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End Abuse. Embrace Hope. Integrating Innovative Best Practices Cincinnati, Ohio

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Collaborative Structure

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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

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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>

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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>

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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>

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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>

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Framework: Prevention Spectrum Influencing Policy & Legislation Changing Organizational Practices Fostering Coalitions & Networks Educating Providers Promoting Community Education Strengthening Individuals Knowledge & Skills

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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>

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Children Exposed to Intimate Partner Violence

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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>

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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>

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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>

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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>

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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>

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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>

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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>

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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

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Orbital Prefrontal Cortex Amygdala Ventral Prefrontal Cortex Trauma Impacts Key Structures Underlying Emotional Regulation Dorsolateral Cortex Anterior Cingulate

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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>

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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>

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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>

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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.)

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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>

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Phase I: Outcomes Pre-Test: 54.4% agree; Post-Test: 94.6% agree

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Phase I: Outcomes

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Phase I: Outcomes

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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>

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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>

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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>

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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>

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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>

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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>

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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>

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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>

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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>

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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>

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Questions?

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