hires </li></ul></ul>
    38. 39. Questions?
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