Safe Start Initiative: Demonstration Project, Phase I Case Studies II (2000 - 2005), Report #2006-2

The author(s) shown below used Federal funds provided by the U.S. Department of Justice and prepared the following final report:

Document Title: Safe Start Initiative: Demonstration Project, Phase I Case Studies II (2000 - 2005), Report #2006-2

Author(s): Association for the Study and Development of Community

Document No.: 248609

Date Received: January 2015

Award Number: 2004-JW-MU-K001

This report has not been published by the U.S. Department of Justice. To provide better customer service, NCJRS has made this Federally- funded grant report available electronically.

Opinions or points of view expressed are those of the author(s) and do not necessarily reflect

the official position or policies of the U.S. Department of Justice.

Safe Start Initiative: Demonstration Project

Safe Start Initiative Phase I

Case Studies II (2000 - 2005)

Report #2006-2

July 2006

Association for the Study and Development of Community 438 N. Fr4ederick Avenue, Suite 315 This project was supported by Grant # 2004Gaithersburg,-JW-MU-K001 awarded MD 20877 by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs,(301)519-0722 U.S. Department • of(301)519-0724 Justice. Points of fax view or opinions in this document are those of the author and do not necessarilywww.capablecommunity.com represent the official position or policies of the U.S. Department of Justice.

Association for the Study and Development of Community 1 September 2005 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. Preface

The Safe Start Demonstration Project Five Year Report (2000 – 2005) was developed by the Association for the Study and Development of Community (ASDC) for the Office of Juvenile Justice and Delinquency Prevention (OJJDP) for the National Evaluation of the Safe Start Demonstration Project. The report covers the first five years (2000 – 2005) of the Safe Start Demonstration Project. Volume 2 includes each site’s case study.

We would like to recognize Katherine Darke Schmitt (Missing and Exploited Children and Child Abuse and Neglect Programs Coordinator and Safe Start Evaluation Manager) for her leadership and support. We would also like to thank Kristen Kracke, Safe Start Program Manager, for her assistance. ASDC staff contributing to this volume include: David Chavis (Project Director); Yvette Lamb (Co-Project Director); Mary Hyde (Senior Managing Associate); Kien Lee (Senior Managing Associate); Joie Acosta (Managing Associate); Deanna Breslin (Associate); Susanna Haywood (Associate); Tina Trent (Senior Managing Associate); Dewitt Webster (Managing Associate). Sylvia Mahon (Office Coordinator) assisted in the production.

ASDC would like to thank the Local Evaluators and Project Directors of the 11 Safe Start Demonstration sites for their assistance with their respective case studies. These case studies would not be possible without the collaboration of many people from among the Safe Start Demonstration Project sites, including each site’s partners who were willing to meet with ASDC during site visits.

Association for the Study and Development of Community i July 2006

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. Table of Contents

Introduction ...... iii

Chapter I Baltimore Safe Start Initiative ...... 1

Chapter II Bridgeport Safe Start Initiative ...... 8

Chapter III Chatham County Safe Start Initiative ...... 29

Chapter IV Chicago Safe Start Initiative ...... 55

Chapter V Pinellas Safe Start Initiative ...... 84

Chapter VI Pueblo of Zuni Safe Start Initiative...... 127

Chapter VII Rochester Safe Start Initiative ...... 132

Chapter VIII San Francisco SafeStart ...... 170

Chapter IX Sitka Safe Start Initiative...... 199

Chapter X Spokane Safe Start Initiative ...... 218

Chapter XI Washington County Safe Start Initiative ...... 251

Association for the Study and Development of Community ii July 2006

Introduction incidence and prevalence of child maltreatment or community violence Eleven communities were competitively might affect public awareness of related selected as Safe Start Demonstration issues. Related to these contextual Project sites: Baltimore, Bridgeport, conditions are community capacities (the Chatham, Chicago, Pinellas, Pueblo of number and quality of initiatives focused Zuni, Rochester (New York), San on improving the well-being of young Francisco, Sitka, Spokane, and children, for example), also expected to Washington County (Maine). The Safe impact project planning and Start Demonstration Project is funded by implementation. According to the theory the Office of Juvenile Justice and of change, community capacity would Delinquency Prevention (OJJDP). The most directly affect assessment and goal of the project was to expand planning, as well as community existing partnerships among service engagement and collaboration. providers in key areas such as early Communities with relatively large childhood education/development, numbers of qualified professionals, for health, mental health, child welfare, instance, might be in a better position to family support, substance abuse reach out to the existing service provider prevention/intervention, domestic networks and engage them in assessment violence/crisis intervention, law and planning processes. In addition, the enforcement, courts, and legal services. capacity to conduct an assessment of Each demonstration site was expected to community needs and resources was create a comprehensive service delivery expected to be greatly influenced by the system to meet the needs of children and availability of local assistance, the their families at any point of entry in the ability to access national assistance, and system of care. Furthermore, this the availability of accurate community comprehensive system was expected to data. Partnerships were to be formed to improve the accessibility, delivery, and plan and initially implement a number of quality of services for young children system change activities. These activities who have been exposed to violence or were expected to change practice across are at high risk of exposure. organizations, within organizations, and at the point of direct services. The A theory of change was developed for system changes achieved were expected the Safe Start Demonstration Project to be continued, or institutionalized, in (See Figure 1). In essence, it was the form of service coordination and expected that collaborative planning and integration and improved service implementation of system change delivery. In turn, the result of continued activities would strengthen communities system changes would be increased in ways that would prevent young community supports for young children children from being exposed to violence exposed to violence such that fewer and reduce the impact of exposure for children would be exposed to violence those who were. More specifically, and the impact of exposure would be contextual conditions (political, reduced. economic, and social) were expected to influence project planning and implementation. For example, the

Association for the Study and Development of Community iii July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Figure 1 SAFE START OVERALL LOGIC MODEL

COMMUNITY CAPACITY

System Change Institutionalization of Activities Change

Integrated Assistance Development of System and Agency Local policies, Increased Community Change (e.g., service National procedures, supports for and uses of coordination and protocols integration; supportive services to address POS/Staff violence exposure and policies; improve Service decreased tolerance of service delivery within integration violence systems) Local Agency & activities (e.g.,

Community cross-disciplinary Point of Service Engagement & training, multi- Change (e.g., Collaboration system MIS) Within improved identification, Reduced assessment, referral, Exposure to Resource follow-up by staff within Violence development, each agency/system) Assessment & identification & Planning reallocation

Community Change

(e.g., increased Reduced Impact New/expanded/ community awareness enhanced of Exposure to of impact of exposure Violence programming and community resources; changed Organization - Community community norms re: X action/awareness violence) activities

Association for the Study and Development of CommunityCONTEXTUAL CONDITIONS iv July 2006 DRAFT This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

These site case studies describe how each Safe Start grantee changed its community to reduce the impact of exposure to violence on young children. Each site’s case study represents a chapter in this volume of the Safe Start Demonstration Project Five Year Report (2000-2005). The analysis is based on the National Evaluation Team’s site visit reports (2004 and 2005), the site’s local evaluation report form (2005), and information obtained from site documents (e.g., progress reports, implementation plans, strategic plans, and other materials). Each report is organized according to the project’s theory of change and covers the first five years of the Safe Start Demonstration Project. Core questions used to guide the analysis include:

• How did community conditions affect the implementation and impact of Safe Start? • How did Safe Start change the community to meet the needs of children exposed to violence? • How was Safe Start institutionalized in the community? • How did Safe Start increase community support for children exposed to violence? • How did Safe Start reduce the number of children exposed to violence? • How did Safe Start reduce the impact of exposure to violence on children?

Association for the Study and Development of Community v July 2006 DRAFT This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

I Baltimore Safe Start Initiative

1. Overview Over the course of the initiative, two major strategies emerged as the means The Baltimore City Safe Start Initiative by which the BCSSI would attempt to (BCSSI) began in 2000 with high hopes achieve these goals. The first strategy of building on the momentum of existing involved the training of community- efforts to address child and family issues based, child-serving professionals in (1) in Baltimore City (e.g., Safe and Sound, key concepts related to the impact of Success by 6, Starting Points, Child exposure to violence on young children Development-Community Policing and (2) clinically proven assessment and program). The vision was to redirect and treatment modalities for exposed refocus some of this momentum to the children. This strategy was developed in issue of children exposed to violence; response to a needs assessment that violence in Baltimore City had been indicated a lack of clinical expertise for identified as a critical public health and identifying and treating young children community issue by policymakers, exposed to violence in Baltimore City service providers, and citizens. To neighborhoods. BCSSI staff envisioned realize its vision, BCSSI began a process the creation of a unified system of to develop a unified screening and identification and referral to treatment assessment procedure for young children through training community providers exposed to violence, to integrate BCSSI and other professionals in a protocol that with the Family League of Baltimore would position BCCSI as the gateway to City’s Family Support Strategy, and to mental health and other services for expand access to mental health services children exposed to violence and their in local communities for children six families. To develop a unified system for years and younger. The formal goals for identification and referral of children the demonstration project were to exposed to violence, the BCSSI sought achieve: to utilize the characteristics of existing provider agencies and to work with these • Broad community awareness of the agencies to create buy-in for the BCSSI impact of exposure to violence on referral protocol. Increasing the numbers young children, of referrals, however, was a significant • Early and consistent identification of challenge throughout the implementation young children exposed to violence, of BCSSI. and • Access to specialized services (e.g., A second strategy for achieving the services from a Safe Start trained goals of BCSSI involved issuing provider) and other appropriate requests-for-proposal for funded projects community-based services for exposed to create incentives for systems change children. within key provider agencies. For example, the Violence Intervention

Association for the Study and Development of Community 1 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Project was funded in response to a years and younger, their families, and request-for-proposal from BCSSI to communities. To what extent did the identify ways to create a domestic Baltimore City Safe Start Initiative violence unit within Child Protective accomplish these goals? What factors Services (Baltimore City Department of contributed to and impeded success? Social Services). These questions are addressed in the following sections, and a timeline of By 2005, more than 100 mental health major events is attached (see Exhibit I- professionals and other community- A). based service providers had been trained by the BCSSI. Two very successful 1.2 Baltimore City, Maryland responses to the request-for-proposal process had been implemented. Yet, The Baltimore City Safe Start Initiative despite the efforts of BCSSI staff, the was planned and implemented within the number of children and families unique context of Baltimore City, involved in Safe Start remained quite Maryland. The following snapshot of small. BCSSI staff, community Baltimore City is intended to help others members, and providers point to several interested in replicating Safe Start to factors that hindered the initiative, compare their own communities to including the need for a local champion Baltimore City. and an inability to create needed buy-in with community members and key Baltimore City lies on the Patapsco agency providers. A decline in political River in the state of Maryland. The use will combined with changes in the of the name “Baltimore City” economy at the federal, state, and local distinguishes this governmental entity levels also served as barriers to the from the County of Baltimore in which it implementation of the Baltimore City resides. The city of Baltimore is the Safe Start Initiative as it was initially largest city in the state of Maryland, envisioned. covering 80 square miles and including 55 neighborhoods (Baltimore City Safe These are among the multiple findings Start Initiative, 2005, p 6). The 2003 from an analysis of the Baltimore City population of Baltimore City was Safe Start Initiative between 2000 and estimated at 629,000; the population has 2005.Using the National Safe Start been declining since 1990. African Demonstration Project logic model as a Americans comprise the majority framework, this report reviews data population (64.3%); European collected over five years as the basis of a Americans, 31.6%; Latinos, 1.7%; and case study of the BCSSI. Asians and Asian Americans, 1.5%. Children five years and younger 1.1 Mission represent 6.4% of the total population of Baltimore City. The median household The Baltimore City Safe Start Initiative income in the city in 2000 was $30,078. focused on continuing the development of a comprehensive system of services to From 2000 to 2005, the BCSSI sought to prevent and reduce the impact of family implement a demonstration project to and community violence on children six address issues of children exposed to violence. Initially focused in seven

Association for the Study and Development of Community 2 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

communities, BCSSI had expanded implementation of the BCSSI: political citywide by the end of the five-year change and economic decline. demonstration project, in response to the increasing need throughout Baltimore 2.1 Political Context City neighborhoods to address family and community violence brought on by The political context for BCSSI changed severe social and economic distress. significantly as program planning and implementation began. Prior to the The seven communities originally funding of the Safe Start grant, key identified for implementation of BCSSI political stakeholders (e.g., the Mayor’s represented 15 neighborhoods in Office, the State’s Attorney) sought to Baltimore City where risks of exposure expand the efforts already underway in to violence were highest for children and Baltimore City neighborhoods to address families, and where rankings were issues of children and families. There negative on indicators associated with was great political will to address issues child well-being (e.g., poverty, of violence at the family and community unemployment, infant deaths, access to level, as demonstrated by applications prenatal care, teen birth rate, child for federal funding dedicated to this mortality). The communities were purpose. Shortly after the BCSSI was predominately African American. funded, however, political leadership Approximately 50% of the city’s adult changed; by 2003-2004, as population, 60% of the city’s children, implementation of Safe Start began, and 33% of the city’s children six years these changes in local government had of age and younger resided in these created a less favorable climate for neighborhoods. These communities were implementing the project. Safe Start was also the focus of several other capacity no longer a key part of the agenda at the building, child, and family initiatives Mayor’s Office, as much of the focus for that will be described in later sections of violence prevention had shifted to this report. programs addressing youth (i.e., adolescent) violence and crime prevention, leaving few, if any, political 2. Contextual Conditions champions in Baltimore City for young children (i.e., six years and younger) Each of the 11 Safe Start initiatives was exposed to family and community implemented within a political, violence. In short, changes in leadership economic, and social context that left the BCSSI without a political ally to affected both the initiative and the ensure that resources, agencies, and broader community’s response to other key stakeholders would remain children exposed to violence. The committed to the project. In addition, context in which Baltimore City during the first two years of the planning implemented its demonstration project and implementation of the BCSSI, a critically impacted the ability of the state level restructuring of social project to reach its identified goals. services was undertaken when a new governor assumed office, resulting in a Two contextual factors significantly reduction of staff and operating budgets impacted the development and for state and local social service agencies. These local and state agencies

Association for the Study and Development of Community 3 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

were primary partners in the BCSSI economic decline. While economic collaborative and principal service decline necessitated that BCSSI expand delivery resources. citywide, little evidence exists that expanding the project either improved or At the local level, leadership changes in impaired the capacity of BCSSI to other key partnering agencies also achieve its project goals. occurred. For example, the police commissioner in Baltimore City was replaced several times over the course of 3. Community Capacity BCSSI implementation. This turnover affected the capacity of BCSSI to engage The Baltimore City Safe Start Initiative front line law enforcement officers in was part of a strategy developed by local following through on identification and government to increase community referral of children exposed to violence capacity for addressing child and family during domestic violence incidents or issues among at-risk populations, by other crisis interventions for which law building on existing community enforcement served as first responder. programs. Specifically, BCSSI was to complement the work of Success By 6 2.2 Economic and Social (SB6) (Baltimore City Safe Start Context Initiative, 2005, p 10).

High rates of poverty and crime exist in 3.1 Existing Community several Baltimore neighborhoods, Resources particularly those that were initially selected for BCSSI services. Social For several years prior to the funding of indicators assessed at the beginning of BCSSI, local government had secured BCSSI showed high levels of poverty, funding and developed programs to substance abuse, unemployment, and foster better outcomes for children and dependence on public assistance. Violent families most at risk for negative crime statistics in Baltimore City were outcomes frequently associated with significantly higher than national living in poverty. These programs averages for cities of similar size, and included (Baltimore City Safe Start family violence statistics indicated that Initiative, 2005, p 10): child physical abuse cases in Baltimore City were more frequent than in all other • After School Strategy, counties in the state of Maryland. Actual • Baltimore Success by 6, implementation of BCSSI began in four • Hot Spots, of the seven communities initially • Safe Schools/Healthy Students, selected; those were neighborhoods that • Youth Violence Council, felt the greatest economic impact of state • Starting Points, and and local budget cuts for social services. • Child Development–Community By year four and continuing through Policing. year five, however, BCSSI expanded the service delivery aspects of its program to A strong track record of success among include all neighborhoods citywide, to these programs suggested that the meet the increasing needs of Baltimore City Safe Start Initiative neighborhoods affected by social and

Association for the Study and Development of Community 4 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

would also do well in addressing another additional significant gaps in service identified issue: family and community level capacities, limiting the ability of violence. Local leaders sought to these neighborhoods to address the issue replicate the success of current programs of children exposed to violence. These by linking a new program (BCSSI) with gaps included: an existing program (Success By 6). • Lack of a payment system for support There were additional reasons to connect of mental health and other services, Baltimore City Safe Start and Success • Gaps in available mental health By 6. First, both projects had the same services and crisis intervention fiscal agent, Family League of Baltimore services, City (a further description of the work of • Critical shortages of mental health the Family League of Baltimore City can providers, be found in the “Community • No evidence of collaboration between Collaboration” section of this report). agencies and across systems to address children exposed to violence, In addition, integration of SB6 and • Lack of knowledge regarding children BCSSI was considered “congruent and exposed to violence at the agency complementary” for meeting the needs level, and of children and families. Success By 6 • Lack of knowledge of the availability would focus on community-based of services on the part of community governance and service delivery; BCSSI providers and community residents. 1 would focus on training mental health and other service providers on issues of 3.2 Training and Technical exposure to violence and related Assistance intervention services. An initial assessment had characterized One strategy used to increase the ability community capacity for the delivery of of BCSSI partners to address existing mental health and social services in the gaps in community capacity was to neighborhoods to be targeted by Success secure technical assistance and training By 6 and BCSSI as uncoordinated and from Safe Start national resources. duplicative. Linking the work of these Training and technical assistance were two programs was seen as a means of provided under the Safe Start leveraging resources for non-duplicative Demonstration Project to grantee sites to services in communities in need of address identified programmatic needs. capacity and infrastructure for mental Over the course of the five-year health and other support services for implementation of BCSSI, technical children exposed to violence. In the end, assistance providers supplied training the goal was to strengthen the and technical assistance in key areas of infrastructure created by Success By 6 need for BCSSI participants, particularly with specialization in concepts related to children exposed to violence. 1 The local evaluator’s scope of work did not include monitoring or measuring the extent to which BCSSI The neighborhood assessment addressed issues identified in the neighborhood (Anderson & Ringgold, 2000) assessment. Activities described here were undertaken to address some of these issues. The undertaken by BCSSI identified impact of these activities cannot be ascertained because of the limited scope of the local evaluation.

Association for the Study and Development of Community 5 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

agency and clinical service providers. address. First, community residents and Training and technical assistance, providers indicated that services for provided by local consultants, content children were fragmented and experts, and national contractors, uncoordinated, making it difficult for focused on: 1) clinical training, families to know where to turn to for assessment, and treatment; 2) a help. Second, communities needed to be management information system; 3) involved in and empowered to find their evaluation; 4) programmatic technical own solutions and strategies for reducing assistance on collaboration; and 5) the impact of violence on young children sustainability (Baltimore City Safe Start and their families. Initiative, 2005). BCSSI program staff used the information gathered from the 4. Community Engagement community assessment to focus its and Collaboration efforts to reduce the impact of exposure to violence on children. Staff intended 4.1 Community Engagement to develop activities focused on the following: Consultants for BCSSI conducted an • initial community needs assessment. Educating the community about Seven themes emerged from the children exposed to violence (e.g., assessment and served as the foundation curriculum, marketing materials); for program planning for the initiative; • Screening tools; these themes provided significant insight • Mental health professional training; into the perspectives and needs of and community residents. The assessment • Identification of community-based, identified a relationship between culturally competent service providers. violence and substance abuse/drugs in Baltimore City neighborhoods that Following concepts of the Safe Start needed to be addressed as a part of the Demonstration Project program design, program to reduce exposure to violence BCSSI sought to engage the community (Anderson & Ringgold, 2000). through these activities and increase the Accessible community and impact of its work by utilizing the neighborhood mental health and strength of its collaborative. counseling services with culturally competent service providers were 4.2 Collaboration identified as critically important for the success of the program. Structured According to BCSSI staff, one of the activities for adults and children, along keystones of the BCSSI was the with improved educational resources, effective collaboration that already also were identified as necessary for existed in Baltimore for this type of reducing violence in neighborhoods. project. The BCSSI intended to maintain close communication with all primary While the above themes were considered leaders and enable partners to use important, two other major themes were leadership and organizational authority perceived as critically important to to lead efforts of the project, such that

Association for the Study and Development of Community 6 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

partners would remain engaged and Baltimore’s Success By 6 Initiative was invested in project outcomes. a movement adopted by Baltimore City Collaboration was structured through to support children and families. Its key partnerships with the two most mission was to ensure that young visible entities involved with families children were healthy, safe, nurtured, and children in Baltimore City: the and ready to learn when they entered Family League of Baltimore City and the school. The goal of the initiative was to Success by 6 Initiative. further Baltimore’s effort, as organized by the Safe and Sound Campaign, to 4.3 Key Partnerships build a citywide network of programs and services to support the health, The Family League of Baltimore City functioning, and self-reliance of the (FLBC) served as the key agency for city’s families and young children (six coordinating the BCSSI initiative. The years and younger). FLBC was founded in 1991 as a quasi- public, non-profit organization, to serve Success By 6 was already operating in as a local management board. Local the neighborhoods to which BCSSI management boards were established to would offer services. As BCSSI began focus attention and resources on to implement community-based improving the well-being of children and strategies in its third year, Success By 6 families by engaging communities and was winding down in these targeted encouraging public and private neighborhoods. The initial expectation partnerships. FLBC did not provide that BCSSI would be able to build on the direct services, but instead initiated accomplishments of Success By 6 did collaborative processes to enhance not materialize. Instead, BCSSI failed to strategic planning efforts to improve engage the targeted neighborhoods. child and family outcomes and Community members, both residents and indicators of well-being. In 1997, the providers, were unwilling to respond to FBLC further focused its efforts on (1) yet another intervention that did not developing a set of results and indicators provide the types of services or that would measure progress toward resources they wanted. Over the five improved outcomes for children and years of the BCSSI, community families, (2) developing strategies that engagement efforts were limited to would have the strongest potential to participation in community events and actually improve those outcomes, and providing community training for (3) establishing data mechanisms to providers and parents. Despite efforts by collect baseline and ongoing data to BCSSI staff to educate community track the impact of these strategies and members about children exposed to to inform citywide and community-level violence and mental health interventions planning and decision making. In to address this issue, these efforts did not addition to bringing this purpose to the produce significant buy-in at the collaborative, FLBC also was able to neighborhood level. BCSSI staff were create formal agreements (Memoranda not able to significantly change the of Agreement) between 28 local attitudes and behaviors of community agencies in support of the startup of the members about using mental health Baltimore City Safe Start Initiative.

Association for the Study and Development of Community 7 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

services to address issues of children 5. Systems Change exposed to violence. 5.1 BCSSI Theory of Change 4.4 Collaborative Structure BCSSI staff envisioned a theory of Under the leadership of the Family change for their initiative that would League of Baltimore City, the BCSSI address the issues faced by the target collaborative was able to draw on the population. Using available resources members of the existing Family Support (fiscal support, technical assistance, Strategy, which included the Baltimore staff, data, management information City Department of Social Services systems, and coordination of planning) (BCDSS), Baltimore Mental Health and through collaboration with key Systems, Baltimore Substance Abuse leaders, community-based agencies, the System, Baltimore City Public Schools, faith community, and the Family and Baltimore City Head Start. The Support Strategy of Success by Six and collaborative was loosely configured, Head Start, BCSSI proposed with FLBC serving as the convener and engagement in two types of activities. facilitator. Over the course of the These activities were: initiative, interest and leadership waned. After the initial planning years ended, • Service coordination and capacity key decision makers began to send lower building, and ranking staff to collaborative meetings. • Community awareness and education. Decisions that needed the input and buy- in of agency authorities were left to A critical result of these activities would agency representatives who did not have be a standardized protocol for screening the authority to agree to or implement for and assessing violence exposure change within their organization. As one among children six years and younger, collaborative member explained, “We which would be shared with provider had the right agencies at the table, but agencies. This protocol was viewed as the wrong people from those agencies.” essential for achieving short term outcomes related to changes in the Nevertheless, BCSSI was able to service delivery system, identification of facilitate partnerships between children, and mobilization of community individual agencies. For example, Child action on behalf of children exposed to Protective Services and the domestic violence. Achieving short term violence sector worked more closely outcomes would further lead to greater together as a result of involvement in the service integration and increased BCSSI collaborative. The placement of a provider competence regarding issues domestic violence provider in BCDSS related to children exposed to violence, and cross training between these two as well as improvements in the condition groups helped enhance the collaboration. of children six years and younger who Key components of this effort are were exposed to violence. In addition, described in the next section. community referrals to services for children exposed to violence would increase. These activities, outputs, and outcomes would ultimately achieve the

Association for the Study and Development of Community 8 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

long term goals of the Safe Start 5.3 Service Delivery2 Demonstration Project: reduced negative impact of exposure to violence on young To implement service coordination and children, and reduced (re)exposure to to address ways to increase protective violence among children six years and factors for children and families in younger. Baltimore City, BCSSI identified and worked with local partners. Partners 5.2 Risk and Protective Factors were originally drawn from political, community, and agency representatives. Baltimore City Safe Start Initiative The major focus of change was the proposed to design a service component delivery of mental health services for to address social risk factors contributing children exposed to violence; the to children’s exposure to violence. An principal partnership was with Baltimore early assessment of community needs Mental Health Systems, the core mental for program development identified the health service provider that was to presence of critical social risk factors provide a direct link to mental health among the target population for BCSSI professionals for training in both services. Program planners for BCSSI children’s exposure to violence and endeavored to develop strategies to identification, assessment, and referral of mitigate or ameliorate these risk factors children. During the five-year by developing a project that would demonstration project, the House of increase and reinforce protective factors. Ruth—Maryland, East Baltimore Mental For example, the project sought to Health Partnerships, Baltimore Child address a priority risk factor of teen Abuse Center, and Urban Behavioral parents by working with these teens in a Associates were the principal partners in manner that would substitute or provide service delivery for BCSSI. As federal positive values, identities, and role funding for the project was coming to an models; increase parenting knowledge, end, BCSSI was able to expand this mentoring, motivation and achievement; group to include six other providers. and develop extended family/support Local providers agreed to participate in networks. For ten priority risk factors Safe Start training and to self-identify as identified as present in the seven Safe Start providers after receiving Safe communities to be served by the Start training. demonstration project, BCSSI, as part of its initial implementation plan, identified The primary goal of BCSSI was to build corresponding protective factors and strong alliances with existing programs activities that would lessen the impact of to reduce service duplication, enhance the risk factors and thereby reduce the positive outcomes for children and risk of violence exposure. Subsequent families, and sustain services and implementation plans (after 2002) did programs beyond the federal funding not consistently focus on these concepts. period. BCSSI envisioned a system continuum to include the following components:

2 Information summarized in this section of the report was found in the 18-month implementation plan (Baltimore City Safe Start Initiative, 2001).

Association for the Study and Development of Community 9 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

neighborhood level: 1) the Baltimore 1.Consistent screening for exposure to City Department of Social Services violence by system agencies and (BCDSS) for physical and sexual abuse; organizations; 2) the Baltimore City Police Department/Child Development- 2.Appropriate and comprehensive family Community Policing/Department of assessment, case management, and Juvenile Services for domestic and follow-up via Family Assessment community violence; and 3) community- Centers (FACs); 3 based organizations for domestic and community violence. All agencies were 3.Developmentally, culturally, and to provide education and training to family appropriate community-based community-based service providers and services to reduce the impact of education and screening to families. All exposure for children six years and agencies also would have relationships younger; with Family Assessment Centers, the courts, and a medical care provider. 4.Electronic directory of services relevant to exposure; Child Development-Community Policing (CD-CP) was essential to the 5.Community response to violence BCSSI strategy as a point-of-service provided by Child Development- provider. The CD-CP model had a Community Policing; demonstrated history of being effective and trusted in Baltimore City 6.Training, education, and technical neighborhoods. According to the CD-CP assistance; design, law enforcement provided trauma response and community 7.Community awareness/education education and training in collaboration campaigns to raise knowledge about with East Baltimore Mental Health young children’s exposure to violence; Systems. East Baltimore Mental Health and Systems was also responsible for training neighborhood-based mental 8.Management information system health providers. Most critically, software capable of tracking families however, CD-CP was to serve as the in the system and supporting gateway for identification and referral evaluation. for children exposed to violence, particularly when law enforcement Three groups were identified as key responded to domestic violence sectors responsible for creating a incidents. Over the course of its five- coordinated system of care at the year implementation, BCSSI provided resources to expand CD-CP to more and 3 Family Assessment Centers (FAC) were designed to more neighborhoods, in an effort help address gaps identified in the community assessment, focus on children six years and younger. specifically, the lack of comprehensive specialized assessments within an integrated and coordinated By year five of the demonstration system of services. FACs were designed to provide project, BCSSI had helped expand CD- family assessment, referral, and case management CP citywide. services at locations convenient to families within each of the targeted neighborhoods. These centers, however, were never implemented.

Association for the Study and Development of Community 10 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

5.4 Service Integration procedures compatible with both BCDSS and other partnering agencies. The major strategy for service Aspects of the process were piloted at integration was to develop a common the neighborhood level during the early tool to be used by all child-serving stages of BCSSI implementation. The agencies (public and private) to identify approach, however, proved difficult to children exposed to violence. Central to implement and was considered a BCSSI’s efforts to ameliorate the duplication of services; agencies viewed harmful effects of exposure to violence the process as costly and demanding. on young children was an ability to Several additional attempts were made identify when such exposure occurred. over the course of the demonstration The BCSSI Best Practices Committee, project to find a way to develop a convened during the planning stages of coordinated system of care. By 2004, the demonstration project, researched BCSSI had dropped screening as a processes used by human service and referral requirement, in an effort to public safety agencies to accomplish this reduce the burden on partnering agencies task. They concluded from their research and families. In 2005, a second attempt that agencies use specific screening to integrate screening questions into procedures to identify children exposed protocols for child-serving agencies was to violence. BCSSI decided to work with attempted, but did not result in full key agencies to expand, if necessary, integration across systems. As a current screening tools to include secondary strategy, BCSSI developed an screening for children exposed to alternative process for referring and violence. Key agencies, (e.g., Baltimore treating children exposed to violence. City Department of Social Services, This approach (Safe Start Intervention Baltimore City Police Department/CD- Services) was an effort to use BCSSI as CP, University of Maryland Medical a gateway for referral and services and System, Baltimore Mental Health to track and monitor results (see Exhibit Systems, and Baltimore City Head Start) I-B for a model of Safe Start agreed to work with BCSSI to adapt Intervention Services). Despite BCSSI’s their current screening procedures to efforts to accommodate the diverse include components that would be needs of its partnering agencies, developed by BCSSI. In turn, BCSSI however, these agencies continued to would provide training and technical resist integrating screening and early assistance to the agencies to ensure that identification of children exposed to staff would be able to implement the violence into their practices. While protocols and tools, as well as have Child Protective Services and Head Start knowledge and understanding of showed evidence of using screening available resources and interventions questions for referral, 53% of cases appropriate for children exposed to referred to Safe Start Intervention violence. Services did not have completed screens. Furthermore, children and families who This process was never fully were referred were difficult to engage implemented because it required the and retain in services. development of uniform assessment, referral, and case management

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It is difficult to determine the exact include items on violence exposure; 8) reasons for the resistance to service establishing protocols for information coordination and integration on the part exchange and referrals between the of BCSSI’s partnering agencies. Several Circuit Court and Child Protective factors (e.g., cost, administrative burden, Services; 9) enhancing relationships family resistance) were mentioned as between CD-CP, Child Protective possible factors for resistance. In Services, and the Domestic Violence addition, BCSSI staff changes, Unit, so that CD-CP could function as a specifically in the position of project referral source for BCSSI; 10) director, were frequent over the course promoting cross-referencing of of the development and implementation information between the Domestic of the demonstration project. This might Violence Unit and Child Protective have contributed to a sense of shifting Services; 11) working with Child priorities and lack of continuity, Protective Services, the State’s Attorney, hampering the development of a and Circuit Court judges to help ensure coordinated and integrated system of that identified children would receive care. treatment; 12) generating public awareness (e.g., through involvement of 5.5 Policy Changes the Mayor’s Office); and 13) identifying long term funding (Baltimore City Safe During the Safe Start planning period Start Initiative, 2005, p 30). (2000-2003), BCSSI’s collaborative subcommittee conducted a policy analysis. Of the 13 policy recommendations, Baltimore City’s response to children BCSSI activities realized five: exposed to violence was identified as a priority issue for policy change, because • The Child Protective Services unit at of the lack of a single authority the Baltimore City Department of responsible for responding to domestic Social Services (the Violence violence and the need for leadership in Intervention Project) established a this area. BCSSI identified 13 specific domestic violence roundtable to foster areas for policy change and developed cross-agency response to victims of recommendations. These family violence. The roundtable recommendations focused on: 1) formal included the Office of the State’s cross-agency governance; 2) defining Attorney—Family Violence Unit, the exposure to violence; 3) including data Baltimore City Police Department, the on children exposed to violence in Circuit Court, House of Ruth— reports to the Mayor’s Office; 4) Maryland, Maryland Network Against mandating core in-service training on Domestic Violence, and BCSSI. The children exposed to violence for child- roundtable will continue to function serving agencies; 5) developing specific beyond the federal funding of BCSSI; actions for reporting and referring • Acceptance of the OJJDP definition of domestic violence incidents involving exposure to violence; children; 6) utilizing a domestic violence • Extensive cross-agency training among unit to provide Safe Start information to the Baltimore City Police victims; 7) expanding the Child Department’s CD-CP, the Baltimore Protective Services assessment tool to

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City Department of Social Services, 6.1 BCSSI Training Strategies and various city and state agencies; • Initiation of development of a credit To address the gap in availability of card-sized referral form for the mental health practitioners using Baltimore City Police Department to appropriate mental health interventions use when responding to domestic for children exposed to violence, BCSSI violence calls; and trained mental health professionals in • Reporting and referral requirements early childhood mental health and for the Baltimore City Police concepts of children exposed to Department for incidents involving violence. BCSSI training efforts children exposed to violence. included infusing principles related to children exposed to violence into BCSSI attributed its difficulty in agencies through a train-the-trainer realizing all 13 policy recommendations model, as well as training on how to use to the relationship between local play therapy as a tool to address agencies and state governance. Many of exposure to violence. In addition, BCSSI the citywide agencies participating in training served to inform providers of BCSSI were obligated to conform to the contacts in collaborating agencies guidelines of the state agency under equipped to respond to children exposed which they operated. They were unable to violence through Safe Start to advocate for or produce change at the Intervention Services. Project evaluation state level to institute many of the data suggest that BCSSI training helped recommendations above. agency staff increase their professional skills and knowledge related to children exposed to violence; the long-term 6. Institutionalization of impact of training on practices related to Change children exposed to violence, however, is not yet clear. BCSSI utilized two primary strategies in attempting to institutionalize change To continue the training component of across the service delivery system for Safe Start beyond the demonstration children exposed to violence. They used project, BCSSI developed and a comprehensive training process, implemented a train-the-trainer model including a train-the-trainer model, to and curriculum. Over 120 agency-based help institutionalize theory and practice providers in 55 agencies citywide have related to children exposed to violence participated in the train-the-trainer among staff of partnering agencies. They series. Between January and September used a process of funding local 2004, four train-the-trainer graduates demonstration projects to gain a foothold reported training 328 individuals using in partnering agencies, in hopes that, the BCSSI curriculum (Baltimore City once initiated, work in the interest of Safe Start Initiative, 2005, p 39). children exposed to violence would Although train-the-trainer activities did continue in individual agencies. These not result in an immediate increase in strategies and their results are described referrals to Safe Start Intervention in this section. Services, two key mental health agencies now have trained staff to work with

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children exposed to violence citywide. In a second demonstration project, Moreover, evidence supports the BCSSI provided funds to the House of contention that agency practices and Ruth—Maryland for its Community provider knowledge of exposure to Outreach Expansion Project, which violence have changed as a result of focused on relationship building through BCSSI training models. The long term community connections, creating an impact of these changes on improved effective referral base, and providing conditions for children exposed to clinical services for identified children violence remains untested. and families. The project supported a community outreach worker who Throughout the implementation of followed up on referrals by going into BCSSI, it was necessary to train agency the community two times per week to level staff continuously because of high meet with families in their homes. staff turnover. This impacted the effectiveness of the training and These two projects provided BCSSI with compromised the institutionalization of its greatest numbers of identified and both training and systems change referred children. The House of Ruth activities. demonstration project produced 53 identified and assessed children and 6.2 Agency Funding Strategies families. Forty of these children and their families received services. The During year four and continuing into Child Protective Services project year five of the demonstration project, generated 89 referrals. Sixty-three of the BCSSI provided resources to the referrals received services, with 41 of Baltimore City Department of Social these cases receiving intensive case Services to conduct a demonstration management and 22 cases receiving project focused on setting up a domestic treatment only (Baltimore City Safe violence unit within Child Protective Start Initiative, 2005, p 34). Services (CPS). Integration of domestic violence issues and CPS came about as a As a result of participating in the BCSSI result of the Department of Social demonstration project, collaborating Services Domestic Violence Continuous agencies were able to leverage the Performance Improvement Team, which experiences gained as BCSSI partners to worked for several years to help the obtain funding through other sources Department of Social Services to focused on children exposed to violence. understand the significant overlap For example, the House of Ruth— between domestic violence and child Maryland’s involvement with BCSSI maltreatment. Discussions between contributed to expanding its program to Child Protective Services and the BCSSI include children six years and younger project director led to the funding of the exposed to violence, thus opening the CPS domestic violence unit as a way for SAMHSA4 funding of its Safe demonstration project, which further led and Bright Futures program. to the incorporation of domestic violence assessment and intervention into CPS investigations. 4 SAMHSA is the Substance Abuse and Mental Health Services Administration, a federal agency whose mission is to “build resilience and

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BCSSI also provided funding for the 8. Reduced Exposure to Child Development Community Policing Violence Project through East Baltimore Mental Health Partnership. As a result of these It is difficult to ascertain whether the efforts, the Baltimore City Police Baltimore City Safe Start Initiative Department is reportedly considering the reduced exposure to violence at the development and staffing of a domestic community level. Data were not violence unit. Despite providing funds to collected for key benchmarks or changes CD-CP, BCSSI was never able to in community level awareness, and systematically collect consistent data on community-wide incidence data were family and domestic violence through not part of the scope of the evaluation of CD-CP or its other law enforcement the demonstration project. partners, possibly due to the very late implementation of a police order that During the five-year implementation of mandates law enforcement officers to the project, involvement of BCSSI collect standard data when called to a program staff with the community was family violence incident. It should be limited to several trainings, community noted that data collection across all programs, and minimum participation in agencies regarding children’s exposure community-sponsored events. An to violence was never fully assessment of the awareness and implemented. knowledge needs of the various neighborhoods in which BCSSI was active was not undertaken as part of the 7. Increased Community demonstration project’s evaluation Supports process.

There is little clear evidence that BCSSI resulted in a significant increase in 9. Reduced Impact of supports available to Baltimore City Exposure to Violence neighborhoods. Nevertheless, BCSSI was able to expand the number of mental Safe Start Intervention Services (SSIS) health providers trained to serve young was developed by BCSSI to evaluate the children and, between 2003 and 2004, impact of treatment on reducing (1) the increased the number of Safe Start symptoms of trauma in children exposed Intervention Service providers in to violence and (2) the stressors in participating neighborhoods. The parents/caregivers associated with Community Outreach Expansion Project children’s exposure to violence (the of the House of Ruth, which funded a details of this research intervention are part-time clinician for in-home given in Exhibit I-C). Eighty-six client community outreach, shows promise of families were referred to SSIS from serving as a continued resource for 2003 to 2005: 70% African American, families. 15% Caucasian, and 1% Native American, with the remaining percentage of unspecified racial identification. The average age of facilitate recovery for people with or at risk for children in this group was four years. substance abuse and mental illness.”

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In the research intervention, 40% of the address issues of children and families children studied reported exposure to was considered sound practice; BCSSI violence in the home in which they was expected to follow the path of usually lived, 10% in a home in which success that other programs had blazed they also lived, 4% in a relative’s home, in these neighborhoods. In the end, and 15% in their community. Of the however, BCSSI was unable to fully children studied, 46% witnessed (heard realize the original vision of its staff and or saw) the violence but were not the partners. intended victim of the violent incident, 17% were the intended victim and were Several factors challenged the BCSSI injured, and 3% were injured but were staff, hindering the ability of the not the intended victim. Domestic demonstration project to stay on track violence was the most common type of and move toward accomplishing its violence reported (36%). Thirteen critical goals. In particular: percent of the children were exposed to community violence, and 17% of the • Political and economic changes at the children experienced physical and/or state and local levels shifted the focus sexual abuse. away from children and families; • Leadership (both within the Of the 86 referrals to Safe Start collaborative and among BCSSI staff) Intervention Services from 2003 to 2005, failed to address the issues identified only six cases were active as of in the pre-planning assessment as December 2005, and only two clients critical to create both change and completed treatment. A comment from success. The most significant issue, one of the participants in the study community engagement and points to the challenges facing BCSSI in involvement, was not effectively engaging and retaining children and carried out; families in research interventions: “the • Turnover in project leadership and staff [are] caring and helpful…able to agency leadership, as well as failure of get concrete needs met, [but it] felt like collaborative leaders to continue to being re-investigated, too many engage collaborative members, questions, felt like being judge[d] as a resulted in poor follow-through and parent, felt like a guinea pig in a compliance with project activities and research project, did not believe the goals; program would be helpful in the long • Dependence on two strategies (i.e., [1] run…” (Baltimore City Safe Start training and [2] funding projects Initiative, 2005). through a request-for-proposal process), to the exclusion of pursuing other means of creating agency and 10. Conclusion community ownership of the initiative, placed a tremendous burden on these A great deal of planning and effort went two strategies to generate a meaningful into the development of the Baltimore reduction in children’s exposure to City Safe Start Initiative. The strategy of violence; and continuing to build capacity within • Basic structural issues were never targeted neighborhoods in Baltimore resolved. Who was BCSSI apart from City by coordinating programs to

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Success By 6 and other child-serving Although significant challenges agencies? What authority did BCSSI impacted the work of the Baltimore City have to command agency change? Safe Start Initiative, staff can point to What was the role of the fiscal agent in several achievements resulting from the ensuring the compliance of partnering work of this demonstration project. agencies and service deliverers? How These include: could BCSSI overcome the SB6 legacy of negative relationships at the • 86 families were assessed, and 10% of neighborhood level? Key project those families received treatment leadership appeared to overlook the services for their children exposed to importance of developing strategies to violence; address these basic structural issues. • 120 staff in 55 agencies were trained in the theory and practice of addressing Overall, the strategies developed and the issue of children exposed to implemented by BCSSI appeared to lack violence; consistency with the issues identified • 2 funded projects (the Violence through the draft community assessment Intervention Project and the process. For example, the community Community Outreach Expansion assessment indicated that active Project) continued beyond the federal community participation in finding funding of BCSSI; and solutions and strategies to reduce • A train-the-trainer curriculum was violence exposure and its impact would developed and is being published for be critical to the project’s success. In distribution to practitioners and contrast, the development, validation, students interested in learning about and implementation of a screening tool children exposed to violence. to be used by mental health professionals and agency staff consumed a majority of While BCSSI as a demonstration project the project’s resources during its first has ended, knowledge and skills related four years. As another example, to children exposed to violence remain exclusive reliance on training mental in the community at large. Two local health professionals to address issues of agencies, the House of Ruth—Maryland violence exposure had no clear and the Kennedy-Kreiger Institute, connection with the assessed need to continue to build on this knowledge base create other changes in the existing as they implement other types of fragmented service delivery system. programming directed to serve children exposed to violence and their families.

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11. References

Anderson, P. & Ringgold, V. (2000, August). Baltimore City Safe Start Initiative, Draft Assessment Report. Baltimore, MD: Author

Association for the Study and Development of Community (2005a). Site visit report: Baltimore City January through December 2004. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2005b). Site visit report: Baltimore City Safe Start Initiative January 1 through September 30, 2005. Gaithersburg, MD: Author.

Baltimore City Safe Start Initiative (2001). 18-month implementation plan (July 2001 – December 2002). Baltimore, MD: Family League of Baltimore City

Baltimore Safe Start Initiative (2005). Local evaluation report form. Baltimore, MD: Author (Available from the Association for the Study and Development of Community).

Exhibit I-A Timeline of Baltimore City Safe Start Initiative Activities and Milestones Major Milestone 1/01-6/01 7/01-12/01 1/02-6/02 7/02-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05

Safe Start Council Collaborative (ongoing since 2000) Safe Start Early Identification Trainings Safe Start Early Childhood Mental Health Trainings BCSSI Quarterly Newsletter (established & ongoing) Safe Start Intervention Services (formed & ongoing) Children Exposed to Violence (CEV) Trainings Children Exposed to Violence Train-the-

Trainer Series Domestic Violence Intervention Demonstration Project (CPS) House of Ruth Community Outreach Expansion Project Provided financial assistance to the Baltimore Child Abuse Center for the implementation of the Violence Intervention Project Safe Start Community Education Awareness Campaign • Baltimore City Safe Start Symposium • BCSSI and Baltimore City Department of Social Services

(BCDSS) Domestic Violence Forum

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Major Milestone 1/01-6/01 7/01-12/01 1/02-6/02 7/02-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05

East Baltimore Mental Health Partnership (EBMHP) added as a BCSSI mental health services provider BCSSI funded staff positions for two Baltimore City agencies that serve children exposed to violence BCSS Project Director resigned BCSS Project Director hired BCSS Training Coordinator position filled

BCSS Training Coordinator resigned BCSS Training Coordinator position filled

Sources: Local Evaluation Report Form 2005; Case Study 2005; Site Visit Summary 2005; Site Visit Report 2005; Progress Reports, July-December 2004 and January-June 2005.

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Exhibit B Baltimore City Service Delivery Model

REFERRAL TO TREATMENT IDENTIFICATION AND REFERRAL & TRACKING

BALTIMORE CITY SAFE START

COMMUNITY-BASED (SSIS) CHILD CARE AGENCIES & PUBLIC Receives referrals; AGENCIES sends to provider agencies; enters •Child care agencies (e.g. Head Start) referral into BCSS •Day care centers database for tracking •CD-CP Unit •BMHS SCREENING & TREATMENT

PROVIDER AGENCIES (clinical treatment, service linkages) DEMONSTRATION •Urban Behavioral Associates PROJECTS •East Baltimore Mental Health Partnership

•House of Ruth Contacts family within 24 hours; conducts assessment •CPS •BCAC Violence Intervention Program LIFE DOMAINS ASSESSMENT

Mental health Services for treatment food, housing, etc.

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Exhibit I-C Baltimore City Safe Start Initiative Research

Overview

Initially, Baltimore City Safe Start Initiative (BCSSI) planned an intervention design that would study the impact of treatment on children exposed to violence with the goal of reducing (1) the impact of exposure to violence and (2) stressors related to a child’s exposure to violence suffered by parents. BCSSI funded two providers (Urban Behavioral Associates and East Baltimore Mental Health Partnership, together known as “Safe Start Intervention Services”) to identify, assess, treat, and refer children exposed to violence. Several challenges, however, prevented BCSSI from conducting its research as originally planned (see “Discussion” section below for more details). As an alternative, BCSSI opted to conduct a pre-post study of a non-uniform intervention program. This study sought to examine the effects of different treatment interventions on changes in (1) symptoms related to violence exposure and (2) stressors affecting parents/caregivers. Data were collected twice, at intake and nine or 16 months post-intervention, using the Trauma Symptoms Checklist for Young Children (TSCYC), the Parenting Stress Index- Short Form (PSI-SF), and the Conner-Davidson Resiliency Scale (CD-RISC).

Method

Clinical staff administered two tools, the TSCYC and the PSI. Baseline data were collected during enrollment, and post-treatment data were gathered after 16 treatment sessions. In addition, the Conner-Davidson Resiliency Scale (CD-RISC) was administered to those parents participating in the parent resiliency group. Data gathered with the CD-RISC were collected at intake and after 9 group sessions.

Sample:

The sample size included a total of 86 cases referred to Safe Start Intervention Services from 2003 to 2005. The average age of a child was 4 years. Seventy percent of the children were African American, 15% Caucasian, 5% bi-racial, and 1% Native American. The other 8% lacked information on racial identification.

Procedure:

Safe Start Intervention Services clinical staff was required to gather demographic information and data on client assessment, treatment, and referral services. All data were entered into a database at the time of enrollment and nine months or 16 months after the start of treatment, depending on the tool used. The local evaluator later retrieved the data for analysis. Analysis on the data was performed to investigate the effects of the more effective treatment in comparison to the less effective one, and to examine the changes in symptoms related to exposure to violence in children and caregivers at pre- and post- treatment assessment.

Results

Outcome data are not available, primarily because providers had difficulty retaining clients. Of the 86 cases referred to SSIS, only 15 clients met criteria for follow-up assessment; of those 15, only seven were successfully contacted by one of the SSIS agencies. Of the seven clients, one refused to complete the PSI at follow-up; the other six completed it successfully and their scores fell within the clinical range.

SSIS providers reported event data on 86 cases, six of which involved multiple children. Data from these cases revealed the following event characteristics:

• Forty percent of children were exposed to violence in their primary home, 10% were exposed in a home in which they also live, 15% were exposed in their community, and 4% in a relative’s home. • Forty-six percent of the children were not the intended victim, but were witnesses to the violence; 17% were the intended victim and were injured; and 3% were not the intended victim, but were injured. • Thirty-six percent of the children were exposed to domestic or family violence, 17% experienced physical/sexual abuse, and 13% were exposed to community violence. • In 16% of the cases, the children witnessed violence with a weapon, while 37% of cases had no weapon involvement.

Discussion

BCSSI’s initial intervention design had to be modified for various reasons: (1) there were low referrals of clients to services; (2) by mid-2004, there were only 50 clients enrolled in SSIS services, which did not provide sufficient data for analysis; and (3) low client retention contributed to incomplete and inconsistent data collection. These challenges necessitated the development of a new research design (i.e., the pre-post design); however, the Safe Start Intervention Services agencies continued to face the same challenges, particularly that of engaging families into services and retaining clients in services. While BCSSI was not successful in conducting their intervention study, they were successful in gathering important demographic data about their community and their clients. They may wish to share these data with service providers in their community.

II Bridgeport Safe Start Initiative

1. Overview • 1,938 professionals participated in trainings on topics related to the The Bridgeport Safe Start Initiative impact of exposure to violence on (BSSI) was designed to promote better children. integration of services to reduce the incidence and impact of exposure to The BSSI embarked on a deliberate violence on young children. The BSSI knowledge building effort to identify employed multiple strategies to achieve gaps in service provision, and to this goal. The strategies focused on identify, adapt, and test “best practices” improving interagency collaboration, to improve service delivery and to increasing knowledge of the impact of achieve better outcomes for children and exposure to violence on children, and their families. Together with the PARK increasing access and quick referral to Project, which provides school-based services. mental health services, the BSSI trained parents to conduct focus groups with The BSSI funded several clinical other parents to identify barriers to agencies between 2000 and 2005 to accessing available services. The BSSI provide services to children identified by helped Child Protective Services create a court advocates, community members, protocol to improve identification of school clinicians, and mandated children exposed to violence. The reporters. In its effort to fill the protocol was tested and determined to knowledge gap, the BSSI provided a increase the number of substantiated variety of trainings to professionals in cases of children exposed to domestic different fields, such as clinicians, law violence and reduce the number of “false enforcement, and Child Protective positives” (i.e., children not exposed to Services. As a result of its efforts, the ongoing family violence). The protocol’s BSSI accomplished the following demonstrated effectiveness led the (Bridgeport Safe Start Initiative, 2003; Connecticut Department of Children and Bridgeport Safe Start Initiative 2004; Families to adopt its use statewide. Bridgeport Safe Start Initiative 2005a):1 In addition, the BSSI helped to build the • 734 children were identified. Of this community’s capacity to reduce the number, 311 children were assessed impact of exposure to violence on using specialized tools, and 506 children by strengthening interagency children were referred to other collaboration and by engaging services; and community leaders. When a small group of community leaders expressed interest 1 These figures were compiled from Progress in engaging in a broad dialogue about Reports (2003-2005) submitted by Bridgeport improving outcomes for children and Safe Start Initiative to the Office of Juvenile families in Bridgeport, the BSSI Justice and Delinquency Prevention.

organized a leadership group that helped The mission of the Bridgeport Safe Start shape a vision for change in the Initiative is to “…create a community community. Focus group findings and that respects the right of Bridgeport’s social network analysis confirmed children and families to be safe and BSSI’s impact on increasing the number nurtured.” The BSSI expected to realize and quality of collaborations among this vision through its goal to reduce the organizations serving the mental health impact and exposure of violence in the needs of children. By bringing home among Bridgeport children six organizations together for shared years and younger. The project hoped to learning and networking opportunities, address the needs of both victims and the BSSI worked to increase the witnesses of violence in the home (i.e., interaction and trust level among child- abused children and children living in serving agencies. homes with domestic violence, respectively; Bridgeport Safe Start A number of BSSI-funded initiatives Initiative, n.d.). How did the BSSI will endure beyond Safe Start funding. grantee accomplish this mission and The Center for Women and Families has with what success? What factors incorporated BSSI’s domestic violence contributed to and impeded success? trainings into its standard community These questions are addressed in the education unit, ensuring that workshops following sections, and a timeline of on the effects of domestic violence on major events is attached (See Exhibit II- children will continue to be offered to A). the community. The use of BSSI Service Plans also will continue to be utilized by key child-serving organizations. These 1.2 City of Bridgeport, service plans, which BSSI-funded Connecticut programs were required to develop for each family, help integrate services as Bridgeport, also known as Park well as provide the foundation for City, sits on the Long Island Sound in systematic collection of service data and Fairfield County, one of the wealthiest follow-up with families. Finally, the counties in the country. Bridgeport is the BSSI worked with the local United Way largest city in Connecticut, but also the and other community organizations to poorest. It is densely populated, covering create a community-wide strategic plan 16.0 square miles with close to 8,721 that will serve as a blueprint for creating residents per square mile. According to a holistic approach to serving young the 2003 Census population estimate, children and their families. The BSSI there are 139,664 people living in the was instrumental in incorporating the city of Bridgeport. The city’s racial and mental health needs of children, ethnic makeup is largely African especially those exposed to violence, American (30.8%). Caucasians account into the blueprint, which is expected to for 45.0% of the population, while garner new funding from the governor’s Asians account for only 3.3%. Early Childhood Investment Initiative. According to the 2000 Census, 28.4% of the population is under 18 years of age 1.1 Mission and 8.2% is under five years of age. The median household income for Bridgeport

is $34,658, significantly lower than the whom was perceived as being "mired" in state median household income of the reviewing of documents, spending "a $53,935. Approximately 18.4% of lot of time on process," and "working in Bridgeport’s population lives below the a silo."2 poverty line, compared to 7.9% for the state of Connecticut as a whole (U.S. Census Bureau, 2006). 2.1 Political Context

When Bridgeport received the 2. Contextual Conditions grant for Safe Start, the city was in the midst of years of corruption. Corruption The city of Bridgeport faced at both the city and state level had several challenges between 2000 and created barriers to interagency 2005 that affected the Safe Start collaboration, as well as a high level of initiative. These challenges are distrust among leaders. When Safe Start explained in the political, economic, and began in 2001, Bridgeport’s mayor, social context sections below. On the Joseph Ganim, was under federal other hand, BSSI experienced indictment; he was eventually convicted facilitating factors that resulted in gains on 15 counts of corruption-related for the initiative. charges. In the meantime, his indictment led to a freeze on federal assistance to One of these facilitating factors the city and limited funding available for was a reorganization of the Department the human services sector (Association of Children and Families (DCF). Before for the Study and Development of 2005, DCF managed statewide programs Community, 2004, p. 2). At the state from three regional offices, making level, Governor John Rowland resigned oversight by regional directors difficult in 2004 following an indictment also and time-consuming. In 2005, DCF related to corruption. This difficult expanded the number of regional offices political environment improved in 2003 to 14, facilitating management of when John Fabrizi was elected as programs on the ground. In particular, Bridgeport’s mayor. Mayor Fabrizi’s the regional director responsible for background as a long-time elementary Bridgeport now had to manage only six school teacher made it easier for the locales, instead of 22, providing the BSSI to acquire his support and buy-in. director with more time to focus attention on each location and more Meanwhile, turnover in a key law flexibility to participate in initiatives enforcement position created a such as BSSI. temporary barrier to BSSI’s implementation. In 2005, Bridgeport The other facilitating factor for Chief of Police Wilbur Chapman BSSI was the 2005 hiring of a new project director, perceived as a good 2 listener, community-minded, and These perceptions were shared during the November 15 and 16, 2005 site visit with the resourceful at bringing key partners into Association for the Study and Development of the initiative. BSSI had employed two Community (ASDC), which is the Safe Start previous project directors, the last of Demonstration Project National Evaluation Team.

resigned from his position; Anthony violence that young children may Armeno stepped in as acting chief. experience. Unlike Chapman, Armeno was not committed to issues of domestic 2.3 Social Context violence and children’s exposure to violence, and, in fact, had a known There were 475 substantiated history of domestic violence (as a cases of abuse and/or neglect of children perpetrator). Therefore, BSSI lost critical six years and younger in 2005. In 2000, support from law enforcement when there were 539 substantiated cases Armeno took over. During the selection (Bridgeport Safe Start Initiative, 2005c). process began for a new chief of police, At the beginning of BSSI, providers who however, Mayor Fabrizi asked The participated in the Design Team reported Center for Women and Families (CWF) that at least 80% of the children they saw to form part of the selection committee, with behavioral problems had been giving CWF a voice in the process. exposed to violence (Bridgeport Safe Although Armeno applied for the Start Initiative, 2005b). The latest data position, the committee selected Bryan on family violence arrests show 1,426 T. Norwood as the new chief of police arrests in 2001, with 653 children either for the term beginning in April 2006. directly involved or present at the time (Bridgeport Safe Start Initiative, 2005c, 2.2 Economic Context p. 5).

High unemployment and high levels of poverty characterized the 3. Community Capacity economic conditions of Bridgeport. As previously noted, household income falls In spite of a struggling economy below the poverty line for nearly 20% of and the public’s generally negative view Bridgeport’s population. According to of local and state government officials, the Connecticut Department of Labor Bridgeport is a community of dedicated (2006), Bridgeport has one of the highest police officers, professional service unemployment rates in the state (7.7%, providers, child-serving agencies, school compared to 4.9% for Connecticut as a teachers and administrators, court whole). Less than one-third of adults are officials, and residents. The BSSI was high school graduates, and only 12% able to take advantage of existing percent have a college degree. The community capacity to help improve homeownership rate is only 40%, inter-agency collaboration and increase compared to 63% for the state as a the focus given to reducing the impact whole. This economic context makes and incidence of children exposed to Bridgeport’s minority community violence. particularly vulnerable to the risk of violence and exposure to violence; BSSI’s key partners in the highly concentrated poverty and few community included: economic opportunities make it difficult to address some of the underlying The Center for Women and conditions that contribute to domestic Families of Eastern Fairfield County, violence, as well as other types of Inc. CWF is dedicated to strengthening

women and families and to eliminating When a court advocate determined that a violence and abuse through education, child was present during a domestic intervention, advocacy, and community violence incident, a form was filled out collaboration. CWF provides services to and forwarded to BSSI, which arranged victims of domestic violence and sexual follow-up with the family. In 2005 there assault, as well as to women returning to was also a part time civil court advocate the community from correctional working with BSSI staff through the facilities. This agency also provides Court Programs at CWF. education in the public schools and to community groups, and works closely The Partnership for Kids or with the police, the courts, hospitals, and the PARK Project. The PARK Project social service organizations to ensure an helps provide access to services for effective response to victims of domestic children and adolescents with behavioral violence and sexual assault. Finally, and mental health challenges and their CWF offers emergency shelter for those families, to make it possible for these needing housing as a result of domestic children and adolescents to remain in violence (Bridgeport Safe Start school and in their own community. It Initiative, n.d.). BSSI was administered uses a school-based system of care to by CWF, which had fiscal responsibility meet this goal, placing staff in the five for BSSI and served in a lead role as a Bridgeport schools that the project member of its Advisory Board. serves. The PARK Project offers its programs in collaboration with local The CWF also administers a agencies and the Bridgeport Board of number of other related initiatives, Education (PARK Project, n.d.). including Communities Against Violence in the Home (CAVITH) and Bridgeport Child Advocacy the Family Violence Outreach Program Coalition (BCAC). BCAC is a coalition (FVOP). CAVITH is a partnership that of 82 member organizations committed to was created to promote a coordinated improving the well-being of Bridgeport's community response to domestic children through a program combining violence in the greater Bridgeport area. research, community planning, advocacy, CAVITH members understand that community education, and mobilization. domestic violence and sexual assault are BCAC promotes policies and programs to community problems that affect ensure that all children have the everyone, and that each agency has a opportunity to grow up healthy and safe role to play in addressing these and receive the education and skills to problems. FVOP is a joint program reach their full potential (Bridgeport Child between CWF and the Department of Advocacy Coalition, n.d.). Children and Families, which provides a defined program of crisis intervention, The Connecticut Department counseling, education, and support to of Children and Families. DCF’s families experiencing violence in the mission is to protect children, improve home that is affecting the children and/or child and family well-being, and support the victim's ability to parent. CWF also and preserve families. As the state’s provides court advocates who work to child protection service agency, DCF identify children exposed to violence. pursues its mission by working with

individual cultures and communities in The BSSI funded the Child Connecticut and partnering with other Guidance Center of Greater Bridgeport, agencies to address individual and group allowing it to expand its early childhood service needs. DCF has a regional office mental health program by adding a full- that serves Bridgeport. The agency time staff person; enabled Child FIRST collaborated with BSSI as a member of to support a full-time program the Advisory Board and worked with coordinator; and expanded CWF’s Court Safe Start to develop and implement the Assessment Program through funding a Domestic Violence Protocol, a tool used full-time staff position to assist court to help DCF investigators identify the advocates with identifying and assessing presence of domestic violence in a the needs of children exposed to family family setting. violence. Also through BSSI funding, the Mental Health Consultation program Child FIRST. Child FIRST was able to provide supervision and identifies and assesses the social, consultation to five mental health emotional, and developmental needs of clinicians to support their work with children six years and younger, and young children (six years and younger) connects these children and their exposed to family violence. Finally, the families to services to address identified BSSI enabled the Classroom needs. Behavioral and developmental Consultation for Early Childhood assessment is provided to families, and Educators to offer 35 hours per week to consultation is provided to childcare provide mental health and early providers and other service providers. childhood consultation to early Child FIRST received funding from childhood educators and to assist with BSSI for assessment, consultation, care identifying children exposed to violence coordination, and service planning for (Bridgeport Safe Start Initiative, 2005c, children exposed to violence and their p. 38). families.

The Bridgeport Health Department and Central Grants offices also both work with BSSI staff. The Central Grants offices was the grantee in 2005.

The BSSI added to the existing community capacity embodied in the agencies described above in three key ways: 1) providing resources to add staff capacity, 2) providing training and technical assistance, and 3) increasing collaboration among agencies.

3.1 Adding Staff Capacity

3.2 Providing Training and service providers in 2001 reported very Technical Assistance limited communication and collaboration among agencies. One goal of BSSI was to increase service providers’ knowledge of the These findings were reinforced impact of violence on young children. by social network analysis that revealed Between 2002 and 2005, BSSI provided more collaborative relationships in 2005 129 training sessions, free to Bridgeport than in 2001. Moreover, direct service providers. Staff from 381 collaborative relationships (i.e. agency- organizations attended, for a total of to-agency, with no “middleman”) 1,938 participants. Among these increased from 2003 to 2005, suggesting sessions was a training program for 35 the existence of a more close-knit providers using the Shelter from the collaborative network. Finally, Storm curriculum, as well as a three-day reciprocal relationships (i.e. two-way training session for 94 Child Protective collaborations) increased, suggesting Services staff on the impact of exposure more meaningful partnerships and more to domestic violence on young children. equitable sharing of resources within relationships (Bridgeport Safe Start Initiative, 2005c, p. 16). 3.3 Increasing Interagency Collaboration 4. Community Engagement While a number of organizations & Collaboration addressed domestic violence and the mental health needs of children prior to BSSI engaged parents, service BSSI, there was little collaboration providers, and the broader community in among them, limiting the potential for a variety of ways. As part of its strategic positive outcomes for children and their planning, the BSSI invited professionals families. The BSSI work facilitated and providers to form a Design Team, improved relationships among agencies and also created a Management Team by convening organizations for shared (recently restructured into a more learning experiences, increasing diverse Advisory Board) to oversee the networking opportunities, and promoting implementation process. The community knowledge development and exchange. was engaged through a social marketing campaign that raised issues of domestic Over the life of the Safe Start violence and children exposure to initiative, collaboration among agencies violence. Both professionals and the serving families affected by violence community were invited to training improved as a result of BSSI activities sessions that raised the same issues. (Bridgeport Safe Start Initiative, 2005c, p. 12). In 2005, service providers 4.1 Community Engagement: described collaborative relationships Professionals with other agencies that had strengthened as a result of treatment The BSSI had mixed success team meetings and ongoing phone and with engaging professionals in the email communication. By contrast, design and implementation of the

initiative. Initially, a group of about 40 30 social service agency executive local service providers and other directors and other community leaders. community representatives came The BSSI provided logistical support to together to form a Design Team. This this effort, and has funded the use of a group worked to identify the areas of professional facilitator through the end greatest need for children exposed to of 2006. The new leadership group is violence and to create an intervention helping to create a shared community design. After the initial effort, however, vision around the needs of children and interest in Safe Start began to dissipate, families and is encouraging learning and and meeting attendance dwindled knowledge sharing across social service (Association for the Study and sectors. Although the BSSI convenes the Development of Community, 2004, p. meetings, the group does not serve in an 6). In response, the BSSI put together a advisory capacity to BSSI. Rather, it Management Team consisting of uses a systems change approach to members from the City Central Grants discuss and address a myriad of health, Office, Bridgeport Child Advocacy education, and policy issues regarding Coalition, and Center for Women and children in Bridgeport. Families, as well as the BSSI project director. The Management Team The BSSI also successfully directed implementation and made engaged local professionals in policy decisions to guide the initiative. addressing existing knowledge gaps regarding service needs. The grantee In 2005, with the arrival of a new conducted a series of focus groups with BSSI project director, the Management service providers in 2002, 2004, and Team was restructured, and a new 2005, to identify barriers to accessing Advisory Board was formed. The services for young children exposed to Management Team had come to be violence in the home. Key findings from perceived as making decisions without the 2005 round of focus groups included input from most of the partners or the the following identified service needs: community, and as keeping the more timely follow-up to reports of child partnership mired in bureaucratic abuse and neglect, enhanced police and process. The Advisory Board expanded court response to domestic violence participation in BSSI’s strategic cases, more bilingual and culturally planning and oversight to 15 policy competent service providers, and help makers and direct service staff, including making services more affordable for the regional director from the families (Bridgeport Safe Start Initiative, Department of Children and Families 2005c, p. 31-32). As a way to encourage (Bridgeport Safe Start Initiative, 2005c, improvements in the system of care, p. 1). BSSI shared the findings of each round of focus groups with local service The BSSI played an additional providers. important bridging role in connecting key community leaders in a dialogue for change, through a leadership group. The dialogue began among five agency leaders and later expanded to more than

4.2 Community Engagement: service provider focus groups described Parents and Caregivers above. Parents cited a lack of responsiveness when making inquires The BSSI engaged in a bilingual about services, difficulty in connecting social marketing campaign to inform with the appropriate agency or person, residents about issues related to children and a lack of respect and trust in their exposed to violence. The campaign engagements with agency staff. encouraged community members to call InfoLine 2-1-1 for service referrals for Using the findings from the children exposed to violence; InfoLine family engagement study, the BSSI and 2-1-1 is a statewide system that connects the PARK Project staff created a series callers to an electronic database of of cultural competency trainings resources. As part of the InfoLine targeting front-line staff, particularly in campaign, BSSI distributed more than the Department of Children and Families 5,000 flip books (i.e., brochures) to and the Connecticut Department of mental health providers, medical staff, Social Services (Bridgeport Safe Start childcare centers, teachers, and other Initiative, 2005c, p. 34). To promote a community members and caregivers who broader dialogue on ways to improve interact with young children. BSSI responsiveness and respectful monitored the effectiveness of the social engagement in the system, the BSSI marketing campaign by analyzing call presented the parental focus group data for the six months before and after findings more than 15 times to a variety the campaign. While the analysis found of audiences in Bridgeport and around no change in the overall InfoLine call the state. volume, it did document a significant increase in calls to “Help me Grow,” the The BSSI also provided formal InfoLine referral service specifically training sessions to parents on issues relating to young children. In addition, related to children’s exposure to there was a significant increase in the violence. Four parent training sessions proportion of calls about family violence were conducted; a total of 91 parents issues as well as child abuse and neglect attended. (Bridgeport Safe Start Initiative, 2005c, p. 21). 5. System Change Activities The BSSI, together with the PARK Project staff, conducted a family On the policy front, BSSI was engagement study to understand barriers hindered by the difficulties facing to accessing available services. To Bridgeport’s political leadership. For conduct the study, six parents were the first few years of the initiative, the trained in all aspects of focus group Mayor’s Office was not engaged in the assessment, including recruitment, initiative, and other city government facilitation, and data analysis. These representatives were not involved in a parents then conducted five focus groups meaningful way. Although the challenge (four with parents and one with of engaging city government leaders providers). The findings echoed some of precluded a significant policy change the same themes that emerged from the effort, the BSSI was able to lay the

groundwork for future policy the Connecticut Department of Children development, as well as contribute to and Families to consider instituting the significant changes in the system of care domestic violence training and use of the for young children exposed to violence protocol statewide.3 in the home. The training and networking Through its focus group studies opportunities offered to Bridgeport’s with service providers and parents, the child-serving agencies served to BSSI identified gaps and barriers in the strengthen collaboration over the five system. This knowledge was used to years of the Safe Start initiative. inform policy makers and service Collaborative relationships grew more providers about how the system of care frequent and reciprocal, leading to actually operated and what needs were service integration across organizations. not currently being met. The BSSI used As an example, the Center for Women the focus group findings to develop and Families and Child FIRST forged a training programs and to make partnership in 2005. Child FIRST recommendations for improving the provides comprehensive, family- system of care. The BSSI-supported centered services to young children and community leadership group (described their families who face multiple, above) is poised to advocate for public complex challenges. Its staff is highly policy changes based on their peer trained in child development and the sharing and the learning generated by the effects of violence and trauma on BSSI. children. As the primary domestic violence service provider in Bridgeport, The BSSI also contributed to a CWF provides crisis services, but not number of system enhancements, long-term counseling for children and leading to better identification of families. In July 2005, the two children exposed to violence in the home organizations began collaborating to and more integrated service provision ensure that all young children at high (see Exhibit II-B for BSSI’s service risk for violence exposure identified delivery model). In working with the through CWF programs would be regional office of the Department of referred to Child FIRST for an Children and Families, BSSI developed assessment and family services. In a protocol for use by Child Protective particular, Child FIRST arranged on-site Services staff to assess the presence of services for families staying in the CWF and impact of domestic violence on domestic violence shelter. This children. After CPS staff attended a partnership has increased the ability of three-day training session, implementation of the protocol in the 3 Statewide implementation is underway. field was tracked for a period of six According to the most recent communication months. The results demonstrated that with the BSSI project director, the Connecticut use of the protocol significantly Department of Children and Families issues a increased CPS investigators’ ability to request for proposals in April 2006 to provide determine when issues of domestic training and support of workers statewide. The Center for Women and Families was awarded violence were present in the home, one of these contracts (training is administered prompting the deputy commissioner of regionally) but other regional efforts are going out to bid again.

both organizations to coordinate care Traumatic Events Screening Inventory and provide clinical services to this (TESI), which all BSSI-funded programs vulnerable population (Bridgeport Safe were required to use to collect specific Start Initiative, 2005c, p. 36). information about the nature and type of 6. Institutionalization of children’s violence exposure. Child Change FIRST also plans to institutionalize the use of BSSI Service Plans, which were For years, Bridgeport lacked a used in the initiative to map out unified voice regarding the needs of children’s service needs and referrals young children and their families. and to collect system-wide data. By Recently, a number of organizations incorporating the Service Plan as part of have spearheaded an effort to develop a its routine assessment process, Child community-wide strategic plan or FIRST will maintain the community’s “blueprint” for serving young children capacity to gather system-level data to and families in Bridgeport. The BSSI address the needs of young children supported this effort, which was led by exposed to family violence (Bridgeport the United Way’s Success by 6 Safe Start Initiative, 2005c, p. 42). Initiative, the Bridgeport Board of Education School Readiness Council, In Bridgeport, workshops the Collaborative Children’s Advisory developed by the BSSI on family Board, and the Bridgeport Discovery violence, safety planning, and the effects Group. The BSSI’s participation was of exposure to violence on young instrumental to incorporating children’s children will be continued as part of the mental health needs, especially as they Center for Women and Families’ relate to children’s exposure to violence, standard community education into the blueprint. In this way, the curriculum. Given its expertise in BSSI’s focus on reducing children’s domestic violence, CWF will exposure to violence and the impact of incorporate training sessions on family that exposure has gained legitimacy violence and the court system, the within a broader change agenda for the effects of violence on children, community. The blueprint is a vehicle by childhood sexual abuse, and the which the community expects to take dynamics of domestic violence and advantage of funding opportunities safety planning. Furthermore, CWF will provided by the governor’s new Early continue to train staff in the Department Childhood Investment Initiative. of Children and Families, the court system, and the Police Department. Some changes in the system of care prompted by BSSI have been institutionalized. The adoption of the domestic violence training and protocol by the Connecticut Department of Children and Families will assist Child Protective Services staff throughout the state in substantiating domestic violence cases where children are present. Child FIRST will continue to use the

Association for the Study and Development of Community 18 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

7. Increased Community were initially referred. For the three Supports program years for which complete data are available, the ratio of recommended- The BSSI helped to create a more to-received services increased from 0.52 supportive community environment for in year one, to 0.56 in year two, to 0.65 serving the needs of young children in year three (Bridgeport Safe Start exposed to violence and their families. Initiative, 2005c, p. 53). These data BSSI’s proactive response to frustration suggest that, over time, families expressed about the lack of engagement experienced fewer service system by community decision makers resulted barriers that prevented them from in the formation of a leadership group, obtaining needed services. through which approximately 40 executive directors and other community Three instruments were used to leaders are discussing ways to improve assess children’s exposure to violence, the system of care through knowledge trauma-related symptoms, and parent sharing and policy action. stress. The Traumatic Events Screening Inventory was used to screen for BSSI’s social marketing exposure to traumatic experiences. The campaign to encourage parents, teachers, Trauma Symptom Checklist for Young day care providers, and other caregivers Children (TSCYC) was used to assess to access resources through InfoLine 2- children’s trauma-related symptoms. The 1-1 successfully engaged the broader Parenting Stress Index was used to community in the process of identifying, examine parental stress. All instruments referring, and accessing services for were administered at baseline and again children exposed to violence. at discharge from services. On average, families participated in services for 6.6 months (Association for the Study and 4 8. Reduced Exposure and Development of Community, 2006b). The number of families for which Impact of Exposure to baseline and discharge data are available Violence varies by instrument. Overall, however, there were observed decreases in By enhancing the system of care, children’s exposure to violence, the the BSSI helped reduce the impact of number of trauma-related symptoms exposure to violence on young children. presented by children, and parenting In part, this was accomplished by stress over time (e.g., between baseline providing mental health services, as well and discharge). For a more detailed as other services as needed. Analysis of summary of the intervention research the BSSI Service Plan data demonstrates findings, see Exhibit II-C. an increase in the ratio of recommended- to-received services as the initiative 9. Conclusion progressed. Each Service Plan documents the services to which clients were referred upon entry into the 4 program, and then follows up with a 90- This information was presented during the Safe Start Demonstration Project National Evaluation day assessment to determine if clients Meeting held May 8-9, 2006. connected to the services to which they

Association for the Study and Development of Community 19 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

The Bridgeport Safe Start • Helped the Department of Initiative promoted better collaboration Children and Families reduce the among service providers by funding number of “false-positive” existing services and by forming children identified as exposed to partnerships with community and violence with the creation of the government agencies to better serve DCF Domestic Violence children six years and younger exposed Protocol; and to violence and their families. The BSSI • Facilitated the creation of a achieved the following while working “blueprint” for a holistic towards its goals: approach to serve young children and their families in Bridgeport. • Trained 1,938 service providers and professionals in recognizing Between 2000 and 2005, the the signs of exposure to violence Bridgeport Safe Start Initiative and its and identifying children exposed partners helped to identify 734 children to violence or at risk of exposure; as exposed to violence, of whom 311 • Launched a social marketing were assessed by a BSSI-funded campaign to train the community program, and 506 were referred to other in the same issues and to educate services. While impact data are limited, them about the services available the BSSI found that, overall, children in in the community, such as services were less prone to experience InfoLine 2-1-1; traumatic events, and that the number of • Formed partnerships with family violence events decreased. There community and government is also evidence that barriers to services organizations (e.g., PARK were reduced, with families receiving a Project and Department of greater proportion of recommended Children and Families, services, as the initiative progressed. respectively), to better serve children and families;

10. References

Association for the Study and Development of Community (2004). Case study: Bridgeport Safe Start Initiative 2004. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2005). Site visit report: Bridgeport Safe Start Initiative January through December 2004. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2006a). Site visit report: Bridgeport Safe Start Demonstration Project January 1 through September 30, 2005. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2006b). Safe Start national evaluation meeting: Meeting notes. Gaithersburg, MD: Author.

Association for the Study and Development of Community 20 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Bridgeport Child Advocacy Coalition (n.d.). Bridgeport Child Advocacy Coalition. Retrieved June 14, 2005 from http://www.bcacct.org

Bridgeport Safe Start Initiative (n.d.). The Bridgeport Safe Start Initiative. Retrieved June 14, 2005 from http://www.cwfefc.org/safe_start.html.

Bridgeport Safe Start Initiative (2003). Bridgeport Safe Start Initiative semi-annual progress report July-December 2003. Bridgeport, CT: Bridgeport Child Advocacy Coalition (Available from the Department of Justice Office of Juvenile Justice and Delinquency Prevention).

Bridgeport Safe Start Initiative (2004). Bridgeport Safe Start Initiative semi-annual progress report July-December 2004. Bridgeport, CT: Bridgeport Child Advocacy Coalition (Available from the Department of Justice Office of Juvenile Justice and Delinquency Prevention). Bridgeport Safe Start Initiative (2005a). Safe start performance measures July-December 2005. Bridgeport, CT: Author (Available from the Department of Justice Office of Juvenile Justice and Delinquency Prevention).

Bridgeport Safe Start Initiative (2005b). 2005 strategic plan. Bridgeport, CT: Author (Available from the Department of Justice Office of Juvenile Justice and Delinquency Prevention).

Bridgeport Safe Start Initiative (2005c). Local evaluation report form. Bridgeport, CT: Author (Available from the Association for the Study and Development of Community).

Connecticut Department of Labor. (2006, April 24). Annual average 2005. Retrieved June 14, 2006 from http://www.ctdol.state.ct.us/lmi/laus/lm05avtn.htm

PARK Project (n.d.). The PARK Project: The partnership for kids. Retrieved June 14, 2005 from http://www.theparkproject.org

U.S. Census Bureau. (2006). State and county quickfacts: data derived from population estimates, 2000 census of population and housing, 1990 census of population and housing, small area income and poverty estimates, county business patterns, 1997 economic census, minority- and women-owned business, building permits, consolidated federal funds report, 1997 census of governments. Retrieved June 14, 2006 from http://quickfacts.census.gov/qfd/states/09/0908000.html

Association for the Study and Development of Community 21 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Exhibit II-A Timeline of Bridgeport Safe Start Initiative Activities and Milestones

Major Milestone 1/02-6/02 7/02-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05

BSSI Bulletin The Center for Women and Families of Eastern Fairfield County, Inc. Court Assessment Project • Domestic Violence Legal On Hold Intervention Trainings Early Childhood Mental Health Program Child and Family Interagency Resource, Support, and Training Program (Child FIRST) Mental Health Consultation Program BSSI Service Providers Trainings BSSI Public Awareness Social

Marketing Campaign BSSI and Bridgeport Discovery Group Classroom Consultation for Early Childhood Providers Initiative Family Violence and Its Effects on

Children Trainings Community Focus Groups Assessments Resource Awareness Project (2-1-1 InfoLine Resource Trainings)

Association for the Study and Development of Community 22 July 2006 DRAFT This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Major Milestone 1/02-6/02 7/02-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05 BSSI Project Director resigned The first project director resigned prior to 2002 during the planning year. Domestic Violence Assessment Project Child Guidance Center of Greater Bridgeport Collaborative Initiative BSSI Symposium Interagency Collaboration Survey

Sources: Bridgeport Safe Start Semi-Annual Progress Report, July-December 2003, January-June 2004, July-December 2004, January-June 2005; Bridgeport local evaluation form 2004; and Bridgeport local evaluation form 2005.

Association for the Study and Development of Community 23 July 2006 DRAFT This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Exhibit II-B

IDENTIFICATION & REFERRAL SOURCES

Community members Mandated reporters Court Advocates Bridgeport Safe Start School Staff Dept. of Children and Families (DCF) Service Delivery Model Center for Women and Families (CWF)*° Child FIRST* Other Mental Health Providers

REFERRAL SOURCES THAT ALSO TREATMENT CONDUCT ASSESSMENT Child FIRST (mental health/family CWF counseling for children and their families) School Staff (CCPˆ) CWF (domestic violence services to women Child FIRST and some support services for children in Other Mental Health Providers shelter) Child Guidance Clinic (mental health) 6 clinicians trained through BSSI Clinical Supervision (home-based clinical services *BSSI funded for children exposed to violence) °Runs the local Domestic Violence Shelter ˆClassroom Consultation Program

Association for the Study and Development of Community 24 July 2006 DRAFT This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Exhibit II-C Bridgeport Safe Start Initiative Intervention Research

Overview

The Bridgeport Safe Start Initiative (BSSI) grantee funded six community-based organizations in an effort to increase service capacity and reduce the impact of exposure to violence on children six years and younger. These organizations included the local domestic violence prevention agency (Center for Women and Families [CWF]) and five mental health serving agencies: Child Guidance (including two programs: Early Childhood Mental Health Program and Child Development-Community Policing), Child FIRST, the Classroom Consultation for Early Childhood Educators, and the Mental Health Consultation Program (Association for the Study and Development of Community, 2004). Funding for the two Child Guidance programs was discontinued, however, due to the difficulty these programs experienced in identifying and providing services to children exposed to violence.

All mental health-serving agencies were required to administer three standardized instruments (the Traumatic Events Screening Inventory [TESI], the Parenting Stress Index/Short Form [PSI/SF], and the Trauma Symptom Checklist for Young Children [TSCYC]) and a patient satisfaction questionnaire at intake and then three months later or at discharge, whichever came first. Results indicated that children experienced a significant decrease in exposure to violence and trauma related symptoms while receiving services, and parents experienced a decrease in stress around parenting related issues.

Method

The BSSI funded programs according to community needs, but focused on the enhancement of services to children exposed to violence. Regardless of the services provided, all agencies were required to collect data on the child victim and to document the service plan developed for individuals at the point of referral. All mental health programs administered the TESI, the PSI, the TSCYC, and the Patient Satisfaction Questionnaire III (PSQ-III). In addition, Child FIRST used the Rochester Safe Start Early Childhood Education Program Survey of Parents to help validate the instrument, and Classroom Consultation for Early Childhood Educators used the Devereux Early Childhood Assessment (DECA) to identify children with socio-emotional concerns. The results of the latter, however, are not included because only five cases were matched at baseline and discharge. Baseline data were collected at the point of intake and then three months later or at discharge, whichever came first.

Sample:

BSSI-funded program staff screened and identified a total of 665 unduplicated children six years and younger in the Bridgeport area. Characteristics of the 248 unduplicated cases served by BSSI-supported mental health programs were reported. The majority of the children served were from a racial/ethnic minority (42.3% Hispanic and

Association for the Study and Development of Community 25 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

32.3% African American), compared to 12.5% described as White. At least 85% of the children were Medicaid eligible (Bridgeport Safe Start Initiative, 2005, p. 64). Procedures:

Mental health clinicians collected data at baseline and at discharge, and entered it into an ACCESS database provided by the evaluation team. De-identified data were sent quarterly and annually to the evaluators, who routinely updated their database as data were submitted. Data gathered by clinicians were analyzed to collect the following:

• Information around children’s exposure to violence o Number of traumatic events experienced by children in their lifetime o Number of family violence traumatic events experienced by children in their lifetime • Information on children’s trauma related symptoms • Information on levels of parenting stress • Information on recommended services vs. services obtained by families

Results

Decreased exposure to violence

BSSI-funded program staff screened and identified a total of 665 children (Bridgeport Safe Start Initiative, 2005, p. 65). Overall, the mental health programs screened at least 222 unduplicated clients. Child FIRST, a primary BSSI-funded mental health provider, screened all children using the Traumatic Events Screening Inventory. According to the most recent data analysis (Association for the Study and Development of Community, 2006), 49 cases were matched at baseline and at discharge using the TESI instrument. The baseline number of events ranged from 1 to 15. The mean number of traumatic events reported at baseline was 3.77 events. The mean number of baseline family violence events was 2.2 events. The mean number of non-family violence events at baseline was 1.5 events. There was a statistically significant decrease in the number of traumatic events experienced by children over time (t = 3.42, p<0.001).

Decreased trauma-related symptoms

A total of 20 matched baseline and discharge Trauma Symptom Checklist for Young Children instruments was administered. For these 20 cases, there was a statistically significant decrease on the posttraumatic stress-intrusion subscale (t = 3.37, p<0.01), the posttraumatic stress-avoidance subscale (t = 2.25, p<0.05), the posttraumatic total subscale (t = 2.33, p<0.05), and the dissociation subscale (t = 2.46, p<0.05), indicating that children’s trauma-related symptoms decreased over time (Association for the Study and Development of Community, 2006).

Association for the Study and Development of Community 26 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Decrease in parenting stress

A total of 45 matched baseline and discharge Parenting Stress Index instruments was administered. For these 45 cases, there was a statistically significant decrease on the parental distress subscale (t = 3.00, p<0.01), indicating a decrease in stress resulting from personal factors directly related to parenting (e.g., impaired sense of parenting competence, lack of social support, presence of depression). There was also a statistically significant decrease on the overall stress scale (t = 2.80, p<0.01; Association for the Study and Development of Community, 2006).

Patient Satisfaction Questionnaire III

Clients completed the PSQ-III at discharge. A total of 43 questionnaires was completed during the first three years of the BSSI. Results showed overall satisfaction with services (93% agreed or strongly agreed that the services were “just about perfect”). Only three families (7%) were disappointed with the services they received. On the other hand, most families (93%) agreed that the system needs improvement (Bridgeport Safe Start Initiative, 2005, p. 72).

Number of Referrals

BSSI-funded program staff documented all services to which families were referred, barriers to receiving services, and whether or not each referred service was received. Over four years, 3,009 services were recommended, and 57% of these services were received (Bridgeport Safe Start Initiative, 2005, p. 68).

Discussion

BSSI-funded services, especially Child FIRST, were successful in working with parents and children to decrease the number of traumatic events in the life of a child and the number of family violence traumatic events. Furthermore, services were successful in reducing a child’s overall exposure to violence. Child FIRST offered families holistic care coordination focused on assessment and referral services; foremost, they ensured that families’ primary needs were met before beginning treatment. Although parents were satisfied with the treatment they received, a lot of work remains to optimize the system of care, as the majority of parents agreed with the statement that the system needs improvement.

References

Association for the Study and Development of Community (2004). Case Study: Bridgeport Safe Start Initiative 2004. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2006). Safe Start national evaluation meeting: Meeting notes. Gaithersburg, MD: Author.

Association for the Study and Development of Community 27 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Bridgeport Safe Start Initiative (2005). Local evaluation report form. Bridgeport, CT: Author (Available from the Association for the Study and Development of Community).

Association for the Study and Development of Community 28 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

III Chatham County Safe Start Initiative

1. Overview specially trained to meet their 1 needs . The Chatham County Safe Start (CCSS) improved the ability of the In the CCSS process, a services county to respond to the needs of coordinator functioned as the centralized children exposed to violence and their point of referral for families and families by formalizing a process to refer children, distributing referrals to direct them to services. Prior to the CCSS service providers who offered services initiative, Chatham County did not have tailored to child and family needs. For a systematic process to identify and refer example, bilingual services, home-based exposed children to the services they therapy, comprehensive therapeutic needed. The CCSS created a centralized services, psychological clinical point of referral for children and utilized assessments, and family advocacy a multi-faceted outreach strategy to services were offered by direct service encourage a wide range of agencies, as providers funded by the CCSS. well as community members, to make referrals. Through a collaborative The CCSS system of partnership, the CCSS helped build the identification and referral operated on capacity of key child-serving the philosophy that there is “no wrong organizations to address the needs of door” for children or families to enter children exposed to violence. As a result the system of care. To operationalize this of these systems change activities, the philosophy, CCSS staff created a CCSS accomplished the following Services Handbook for service providers between May 2002 and December 2005: and community members, which clearly defined the processes to identify, refer, • 447 children exposed to violence and respond to children exposed to were identified by 20 different violence. CCSS staff and partners community sources; educated community residents and • 261 children were assessed by professionals about the identification and the services coordinator or direct

service providers funded by the 1 The numbers of children identified, assessed, CCSS; and and referred are larger than the numbers • 204 children received clinical or officially submitted by Chatham County Safe home-based therapy, and/or Start to the Office of Juvenile Justice and family advocacy services from Delinquency Prevention between January 2003 and October 2005. These revised numbers are direct services providers based on a recent review of the Chatham County Safe Start Client Database for May 2002 to December 2005 by the Association for the Study and Development of Community (ASDC), which is the Safe Start Demonstration Project National Evaluation Team.

Association for the Study and Development of Community 29 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

referral process through targeted community outreach and formal training 1.1 Mission workshops. CCSS staff and partners also facilitated the development of a shared The vision of the CCSS was to definition of violence, which helped to reduce the risk and impact of witnessing create a common language for or experiencing violence for young discussing the impact of exposure to children (8 years and younger) by violence on children. creating safe communities, an integrated system of care, and safe families. How Overall, the CCSS greatly did the CCSS accomplish this mission increased the numbers of children and with what success? What factors identified and increased the number of contributed to and impeded success? children served, to a lesser extent. These questions are addressed in the Between May 2002 and December 2005, following sections and a timeline of CCSS served approximately 25-30% of major events is attached (III-A). the children under nine years of age who witness violence so severe it results in a 1.2 Chatham County, North 2 call to the police . While the CCSS Carolina demonstration project experienced a number of successes, as suggested by The CCSS initiative was planned these numbers, challenges to and implemented within the unique implementation limited its potential context of Chatham County, North impact. For example, institutional Carolina. The following snapshot of restructuring in key state and local Chatham County is intended to help agencies led to turnover in personnel and others interested in replicating Safe Start inconsistent participation in the to compare their own communities to initiative. Low existing community Chatham County. capacity in Chatham County, particularly with regard to serving Chatham County is located in the children and families in at-risk areas, geographic center of North Carolina and limited the availability of mental health encompasses an area of 683 square miles service providers. Turnover in CCSS (U.S. Census Bureau, 2000). Sixteen staff, especially in the critical project percent of the county’s approximately director and services coordinator 58,002 residents (U.S. Census Bureau, positions, created implementation 2006) live within the county’s two challenges as well. Finally, differences towns: Siler City (6,966 citizens) and in philosophical approaches among the Pittsboro (2,226 citizens; North Carolina participating partners created conflicts in Data Center, n.d.). The county’s priorities and implementation hurdles, population is White (82%), Black (15%), some of which were mitigated, others of and Asian (2%). According to the U.S. which continue to challenge the Census Bureau (2006), people of demonstration project. Hispanic or Latino origin account for 11% of the population (double the percentage for North Carolina as a 2 This figure is based on a revised estimate from whole). Safe Start staff indicated that the Chatham County 2002 police call data and 2002 Hispanic population may be larger than data from the local domestic violence agency.

Association for the Study and Development of Community 30 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

11%, however, issues of language, speaking children and families, the culture, and immigration status make it CCSS funded bilingual service providers difficult to survey this population. Six to respond to the growing Latino percent of the population consists of population. children under five years old. The median value of a home in Chatham in Resources for non-profit 2000 was $127,200 and the median prevention and protection services (e.g., household income in 1999 was $42,851 intensive home visitation for children (U.S. Census Bureau, 2004). and their families) and child welfare and family support services were reduced or 2. Contextual Conditions eliminated in North Carolina when funding priorities were shifted to meet CCSS was implemented in a federal mandates against terrorism. The rural context during a time of change for state social services budget decreased by many of the major state and local over 6% in 2002, and continued budget systems that serve children and families. deficits in North Carolina have further These contextual conditions affected the reduced social welfare services (e.g., CCSS and the broader community’s education, mental health, child care, response to children exposed to violence. juvenile justice). Smart Start, a local school readiness initiative for children 2.1 Rural Conditions run by Chatham County Partnership for Children, suffered a 25% funding cut As a small rural community, over the past five years. Finally, as part Chatham County had limited capacity to of a state-wide restructuring of the address challenges to the community mental health system, the state narrowed such as changes in population diversity, the scope of Medicaid-funded early a lack of accessible and affordable intervention services to exclude children public transportation, and inconvenient exposed to violence. Direct service service hours that created barriers to providers funded by the CCSS provided services for children and families. CCSS clinical assessment and in-home and was designed to address these conditions therapeutic services for children and through fully-funded direct services families to fill the gap in services created tailored to children exposed to violence by these budget cuts and changes in the and their families. public mental health system.

The Latino population in Home-based therapy also Chatham County, one of the largest in addressed the lack of accessible and North Carolina, increased 741% between affordable transportation and 1990 and 2000. For the most part, social inconvenient hours of service, which services have inadequately responded to made it difficult for families to access this changing demographic (e.g., no services in Chatham County. Many substance abuse treatment available in people in the county work multiple jobs Spanish, one part-time bilingual case and would prefer to access services worker, one police officer that speaks during evening or weekend hours. Spanish; North Carolina Data Center, n.d). To meet the needs of Spanish-

Association for the Study and Development of Community 31 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

2.2 Changes in State and Local Systems The Orange, Person and Chatham Counties Mental Health Clinic, In 2003, the Chatham County the public mental health agency for Department of Social Services became a Chatham County, was an inconsistent pilot site for the family-focused Multiple collaboration partner because a statewide Response System, greatly facilitating restructuring of the mental health implementation of CCSS. The Multiple services system created uncertainty in Response System allowed Child leadership and resulted in high turnover. Protective Services the opportunity to Orange, Person and Chatham Counties help families keep their children by Mental Health Clinic also had difficulty providing an alternative to removal from keeping their funded bilingual service the home when there were reports of provider position filled and it remained child abuse or neglect. By using a vacant for a year. The CCSS was left to collaborative approach, including in- rely on a small number of private home services and child and family team providers to meet the needs of children meetings, the Multiple Response System and their families. represented a change in philosophy and approach that helped to strengthen Turnover in local political relationships between child welfare and leadership and within local partner other family-focused community agencies also affected the project. On the organizations and agencies, including negative side, on the Board of County the CCSS. The adoption of the Multiple Commissioners, turnover among Response System statewide provided the supporters of early childhood initiatives CCSS with an opportunity to encourage resulted in a shift of agenda away from and assist the Chatham County children exposed to violence, in favor of Department of Social Services in issues of growth and land use, applying to be a pilot site, solidifying the development of water and sewer collaborative relationship between the services, and rural taxation issues. The CCSS and child welfare and helping to turnover of four commissioners (out of a more closely align the Department of total of five) reduced political support Social Services and the mission of the for Safe Start and hindered the ability of CCSS. The consistent and strong the CCSS to impact local policy in participation of the Department of Social Chatham County. Instead of focusing Services in CCSS implementation was efforts on a community level policy reflected in their 132 referrals (the most agenda, therefore, CCSS staff from any agency) and was critical to emphasized the creation of a Services helping families and children access the Handbook to impact agency level coordinated services of the CCSS. procedures related to the identification and referral of children exposed to Other changes in systems and violence. Though practical, this leadership at the state and local levels, approach limited the range of the CCSS however, disrupted existing relationships impact. Past research has shown that with CCSS, slowed the implementation environmental strategies (e.g., state and process, and limited the ability of the local legislation) are critical when trying CCSS to achieve its goals. to impact health-compromising

Association for the Study and Development of Community 32 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

behaviors at the community level and which needed professional and (Birckmayer et al., 2004). active intervention. To develop a working definition of violence for On the other hand, turnover in Chatham County, this feedback was the Department of Social Services had a compiled and integrated with research- positive impact on the CCSS because the based definitions of violence from the incoming director believed in the Centers for Disease Control, the Child mission of CCSS and was invested in Witness to Violence Project, and the the family-focused approach. As a result, National Evaluation Team. The full the Department of Social Services Chatham County definition of violence increased its involvement in community- is available in III-B. based planning and collaborative efforts, and ultimately provided the CCSS with According to CCSS staff and 30% of it referrals for identification or community partners, this process helped services, the most referrals from any to assess community norms around single agency. violent behavior (identifying areas to be targeted for change) and created a common awareness and understanding 3. Community Capacity of “children’s exposure to violence.” This common understanding was necessary as a first step to engage Despite challenges presented by community partners for both a rural context and reorganization of collaboration and referrals. Additionally, public mental health agencies at the state the early investment in developing this and local levels, the CCSS built a greater common definition facilitated capacity to serve children and families communication among CCSS staff exposed to violence by facilitating the throughout the life of the initiative, development of a shared definition of allowing time and energy to be spent on violence and creating a mechanism to planning and implementation activities track the identification and referral of rather than on resolving confusion or children exposed to violence in Chatham miscommunication around the focus of County. The CCSS was able to augment the initiative. the relatively low existing capacity of the community, and more importantly, With support from the National begin to integrate and link services Civic League, the CCSS developed the through its centralized identification and community capacity to track referral system. identification and referral of children exposed to violence by creating and Prior to CCSS, the community using a computerized tracking and did not have a common language to monitoring system. The Chatham discuss the impact of violence exposure County Partnership for Children’s on children. The CCSS engaged in an executive director attended the Unified extensive process (from November 2001 Fiscal Planning Peer-to-Peer Meeting to to May 2002) of soliciting feedback learn how a database for managed care from professionals and community could serve as a tool for utilizing members regarding which types of blended funding. Consequently, the negative acts were considered tolerable

Association for the Study and Development of Community 33 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

CCSS contracted with a computer members through a local outreach specialist to create a database for coordinator and social marketing tracking and monitoring children campaigns. Local agencies also were exposed to violence. This database was engaged in initial planning efforts used to extract complete and accurate through strategic planning work groups; data, which CCSS staff used to apply for agencies invested in the process additional funding from a variety of continued on with Safe Start by sources to sustain critical elements of the participating in the CCSS collaboration. CCSS project. Although the CCSS was not awarded all of the funding that it 4.1 Engaging Professionals sought, this system offered the initiative the capacity to track information in a Between 2000 and 2005, the way that was relevant to both the CCSS CCSS conducted extensive training with and funders, and may help the CCSS professionals to raise awareness of initiative procure future funding for violence exposure issues and to engage services for children exposed to the professional community in the violence. identification and referral of exposed children. Professionals attended multiple To develop these capacities, the trainings and the attendance at these CCSS engaged the assistance of support at trainings totaled 3,455. Additionally, the both the national level (e.g., National CCSS conducted 53 small group Civic League) and the local level (e.g., trainings for CCSS staff and community professionals, community residents, and partners. These trainings resulted in 447 agencies and organizations). Strategies to referrals to CCSS from 20 different engage local agencies and community community sources, including social members are discussed next. services, domestic violence agencies, law enforcement, parents, direct service providers, schools, and child care 4. Local Agency and providers. To increase service providers’ Community Engagement capacity to serve the diverse population and Collaboration of Chatham County, the CCSS also funded specialized training on the

treatment of children (e.g., trauma and For the CCSS to achieve its loss in children certification training), on goals, it was critical for the initiative to the effects of exposure to violence on engage local professionals, parents and brain development and child community residents, and agencies and development, on marriage counseling, organizations. Initial engagement of the and on culturally competent practice professional community was achieved (e.g., Best Practices for Serving the during the early assessment and planning Latino Population). The CCSS also phases of CCSS and continued through offered Safe Havens training to child CCSS-sponsored trainings. Community care providers and teachers and hosted stakeholders also participated in the an annual Focus on Child Care initial community assessment, and in Conference, which included issues community forums to inform planning related to children’s exposure to and implementation. The CCSS violence on its agenda. continued to reach out to community

Association for the Study and Development of Community 34 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

• Conducting presentations to 4.2 Engaging Parents and ministers from the faith Community Residents community, • Publishing a Spanish newsletter The CCSS conducted outreach to on children and violence, communities through partnering • Participating in community agencies and an outreach coordinator. events, Having identified the faith community as • Contacting 19 local businesses to an important avenue for reaching solicit their support in reaching community members in a rural setting, employees and customers and The CCSS supported Family Violence distributing literature about Safe and Rape Crisis Center/Coalition for Start, and Family Peace prayer breakfasts, • Participating as a monthly guest conferences, and other activities as a on a Spanish radio show (“La way to engage faith communities and Charla”) beginning in June 2004. help them train youth and young adults to develop healthy relationships and The outreach coordinator was prevent domestic violence. Members of successful in engaging families from the the faith community attended multiple targeted neighborhoods, especially activities and attendance at these Spanish-speaking families. The activities totaled 600. community outreach efforts increased the number of residents informed of Safe Beginning in 2004, the CCSS Start, with one out of every two residents also conducted outreach through a having heard of Safe Start (Cole, G., community outreach coordinator, to 2005).3 Almost half (46%) of all Safe engage the Hispanic community in two Start clients lived in Siler City (one of high risk neighborhoods in Siler City. the locations targeted by the outreach Originally, CCSS staff and partners had coordinator), and 35% were Spanish- envisioned extensive community speaking. outreach across the county. Due to competing priorities and staff turnover, however, the initiative was unable to initiate their community development and outreach program and hire the outreach coordinator until October 2004, which limited their focused outreach efforts to two targeted neighborhoods. The outreach activities included:

• Going door-to-door on a biweekly basis to talk with parents and distribute literature on issues related to exposure to violence,

3 Preliminary results from the Neighborhood Listening Survey conducted by Chatham County Safe Start.

Association for the Study and Development of Community 35 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Although the CCSS focused authority to make decisions on the outreach efforts on two target areas, the strategic direction of the initiative initiative also worked to increase (Association for the Study and countywide community awareness by: Development of Community, 2005b). Members reported that their decision • Sponsoring public awareness making authority began to diminish events for the prevention of child when program implementation began, abuse and neglect (e.g., family during the second and third years of the festivals, blue ribbon campaigns) project. While members were kept in coordination with Allies for informed, they did not have an active Chatham Children, a multi- role in decision making. Frustrated by agency group focused on this artificial division between planning preventing child abuse in and implementation, members raised the Chatham; issue with the lead agency, the Chatham • Organizing public awareness County Partnership for Children. The events for Domestic Violence partners then participated in Awareness Month in collaboration training, which greatly collaboration with the Coalition enhanced the participatory process. for Family Peace (Chatham During the end of year four and County Safe Start Initiative, throughout year five of the initiative, 2004); and collaboration members once again took a • Sponsoring booths at 19 street more active role in the decision making fairs in Pittsboro and Siler City process. Unfortunately, the tension between May 2001 and October between collaboration members and the 2005. lead agency may have slowed the progress of the CCSS during a crucial It is difficult to determine what point in implementation. impact these activities had on countywide community awareness or The CCSS collaboration partners tolerance of violence because included key agencies from the law countywide data were not collected. enforcement, social services, public health, and domestic violence sectors, 4.3 Engaging Collaboration specifically the following community Partners members and agencies: the Chatham County Partnership for Children; the The CCSS engaged partners in Department of Social Services; the group-based collaboration through a Family Violence and Rape Crisis Center; Memorandum of Agreement; the Board the Public Health Department; Chatham of Directors of the Chatham County Counseling; Orange, Person and Partnership for Children maintained Chatham Counties Mental Health Clinic; oversight of the initiative. During the and individual direct service providers. first year of the collaboration, partners The courts, Chatham County Public were an integral part of the decision Schools, and law enforcement agencies making process. After the planning (i.e., Chatham County Sheriff’s Office phase, however, collaboration partners and Pittsboro Police Department) found it difficult to maintain the participated to a lesser degree.

Association for the Study and Development of Community 36 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

on service delivery and coordination The model that the CCSS because turnover in both staff and selected to improve service delivery and leadership in the child-serving systems coordination used partnerships in the in Chatham County made it difficult for collaboration for planning, decision agencies to collaborate. making, and referral of children and families for services; this model proved Although the CCSS did not ineffective in helping the CCSS integrate improve collaboration between agencies the system of care for children and in Chatham County, the initiative did families. The system of care in Chatham engage in efforts to improve the system County before CCSS was described as a of care for children. These activities are “collection of services” rather than a discussed next. “coordinated and integrated system of services.” Although the CCSS developed a mechanism to guide case design, 5. System Change Activities planning, and coordination, this mechanism did not encourage The CCSS developed and refined interagency communication and a system of identification and referral information sharing or change the that encouraged a range of agencies and existing “one-way” relationships community members to make referrals, between agencies (i.e., child-serving used a centralized point of referral to community partners did not experience connect those referred to service any change in level of collaboration or providers, and expanded and enhanced formal processes of interaction). existing services to meet the unique needs of the community. A diagram of Evidence from the network the CCSS identification, referral, and analysis of collaboration between child- treatment model is attached (Exhibit III- 4 serving agencies in Chatham supports C). As a result of these systems change this observation, indicating that no activities, the CCSS accomplished the meaningful change occurred in the following between May 2002 and amount of collaboration between child- December 2005: serving agencies, their perceived productivity, or their importance to each • 447 children exposed to violence other over the life of the initiative. were identified by 20 different community sources; The collaboration that seemed to • 261 children were assessed by occur depended on positive relationships the services coordinator or direct between individuals in different service providers funded by the organizations, making it vulnerable to CCSS; and staff turnover. Thus, CCSS collaboration • 204 children received clinical or may not have had the expected impact home-based therapy and/or family advocacy services from

4 Results of the Chatham County Safe Start direct services providers Network Analysis indicated that the level of specially trained to meet their collaboration between key child-serving agencies needs. in Chatham County did not change as a result of Chatham County Safe Start efforts.

Association for the Study and Development of Community 37 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

In addition, the CCSS created the residents. This represented a significant foundation to improve the court’s accomplishment in that, prior to CCSS, responsiveness to children and families no agency or system routinely identified involved in violent events through a children exposed to violence or at risk comprehensive court assessment and for exposure. support of a supervised visitation program. To help identify and refer families to the CCSS service 5.1 Identification from Multiple coordination system, the initiative also Points of Entry funded a Family Responder position to answer all domestic violence calls with In the vision of the CCSS, Sheriff’s Office deputies. This position “whenever and wherever a Chatham increased police awareness of children at County child is a victim or witness of a the scene of domestic violence and violent event, a coordinated community improved the ability of law enforcement system responds to the needs of that to refer to the CCSS service coordination child, so that every child has the system, as evidenced by 102 referrals opportunity to grow healthy and strong” (third most frequent referral source, (Chatham County Safe Start Initiative, constituting 23% of referrals to CCSS). 2004). This vision guided the planning On the other hand, this position and implementation of system change exacerbated existing tensions between activities. domestic violence and social service sectors created by philosophical The CCSS paved the way for differences between the mother’s rights identification of children exposed to and the child’s need for safety. Because violence in Chatham County by of the serious nature of the situations identifying economically disadvantaged that the Family Responder encountered, neighborhoods with a high incidence of he/she directed many referrals to children exposed to violence through an traditional child welfare services rather analysis of police data (Chatham County than to the CCSS services coordinator. Safe Start Initiative, 2001).5 This proved frustrating to the domestic violence advocates who believe that As previously mentioned, both removing a child from a home that community residents and professionals exposed him/her to domestic violence in Chatham County were informed about will further punish the domestic violence how to identify and refer children victim making it difficult for him/her to exposed to violence. The CCSS received seek help. The large number of referrals referrals from 20 different sources in the to child welfare services not only community, including social services, exacerbated existing tensions and law enforcement, and domestic violence negatively impacted the ability of some agencies, as well as community key partners to work together on CCSS activities, but also made it difficult for

5 the CCSS to maintain a steady stream of More information can be found about this effort referrals from the Family Responder. in the Police Call Data Study in the Chatham County Safe Start Strategic Plan, 2001 submitted by Chatham County Safe Start to the Office of Juvenile Justice and Delinquency Prevention.

Association for the Study and Development of Community 38 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

On the other hand, by acting as a coordination system; turnover in the bridge between law enforcement and services coordinator position created child welfare, the Family Responder insufficient follow-up with referral strengthened the relationship between sources and delayed initial contact with these two sectors, which helped them to parents which decreased the likelihood build trust and work together more they would accept Safe Start services. efficiently. This improved relationship However, the services coordinator hired led to improved response time of child in year three was able to implement a welfare to calls from law enforcement more efficient service coordination and increased support offered by law system. enforcement to child welfare workers (e.g., escort services to dangerous Turnover also occurred in the situations, testifying for child welfare CCSS project director position. The case; Chatham County Safe Start second project director was hired in Initiative, 2005). 2003; her leadership was considered an asset to the project because she helped to 5.2 Centralized Referral Point repair relationships damaged by inconsistency and confusion during the To complement its identification initial implementation of the and referral system, the CCSS identification, referral, and service established a services coordinator coordination process. Even so, position to receive referrals and connect philosophical differences and pre- children and families to a group of existing tensions between the social CCSS-funded service providers specially services and domestic violence sectors— trained to meet their needs. two of the three sectors that provided the majority of referrals to CCSS—may To facilitate the referral process have hindered the ability of the CCSS to and support service coordination, the maintain a steady stream of referrals CCSS developed a Services Handbook, from law enforcement (i.e., Family available in Spanish and English, which Responder) and domestic violence included key documents such as a the agencies. CCSS Clients Rights Brochure, Confidentiality Policy and Agreement, 5.3 Expanded and Enhanced Grievance Policy and Procedures, and Services Client Record Policy and Procedures. The Handbook was used as a training The sparse population density and information dissemination tool for and rural geography of Chatham County community residents and professionals. made it difficult to coordinate and The CCSS also produced a condensed provide services to families. The local five-page version of the handbook public mental health agency did not entitled Identification and Referral serve children ages 0 to 3. In addition, Guide to streamline the information for the number of service providers was service providers. insufficient to meet the needs across the county; any one service provider in The services coordinator was a Chatham County had insufficient the critical element of the service capacity to adequately serve the entire

Association for the Study and Development of Community 39 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

county. In response to these challenges, fully funded. Thus, families and children the CCSS worked with a diverse group who did not meet the new, more narrow of local public and private direct service Medicaid eligibility for mental health providers to tailor services to meet services and/or could not afford to pay community needs and increase access to were still able to take advantage of services for children and families. CCSS services. Specifically: The quality of service • Child, couples, and family coordination was improved by engaging therapy for the Spanish-speaking CCSS-funded service providers in population were provided by ongoing discussions to refine the bilingual service providers from centralized referral process; as a result of the Family Violence and Rape feedback from service providers, service Crisis Center; coordination was streamlined, and • In-home counseling and parent children and families received services education were offered by the more quickly. Also to improve quality of Healthy Families Program of the services, the CCSS brought direct Chatham County Health service providers and the services Department and the Family coordinator together on a regular basis to Violence and Rape Crisis Center. share information and treatment Intensive, home-based, multi- strategies at Case Management Team systemic therapy was offered by meetings. Prior to CCSS, direct service a local private provider. Home- providers in Chatham County had a based services helped to decrease strong desire to work together, but joint the stigma of mental health case planning was difficult because each treatment that families in a small organization had its own focus, 6 community face, as well as treatment goals, and funding sources. making services available at a time and place that In addition to expanding the accommodated parents’ work scope and improving the quality of schedules, daily routines, and services in Chatham County, the CCSS family needs; and improved the system’s ability to engage • Child and adult psychotherapy families by carefully addressing their using multiple therapy concerns about privacy and techniques (e.g., play therapy, confidentiality. To safeguard privacy cognitive behavioral, and and confidentiality, the CCSS closed psychodynamic) were offered by Case Management Team meetings to a local private service provider, collaboration partners and removed all Carolina Outreach, and Chatham community partner information from Counseling Center to fill a gap in consent forms. Families were educated therapeutic services in Chatham on their right to confidentiality and County. privacy through a Clients Rights Brochure, Confidentiality Policy and The CCSS was able to expand the availability of services to families 6 This information is based on a review of and children because its services were records to explore case level collaboration that existed prior to Chatham County Safe Start.

Association for the Study and Development of Community 40 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Agreement, Grievance Policy and Procedures, and Client Record Policy and Procedures. The development of Client Record Policy and Procedures also improved the consistency of client data collected by the CCSS .

Association for the Study and Development of Community 41 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

5.4 Responsiveness of the Court The CCSS was successful in System institutionalizing several changes to the system of care in Chatham County,7 and With support from the National in November 2005 was approved to Civic League, the CCSS completed an receive a Congressional Appropriation assessment of strengths, weaknesses, and Earmark for $150,000 to continue areas for possible future reform in funding CCSS staff. Although Chatham’s child welfare court system. institutionalization of change occurred at The assessment created a mechanism for both the system and agency level as well the court and the Department of Social as at the point of service, the CCSS Services to work together on systems model of service delivery and reform to improve their responses to coordination is ultimately sustainable children exposed to violence. The only if the services coordinator position assessment was completed in 2005, and continues to be funded. the CCSS has set aside some of its remaining funds to dedicate to future 6.1 System and Agency Change reforms. The CCSS developed a Additionally, supervised mechanism to collect data needed to visitation for families in Chatham apply for additional funding to sustain County will be funded as a result of a critical elements of the initiative. For grant, which CCSS staff helped to write, example, the Child Well-Being from Safe Havens Grant Program Collaborative agreed to fund in-home established by the Violence Against services in Chatham County based on Women Act of 2000. The CCSS will single-subject research conducted by the continue to support the supervised CCSS . The Child Well-Being visitation program by offering training to Collaborative was formed by the county supervised visitation staff through the in 2004 to monitor the mental health Community Peace Training Committee needs of children during the process of and the Court Development Workgroup, restructuring the local mental heath and the Executive Director of the services system. It is also charged with Chatham County Partnership for disbursing community alternative funds Children will continue to serve on the made available through the mental Advisory Committee of Family health reform. Visitation Services. 6.2 Point of Service In addition to court reform and supervised visitation, several other The CCSS impacted the point of changes created by the CCSS will be service in Chatham County by sustained. These changes are discussed next. 7 Chatham County Safe Start made efforts to plan for sustainability through funds provided by the Child Well-Being Collaborative, as well as national support from McCoy Associates and 6. Institutionalization of Systems Improvement Training and Technical Change Assistance Program, which assisted Chatham County Safe Start with their Resource Development Plan.

Association for the Study and Development of Community 42 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

increasing professional awareness of children and violence contributed to this issues related to children and violence; increased awareness. infusing the vision, mission, and focus of the CCSS into other agencies; and The vision and mission of the providing a mechanism for collaborative CCSS was infused into other agencies. case management that will continue to For example, the CCSS collaborated be used by service providers. with El Futuro, a non-profit established in 2005 to provide culturally competent Professionals in Chatham gained bilingual mental health services to an increased awareness and knowledge Latinos in Chatham and Orange of the system of care and issues related Counties. The CCSS helped El Futuro to children exposed to violence, which plan and develop services appropriate to will remain in the community after the mental health needs of children CCSS funding ends, as evidenced by the exposed to violence; these services will following comments:8 continue to be offered after Safe Start funding ends. In addition, the • “We are aware of the problems Community Peace Training Committee that we face in Chatham of the Family Violence and Rape Crisis County.” Center volunteered to maintain a focus • “Community professionals on children exposed to violence in its perceive [children exposed to trainings, because the committee had violence] as a problem and have participated in implementing CCSS responded through the creation training during the initiative. of new positions and services.” • “[Coalition for Family Peace Direct service providers funded staff] used to just focus on the by the CCSS are transitioning into adult and not think about the community agencies and will continue to child. There is greater awareness participate in Case Management Team of how domestic violence meetings, unfunded, to maintain the impacts children. When mothers improved quality of services for families complain about their children’s and children exposed to violence. behavior problems, the workers model appropriate parenting As a result of systems change techniques. Women are starting activities, the CCSS has increased to change. Children are also community supports for children and changing. At our last blue ribbon families exposed to violence. campaign in April, children understood the significance of the ribbon. One child said, ‘They 7. Increased Community don’t have to spank me.’” Supports

The extensive training of The CCSS increased supports professionals on issues related to and services for children and families exposed to violence through its efforts to 8 These comments were made during a focus coordinate and expand services, as well group of professionals in Chatham, conducted in 2003. as through its focus on educating

Association for the Study and Development of Community 43 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

professionals and community members with cases that would otherwise not have on how to identify and refer children been serious enough to qualify for social exposed to violence. Increased services. Additionally, the CCSS community supports resulted in: worked collaboratively with the Sheriff’s Office to fund a Family Responder • Professionals who received position (social worker) to accompany training from the CCSS and police officers to the scene of calls increased their knowledge of involving violence and children. This issues related to the identification position helped to expand the capacity of and treatment of children the domestic violence unit within the exposed to violence; and Sheriff’s Office, which consisted of a • Expanded, enhanced, and better single officer. The CCSS funded the coordinated services to identify Family Violence and Rape Crisis Center and treat children and families to provide home-based family advocacy exposed to violence, whereby the services to meet the needs of children CCSS identified 447 children and families exposed to violence. These through 20 different referral three partners provided the majority of sources, assessed 261 children, referrals to the CCSS for assessment and referred 204 children and/or services: exposed to violence to treatment. • The Department of Social The CCSS was able to identify Services referred 132 children and serve these children because several (30%); key child-serving institutions (i.e., social • The Chatham County Sheriff’s service, law enforcement, and domestic Office referred 102 children violence agencies) were committed to (23%); and helping children, and the CCSS offered • Domestic violence agencies these agencies resources to fulfill their referred 100 children (22%). commitment. However, the quality and Law enforcement, social service, efficiency of service coordination was and domestic violence agencies in inconsistent because of limited Chatham County demonstrated their community capacity, and CCSS staff commitment to helping children through turnover. As previously mentioned, their participation in the CCSS restructuring and/or leadership turnover collaboration and through the referrals in the public mental health system, that they made. public school system, Sheriff’s Office, local police department disrupted The CCSS offered these existing relationships and made it agencies resources that helped to difficult for the CCSS to consistently improve their capacity to meet the needs engage these partners in the service of children exposed to violence. As coordination system. Pre-existing previously mentioned, pilot-testing of tensions between social services and the Multiple Response System expanded domestic violence agencies were the Department of Social Services’ exacerbated as a result of the Family capacity to meet the needs of families Responder, a position funded by the

Association for the Study and Development of Community 44 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

CCSS , contributing to inconsistent relationship with clients. Single-subject referrals from law enforcement and data indicated that interventions tailored domestic violence agencies to the CCSS to the unique needs of children and services coordinator. families are related to positive changes in the conditions associated with The limited community capacity violence exposure. To measure progress of a small rural community like toward case goals, service providers Chatham, which was further limited by tracked indicators that clients were cuts to funding for social services, made meeting objectives related to their goals. it difficult for overburdened systems to By August 2005, clients had completed find the time, resources, or staff to 75 (78%) of established objectives participate in CCSS activities. The Safe successfully, a statistically significant Start project director and services finding.9 However, threats to validity coordinator positions each turned over and limitations of the study make it three times during the life of the difficult to establish a causal link initiative. This turnover created between the services funded by CCSS inconsistency and confusion during the and a positive change in target initial implementation of the child conditions. More information on the identification, referral, and service intervention research conducted by the coordination aspect of the project and CCSS is available in III D. damaged relationships between the CCSS and referring community sources. Although changes in the rates of Although the CCSS worked to repair abuse, neglect, and violent crime from these relationships, the initiative’s ability 2000 to 2004 cannot be attributed to to impact the system of care in Chatham CCSS, there were positive trends in the County was reduced. total number of child abuse and neglect reports in Chatham (27% decrease), total Nevertheless, the CCSS number of substantiated cases of child demonstrated a viable way to reduce the abuse and neglect (25.5% decrease), and impact of exposure to violence for violent crime rate (5% decrease), children and their families, discussed following the implementation of CCSS. next.

9. Conclusions 8. Reduced Exposure to Violence and Impact of The planning and Exposure to Violence implementation of CCSS was guided by the vision that a coordinated community The CCSS demonstrated that system can best serve the needs of direct services tailored to family needs children who are victims or witnesses of are an effective way to reduce the impact violence. To realize this vision, the of exposure to violence on children and CCSS worked to create safe their families (see Exhibit III-D). By communities, an integrated system of tailoring intervention strategies, the CCSS offered service providers the 9 opportunity to sustain a therapeutic Statistical significance suggests that it is highly unlikely the improvement occurred by chance.

Association for the Study and Development of Community 45 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

care, and safe families. The CCSS was families. The greatest challenge that the successful in (1) developing an CCSS will face in the future is finding identification system that allowed funding to continue the services referral from any point of entry, (2) coordinator position, which is key to establishing a centralized referral point, sustaining the CCSS model of service and (3) enhancing and expanding coordination and delivery. After CCSS existing services to meet community funding ends, services in Chatham needs. County will continue to be expanded and enhanced through home-based therapy The greatest challenge that the funded by the Child Well-Being CCSS faced was the change and Collaborative and continued reorganization in major child-serving opportunities for service providers to systems at the statewide and local levels. share information and treatment The rural conditions of the community strategies through Case Management also challenged project design and Team meetings. The greatest footprint implementation, but the CCSS that the CCSS will leave, however, is successfully tailored direct services to increased awareness of issues related to meet the unique needs of a rural children exposed to violence in the community, offering home-based professional and targeted communities. therapy, bilingual services, and comprehensive therapeutic services for

10. References

Association for the Study and Development of Community (2005a). Site visit report: Chatham County Safe Start Demonstration Project January 1 through December 31, 2004. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2005b). Site visit report: Chatham County Safe Start Demonstration Project January 1 through October 15, 2005. Gaithersburg, MD: Author.

Birckmayer, J.D., Holder, H.D., Yacoubian, G.S., & Friend, K.B. (2004). A general causal model to guide alcohol, tobacco and illicit drug prevention: Assessing the research evidence. Journal of Drug Education, 34(2), 121-153.

Chatham County Safe Start Initiative (2001). Chatham County Safe Start Strategic Plan. Pittsboro, NC: Author (Available from the Department of Justice Office of Juvenile Justice and Delinquency Prevention).

Chatham County Safe Start Initiative (2004). Strategic Plan Phase V: November 1, 2004- October 31, 2005. Chatham County, NC: Author (Available from the Department of Justice Office of Juvenile Justice and Delinquency Prevention).

Association for the Study and Development of Community 46 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Chatham County Safe Start Initiative (2005). Local evaluation report form. Pittsboro, NC: Author (Available from the Association for the Study and Development of Community).

Cole, G. (2005). Final report on the effectiveness of safe start’s efforts to develop self- efficacy in a community at risk of violence. Pittsboro, NC: Chatham County Safe Start Initiative.

North Carolina Data Center (n.d.). North Carolina state demographics. Retrieved June 14, 2006 from http://demog.state.nc.us/

U.S. Census Bureau. (2000). 2000 U.S. Census. Retrieved June 14, 2006 from http://www.census.gov/main/www/cen2000.html

U.S. Census Bureau. (n.d.). North Carolina quicklinks. Retrieved June 14, 2006 from http://quickfacts.census.gov/qfd/states/37000.htm

Association for the Study and Development of Community 47 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Exhibit III-A Timeline of Chatham County Safe Start Initiative Activities and Milestones

Major Milestones 1/01-6/01 7/01-12/01 1/02-6/02 7/02/-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05

Definition of Violence constructed Direct service providers funded to provide services to families and children • Hired three direct service providers and contracted with four agencies in targeted communities • Contracted with seven direct service providers Case Management Team (formed and ongoing) Services Handbook (revised annually) Family Responder position Neighborhood listening project Community outreach activities • Participation on a Spanish radio show • Presentations to faith community and Hispanic community • Published Spanish newsletter on children and violence • Sponsored booths at local street fairs • Public awareness events with Allies for Chatham (e.g., family festivals) • Domestic Violence Awareness

Association for the Study and Development of Community 48 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Major Milestones 1/01-6/01 7/01-12/01 1/02-6/02 7/02/-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05

Month events with Coalition for Family Peace Judicial forums Court assessment Database to monitor children exposed to violence created and revised Child Witness to Violence Project OJJDP no-cost extension approved Received funding for in-home services from Child Well-Being Collaborative Congressional Appropriation Earmark for $150,000 approved CCSS Project Director position filled Project Director resigned CCSS Services Coordinator position filled Services Coordinator resigned CCSS Community Outreach Coordinator position filled Community Outreach Coordinator resigned

Sources: Local Evaluation Report Form, 2004 & 2005; Evaluation Plan 2004; Progress Reports, January-June 2002, January-June 2003, July-December 2003, January-June 2004, July-December 2004, January-June 2005, July-December 2005.

Association for the Study and Development of Community 49 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Exhibit III-B Chatham County Definition of the Type of Violence that Requires Professional Intervention

Professionals and community members in Chatham County agreed that professional intervention is necessary if a child experiences or witnesses any of the following:

• Persistent verbal or physical harassment, such as bullying and threatening, toward the child or others in the child’s environment; • Punching with a closed fist; • Hitting with an open hand with enough force to physically move any body part of the victim; • Physical contact of any type that is hurtful to the victim and/or leaves a mark or indication that lasts more than 12 to 24 hours, but may not require medical attention; • Throwing objects at people and destruction of property around people; • Threatening serious violence (including homicide and suicide), threatening with weapons, or display of weapons associated with violent language and/or behavior; • Sexual harassment (inappropriate touching and/or sexual language); • Sexual abuse as defined by NC statute; • Child exposure to violent sexual activity, including pornography; and • Animal abuse.

Association for the Study and Development of Community 50 July 2006 DRAFT This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Exhibit III-C Chatham County Safe Start Service Delivery Model

REDUCE

EXPOSURE REDUCE IMPACT DSP

Clinical Other Services

Court C OPC E In-home Therapy V (Paul Tierney) CMT Case E W Coordination X I Family Service S In-home Therapy Goal 1: Law Coordinator P T Responder C (Carolina Outrch.) Strengthen Enforcement R O N FVRC Therapy Neighborhoods E S E E Closure Family Advocacy Activities E S N Refuse S.S. I Clinical Therapy D S Community N (Paula Browder) Goal 2: Communi G Provide/Enhance Child Service ty Family Allies C Coordination Services

I Professional L B Education and Training D O Child

Protective CRT/ R T Law CPS C P S Sub- Services Child G.A.L E Enforcement/ INTAKE INVST. stantiated Lay Education H Protection N Community and Training V Team

I C NOT INVST. Unsubstantiated Other FOSTER T Services I CARE/ ADOPTION M Goal 3: Enhance System CLOSURE

TIME

Community I.D. Safe Start- CPS/Child Other Decision or Community Care Primary Primary Secondary Primary CPS Case and Referral funded Service Welfare Service Community Decision Point Management Safe Start CPS/Child (Conditional) Management Source Service Mechanism Case Flow Welfare Case Case Flow Information Flow Flow Association for the Study and DevelopmentThis document of Community is a research report submitted to the U.S. Department of Justice. This report has not 51 been published by the Department. Opinions or points of view expressed are those of the author(s) July 2006 DRAFT and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Exhibit III-D Chatham County Safe Start Intervention Research

Overview

The Chatham County Safe Start (CCSS) funded nine direct service providers from the Chatham County Health Department, Family Violence and Rape Crisis Center, Chatham Counseling, Carolina Outreach, and two private practices to provide intervention services to reduce the impact of exposure to violence on children and their families. To evaluate the effectiveness of the services, each of which used different intervention models, single-subject data for 37 cases were collected by five providers (three from the Family Violence and Rape Crisis Center, one in private practice, and one from Carolina Outreach) and analyzed by the CCSS local evaluator. Only five of the nine service providers funded by the CCSS provided single-subject research data because it was difficult to consistently obtain data from veteran counselors and service providers who were resistant to incorporating single-subject research into their existing treatment strategies and case management. The data collection methods and results are discussed in further detail below.

Method

The local evaluator trained direct service providers to design and implement a single-subject study for each intervention model, to enter their single-subject data into an Excel database, and to conduct the graphical analysis of single-subject data needed to inform clinical or case decision-making using simple math. Additionally, technical assistance for single-subject research design was integrated into Case Management Team meetings.

Interventions were implemented at the family and individual level to reduce risk factors for family violence, while increasing protective factors. Of the 56 cases for which single-subject research data were collected, 37 included sufficient data to conduct an analysis of case objectives. Of the cases reviewed for the research study, 27 were closed and therefore included sufficient information about functioning before, during, and after the intervention; ten were open cases and therefore included information about functioning only before and during the intervention.

Sample

Cases consisted of parents and children, with a range of one to three clients per case (M=1.3). Hispanic mothers less than 30 years of age with exposure to domestic violence were the most frequently identified adult clients. Services funded by the CCSS that were evaluated using the single-subject research design included:

• In-home family counseling and parent education provided by the Family Advocacy Program of the Family Violence and Rape Crisis Center;

Association for the Study and Development of Community 52 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

• Individual child therapy provided by the Bilingual Child Therapy Program of the Family Violence and Rape Crisis Center; • Family, couples, and/or child therapy provided by the Bilingual Couples and Family Therapy Program of the Family Violence and Rape Crisis Center; • Individual adult and/or child therapy provided by the Carolina Outreach organization, a private provider; and • Multi-systemic therapy provided to families by the Intensive Home-based Therapy Program, a private provider.

Procedure

Single-subject research design was used to evaluate the effectiveness of services, because each service was based on a different model of practice and was focused on a certain set of effects or types of client. Data on case goals were collected for a minimum of seven data points in three phases: (1) prior to the intervention, (2) during the course of the intervention, and (3) following the termination of the intervention.

Direct service providers collected information on the most important intervention goals (e.g., improve the child’s mental health), objectives by goals (e.g., reduce traumatic rage), and each objective’s indicator or measure (e.g., mother’s weekly count of the number of child’s tantrums). Additionally, client demographic information and descriptive information on services received were recorded by direct service providers.

The data for each phase were entered into Excel, and a line graph was generated to show changes in indicators over time. To confirm the belief that the intervention was successful in changing the desired behavior (e.g., number of child’s tantrums), service providers also plotted a trend line for each period of research.

The local evaluator conducted two additional analyses to confirm the service providers’ findings:

• Linear regression, a statistical technique performed using SPSS, to identify any relationship between the frequency of the behavior (e.g., child’s tantrums) and the passage of time; and • A review of the written case materials to determine if any changes in the client’s life corresponded with the observed changes in behavior.

Results

Service providers reported a total of 52 case goals, including improvement in: child behavior management (33%), child mental health (19%), adult interpersonal relationships (13%), adult mental health (13%), parenting confidence (11%), adult/child interpersonal relationships (4%), communication (4%), and child safety (2%). To meet those goals, service providers reported 96 objectives. The most frequently reported objectives were reduction in negative behavior (29%); increase in positive interpersonal interactions

Association for the Study and Development of Community 53 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

(8%), emotional expressiveness (7%), and parenting confidence (6%); and reduction in worry related to PTSD (5%), sleep disturbance related to PTSD (5%), and anger (4%).

Clients completed 75 of the objectives successfully (78%), a statistically significant finding.10 A chi-square analysis revealed that the success of clients was not contingent on their age, ethnicity, gender, family role, goal, counselor, type of exposure, number of counselor contacts, and/or whether or not the case had been closed.

Discussion

The results suggest that services funded by the CCSS increased children’s resilience and reduced dysfunction when they received at least nine sessions of an intervention. However, threats to validity and limitation of the study make it difficult to establish a causal link between the services funded by the CCSS and a positive change in target conditions. Three possible threats to the validity of the study are: (1) selection bias due to the fact that intervention research participants were those that completed enough intervention sessions to participate in the study, (2) measurement bias due to the fact that parents collected the majority of the data, and (3) bias created by single-subject design. Additionally, the use of multiple interventions did not allow researchers to isolate the effects of concurrent interventions or environmental conditions, thus limiting the power of the results.

______10 Statistical significance was at the

Association for the Study and Development of Community 54 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

IV Chicago Safe Start Initiative

1. Overview Family Focus and the Community Mental Health Council (in the Chicago Safe Start (CSS) was Englewood community) as well as by developed and implemented using a service providers located in six Safe collaborative approach involving from the Start sites. These service community residents, community providers also implemented referral and organizations, and city and state recruitment protocols within their own agencies serving children six years and agencies to link children and families to younger and their families. The initiative CSS services. These two main strategies focused on the Roseland/Pullman and were identified as “Incident-Based” and Englewood communities, the 5th and 7th “Symptom- Based” methods for police districts in Chicago, respectively. increasing access to CSS services. A major component of the effort was the strategic use of its Implementation The two main strategies Advisory Board (IAB) to ensure described above for increasing access to progress in enhancing the service CSS services (i.e., referrals from first delivery system. Collaborating agencies responders and inter/intra-agency and community residents represented on referrals) were identified as “incident- the IAB contributed to the success of based” and “symptom-based” methods. CSS by serving on formal teams, In total, the following numbers of councils and subcommittees that children were identified, referred for mirrored the components of the CSS services, and assessed for needs service delivery system. The CSS (Chicago Safe Start Initiative, 2003; training curriculum was a key strategy Chicago Safe Start Initiative, 2004a; 1 used to enhance the community’s Chicago Safe Start Initiative, 2005a): capacity for responding to children exposed to violence. Other key strategies • 1,386 children exposed to used to create a more responsive system violence were identified between of care included working with the 2003 and 2005; Chicago Police Department, the Chicago • 923 children were referred to Fire Department, and the City of CSS services between 2004 and Chicago’s Domestic Violence Helpline 2005; and to make it possible for these agencies to • 474 children were screened by identify children exposed to domestic CSS providers between 2004 and and community violence and refer them 2005. to appropriate services. Services appropriate for children exposed to violence were provided by Metropolitan 1 These figures were compiled from Progress Family Services (in the Reports (2003-2005) submitted by Chicago Safe Roseland/Pullman community) and by Start to the Office of Juvenile Justice and Delinquency Prevention.

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A subset of children and families did the Chicago Safe Start grantee agreed to participate in research that accomplish this mission and with what allowed CSS staff and its local evaluator success? What factors contributed to and to examine improvement in child and impeded success? These questions are caregiver outcomes. Research findings addressed in the following sections, and indicated that children and caregivers a timeline of major events is attached benefited in many ways from Safe Start (IV-A). services (e.g., case management, therapy, parenting skills training, family 1.2 Chicago, support services). Specifically, (Roseland/Pullman and additional exposure to violence was Greater Englewood reduced for a majority of children, Communities), Illinois children expressed fewer trauma symptoms, and caregiver functioning Chicago Safe Start was planned improved. and implemented within the unique context of the Roseland/Pullman and After federal funding ends, key Greater Englewood communities of components of Chicago Safe Start will Chicago. The following snapshot of continue through state and local funding these two communities is intended to and institutionalization efforts with CSS help others interested in replicating Safe partners. For example, the Illinois Start to compare their own communities Violence Prevention Authority will to Roseland/Pullman and Greater sustain direct services to children Englewood (Chicago Safe Start exposed to violence in the CSS Initiative, 2005, p. 4; U.S. Census communities. In addition, the Chicago Bureau, n.d.). Department of Public Health has committed to support two CSS staff Roseland, one of Chicago’s 77 positions. Finally, the CSS “incubator community areas, is located on the far approach” will leave a legacy of CSS- south side of the city and includes the specific programming within other neighborhoods of Roseland, Fernwood agency programs. and Princeton Park. The area encompasses 4.85 square miles and is 1.1 Mission home to 52,723 residents (a 6.7% decrease from 1990), according to the Chicago Safe Start’s mission was 2000 U.S. Census. Pullman, a to prevent and reduce the impact of community area adjacent to Roseland, exposure to violence on children ages includes the neighborhoods of Pullman five and younger. The grantee’s goal and Cottage Grove Heights, and covers was to improve access, delivery and an area of 4.85 square miles with 8,921 quality of services through a balance of residents. African Americans make up prevention and intervention efforts. 95% of the two combined areas: 20% of Chicago Safe Start focused on education families and 38% of children five years and new kinds of collaborations among and younger live below the federally city and state service agencies, defined poverty level. These figures are community organizations and residents reflected in a median household income (Chicago Safe Start Initiative, n.d.). How of $36,291 for the average family of three.

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Also on Chicago’s south side, the community violence. Working with Englewood and Hamilton Park these local community leaders facilitated neighborhoods make up the Englewood CSS’s entry into two communities that community area. Ninety-eight percent of generally distrust federally funded the nearly 3,000 Englewood residents programs. are African American, living in an area of 3.09 square miles. The median 2.1 Political and Economic income for an Englewood household is Context $22,884, with 34% of families and 50% of the children five years and younger Legislation and administrative living in poverty. The average family policies. The Ounce of Prevention Fund size in Englewood is four. (OPF) invests in children through innovative direct service and research, while Voices of Illinois Children (VIC) 2. Contextual Conditions works with families, communities, and policymakers to ensure that all children Chicago Safe Start was grow up healthy, nurtured, safe, and well developed and implemented in a city that educated. In 2002, these two considers violence prevention an organizations combined efforts under a important public agenda item. new initiative, the Illinois Children’s Historically and currently, Chicago has Mental Health Partnership. CSS staff invested resources in preventing family joined the board of this partnership in and community violence and enhancing 2002 and took on the role of educating early childhood mental health services. these agencies on the impact of violence Monetary investment in various on children five years and younger, and prevention programs reflects political advocating for mental health services to and public support for this issue. The address the needs of these children CSS was able to build upon this (Chicago Safe Start Initiative, 2005, p. infrastructure and further this political 3). agenda by expanding the focus to include young children exposed to Support of political leaders. The violence. Futures for Kids Advisory Board, chaired by Illinois’ First Lady in 2003, CSS evolved also in the context took as one of its main areas of focus of two low-income communities that children’s mental health. The board place children at high risk of exposure to formed a subcommittee to look at this violence, given their high rates of violent issue, with particular sensitivity to the crime and domestic violence as linkages between mental health services, compared to the overall rates in the city juvenile delinquency, and early exposure of Chicago. Despite relatively high rates to violence. In the 2003 budget year, of violence, however, the Futures for Kids was successful in Roseland/Pullman and Greater securing $2.0 million in mental health Englewood communities are cohesive, services for youth leaving juvenile with many long-term residents and detention centers, bringing its three-year active community leaders invested in total of new funding to $6.0 million. organizing residents to respond to Chicago Safe Start, through joint

Association for the Study and Development of Community 57 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

members on the Steering Committee and an additional $1.1 million for the Future for Kids Advisory Board, as children’s therapy; well as through direct participation on • The city of Chicago provides the children’s mental health $2.0 million each year through subcommittee, helped advance the goal Community Development Block of increasing access to mental health Grant funds to support the service for children (Chicago Safe Start Family Violence Initiative. The Initiative, 2005, p. 3). grant language was modified in 2004 to include expectations that In addition, the following state, 2005 grantees would train staff local, and private budgets support on issues of children exposed to programming for children exposed to violence; and violence in Illinois and Chicago • The Illinois Department of (Chicago Safe Start Initiative, 2005, p. Health and Human Services 4): provides more than $23 million dollars to support domestic • In August 2001, the Chicago violence shelters and related Department of Children and services. Twenty two million Family Services (DCFS) funded dollars come out of state general services to prevent the co- revenue funds, and an additional occurrence of child abuse and $1 million in special services domestic violence, specifically funds are acquired through a tax recognizing the needs of children form check-off that allows tax who witness domestic violence. payers to designate a portion of The Child Abuse Prevention their refund to this fund. Fund, a tax check-off program, is currently in the second year of Chicago Safe Start (CSS) staff funding 12 such service leveraged this political and economic programs statewide. In 2005, environment in the city of Chicago and approximately $580,000 was the state of Illinois by placing the needs used to serve a population of children exposed to violence on the experiencing domestic violence public agenda. For example, CSS staff and child abuse concurrently; collaborated with the Illinois Violence • The Illinois Violence Prevention Prevention Authority (IVPA) to Authority (IVPA) provides advocate for passage of the Illinois $500,000 in funding annually to Children’s Mental Health Act of 2003 nine sites providing services to (Chicago Safe Start Initiative, 2005, p. children exposed to violence. 14).2 This act ensures that schools 1) The CSS received IVPA funding regard social and emotional development as one of those sites; as integral to the mission of schools and • In the current fiscal year, the a critical component of student academic Illinois Coalition Against Domestic Violence received 2 These perceptions were shared during the $207,000 to provide counseling October 4 and 5, 2004, and October 6 and 7, and other services to children and 2005 site visits conducted by the Safe Start Demonstration Project National Evaluation Team.

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readiness and school success and 2) take emphasizing the violence in low-income, concrete steps to address students’ social urban, predominantly African American and emotional development. The passing communities, the media play an of the act helped emphasize the important role in perpetuating the cycle importance of addressing issues of of racism, escalating violence, and children exposed to violence by 1) stigmatization that these communities helping to de-stigmatize mental health; experience. 2) highlighting the need for addressing the mental health of children, including For historical reasons, the those exposed to violence; and 3) Roseland/Pullman and Greater potentially tapping into service systems Englewood communities mistrust and to help identify and refer children suspect members of the Chicago Police exposed to violence. Department and the Department of Children and Family Services. Incidents 2.2 Social Context of police brutality abound in these communities. In addition, the The social context in which Department of Children and Family Chicago Safe Start (CSS) evolved both Services removes children from the challenged and facilitated the home and terminates parental rights at achievement of its goals. On the one the highest rates among African hand, the CSS served two low-income American families in Chicago: these communities with high rates of violent families have the lowest rates in Illinois crimes and domestic violence compared for parent-child reunification. Ninety- to those Chicago overall. The rates of five percent of children removed from family violence per 1,000 residents for their homes in Chicago are African Roseland/Pullman and Greater American (Pardo, 1999). As Englewood are 27.5 and 40, predominately African American respectively, greatly exceeding the communities, Roseland/Pullman and overall rate of 15.9 violent crimes per Englewood have undoubtedly 1,000 residents in the city of Chicago as experienced removal of children from a whole (Chicago Safe Start Initiative, homes and termination of parental rights, 2005, p. 5 & 19). Related challenges in as well as police brutality, leading to these communities are associated with mistrust and suspicion of government the vestiges of individually mediated, agencies. Albeit warranted, this mistrust internalized, and institutional racism – and suspicion creates challenges for challenges characteristic of urban, large federal government projects like predominantly African American Chicago Safe Start (CSS) to gain entry communities across the United States. into the community. Racism permeates individuals, families, groups, and systems throughout these On the other hand, the positive communities, and impacts employment, social supports and networks within the education, and health opportunities, Roseland/Pullman and Englewood contributing to increases in family and communities provide a buffer to community violence. An outgrowth of counteract the numerous challenges this racism is stigmatization of such these communities face, including steady communities in the media. By increases in violence. For example,

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many families have lived in the helped overcome barriers to community Roseland/Pullman and Englewood access. This community capacity is communities for generations, addressed in the next section. contributing to community cohesion. This cohesion has supported a long history of community member 3. Community Capacity involvement in local change efforts, through collaborative relationships with Because of the cohesion among established local service provider members of the Roseland/Pullman and agencies. For example, an indicator of Englewood communities and their cohesion in the two communities is history of collaborating willingly and member involvement in Local Area effectively with local area providers, the Networks (LANs) which are responsible CSS faced minimal challenge to for developing community-based incorporating issues of children exposed services for children and adolescents to violence into the community agenda. within their local geographic area In addition, the CSS lead agency, the (Chicago Safe Start Initiative, 2005, p. Chicago Department of Public Health, 4). Through the Chicago Department of had significant experience in leading Public Health (CDPH), the participatory community-wide planning Roseland/Pullman and Englewood processes. For example, CDPH led the communities also have local health “Prevent Violence, Chicago!” strategic facility management boards that solicit planning project from 1996 to 2002, to consumer participation and leadership. establish a framework for a Dedicated participants in both CSS comprehensive citywide approach to districts are committed maintaining this violence prevention programs. This work (e.g., determining health resource initiative provided the framework allocation and utilization), with or through which Chicago Safe Start was without continuing government support funded and implemented (Chicago Safe (Chicago Safe Start Initiative, 2005, p. Start Initiative, 2005, p. 5). In other 4). words, the Roseland/Pullman and Greater Englewood communites were, in A political, economic, and social many ways, poised for a community- context with such tremendous based intiative such as CSS. challenges, as well as opportunities, called for a well-defined, effective Additional capacities included service delivery system for the several children’s mental health identification, referral, and treatment of programs. At least 14 outpatient and children exposed to violence. To develop eight inpatient mental health facilities in such a system, the CSS was able to Chicago are able to provide some level build upon the long history of service of mental health services to children. provision by mental health agencies such Services for families experiencing as Family Focus, Metropolitan Family violence include 67 domestic violence Services, and Community Mental Health programs, as well as 31 intervention Council, Inc. These providers, along programs for male perpetrators. Funding with collaborative community members for victims of family violence in Illinois and CSS’s community-oriented focus has been relatively stable, though

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minimally adequate (Chicago Safe Start Initiative, 2005, p. 7). A large portion of the training was organized through the CSS annual Despite these important training calendar. Trainees included staff resources, several gaps in services and or members of child and youth service barriers to access existed throughout the agencies, social service agencies, the state. For example, prior to CSS, courts, faith communities, and other children exposed to violence received relevant services and programs. The little attention from mental health training curriculum had five modules: 1) providers. In addition, without a specific building public awareness about children diagnosis, mental health services were exposed to violence, 2) understanding generally not available to children six the effects of exposure to violence on years and younger. Structured children’s development 3) defining the interventions following exposure to role of culture in children exposed to violence and trauma were inconsistent violence 4) responding to children and uncoordinated across systems; to exposed to violence and 5) a practicum date, agencies still have not component focused on opportunities to implemented standards for services for intervene with families in crisis. children exposed to violence. Finally, Components of these modules were fully prior to CSS, formal functional or partially incorporated into all CSS relationships between mental health and training sessions.3 Other activities family support service providers were include seminars, train-the-trainer inconsistent. efforts, and public awareness training sessions. From the start of the project 3.1 Integrated Assistance through October 31, 2005, Chicag Safe Start staff conducted 61 CSS training Local training and technical sessions for 1,778 participants, three assistance. Chicago Safe Start staff seminars for 395 participants, ten train- increased the community’s capacity the-trainer activities for 27 participants, (e.g., knowledge, skills, resources, and 252 public awareness training relationships) to respond to children sessions for 5,592 participants -- a total exposed to violence. Training and of 326 trainings for 7,792 participants3. technical assistance were the most See Table 1 for a summary of the common strategies used to develop the number sessions offered and the number capacity of the agencies and individuals of participants (Chicago Safe Start affiliated with CSS. These trainings led Initiative, 2005, p. 4). to the enhancement of capacity not only within the collaborative agencies and Table 1. communities served by the CSS , but Chicago Safe Start Training Sessions also in communities and agencies throughout the city of Chicago and the Session Number Number of state of Illinois. The extensive training component of CSS enhanced the skills of 3 its partners through providing education These models were shared by participants during the October 6 and 7, 2005 site visit on a myriad of topics related to children conducted by the Start to the Safe Start exposed to violence and their families. Demonstration Project National Evaluation Team.

Association for the Study and Development of Community 61 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Type of Participants they were doing more personally to Sessions address children exposed to violence CSS 61 1,779 than they had done before the session. Training Finally, of 87 caregivers trained, 28 Seminars 3 395 completed training evaluations. Of these Train-the- 10 27 28, 93% reported that they could define Trainer exposure to violence, describe how Public 252 5,592 exposure impacts children, and take Awareness action to help exposed children (Chicago Training Safe Start Initiative, 2005, p. 9). Total 326 7,793 National training and technical Of the 1,779 participants in CSS assistance. The CSS received training training sessions, 96% of those who and technical assistance from the attended workshops of 30 minutes or following national providers (Chicago longer and 75% of those who attended Safe Start Initiative, 2005, p. 10): brief 15-minute presentations stated that, after the training, they could define • Abner Bowles/Kwesi Rollins, on exposure to violence, identify three sustainability impacts of exposure to violence on • James Lewis, on first responder children, and help a child exposed to and direct services violence. In addition, 96% of total • Jane Glover, on literature and participants (workshop or brief session) other resources agreed or strongly agreed with the • Serena Hubert , on court action statement, I know what action to take to • Patricia Van Horn, on case help a child exposed to violence.” Of consultation/direct services participants attending seminars, 92% reported that they could define exposure, In 2005,4 the Chicago Safe Start identify its impacts and help exposed grantee also received technical children; and 93% agreed or strongly assistance from the Institute for agreed with the statement “I plan to Community Peace (ICP) around strategic become involved with efforts to help planning and collaboration with its children exposed to violence.” Eighty- partner agencies. ICP helped CSS staff five percent of participants stated that to gauge its partners’ sense of they fully intended to complete personal connectedness and satisfaction with the action plans to address children exposed present course of the initiative, and to violence. More than 18 months after interviewed key partners to help participation in a CSS education session, maximize the strength and function of the number of participants who agreed or CSS. One significant change that came strongly agreed that they could a) define out of the ICP assistance was the exposure, b) describe three ways it decision to replace CSS staff with impacts children, and c) take appropriate action to help, remained above the 4 This information was obtained shared by immediate post-session target level of participants during the October 6 and 7, 2005 85%. After the same elapsed time, most site visit conducted by the Safe Start respondents (79%) also reported that Demonstration Project National Evaluation Team.

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service providers as conveners and Violence, the Illinois Violence facilitators of the Community Councils Prevention Authority, the Domestic in the Englewood and Roseland Violence Mental Health Policy communities. Another significant Initiative, Chicago Police Department, change was the development of the Chicago Public Schools, Illinois Sustainability Committee as part of the Department of Children and Family Implementation Advisory Board. Services, Chicago Department of Child Through its strategic planning efforts, and Youth Services, Commission on this subcommittee developed strategies Children and Violence, Partnership for that will sustain the CSS mission and Quality Child Care, Chicago Department vision beyond the federal funding of Public Health, LaRabida Hospital, period. Chicago Department of Human Services, Chicago Metro Association for the Chicago Safe Start staff Education of Young Children - leveraged the capacities of target Commission on Children and Violence, communities, especially the existing University of Illinois - School of Social platforms of violence prevention Work, Children’s Home and Aid programs and collaborative partnerships, Society, Cook County Circuit Court - to further increase the capacity of service Child Protection Division, State’s providers and caregivers. The ways in Attorney’s Office, and Public which CSS staff and partners worked Guardian’s Office (Chicago Safe Start together to create a comprehensive Initiative, 2005, p. 10). system of care responsive to children exposed to violence is described next. The role of the Implementation Advisory Board was to ensure progress 4. Community Engagement of the implementation plan by enhancing and Collaboration the service delivery system and developing and implementing strategies

to influence system-wide change at the Chicago Safe Start (CSS) was a level of service provision. The IAB was collaboration of community residents, established in 2002, replacing the prior community organizations, and city and CSS Steering Committee. Agencies with state agencies responsible for serving or leadership and decision-making roles on caring for children six years and the IAB were Chicago Metropolis 2020, younger. CSS staff and partners worked the Chicago Police Department, the to expand and enhance the service delivery system to reduce the impact of exposure to violence on young children from traffic congestion to early childhood, with and their families through an cooperation from the region’s business, civic, Implementation Advisory Board and government and its resident sectors to ensure that workgroups. Agencies involved the Chicago region is a place where people want included: Chicago Metropolis 2020 to work and live. The organization has been 5 active in addressing early childhood education (n.d.) , the Mayor’s Office on Domestic by convening the Early Care and Education Assembly (along with the Governor’s Office), 5 Chicago Metropolis 2020 is a non-profit engaging business and civic leaders in early organization started by the Commercial Club of childhood public policy issues, and working with Chicago. The purpose of Chicago Metropolis the local and state governments to address early 2020 is to address regional challenges, ranging childhood matters.

Association for the Study and Development of Community 63 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Juvenile Court, the Mayor’s Office on families to family support and/or Domestic Violence, and the Illinois mental health services, as Violence Prevention Authority. appropriate. This team also was responsible for the development The IAB was made up of six and oversight of the incident- implementation teams: 1) Direct Service based response system, made up Team, 2) First Responder Team, 3) of the first responder protocol; Training Collaborative Team, 4) Data Domestic Violence Helpline and Evaluation Team, 5) Public referral card distribution; Awareness and Education Team, and 6) Helpline capacity development; Court Action Team. The IAB also and linkages between domestic included the Englewood and Roseland violence and family support Community Councils and two ad-hoc services, and emergency room subcommittees: the Sustainability and mental health/family support Committee and the City Group on partners. Officers from the Children Exposed to Violence. A Chicago Police Department and description of the teams, councils, and the Chicago Fire Department ad hoc subcommittees follows Chicago Emergency Medical Services Safe Start Initiative (2004c, p. 17): (EMS) are first on the scene of a domestic violence incident. • Direct Service Implementation Under the incident-based Team developed and response system, these officers implemented a core program plan were responsible for referring that defined the components of affected family members to the the family support services and Helpline, where they could mental health services provided access information about under Safe Start. The team children exposed to violence. focused on the clarification of interventions, the tracking and • Training Collaborative achievement of impacts, Implementation Team increasing referrals and outreach, identified, recruited, and building partnerships with collaborated with potential consumers and providers and the institutional partners to carry out development of overall program research, training, and capacity sustainability. building for service providers and first responders. The team • First Responder – Incident emphasized knowledge and skill Based Implementation Team development driven by research developed the detailed findings, and also engaged in procedures and protocols for first program evaluation and seeking responders to identify children at resources for sustainability. domestic violence and community violence (non- • Data and Evaluation domestic) scenes and participated Implementation Team provided in developing procedures for consultation and support to the linking these children and their local evaluator team, ensuring

Association for the Study and Development of Community 64 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

that appropriate process, various offices and initiatives outcome, and systems change related to local courts (e.g., data collection opportunities professional development, were identified, and that the data advocacy for increased capacity were collected and evaluated. in services, refinement of court- This team also reviewed data related processes). The Court collection instruments, supported Action Team arranged training the development of evaluation on CSS provider services for all reports, and partnered with other child protection judges during pertinent evaluation-based one of their standing judges initiatives to expand the meetings. This also guided the programming and policy identification and tracking of knowledge base around children data underscoring the impact of exposed to violence. For exposure and intervention. example, the team was responsible for revising the • Community Councils - evaluation logic model to achieve Englewood and Pullman greater alignment with the CSS promoted public awareness, vision. consumer engagement, service development and referral, as well • Public Awareness and as training consumers and Education Implementation professionals in the two Chicago Team implemented campaigns to Safe Start communities. A recent increase knowledge of the change in the councils was the problem of children exposed to replacement of CSS staff with violence and of resources to treat CSS service providers as or prevent violence exposure; conveners and facilitators of these campaigns had the council meetings. secondary goals of influencing public policy development and • Sustainability Committee encouraging the existing system developed the overall to respond to the needs of young sustainability plan, the funding children exposed to violence. For strategy, and strategies to ensure example, in collaboration with institutional support of Safe the Battered Women’s Network, Start. the Public Awareness and Education Team contributed to a • City Group on Children children’s art and photo exhibit Exposed to Violence consisted during Domestic Violence of 1) staff of city and state Awareness Month. agencies and community organizations and 2) community • Court Action Implementation residents affiliated with CSS. Team identified and advanced City group members served on specific programs and policy these teams, councils and development around children subcommittees with a level of exposed to violence across

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involvement based on interest CSS was instrumental in and areas of expertise. fostering effective community engagement and collaboration among its In 2005, Chicago Safe Start staff staff, local provider agencies and increased its involvement with other members of the Roseland/Pullman and organizations in the Chicago area Englewood communities. Through its working on issues related to children Implementation Advisory Board, CSS exposed to violence. For example, CSS took advantage of existing linkages service providers joined CSS staff on the poised to formalize a system to help Illinois Violence Prevention Authority identify, assess and provide treatment for board to work with the IVPA on its Safe children exposed to violence and their from the Start initiative.6 Safe from the families. The next section discusses in Start coalitions were modeled after the detail how this formalized system Safe Start Demonstration Project. worked.

CSS staff members and collaborative partners also served on the 5. Systems Change following leadership boards associated Activities with children exposed to violence and their families: The Mayor’s Office on Chicago Safe Start staff and Domestic Violence; the Illinois Teen partners improved organizational Dating Violence Strategic Planning identification and response protocols, Board; Greater Englewood Health coordinated and integrated services, Advisory Board; Greater Roseland enhanced services through training and District Health Council; Developing engaged in several community Communities Project, Inc. Area-wide awareness efforts to create a more Taskforce; Chicago Police Department th th responsive system of care for children 5 and 7 District Domestic Violence exposed to violence. A central Sub-Committees; and the Healthcare component of the CSS effort was the Consortium of Illinois (Chicago Safe development of a service delivery Start Initiative, 2005, p. 20). pathway with both incident-based and symptom-based methods for identifying children exposed to violence was created as a central component of CSS (see IV- 6 The Illinois Safe from the Start program was B). These system change activities are launched in 2001 with the goal of providing described in more detail below. comprehensive support for very young children (five years and younger) who have been exposed to violence. For purposes of this program, 5.1 Development of Policies, children who have been exposed to violence Procedures, and Protocols include victims of abuse, neglect, or maltreatment; and children who have witnessed Several organizations modified domestic violence, sexual assault, or other their protocols to better identify children violent crimes. Six sites across Illinois with Safe from the Start coalitions received funding to plan exposed to violence and refer them to and implement the program; all of these sites are CSS services. Specific examples now actively addressing the problem of children include: exposed to violence in their home and/or communities.

Association for the Study and Development of Community 66 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

• Police in the Englewood and • The Chicago Department of Pullman districts changed their Public Health and Maternal and protocol for responding to Child Health clinics are refining domestic violence incidents to their data collection around include identification and referral caring for young children and of children exposed to violence; screening for children exposed to • The city of Chicago’s Domestic violence; Violence Helpline (Helpline) • Metropolitan Family Services modified its protocols to accept streamlined its intake process, calls for services for children moving from a system in which exposed to community violence CSS-related screening was and added CSS direct service shared across several staff agencies to its resources members to one in which a full- database; time social worker began fields • Family Focus and the and screens all CSS cases. This Community Mental Health procedural change led to more Council (both in Englewood) accurate information gathering instituted referral/recruitment and facilitated potential follow- protocols. These agencies now up with clients; and not only track referrals within • Family Focus sends a counselor, their individual agencies, but also once a week, to the Chicago keep track of referrals that they Department of Human Services make to each other. Cross- to conduct screening for children agency referrals are made exposed to violence among because the two agencies provide Temporary Assistance for Needy unique services: Family Focus Families (TANF) recipients. provides family support services TANF provides a captive and CMHC provides mental audience for Family Focus, health services. Recruitment linking receipt of assistance from within existing caseloads stipends to completion of a class also increases access to service on children exposed to violence. providers trained to help children exposed to violence; These changes increased the • The Safer Foundation (n.d.)7 likelihood that children exposed to modified its management violence would be identified and information system to include referred to CSS providers. specific questions about children exposed to violence in order to 5.2 Service Coordination and guide referral for parenting Integration education; CSS staff and partners developed two methods for improving service delivery. In the first method (i.e., 7 The Safer Foundation is a private non-profit organization that helps ex-offenders help incident-based response system), first themselves stay out of prison and turn their lives responders from the Chicago Police around through re-entry services, monitoring, Department and the Chicago Fire and training.

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Department Emergency Medical and appropriate treatment within the Services EMS provided contact cards to agency (i.e., families received family families in domestic violence situations. support services, mental health services, These cards contained contact or both, as needed). The CSS also information for the Domestic Violence supported the once weekly placement of Helpline. Families who contacted the a mental health worker from the Helpline were referred to CSS service Community Mental Health Council at providers or traditional domestic Family Focus. This practice increased violence service providers, who then fed the likelihood of continuity in services the referrals to CSS staff to record the for families, and, thus, the likelihood of information for tracking purposes. continuation of services. Incident-based responders also began to refer cases directly to service providers. 5.3 New, Enhanced, and One challenge in this system, however, Expanded Programming was the elapsed time between identification of a child by an incident- Several agencies adopted training based responder and referral to a service on issues of children exposed to violence provider. During this time lapse, families to increase the ability of their service could be lost in the system, due to providers to recognize and respond to changes in addresses or phone number, the specialized needs of these children. or because the family moved on to Specific examples include (Chicago Safe address more pressing needs and/or lost Start Initiative, 2005, p. 14 & 16): a sense of urgency regarding mental health services after the crisis situation • In 2005, the Chicago Department ended. This delay impeded the seamless of Children and Youth Services flow of the service delivery system. implemented systemwide training for Head Start workers The second method for service on children exposed to violence delivery was symptom-based. This issues; method involved community providers • The 2005 Community such as social service agencies, school Development Block Grants for administrators and teachers, and daycare the Family Violence Initiative center staff. Community members also included expectations that its formed a part of this system (i.e., grantees would receive training community members could identify and on children exposed to violence; refer children, as well). Symptom-based • The Illinois Association of responders were trained to identify Family Childcare intends to children exposed to violence in their develop training on children immediate environment and refer them exposed to violence for all its to CSS service providers. For example, members in 2006; and Metropolitan Family Services, which • The CSS collaborative trained houses both family support and mental Helpline staff to effectively health services divisions, incorporated a identify and refer children process that led to sharing of cases exposed to violence in the between these divisions. This change context of domestic violence aided in improved identification, referral calls. Helpline staff also received

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training to identify and refer Roseland/Pullman Annual Family Fun children exposed to community Day and sponsored educational forums violence. targeting potential agency partners during National Domestic Violence 5.4 Community Awareness Awareness Month. CSS staff participation in all of these community A local marketing agency activities included the distribution of provided its services pro bono to the balloons, t-shirts, bookmarks, and other Chicago Safe Start grantee to develop a promotional materials with CSS public awareness campaign focused on information. A banner displayed year children exposed to violence. The round at the Chicago Pedway also products of this campaign included a helped to improve community video to educate police and EMS first awareness. responders on how to better respond to situations encountered in their work. Additionally, the following The title of the video is “Responding to efforts provided opportunities for Child Victims and Witnesses - educating community residents, local Improving Case Outcomes.” The businesses and community agency also helped produce a video for organizations: parents with an accompanying storybook for children to share with their families. • 2,500 door hangers displaying The storybook provides information on information about domestic issues of children exposed to violence violence and children exposed to and a resource list of mental health violence were distributed door- providers and child-serving agencies. to-door in the community (Chicago Safe Start Initiative, Community members provided 2005, p. 17), input on marketing materials throughout • 2,000 flyers about children the production process. This exposed to violence and CSS involvement included feedback to the resources were distributed marketing agency on the training video (Chicago Safe Start Initiative, for first responders. The dissemination 2005, p. 17), of these materials to child-serving • Posters were displayed in agencies and community members community organizations and promoted the CSS ’s goal of increasing childcare centers, community awareness of children • Five community health and exposed to violence. safety fairs (Happy Healthy Kids Fests) were held, The CSS also helped to increase • Workshops on children exposed community awareness through its to violence were conducted in the involvement in a variety of activities community, such as local parades, including the Bud • Presentations about children Billiken Parade (an annual African exposed to violence were made American event) and the Englewood at social service agencies, community Back-to-School Parade. • ABC-7 aired a two-part series on CSS staff participated in the children exposed to violence, and

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• CAN-TV aired a program on community members, led to institutional children exposed to violence change at the system , agency, point-of- along with Prevent Child Abuse service, and community levels. America. Institutional change is addressed in the next section. In current awareness efforts, CSS direct service agencies are in the process of developing “CSS Ambassadors” from 6. Institutionalization of their past client base and other sources to Change help promote CSS in their communities. In addition, local CSS councils will The mission and goals of CSS develop community action plans (2006) were institutionalized through the to engage residents in response to adoption of protocols by several specific violent events to help organizations. These various protocols, underscore the lack of acceptance of described in detail in the preceding these events and their impact on section, help to ensure the identification everyone, especially young children. of children exposed to violence and referral to service providers trained to Through these systems change respond appropriately. In addition, CSS activities, Chicago Safe Start designed developed a “co-facilitation” model, or and implemented an effective plan to an “incubator” approach, to sustaining identify, refer, assess, and treat children CSS practices and services. This model exposed to violence and their families. partnered CSS staff with other program As a result of these activities, the staff to implement CSS-specific following were accomplished (Chicago programming within other agencies Safe Start Initiative, 2003; Chicago Safe (Chicago Safe Start Initiative, 2005, p. Start Initiative, 2004a; Chicago Safe 23). Through training and technical Start Initiative, 2005a): assistance, CSS staff helped these “incubator” agencies integrate policies • 1,386 children exposed to and procedures into their overall violence were identified between organizational structure, to guide the 2003 and 2005; direction of efforts addressing children • 923 children were referred to exposed to violence. The success of this CSS services between 2004 and approach was due in part to the inclusion 2005; and of training as part of service provider • 474 children were screened by agreements. Under these agreements, CSS providers between 2004 and providers were obligated to work on 2005. multi-year plans to train clinical and counseling staff, facilitate in-house The CSS ’s formalized planning groups, and identify and procedures for identification, referral, include other satellite offices in the assessment and treatment of children six training. For example, through CSS years and younger, coupled with train-the-trainer activities, Metropolitan mechanisms designed to embed its Family Services has integrated vision into the organizational structure identification and assessment of children of its partners and the mindset of exposed to violence into its six regional

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sites as a result of its association with associated with exposure to violence and CSS in the Pullman community. responding to them effectively increased Similarly, Family Focus integrated due to CSS programming and training assessment instruments for children efforts. Co-location of a CSS staff exposed to violence across its seven person within many of the city-, county-, direct service centers in Chicago and and state- level clinics/programs in the surrounding suburbs. community increased awareness of children exposed to violence and Funding from other sources was referrals to services. CSS service obtained to continue key components of providers also expanded within-agency CSS, as well. CSS staff secured funding referral/recruitment into CSS programs from the Illinois Violence Prevention (Chicago Safe Start Initiative, 2005, p. Authority to sustain direct services to 18). children exposed to violence in the target communities. The Chicago Department of Public Health committed to support 8. Reduced Exposure and two CSS staff positions (the education Impact of Exposure to coordinator and the implementation Violence coordinator) after federal support ceases; support for a third position is under Outcome data indicate that discussion. The Department of Children children and their caregivers and Youth Services committed $100,000 significantly benefited from CSS to expand children exposed to violence services. These findings are described in training and materials to Head Start and detail in IV-C and are briefly early care providers in 2005 and 2006. summarized here. The Department of Children and Family

Services funded the collaborative in the Several instruments were used to amount of $125,000 to produce the assess exposure to violence and the children exposed to violence awareness impact of CSS services on reducing the and response cartoon (2005; (Chicago impact of exposure to violence for Safe Start Initiative, 2005, p. 17). participating families. Services included intake/assessment, case management, information and referral, service plan 7. Increased Community development, case collaboration, family Supports support services, parenting skills education, individual adult therapy, Families and children exposed to crisis intervention, group therapy, and violence have greater access to family therapy. appropriate services as a result of CSS. All CSS trainings and materials provided Therapists noted that 66% of families with resource information. The children in services had no significant police and Helpline staff became additional exposure to violence after important points of entry into services. treatment began, 24% did have The number of service providers in the additional significant exposure, and the target communities and citywide that are remaining 10% of the children had now capable of recognizing symptoms unknown additional exposure (generally

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because they prematurely terminated were delivered in the home, and that from treatment). Also according to children with no additional exposure to therapists, parenting skills increased, violence improved significantly more such that caregivers were more aware of than children with continuing exposure. the effects of violence on children and The more sessions children and were better able to manage the effects of caregivers attended, the more both exposure to violence for both their improved. Children improved the most children and themselves. when services focused on identifying and expressing feelings, community Caregivers reported observing violence, safety planning, or conflict fewer trauma symptoms among their resolution skills. Children improved the children post-intervention than they did least when services focused on sexual pre-intervention. The decrease in abuse, media violence, or dealing with symptoms was statistically significant separation. When services for caregivers for older children, though not for focused on appropriate discipline, younger children. parent-child communication skills, building a support system, or community Therapists’ ratings indicated violence, caregivers improved the most. small, but significant improvements in When services for caregivers focused on child outcomes. Greatest improvement safety planning or media violence, was seen in the ability to identify caregivers improved the least (Chicago feelings, decrease in overall symptoms, Safe Start Initiative, 2005, p. 33). improved pro-social skills, and improved management of anger and aggression. Children improved least in the area of 9. Conclusion posttraumatic stress disorder (PTSD) symptoms. The planning and

implementation of Chicago Safe Start Therapists’ ratings indicated achieved a high degree of success as a significant improvement in caregivers’ result of two supportive and cohesive functioning as a result of treatment, as communities; local agencies that took well. Following the intervention, the necessary steps to address issues caregivers showed significant related to children exposed to violence improvements in their knowledge of and their families; and a well funded, children’s exposure to violence, overall community-oriented governing body. family functioning, understanding of With the further assets of an extensive children’s appropriate developmental and strategic collaboration plan, a behavior, ability to take care of their training curriculum, and a community own mental health needs following awareness effort that targeted key exposure to violence, and parenting community and agency stakeholders, the skills. Caregivers improved least in the CSS tapped into the existing strengths areas of supportive relationships and of the Roseland/Pullman and Englewood environmental stability. communities to establish a formal

system of identifying, referring, The data also showed that assessing and treating children exposed caregivers improve more when services to violence and their families. Without a

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supportive and cohesive community, promote the CSS vision and mission and local agencies would not have expand it to other areas of Chicago and participated in the development of a throughout Illinois. These efforts include service delivery system capable of a comprehensive training curriculum and responding to children exposed to a capacity building mechanism that violence. Children and their caregivers helped “incubate” the CSS vision within significantly benefited from CSS the structure of several organizations services, including experiencing a crucial for meeting the needs of children reduction in exposure to violence while exposed to violence and their families. participating in services. The greatest The CSS will leave a positive legacy in challenge the CSS faced was the Roseland/Pullman and Englewood counteracting the high levels of domestic communities. and community violence in the two communities. Efforts are in place to

10. Reference

Association for the Study and Development of Community (2005). Site visit report: Chicago Safe Start January through December 2004. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2006). Site visit report: Chicago Safe Start January 1 through September 30, 2005. Gaithersburg, MD: Author.

Chicago Metropolis 2020 (n.d.). Chicago Metropolis 2020. Retrieved June 14, 2006 from http://commercialclubchicago.org/metropolis2020/index.html

Chicago Safe Start Initiative (n.d.). About Chicago Safe Start. Retrieved June 14, 2006 from http://www.chicagosafestart.net/Components/AboutSafeStart.asp

Chicago Safe Start Initiative (2003). Progress report December 2003. Chicago, IL: Author (Available from the Department of Justice Office of Juvenile Justice and Delinquency Prevention).

Chicago Safe Start Initiative (2004a). Progress report December 2004. Chicago, IL: Author (Available from the Department of Justice Office of Juvenile Justice and Delinquency Prevention).

Chicago Safe Start Initiative (2004b). Local evaluation report form. Chicago, IL: Author (Available from the Association for the Study and Development of Community).

Chicago Safe Start Initiative (2004c). Implementation Plan Phase IV: November 2004- October 2005. Chicago, IL: Author (Available from the Association for the Study and Development of Community).

Association for the Study and Development of Community 73 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Chicago Safe Start Initiative (2005a). Progress report December 2005. Chicago, IL: Author (Available from the Department of Justice Office of Juvenile Justice and Delinquency Prevention).

Chicago Safe Start Initiative (2005b). Local evaluation report form. Chicago, IL: Author (Available from the Association for the Study and Development of Community).

Pardo, N. (1999). Losing their children: As state cracks down on parents, black families splinter. Retrieved June 14, 2006 from http://www.Chicagoreporter.com/1999/01- 99/0199main.htm

Safer Foundation (n.d.). Safer Foundation. Retrieved June 14, 2006 from http://www.saferfoundation.org/viewpage.asp?id=4

U.S. Census Bureau. (n.d.). State and county quickfacts. Census. Retrieved June 14, 2006 from http://quickfacts.census.gov

Association for the Study and Development of Community 74 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Exhibit IV-A Timeline of Chicago Safe Start Initiative Activities and Milestones

Major Milestones 1/00-6/00 7/00- 1/01- 7/01- 1/02- 7/02/- 1/03- 7/03- 1/04- 7/04- 1/05- 7/05- 12/00 6/01 12/01 6/02 12/02 6/03 12/03 6/04 12/04 6/05 12/05 Project Director position filled Project Coordinator position filled Community Needs Assessment Public Awareness Campaign Created initial CSS training curriculum Two coordinator positions filled (education

& implementation) Implementation Advisory Board and workgroups25 Incident- and Symptom-Based Response System Monitoring Intervention Research Report: Family Outcomes Pilot and Full Study Tier II funding awarded Sustainability Plan Complete Train-the-trainer training Roseland Safe Start Council forum Completed the preliminary draft of the CSS training curriculum Sources: Local Evaluation Report Form : 2004 and 2005; Evaluation Plan 2004; Progress Reports: January-June 2002; July-December 2003; January-June 2004; July-December 2004; January-June 2005; and July-December 2005

25 The Internal Advisory Board and workgroups consist of the following: Chicago Metropolis 2020, the Mayor’s Office on Domestic Violence, the Illinois Violence Prevention Authority, the Domestic Violence Mental Health Policy Initiative, Chicago Police Department, Chicago Public Schools, Illinois Department of Children & Family Services, Chicago Department of Child & Youth Services, Commission on Children & Violence, Partnership for Quality Child Care, Chicago Department of Public Health, LaRabida Hospital, Chicago Department of Human Services, Chicago Metro Association for the Education of Youth Children – Commission on Child & Violence, Mayor’s Office, University of Illinois – School of Social Work, Children’s Home and Aid Society, Cook County Circuit Court – Child Protection Division, State’s Attorney Office, Public Guardian’s Office. Source: LERF 2005 (p. 10).

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Exhibit IV-B COMMUNITY VIOLENCE DOMESTIC VIOLENCE OTHER VIOLENCE

Incident-based- 1st Responders Symptom-based responders Police; Fire Dept/EMS Community providers (e.g., social -Identification Outreach method: service agencies, schools & daycare Ad hoc booster training centers) and community members Outreach method: On-going community outreach Mayor’s Office of by CSS Providers Domestic Violence HELPLINE

Domestic Violence Traditional Service Providers

CHICAGO SAFE PULLMAN START PROVIDERS ENGLEWOOD COMMUNITY COMMUNITY

-Screening METROPOLITAN -Internal/External -Screening COMMUNITY FAMILY SERVICES Referral -Internal/External MENTAL FAMILY FOCUS Referral Family Support HEALTH -Assessment Services COUNCIL -Assessment Family Mental -Intervention Mental Health -Intervention Support Health Services Services Services

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Exhibit IV-C Chicago Safe Start Intervention Research26

Overview

Chicago Safe Start (CSS) intervention research was designed to assess direct services (e.g., case management, counseling, family support services) to children exposed to violence and their caregivers (parents or guardians). To expand the evaluation of direct services beyond Family Focus, Metropolitan Family Services and Community Mental Health Council, CSS collaborated with a state-level violence prevention agency serving a similar population in different locations. A total of nine provider agencies, across Illinois, began providing joint reporting of direct services to children exposed to violence and their caregivers beginning in July 2004 (note: the services began earlier for both CSS and Safe from the Start). Assessments were conducted using the Child and Caregiver Completion of Services Forms which capture provider information such as therapists’ credentials and experience, location and description of services provided, content of services, and therapists’ ratings of outcomes for children and caregivers.

Methods

Sample

Three CSS sites plus six Safe from the Start sites served families using Safe Start- based treatment teams. Intake data were available for 233 children. Matched pre and post-intervention data from the CSS Questionnaire and the Trauma Symptom Checklist for Young Children (TSCYC) were available for approximately 65 children. Completion of Services Forms were available for 177 caregivers. Information from the Chicago Safe Start Intake/Screening Forms indicated that the average age of children served was 33 months old and 48% of children were female.

Procedures

Each CSS service provider administered the screening and assessment instruments to families before their participation in services. The TSCYC and CSS Questionnaire were completed before, during, and after intervention; and the Completion of Services Forms were completed by service providers after families terminated from services. CSS providers received monthly feedback regarding the completeness of their Safe Start case records.

26 The information summarized here is discussed in detail in the Local Evaluation Report Form (Chicago Safe Start Initiative, 2005), Section II. The local evaluator contributed significantly to the writing of this section. This information was also presented by the Chicago Safe Start local evaluator at a national evaluation meeting May 8 and 9, 2006 (Association for the Study and Development of Community, 2006).

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Instruments used included:

• CSS Intake/Screening Form • Family Referrals Form • CSS Questionnaire • Trauma Symptom Checklist for Young Children • Child and Caregiver Completion of Services Forms

Impacts were assessed via the CSS Questionnaire, the TSCYC, and the Completion of Services Form. The TSCYC and the CSS Questionnaire were completed at the CSS sites only. The Child and Caregiver Completion of Services Forms were common to all sites. Family needs were identified via the Family Referrals Form, which providers used to track inter- and intra- agency referrals for additional services.

Results

Pre-intervention exposure and symptoms. Sixty two percent of the children had been exposed to domestic violence, 46% had witnessed community violence, and 76% had repeated exposures to any type of violence.

The most common pre-treatment symptoms of exposure to violence were: “very protective of family members” (39%); “highly aggressive, emotional or distractible” (39%); and “often very emotional and exhibiting mood swings” (32%). For older children (between 37 and 72 months old), the following symptoms were noted most frequently: “very protective of family members” (56%); “highly aggressive, anxious, or distractible” (53%); and “cries often, very emotional, mood swings” (44%). Of note, caregiver reports indicated fewer symptoms for younger children (under 36 months) than for older children. Symptoms for younger children noted most often included: “cries often, very emotional, mood swings” (35%); “increased anxiety about separation from caregivers, increased clinginess” (32%); and “expressed fear often” (30%). The data indicated that children who had not yet completed services, or who prematurely terminated from services, were experiencing greater trauma symptoms at the time of intake. High family mobility and high stress communities were intervening factors.

Post-intervention outcomes. Therapists noted that 66% of children had no significant additional exposure to violence after treatment began, 24% did have additional significant exposure, and the remaining 10% of children had unknown additional exposure (generally because they prematurely terminated from treatment). Also according to therapists, parenting skills increased such that caregivers were more aware of the effects of violence on children and were better able to manage the effects of exposure to violence for both their children and themselves.

Caregivers reported observing fewer trauma symptoms among their children post- intervention than they did pre-intervention as measured by the TSCYC. The decrease in symptoms was statistically significant for older children, though not for younger children.

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Inspection of the data from the CSS Questionnaire indicated that caregivers increased their scores on this measure; however this increase was not statistically significant. Inspection of the subscale scores revealed that increased knowledge of the impact of exposure to violence on young children was the area most impacted by intervention. Inspection of the means revealed that caregivers rated themselves well on ‘self-care’ and how to help their child even before services begin.

Therapists’ ratings on the Child Completion of Services form indicated small, but significant improvements in child outcomes. Greatest improvement was seen in the ability to identify their feelings, a decrease in overall symptoms, improved pro-social skills, and improved management of anger and aggression. Children improved least in the area of posttraumatic stress disorder (PTSD) symptoms.

Therapists’ ratings on the Caregiver Completion of Services form indicated significant improvement in caregivers’ functioning as a result of treatment. Following the intervention, caregivers showed significant improvements in their knowledge of children’s exposure to violence, overall family functioning, understanding of children’s appropriate developmental behavior, the caregiver’s ability to take care of their own mental health needs following exposure to violence, and parenting skills. Caregivers improved least in the areas of supportive relationships and environmental stability.

Other data showed that caregivers improved more when services were delivered in the home, and that children with no additional exposure to violence improved significantly more than children with continuing exposure. The more sessions children and caregivers attended, the more both improved. Children improved the most when services focused on identifying and expressing feelings, community violence, safety planning, or conflict resolution skills. Children improved the least when services focused on sexual abuse, media violence, or dealing with separation. When services for caregivers focused on appropriate discipline, parent-child communication skills, building a support system, or community violence, caregivers improved the most. When services for caregivers focused on safety planning or media violence, caregivers improved the least (Chicago Safe Start Initiative, 2003, p. 33).

Additional analyses assessed the relationship between the content and characteristics of services and outcomes for children and caregivers as measured by the Professional Summary Report sections of the Completion of Services Forms. First, the correlation between number of sessions the child and caregiver attended and the child and caregiver outcomes (e.g., the Professional Summary Report or PSR) was assessed. The number of sessions that caregivers attended was significantly correlated with both child and caregiver outcomes. As could be expected, the number of sessions a child attended was significantly correlated with child, but not caregiver, outcomes.

Next, the relationship between additional exposure to violence and outcomes was assessed. Overall, the analysis of variance was significant. Inspection of the means revealed that children with no additional exposure to violence improved the most, while children who had continued exposure to violence or for whom additional exposure to

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violence was unknown (usually because these families dropped out of treatment prematurely) had little or no improvement.

Finally, in order to better understand the relationship between the content of interventions offered to children and their caregivers and the outcomes of services, a series of regression analyses were performed. First, the association between caregiver interventions and caregiver and child outcomes was examined, followed by an additional regression analysis examining the relationship between the content of services for children and child outcomes.

For the first regression analysis, the association between the number of sessions and the content of the interventions, and caregiver outcomes as measured by the PSR were assessed. Overall the model was significant (F(19,184)=7.95, p<.001, adjusted R- square = .39), accounting for nearly 40% of the variance in caregiver PSR scores. Of the predictor variables, parent-child communication skills, appropriate discipline, and gang involvement were significantly and positively associated with caregiver PSR scores, while media violence and safety planning were significantly and inversely related to caregiver outcomes. For the second regression analysis, the association between the number of sessions and the content of the interventions, and child outcomes were assessed. Overall the model was significant (F(19,137)=2.15, p<.01, adjusted R-square = .12), accounting for over 10% of the variance in child PSR scores. For child outcomes, the number of sessions the caregiver attended and appropriate discipline were significantly and positively associated with child PSR scores, while domestic violence and anger management skills were inversely related to child outcomes.

Finally, the association between the number and content of the child interventions, and child outcomes were assessed. Overall the model was significant (F(25,81)=3.88, p<.001, adjusted R-square = .404), accounting for over 40% of the variance in child PSR scores. Identifying/expressing feelings, community violence, good touch/bad touch, safety planning, and decision making skills were significantly and positively associated with child PSR scores, while sexual abuse, media violence, and dealing with separation were inversely related to child outcomes.

Discussion

This unique multi-site evaluation of services for children exposed to violence and their caregivers offers an interesting picture of both services and outcomes. At the conclusion of services, therapists rated caregivers as significantly improved on the PSR. To a lesser extent, therapists also rated children as significantly improved on the PSR.

The finding of positive correlations between the number of sessions attended and outcomes supports the validity of this evaluation. As could be expected, the more sessions caregivers attended, the more caregivers and children improved. However, the number of sessions that children attended influenced child, but not caregiver outcomes. The common sense nature of these results provide evidence for the validity of this evaluation.

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Another finding that provides evidence for the validity of this evaluation is children with no additional exposure to violence improve significantly more than children who continue to be exposed to violence. This is a common sense finding that has clear implications for practice. When working with children exposed to violence, ending the children’s exposure to violence should be the first goal addressed by services.

Clearly, some of the more interesting findings of this study were the results of the regression analyses. When services for caregivers focused on parent-child communication skills, appropriate discipline, or gang involvement, caregivers improved the most. This finding may indicate that when services focus on the concrete behaviors of parent-child communication and appropriate discipline, caregivers might get some immediate relief. Also, ending involvement in gangs or limited exposure to gang activity seems to also offer caregivers immediate relief. When services for caregivers focused on safety planning or media violence, caregivers improved the least. It’s likely that when services focused on safety planning, the caregiver was in immediate danger from domestic violence. In these cases, slower therapeutic advances could certainly be expected. When media violence is a focus of treatment, floor effects might come into play where the caregivers and children might not have been experiencing serious symptoms or difficulty functioning at the start of services.

Similar to the finding for caregiver outcomes, when services for caregivers focused on appropriate discipline, children improved the most. Teaching parents appropriate ways to discipline their children appears to have benefits both for children and caregivers.

Also, when services for caregivers focused on domestic violence or anger management skills, children improved the least. Again, children might be slow to experience therapeutic gains when caregivers seek services for these types of presenting problems. Or it may be that anger management services and domestic violence services for caregivers provide little benefit for children. For adult, these services were not significantly associated with outcomes.

When services for children focused on identifying/expressing feelings, community violence, good touch/bad touch, safety planning, or decision making skills, children improved the most. These types of services should be considered when working with children exposed to violence. A focus on community violence was also positively and significantly associated with outcomes. This finding might reflect the situation that children exposed to community violence are likely to improve more quickly than children exposed to domestic violence or sexual abuse. This interpretation is supported by the finding that when services for children focused on sexual abuse, children improved the least. Similarly, “dealing with separation” was inversely associated with outcomes for children, suggesting that these issues might require longer services, more intensive services, or a different type of intervention to help children dealing with separations and losses. Keep in mind that the average number of sessions attended by children was only seven.

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Clearly, one limitation of this research was that the ratings of the service providers were used to evaluate outcomes. So the service providers were essentially evaluating themselves. While the results appeared to be valid, the study would have been strengthened by an outside observer’s evaluation of outcomes (perhaps the caregiver’s or a teacher).

Furthermore, the implications for interventions resulting from this evaluation would have been strengthened by an experimental design where families were randomized into clearly proscribed interventions. Instead, interventions were individualized and were largely (and perhaps most appropriately) shaped by the families’ presenting problems. None-the-less, this evaluation provides important information that service providers should consider when developing treatment plans for families. Interventions for caregivers addressing appropriate discipline and parent-child communication skills should be encouraged and further developed. For children, increased attention should be paid to interventions that address identifying/ expressing feelings, good touch/bad touch, safety planning, and decision making skills.

Summary

Overall Improvement • At the conclusion of services, therapists rated caregivers as significantly improved on the PSR. • To a lesser extent, therapists also rated children as significantly improved on the PSR.

Number of Sessions • The more sessions children attended, the more children improved. • The more sessions caregivers attended, the more caregivers improved. • The more sessions caregivers attended, the more children improved.

Continued Exposure to Violence • Children with no additional exposure to violence improve significantly more than children who continue to be exposed to violence.

Content of Services • When services for caregivers focused on parent-child communication skills, appropriate discipline, or gang involvement, caregivers improved the most. • When services for caregivers focused on safety planning or media violence, caregivers improved the least. • When services for caregivers focused on appropriate discipline, children improved the most. • When services for caregivers focused on domestic violence or anger management skills, children improved the least.

Association for the Study and Development of Community 82 July 2006 DRAFT This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

• When services for children focused on identifying/expressing feelings, community violence, good touch/bad touch, safety planning, or decision making skills, children improved the most. • When services for children focused on sexual abuse, media violence, or dealing with separation, children improved the least.

References

Association for the Study and Development of Community (2006). Safe Start national evaluation meeting: Meeting notes. Gaithersburg, MD: Author.

Chicago Safe Start Initiative (2005). Local evaluation report form. Chicago, IL: Author (Available from the Association for the Study and Development of Community).

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V Pinellas Safe Start Initiative

1. Overview systematic screening, identification, and referral of children exposed to violence Pinellas Safe Start (PSS) was and their families; providing information developed and implemented by building about children exposed to violence to upon the county’s tradition of parents and caregivers; contributing collaboration. Key service providers service data to the evaluation; and likely to be accessed by families with working toward a shared client young children exposed to violence were information system. engaged in an assessment and planning process that resulted in a three-tiered The SSPC agencies brought collaboration structure and the together the perspectives and expertise development of an integrated service of domestic violence services, child delivery model. One collaborative body, protection and related clinical services, the Leadership Council, was established public health (especially violence to provide policy and programmatic prevention and home visiting/family oversight for PSS. The second support), and community resource collaborative body, the Safe Start information and referral. Collectively, Partnership Center (SSPC), was formed these agencies offered a service to enhance, coordinate, and create continuum ranging from prevention and services. The third level of collaboration early intervention (e.g., home involved community partners that were visiting/family support, information less directly involved in policy and about community resources) to crisis programmatic oversight, but who were services and treatment (e.g., domestic important to PSS’s implementation due violence and child protection services). to missions overlapping with that of Safe The SSPC agencies were well positioned Start. for early identification of children exposed to violence due to the large Central to PSS was the Safe Start number of families with young children Partnership Center, composed of five that used their services for other reasons. agencies: Help-A-Child, 2-1-1 Tampa To fill a gap in the services of existing Bay Cares, The Haven, CASA, and the agencies, PSS developed and funded Pinellas County Health Department. intensive and individualized service These agencies received funding from components (e.g., comprehensive family Safe Start in response to a competitive assessment, family support), specifically bid to implement an integrated service for children exposed to violence. delivery model as a collaborative body. Contractual responsibilities associated PSS also developed and funded with Safe Start funding included using a (at least in part) two additional services common definition of “children exposed for children exposed to violence. The to violence;” implementing protocols for Clearwater Child Development-

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Community Policing (CD-CP) Program PSS increased community was established in Pinellas through awareness of children exposed to training and technical assistance from violence, increased the community’s the National Center for Children capacity to respond to these children and Exposed to Violence, coordinated by their families, and may have reduced PSS. There was no program of this type parental stress through its intensive prior to Safe Start. PSS also enhanced family services. Key components of PSS Coordinated Child Care by funding a will continue with the support of local Safe Start trained staff person for the funding, after federal funding ends. This existing Project Challenge program. The case study report summarizes how PSS Safe Start consultant enhanced existing accomplished these outcomes and under services by providing more home visits what conditions and parent support than other Project Challenge staff. Coordinated Child Care 1.1 Mission also received funding to participate in the local evaluation and to contribute The mission of PSS was to data for the comparison group included prevent and reduce the impact of in the intervention research study. violence on young children and their families by enhancing and integrating Together, the Safe Start the supports and services offered by Partnership Center, the Child community providers, agencies, and Development-Community Policing institutions, and by creating a Program, and Coordinated Child Care’s community culture of valuing, caring Safe Start-enhanced Project Challenge for, and safeguarding children. How did (Enhanced Project Challenge) PSS accomplish this mission and with accomplished the following between what success? What factors contributed May 2002 and December 2005 (Pinellas to and impeded success? These Safe Start Initiative, 2006) questions are addressed in the following sections, and a timeline of major events • 8,388 young children exposed to is attached (Exhibit V-A). violence were identified through Safe Start programs between 1.2 Pinellas County, Florida May 2002 and December 2005; • 2,406 young children exposed to PSS was planned and violence were referred to services implemented within the unique context between May 2002 and of Pinellas County, Florida. The December 2005; and following snapshot of Pinellas County is • 558 young children exposed to intended to help others interested in violence were assessed by a Safe replicating Safe Start to compare their Start Family Advocate, a CD-CP own communities to Pinellas County. clinician, or the Project Challenge Safe Start consultant Pinellas County is located on to develop appropriate support Florida’s West Coast, bordered by the and service plans between May Gulf of Mexico to the west and Tampa 2002 and December 2005. Bay to the east. The county has a land area of 280 square miles, with an

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average 3,339 residents per square mile PSS operated within a state as of 2002, making it the most densely policy environment that mandates populated county in Florida (Pinellas collaboration and coordination of County Government, n.d.). According to services among the key sectors that serve the 2005 Census estimate, Pinellas families with young children—goals County had a total population of 928,032 consistent with Safe Start. Florida’s (U.S. Census Bureau, 2005). The political context is favorable for county’s population is largely European reducing children’s exposure to violence American (87% in 2000), with through a coordinated response to significant African American (9% in families. For example, the State of 2000), Hispanic or Latino (5% in 2000), Florida has 25 Community Child Care and Asian (2% in 2000) populations Coordinating (4C) agencies as part of its (U.S. Census Bureau, n.d.). According to system for providing scholarship child Census estimates, 63,662 children six care for families who need help paying years and younger were living in for child care while they work to become Pinellas County in 2000, accounting for self-sufficient (Coordinated Child Care about 7% of the county’s total of Pinellas, Inc., n.d.). The 4C agencies population (Pinellas Safe Start Initiative, act as a primary resource for children, 2005, p. 6). The median household families, providers, and employers; their income in most zip code areas of main office is located in Pinellas Pinellas County was between $27,000 County. As another example of the and $36,000 in 2000; about 17% of favorable political context in Florida, the households, however, were estimated to state mandates the use of Domestic have incomes under $15,000 (Pinellas Violence-Child Protection Agreements, Safe Start Initiative, 2005, p. 5). thereby requiring domestic violence According to 2000 Census estimates, service providers and child protection 71% of homes in Pinellas County were agencies to agree on how they will owner occupied (U.S. Census Bureau, communicate when an allegation of 2000). As of September 2005, the abuse involves a child or parent who median cost of an existing single-family may be staying at a domestic violence home in Pinellas County was $215,200 center (Pinellas Safe Start Initiative, (Pinellas Safe Start Initiative, 2005, p. 5- 2005, p. 1). The Pinellas agreement 6). includes a specific goal to reduce the impact of violence exposure on children and calls for staff cross-training on 2. Contextual Conditions children’s exposure to violence. Furthermore, the Unified Family Court PSS was implemented within a model calls for “one family-one judge,” political, economic, and social context i.e., a fully integrated, comprehensive that affected both the initiative and the approach to handling all civil court cases broader community’s response to involving any family member when the children exposed to violence. family is involved in a dependency case. The original Unified Family Court in 2.1 Political Context Pinellas County was implemented through grant funding in 2002; since then, the unified approach has become

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state recommended policy (Pinellas Safe child maltreatment reports. The Safe Start Initiative, 2005, p. 1). Children Coalition (which includes the lead agency for Community-Based Care In contrast to the favorable and multiple service providers) provides political context for Safe Start, local case management, foster care, adoptions, implementation of a state mandate to and other child protection services. The privatize all child protective services and Child Protection Team at Help-A-Child create Community-Based Care.1 provides forensic exams and some negatively impacted PSS’s goal of clinical services. The State’s Attorney’s coordinating agency responses to office prosecutes perpetrators of child children exposed to violence. The abuse and neglect. A combination of private service provider awarded the public defenders and private attorneys initial service contract as lead agency for represents families. Within this system, Community-Based Care in Pinellas and prevention and home-based intervention Pasco Counties seriously impeded the services are not formally connected with local system’s ability to serve children child protection services and out-of- and families in need, by operating in home care. Finally, huge case loads for isolation from others in the service child protection service workers impede community. A change in the lead agency high quality service delivery and for Pinellas County’s Community-Based contribute to large numbers of children Care in spring 2004 required removed from their families. All of considerable stakeholder time and PSS’s resources could have easily been energy; Safe Start staff was actively consumed by efforts to improve involved in the planning and transition coordination of services within the child process, which included changes in protection system alone. leadership, organization, and strategy. 2.2 Economic Context2 More broadly, the complexity and fragmentation of the child protection PSS unfolded within a relatively system in Pinellas County created healthy local economic environment that challenges for implementing an supports services for children and integrated service delivery strategy for families. The Juvenile Welfare Board children exposed to violence. The (JWB) of Pinellas County, a local number of entities responsible for independent taxing authority that plans, various components of service delivery funds, and coordinates social services for helps to illustrate the complexity of the children and families, provides a secure system. The Sheriff’s Office investigates local funding source for many human and health services in the county. In the last few years, local tax revenue has 1 In 1996, the Florida Legislature enacted legislation requiring the Department of Children increased in Pinellas County, its and Families (DCF) to develop a plan to municipalities, and the Juvenile Welfare privatize all child protective services and create Board. While the increased revenues community-based care. Privatization was to be have not resulted in increased support of phased in over a three-year period, beginning January 1, 2000, with the goal of building partnerships in the community by transitioning 2 Information summarized in this section was all foster, adoption, and child protective services reported in the local evaluation report form to local providers. (Pinellas Safe Start Initiative, 2005, p. 3).

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children’s services by the County or experience unacceptable rates of municipalities, they have at least allowed domestic violence and child these funding sources to remain steady, maltreatment. In 2003, the rate of protecting some children’s service domestic violence in Pinellas County providers from feeling the impact of was 935 per 100,000. The Pinellas recent trends toward reduced state Domestic Violence Task Force estimated funding. Many agencies and programs, that for each incident of family violence however, are experiencing funding reported, nine incidents go unreported. reductions; because state funding In 1999, an estimated 15% of the continues to be the mainstay of most population of children six years and child welfare programs in Pinellas younger were exposed to violence or at County, Florida’s economic conditions high risk for exposure. Since PSS began have a direct impact on the availability systematic screening, more than 8,000 of resources for human services in the children six years and younger have county. On the other hand, changes in been identified as exposed to violence. recent legislation may provide new An examination of SAMIS4 data from funding opportunities. For example, the three recent fiscal years finds that over Revenue Maximization Legislation now 600 participants in JWB-funded agencies allows the Juvenile Welfare Board. reported “children exposed to violence” as the primary reason for participation in While children’s services in JWB-funded programs. As a final Pinellas operate within a relatively stable example of need for services, as of funding environment, the large August 2005, Florida’s child geographical area and complex system abuse/neglect rate was 31.5 per 1,000 of services created challenges for Safe children; only two other U.S. states have Start in developing and implementing a rates above 20 per 1,000. coordinated response to families and children exposed to violence. The state recently announced a Differences in funding, regulation, and goal of cutting child abuse in half over state and federal policy and priority the next five years, reflecting Florida’s create an environment in which service social commitment to reducing this agencies and organizations often extreme form of exposure to violence. In function in isolation from each other. general, the professional community of These same differences create various service providers has shown its eligibility requirements that can make it commitment to addressing the issue of difficult for families to navigate the violence broadly, as well the specific system and obtain needed services. issues of the impact of violence on young children, through its support of 2.3 Social Context3 PSS. It is less clear how important this issue is among the general public. The need for PSS remained clear throughout its implementation, as the In summary, PSS unfolded Pinellas County community continued to within very specific contextual

3 Information summarized in this section was 4 SAMIS is Services and Activities Management reported in the local evaluation report form Information System, a web-enabled reporting (Pinellas Safe Start Initiative, 2005, p. 7-9). program for fiscal and case participant data.

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conditions. In addition, Pinellas County collaborating to better serve children and has unique community capacities for families—a tradition PSS built upon planning and implementing an initiative successfully. According to 2005 site visit such as Safe Start. A primary objective participants, individuals representing the of the Safe Start Demonstration Project organizations that implemented Safe was to mobilize collaborative Start programs have, in many cases, relationships for the purpose of worked together over the years on coordinating service providers to offer a various projects. In addition, many of comprehensive response to families with these individuals participate in the young children exposed to violence. The numerous coalitions that exist in Pinellas service provider network in Pinellas County (e.g., Community-Based Care County was prepared to do just that, and Coalition, Safe Children Coalition, had many resources available for Domestic Violence Task Force, etc.). At developing a comprehensive response. the county level, two major efforts to In turn, PSS was able to increase expand comprehensive community community capacity as it was planning capacity are in the implemented over time. implementation stage: (1) the formation of a Health & Human Services Coordinating Council and (2) the 3. Community Capacity development of a social indicator website useful for grant applications, According to site visit (2004, community planning, and the general 2005) participants, Pinellas County is public (Pinellas Safe Start Initiative, “resource rich” and a place where there 2005, p. 2). is a “history and willingness to collaborate.” The professional 3.1 Training and Technical community, therefore, was well Assistance positioned to develop a comprehensive and coordinated response to children PSS and local partners have exposed to violence. Information offered the professional community provided in the 2005 Local Evaluation specialized training opportunities to Report Form (pp. 10-11) supports this increase their capacity to serve young characterization. For example, as children exposed to violence. Between described above, the Juvenile Welfare July 2002 and December 2005, 8,302 Board is a secure funding source for service providers and community many human and health services in members received training affiliated Pinellas County, including PSS services. with PSS, whether through its full In addition, several service providers in training curriculum, a brief or enhanced the county share a commitment to, and presentation, or sponsorship (e.g., PSS expertise in, children and families, paid for clinicians to receive training in facilitating their investment in PSS (see, Child-Parent Psychotherapy and Parent- for example, the 2004 2-1-1 Tampa Bay Child Interaction Therapy; Pinellas Safe Cares Resource Guide). Many service Start Initiative, 2006; Pinellas Safe Start providers in the county (e.g., Healthy Initiative, 2005, p. 21). Trainings Families Pinellas, Total Family provided by Safe Start staff were Strategies) have a long history of evaluated using surveys. On recent

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surveys, 82% of 167 respondents meeting with site staff and collaborative reported that the training information members to assess the site’s strengths, would be useful to them in their work; challenges, and progress relative to 79% thought it would be useful to them training and technical assistance. PSS in their personal life; 93% reported that recently used NCL funds to bring in the training was informative; and 94% Alicia Lieberman and Charles Zeanah, reported that the training was beneficial two noted psychologists specializing in (Pinellas Safe Start Initiative, 2005, p. young children and trauma, as the 23). keynote speakers for the Florida Association of Infant Mental Health In addition to training available conference. PSS also received technical through PSS, the Juvenile Welfare Board assistance from the National Civic offers over 200 half- and full-day League for a research project: “Removal workshops, training session, Factors in Child Welfare Cases” conferences, and other education (Pinellas Safe Start Initiative, 2005, p. programs annually, a number of which 23) are directly related to young children exposed to violence. Within the context of these community conditions and through the PSS also wrote a series of eight support of local and national technical reports that summarize key project assistance, the community was engaged activities, with the goal of making these in the planning and implementation of reports available to other practitioners in PSS, and collaborative partnerships were the community. The report series is created. How the community was expected to provide one source of engaged and the collaborative structures information for service providers that resulted are discussed next. interested in learning about and from the Safe Start project. Safe Start reports will be made available through the National 4. Community Engagement Center for Children Exposed to Violence and Collaboration and through the Juvenile Welfare 5 Board’s library. Initial engagement of the professional community was achieved PSS worked with the National during the early assessment and planning Civic League (NCL) to bring national phases of PSS. Community stakeholders expertise and resources to bear on local participated in the initial community efforts to improve infant mental health assessment that was conducted to inform and the child welfare system. The planning efforts. Local agencies were National Civic League made four site also engaged in initial planning efforts visits (November 2002, June 2003, May through strategic planning work groups. 2004, June 2005) for the purpose of

5 Pinellas Safe Start hopes to make reports available through the Pinellas Safe Start Initiative (n.d.), however final arrangements for the website in the future have not been confirmed.

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4.1 Community Engagement: planning process suggested that some Professionals6 portion of these children were exhibiting behavior resulting from violence Safe Start grant staff, with exposure. Subsequently, Coordinated support from JWB and many community Child Care added screening questions to stakeholders, conducted early its family needs questionnaire to help assessment activities; contractual identify exposure to violence as a source consultants conducted specific studies. of behavior problems, and PSS funded a Assessment of the community and local Safe Start specialist within the early service agencies was critical to planning childhood. the implementation of PSS. One study, for example, estimated the number of During two phases of assessment Pinellas children exposed to violence or and planning activities, local agencies at high risk for exposure, to project the were engaged through strategic planning number of children likely to access work groups. Eleven work groups were services. The initial community created, with members reflecting over assessment found that many children 113 organizational constituencies. Work were exposed or at risk; that no groups studied the issues, contributed systematic community response was data, participated in program design, available; and that there were many wrote sections of the plans, and in some resources available in the community cases reviewed and provided feedback that could be mobilized, enhanced, and on the overall PSS grant application. The coordinated to improve the response to frequency and duration of involvement children and their families to reduce the of each work group participant differed impact of exposure. In recognition of based on expertise and resources. these findings, the Safe Start program was designed to be countywide, to The planning group’s desire to provide multiple points of entry, to link inform service providers about children existing services, and to provide exposed to violence and early childhood consistent messages in training and development led to the 2001 creation of community awareness throughout the the PSS Training Curriculum and county. The Safe Start Partnership Trainer’s Guide (with revisions Center (SSPC; described in more detail continuing through 2006). Because PSS in sections 4.3 and 5.1) was formed as a recognized the ongoing need for service result of the community planning providers and caregivers to have process. information about children’s exposure to violence, one role of the Safe Start The initial community Partnership Center was defined as a assessment also indicated that many clearinghouse for information on young children were losing child care children exposed to violence and local placements due to severe behavior resources (2002). problems. Early childhood system representatives who participated in the Overall, the first phase of assessment and planning occurred

6 Information summarized in this section was between May 1, 2000 and April 30, reported in the local evaluation report form 2001. The second phase of assessment (Pinellas Safe Start Initiative, 2005, p. 29-30).

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and planning occurred between May 1, as the single biggest achievement of PSS 2001 and October 31, 2002. In other in 2005. According to a number of site words, assessment and planning visit (2005) participants, the community continued through the initial engagement component of PSS “got its implementation stage. legs” in 2005; this accomplishment was attributed primarily to the efforts of the 4.2 Community Engagement: community outreach coordinator and the Parents and Caregivers neighborhood facilitators and ambassadors in his charge. Ambassadors Key findings from the PSS social and facilitators were recruited to help marketing study conducted in 2002 deliver Safe Start’s message, as well as indicated low levels of awareness in the the tools and resources necessary to community about the effects of exposure reduce the number of children to violence, as well as about appropriate witnessing and impacted by violence, services and programs. Participants in through presentations to community and the study (e.g., community leaders, child professional groups and by building care providers, and parents/caregivers) partnerships with local sponsors, expressed strong agreement that the philanthropists, and media outlets. As of primary sources of exposure were October 31, 2005, 46 PSS ambassadors domestic violence and the media (volunteers) and five facilitators (under (Pinellas Safe Start Initiative, 2005, p. contract) had made 39 presentations to 31). The social marketing study was over 500 community members in a wide conducted prior to implementing any variety of community groups and public awareness campaign; findings organizations, including day care, early from the study were used to design the childhood education, health and social public awareness materials and services, and civic groups. Ambassadors strategies. Educating caregivers about and facilitators reached parents and other issues of children exposed to violence family members through presentations at was achieved through the PSS website local shelters, neighborhood family (2003), the Public Awareness Campaign centers, and churches. (2003), the Safe Start Partnership Center Outreach Plan (2003), education 4.3 Collaboration7 programs for parents and caregivers at high risk of perpetrating or experiencing PSS used a three-tiered domestic violence (2004; Batterers collaboration structure, allowing Intervention Program, Project Success, agencies to choose a level of Alpha House, YWCA homeless shelter involvement in the project based on their for families and young children), and the interest and commitment. The structure, Community Engagement Project (2004). composed of a Leadership Council (1), All of these strategies for engaging the Safe Start Partnership Center (2), and parents and caregivers continued through 2006.

7 Increased awareness of children Information summarized in this section was obtained through personal communication (e.g., exposed to violence among community in-person discussions, telephone conversations, members and service agencies was cited email) with the Pinellas Safe Start project director.

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community partners (3), was generated collaborative with contractual through a community planning process. obligations to PSS, was a smaller The most formal voluntary collaborative within PSS comprised of a collaborative body was the Leadership lead agency (Help-A-Child) and four Council, which met quarterly, and other subcontracted point-of-service served as the official leadership and providers (2-1-1 Tampa Bay Cares, The decision making group for PSS. The Haven, CASA, and Pinellas County Leadership Council was made up of Health Department; each is described in agencies with a role in the system of care more detail in section 5.1). SSPC was for children exposed to violence (such as funded to implement an integrated child protection, courts, law service delivery model for children enforcement, and the School Board) and exposed to violence, through a request- broad based coalitions with related for-proposal process. Memoranda of missions (such as the Domestic Violence Understanding (MOUs) regarding Task Force, Healthy Start Coalition, partner roles and responsibilities Early Learning Coalition, and outlined some aspects of SSPC’s Community Councils). Agency contractual obligations to Safe Start. representatives were formally designated or appointed by agency senior Contractual responsibilities management, and coalition included using a common definition of representatives were designated by a “children exposed to violence;” constituent body of the coalition. The implementing protocols for systematic Council had both voting and non-voting screening, identification and referral of members. Voting members approved children exposed to violence and their funding requests to OJJDP, were families; providing information about responsible for strategic planning, children exposed to violence to parents determined Council membership, and caregivers; contributing service data determined the Council’s organizational to the evaluation; and working toward a structure, and decided on letters of shared client information system. support when pursuing funding. These Partners formally agreed to train staff in members reached their decisions by their own agencies on issues related to consensus. Over the five year course of children exposed to violence and how to the grant, numerous work groups, implement screening, identification, and request-for-proposal teams, and ad hoc referral protocols and provide committees formed and disbanded to information to families. Partners address specific tasks and issues; participated in interdisciplinary staffing however, products and recommendations meetings as well as informal problem of these groups were always brought solving for families with complex needs. back to the Leadership Council for In addition, partners developed parent action or consent. These groups included education materials to be used by all community partners and staff of funded agencies, and shared responsibility for agencies, as well as Leadership Council meeting community education and members. training goals. In this way, the SSPC functioned as a central point of contact The Safe Start Partnership for agencies and the community for Center, a funded service delivery children exposed to violence, by

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providing information, referrals, and partners had looser connections to the training. SSPC communication and project, and varying degrees of collaboration were maintained through investment and involvement. regular meetings of management and Nevertheless, Leadership Council direct service staff; the SSPC held meetings were open to the community, “Partnership” meetings bimonthly and allowing community partners to attend “Direct Service” meetings monthly. Two as interest dictated. Community partners other agencies that received Safe Start could and did bring issues to the table, funding to deliver services related to and input from community partners was children exposed to violence often considered in decision-making. participated in SSPC meetings as well as SSPC coordinated events. 5. System Change Activities The Safe Start Leadership Council and the Juvenile Welfare Board (the lead PSS changed the service provider agency for PSS) regularly reviewed the network by building the capacity of extent to which SSPC partners were existing services to respond to young meeting their contractual obligations. children exposed to violence, Partners were able to accept their coordinating existing services, and contractual responsibilities due to the creating new services to fill gaps in the guidance and approval of the Leadership network. Service integration was Council. In addition, SSPC partners accomplished by creating formal received funding sufficient to allow partnerships among service providers senior-level staff to participate in (e.g., the Safe Start Partnership Center, interagency meetings, planning, and Clearwater Child Development- training. Community Policing), which allowed for identifications and referrals among Community partners (PSS agencies to be coordinated and collaborative tier 3) included sequenced in a way that made sense for organizations or individuals with families. The SSPC received funding to missions similar to that of PSS, for develop an intensive family service example, key agencies in children’s component specifically geared toward mental health, family services, and other assessing the impact of violence related sectors, as well as citizen’s exposure and supporting families to groups and community leaders. make changes in their lives and to access other services if needed. In addition, PSS Membership within the three established the Clearwater Child tiers of collaboration overlapped in some Development-Community Policing cases. The Leadership Council consisted Program through training and technical of decision-makers from organizations, assistance, and assisted the program in while the SSPC was made up of program securing funding for a full time managers from partnership agencies, as coordinator. PSS also funded a Safe well as front line staff with daily Start specialist to enhance Coordinated operations knowledge. Community Child Care’s existing Project Challenge partners collaborated with PSS, but had services, leading to the addition of a no contractual obligations. Community violence exposure screening question to

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Coordinated Child Care’s family needs exposure. SSPC’s coordination of assessment, and a home visit component responses included building the capacity for families identifying children exposed of service providers to identify children to violence as a concern. Integration was exposed to violence, to assess and also accomplished through involvement prioritize the needs of these children and of PSS in broader community efforts to their families, and to connect families coordinate responses to families and children to the services that would experiencing domestic violence and with best meet their needs in a sequence that children exposed to this violence. made sense for the family. For example, one family might have resources such as stable housing, employment, and health 5.1 Safe Start Partnership insurance, making therapeutic services Center: An Integrated for the young child and parents the most Service Delivery Model8 appropriate referral. This family might be referred directly to a mental health Safe Start Partnership Center. provider in the community, such as The Safe Start Partnership Center was Directions for Mental Health. Another the centerpiece of PSS’s approach to family, however, might have unstable improving services for children exposed housing, lack employment and to violence. SSPC offered services insurance, and might still be ranging from early identification (e.g., experiencing violence in the home. This through systematic screening by partner family would likely be stabilized first to agencies, and information and referrals meet basic needs (e.g., safety plan, provided to families at any point of shelter housing if desired, etc.), and then entry), to intensive and individualized therapeutic services might be offered. family services (e.g., comprehensive The latter family might be a good fit for assessment and family support, service the intensive family services component coordination, and multi-disciplinary of SSPC. staffing when needed) for children exposed to violence, offered in the home Together, the Safe Start or community setting by family Partnership Center, the Child advocates and a case manager housed at Development-Community Policing Help-A-Child. (See Attachment B for a Program, and Coordinated Child Care’s model of the PSS pathways to service.) Safe Start-enhanced Project Challenge (Enhanced Project Challenge) The SSPC provides a model for accomplished the following between coordinating the professional May 2002 and December 2005: community’s response to families with children exposed to violence or at risk of • 8,388 young children exposed to violence were identified through Safe Start programs between 8 Information summarized in this section was May 2002 and December 2005; obtained during site visits (November 9 and 10, • 2,406 young children exposed to 2004, and November 14 and 15, 2005); local evaluation report form (Pinellas Safe Start violence were referred to services Initiative, 2005a, p. 17-20), and the Semi-annual between May 2002 and Progress Report (Pinellas Safe Start Initiative, December 2005; and 2005b, p. 1).

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• 558 young children exposed to children six years and younger violence were assessed by a Safe who entered shelters were Start Family Advocate, a CD-CP assumed to be exposed or at high clinician, or the Project risk of exposure to violence and Challenge Safe Start consultant therefore were “counted” as to develop appropriate support “identified.” In addition, parents and service plans between May attending domestic violence 2002 and December 2005. support groups or other community outreach activities To accomplish these outcomes, were asked about children six the PSS partners had to develop, years or younger; the support enhance, and expand policies and daily group sign-in sheet was designed practices. One key objective of the SSPC with a space for parents to was to develop collaborative interagency indicate the presence of children protocols for identifying, referring, and six years or younger in the home. providing services to children exposed to These children were considered violence, and also for sharing exposed or at high risk of information on client cases. The goals exposure and were counted. for identifying children were (1) to Parents were given information provide parents/caregivers with about children exposed to information about children exposed to violence to ensure that violence and (2) to provide appropriate identification would lead referrals. SSPC developed parent immediately to services. information materials to be used by all • Pinellas County Health partner agencies; partnership agency Department. Forms used by representatives met regularly to establish family home visitor staff to common protocols for intake and referral document various types of and to work toward a shared client information gathered during the information system. Between 2002 and visit (e.g., risk factors and 2005, 50 policies were created, services) included a code for enhanced, or expanded to accomplish the domestic violence and children’s goals of the Safe Start Partnership exposure to violence. When Center. For example, because of PSS, domestic violence was coded, each agency in the SSPC began to children exposed to this violence identify children exposed to violence were counted in the formal using some set of questions or “identified” tally reported to information from their existing intake OJJDP. Parents were given and/or questions added to their information about children intake/assessment forms. The following exposed to violence to ensure summarizes the information and criteria that identification would lead that the partners used to identify children immediately to services. exposed to violence and to document • 2-1-1 Tampa Bay Cares. Phone program statistics: counselors followed a protocol that included questions about • CASA and The Haven (the immediate safety issues if the domestic violence centers). All initial request for information

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seemed to indicate violence as a 5.2 Safe Start Services for factor and the involvement of Children Exposed to Violence children. If domestic violence was an initial concern, Intensive family services counselors referred the caller to component of the Safe Start Partnership domestic violence services and Center. Families with at least one child counted the child (the same child six years or younger known to be would be counted again if he or exposed to violence were referred for she presented at a shelter). comprehensive assessment and family Depending on circumstances, 2- support when needs were complex and 1-1 Tampa Bay Cares also barriers to services existed that the referred to the SSPC or to other program making the identification could community programs, based on not address. Families referred to the family interest, location, etc. intensive and individualized service Parents were given information component of the SSPC typically needed about children exposed to additional help to sort out priorities and violence to ensure that access services. identification would lead immediately to services. The intensive family services • Help-A-Child. The Child component took a holistic family Protection Team reviewed child approach. Families in intensive services abuse reports and tallied the received comprehensive assessment, indicators of domestic violence crisis support, and short-term in the case at first report. At this support/case management to help them point, the tally represented sort out complex situations. Further, statistical information only, intensive service providers developed an although the Team sometimes individualized plan of action for each made recommendations to child family, negotiated barriers to accessing protection investigators (i.e., the services, and helped the family make Sheriff’s office), based on record changes in lifestyle and situation to review. The Team also flagged improve child safety and well-being. The cases for further follow up, goals of intensive services were to including further exploration of support and strengthen parental domestic violence factors in the understanding of violence exposure and case and a potential referral or its impact on the child/family, increase consultation with SSPC parental ability to address a child’s regarding children exposed to needs, and help the family link with violence. Parents were given longer term supports and services that information about children might be needed to help the family exposed to violence to ensure continue on a path to improve child that identification would lead safety and well-being. In some cases, the immediately to services (except priorities were treatment/intervention for during the initial review of Child parents, along with appropriate child Protection Team reports). care and improved parenting skills. In other situations, the plan called for

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longer term therapeutic services and In the operation of the CD-CP, specialized child care for the child. mental health clinicians from Directions for Mental Health, Inc. were paired with Families that received intensive officers from the Clearwater Police Safe Start services also were referred to Department. All CD-CP referrals came other services, based on identified needs. from police officers. Officers at the The Safe Start Partnership Center kept scene of a violent incident requested an records of the number of referrals made on-call clinician to come to the scene, or to agencies on behalf of children made a referral to the CD-CP exposed to violence. Between October Coordinator to follow up with the family 2003 and September 2005, 210 children the next day. The police-mental health exposed to violence were assessed by team provided crisis intervention and family advocates. Each child received at attempted to restore a sense of security least one referral for further assistance for the child after a traumatic incident. based on his or her exposure to violence. Safety planning was completed with A total of 260 referrals to mental health, both the child and the parents. medical, education, and “other” services Information was provided to parents were made; 127 of these referrals (49%) about the effects of violence on children. resulted in the delivery of services. A brief assessment was completed to determine the needs of the child and Clearwater Child Development- family, and appropriate referrals were Community Policing. Clearwater is the provided. only Child Development-Community Policing (CD-CP) site in Florida. CD-CP Coordinated Child Care: was implemented in Clearwater in 2001 Enhanced Project Challenge. through training and technical assistance Coordinated Child Care (CCC) is the provided by PSS and the National Center central agency for child care resource for Children Exposed to Violence and referral in Pinellas County. It assists (NCCEV). Although it started on a Pinellas County families with finding volunteer basis, with a focus on children care, helps low/middle income community policing squads, CD-CP in families pay for child care, provides Clearwater is now citywide, and the improvement resources for child care entire police department has received providers, and provides other family training regarding the effects of violence support and education services. CCC on children. also offers developmental screening and behavioral services, such as Project A team of police officers and Challenge, that are open to any child in a mental health clinicians met to develop child care program, public or private, in the training for the police department. Pinellas County. Eligibility criteria for The team wanted to present the Project Challenge include: the child is information in such a way that even five years or younger; the child is hardened veteran officers could relate to attending a child care program; and the the experiences of children living in child is having behavioral or emotional violent environments. problems in that setting. CCC also manages child care subsidies

Association for the Study and Development of Community 98 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

(scholarships) for eligible children Network, offered clinicians from several through consolidation of public funds. agencies and private practice two extended training opportunities. Two Coordinated Child Care was evidence-based treatment models were enhanced by the addition of a Safe Start taught: Child-Parent Psychotherapy and trained staff person to the existing Parent-Child Interaction Therapy. Project Challenge program; the Safe Clinicians trained in these models have Start consultant improved the capacity of the capacity to respond more effectively the system to serve children impacted by to families affected by violence. violence by providing more home visits and parent support services than other Domestic Violence-Child Project Challenge staff. Safe Start also Protection Coordination. Collaboration has enhanced staff training for child care between domestic violence victim providers through offering regularly services and child protection services scheduled workshops related to children has increased significantly in Pinellas exposed to violence. County in the past five years. This has been due in large part to the efforts and Because of PSS, Coordinated involvement of PSS, and is particularly Child Care added a question to its significant, given historic differences in existing family needs questionnaire, perspective between the two service which is used at intake, eligibility re- systems with regard to children’s determination, or referral to special exposure to violence, the complex and children’s services. This question asked somewhat ambiguous body of law, and whether the child has experienced the lack of clarity around when/if something potentially upsetting (“such children’s exposure to violence as an auto accident or family violence”). constitutes child maltreatment and what When a family responded “yes,” staff the legal response should be. followed up to confirm violence exposure, and a referral (voluntary) was Since its inception, PSS has been made to the CCC Safe Start specialist. actively involved with the agencies and coalitions that comprise both the 5.3 Community county’s Community-Based Care system Partners/Broader Network: for child welfare and the domestic System Enhancements and violence system. For example, the Integration9 Domestic Violence Task Force developed guiding principles for a Early Childhood Mental Health coordinated community response to Services. PSS, in partnership with domestic violence cases involving Directions for Mental Health and the children. The SSPC provides a specific National Child Traumatic Stress example of coordination between the domestic violence and child protection systems. The county’s two certified 9 Information summarized in this section was domestic violence providers (CASA and obtained during site visits (November 9 and 10, the Haven) are part of the SSPC, along 2004, and November 14 and 15, 2005); and was reported in the local evaluation report form with Help-a-Child, which has under its (Pinellas Safe Start Initiative, 2005a, p. 13 & umbrella the Child Protection Team; 25).

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medical foster care; and the Exchange domestic violence, they are able to do Club, a child abuse prevention program. outreach to families of those arrested, The other SSPC partner, Pinellas County which in turn provides opportunities to Health Department, is also the lead screen for children exposed to violence agency for several home visiting model and to provide information and referrals child abuse prevention programs, under to the non-battering parent. the “Healthy Start” umbrella; this includes Healthy Families Pinellas, one Project Success. Project Success, of the largest Healthy Families groups in an educational program operated at the America. An example of the potential jail by the Pinellas County Sheriff’s benefit to children of coordination Office, is aimed at preparing mothers in between the domestic violence and child jail for release. Since 2003, Safe Start protection systems is seen in a family has provided quarterly workshops to with young children that enters a shelter participants on children exposed to and appears to be in need of specialized violence and community resources. The assessment and support (e.g., for jail has served as an important children exposed to violence). Shelter community venue for Safe Start staff could contact the SSPC family workshops, along with other venues advocates or the case manager at Help- likely to see exposed or at-risk children A-Child, to set up an initial visit with the and their families (e.g., Alpha House, a family at the shelter within 48 hours or program for unwed mothers; the less. Alternatively, if the SSPC case guardian ad litem program; the YWCA manager at Help-A-Child was working homeless shelter for families with young with a family in need of domestic children; Head Start). violence services or a consultation about domestic violence issues or legal issues, he or she could quickly connect the 6. Institutionalization of family with a domestic violence Change advocate. The CCC Safe Start specialist also worked closely with the SSPC PSS accomplished several of its direct services team, to connect families original objectives and as a result made identified in child care settings with several lasting changes in the service domestic violence services. delivery system.

Batterer’s Intervention Program. 6.1 System and Agency Change In January 2004, PSS contracted with a qualified provider to offer a weekly Local funding was obtained to Batterer Intervention Program (BIP) in continue key programs (Pinellas Safe the Pinellas County jail. The content was Start Initiative, 2005a, p.2). The enhanced in collaboration with the following PSS programs were funded by Domestic Violence Task Force, to the Juvenile Welfare Board or the include information in each session County. about the impact of violence on children and available community resources. LOCAL FUNDING TO CONTINUE Because domestic violence centers CHILDREN EXPOSED TO VIOLENCE receive police reports upon arrest for PROGRAMS THAT STARTED WITH

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OJJDP SAFE START FUNDING agreed that service provision for children Amount Funder Year exposed to violence had improved since Awardedthe implementation of PSS (Pinellas SSPC $296,000 JWB FY 2005-Safe Start Initiative, 2005c, p. 3). 06 CD-CP $70,000 JWB FY 2004-6.2 Point of Service Change 05 CCC $54,000 JWB FY 2005- In addition to increased service 06 coordination and additional services for Batterer $5,000 County/PCSO FY 2005-children exposed to violence, PSS has Education 06 resulted in more public and private clinicians in Pinellas County trained to In addition to continuation of effectively respond to young children funding, several other sources of and their families. Clinicians trained in evidence indicate the ways in which PSS evidence-based models were surveyed has permanently changed the service during the summer of 2005. All provider network. The Leadership respondents reported that the training Council will continue meeting due to the had changed their practice. Child-Parent importance of a coordinated response Psychotherapy trainees were asked to and the need to maintain an interagency estimate the fraction of their current advocacy for the issue. Increased caseload in which they were referrals over two fiscal years indicate implementing the model; responses dissemination of information across ranged from 3% to 99%, with an average agencies and within agencies regarding of 42%. Parent-Child Interaction Safe Start and children exposed to Therapy trainees were asked to make violence. PSS not only improved similar estimates; responses ranged from awareness and knowledge about children 0% to 60 or 70%, with an average of exposed to violence and appropriate approximately 20% (Pinellas Safe Start services, but also willingness to make a Initiative, 2005a, p. 14). referral. According to key stakeholders (service providers), service delivery has 6.3 Community Change improved since PSS implementation. PSS has made information about Eighty five percent of Key children exposed to violence and related Informant Survey participants (2005) programs more readily available. A thought the service provider network’s website hosted by 2-1-1 Tampa Bay ability to identify children exposed to Cares promotes Safe Start messages on violence had improved since Safe Start children exposed to violence and was initiated. Ninety percent thought the information on how to get help. The network’s ability to assess identified program tracks the number of visits to children had improved since Safe Start the website as an indicator of was initiated. And 88% thought the information dissemination; from the time network’s ability to make referrals for of its launch in December 2003 through identified and assessed children had September 2005, the website received improved since Safe Start was initiated. over 7,300 contacts (Pinellas Safe Start The majority of individuals surveyed Initiative, 2005a, p. 39). Informational

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materials developed for parents and 2005a, p. 46-47). Although PSS did not caregivers are provided when parents of obtain a significant level of corporate children exposed to violence are support for media buys, billboards, etc., contacted in person. Training has Safe Start was able to produce high provided another avenue for quality materials on a modest budget, disseminating information about the and to distribute these materials via program; training efforts appear to be volunteers and agencies to generate effective, as a survey of 99 staff some sustainability (the first priority for members at five local agencies found the campaign). The SSPC is expected to that 82% of those surveyed knew at least continue to provide community one method for contacting PSS (Pinellas education and training through some of Safe Start Initiative, 2005a, p. 44). The the venues and contacts identified during Safe Start Partnership Center also has the grant period. provided training at local colleges and at grand rounds at a local hospital to inform staff members and students about 7. Increased Community screening for domestic violence and Supports exposure to violence in children. In the future, the Safe Start Partnership Center The support available to Pinellas will continue to function as a central County families experiencing violence point of access to information and has increased through OJJDP Safe Start existing community resources, as well as funding; improved support will be a source of expertise in working with sustained with local funding, as several families experiencing violence. Safe Start programs will continue to provide services to children exposed to Finally, the PSS public violence. The Safe Start Demonstration awareness campaign has provided the Project may be thought of, therefore, as community with information about a community-level intervention. children exposed to violence and where Important community-level changes that to get help, using brochures and public ultimately impact family and child well- service announcements on both being include changes in social norms television and radio and at public events. that reduce public tolerance of exposing The Tampa Bay Devil Rays partnered children to violence and changes in the with PSS in public awareness events in service system responsible for helping 2004 and 2005; the Rays’ support for families experiencing violence. An PSS is expected to continue in the future informed and responsive community is (Pinellas Safe Start Initiative, 2005a, p. essential for improving child and family 48). The PSS Community Engagement well-being. Without strong community Project provided some evidence for support, both professional and public, improved public awareness of children fewer families experiencing violence are exposed to violence . All attendees (38 likely to receive the help they need to for four presentations) reported better make a change. PSS changed the understanding of issues related to community by improving the children exposed to violence and ways to coordination of services, enhancing the respond to children who have been quality of services available to families exposed (Pinellas Safe Start Initiative, with young children exposed to violence,

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making additional services available to groups, total parental stress decreased these families, and increasing public during participation in the intervention, awareness of children exposed to but the changes were not statistically violence. significant. Information about changes in child well-being is not yet available because only five families have 8. Reduced Exposure to completed the child measure. Violence Given an expected influence on

the well-being of both parents and their The long term vision for the children, parents’ needs and resources National Safe Start Demonstration also were examined. As predicted, Project and for Pinellas is that over time, parents with more needs reported higher with increased awareness of children stress and more negative perceptions of exposed to violence and more preventive their children. In contrast, as resources services, fewer children will be exposed; available to parents increased, their however, Pinellas did not anticipate, nor stress levels decreased, and their propose to OJJDP as an outcome, that a perceptions of their children were more measurable reduction in children’s positive. Generally speaking, therefore, a exposure would result during the period parent’s ability to cope appeared to be of the grant. Evidence that fewer related to the parent’s abilities and not to Pinellas County children are being his or her child’s characteristics. exposed to violence because of PSS was therefore not systematically gathered. PSS experienced typical Nevertheless, preliminary evidence challenges to its research design, exists that PSS has increased public specifically, attrition and compliance awareness of the issues associated with with comparison group assignment. children’s exposure to violence and how Families do not always participate in to get help. services long enough to meet the data 9. Reduced Impact of collection needs of research and, even if Exposure to Violence they do, they may not agree to comply with the demands of data collection. Of ultimate interest are the child Service providers often prioritize and family results achieved by PSS. Are meeting the immediate needs of children families with young children exposed to and families over the information needs violence better off because of services of researchers, even if the information provided by PSS? PSS determined the may one day improve services. effect of its specialized services on children using a comparison group study Documentation of changes in (see Attachment C for a more detailed child and family well-being for all 8,388 summary of PSS’s intervention children identified as exposed to research). Three groups were compared: violence was not feasible. Tracking children and families served by the change for this number of children and SSPC intensive family services their families would have required an component, the Project Challenge Safe unprecedented level of data coordination Start group, and the Project Challenge and sharing among service providers, comparison group. In the two Safe Start

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assuming that all of these families were professionals, in turn, to help change the engaged successfully in some form of knowledge, attitudes, and behaviors of intervention and participated long families with young children who have enough to achieve outcomes. Nor was it been exposed to violence. Change was possible to track child and family-level achieved through effective leadership outcomes for all Safe Start programs and capacity building, development of a (e.g., CD-CP) and partners (e.g., CASA, central point of access to services and The Haven, Pinellas County Health information, enhanced and intensive Department, 2-1-1 Tampa Bay Cares). services, and securing resources for Furthermore, it was not within the scope sustaining these changes. PSS’s of the PSS evaluation or resources to strongest achievements were the ways in evaluate child outcomes after clinicians which the project enhanced and were trained in either Child-Parent integrated supports and services for Psychotherapy or Parent-Child families with young children exposed to Interaction Therapy (Van Horn & violence; however, data limitations Lieberman, 2006).10 On the other hand, prevent definitive statements about the it was possible to examine the project’s success in reducing the impact effectiveness of the specialized of violence exposure. The success of the intervention components administered public awareness campaign was by Safe Start project staff at Help-A- commensurate with the investment of Child and Coordinated Child Care for resources. The Key Informant Survey, some children and their families. responses of community training participants, and the number of web site Given that it took five years to visits all indicate a significant increase in develop the capacity and coordination awareness and concern about children among service providers to identify exposed to violence in Pinellas County. children exposed to violence, however, it Two challenges that PSS faces in the does not seem unreasonable to think that immediate future are establishing it will take an equal amount of time for system-wide data sharing practices and the network of providers to agree on identifying new champions for children common outcomes and to integrate the exposed to violence as dedicated as the necessary data collection procedures into current leadership core in Pinellas daily practice. In short, due to lack of the County. The fact that Safe Start necessary data, it is not possible at this programs will continue and that PSS has time to fully determine the impact of been recognized by the state as a PSS on children and families. resource for coordination between the domestic violence and child protection sectors in its five-year plan to reduce 10. Conclusion child maltreatment perhaps best attest to the project’s positive influence in the The primary focus of this project community over the last five years. was to change the knowledge, attitudes, and behaviors of human service professionals, to enable these

10 Both therapeutic models are evidence-based.

Association for the Study and Development of Community 104 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

11. References

Association for the Study and Development of Community (2005a). Site visit report: Pinellas Safe Start Initiative January-November 2004. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2005b). Site visit report: Pinellas Safe Start Initiative January 1 through November 15, 2005. Gaithersburg, MD: Author.

Coordinated Child Care of Pinellas, Inc. (n.d.). CCC’S Services. Retrieved June 14, 2006 from www.childcarepinellas.org

Pinellas County Government (n.d.). Pinellas County. Retrieved June 14, 2006 from http://www.pinellascounty.org/

Pinellas Safe Start Initiative (n.d.). Safe Start. Retrieved June 14, 2006 from http://www.pinellassafestart.org/en/

Pinellas Safe Start Initiative (2006). Pinellas Safe Start Implementation Phase Accomplishment, 2002-2005. Pinellas County, FL: Author (Available from the Association for the Study and Development of Community).

Pinellas Safe Start Initiative (2005a). Local evaluation report form: Section I. Pinellas County, FL: Author (Available from the Association for the Study and Development of Community).

Pinellas Safe Start Initiative (2005b). Semi-annual progress report #11. Pinellas County, FL: Author (Available from the Department of Justice Office of Juvenile Justice and Delinquency Prevention).

Pinellas Safe Start Initiative (2005c). Local evaluation report form: Section II. Pinellas County, FL: Author (Available from the Association for the Study and Development of Community).

U.S. Census Bureau. (n.d.). Florida quicklinks. Retrieved June 14, 2006 from http://quickfacts.census.gov/qfd/states/12000.html

U.S. Census Bureau. (2000). Fact Sheet. Retrieved June 14, 2006 from http://factfinder.census.gov/servlet/SAFFFacts?

U.S. Census Bureau. (2005). Population Estimate. Retrieved June 14, 2006 from http://factfinder.census.gov/servlet/SAFFPopulation?

Association for the Study and Development of Community 105 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Van Horn, P. & Lieberman, A.F. (2006). Child-parent psychotherapy and the Early Trauma Treatment Network. In M. M. Feerick & G. B. Silverman (Eds.), Children exposed to violence (pp. 87-105). Baltimore, MD: Paul H. Brookes Publishing Co.

Association for the Study and Development of Community 106 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Exhibit V-A Timeline of Pinellas Safe Start Initiative Activities and Milestones

Major Milestones 1/01-12/01 1/02-12/02 1/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05 Community assessment conducted Training Guide & Curriculum developed • Revisions on-going Leadership Council (formed & ongoing) Development of shared information systems: SAMIS (Services and Activities Management Information System)/TBIN (Tampa Bay Information Network) Social marketing study CD-CP (Child Development-Community Policing Program) • 31 individuals received training through the CD-CP project Safe Start Partnership Center (formed & ongoing) Children’s Summit Development of the Pinellas Safe Start website (pinellassafestart.org ) Project Success Help-A-Child intensive family services (formed & ongoing) • Case Worker position established Coordinated Child Care (CCC)/Enhanced Project Challenge • Contract established with CCC/Project Challenge • CCC created a new position devoted to working with Safe Start;

JWB allocated Safe Start funds for this position • CCC Safe Start Specialist position filled Intervention research • Tier II measure: Temperament and Atypical Behavior Scale (TABS) • Tier II risk/protective factors

Association for the Study and Development of Community 107 July 2006

Major Milestones 1/01-12/01 1/02-12/02 1/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05 Public awareness campaign Community engagement project • Community Involvement and Training Coordinator position filled • Ambassador program started with training for first 23 ambassadors • Neighborhood facilitators hired Batterer’s Intervention Project

Intensive mental health services training • 13 individuals trained in parent-child interaction therapy • 16 mental health professionals trained in child-parent psychotherapy Dependency court study (factors for removal)

Sources: LERF, 2004 and 2005; Progress Reports, January-July 2002, January-June 2004, July-December 2004, and July-December 2005.

Association for the Study and Development of Community 108 July 2006

Exhibit V-B Pinellas Safe Start Service Delivery Model Showing Pathways to Service

Red Arrows: All families with children exposed to violence Blue Arrows: Referrals Help-A-Child Concerned Child Protection Citizens Team Parents/ Intensive Family Services Caregivers (Help-A-Child) Batterer’s Safe Start Partnership Center Education • Crisis counseling (Jail) Help-A-Child • Comprehensive family assessment • Parent-child observations Project Success • Weekly home visits The Haven Casa (Jail) • Support services for parents • Some Families Family plan assistance Courts • Resource referral and service 2-1-1 PC Health Dept. coordination • Multi-disciplinary team, if needed

Early Average 12-16 weeks of intensive services Law Childhood 90 day follow-up Enforcement Education/ Schools CD – CP

• Clearwater Coordinated Child Care Project Challenge Police Department

Coordinated Child Care Project • Behavioral and developmental • Directions for Challenge screening Mental Health • Observe child in child care setting • Some Families • SomeFamilies Safe Start Monthly home visits Consultant • Support services for parents • Consultation with child care providers to maintain the child in care • Therapeutic child care, if needed • Behavior management and developmental activities for parent and child care provider Child Development-Community Policing • Resource referral and service

• coordination Crisis counseling/support • Consultation

• Provide information to parents about impact of violence exposure • Average 12-16 months of service Referrals to mental health services

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Exhibit V-C Pinellas Safe Start Intervention Research1

Overview

Pinellas Safe Start’s intervention research was designed to evaluate service system improvement and the impact of SSPC’s intensive family services component (a home-based program) and Coordinated Child Care’s Project Challenge (a childcare-based program). These two interventions were developed to reduce the impact of exposure to violence on young children. Both interventions provided families and children with comprehensive assessment and screening, behavioral observations, counseling and consultation, home visits, and resource referral and service coordination. A comparison group study was used to investigate the effects of these interventions (e.g., service provision) on children. Differences in parent stress and parent-child dynamics among three groups of children and families (two intervention groups and one comparison group) were examined. The information summarized here is discussed in detail in the 2005 Local Evaluation Report Form, Section II (pp. 3-11; pp. 20-21).

Methods

Two methods were used to conduct Pinellas Safe Start’s intervention research.

Service System Improvement (Method 1)

Sample.

The sample consisted of 56 Pinellas County service providers. The largest group of respondents represented non-profit organizations that are non-faith based (45.3%). Thirty percent of respondents represented governmental agencies. Another 13.2% of respondents represented faith-based organizations, and 11.3% represented for-profit organizations. Fifty-five percent of the respondents were in management positions, and 45% were in direct service positions. Over 83% of the key informant respondents had worked for their agency for three or more years. Almost half (41%) of the respondents were employed at their agency for 10 or more years. The average length of employment was 11 years.

Procedures.

Key informant telephone interviews were conducted in 2002. This protocol was followed in 2005 with one modification: the questionnaire was mailed to key informants. The Key Informant Survey was sent (January 2005) to 120 stakeholders involved with the Pinellas Safe Start project. The survey asked for retrospective recall to compare the current state of services for children exposed to violence and services two years before

1 For a complete description of Pinellas Safe Start’s intervention research, refer to the local evaluation report form (Pinellas Safe Start, 2005).

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Safe Start was implemented. Fifty-six completed surveys were returned, for a 47% response rate. The survey included a total of 28 questions developed to measure the contributions of Pinellas Safe Start in raising awareness of children exposed to violence and strengthening service provision for children and their families (see Appendix 1 of the 2005 Local Evaluation Report Form for a copy of the survey). Responses to three questions were used to describe service providers’ perceptions of service improvement. These questions were:

(Q 20) What do you think of the CEV service provider network member’s ability to identify children who are exposed to violence?

(Q 21) What do you think of the CEV service provider network member’s ability to assess children who are exposed to violence once they are identified?

(Q22) What do you think of the CEV service provider network member’s ability to make referrals for children who have been exposed to violence once they have been identified and assessed?

Response options for these questions were:

They are much better now They are somewhat better now They are about the same now as they were They are somewhat worse now They are quite a bit worse now Don’t know

Intervention Impact (Method 2)

Sample.

Information about the characteristics of the families that participated in the intervention research was extracted from client case files.

Group 1 (89 families). Parents and children in Group 1 participated in SSPC’s intensive family services component. A majority (77.9%) of the parents were Caucasian. Parents, on average, were 41 years old. Three-fourths of the parents had an income level below $20,000 a year. Most parents (83.4%) had earned a high school diploma or had obtained higher levels of educational achievement. The mean number of adults in the household was 2.1. Eighty-eight percent of the parents were not married. On average, parents and children in Group 1 participated in the program for 95.65 days. Children (N = 44) in Group 1 were predominantly Caucasian (72.7%). The average age of children in this group was 4.00 years. On average, these children had 1.31 siblings.

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Group 2 (31 families). Parents and children in Group 2 participated in Coordinated Child Care’s (CCC) Enhanced Project Challenge program. The Enhanced program included a Safe Start consultant trained to help childcare providers understand the behavioral symptoms that can indicate exposure to violence. A majority (82.4%) of the parents were Caucasian. Parents, on average, were 36 years old. Sixty-one percent of the parents had an income level below $20,000 a year. Most parents (90%) had earned a high school diploma or had obtained higher levels of educational achievement. The mean number of adults in the household was 2.1. Sixty percent of the parents were not married. On average, parents and children in Group 2 participated in the program for 342.51 days. Children (N = 23) in Group 2 were predominantly Caucasian (60.9%). The average age of children in this group was 3.51 years. On average, these children had 1.03 siblings.

Group 3 (4 families). Parents and children in Group 3 participated in Coordinated Child Care’s (CCC) Project Challenge program. This program did not include a Safe Start consultant. All of the parents were Caucasian. Parents, on average, were 33 years old. Thirty three percent of the parents had an income level below $20,000 a year. Most parents (83%) had earned a high school diploma or had obtained higher levels of educational achievement. The mean number of adults in the household was 2. Thirty- three percent of the parents were not married. On average, parents and children in Group 3 participated in the program for 361.51 days. Children (N = 4) in Group 3 were all Caucasian. The average age of children in this group was 2.83 years. On average, these children had 1.25 siblings.

Procedures

Data collection for the comparison group study began in January 2004 and ended in September 2005. The tools administered were the Parenting Stress Index (PSI), used to measure parents’ total stress level based on three subscales (Parental Stress, Parent/Child Dysfunctional Interaction, Difficult Child), and the Temperament and Atypical Behavior Scale (TABS), used to measure the parent-child dynamic. The PSI was administered to parents three times: at intake, 65 days later, and 3 months after the second administration. A total of 130 parents completed the pre-test. Of these, 91 completed the mid-test, and 65 completed the post-test. The number of parents completing the full complement of PSIs was 58. Administration of the TABS began in October 2004. Only five participants completed all three administrations of the TABS. The TABS was also administered three times: at intake, 65 days later, and 3 months after the second administration.

Results

Service System Improvement

The majority of survey respondents were in agreement on the statements regarding service improvement. They believed the service provision for children exposed to violence had improved since the implementation of Pinellas Safe Start.

Intervention Impact

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Both intervention groups reported a decrease in overall parent stress after receiving services, but these changes were not statistically significant. Changes in parent- child dynamics could not be determined due to the low number of parents completing the measurement tool used to assess this outcome.

More specifically, the two intervention groups showed a reduction in the PSI scores for each of the domains (Difficult Child, Parental Distress, Parent-Child Dysfunctional Interaction) between the pre-and post-tests. However, the change was not statistically significant. It is worth noting, however, that Group 2 (Enhanced Project Challenge) scores on the PSI were above the normative range in the Difficult Child and Total Stress scores at baseline and were within the normative range at the second and third administration of the PSI.

Discussion

According to Pinellas County service providers, the service system has improved since the implementation of Safe Start. Ideally, additional key stakeholder perceptions (e.g., families) would have been included in this assessment of the service system. The comparison group study had some limitations that prevented accurate data analysis. For instance, Group 3 (the comparison group) always had a significantly lower number of participants. The late administration of the TABS measurement contributed to an inability to evaluate child outcomes. Also, the sample number of participants at the end of the study was notably less than the sample number of participants at the beginning of the study. This occurred mainly because families either moved away or stopped receiving services. Despite these limiting factors, the comparison group study shows that both intervention groups reported a decrease in overall parental stress after receiving services. In addition, Group 2 families’ stress levels were within the normative range after participating in Coordinated Child Care’s Enhanced Project Challenge program.

Reference

Pinellas Safe Start Initiative (2005). Local evaluation report form: Section II. Pinellas County, FL: Author (Available from the Association for the Study and Development of Community).

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VI Pueblo of Zuni Safe Start Initiative

1. Overview project planning and implementation. For example, the incidence and The Pueblo of Zuni was prevalence of child maltreatment or competitively selected as one of 11 Safe community violence might affect public Start Demonstration Project sites. The awareness of related issues. Related to Safe Start Demonstration Project is these contextual conditions are funded by the Office of Juvenile Justice community capacities (the number and and Delinquency Prevention (OJJDP). quality of initiatives intended to improve The goal of the project was to expand the well-being of young children, for existing partnerships among service example), also expected to impact providers in key areas such as early project planning and implementation. childhood education/development, According to the theory, community health, mental health, child welfare, capacity would most directly affect family support, substance abuse assessment and planning, as well as prevention/intervention, domestic community engagement and violence/crisis intervention, law collaboration. Communities with enforcement, courts, and legal services. relatively large numbers of qualified Each demonstration site was expected to professionals, for instance, might be in a create a comprehensive service delivery better position to reach out to the system to meet the needs of children and existing service provider network and their families at any point of entry in the engage providers in assessment and system of care. Furthermore, this planning processes. In addition, the comprehensive system was expected to capacity to conduct an assessment of improve the accessibility, delivery, and community needs and resources was quality of services for children six years expected to be greatly influenced by the and younger who have been exposed to availability of local assistance, the violence or are at high risk of exposure. ability to access national assistance, and the availability of accurate community A theory of change was data. Partnerships were to be formed to developed for the Safe Start plan and initially implement a number of Demonstration Project. In essence, it system change activities. These activities was expected that collaborative planning were expected to change practice across and implementation of system change organizations, within organizations, and activities would strengthen communities at the point of direct services. The in ways that would prevent young system changes achieved were expected children from being exposed to violence to be continued, or institutionalized, in and reduce the impact of exposure for the form of service coordination and those who were. According to the integration and improved service theory, contextual conditions (political, delivery. In turn, the result of continued economic, and social) would influence system changes would be increased

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community supports for young children • How did the Zuni SSI reduce the exposed to violence such that fewer impact of exposure to violence? children would be exposed to violence and the impact of exposure would be The mission of the Zuni SSI, reduced. spearheaded by a management team and currently located in the Division of This case study report describes Public Safety, was to create a culturally how the Zuni SSI changed systems to sensitive system to enhance child reduce the impact of exposure to advocacy and community prevention and violence on young children. The analysis intervention services, to protect Zuni is based on the National Evaluation children exposed to violence and their Team’s site visit report (Association for families. This system will draw on the Study and Development of traditional Zuni ways of healing and Community, 2004; Association for the western approaches that are evidence- Study and Development of Community, based (Pueblo of Zuni Safe Start 2006), the site’s local evaluation report Collaborative, 2005). form (Pueblo of Zuni Safe Start Initiative, 2005) for those two years, and How did the Zuni SSI other reports and information generated accomplish this mission and with what by the site (e.g., progress reports, success? What factors contributed to and implementation plans, strategic plans, impeded success? These questions are and other materials). This case study addressed in the following sections, and report is organized according to the Safe a timeline of major events is attached Start Demonstration Project theory of (see Appendix A). change and covers the first four years of the Zuni SSI. 2. Contextual Conditions Core questions used to guide the analysis include: The Pueblo of Zuni is a rural Indian reservation, covering • How did community conditions approximately 725 square miles in west affect the implementation and central New Mexico and isolated from impact of the Zuni SSI? surrounding cities. Zuni is the most • How did the Zuni SSI change the traditional and largest of the 19 New community to meet the needs of Mexico Pueblo tribes, with a total children exposed to violence? population of 9,311, of which 772 • How was the Zuni SSI (8.3%) are children under the age of five institutionalized in the (U.S. Census Bureau, 2000). The median community? age is 26.5 years. The main industry is • How did the Zuni SSI increase the production of arts, including inlay community support for children silver jewelry, stone fetishes, and pottery exposed to violence? (Pueblo of Zuni Tourism Department, • How did the Zuni SSI reduce the 2005). number of children exposed to violence? The Zuni people have their own language; approximately 73% of the

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population reported that they spoke divisions. The Tribal Council’s election English less than “very well” (U.S. every four years (the last election Census Bureau, 2000). About sixty-eight occurred in 2002) in addition to the percent of the population 25 years and reorganization had both positive and older had a high school degree or higher, negative impact on the Zuni SSI (see and 5% had a bachelor’s degree or Section 5 for further detail). higher (U.S. Census Bureau, 2000). The median income in 1999 was $28,000. The presence of violence is a About 44% of families had income symptom of historical trauma that has below poverty level; half of the families emerged within the last 20 to 30 years, were led by a female with no husband after tribal members experienced years present, and with children under 18 of oppression (Pueblo of Zuni Safe Start years. Further, more than half of the Initiative, 2005). The Zuni people have population (67%) was unemployed in struggled to maintain their ways of life 1999, according to data published by the despite early European immigrant Department of the Interior Bureau of settlers, the Mexican-American war, and Indian Affairs (Pueblo of Zuni Safe Start other external forces that have Initiative, 2005).38 threatened their culture and identify (Kittleson, n.d). Many Zuni leaders and The closest city to the Zuni tribe residents who met with the National is Gallup, which is 38 miles away. Tribal Evaluation Team in 2004 and 2005 members must travel to Gallup for expressed concern that their children recreational activities (e.g., movies) and would continue to lose their cultural major supplies (e.g., food, clothing). For identify and fall victim to substance any major health need (e.g., surgical abuse and domestic violence. procedures), patients have to travel 32 miles to the nearest hospital. The Tribal Council and other members of the tribe (e.g., tribal elders, The Zuni governing structure agency directors), therefore, see the centers around a Tribal Council, conservation of tribal values as the key consisting of the Governor, the to diminishing Zuni children’s exposure Lieutenant Governor, and six Council to violence and the impact of childhood Members, each of whom is elected for a exposure to violence. These stakeholders four-year term. The Council Member place particular emphasis on the who receives the largest number of votes importance of building a strong in each election serves as Head Council community, whose members support Member. A Tribal Administrator each other. Understanding tribal values supports the Tribal Council. The Tribal and tribal culture is vital to each tribal Council has been working on member, and especially to its future reorganization of the tribal government leaders (i.e., Zuni children). Therefore, since late 2000, resulting in fewer the Zuni SSI provided an opportunity not divisions39 and new directors in some only to stop the cycle of abuse, but also

38 More recent statistics were not available. and Training Services, Division of Health 39 The divisions that make up the tribal Services, Division of Human Services, Division government include the Division of of Public Safety, Division of Housing Services, Administrative Services, Division of Education and Division of Natural Resources.

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to promote Native traditions by • Zuni Entrepreneurial Enterprises, reestablishing a holistic and accountable Inc. (ZEE), a nonprofit 501(c)3 support system for Zuni families and organization that provides children. As one agency leader said services in the Pueblo and during a meeting with the National elsewhere in southern McKinley Evaluation Team in 2004, “we need to County. ZEE assists children look back at where we came from to see three years and younger at risk where we are going” (Association for the for or suffering from Study and Development of Community, developmental delays as a result 2005). of birth defects, premature birth, or maternal substance abuse; and • New Beginnings, which operates 3. Community Capacity the only domestic violence shelter on the reservation for 3.1 Before the Zuni SSI battered women and their children. Prior to the Zuni SSI, the capacity of the community to address the Other agencies and programs in impact of exposure to violence was contact with families experiencing limited by 1) a shortage of professionals violence also operated independently; knowledgeable about issues related to these included, for example, the Division early childhood exposure to violence, 2) of Education and Training (housing the lack of coordination across agencies that Temporary Assistance for Needy interact with children and their families, Families program), Social Services and 3) community denial of the extent of (housing the Family Preservation domestic violence within Zuni families. Program), and Head Start. Consequently, services were fragmented. According to Shortage of knowledgeable and several people who met with the skilled professionals. Prior to the Zuni National Evaluation Team in 2004 and SSI, the Zuni people had access to a 2005, turf issues affected single licensed psychologist with communication and collaboration among expertise in early childhood trauma. This division directors, program managers, psychologist advised the Zuni SSI, but and service providers. Domestic was not able to provide any clinical violence survivors who met with the assistance due to other professional National Evaluation Team in 2005 demands. The Zuni Comprehensive echoed this assessment. Health Center employed mental health professionals, but none who specialized Community awareness of the in childhood trauma. extent of the problem. Domestic violence was described as a taboo issue Lack of coordination across in the community. At the individual agencies. The following agencies level, the issue elicited feelings of offered services to at-risk children on the shame. At the community level, the issue Pueblo, but functioned independently: implied a loss of Native traditions and the community’s diminishing capacity to pass on its cultural assets to future

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generations. The practice of Child and domestic violence survivors who Protective Services was to remove Zuni met with the National Evaluation Team children from homes experiencing in 2005 reported that the general violence and to place them in homes community has gained in awareness of outside the Pueblo, thus detaching them the issues of children and violence. This from their cultural roots—and was evident in the increased number of strengthening the association between self-referrals and referrals by families domestic violence and loss of cultural and friends to the Zuni SSI, referrals by heritage. school counselors, and higher attendance at community presentations on the topic. 3.2 After the Zuni SSI

The community’s capacity to 4. Integrated Assistance identify and respond to young children exposed to violence improved as a result Since its inception, the Zuni SSI of the Zuni SSI. has received extensive technical assistance from a number of Knowledge about the impact of organizations contracted by the Office of childhood exposure to violence. Both Juvenile Justice and Delinquency community members and professionals Prevention, including the National (e.g., police officers, Head Start Center for Children Exposed to Violence teachers) increased their knowledge of (NCCEV), National Council of Juvenile the issues of children and violence and Family Court Judges (NCJFCJ), through presentations by SSI staff and National Civic League (NCL), Systems experts from the National Center for Improvement Training and Technical Children Exposed to Violence. (See Assistance Project (SITTAP), and the Section 6 for further explanation.) Institute of Community Peace.

Coordination of services. The The lack of coordination across Zuni SSI staff, particularly the family agencies, partly due to turf issues, was support services coordinator, helped one of the challenges faced by the Zuni coordinate services across agencies by SSI staff; therefore, extensive technical providing a central point for receiving assistance was sought by the staff in this referrals, following up with families, and area. For example, NCCEV provided keeping referral sources updated on the assistance on the child development- status of their referred cases. community policing model, visiting the Nevertheless, cross-agency collaboration Pueblo several times to bring division remained limited; many people who met directors together to collaborate on this with the National Evaluation Team model and to train police officers. attributed this limitation in part to a lack of tribal policies mandating NCJFCJ, through the Zuni SSI, collaboration. assisted in the development of the Zuni Tribal Court. More recently, in 2005, Increased visibility of issues NCL engaged the Center for Network related to the impact of early childhood Development to conduct a feasibility exposure to violence. The SSI partners study for an online case management

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system for the Pueblo. SITTAP case management procedures, conducted training on the Indian Child because the Zuni staff felt that Welfare Act and provided assistance to Chatham County’s rural SSI staff on their intake process. characteristic most closely SITTAP also helped the Zuni SSI with resembled that of the Zuni its implementation plan; provided community; and training on sustainability; and facilitated • The Washington County Safe conflict management between certain Start Initiative staff, including a agency directors, program managers, and child protective services service providers. representative and the social services director from the Because the technical assistance Passamaquoddy Tribe, visited the was always not tailored to the unique Pueblo to share practices for challenges faced by a Native American responding to children exposed community, it was not always well to violence. Zuni SSI staff, received by tribal agency directors. however, did not find this Some of the national technical assistance exchange useful, because of providers’ lack of understanding of limited involvement on the part Native traditions impacted their ability of Zuni division directors. to enhance the capacity of the tribe. Promising practices and approaches for helping Native children and families 5. Local Agency and were based on Western standards, and Community Engagement the impact of historical trauma on and Collaboration generations of Native people was not addressed in interventions. SSI staff who The collaboration that supported met with the National Evaluation Team the Zuni SSI was facilitated by the indicated that a significant amount of involvement of 1) credible leaders and time was spent educating technical staff, 2) the initiative’s function as the assistance providers on the Native “glue” that held together programs culture and contextual conditions (e.g., across agencies, and 3) relationships SSI staff walked each new provider with agencies that served as different through the Native museum). The major entry points into the lives of Zuni challenge appeared to be finding a way children and families. to mutually engage native leaders and non-native technical assistance On the other hand, leadership and providers. staff turnover, due to an unstable

political and funding environment, and The Zuni SSI staff also turf issues, challenged collaboration. As exchanged information and received mentioned in the previous section, the assistance from other Safe Start sites: Zuni SSI sought extensive technical

assistance in this area. • The Zuni SSI adopted and

adapted Chatham County Safe Start Initiative’s screening protocols, consent forms, and

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5.1 Credible Leaders and Staff Collaborative members also The Zuni SSI was led by a frequently commended the Zuni SSI Management Team made up of higher- director and the family support services level leaders, including two Tribal coordinator for their leadership and Council members, directors of the competence in promoting collaboration, Division of Human Services and the keeping all the stakeholders informed Division of Public Safety, the tribal about the initiative’s progress, and administrator, the chief of police, the engaging families. The Zuni SSI director Social Services director, and the SSI was able to build on existing director. The Team was supported by the relationships; her family was known for Training and Technical Assistance and its political activism in the community. Public Awareness Committee, chaired Domestic violence survivors described by a police officer and comprised of the family support services coordinator approximately ten representatives from as approachable and trustworthy; they various community agencies. This felt comfortable with her, and were committee oversaw activities to increase willing to entrust their children to her the community’s awareness of issues care. related to childhood exposure to violence. The Policy and Procedures 5.2 Zuni SSI’s Function as the Committee, responsible for developing “Glue” policies and procedures to guide responses to children exposed to Staff from partner agencies violence, and active early on in the described the Zuni SSI staff as the glue initiative, was no longer operational in that held together programs across 2005; its members had left the Pueblo. A agencies. The SSI staff used a customer group of managers from the Division of service approach, frequently asking staff Human Services assumed the from other agencies “how we can help committee’s function and, at the time of you.” The family support services this report, was working on developing coordinator’s effort to consistently an electronic case management system. update partner agencies on the status of their referrals reinforced the initiative’s The Zuni SSI staff believed that function as the “glue.” According to the support from the Tribal Council and, people who met with the National more recently in 2005, from a tribal Evaluation Team, the initiative judge, brought credibility to the responded to needs beyond domestic initiative. Not only was the judge a well- violence, such as job placement, respected leader in the community, he housing, and clothing. had the authority to mandate batterers and victims to seek help for themselves Staff members’ connections and and their children. Specific Tribal deep knowledge of the community Council members were perceived as enabled them to provide various types of champions of the initiative; they assistance to families in need, and to attended meetings convened by OJJDP coordinate services to better respond to and supported the Zuni SSI project these families. director.

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5.3 Relationships With serving children and families from Agencies That Served As multiple sectors. The Zuni SSI also Different Entry Points Into developed relationships with the Victims The Lives Of Zuni Children of Crime Act representative, the Tribal And Families Court, and the Family Preservation Program. Although Zuni Entrepreneurial Enterprises (ZEE) is located on the All of the above programs and Pueblo, the agency’s funding comes agencies became referral sources for the directly from the State Department of Zuni SSI, given their frequent contact Health, Medicaid, and several private with families experiencing domestic sources. This funding is not funneled violence. through the Tribal Council, leaving the Council with no authority over ZEE Also noteworthy is the Zuni SSI mandates, and marking ZEE as an staff involvement with the Tribal Youth outside entity independent of tribal Grant project in 2004. The collaboration social and health structures. Therefore, seemed natural because 1) the two the Zuni SSI’s engagement of ZEE was initiatives shared similar goals (i.e., to considered a major accomplishment reduce violence in their community), because it brought ZEE, a resource on providing a natural partnership for the reservation but considered an outside strengthening the community’s support entity, closer to the Tribal Council and system for children and youth, and 2) the other tribal programs. same agencies and decision makers involved in the Zuni SSI collaboration Early on in the initiative, ZEE were involved in the Tribal Youth Grant staff members were involved project (e.g., directors of the Division of peripherally with the Zuni SSI; it was Human Services and the Division of not until the SSI director reached out to Public Safety). ZEE’s director that a formal memorandum of agreement between the 5.4 Leadership and Staff two entities was developed. This link Turnover enabled ZEE to strengthen its connection with the Tribal Council. Leadership and staff turnover affected collaboration. From 2003 to Collaboration between 2005, turnover occurred in the Division Temporary Assistance for Needy of Public Safety, the Zuni Police Families (housed in the Division of Department, New Beginnings, the Education and Training) and the Zuni Division of Human Services, and Social SSI began when the family support Services. Such turnover had two services coordinator was hired in consequences. October of 2004. The services coordinator also engaged Head Start in The location of the Zuni SSI the collaboration. The relationship changed three times, from an initiative between the Zuni SSI and Head Start under the Social Services director’s was reinforced through the mutual supervision to an initiative under the participation of Head Start and SSI staff direct supervision of the Division of in meetings that involved professionals

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Human Services’ director, and then to agency as a referral source for young the Division of Public Safety in 2005. children exposed to violence and their The first change was an attempt to families. elevate the initiative’s value by placing the initiative under the direct supervision of the Division of Human Services’ 6. Systems Change director, who occupied a higher position Activities than the Social Services director in the tribal organization scheme. The second 6.1 Community Assessment and change occurred because of the heavy Planning involvement of police officers in the initiative, making the Division of Public During the planning phase of the Safety a more natural home for the Zuni Zuni SSI, a group of agency SSI. With each change of agency came representatives came together and 1) new supervision; new lines of conducted discussion groups with communication; and, in one instance, a service providers, political and religious new office. This instability created a leaders, elders, and family members; 2) sense of impermanence and diminished examined hospital cases involving the initiative’s capacity to grow and children exposed to violence; 3) become institutionalized. examined 911 call records for co- occurring presence of children and Improvements and policy violence; and 4) reviewed national decisions related to the Zuni SSI’s reports such as KidsCount and research sustainability were always uncertain. For findings on victimization published by example, in 2004, the director of the the American Indian Development Division of Public Safety decided to add Associates in 2004 (Pueblo of Zuni Safe CDCP to the Division’s budget as a line Start Initiative, 2004). item, ensuring resources for the training of police officers and for supporting The information gathered and their role in identifying children exposed reported in the local evaluation report to violence. Police officers involved in form (Pueblo of Zuni Safe Start the Zuni SSI, however, were unsure if Initiative, 2004) showed that: the new Division director and police chief would maintain this commitment. • The majority of exposure to A similar situation arose with leadership violence among Zuni children turnover in Social Services. The was related to domestic violence, outgoing director had not supported the 40 even though domestic violence Zuni SSI , and it was uncertain whether appeared to be underreported; or not the new director would be • Most domestic violence incidents supportive, affecting the role of this were related to alcohol use or intoxication, followed by 40 The people who met with the National emotional stress and marital Evaluation Team gave different reasons for why the director was not supportive of the Zuni SSI. problems; • Some believed that he viewed the Zuni SSI as About two thirds of the competing with other Social Services programs; respondents to a survey others believed that he had a personal conflict conducted by the American with the Zuni SSI director.

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Indian Development Associate awareness, it was unlikely that families indicated domestic violence as a would seek help. problem, while the remaining one third reported that it was Domestic violence, however, was “somewhat” or “maybe” a a taboo subject in the community; problem; and introducing the subject directly might • Slightly more than one third of have deterred some people from getting the victims who responded to the help. Instead, the Zuni SSI focused on survey reported that they sought inspiring the community with help, primarily through social information about the tribe’s cultural and services, law enforcement, and/or family traditions, and indirectly the court system. reminding the community that domestic violence violates these traditions. Discussion group participants Several Zuni leaders claimed that Zuni also generated a list of risk and youth and young adults did not know protective factors related to children’s enough about their cultural roots, which exposure to violence; among them was they considered a protective factor the importance of Zuni values as a against negative influences. protective factor. In 2004, two tribal elders The Zuni SSI used the above presented frequent programs on Zuni information to emphasize the need for cultural heritage; women made up the community awareness and action, to majority of those attending these garner support from the Tribal Council programs. In 2005, these programs to address children’s exposure to appeared to decrease in frequency, while violence (e.g., the tribe seeks autonomy presentations directly addressing to determine how and who is certified to domestic violence increased. This may educate the younger generation about the signify a growing willingness among Zuni language and culture), and to Zuni families to talk about domestic identify gaps in the referral and violence, a perception supported by treatment process for children exposed people with whom the National to violence (Pueblo of Zuni Safe Start Evaluation Team met. In total, Initiative, 2005). Zuni has established a approximately 1,200 people attended partnership with the state board of SSI-related events, presentations, and education in an effort to preserve the trainings in 2004 and 2005 (not Zuni language. There has been no accounting for people who attended further assessment to inform the Zuni events more than once).41 SSI. As part of the increasingly direct 6.2 Community Action and focus on domestic violence, the Zuni SSI Awareness took advantage of Domestic Violence Month in October (2005) to inundate the The Zuni SSI invested a lot of community with information related to time to increase the community’s domestic violence and childhood awareness of the impact of domestic violence on young children. Without this 41 Summary of events and attendees, May 18, 2006.

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exposure to violence. A total of 11 will set higher standards for agencies events occurred, from a “domestic that respond to tribal children’s needs. violence walkathon” to presentations about the effects of violence on children. Mandated services. Tribal judges changed their practices related to From 2004 to 2005, attendance at domestic violence cases by mandating Zuni SSI events increased, as did that victims undergo an intake process referrals (including self-referrals).42 This by Zuni SSI staff within 48 hours of the pattern may be the result of the SSI arraignment. The Family Preservation community awareness activities; a direct Program representative reinforced this link could not be established. practice, also mandating her court- ordered clients to attend presentations by 6.3 Development of Policies, the initiative. Procedures, and Protocols Prescribe the way agencies work The Zuni SSI influenced policies, together to respond to children exposed procedures, and protocols by to violence and their families. The incorporating children exposed to initiative developed a protocol for how violence into the tribe’s general policy the police, victim advocates, and the SSI on child well-being, mandating SSI family support services coordinator services, and developing procedures for should respond to a domestic violence how agencies should work together to situation. According to this protocol, respond to children exposed to violence. police officers responding to a domestic violence call were expected to ask if Incorporating children exposed children were present and to record their to violence into the tribe’s general ages and names; however, several policy on child well-being. The initiative domestic violence survivors who met played a pivotal role in revising the with the National Evaluation Team tribe’s policy on child well-being (i.e., reported that not all police officers the Children’s Code), which was written followed this protocol. more than 30 years ago and did not contain any information on children’s The Temporary Assistance for exposure to violence. The Zuni SSI Needy Families coordinator incorporated director collaborated with a judge to add domestic violence into the agency’s information about children’s exposure to eligibility screening, such that violence and child abuse and neglect to participation in SSI services for families the code, and to develop a statement that experiencing violence was a condition services must be culturally competent for TANF aid. and responsive to Zuni traditions. One tribal leader described the Children’s The Zuni SSI also developed a Code as “the Zuni SSI’s legacy.” The standard referral form for all agencies to Children’s Code was distributed for use. public review in October 2005. The code, once approved by the community, 6.4 Service Integration

42 Summary of events and attendees, May 18, 2006

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Service integration occurred 2005 resigned after a few months initially in the form of the child because of other competing demands (he development-community policing had retained a full-time job elsewhere, (CDCP) model As of 2005, however, making it difficult to dedicate time to the full implementation and Zuni SSI). institutionalization of CDCP remained uncertain because of leadership changes Multiple points for identification in the Division of Public Safety and the and referral. The number of referral Zuni Police Department, as well as sources for the Zuni SSI expanded over unwillingness to follow CDCP protocol, time. By the end of 2005, at least eight reluctance to complete more forms than agencies (New Beginnings, Head Start, necessary, and lack of support for schools, Tribal Court, Zuni Police community policing among some Department, Zuni Comprehensive officers. Further, the Zuni SSI staff have Health Center, Education and Career been unsuccessful in retaining a mental Development Center, and Family health partner for the CDCP team. A Preservation Program), as well as psychologist was engaged in early 2006, families and friends, served as referral but he resigned a few months later due to sources. All agencies were expected to competing responsibilities (see next use a standard referral form developed section for further details). by the Zuni SSI.

6.5 New, Expanded, and Upon receiving a referral, the Enhanced Programming family support services coordinator contacted the family to schedule an The Zuni SSI established a intake assessment, identify other needs process for identifying, referring, and (e.g., food, clothing, housing, assisting children exposed to violence employment), and explain the options and their families (see Appendix B). available for help to the family and Although developed early on, this children. If necessary and appropriate, process did not become fully operational the family support services coordinator until the hiring of the family support also referred the family and child to services coordinator in late 2004 and the other agencies for specialized assistance, signing of a memorandum of agreement including ZEE (for children three years with Zuni Entrepreneurial Enterprises to and younger), Zuni Comprehensive provide clinical assistance.43 The Health Center (for medical reasons), procedures for referring children Zuni Recovery Center (for substance exposed to violence were well defined, abuse), and the Batterers Intervention whereas the procedures for assessing, Program. treating, and following up remained inadequate. This inadequacy was largely One of the strengths frequently due to the lack of a licensed, SSI- cited by partner agency representatives dedicated mental health partner with was the family support services expertise in young children exposed to coordinator’s diligence in informing violence; a psychologist hired in early them of the status of the referrals. A total of 114 children in need of 43 Note: As of the end of 2005, ZEE had not help was identified between July 2004 received any referrals.

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and December 2005. In 2005, self- Zuni cultural traditions. She used this referrals emerged as a referral source; improved curricula with a group of eight Safe Start staff perceived this as a sign Head Start children over a three- to six- of willingness by Zuni families to seek month period. The Head Start help (see Table 1). representative described the children as excited and open to discussing their Table 1: Number of Referrals to SSI concerns with the family support from January until September 2005 services coordinator. Five adult survivors echoed this perception in their Zuni Police Department 18 meeting with the National Evaluation Self-referral 4 Team in 2005. Tribal Court 3 Social Services 2 The family support services New Beginnings 2 coordinator also designed and conducted Other 4 peer-group support for two groups of victims. Each group participated in Assistance to children and weekly sessions for ten weeks; an families. As previously mentioned, the average of five victims attended each child psychologist hired in January 2005 session. The services coordinator to assess and treat children exposed to frequently linked participants to housing violence and their families resigned in services, career education programs, and April due to other competing demands other programs. (he was a school principal and served as the SSI psychologist only after school In general, the SSI raised hours and on weekends). This awareness about how Native children psychologist was initially a member of should be treated by service providers, the CDCP team and had received community leaders, and families. For training from the University of instance, the Tribal Council has entered Oklahoma on the adaptation of Parent- into discussion of the development of a Child Interactive Therapy for Native tribal foster care program, to ensure that families; his resignation, therefore, left a all Native children removed from their gap in the continuum of services for homes because of abuse and neglect young children exposed to violence and remain on the Pueblo. The current their families. practice is to place children in foster homes outside the Pueblo, thus Consequently, the family support detaching them from their cultural roots. services coordinator stepped in to develop and facilitate support groups to 7. Institutionalization of assist domestic violence survivors and Change their children. She was expected to serve in this capacity until a licensed No local resources for the Zuni psychologist specializing in early SSI have been identified and developed childhood trauma was hired. She adapted in the Pueblo. At the time of the and combined existing curricula National Evaluation Team’s site visit in designed to help children express their 2005, Tribal Council members and SSI feelings and develop their character with staff had discussed the following

Association for the Study and Development of Community 139 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

possibilities: third-party reimbursement possible with the federal grant for clients, gaming fees, consolidation of (i.e., three full-time staff people); funding across different divisions, and a and fiscal analysis of the Social Services • Dependence on individuals and division’s budget to determine additional their capacities, such that sources of support for the Zuni SSI. knowledge about the Zuni SSI and inter-agency responses will The changes that will be continue to be limited to the sustained are: primary liaison in each organization until protocols are • Revisions to the Children’s institutionalized and enforced. Code; • Community awareness and Despite the uncertainty of its understanding of the impact of future, the Zuni SSI has helped develop childhood exposure to violence; two forms of community support for and young children exposed to violence and • New collaborative relationships. their families.

According to families participating in SSI support groups, the 8. Increased Community initiative sparked a change process Supports through which community members have become more aware of domestic The Zuni SSI resulted in two violence and its impact on children, and forms of community support that agencies have started to work together. participants described as essential to In one person’s words, “This is the reducing domestic violence and its beginning of something great for our impact on young children: children, and we have the hope to say that…the SSI opens doors for taking • Site visit participants, both care of ourselves.” service recipients and service providers, reported that the SSI Tribal Council members have led to a stronger emphasis on expressed their commitment to the SSI’s viewing the family holistically values and principles; however, the (consistent with the Zuni sustainability of these values and culture), for example: principles has been hindered by: " SSI helped families with needs such as clothing, • An unstable political household items, childcare, environment (i.e., leadership and transportation, in part turnover in Divisions and through linking to individual organizations); donors in the community to • Lack of a permanent mental help specific families (e.g., health resource on early SSI found a donor to provide childhood trauma in the Pueblo; propane to a family). Even if • Insufficient funds for sustaining the initiative does not the level of staffing made continue beyond federal

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funding, it is likely that the support groups were not evaluated. The value of agencies working impact of exposure to violence may be together to respond to a reduced among the children who family's needs has been participated in the group sessions instilled and will continue. conducted by the family support services • The Zuni SSI integrated the coordinator, who taught them how to tribe’s traditions and values into express their feelings; however, there its presentations on domestic were no supporting evidence to confirm violence and its impact, helping this possibility. families to focus on their traditional assets and to develop a sense of hope for their 11. Conclusion children’s future. Site visit participants frequently described the Zuni SSI as an entity that 9. Reduced Exposure to brought services together, functioned as Violence a broker of relationship building among agencies, and provided support services There were no data to determine for children exposed to violence and if Zuni children’s exposure to violence their families. Support groups for a small has been reduced. Anecdotal information number of children and adult victims from the Zuni SSI service recipients who were created and facilitated. Any mental met with the National Evaluation Team health assistance beyond this for reflected the belief that perpetrators of children exposed to violence, however, violence will be encouraged to seek help not available because the initiative could (for themselves and their families), if not retain a full-time mental health they understand how their behavior partner. affects exposed children. Participants in the group sessions might reduce their Anecdotal evidence suggests that children’s exposure to violence after the capacity of existing service providers learning more about its impact. in the Pueblo to respond to children exposed to violence and their families has increased. Service providers reported 10. Reduced Impact of better understanding of the issue of Exposure to Violence childhood exposure to violence and increased knowledge of where to refer There were no data to determine children and their families for assistance. if the impact of exposure to violence has There is some evidence that suggests been reduced because the initiative has that community awareness has increased not been able to engage a mental health as a result of the SSI (i.e., higher partner to develop an intervention. The attendance at presentations on domestic support groups created and facilitated by violence and increasing self-referrals). the family support services coordinator was a pragmatic alternative to the Zuni SSI progress thus far resignation of the initiative’s mental appears to have been facilitated by: health partner. The impact of these

Association for the Study and Development of Community 141 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

• The Tribal Council’s did not receive the assistance commitment to stay informed they needed; and to support SSI staff; • Leadership and staff turnover in • Staff knowledge of where to go partner agencies and divisions; for resources and information and (e.g., Zuni cultural traditions), • Uncertain funding in the future. ability to cultivate strong relationships, and persistence in The initiative was still dependent coordination and follow-up; and on the staff members to broker • The approach of linking Zuni relationships and coordinate services. cultural traditions and domestic There was an attempt in 2004 to violence, making the issue more institutionalize the child development- acceptable for public discussion. community policing model; however, leadership changes in the Division of Further development and Public Safety in 2005 prevented the institutionalization of the Zuni SSI, institutionalization. however, has been hindered by: The year 2006 will be especially • Decades of trauma, contributing critical to the Zuni SSI because of tribal to the cycle of violence in the elections. Depending on election results, Pueblo and making the subject of the initiative could gain momentum and domestic violence a continually attention, or it could receive the same challenging one; level of support without a major thrust in • Distrust of service providers the direction of expansion and among some families because of institutionalization. past experiences in which they

12. References

Association for the Study and Development of Community (2004). Site visit report: Pueblo of Zuni Safe Start Initiative January 2002-December 2004. Gaithersburg, MD: Author. Association for the Study and Development of Community (2005). Case study: Pueblo of Zuni Safe Start Initiative January 2002 through December 2004. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2006). Site visit report: Pueblo of Zuni Safe Start Initiative. Gaithersburg, MD: Author.

Kittleson, A. (n.d.). Zuni. Minnesota State University. Retrieved June 14, 2006 from http://www.mnsu.edu/emuseum/cultural/northamerica/zuni.html

Pueblo of Zuni Safe Start Collaborative (2005). Zuni Tribe Safe Start Project Revised Implementation Plan: May 2004 to April 2005. Zuni, NM: Author.

Association for the Study and Development of Community 142 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Pueblo of Zuni Safe Start Initiative (2004). Local evaluation report form. Zuni, NM: Author (Available from the Association for the Study and Development of Community).

Pueblo of Zuni Safe Start Initiative (2005). Local evaluation report form. Zuni, NM: Author (Available from the Association for the Study and Development of Community).

Pueblo of Zuni Tourism Department (2005). Zuni visitors guide. Retrieved June 14, 2006 from www.experiencezuni.com

U.S. Census Bureau. (2000). 2000 U.S. Census. Retrieved June 14, 2006 from http://www.census.gov/main/www/cen2000.html

Appendix A Timeline of Pueblo of Zuni Safe Start Initiative Activities and Milestones

Timeline of Pueblo of Zuni Safe Start Initiative Activities and Milestones

Major Milestones 1/02-6/02 7/02-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05 Project Coordinator hired Strategic and implementation plans submitted to

OJJDP Retreat for Collaborative Technical assistance site visit by NCCJ Technical assistance site visit by NCCEV on

CDCP Trainings, workshops, and community

presentations Participation in Sustainability Training by the

Institute for Community Peace Training by SITTAP Visit to NCCEV in New Haven Collaboration initiated with the TYG project and

VOCA Family Support Services Coordinator hired Clinician (Dr. James Sweeney) hired Memorandum of agreement with ZEE finalized

and engagement of New Beginnings started Child psychologist hired and resigned CDCP Institutionalized Social Services leadership changes Tribal court mandated referrals to Zuni SSI Tribal Program Grant awarded Sources: LERF, 2004 and 2005; National Evaluation Case Study, 2004; and Site Visit Report 2005.

Association for the Study and Development of Community 130 September 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. Exhibit VI-B

PUEBLO OF ZUNI SAFE START INITIATIVE SERVICE PATHWAY, 2005

Family/Community

New Beginnings

Education and Career Family Support Services Development Center Family Support Services Coordinator (FSC) Coordinator at SSI Intake assessment (TESI, Schools Go to scene or home safety, risk follow up in 8 hours assessment) Zuni Comprehensive Zuni Police Tell about SSI programs Health Center Department (food, other needs) Provide choice in Tribal Court accepting services unless Inform referral agency court mandated Family Preservation of status Other services Program

Police Department

If yes, FSC meets with family/children

Refer to: FSC conducts ZEE group sessions Zuni Comprehensive Health Center Zuni Recovery Center Batterer Intervention

VII Rochester Safe Start Initiative

1. Overview community responsibility for responding to children exposed To address the issue of children’s to violence at home and in the exposure to violence, the Rochester Safe community by changing Start (RSS) grantee built upon two community norms, attitudes and existing community capacities: 1) behavior; extensive services with a number of • A training initiative based on the initiatives focused on young children, Shelter from the Storm and 2) a long history of close curriculum, designed to focus on collaboration among government a range of people who serve agencies and non-profits in the children and families and educate community. them about the effects of violence and ways they can help; As a community, Rochester and strongly emphasizes prevention as a • A mentoring project (Early strategy and has invested considerable Childhood Education resources in the early childhood system. Intervention), designed to help Children’s Institute, the parent agency teachers and other adults in early for RSS, promotes the social and childhood classrooms to emotional well-being of children and recognize that difficult child relies on community partnerships to behaviors may be caused by inspire and implement positive public exposure to violence and to policy. Consistent with the community’s provide ways of responding. priorities for young children and the expertise of the Children’s Institute, the Three additional RSS RSS committed to designing and interventions integrated services across implementing a range of initiatives that disciplines: both built upon existing resources and addressed gaps in the existing system. • The SAFE Kids intervention forged a partnership between First, the RSS developed and police and social workers on implemented several nontraditional behalf of young children exposed approaches (e.g., non-mental health to violence in the community or approaches) to responding to children at home; exposed to violence at home and in the community: • The Children in Court intervention assigned domestic • A media campaign (Shadow of violence victim advocates to Violence), designed to increase families in the court system.

These advocates helped to federal grant period. The explain the impact of the legal Rochester Ad Council process on the children involved approved Safe Start as a and how to seek orders of community initiative for protection. As part of Children in 2005 and 2006, which Court, the RSS also worked to will mean extensive implement Fast Track Supervised assistance with creative Visitation, a program designed and marketing approaches for families affected by domestic for phase two of the violence, to reduce the amount of Shadow of Violence time families had to wait for campaign. The final visitations between parents and amount of financial children; and support is still under • The Mt. Hope-Foster Care discussion. The RSS also intervention offered specialized received $1,000.00 from mental health services to young Target in support of phase children abused or neglected so two (Rochester Safe Start severely that they had to be Initiative, 2005a, p. 34). removed from their homes and placed in foster care. • Shelter from the Storm o The training initiative The success of these reached 2,313 interventions varied, as determined by participants between 2003 continuous use of evaluation findings: and 2005 (Rochester Safe Start Initiative, 2003; • Shadow of Violence Rochester Safe Start o The media campaign was Initiative, 2004; evaluated using a non- Rochester Safe Start equivalent control group. Initiative, 2005b).1 Findings indicated an increase in the proportion o Children’s Institute of adults in the campaign obtained an AmeriCorps target community who worker in 2004 and 2005 reported taking action (vs. to provide assistance with doing nothing) after training and logistics for seeing a child being Shelter from the Storm exposed to violence trainings (Rochester Safe (Rochester Safe Start Start Initiative, 2005aa, p. Initiative, 2005a, p. 54). 34). There was no increase in such self-reported • Early Childhood Education behavior in the Intervention comparison community.

1 These figures were reported in the Progress o The media campaign was Reports (2003-2005) submitted by Rochester also funded beyond the Safe Start to the Office of Juvenile Justice and Delinquency Prevention.

o The mentoring project of children exposed to was evaluated using a violence who received randomized clinical trial referrals for assessment design. Children in and treatment. Social classrooms with mentors workers had contact with demonstrated more 119 of these children, 84 positive growth in their of whom were classified cognitive, social, and as receiving the “highest” physical functioning than level of service delivery children in classrooms (Rochester Safe Start without mentors. This Initiative, 2005a, p. 47). difference between groups of children was o In 2005, SAFE Kids was statistically significant assumed by the Society (Rochester Safe Start for the Protection and Initiative, 2005a, p. 53). Care of Children (SPCC) through local grant o In 2005, the Early funding and SPCC Childhood Education Board-designated funds Intervention received (Rochester Safe Start $148,000 from the New Initiative, 2005a, p. 34). York State Office of Children and Family • Children in Court Services to provide o The Children in Court mentoring for 30 previous intervention increased the control classrooms, expertise of domestic booster sessions for 30 violence advocates intervention classrooms, related to children and training for Parent exposed to violence, and Group Leaders and Site expanded supervised Coordinators (Rochester visitation available both Safe Start Initiative, in the Domestic Violence 2005a, p. 34). This Intensive Intervention project has been branch of Family Court expanded both in size and and in the new Integrated scope through the Early Domestic Violence Court. Childhood Professional Development grant from o The Alternatives for the U.S. Department of Battered Women (ABW) Education. Child Advocate Project served 574 families with • SAFE Kids children six years and o SAFE Kids reached 305 younger between May children between April 2003 and October 2004. 2002 and February 2004, These families had 801 increasing the proportion children six years and

younger and 386 children older than six. This program ended in 2005 (Rochester Safe Start Initiative, 2005a, p. 47).

o Fast Track Supervised Visitation received referrals for 53 families; 48 families accepted the referral and received supervised visits. Within these 48 families, approximately 96 parents and 70 children were served (Rochester Safe Start Initiative, 2005a, p. 47), and the average wait for service was one to two weeks as opposed to six months in the general supervised visitation program. Fast Track Supervised Visitation will be resumed through RSS in 2006.

• Mt. Hope-Foster Care The mission2 of Rochester Safe o The Mt. Hope-Foster Start was to make Rochester a Care intervention served community responsive to the needs of all 101 young children in children, especially those exposed to foster care through the violence. Key goals included increasing Foster Care Pediatric overall awareness of the harmful effects Clinic from April 2002 to of exposure to violence on children six April 2004 (Rochester years and younger; reducing the impact Safe Start Initiative, when children were exposed to violence; 2005a, p. 36). and ensuring that the community o The program was provides exposed children with all of the institutionalized in the support and resources needed to cope, community through adapt, and remain healthy. Affecting the United Way funding in community agenda through public policy 2004 (Rochester Safe and resource allocation was also a Start Initiative, 2005a, p. critical goal. How did the Rochester Safe 36). Start grantee accomplish this mission and with what success? What factors The Rochester Safe Start grantee contributed to and impeded success? was able to incorporate expertise in the These questions are addressed in the area of children exposed to violence into following sections, and a timeline of existing systems for young children. major events is attached (Exhibit VII-A). Using this overall approach, and through several specific interventions, the 1.1 Rochester, New York Rochester Safe Start grantee helped to create a community more responsive to Rochester Safe Start was planned the needs of all children, including those and implemented within the unique exposed to violence in their home and in context of Rochester, New York. The their community. Evaluation findings following snapshot of Rochester is further suggest that providing early intended to help others interested in childhood educators with coaching replicating Safe Start to compare their around children exposed to violence own communities to Rochester. issues may be an effective way to improve all children’s growth, including The city of Rochester, with a the growth of children who have been population of 219,7733 is the seat of exposed to violence. Finally, a social Monroe County, and is located on the marketing campaign geared toward Genesee River and Lake Ontario in helping children by sending messages to upstate New York (U.S. Census Bureau, adults may be an effective way to n.d.). Before the rise of Silicon Valley in change adults’ behavior and expectations California, Rochester was considered a to support positive outcomes for high-tech city, depending primarily on children.

2 The mission and goals for RSS were taken from 1.1 Mission the Rochester Safe Start brochure written and designed by Idea Connections. 3 The 2004 population estimate for Rochester, New York is 212,481.

Kodak and Xerox to employ its 14608, over 40% of families have no car residents. In recent years, however, both and over 12% have no phone. In 14611, Kodak and Xerox have downsized, about one-third of families have no car leaving many residents unemployed;4 and over 9% have no phone. By contrast, Rochester has recently been identified as the ZIP code 14610 on the far east side having one of the highest rates of job is virtually all white, with high education loss among 40 large cities. The people levels, a median family income that of Rochester are ethnically diverse, with exceeds the county median, median more than 50% identifying themselves housing value nearly double that of the as people of color: 40.1% African two impoverished ZIP codes, only one in American, 12.8% Latino, and a small twenty families in poverty, and only one percentage of Asian/Pacific Islander or in six female households with children Native American descent (2.7%/0.2% under five in poverty. and 1.3%, respectively). The remaining 44.3% of residents are European According to the Children’s American. According to the 2000 Defense Fund, Rochester has the 11th Census, there were 24,299 children six highest child poverty rate of the 245 years and younger residing in the city of largest American cities. Child poverty Rochester. This represents a decline of has been unacceptably high in the city 16% in this segment of the population for a number of years, especially among from the 29,016 young children some sub-populations, with a consistent estimated ten years earlier. 40% of all children under six years living in poverty from 1990 to 2000. Within the city, poverty is Among children in married-family concentrated in the "crescent." households, 14% were living in poverty According to the 2000 Census, median in 2000; in single-parent families headed family income in ZIP codes 14608 and by males, almost one-third of children 14611 on the city's west side was less were below poverty level (an increase of than one-half the national and county 78% since 1990); and, worst of all, medians, and only three-quarters of the 59.4% of all children in female-headed city median. One-third of all families in households were living in poverty in these ZIP codes had incomes below the 1999. poverty line; this fraction rose to about one-half for families with children under five years, and even higher for female 2. Contextual Conditions householders with children under five. A high percentage of families in these During the planning and areas rent, and the majority of renters implementation of Rochester Safe Start, spend more than 30% of their income on Rochester’s community agenda for rent. More than one in eight properties young children focused on preventing are vacant in these areas. In ZIP code child abuse and neglect and promoting social and emotional well-being in early childhood. Considerable resources were 4 These trends were discussed during the October 3 and 4, 2005 site visit with the Safe Start invested in strengthening the early Demonstration Project National Evaluation childhood system, as well as prevention Team. services designed to keep children out of

foster care. Budget constraints during the initiatives that respond to child life of RSS, however, created challenges maltreatment (e.g., Do Right by Kids in terms of enhancing and expanding and Children’s Agenda, respectively). services dependent on public funding. Children's Agenda promotes home Relatively high rates of child poverty visiting by nurses and has obtained and unemployment created a social county and other funding to serve 100 context that justified the priorities high-risk families, starting in 2006. established by the community and RSS, but also created needs that would Protecting children from perpetually exceed capacity. This community violence. Political and public environment affected the design of intolerance of community violence is Rochester Safe Start and influenced the illustrated in the outgoing mayor’s quick initiative’s implementation. For response to recent violence involving example, RSS was designed based on children. In 2005, the city experienced the assumption that creating a “system” high levels of violence, with four of targeted services for young children murders of children under the age of 17, exposed to violence would be largely the scalding death of a toddler, and impossible, and that incorporating injury to a two-year old struck by a stray expertise into existing systems would be bullet. Violence became a critical issue a more successful approach (Rochester in the mayoral campaign. The out-going Safe Start Initiative, 2005a, p. 36).5 mayor, rather than acting as a lame duck, convened citizens and organizational leaders to create a strategic plan to 2.1 Political and Economic respond to youth violence in Rochester. Context Promoting child wellness. There Protecting children from violence is growing consensus in Rochester about in the home. There is strong support for the importance of promoting social- preventing child abuse and neglect in emotional wellness at the early Rochester. Over the past 20 years, the childhood level. As will be described in child welfare system has built a diverse Section 3 of this report, Rochester has set of services to prevent placement in several resources dedicated to promoting foster care. Until recently, these healthy development in early childhood. programs were, in theory, open to referral from the community; however, Political leadership and budget constraints have restricted the infrastructure. In 2004, Monroe County programs to children reported to Child experienced changes in leadership and Protective Services. Since 2002, the infrastructure. In January 2004, a new trend in number of families and children county executive took office; in July served has been downward. In addition 2004, a new director was appointed to to the formal child welfare system, head the county Department of Human Rochester has both public and private and Health Services (DHHS). Both new leaders publicly stated their intention to maintain services to the community 5 This intentional strategy was discussed during the October 3 and 4, 2005 site visit with the Safe without raising taxes. Start Demonstration Project National Evaluation Team.

The Rochester Police different approaches and paradigms of Department was restructured in June child protective services and domestic 2004, with the consolidation of seven violence available to both systems. precincts into two: the east and west side. The seven-precinct structure had Resources for services. The linked to the city’s six Neighborhood county government is the primary source Empowerment Teams, established to of funding for human services in Monroe help reduce neighborhood nuisances and County. Between 2002 and 2005, the solve neighborhood problems through county, as well as the city of Rochester, the collaboration of residents and city the school district, and New York state, staff. According to RSS staff,6 the all experienced severe budget shortfalls. restructuring of precincts prompted a Monroe County’s previous and current single-minded departmental focus on local administrations have not supported successfully transitioning officers from tax increases to offset budget shortfalls. the old system to the new one. Only the sales tax rate has increased, and only by one quarter of one percent. In spring 2005, the chief of According to site visit participants, police resigned to run for mayor, and county residents, in general, do not was elected in November 2005, on a support tax increases. platform of public safety, education and youth support services, economic Budget constraints have had the development, community development, strongest impact on programs designed and streamlining government. to prevent children from entering foster Transition teams have formed; the youth care (i.e., preventive services) and team is largely focused on teens and county support for school nurses in city young adults. schools. Constraints forced the RSS to seek nonpublic funding to support Both at the state and local levels, expanded and enhanced services. there is recognition of the overlap Constraints also generated increased between domestic violence and child tension between levels of government. abuse and the need for greater From 2000 to 2003, antagonism between collaboration between these sectors. the county executive and the city mayor Despite tensions, the two systems have hurt the Rochester community’s ability worked together (e.g., in the Safety First to get things done. Tensions have greatly initiative7), to use a “Double subsided with the election of the new Perspective” approach to children and County Executive. families. Double Perspective makes the United Way funding preserved some of Rochester’s prevention services, 6 These perceptions were shared during the October 3 and 4, 2005 site visit with the Safe including RSS interventions, in the face Start Demonstration Project National Evaluation of significant city and county budget Team. cuts. Site visit (2005) participants, as 7 The Safety First initiative out-stationed a well as RSS staff, described the domestic violence worker on a Child Protective importance of this source of funding for Services Investigation Team to provide consultation and intervention in cases in which implementation of RSS interventions there appeared to be co-occurring child and the realization of RSS goals. As the maltreatment and domestic violence.

city (Rochester) and county (Monroe) According to a 2004 Monroe County steadily decreased their budgets for report,8 Rochester, representing 30% of child- and family-serving organizations, Monroe County’s population, accounted agencies, and institutions, the United for 71% of all incidents of domestic Way continued its financial support. violence reported in the county in 2003. This support enabled the RSS and its Murders in Rochester occur at a rate of partners to continue to promote the 50 to 60 per year. In recent years, the social and emotional well-being of Rochester Police Department has young children. United Way began its responded to over 20,000 calls per year three-year funding cycle application classified as “domestic/family problem,” process in mid 2005; how this will affect with 26,666 of these calls in 2003 alone. funding for children exposed to violence According to a 1999 study, children remains to be seen. witnessed 20% of all incidents of domestic violence later tried in the 2.2 Social Context Rochester City Court.

Child abuse and neglect. The The level of children’s exposure Monroe County child welfare system to community violence can only be serves at least 4,000 young children (18 estimated from existing data. From years and younger) annually through 1992 to 1997, Rochester saw the Child Protective Services, Preventive following annual crime rates: between Services, and Foster Care. Waits for 29 and 65 murders, 57 and 80 suicides, Preventive Services vary, but can be up and 2,200 and 2,800 serious violent to a month or more. Each year, the crimes (Part 1 crimes, which include REACH Clinic of Strong Hospital treats murder, forcible rape, aggravated over 300 victims of child sexual abuse. assault, and robbery). The PACE survey In the fall of 2004, a Child Advocacy of parents of in-coming kindergarteners Center opened in Rochester. Child includes a series of questions on Protective Services, police officers, the exposure to violence in the community district attorney, REACH providers, and and at home. The 2003-2004 results other services are co-located in this found that 16% of children had center, to investigate cases of child witnessed violence in the neighborhood sexual abuse or severe physical abuse. and 13% had witnessed violence in the A Family Trauma Program at the home before they entered kindergarten. Society for the Protection and Care of This is likely an under-report Children (SPCC) provides social work (Greenberg, Lotyczewski, and services to families in which a child has Hightower, 2005). Based on these died due to abuse or neglect. What is numbers, during their five preschool particularly lacking in Rochester is early years, children born in 1992 had 281 intervention for cases that may not be chances to witness or hear about a accepted as a report or indicated as a murder, 342 chances to be affected by a substantiated child abuse/neglect case. suicide, and 12,773 chances to witness or hear about a serious violent event. Community and domestic violence. The majority of violence in 8 Monroe County Profile for Human Services Monroe County occurs in Rochester. Planning for the 2004–2007 Integrated County Planning Process.

Given the additional 24,000 family young children exposed to community service calls to police per year (for violence. approximately 120,000 calls over five years), it is clear that young children in Expanding the domestic violence Rochester live in an environment in system sufficiently to meet all needs of which exposure to significant violence is children exposed to violence was also extremely likely. deemed unfeasible at the start of RSS.

Nevertheless, site visit (2005) 3. Community Capacity participants described Rochester as resource-rich and considered this an

important community capacity for Despite the numerous resources implementing RSS successfully; the available in Rochester (e.g., services for broad array of existing services for children and families, strong working families and children provided platforms relationships among service providers, for services to children exposed to as discussed below), the needs of violence and allowed Rochester Safe children exposed to community and Start to bridge existing gaps and barriers family violence outstrip the capacity of in services. the community to build a service system exclusively focused on children exposed In particular, several Rochester to violence. For example, prior to RSS, organizations, agencies, and institutions existing services for mental health care share a commitment to and expertise in for young children, including those early childhood that facilitated exposed to violence, were insufficient, investment in RSS: due to lack of therapists with specific expertise, funding streams that did not • readily reimburse for mental health care Children’s Institute develops and for children under six, and state and promotes prevention and early local priorities that have traditionally intervention programs, evaluates ignored children's mental health. children's conditions and programs, conducts training for As another example, the police professionals, and forms have first contact with young children community partnerships to exposed to community violence, but address public policy; • police officers have other priorities in Mt. Hope Family Center is a what are often crisis situations. Young nationally recognized research child victims receive medical treatment, institute that has pioneered a but limited social work services are community-supported, complete available in emergency departments. family approach to the treatment Rochester does have two programs that and prevention of child abuse focus on sibling survivors, but these and family violence, as well as programs tend to serve school age the promotion of positive child children rather than younger ages, and development, the improvement are underfunded, often relying on of parenting skills, and the volunteers. There is little else targeted to prevention of child maltreatment; and

• Society for the Protection and two-week rotation with a Care of Children provides free, community health agency; home-based counseling to • REACH is a program that children and families impacted conducts psychosocial and by domestic violence, as well as medical evaluations of children a safe, neutral, and supervised (18 years of age and younger) for setting for the exchange of suspected sexual and/or severe children whose families are physical abuse. Evaluations are court-involved because of conducted at the Golisano’s domestic violence. Children's Hospital at Strong; • The Rochester Police The ability of this community of Department houses a Family child-serving groups to define a core Crisis Intervention Team goal (i.e., promoting the social and (FACIT) to assist police in their emotional well-being of children) was response to conflict, including identified as a critical capacity for the family violence. The Team implementation of RSS. consists of civilian social workers who refer families in In addition, the United Way, the crisis to community services; and University of Rochester’s Pediatric • Alternatives for Battered Women Links program, the REACH program at has a children's program that Golisano’s Children’s Hospital at served 420 children of all ages in Strong, the Rochester Police its shelter and more than 500 Department, and Alternatives for children from the community in Battered Women contribute to the 1999-2000. community’s capacity to serve young children: Many of these organizations, agencies, and institutions collaborate • United Way sponsors, among with one another to better serve young other projects, Success By Six, children—a tradition that RSS built upon which ensures that young successfully. This practice of children are born healthy, remain collaboration is documented in healthy, and are ready to organizational and program descriptions successfully enter school by age and also was described by several site six; visit participants. For example: • University of Rochester’s Pediatric Links with the • Assisting Children Through Community is a program that Transition is an encourages pediatric residents to “interdisciplinary” (quotes improve the health of children in added) effort of the Children’s their communities who lack Institute; New York’s State’s access to care because of social Unified Court Systems Seventh or economic conditions or special Judicial District; and the legal, health needs. Pediatric residents judicial, mental health, and in this program participate in a mediation communities to

support children whose parents • The Early Childhood are divorcing; Development Initiative is an • The Bivona Child Advocacy initiative in Rochester/Monroe Center uses a “multidisciplinary” County that strives to build a (quotes added) approach community-based network of including Child Protective early childhood providers to Services, Law Enforcement, promote a self-sustaining child REACH program at Golisano’s care sector; Children’s Hospital at Strong, • The United Way’s Success By Rape Crisis of Planned Six project encourages and Parenthood, and the Monroe facilitates collaborations and County District Attorney’s partnerships to unite community Office to serve young victims of businesses, government, service sexual assault; and providers, advocates, educators, • Children’s Institute often serves and families; as a managing partner, or in a • The Babies Can’t Wait Initiative, non-management role, for efforts funded by the Robert Wood among agencies, families, and Johnson Foundation, is a cross- the community that support systems collaborative approach young children and their families to incorporate knowledge from in their growth and development. courts, child welfare, service Almost all of the work of providers, and child advocates in Children’s Institute is done in support of the well-being of partnership; partnership is a core children in the welfare system. value of their work. Examples of The initiative hosts a court-based community partnerships include series to educate professionals the Rochester Early about the medical, Enhancement Project, the developmental, and emotional Rochester Early Childhood needs of young children in foster Assessment Partnership, the care; Early Education Professional • Rochester Safe Start staff are Development Project, and involved in other collaborative Rochester Safe Start. efforts in the community including the Police-Citizen Five additional examples of how Interaction Committee, the Rochester service providers work Domestic Violence Consortium, together and with other sectors of the and the Pediatric Links Board; community (e.g., business, government) and include the following: • Family Court has a special branch, the Domestic Violence • The Domestic Violence Intensive Intervention Court Consortium is a consortium of (DVIIC), with a safe waiting community agencies working room that houses probation staff together to address the issues of to assist in the preparation of domestic violence; petitions, an ABW advocate to provide support and referral, and

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Legal Aid Society system of holistic early representatives to provide childhood education that counsel for petitioners. The addresses the whole child, as University of Rochester recently opposed to focusing primarily on received an NIMH grant to place cognitive development and a mental health professional in literacy, as many other early this waiting area to help with childhood education programs issues of trauma and stress. Staff do; and for the DVIIC support a larger • Health Action, a group of 15 partnership and are eager to community partners representing respond to needs identified by business, education, and health the partnership. In 2002, Monroe care sectors, was convened by County became the site of an the Monroe County Department Integrated Domestic Violence of Health to “improve the health (IDV) Court for families with of the citizens of (Monroe cases pending in both family County by aligning community court and criminal court. RSS has resources to focus on selected provided training to court priorities for action” Monroe personnel and to Law Guardians County, 2006). This group to increase skills and knowledge releases a health “report card” on about children exposed to the priority area of maternal/child violence. health, among others, and addresses this priority through In addition to their collaborative the use of secondary data efforts in service provision, the analysis, as well as development, Rochester community works together on implementation, and evaluation several efforts to increase the social, of interventions. In 2005, Health emotional, and physical health of Action made a significant shift children: from an emphasis on physical health to prioritizing the social- • The Ad Council of Rochester is a emotional wellbeing of children. critical resource, providing free or low-cost help with marketing, In addition to the collaboration of creative consultation, and these organizations, site visit (2005) distribution of media campaigns, participants discussed the important including the RSS Shadow of community capacity of using evidence- Violence campaign. This local based practices and a data-driven partnership of business and approach to service delivery. Inherent to human services is a unique this approach is the ability to analyze aspect of RSS; data. Site visit participants gave several • The Early Childhood examples of how data can be and has Development Initiative is a been used to strengthen programs: 1) critical “driver” of social- incorporation of evaluation tools into emotional issues in the daily program operations, 2) use of data community and has worked for as evidence for a program’s need, 3) use more than a decade to build a of evidence of effectiveness for

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prioritizing program funding, and 4) use practice has improved the quality of research to better understand the of child and family services, issues related to children exposed to including RSS interventions, by violence. instituting an evaluation component for each of its Many site visit (2005) programs. Investing resources in participants also identified Children’s evaluation helps Children’s Institute as an important community Institute to dedicate limited resource instrumental to the successes of resources to interventions with RSS. demonstrated positive impact. Evaluation findings have been • Children’s Institute is a respected used to prioritize resources community convener with the dedicated to RSS interventions ability to engage leaders in over time. initiatives, including RSS. Many site visit participants cited 3.1 Training and Technical Children’s Institute’s ability to Assistance find the voices in a system or community, engage a community Rochester Safe Start staff through outreach, support provided the professional community existing alliances, integrate with a variety of training opportunities efforts to avoid duplication, and that improved capacity to respond to obtain community buy-in; young children exposed to violence. For • Children’s Institute’s expertise in example, Shelter from the Storm training the social and emotional was provided throughout the life of the development of young children initiative. Mentors participating in the commanded the needed trust, Early Childhood Education Intervention respect, and credibility for also received training throughout the life implementing RSS interventions. of the initiative (Rochester Safe Start Children’s Institute gained Initiative, 2005a, p. 25). community trust not only through its expertise, but also because it In addition, the resource-rich was perceived as having a neutral community provided Rochester Safe motivation for involvement in the Start with several important sources of issue of children exposed to local technical assistance. Catherine violence, as opposed to the Cerulli, JD, PhD, Director of the typically more political agendas University of Rochester Laboratory of of various advocacy groups. For Interpersonal Violence and example, through SAFE Kids, Victimization (LIVV), provided local Children’s Institute connected evaluation technical assistance in an law enforcement and the service effort to estimate under-reporting of the community—sectors with very presence of children six years and different priorities and practices; younger (including prenatal children) at and scenes of violence to which the • Children’s Institute’s Rochester Police Department responded. commitment to evidence-based Dr. Cerulli and her team found massive

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under-reporting. LIVV also organized strengths and challenges. Lastly, the the training for Law Guardians in Systems Improvement Training and November 2003 and has submitted Technical Assistance Project (SITTAP) papers both on that training and on a 50- provided important technical assistance state review of law and cases regarding around community engagement, policy endangering the welfare of a child as it initiatives, and sustainability. relates to exposure to domestic violence. One valuable consequence of this work is that Dr. Cerulli now includes a 4. Collaboration and discussion of children exposed to Community Engagement violence in all her medical and law school teaching, in addition to state Government agencies and non- training. Dr. Cerulli is also working to profits in Monroe County share a long bring Shelter from the Storm training history of close collaboration; RSS grew (module 5) to the medical community. out of the close collaborative history and working relationships among Furthermore, in 2005, Dr. administrators and staff in various non- Danielle Thomas-Taylor, a fellow in profit and government agencies pediatrics at the University of Rochester throughout the city and county. This Medical School, obtained Institutional collaboration can be seen at all stages of Review Board approval for a follow-up the initiative's life. Success in winning study on the RSS sample of cases. Dr. the grant was the result of strong Thomas-Taylor will screen RSS cases collaboration between the county health against the pediatric files of two hospital department and the Children’s Institue clinics to see what pediatricians knew through the Rochester Early about exposure to violence and, if they Enhancement Project, a Children's knew, whether they did anything. Institute-facilitated collaborative of many local agencies that aims to Rochester Safe Start staff also increase struggling families’ability to reported several sources of national realize their full potential. Success in assistance that were useful for sustaining RSS has been much easier implementing the initiative (Rochester than it might otherwise have been, given Safe Start Initiative, 2005a, p. 16-17). the network of collaborating non-profits The Office of Juvenile Justice and and government agencies already in Delinquency Prevention provided place at program inception. The structure feedback on strategic and and process of collaboration developed implementation plans that helped staff for the design and implementation of refine their strategies over time. The Rochester Safe Start is discussed next. National Center for Children Exposed to Violence assisted with the startup and 4.1 Early Assessment and continuous improvement of the SAFE Planning9 Kids intervention (described further in Section 5). The National Evaluation Team helped staff with the intiative’s evaluation plan, as well as promoting 9 Information in this section was reported in the useful reflection on the initiative’s local evaluation report form (Rochester Safe Start Initiative, 2005a, p. 22).

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A community assessment, prepared by the Rochester Safe Start project coordinator with extensive assistance from staff in key organizations and agencies, was completed in August 2000 and supplemented through the work of the Center for Governmental Research, with results submitted to RSS staff in October 2000. Assessment findings identified both community strengths as potential platforms for RSS, and gaps and barriers as a basis for improving responses to children exposed to violence (Rochester Safe Start Initiative, 2005a, p. 25-26). Think tanks began the assessment/planning process and laid out a conceptual framework that stressed an ecological approach to the issue of children exposed to violence. Work groups on 1) community assets, 2) practices, and 3) evaluation were organized to complete 1) a survey of existing resources, 2) focus groups with over 130 providers and 40 family members, and 3) an assessment of existing data, respectively. A “rolling retreat” held on October 26, 2000 introduced community leaders to the concept of resilience and the impact of child abuse/neglect, domestic violence, and community violence using local experts and consultants from the National Center for Children Exposed to Violence. The second installment of the rolling retreat on October 31, 2000 presented the results of the work groups, as well as the Center for Governmental Research Community assessment, and then identified key priorities for the implementation plan. These priorities are reflected in the six interventions developed (described in more detail in Section 6).

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4.2 The Collaborative Council The structure of the and Associated Teams: Collaborative Council evolved based on Structure and Function10 the needs of the initiative at any given point in time. For example, at the The Safe Start Collaborative beginning of the project, 60 to 100 Council was responsible for decision- people were actively involved. Some making about the initiative. Although were members of the Collaboration basic principles were developed to guide Council; some were members of the and focus the planning of efforts within council as well as various Planning a collaborative setting, formal policies Teams in different substantive areas; were never implemented to structure the some participated only on Design RSS collaborative processes. Teams. By 2005, the Collaboration Collaborative members did not vote; Council had been eliminated, to be rather, they reached consensus on issues replaced by the smaller Strategy Team as by allowing all members an opportunity the locus of decision-making. Site visit to speak. Participation levels and (2005) participants indicated that this intensity varied with the stage of the change occurred because of the need for initiative. During the planning stage, the a smaller decision-making structure Collaborative Council met at least capable of focusing on the components monthly, and Design Teams (described of RSS that could be sustained, and further below) met at least two or three implementing these components before times monthly. Attendance at all federal funding ended. The Strategy meetings was extremely high throughout Team was made up of six core team the planning phase, with critical members, RSS staff, and team leaders community leaders such as a United from the RSS communications, Way vice president attending almost community engagement, critical every meeting, or at least sending interventions, and critical sectors teams. someone in his stead. The RSS project This structure facilitated decision- director and project coordinator attended making but reduced the reach of RSS all or almost all of the planning-stage somewhat. Teams for key results areas meetings, as well. The local evaluator (e.g., awareness) were identified and was present for the vast majority of these strategies outlined (Rochester Safe Start meetings, and the director of the local Initiative, 2005a, p. 18). evaluation attended on an as-needed basis. A Steering Team, consisting of the Similarly, associated teams were co-chairs of the Collaboration Council created and disbanded at various stages (i.e., counsel to the county executive and of the initiative. Planning Teams, for the director of the county health example, evolved into Design Teams department) met with staff monthly to responsible for the nuts and bolts of review progress, identify problems, and designing and implementing various facilitate solutions. interventions, including those targeting community norms and education, early childhood education, domestic violence, and police-mental health; the work of

10 Information in this section was reported in the these teams was refined over 2001. In local evaluation report form (Rochester Safe the first quarter of 2002, Review Teams Start Initiative, 2005a, p. 18 & 22).

Association for the Study and Development of Community 148 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

developed requests for proposal, engaged leaders who had reviewed applications, and decision-making authority within recommended providers to the their organizations. These Collaboration Council. By Spring 2002, decision-makers were not, RSS was ready for startup of new and however, the public face of their expanded services, and was actively organizations, and were therefore beginning work on public awareness and less inclined to expend the training. Contractual arrangements were energy of the collaborative on the developed, and along with those, many promotion of their own deep partnerships with local agencies organizational agendas; and were formed and maintained. Through • The three-tier structure of the implementation phase, Design collaboration used by Children’s Teams were consulted when issues Institute/Rochester Safe Start arose, although meetings became less was identified as a successful regular as the work of implementation model. In the three-tier model, began and difficulties decreased. community needs and interests Implementation Teams then formed for (top tier) drive the decisions of each intervention. an initiative; the middle tier consists of the “doers” (e.g., Perceived strengths and deputy directors); and the bottom weaknesses of the Safe Start tier includes the highest level of collaborative emerged during leadership (e.g., mayor), required discussions with site visit (2005) for successful implementation of participants. Collaborative strengths an initiative. The Strategy Team included: operated at tier two, to make timely decisions informed by • Children’s Institute has strong community members, but also relationships with community able to impact organizational leaders, which gave the leaders. This model is shown in collaborative access to important Figure 1. resources. For example, in 2005, a municipal official contacted Figure 1. Three-Tier Collaborative Children’s Institute to manage Model member item money (i.e., discretionary funds). These funds were used to plan and design the Community/Neighborhood Safe at Home program. The United Way and Children’s Institute continue to work collaboratively to identify Senior Systems Managers funding priorities; (Operating Issues) • Members of the Strategy Team were well positioned within their own organizations, which Top Leadership facilitated implementation of Level RSS. RSS staff strategically (Policy Issues)

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additional period, given the complexity of RSS and the One collaborative limitation was continuing importance of the identified by some site visit (2005) project director to RSS. participants: • The team that produced phase one of the Shadow of Violence • The Safe Start collaborative campaign changed entirely over included a limited number of the summer of 2005. The creative professionals working directly director and art director left the with families; therefore, some agency to which Safe Start was participants viewed the assigned, and the chief executive collaborative as lacking officer of the Ad Council also important input. The failure to left to become vice president of create a more representative communications for the United decision-making body might Way. These changes meant have hindered the investment of orienting an entirely new team frontline service provides in RSS and negotiating the creative interventions. This limitation was direction for phase two. attributed to both the Strategy Team and the earlier 4.3 Community Engagement Collaborative Council configuration. The director of In the second half of 2005, the Child Welfare, a Strategy Team RSS began to develop its community member, resigned in August engagement strategy in earnest. In the 2005. After his resignation, the fall of 2005, RSS received a small Strategy Team did not have planning grant from the city of representation from Child Rochester through the New York State Welfare. Office of Children and Family Services to focus on families affected by domestic Other factors also challenged the violence in the west side of the city Collaborative Council’s ability to focus (Sector 3). With technical assistance on implementation and sustainability from the city and from the Rochester efforts in 2005: Community Area Foundation Community Engagement program • Within Children's Institute, officer, the RSS began work on building agency reorganization occurred, relationships with two contrasting leaving the RSS project director neighborhood associations by preparing to head both community an issue paper on needs, which is partnerships and national currently being tested through services for about six months. A "community conversations." The need new director of community for a community organizer became partnerships began in December apparent in 2005, and the RSS will fill a 2005, but the transitioning of part-time contracted position in early responsibilities from the RSS 2006. That individual will not only project director to this new complete the planning process, but will director will continue for an also connect with larger city anti-

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violence efforts. These efforts include change strategies to improve the access, those of the outgoing mayor, to create a delivery, and quality of services for city Office of Child Safety and to young children exposed to violence. coordinate public and private funding for Rochester Safe Start’s overall approach community violence prevention efforts to system change and specific to build a safer and more viable interventions are discussed next. The community for children and youth.11 interventions range from broad community awareness to narrow focus In general, Rochester Safe Start on individual children. staff was less adept at engagement of residents in high crime areas than at Rochester Safe Start was engaging professionals in the operationalized by embedding resources community. Furthermore, RSS staff in existing community programs, with underestimated the extent to which some the goal of addressing unmet community communities view domestic violence as needs. As one site visit (2005) acceptable behavior. Changing participant stated, Rochester Safe Start community norms around this type of “didn’t develop a pipeline to therapeutic violence will be more difficult than interventions.” Others described RSS as originally anticipated. The Safe at Home seeking to raise awareness of the issue of planning process with a local children exposed to violence without Neighborhood Empowerment Team also creating additional burdens for families took longer than expected, in part due to and service organizations. Instead, RSS the difficulty of finding residents staff dedicated resources to enhance interested in the project. ongoing efforts. One participant described the approach as follows: “Rochester Safe Start was behind the 5. System Change Activities scenes pulling the strings, nice web, bringing the community together as a Safe Start demonstration sites are whole.” Another participant described expected to improve the system of care this strategy as “quiet infiltration.” This for young children exposed to violence approach is represented in Exhibit VII- by implementing a balanced, B. comprehensive approach, spanning five domains of system change: 1) Rochester Safe Start staff development of policies, procedures, and engaged multiple sectors of the protocols; 2) service integration community to implement both universal activities; 3) resource development, and targeted system change activities. identification, and reallocation; 4) new, RSS staff worked with early childhood expanded, or enhanced programming; providers, the courts, the police and 5) community action and awareness department, and mental health providers activities. Rochester Safe Start staff and to offer children and families universal partners designed and implemented six interventions (social marketing core interventions that used these system campaign, the Early Childhood Education Intervention, community

11 At the time of this report, this proposed idea engagement/Safe at Home), as well as did not appear to be on the agenda of the current targeted interventions (SAFE Kids, city administration.

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mental health services for foster care RSS staff and partners concluded children, supervised visitation, court that the domestic violence system could advocates), designed to reduce not be expanded sufficiently to meet all children’s exposure to violence and its needs. This conclusion provided the impact. Each of these interventions is impetus for the training initiative that described next. consisted of three components: 1) Shelter from the Storm (1-2 day trainings on children exposed to 5.1 Shadow of Violence Media domestic violence), 2) conferences, and Campaign 3) presentations. These components created a unique approach to training RSS staff utilized the Ad Council that created two training streams: of Rochester’s expertise in social clinical and nonclinical. The bulk of marketing to conduct a public awareness training participants have attended campaign designed to mobilize adults in conference and presentations. The the community to respond to children training initiative reached 2,313 exposed to violence at home and in the participants between 2003 and 2005 community. Campaign components (Rochester Safe Start Initiative, 2003; included a television commercial; print Rochester Safe Start Initiative, 2004; ads; and at a grass-roots level, posters, Rochester Safe Start Initiative, 2005b).13 brochures, and door hangers for In 2006 the focus of presentations will distribution at churches, community shift from staff to community residents. centers, businesses, and homes. Most site visit (2005) participants identified 5.3 Early Childhood Education increasing community awareness of Intervention issues related to children’s exposure to violence as an important An initiative focused on early accomplishment of RSS. childhood should, logically, work within the system that sees the most children The Shadow of Violence six years and younger outside the family. Campaign was an innovation, not only Early childhood programs in Rochester for Rochester but also more broadly. have increasing contact with children Based on academic literature reviews three to five years of age. At the age of conducted by RSS staff and National two, 49% of the city’s children are in Center for Children Exposed to Violence center or family care. By age three, 55% Resource Center librarians, the Shadow of children are enrolled in child care; by campaign was the first of its type. age four, that percentage increases to 70%. Other estimates put the percentage of four-year-olds in child care at over 12 5.2 Training Initiative 80% (Rochester Safe Start Initiative, 2005a, p. 11). Based on these numbers and, more importantly, the evidence that

12 For a full description of the trainings 13 This figure was compiled from Progress provided, see the local evaluation report form, Reports (2003-2005) submitted by Rochester 2005 (Rochester Safe Start Initiative, 2005a, p. Safe Start to the Office of Juvenile Justice and 14-15). Delinquency Prevention.

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high quality early childhood education is violence. The protocol development a strong protective factor for at-risk process provided mentors and consultant children, the RSS committed to staff with an opportunity not only to enhancing the ability of early childhood formalize their procedures and educators to respond to children exposed responsibilities, but also to discuss to violence. Mentoring was a key part of which coaching methods were most this quality improvement system. effective and how other methods could be improved. Mentors now have formal The Early Childhood Education policies and procedures to which they Intervention was universal, with all can refer in their work with teachers and children—and therefore all those children in Rochester daycare centers. exposed to violence—receiving the intervention indirectly through their 5.4 SAFE Kids Program teachers. This was a new approach in Rochester, and in general in the field of Although a variant of an existing children exposed to violence. Mentors program (child development-community supported teachers by working with policing, developed by New Haven and children not fully engaged in the group Yale), SAFE Kids was new to learning process and by providing Rochester. The program forged a teachers with a variety of support. partnership between police and social Mentors supported and assisted teachers workers (employed by the Society for by providing them with educational the Protection and Care of Children), on materials and other resources on the behalf of young children exposed to behavioral signs that can indicate violence in the communtiy or home. exposure to violence, consulting with SAFE Kids increased police them on issues such as classroom setup, identification of children exposed to observing child and adult behavior in the violence at the scene of community or classroom, providing insight on child- domestic violence calls, bringing many parent interactions in the classroom, children who might not otherwise have taking teachers on guided observations received services into the network of of model classrooms, and modeling resources available for children exposed strategies and techniques to assist to violence in the community. teacher. Additionally, teachers suggested referral services or personally referred From the outset, the SAFE Kids children to appropriate service providers. project included case consultation Collaboration, therefore, was inherent in meetings among SPCC, the Rochester the mentor process. Police Department, and the Family Crisis Intervention Team. The RSS During the summer of 2004, RSS coordinator attended these meetings, and staff developed a protocol manual for the RSS administrative assistant participants in the Early Childhood maintained files of cases and took Education Intervention. The manual meeting minutes on general issues. outlined the role and responsibility of Child Protective Services, the Mobile mentors when coaching teachers of Crisis Mental Health Team from Strong three- and four- year-olds to respond Hospital, and on occasion other appropriately to a child exposed to providers attended these meetings, as

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well. At meetings, each new case was Project and Fast Track Supervised presented and next steps were identified. Visitation.

SAFE Kids did not achieve 24- Between May 2003 and October hour crisis response in the vast majority 2004, the ABW Child Advocate Project of cases, because of delays in referral by served 574 families with children six police officers. In early 2005, SPCC years and younger. These families were provided one social worker, without involved in either Integrated Domestic round-the-clock backup, to police Violence Court or Domestic Violence officers, but suspended this aspect of the Intensive Intervention Court, and had program during June and July (2005), 801 children six years and younger and after a key SPCC staff person resigned. 386 children older than six. All families A SAFE Kids memorandum of received court advocacy services in agreement documents the relationship DVIIC and/or IDV. Additionally, all among SPCC, the Rochester Police families were informed of ABW services Department, and FACIT. Should SAFE and a variety of community-based Kids continue, an update will be needed services. Families were specifically to reflect the revised structure. asked at intake about early childhood and health services for their children, There were mixed perceptions and referrals were made as needed. about the success of this program among Additionally, families could access site visit (2005) participants. From ABW’s partnership with the Legal Aid program inception in March 2002 to Society of Rochester for civil legal February 2004, SAFE Kids responded to services (Rochester Safe Start Initiative, 130 incidents involving 305 children. 2005a, p. 47). The advocate project During the second 12 months of that 24- ended in 2005, because a separate ABW month period (i.e., during the period for advocate made less sense than ensuring which accurate data on service delivery expertise in children exposed to violence are available), social workers had among all court advocates. contact with (and thus could be considered to have served) 119 children. Fast Track Supervised Visitation, Eighty-four of these children were provided by the Society for the classified as receiving the “highest” Protection and Care of Children, offered level of service delivery (i.e., contact expedited visitation services for court- between the social worker and both the involved families experiencing domestic child exposed to violence and the violence that physically endangered their involved family; Rochester Safe Start children. During visitation, non- Initiative, 2005a, p. 47). custodial parents received coaching on appropriate parenting behavior. Both 5.5 Children in Court Program parents were taught how to focus on and prioritize their children’s needs. The The Children in Court program program received referrals for 53 was an innovation in Rochester, and families, and 48 families acted upon and included two projects: the Alternatives received supervised visits. This for Battered Women Child Advocate translated to approximately 96 parents and 70 children served. Among these

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families, the average wait for service was one to two weeks, as opposed to six The Domestic Violence months in the general supervised Consortium developed child-focused visitation program (Rochester Safe Start protocols for handling cases of domestic Initiative, 2005a, p. 47). Based on results violence for service providers and the described in the final report on the Fast courts in 2005; protocols for law Track project, the RSS agreed to fund enforcement and the district attorney had and rigorously evaluate this approach to been developed previously. RSS staff supervised visitation; that project will contributed the child piece to the service begin in 2006. provider protocols and is involved in development of training. RSS staff also Through Children in Court, helped obtain buy-in for implementation ABW and SPCC met regularly, of the protocols. The Domestic Violence primarily to review program Consortium planned to audit development and problem-solve, but implementation of the protocols, but was also to confer on specific families. This not awarded funding needed for that process ended with the completion of the effort; the consortium is applying again project. and is positioned to conduct the audits in 2006-2007. In the meantime, the county 5.6 Mt. Hope-Foster Care has provided bridge funding for the Intervention Domesitc Violence Consortium to continue its efforts at implementating the The Mt. Hope-Foster Care protocols. intervention was an expansion of Mt. Hope's well-known approach to helping children facing serious difficulties, 6. Institutionalization of especially child abuse and neglect. The Change program provided young children in foster care ready access to rapid Rochester Safe Start assessment; contextual assessment accomplished many of its original (observing and analyzing behaviors in objectives and as a result made several different settings to understand lasting changes in the service delivery differential symptoms); consultation system. with the foster care worker, foster parents, and bioparents; and child therapy. Mt. Hope reached 101 children 6.1 System and Agency between April 2002 and April 2004 Change14 (Rochester Safe Start Initiative, 2005a, p. 36). Case sharing and collaboration The protocols developed by the among the Mt. Hope therapist, foster Domestic Violence Consortium for law care worker, and Foster Care Pediatric enforcement, the district attorney, the Clinic were on a child-by-child basis. courts, and service providers represent No regular mechanism for case consultation was used in the project.

14 Information in this section was reported in the 5.7 Domestic Violence local evaluation report form (Rochester Safe Consortium Protocols Start Initiative, 2005a, p. 32).

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change at both the system and agency evaluation suggests that information in levels, as each system begins to focus on the curriculum was new and useful to how children are affected by exposure to participants. Efforts to institutionalize violence. RSS staff advocated for a Shelter from the Storm included section in the service providers protocol development of co-sponsorship, dealing with children exposed to calculation of a cost structure, and violence, and took leadership in drafting preparation of an application for support that section. RSS staff was also active in from the New York State Office of planning for the invitational conference Children and Family Services, as well as in October 2004 and the general plans for incorporation within at least conference in May 2005, where two major systems in 2005. Evaluation education and training on how to of the Law Guardian training resulted in implement the protocols took place. a more intensive training on interviewing children, as well as 1) a In addition, RSS staff contributed column in the newspaper of record for to improving mandated reporter training attorneys, and 2) a review of the through the Do Right by Kids initiative, literature on adult learning as it relates to which resulted in greater openness of the increasing attorney expertise on children local child abuse hotline to provide exposed to violence, which will affect consultation for child-related incidents the training provided to Law Guardians that do not rise to the level of a in the 7th Judicial District. mandated report. The SAFE Kids protocol developed in spring 2004 also In the future, the New York State represents an important agency-level Office of Children and Family Services, change. The institutionalization of Mt. rather than Safe Start, will fund the Early Hope-Foster Care interventions ensures Childhood Education Intervention. A the provision of mental health care for screening tool was developed children in foster care under the age of simultaneously to, but not as part of, the six. This change is both a point-of- intervention as part of the other service and an institutional change. community work on children. The intervention and screening tool 6.2 Point-of-Service Change15 development were a parallel process, clearly impacting one another. The The Rochester Safe Start screening questions have been Training Initiative increased the incorporated into PACE, a form expertise of over 500 clinical and non- completed by the parents of all incoming clinical providers of services to young kindergarteners in the Rochester City children, through Shelter from the School District. In addition, the Storm, as well as providing other mentoring system has institutionalized a training to over 1,000 additional set of training materials for mentors on attorneys, police, court personnel, and knowledge and skills in responding to early childhood providers. Feedback children exposed to violence. The cadre from the Shelter from the Storm training of mentors who worked with 35 classrooms for 18 months is now

15 Information in this section was reported in the working with 30 more to increase local evaluation report form (Rochester Safe teachers’ skills in responding to children Start Initiative, 2005a, p. 32).

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exposed to violence. The expertise developed through RSS will be infused into a larger Early Childhood Professional Development grant that will provide 26 mentors for infant/toddler as well as preschool early childhood programs.

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• In 2005, the Early Childhood 16 6.3 Community Change Education Intervention received $148,000 from the New York Changing adults’ knowledge, State Office of Children and attitudes, behavior, and expectations of Family Services to provide themselves and others can contribute to mentoring to 30 prior control positive outcomes for children exposed classrooms, booster sessions for to violence. A link between social 30 intervention classrooms, and marketing and child outcomes is not a training for Parent Group common finding in the academic Leaders and Site Coordinators. literature, if only because there have In 2006, mentors will be been few social marketing campaigns transitioned to the Early geared toward helping children by Education Professional sending messages to adults, evaluated in Development grant. The training valid ways, and published. Evaluation of developed through Safe Start is the Rochester Safe Start Shadow of now provided to all mentors; Violence campaign showed an increase • In 2005, SAFE Kids was in the proportion of adults in the assumed by the Society for the campaign target community who Protection and Care of Children reported responding after seeing a child through local grant funding and being exposed to violence. Among SPCC Board-designated funds. survey respondents who had been SPCC has approached the county bystanders to children exposed to executive, the Red Cross, and violence in the previous six months, others for on-going funding common actions taken by those who support in subsequent years; responded to the exposure included • In April 2004, the United Way listening to the child’s story, comforting picked up the Mt. Hope Family the child, contacting the authorities Center services for young (police and/or Child Protective children in foster care; and Services), calling Lifeline, and other • Fast Track Supervised Visitation appropriate responses. There was not an could be replicated as a national increase in such self-reported behavior model if evaluation findings in the comparison community. support its ability to reduce the impact of children’s exposure to violence. 7. Increased Community Supports

Rochester Safe Start successfully obtained funding for key service components:

16 Information in this section was reported in the local evaluation report form (Rochester Safe Start Initiative, 2005a, p. 33).

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RSS continued its relationship Despite these important changes with the Ad Council and is seeking in community support for children additional support for community exposed to violence and their families, education: there remain gaps and barriers to accessing and receiving services specific • The Ad Council approved Safe for exposure to violence in Rochester: Start as a community initiative for 2005 and 2006. This • Systems do not systematically approval will provide extensive identify children exposed to assistance with creative and violence; marketing approaches for phase • Multiple points of entry mean a two of the Shadow of Violence child may or may not receive campaign; services. Are protocols in place • Application for additional that ensure referral for and assistance for phase two of the connection with services from Shadow of Violence campaign any point of entry into the was made to the federal Office of system? Evidence from local Victims of Crime. This studies and from case reviews application was not funded; and suggests that referral processes • RSS received $1,000 from Target vary considerably across points in support of phase two of the of entry; and Shadow of Violence campaign. • Access to services is an issue that extends beyond Rochester Safe RSS community partners will Start; RSS staff must link with continue to advocate for reducing larger community efforts children’s exposure to violence beyond designed to improve access to federal funding. United Way now needed services. recognizes that violence is an issue that touches all of its project areas. More specific to sustaining RSS, the United 8. Reduced Exposure to Way plans to work with Children’s Violence17 Institute/RSS staff on sustaining the “Safe Start Initiative infrastructure” Rochester Safe Start (e.g., staff positions). The Domestic interventions were not designed to Violence Consortium will continue to reduce exposure to violence in the sense keep the community aware of the impact of primary prevention, nor did of domestic violence, on both adult and evaluations designed to assess program child victims. Individuals who implementation focus on this outcome. participated in and provided Shelter Early intervention was the primary goal from the Storm training will continue to of RSS interventions. Nevertheless, there offer their knowledge and awareness of are several programs and initiatives children exposed to violence to those with whom they work within the community. 17 Information in this section was reported in the local evaluation report form (Rochester Safe Start Initiative, 2005a, p. 37-38).

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underway in Rochester that have the but are having difficulty potential to reduce exposure to violence: obtaining referrals; • Mt. Hope Family Center has • In fall 2004, the Rochester Police received a federal grant to study Department developed an domestic violence and young initiative to identify homes in children. Project FUTURE which six or more domestic focuses on toddlers (23 to 25 violence incidents have occurred. months) to look at the impact of Officers and the Family Crisis domestic violence; however, this Intervention Team approach is a research study rather than the these families to offer services study of a program; and and warn the perpetrator in hopes • Mt. Hope Family Center also of reducing further violence. As received a federal grant to study of yet, no outcome data are maternal depression and available; attachment and provide services • The ACT program is aimed at to depressed mothers. These helping parents and others in services are likely to prevent close contact with children to neglect of infants, providing teach children nonviolent another resource for young problem-solving. RSS families. community assessment identified child-on-child violence as a key 9. Reduced Impact of issue, and this is one effort to Exposure to Violence18 address that problem. The ACT curriculum was developed by the As described in Section 3 of this American Psychological report, the Rochester Safe Start grantee Association and the National systematically used evaluaton data to Association for the Education of monitor and improve its various Young Children. RSS interventions. Process evaluation participated in the initial national findings were used to improve upon or launch of training trainers. No eliminate interventions over the life of outcome data on actual the intiative. The evaluations of the prevention of violence are likely Shadow of Violence campaign and the to be collected; Early Childhood Education Intervention • Alternatives for Battered Women were the only evaluations designed to is maintaining its children's assess intervention outcomes. Neither program in the shelter, and the was designed to examine a reduced Society for the Protection and impact of exposure to violence; rather, Care of Children is maintaining changes in community norms and its Family Violence Program. classroom-level changes in child Family Court and Integrated development, respectively, were the Domestic Violence Court have focus of these evaluations. These maintained their services. evaluations are described in more detail Batterers intervention programs in Rochester include children 18 Information in this section was reported in the exposed to violence components, local evaluation report form (Rochester Safe Start Initiative, 2005a, p. 39-40).

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in Exhibit VII-C and are summarized briefly here.

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9.1 Shadow of Violence Children in classrooms with mentors Evaluation demonstrated more positive growth in their cognitive, social, and physical This evaluation employed a non- functioning than children in classrooms equivalent control group design, in without mentors. This difference was which the control group was a high- statistically signficant. crime portion of Buffalo similar to the treatment group (Rochester's “crescent of violence”). Four hundred random digit dialing interviews were conducted 10. Conclusion in each city, both pre- and post- intervention, for a total sample size of Rochester Safe Start staff and 1,600. The evaluation measured partners successfully implemented and achievement of five objectives: sustained some of its critical increased awareness, increased interventions. Making the shift to knowledge of impact, and three changes sustainability planning, which also in norms. Findings indicated an increase involved implementing new projects in the proportion of adults in the (i.e., Safe at Home, evaluation designs), campaign target community who during a year of internal changes and reported acting after seeing a child being uncertainty with regard to federal exposed to violence. There was not an funding, was challenging. Rochester increase in this behavior in the Safe Start staff, Children’s Institute staff, comparison community. A second, very and their community partners similar ad campaign and study will strengthened Rochester’s response to commence in early 2006. children exposed to violence and their families through trusting relationships, 9.2 Early Childhood Education engaged leadership, and skilled staff Intervention Evaluation dedicated to the mission of Safe Start. Additionally, the use of evidence-based This evaluation employed a practices and evaluation data was randomized clinical trial design. The integral to the development and data set consists of 615 observations, for modification of the community response. children whose parents consented to RSS intentionally focused on building provide data on exposure to and the capacity of existing service providers symptoms of violence at each program as opposed to developing new systems. year's start. Teachers in these Using a behind-the-scenes strategy, RSS observations remained constant (with the staff was less concerned about name or exception of teachers lost to attrition and brand recognition and more invested in replaced), while children in the helping other organizations, agencies, observations changed from year one to and institutions develop the knowledge, year two. Data sources included parents, skills, awareness, and relationships teachers, RSS, and Rochester Early needed to address the issue of children Childhood Assessment Partnership. exposed to violence.

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11. References

Association for the Study and Development of Community (2005a). Site visit report: Rochester Safe Start Initiative January-December 2005. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2005b). Site visit report: Rochester Safe Start Initiative January 1 through September 30, 2005. Gaithersburg, MD: Author.

Greenberg, S. R., Lotyczewski, B.S., & Hightower, A.D. (2005). Community Report on Children Entering School in 2003-2004. Rochester, NY T04-008, 23-24. Retrieved June 14, 2006 from www.childrensinstitute.net/images/PACEreport04.

Rochester Safe Start Initiative (2003). Progress report Section I July-December, 2003. Rochester, NY: Author (Available from the Association for the Study and Development of Community).

Rochester Safe Start Initiative (2004). Progress report Section I January-June, 2004. Rochester, NY: Author (Available from the Association for the Study and Development of Community).

Rochester Safe Start Initiative (2005). Local evaluation report form. Rochester, NY: Author (Available from the Association for the Study and Development of Community).

Monroe County (2006). Health Action. Retrieved June 14, 2006 from http://www.monroecounty.gov/health-healthaction.php

U.S. Census Bureau. (n.d.). Fact sheet. Retrieved June 14, 2006 from http://factfinder.census.gov/servlet/SAFFFacts?

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Exhibit VII-A Timeline of Rochester Safe Start Initiative Activities and Milestones

Major Milestone 1/02-6/02 7/02- 1/03-6/03 7/03- 1/04-6/04 7/04-12/04 1/05-6/05 7/05- 12/02 12/03 12/05 Shadow of Violence media campaign • Received Telly award for Shadow of

Violence public service announcement • Approved for an additional year as a community initiative for the Ad Council of Rochester Training Initiative for children exposed to violence • “Babies Can’t Wait” series • Law Guardians Training implemented • Law Guardians Training developed into a monthly column series in the Daily Record Early Childhood Education Intervention • Development of consultant/mentor

protocol manual • Early Childhood Education Intervention incorporated into the Early Educators Professional Development grant SAFE Kids intervention • Creation of SAFE Kids Memorandum of Agreement • SAFE Kids incorporated into the Family Violence Program of the Society for the Protection & Care of Children (SPCC) Children in Court initiative

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Major Milestone 1/02-6/02 7/02- 1/03-6/03 7/03- 1/04-6/04 7/04-12/04 1/05-6/05 7/05- 12/02 12/03 12/05 Mt. Hope Family Center Child in Context intervention • Received United Way funding to continue program

Pilot training on children exposed to violence for probation officers Safe at Home community engagement planning process

Sources: Rochester Progress Reports: January-June 2004, July-December 2004, January-June 2005, July-December 2005; Rochester Safe Start Highlights: 2004 and Looking Ahead, February 2005, March 2005, April 2005, May 2005, June and July 2005, August 2005; Rochester Local Evaluation Form: 2004, 2005.

Association for the Study and Development of Community 165 July 2006 DRAFT This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. Exhibit VII-B ROCHESTER SAFE START SERVICE DELIVERY MODEL

Rochester Community

Safe At Home/ Shadow of Violence (Safe Start Trainings)

Early Childhood ROCHESTER SAFE Police Providers ECMP Kids Department (Safe Start Trainings) SAFE START (Safe Start Trainings)

Fast Track Supervised Visitation

Courts & SPCC (Safe Start Trainings)

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Exhibit VII-C Rochester Safe Start Intervention Research

Overview

The Rochester Safe Start (RSS) grantee used various methods as part of its intervention research. However, the only two interventions that were evaluated using a comparison design were the Shadow of Violence media campaign and the Early Childhood Education Intervention. For purposes of this case study, these two evaluations are highlighted. The Shadow of Violence campaign aimed at changing community norms and attitudes. The message was simple: Children are harmed by witnessing violence…and the community can help. The campaign components included a television commercial; print ads; and at a grass-roots level, posters, brochures, and door hangers for distribution at churches, community centers, businesses, and homes. The Early Childhood Education Intervention mentored teachers and other adults in early childhood classrooms to recognize that difficult child behaviors may be caused by exposure to violence. Mentors also guided adults to create environments, both physical and psychological, that are supportive for children who have witnessed violence. For example, mentors showed teachers classroom layouts that children find reassuring, helped teachers structure their school day in a familiar and comforting fashion, and offered techniques for encouraging withdrawn children to open up about their feelings and for responding to children who act aggressively.

Methods

The Shadow of Violence evaluation employed a non-equivalent control group design, in which the control group was a high-crime portion of Buffalo similar to the treatment group (Rochester's crescent area).

The Early Childhood Education Intervention evaluation used a randomized control group design, in which mentors were randomly assigned to classrooms.

Sample:

The Shadow of Violence sample: Four hundred random digit dialing interviews were conducted in each city, both pre- and post-intervention, for a total sample size of 1,600.

The Early Childhood Education Intervention sample: The Early Childhood Education Intervention targeted 65 preschool classrooms and had a sample size of 615 children.

Procedures:

Shadow of Violence Campaign. Random digit dialing was used to survey residents. The evaluation measured achievement of five objectives: increased awareness,

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increased knowledge of impact, and three changes in norms. Multivariate survey- weighted logistic regression analysis was employed. STATA (a common survey logit program) was the statistical software package employed to analyze the survey data.

Early Childhood Education Intervention. Data for the Early Childhood Education Intervention were collected between 2002 and 2004 by parents, teachers, Rochester Safe Start, and the Rochester Early Childhood Assessment Partnership. Two standardized instruments were used to assess the impact of violence on young children: the Teacher- Child Rating Scale (T-CRS) and the Child Observation Record (COR). The T-CRS measures the child’s socio-emotional behavior by assessing the child’s task orientation, behavior control, assertiveness, and peer social skills. The COR assesses a child’s development and progress in different educational areas, and helps teachers construct a profile of the child. Data were analyzed using hierarchical linear modeling, which controls for shared variance (e.g., differences in classrooms are statistically separated from differences in children’s outcomes). Furthermore, a parent survey was administered pre-intervention to assess exposure to violence and symptoms related to exposure to violence. These data were then analyzed to study a child’s level of exposure to violence and the symptoms associated with exposure.

Results

Shadow of Violence. The statistically significant and substantively large increase in reported activity by adult bystanders to children exposed to violence (discussed above) constitutes an increase in a very important protective factor. Subsequent multivariate analysis using logistic regression indicates that post-campaign Rochester respondents who reported being a bystander to a child exposed to violence were over ten times more likely than other reported bystanders (i.e., pre-campaign in Rochester and pre- and post- campaign in Buffalo) to act (i.e., odds ratio on variable that interacts city and time point is 10.2; p=0.009).

Early Childhood Education Intervention. Parents of 1,934 children, 88% of whom were kindergartners, completed the parent survey for the 2003-2004 school year. Results showed that 16% of the children had witnessed violence in their community and 13% had witnessed violence at home.

Results obtained using the T-CRS instruments revealed no differences in scores between intervention and control groups. However, the COR instrument results showed positive changes post-intervention on all three subscales of the COR. Additionally, positive changes were observed in the total scores for treatment versus control groups. A 0.66 estimated effect size for the difference in the total COR growth suggests that mentors were successful in supporting teachers so that they were able to provide positive learning environments that helped children’s progress.

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Discussion

Intervention research findings suggest that a media campaign and a mentoring model can be effective ways of intervening on behalf of young children exposed to violence. An effective social marketing campaign may be able to influence adult norms and attitudes, such that adults intervene when children have been exposed to violence. Such intervention is likely to contribute to more positive outcomes for children exposed to violence if norms and attitudes are changed for a significant numbers of adults in a community. In addition, providing early childhood educators with coaching and mentoring support can help children through their teachers. Initial evaluation findings suggest that focusing on the key adults in children’s lives is a powerful way to promote wellness in early childhood.

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VIII San Francisco SafeStart

along with several standing and ad hoc 1. Overview committees that focused on specific issues (e.g., evaluation, public education, batterer Prior to the San Francisco SafeStart intervention, sustainability, and cultural initiative, the city and county of San competence), supported the Council. This Francisco had limited data on children structure enabled all stakeholders to exposed to violence, inadequate capacity participate according to their availability, (knowledge, skills, and resources) for functions, and interests. responding to the specific needs of these children, and an incomplete continuum of The Advisory Council had another support and fragmented services for this unique feature: the Parent Team, which special population. Guided by its Advisory functioned as a committee. This team, made Council of 28 to 31 representatives from ten up of five people who had experienced sectors,1 SafeStart worked to address these violence in their lives, ensured that SafeStart limitations by 1) increasing the effectiveness strategies were informed by the perspectives of services by training point-of-service of families affected by violence, in addition providers on how best to respond to children to those of service providers and other exposed to violence; 2) preventing professionals. The Parent Team developed a childhood exposure to violence by mentoring program through which its sensitizing the public to the issue; 3) members mentored eight domestic violence reducing the impact of exposure by survivors to support other survivors and providing early intervention and treatment; speak publicly about violence and its impact and 4) improving systems by promoting a on young children. core set of values, beliefs, and practices for responding to young children exposed to To increase the effectiveness of violence. services by training point-of-service providers on how best to respond to children The Advisory Council, chaired by exposed to violence (SafeStart goal #1), the the presiding judge for the San Francisco San Francisco SafeStart grantee conducted Unified Family Court, consisted of three annual SafeStart Academies, three influential leaders who were well respected annual conferences, and several trainings to in the community and in positions to affect specific groups (e.g., the school district). decision-making and policies. A Steering Over 3,000 people have attended at least one Committee of nine people who served as the SafeStart training event (Fox & Mayer, Advisory Council’s executive committee, 2005).

1 The sectors included child welfare, law SafeStart’s second goal, to sensitize enforcement, family court, domestic violence, the public to the issue of childhood exposure batterer intervention, health and behavioral health, to violence and its impact, was education, early childcare, youth development, and accomplished through a 2004 public community-based family support services.

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education campaign with the theme, “You’re neighborhoods throughout the city, provide Not Just Hitting Her—Domestic Violence parent-to-parent support, peer counseling Hurts Children Too.” The campaign, co- and home visits, information and referral, sponsored by the Saint Francis Memorial parent education, and support services in Hospital and the California Attorney different languages. They have staff General’s Office, distributed 30,000 flyers members who share cultural characteristics to every elementary school, child with the families in the neighborhood; development program, and Head Start hence, families are more likely to go to the program throughout the city. Graphics were centers than to a mental health clinic for placed inside 300 buses, on the rear of 50 help. All but one family resource center has buses, and on 30 bus shelters. The campaign the capacity to provide behavioral health was covered on four television stations and services, as well. To further increase the five radio stations, and in three local likelihood of identifying children exposed to newspapers. violence and link services, SafeStart also funded one liaison in the police department To reduce the impact of exposure by and another in family court, and established providing early intervention and treatment a dedicated telephone line for SafeStart (“the (goal #3), the SafeStart grantee used a multi- Support Line”). prong strategy that 1) built upon and expanded the existing infrastructure of six The Service Delivery Team family resource centers2 (FRCs) by funding consisted of the six FRC family advocates, one family advocate position in each center,3 the two SafeStart liaisons, the Support Line 2) established a Service Delivery Team coordinator, a representative from Child made up of point-of-service providers as the Protective Services, a domestic violence primary mechanism for service victim advocate, an adult probation officer, coordination, and 3) funded three clinician two to three behavioral health service positions (two full-time and one part-time). providers, and two child trauma and child development specialists. The team planned Family resource centers, and coordinated its responses to a child and conveniently located in different his/her family, ensuring that the child and family received all the support needed (e.g., 2 Family resource centers collaborate with local batterer intervention, treatment, parenting agencies and help many parents, families, and support, and/or shelter). Children exposed to children access information about early intervention violence could receive treatment from the services. Some of the FRCs operate as independent sites in community settings; others are based in behavioral health specialists in the family regional centers, local education agencies, public resource centers, SafeStart’s clinicians, other health facilities, or hospitals. One of the six clinicians available through the Department SafeStart-funded centers was not a family resource of Public Health Behavioral Health Services, center; it was a public health center that provides or the Child Trauma Research Project (a behavioral health services rather than family support approaches (case management, advocacy). This joint endeavor of the University of center, however, had the same contractual obligations California San Francisco’s Department of to SafeStart as the other true family support agencies; Psychiatry and the San Francisco General hence, it was treated just like a family resource Hospital). center. 3A senior staff person from each family resource center served on the Advisory Council, while the From the time of its establishment family advocates were involved in the Service through October 31, 2005, the SafeStart Delivery Team.

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Support Line received a total of 408 calls, was developed, police reports of domestic 262 of which were referred to SafeStart violence crimes were examined, and 238 services (San Francisco SafeStart Initiative, batterer intervention program participants 2005a). The Service Delivery Team served a were surveyed. A study of child welfare and total of 351 families and 702 children (Fox family court practices related to families & Mayer, 2005). experiencing domestic violence will be released in early 2006. The grantee used its Further, Service Delivery Team research findings to increase the awareness members were expected to attend the annual of service providers, advocates, SafeStart Academies and conferences to policymakers, and the wider community continuously improve their knowledge and about the magnitude of the problem, and to skills. They were offered opportunities to encourage them to identify and refer attend trainings outside of SafeStart; some children exposed to violence. members took advantage of these opportunities. Their specialized knowledge The San Francisco SafeStart helped made them consultants and trainers within promote the understanding that no single their home agencies for issues related to system or agency can adequately respond to children’s exposure to violence. By the end the needs of children exposed to violence. of 2005, they had provided over 169 hours Instead, a multi-system solution is required. of formal training to 990 people across their This solution, however, surfaces tensions home agencies (San Francisco SafeStart associated with differences in the way Initiative, 2005a). various disciplines and sectors respond to children and families (e.g., police, child To improve systems by promoting a protective services, domestic violence core set of values, beliefs, and practices for victim advocates). The racial, ethnic, and responding to young children exposed to cultural diversity of San Francisco also violence (goal #4), SafeStart’s staff, with require linguistic and cultural competence assistance from its partners, developed eight among services providers; there were few policies; a ninth policy was being developed professionals trained to help young children at the time of this case study. These policies, exposed to violence, and even fewer with developed and continuously refined by the the linguistic and cultural competency Service Delivery Team and Parent Team, necessary to help children from diverse were distributed to SafeStart partners and backgrounds. other agencies to guide their response to children exposed to violence and their In summary, SafeStart laid the families. SafeStart staff also created a foundation for changing systems to further manual, “Core Values, Practices, and Beliefs improve the support for young children for Responding to Children Exposed to exposed not only to domestic violence, but Violence,” which will be available on CD- possibly community violence, as well (the ROM in 2006. latter form violence, however, was not addressed to the same extent as domestic Finally, SafeStart helped generate violence). The future of the initiative was new knowledge about the characteristics of uncertain at the time of this report. young children in the city exposed to Decisions made in 2004 about sustainability violence, their families, and the response to were “being called into question” (San their needs. A database of over 500 cases Francisco SafeStart Initiative, 2005b).

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Nevertheless, federal and local funds will While children five years and continue to support the initiative until mid- younger make up a relatively small 2007. The Advisory Council and a subgroup percentage of San Francisco’s total of its members met several times in fall population (5.3% in 2004) compared to 2005 to develop a sustainability plan, which other Bay area cities, a study sponsored by was anticipated to be in place by the the San Francisco SafeStart found that 15% beginning of 2006. The clearest strategy at to 20% of children six years and younger are the time of this report was the dissemination exposed to violence every year (White & of the SafeStart model through the “Core Shields, 2003). Another study showed that Values, Practices, and Beliefs for 17,000 elementary school students could be Responding to Children Exposed to exposed to 600 crimes annually (Fox, Violence” manual. 2005a). The level of violence in San Francisco was at its peak in 2005, compared 1.1 Mission to the previous ten years (San Francisco SafeStart Initiative, 2005c). The mission of the San Francisco SafeStart, spearheaded by its Advisory Poverty also affects families and Council and located in the San Francisco children in San Francisco. Approximately Department of Children, Youth, and Their 7% of families and 13% of children ages 5 Families (DCYF), was to “change existing to 17 lived below the poverty level in 2003 systems to ensure that every child raised in (San Francisco SafeStart Initiative, 2005c). the city and county of San Francisco will The majority of these families and children live free from violence.” SafeStart’s goals were of African American, Latino, or Asian were to 1) increase effectiveness of services descent. by training point-of-service providers on how best to respond to children exposed to On the other hand, San Francisco has violence; 2) prevent childhood exposure to seen numerous initiatives and legislation violence by sensitizing the public to the intended to promote children’s well-being, issue; 3) reduce the impact of exposure by such as: providing early intervention and treatment; and 4) improve systems by promoting a core • The Children’s Fund4 and set of values, beliefs, and practices for California’s Proposition 10 funds;5 responding to young children exposed to • The Greenbook Initiative, a joint violence. SafeStart’s priority was to keep initiative of the U.S. Departments of families together (Fox & Mayer, 2005). 4 For every $100 of property tax, three cents are How did SafeStart accomplish this allocated to The Children’s Fund. The Fund, mission and with what success? What managed by the San Francisco Department of factors contributed to and impeded success? Children, Youth, and Their Families, provides support to organizations in the public, private, and These questions are addressed in the nonprofit sectors to develop innovative programs for following sections, and a timeline of major children and youth (Department of Children, Youth, events is attached (Exhibit VIII-A). and Their Families, 2003). 5 Also known as the California Children and Families First Act of 1998, this Proposition imposed an additional surtax of 50 cents per cigarette pack and 2. Contextual Conditions increased the tax on other tobacco products (cigars, chewing tobacco, pipe tobacco, etc.) by the equivalent of one dollar per pack.

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Justice and Health and Human In 2005, Mayor Gavin Newsom Services, designed to improve the considered establishing an Office of quality of services provided by local Violence Prevention to coordinate all jurisdictions to families threatened ongoing and related violence prevention by domestic violence or child efforts. More recently, in January 2006, a maltreatment or abuse, for which the law (AB 1179) was passed to fine retailers city and county of San Francisco are $1,000 for selling violent video games to one of six demonstration sites; minors. • The Children’s System of Care, intended to reform service delivery All of these initiatives created a systems for seriously emotionally favorable context in the city for promoting disturbed children to reduce their issues of children’s exposure to violence. out-of-home placement; None, however, conflicted or competed with • Starting Points Initiative, which the San Francisco SafeStart, according to the established the Early Childhood majority of SafeStart collaborative members Interagency Council to guide the (Association for the Study and Development development and implementation of of Community, 2005c). Instead, the San a citywide strategic plan to improve Francisco SafeStart grantee was able to use services for children five years and the existing momentum as a catalyst to younger; maintain and sharpen the focus on young • Safe Havens Supervised Visitation children exposed to violence. and Safe Exchange Initiative, housed in the Department of Children, Factors that helped connect the San Youth, and Their Families, which Francisco to other, related initiatives in the creates safe places for visitation with city and county included SafeStart’s location and exchange of child victims of in the Department of Children, Youth, and domestic violence, abuse, sexual Their Families (which leads initiatives in the assault, or stalking; city related to children); engagement of • Justice and Courage, a public/private various agency leaders (described in more collaborative to address detail in Section 5), and staff and recommendations made by the City collaborative members’ relationships (e.g., Attorney’s Office regarding the collaborative members who served on city’s domestic violence response advisory committees for other initiatives). systems (San Francisco SafeStart Initiative, 2005c); and • The Community Response Network, another collaborative led by the Department of Children, Youth, and Their Families, responsible for the development and implementation of a comprehensive community response to gang and youth violence in three neighborhoods (San Francisco SafeStart Initiative, 2005c).

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3. Community Capacity also few professionals trained to help this population, and even fewer with the Despite the many organizations and linguistic and cultural competency to serve initiatives focused on young children’s well- the racially and culturally diverse families in being, the community’s capacity to support San Francisco (Association for the Study young children exposed to violence was and Development of Community, 2005c). limited. SafeStart’s goals and strategies were intended to address these limitations. The San Francisco SafeStart began to fill the gap in knowledge and skills by Knowledge about children exposed offering extensive training on the impact of to violence and its impact. Prior to childhood exposure to violence to a wide SafeStart, San Francisco had few data on range of professionals. (See Section 6.2 for children exposed to violence, including further description of the trainings.) incidence, demographic characteristics, or nature of exposure. There were no legal Continuum of support and services requirements, procedures, or infrastructure for young children exposed to domestic for collecting such data (Fox & Mayer, violence and their families. The traditional 2005). Without such data, these children’s response to children exposed to violence and needs went undetected, and the public was their families was fragmented. Support not fully aware of the impact of their networks trusted by families (e.g., family exposure to violence. Consequently, resource centers, faith groups, teachers, programs and initiatives meant to support childcare providers) were not connected to exposed children and their families were mental health services and shelters capable likely inadequate in design. SafeStart of providing expert assistance. Criminal and addressed this limitation through a public family court orders sometimes conflicted. education campaign in 2004, and by Batterer intervention programs and domestic sponsoring several studies about children’s violence victim advocates focused on exposure to violence. different members of the family.

Knowledge and skills specifically Additionally, first-time domestic related to young children exposed to violence victims require different support violence. Many agencies and initiatives in from victims who experience such violence San Francisco are dedicated to ensuring regularly, according to point-of-service staff children’s well-being. Prior to SafeStart, who met with the National Evaluation Team however, none specialized in the impact of in 2004 and 2005. The former may be less childhood exposure to violence, with the ready to leave the batterer and go to a exception of the Child Trauma Research shelter; in such cases, counseling and other Project,6 which, alone, had limited capacity family support assistance may be the best to address the needs of all children exposed solution. On the other hand, a victim who is to violence in San Francisco. There were ready to move on and live an improved life without violence may need help transitioning into her/his new community 6 A joint endeavor of the University of California San and family. San Francisco’s systems were Francisco’s Department of Psychiatry and the San not prepared to provide the support Francisco General Hospital, the Child Trauma Research Project serves children six years and appropriate for victims at different stages of younger and their families who have been involved in domestic violence.

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readiness for change and in need of different helped the initiative generate and types of help. disseminate new knowledge about the impact of children’s exposure to violence, The San Francisco SafeStart grantee and to expand the number of local brought together different systems to professionals who knew about the issue. coordinate their response to children exposed to violence and their families As examples of local resources on through 1) a diverse Advisory Council made young children’s exposure to violence from up agency leaders and policymakers, 2) a which the initiative benefited: Service Delivery Team made up of point-of- service providers (described in more detail • The Child Trauma Research Project in Section 5.1), 3) hiring and placement of a training director (also an assistant SafeStart liaison in the police department clinical professor at the University of and family court, 4) contracting of family California San Francisco) provided resource centers7 (FRCs) and other ongoing case consultation to the providers (whose family advocates and initiative’s Service Delivery Team, mental health service providers were part of ensuring that the team’s point-of- the Service Delivery Team) to provide service providers learned about the family support and behavioral health impact of childhood exposure to services, and 4) establishment of a violence and how to respond to the designated telephone line for SafeStart- needs of exposed children and their related inquiries and referrals (“the Support families; Line”). These improvements (discussed in • Two local psychologists were detail in Sections 5 and 6) linked agencies engaged by SafeStart to conduct and services to one another to share trainings in 2005 on “vicarious information about service gaps, as well as trauma” (the negative effects on the status of particular cases. SafeStart staff service providers who work with also developed formal policies to encourage traumatized clients over time; less fragmented services and more uniform Shields, 2006); and responses to children exposed to violence • The Greater Bay Area Child Abuse across systems (see Section 6 for further Prevention Coalition and the San information about policies). Francisco Child Abuse Council/TALKLine partnered with SafeStart to conduct a presentation 4. Integrated Assistance about “Working with Sexually Aggressive Children and Their The San Francisco SafeStart grantee Families” in late 2005 (Shields, was able to garner local and national 2006). resources for a wide range of support, which Service Delivery Team members, who were consistent beneficiaries of the 7 Family resource centers collaborate with local above training and technical assistance, agencies and help many parents, families, and served, in turn, as consultants on the issue of children access information about early intervention children’s exposure to violence to other staff services. Some of the FRCs operate as independent sites in community settings; others are based in within their own agencies. regional centers, local education agencies, public health facilities, or hospitals.

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The SafeStart grantee also frequently from an accident, injury, or sudden shocking built on the expertise of professionals in one event). sector to teach those in another sector. For example, domestic violence sector representatives provided specialized 16-hour 5. Local Agency and training on domestic violence to the Service Community Engagement and Delivery Team, and batterer intervention Collaboration program representatives trained participants at a SafeStart Annual Academy about the psyche of a batterer. The San Francisco SafeStart collaborative was characterized by: With the availability of local • expertise in the area of early intervention Representation from a wide range of and treatment for young children exposed to sectors that serve families and violence, the San Francisco SafeStart children; • grantee was able to take advantage of A multi-level structure that enabled national technical assistance funded by the people in different agencies to stay Office of Juvenile Justice and Delinquency involved according to their positions Prevention for other areas of need, and functions within their respective particularly facilitation of meetings, agencies; • research, and dissemination of research A core group of committed members findings. who facilitated the initiative’s stability and progress, despite For instance, the National Civic changes in the political environment League facilitated a strategic planning and staff turnover; and • meeting for the initiative’s Advisory Continued efforts to engage more Council in 2003. The grantee also used agencies and organizations. national technical assistance funds to sponsor the SafeStart director’s presentation The initiative’s progress was further at two conferences in 2005 and the supported by staff members who had the development of a five-year capstone report capacity to educate, facilitate, manage, and about the initiative. An additional $52,000 administer all at the same time, as well as a was obtained through the national evaluation local evaluator who was able to provide to conduct studies of police reports of information to aid decision-making. domestic violence and the presence of children at the scene, as well as current child Like all other Safe Start grantees, the welfare and family court practices related to San Francisco SafeStart grantee encountered families experiencing domestic violence. philosophical differences in the way some agencies viewed victims and perpetrators of The San Francisco SafeStart grantee domestic violence, family relations, and also consulted the National Child Traumatic appropriate responses to children exposed to Stress Network and the National Center for violence and their families; these Posttraumatic Stress Disorder to develop its differences, however, did not impede the annual conference in 2005 on psychological initiative in any major way. first aid (i.e., knowledge and skills to assist people with emotional distress resulting 5.1 Representation from a Wide Range of Sectors

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rotating policy for judges, she was expected SafeStart’s collaborative involved to return as the Council’s chair in 2006 people from a broad range of sectors, when she becomes the supervising judge for including: child welfare, law enforcement, the Unified Family Court. Many Council family court, adult probation, domestic members reported that Judge Hitchens’ violence, batterer intervention, health and leadership brought credibility to SafeStart behavioral health, education, early childcare, (Association for the Study and Development youth development, and community-based of Community, 2005c). They also credited family support services. Representatives the SafeStart director for his ability to from six family resource centers (part of the engage influential people and retain their city’s community-based family support involvement, even though they perceived his services system) were also involved in the style to be somewhat confrontational on a collaborative; these centers served different few occasions. His knowledge of systems racial and ethnic groups. and how to navigate them were also cited as strengths (Association for the Study and 5.2 A Multi-Level Structure Development of Community, 2005c).

SafeStart’s structure allowed its After two years, Council members participants to have clear roles, provide found it increasingly difficult to have input, develop relationships, and influence extensive discussions about particular issues decisions in an organized and efficient and tasks, due to the large number of manner. members and their competing demands. To overcome this challenge, the Council’s role Oversight for planning, evolved to one of issuing final approval and implementation, and evaluation. A fairly endorsement of decisions. A Steering large and diverse Advisory Council made up Committee made up of nine self-nominated of approximately 28 to 31 agency people was established in 2002 to act as the representatives was established in 2000 to Council’s executive committee. Steering oversee the planning, implementation, and Committee members included the Advisory evaluation of the initiative. Council Council chairperson, along with members were typically people with representatives from the Department of influence in their agencies and, sometimes, Public Health Behavioral Health Services; across sectors, for example, agency directors Child Trauma Research Project; Department or knowledgeable persons to whom others of Children, Youth, and Their Families; listened (the Child Trauma Research Project Bayview-Hunters Point Family Resource training director, the clinical supervisor from Center; manalive (batterer intervention the Department of Public Health Behavioral program); a Parent Team member (see Health Services, etc.). SafeStart developed section on “Community Engagement” for a memoranda of understanding with the description of the Parent Team); and representatives’ agencies. The Honorable SafeStart staff. Donna Hitchens, presiding judge for the San Francisco Superior Court, chaired the Committees also were established to Advisory Council from the time of its enable a smaller group of members to focus inception. Although her term was briefly on specific topics. Some of these interrupted in 2005 when another judge committees were permanent (e.g., stepped into her position due to the city’s Evaluation Committee); others were

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temporary, based on need (e.g., Batterer’s professionals. The majority of the five Intervention Committee, Public Education people were engaged through family Committee, and Committee on resource centers. Sustainability). In 2004, the Parent Team applied for Service delivery. A collaborative of and received a small grant from the First 5 point-of-service providers was created in the Commission9 to develop a mentoring form of the Service Delivery Team. The program. Through this program, the Parent team included 12 providers whose positions Team trained eight domestic violence were funded by SafeStart,8 as well as survivors in communication, public representatives from Child Protective speaking, facilitation skills, and how to Services, adult probation, domestic violence support other survivors. The Parent Team agencies, Department of Public Health’s and the mentoring program was a step Community Behavioral Health Services, forward in involving people who have City College’s Department of Child experienced violence in a city-wide Development, and Child Trauma Research initiative. Project. Beginning in 2001, the Service Delivery Team met three times every month, The Parent Team, however, did not twice for case analysis and once for policy have a strategic and structured process for development and training. Section 6.2 identifying mentees (i.e., recent domestic describes in more detail the Service Delivery violence survivors in need of support) and Team’s function and accomplishments. The was not well integrated into other SafeStart Service Delivery Team and the Advisory program components. Only one mentor- Council were linked via the SafeStart staff mentee relationship was established, though person who facilitated the team’s meetings many more mentors were trained. and the Child Trauma Research Project representative. Further, senior staff from the In late 2005, it became apparent to agencies in which the 12 SafeStart-funded SafeStart staff that the Parent Team should providers were housed participated in the work more closely with the Service Delivery Advisory Council. Team, rather than the Advisory Council, because the former was better positioned to Community engagement. The San identify mentees due to its members’ Francisco SafeStart collaborative had frequent contact with victims. A Parent another unique feature: the Parent Team, Team leader will attend Service Delivery which functioned as an Advisory Council Team meetings in the future to better committee. This team, made up of five establish the connection. people who had experienced violence in their lives, ensured that SafeStart strategies 5.3 Stable Leadership from a Core were informed by the perspectives of Group of People families affected by violence, in addition to those of service providers and other

9 The First 5 Commission, guided by the San 8 The funded positions included one family advocate Francisco Children and Families Commission, is part in each of six family resource centers, one liaison in of a statewide movement to assist public agencies, the San Francisco Police Department, one liaison in non-profit organizations, and parent groups in the Unified Family Court, two full-time and one part- providing support for children five years and time clinicians, and the Support Line coordinator. younger.

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Representation from a wide range of sectors (see Section 5.1) was consistent, 5.4 Continued Effort to Engage even though representatives changed as a Agencies result of turnover in the participating agencies. A core group of people, however, The SafeStart grantee made was involved in SafeStart from its first or continued efforts to engage agencies that second year. This core group helped buffer were absent from the collaborative or did the impact of leadership and staff turnover not have a firm commitment. For instance, that affected the collaborative, to keep the in 2005, the San Francisco SafeStart staff initiative on track. engaged in initial dialogue with the director of the Lesbian, Gay, Bisexual, and The core group included the Transgender (LGBT) Center. This dialogue Advisory Council chairperson (Judge Donna grew out of the SafeStart Cultural Hitchens), leaders from the domestic Competence Committee10 recommendation violence sector, several family resource that SafeStart reach out to the gay, lesbian, center directors, the Department of Public bisexual, transgender, and queer community, Health’s Behavioral Health Services which was not immune to domestic representative, the current SafeStart staff violence. The Children of Lesbians and members, and the local evaluator (San Gays Everywhere (COLAGE), Our Family Francisco SafeStart Initiative, 2002; San Coalition, and the San Francisco LGBT Francisco SafeStart Initiative, 2003a). Their Community Center presented information on early and steadfast involvement was key to how to work with same-gender families to the initiative’s progress during times of the Service Delivery Team in 2005. uncertainty. According to a few collaborative members interviewed by the National Evaluation For example, the director position at Team during a site visit in December 2005, the Department of Children, Youth, and engagement of LGBT families would be Their Families (lead agency for SafeStart) difficult, because these families already have changed three times during SafeStart’s life. their own support system. During the first turnover in 2001, the Although an adult probation officer department’s deputy director (who remained participated in the SafeStart collaborative, involved with SafeStart until 2004) and a the Adult Probation Department and senior analyst provided interim leadership to SafeStart did not initially have a SafeStart (San Francisco SafeStart Initiative, memorandum of agreement, primarily 2002). The senior analyst also used her because the chief probation officer was not evaluation knowledge to help identify and willing to sign one. When a new chief was select a new local evaluator after the hired, however, he immediately signed a previous evaluator resigned from the memorandum of agreement between initiative in 2001. During that same year, the SafeStart and the department, allowing SafeStart director resigned, and a new SafeStart family advocates in participating director was hired in December 2001. Had it not been for the commitment and steadfast involvement of DCYF staff and other 10 Because of the city and county’s diverse partners who stepped in to provide population, cultural competence issues were raised in the Advisory Council. As a result, an ad hoc continuity, these staff changes could have committee was established in 2004 to strengthen the diverted the initiative. initiative’s response to the city and county’s growing diversity.

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family resource centers access to probation SafeStart was no longer a priority in 2005, information on adults in SafeStart client because 1) it was considered possibly too families. late in the process to involve them, and 2) information about SafeStart had been Other new engagement in 2005 distributed widely enough that staff was now included: busy responding to inquiries for help, and no longer had the capacity for more outreach. • The involvement of a YMCA representative on the Advisory 5.5 Differences in Philosophical Council, as a result of the Boys and Orientations Toward Helping Girls Club’s withdrawal from the Children Exposed to Violence Council because it could no longer and Their Families commit the staff time needed for participation; and The relationship between SafeStart • A non-SafeStart service provider on and the domestic violence sector was the Service Delivery Team for the especially challenging, though not a major first time. SafeStart goals were impediment, throughout the initiative’s included in this local service lifespan. Domestic violence sector leaders provider’s grant application to the contended that SafeStart’s leadership did not First 5 Commission in 2005. The acknowledge or support the sector’s long- grant was awarded, and the local established infrastructure for women and service provider was invited to children exposed to violence. (Note, participate in the initiative. however, that the original needs assessment conducted by SafeStart showed that the The SafeStart grantee continued to majority of domestic violence agencies did enjoy a cooperative relationship with the not have “any systematic or consistent way” school district, providing trainings to child for training it’s staff on issues of children’s development program site managers, school exposure to violence and its impact. This health program staff, teachers, and parents. finding suggested that the existing domestic The SafeStart director was an active violence infrastructure for children exposed participant in the Citywide School Health to violence was insufficient (San Francisco Committee (Fox, 2005b). In 2005, the Safe Start Initiative, 2000, p. 18). Domestic director received requests from over ten violence leaders believed that, instead of schools for assistance in responding to building upon and strengthening this young children exposed to violence. existing infrastructure, SafeStart opted to create new services and entry points by Faith and grassroots (e.g., funding family resource centers and several neighborhood association) groups were not other providers to assist domestic violence involved in SafeStart; however, grassroots victims. linkages were possible through SafeStart’s relationship with the family resource From the SafeStart leadership centers. In 2005, SafeStart staff did attempt perspective, the source of the tension was to develop a relationship with the San ideological differences between SafeStart Francisco Organizing Project at Bethel and the domestic violence sector with regard Baptist Church. Overall, however, outreach to approaches to dealing with families to these un- or under- represented groups in experiencing violence. According to SafeStart leadership, leaders in the domestic

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violence sector did not support SafeStart’s • Existing demographic information about decision to use multiple means to approach children and families who reside in the the problem, including batterer intervention. city and county of San Francisco.

Several SafeStart partners The SafeStart grantee also collected its own acknowledged the tension between SafeStart data about children's exposure to violence to and the domestic violence sector; at the supplement the existing information. During same time, they indicated that this tension the planning phase, the initiative's first did not prevent anyone in the domestic evaluator collaborated with local agencies to violence sector from participating in the plan and conduct 15 focus groups with a Advisory Council. The SafeStart grantee variety of stakeholders, including teen continuously worked to engage the domestic parents, youth who had witnessed violence, violence community and acknowledged the individuals involved in substance abuse views of domestic violence representatives services, public housing residents, and in the context of Advisory Council parents and service providers of African discussions and decisions. Some partners American, Asian/Pacific Islander, and added that the estrangement between Latino descent. Additionally, 22 key members of the domestic violence sector informant interviews with service providers, and those associated with other family and community leaders, and agency directors child services was present prior to SafeStart. were conducted. In 2003 after This was not unusual; in fact, many other implementation began, the SafeStart grantee Safe Start demonstration sites reported conducted a survey of parents to examine similar tensions within their community and their readiness to discuss the impact of collaborative because of existing stereotypes exposure to violence on their young and distrust among leaders of the domestic children. violence prevention sector vs. leaders in the family and child services sector. The SafeStart grantee used information such as that provided by the above agencies, as well as its own data collection efforts, the 6. System Change Activities local evaluator's semi-annual reports, and the study on police reports of domestic 6.1 Community Assessment and violence crimes to inform its initial and Planning subsequent strategic planning meetings. A committee was established to deliberately The San Francisco SafeStart grantee built on ensure the use of data in planning and existing efforts to obtain information about strategy improvement (i.e., the evaluation services available to children and families, committee) and its role remained prominent including: throughout the initiative's lifespan.

• A needs assessment of children and families every other year by the 6.2 Community Action and Department of Children, Youth, and Awareness Their Families; • An annual survey of public services by The San Francisco SafeStart raised the city controller's office; and awareness at three levels: public,

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professionals who work with children and The SafeStart Academy and families, and policymakers. conference trainings covered topics such Raising the public’s awareness. In vicarious trauma, psychological aid, January 2004, the SafeStart grantee developmental disabilities, child support launched a public education campaign with enforcement, and domestic violence. In the theme, “You’re Not Just Hitting Her— some cases, experts within one field trained Domestic Violence Hurts Children Too.” providers in another field. For example, at The campaign distributed 30,000 flyers to SafeStart’s annual conference in 2004, every elementary school, child development batterer intervention program staff trained program, and Head Start program in the city; domestic violence advocates, while a placed graphics inside 300 buses, on the rear facilitator from the Child Trauma Research of 50 buses, and on 30 bus shelters; made Project trained batterer intervention program public service announcements on SFGTV, staff. In total, approximately 700 people AccessSF, and six AM and FM radio attended the Academies and conferences stations; and conducted a television (Association for the Study and Development interview. of Community, 2005c; A. Fox, personal communication, March 14, 2006; San In addition, the campaign received Francisco SafeStart Initiative, 2004; San coverage on four television stations and five Francisco SafeStart Initiative, 2005a).11 radio stations, and in four newspapers: San Francisco Observer, San Francisco Bay Specialized trainings that covered View, El Mensajero, and Sing Tao Daily. All related topics such as transitional housing campaign materials publicized the telephone for victims of domestic violence and the number for the SafeStart Support Line (see neurodevelopmental impact of child Section 6.4 for further explanation about the maltreatment were offered to SafeStart’s Support Line). The campaign increased the Service Delivery Team members12 and staff visibility of San Francisco SafeStart and of partner agencies. SafeStart also provided enabled several organizations, including two training through smaller, separate events organizations that were not members of the when requested. For example, in 2002, a Advisory Council (Saint Francis Memorial total of 111 people from different agencies, Hospital and California Attorney General’s including the school district, were trained. Office), to demonstrate their commitment to children exposed to violence by contributing Service Delivery Team members, in funds to the campaign. turn, provided a total of 169 hours of formal training to 990 people, as consultants within Raising the awareness, knowledge, their home agencies. and skills of professionals who work with children and families. The San Francisco Raising the awareness of SafeStart helped professionals who work policymakers. SafeStart Advisory Council with children and families better understand issues related to exposure to violence 11 The trainings in 2004 serendipitously coincided through three annual SafeStart Academies with a new mandate for mental health professionals and three annual conferences, as well as to be trained in spousal and partner abuse, which may other specialized trainings. have contributed to the high participation levels in that year. 12 Over 50 training opportunities were offered (SafeStart did not track the extent to which the members took advantage of the opportunities).

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members helped to educate 13 elected Service Delivery Team. Beginning with its officials on issues related to childhood inception in 2001, the Team met three times exposure to violence and the need for a each month, twice for case analysis and once public policy response. In 2004, a member for policy development and training. Team of the city’s Board of Supervisors granted members discussed cases without disclosing the SafeStart director’s request for a hearing client names, a confidentiality policy on how trauma impacts a child’s brain established by SafeStart in compliance with (Association for the Study and Development state laws. Dr. Patricia Van Horn from the of Community, 2005c). Child Trauma Research Project provided clinical assistance during case analysis. While SafeStart’s public education Together, Service Delivery Team members and awareness raising efforts were not planned the best response to a child and evaluated formally, anecdotal information his/her family and considered what each from SafeStart partners suggests that the department could do with the family to above activities and events directly or maximize support for the child and his/her indirectly contributed to 1) public awareness family. of family violence and children exposed to violence, 2) public knowledge of available Service Delivery Team members resources and professional services, and 3) participated in the annual SafeStart visibility of children’s exposure to violence Academies and conferences, and also were as an acceptable subject of discussion. This offered over 50 specialized trainings. is evident from incidents such as: Trainings were offered repeatedly and regularly because of staff turnover. • An article by the San Francisco According to SafeStart staff and Service Chronicle about infant mental health Delivery Team members interviewed by the in 2004; National Evaluation Team in 2004 and • Over ten inquiries to SafeStart from 2005, the majority of team members found schools, for assistance in responding the trainings useful, despite their repetition. to young children exposed to violence in 2005; The Service Delivery Team: • A call from a faith leader to the SafeStart police liaison about a • Offered service providers a safe way particular case; to seek advice from each other about • A fundraiser by Kate Spade a family’s situation, and to (designer of women’s accessories) understand how each agency in the for children exposed to violence; and system might respond (e.g., family • An increased number in “show of resource center staff found it very hands” among training participants helpful to hear directly from the who claimed to know something police liaison how the police would about the impact of exposure to respond to a specific situation, violence on young children. making it possible for them to explain these procedures to clients); 6.3 Service Integration and • Enabled staff from different agencies Service integration as a result of to develop relationships with each SafeStart occurred primarily through the other and become allies with a

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shared commitment to supporting clinicians to serve families referred to families (e.g., when a point-of- SafeStart. service provider needed to review a case and no family advocate or Initially, SafeStart focused on six supervisor was available, she felt neighborhoods with high rates of violence; comfortable calling the Child only residents from these neighborhoods Protective Services director for were eligible for SafeStart services. The consultation). neighborhoods were the Western Addition, Chinatown, Mission, Bayview-Hunter’s The Service Delivery Team also Point, Visitacion Valley, and Ocean View- promoted understanding across professional Merced Heights-Ingleside (OMI). The cultures by providing a setting in which majority of family resource centers were providers from different agencies and located in these neighborhoods. sectors were required to interact with each other (e.g., family advocates had to interact In late 2004, the Advisory Council and deal with batterer intervention program decided to remove this eligibility criterion to advocates, and behavioral health clinicians 1) diminish the perception that some had to understand what sort of information neighborhoods, particularly low-income and family court personnel need). ethnic neighborhoods, were “problem” areas; 2) allow access to low-income and 6.4 New, Enhanced, and culturally diverse families who did not live Expanded Programming in these neighborhoods, but were in need of services; and 3) diminish the perception that SafeStart’s priority was to keep middle- and higher-income White families families together; hence, it used a family- outside of the above neighborhoods do not centered approach in which all family experience domestic violence. members, including the perpetrator and adult and child victims, received help with the Family advocates dedicated to intent of staying as a family unit to the assisting children exposed to violence and extent possible. their families. SafeStart built on and expanded the capacities of six family SafeStart did the following to resource centers by funding a family provide early intervention and treatment to advocate dedicated to addressing the impact reduce the impact of exposure: 1) funded of childhood exposure to violence at each family advocate positions in six family center. Family advocates, who received resource centers to help identify, assess, and extensive training on issues related to treat children exposed to violence and their children’s exposure to violence, enabled families; 2) funded two liaisons (one in the centers to provide proper support to children police department and one in family court) and their families. They also served as to help identify and refer children exposed consultants to other center staff who came to violence and their families, and to provide into contact with children exposed to information about the status of cases; 3) violence and their families. One family established the SafeStart Support Line to resource center (Instituto Familiar de la handle callers and make referrals; and 4) Raza, see below) used SafeStart funds not funded two full-time and one part-time only for a family advocate, but also to hire a clinician accessible to all SafeStart families.

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The six family resource centers received $10,000 less. Three centers and one included Asian Perinatal Associates, center earned an increment and decrement, Bayview-Hunters Point Family Resource respectively (A. Fox, personal Center, Instituto Familiar de la Raza, Urban communication, March 26, 2006). Services YMCA, Homeless Prenatal Program, and Living in a Nonviolent SafeStart police and family court Community (LINC).13 These centers, liaisons. The initiative funded a police located in neighborhoods throughout the liaison in the San Francisco Police city, provide parent-to-parent support, peer Department’s Domestic Violence Response counseling and home visits, information and Unit. This person was responsible for referral, parent education, and support reviewing police reports of domestic services in different languages. The centers violence cases, to ensure that police officers have staff members who share cultural completed all information correctly. If characteristics with the families in the reports were inadequate, the liaison followed neighborhood; hence, families are more up with the officer(s) and the unit’s likely to go to the centers than to a mental commander. He also communicated each health clinic for help. All but the Bayview- case to a family advocate and referred the Hunters Point Family Resource Center have victim to SafeStart services, as well as the capacity to provide behavioral health conducting police roll-call training on issues services; the family advocate at this center related to children exposed to violence. This referred families to other centers or to the position, created in 2002, lapsed into a SafeStart clinicians. hiatus status after the first liaison resigned in 2003. The position was not refilled until The centers were selected through a June 2004, after the police department competitive process, based on their response underwent a leadership transition due to to a SafeStart request-for-proposal. Mayor Newsom’s election. After the hiring Performance measures were based on of the new liaison in 2004, police reporting several indicators, including the number of of domestic violence incidents and presence families served and compliance with of children improved (Association for the SafeStart policies. SafeStart established a Study and Development of Community, “bonus plan” to encourage the centers to 2005c). serve as many families as possible. According to this plan, centers that exceeded SafeStart also funded a family court a minimum number of families served liaison, who was hired as a contractor in during their first six months received a 2002 and became a full-time employee of $10,000 increment in funding for the next San Francisco Superior Court in 2003. This fiscal year. On the other hand, centers that liaison informed the Service Delivery Team served fewer families than the minimum of the status of SafeStart families in the court system. She also reviewed cases and

13 LINC is not a family resource center; it is a public identified and referred children exposed to health center associated with the University of violence to a family advocate and SafeStart California and the National Center of Excellence in services. Women's Health. LINC focuses more on public health approaches (cognitive-behavioral, therapeutic, SafeStart Support Line. The psycho-educational), rather than family support approaches (case management, advocacy). For SafeStart Support Line (415-565-SAVE) purposes of SafeStart, however, LINC was treated as began operating in November 2002; by a family resource center.

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2003, agencies were receiving referrals through the first six entry points were through the Support Line. Also in 2003, the referred to a family advocate at one of the Support Line coordinator position family resource centers, depending on the transitioned from WOMAN, Inc., to the person’s preference, cultural background TalkLine Family Resource Center. Calls to and language, location of residence, and the Support Line could be accepted by any type of need. trained counselor anywhere with a telephone and an Internet connection. The counselor The adult and/or child victim who answered the call entered the caller’s participated in an intake process with a information into the Internet system, SafeStart family advocate at the family generating an email alert to the family resource center. The family advocate also advocate to whom the referral was made. typically assisted the victim in making a The family advocate downloaded the police report and obtaining a restraining referral and contacted the caller. The line order, accompanied the victim to a shelter, was publicized through brochures, referral and developed a safety plan for the family. cards, Child Protective Services, and other The family, including the child, received public education campaign materials. The family support services from the advocate Support Line coordinator monitored the and the family resource center.14 All but one system and provided assistance in family resource center also had the capacity developing a follow-up plan for callers when to provide behavioral health services. This requested. one center referred to a behavioral health service provider at another location Clinicians. SafeStart funded two convenient to the victim. full-time clinicians and one part-time clinician; two of the three were housed in Through the SafeStart Advisory family resource centers and one in a satellite Council, batterer intervention and shelter location for the Department of Public Health assistance also were available to families. Community Behavioral Health Services. Several family advocates reported that they Along with the behavioral health service often referred victims to a shelter if they providers in five of the six family resource believed the victim and child were in centers and other clinicians employed by the danger. Department of Pubic Health Community Behavioral Health Services, these SafeStart The family advocate at each family clinicians were available to help SafeStart resource center determined the type and families. In 2005, both full-time clinicians level of need based on the intake resigned; by the end of 2005, their positions assessment. Often, the family resource had not been filled. center could address all needs through its menu of services (e.g., housing, Process for identifying, referring, employment, counseling, and parenting skill assessing, and treating children exposed to development). violence. Adult and/or child victims of domestic violence were identified through Clinical intervention could be the SafeStart Support Line, the police provided by: department, family court, the Parent Team,

Child Protective Services, schools, and 14 All family resource centers except for LINC had family resource centers. Those identified the capacity to provide such support services, including parenting classes and counseling services.

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general public could look for • The family resource center’s assistance; behavioral health specialist; • Pooling of knowledge, skills, • SafeStart’s clinicians; or resources, and relationships across • Child Trauma Research Project, if systems and at multiple levels the case was severe. (policy and point-of-service).

The family advocate also had the 6.5 Development of Policies, option of seeking assistance from the Procedures, And Protocols Service Delivery Team, if necessary. The San Francisco SafeStart staff The majority of children were and partners developed and distributed eight identified through family resource centers policies to guide the response of agencies to and the Support Line. Between November 1, young children exposed to violence. The 2003, and October 31, 2005, the Support policies embody Line responded to 408 calls and referred 262 callers to SafeStart services; family resource centers provided services to 185 families and 367 children (Shields, 2006). The entire Service Delivery Team, which included the family advocates, SafeStart liaisons, Support Line coordinator, and SafeStart clinicians, served a total of 351 families and 702 children over the lifetime of the initiative (Fox & Mayer, 2005).

Exhibit VIII-B illustrates the path developed by the SafeStart grantee for identifying, referring, assessing, and treating children exposed to violence and their families. The strengths of the service pathway lie in the following features:

• Better coordination of service providers and agencies that respond to children exposed to violence and their families; • Closer working relationships between family advocates and the police and family court, which made it easier to retrieve information and track cases, as well as help families navigate systems; • A core team of people dedicated to children exposed to violence to whom other professionals and the

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SafeStart’s core values, practices, and information on how the parent or parents beliefs. They include: could assist their children) and to schedule an appointment to take place within 48 • Policy 1: Victim Services hours. • Policy 2: Developmental Disabilities • Policy 3: Consent & Confidentiality Monitoring of the family advocates’ • Policy 4: Standards of Care performance by the local evaluator indicated • Policy 5: Family Support Practices compliance with SafeStart procedures, • Policy 6: Child Abuse and Neglect including timeliness in their follow-up with • Policy 7: Domestic Violence (under families and creation of case management development) plans (Shields, 2006). • Policy 8: Batterer’s Intervention 6.6 Development, Identification, A ninth policy, on early childhood and Allocation of Resources behavioral health, was being developed at the time of writing this report. Throughout Through the Department of Children, the course of the initiative, the Advisory Youth, and Their Families, the Mayor’s Council and Service Delivery Team Office contributed $500,000 each year to the regularly reviewed and re-approved each San Francisco SafeStart for three successive policy, to ensure that all policies remained years: 2004, 2005, and 2006. Between 2000 up-to-date. and 2003, the Children’s Fund contributed $325,000 to the initiative. In addition to SafeStart staff encouraged its these contributions, the SafeStart grantee partners and other agencies working with leveraged about $135,000 ($120,000 from families and children to adopt these policies. the Department of Children, Youth, and According to the local evaluator, a total of Their Families; and the remaining $15,000 35 agencies adopted the policies in 2004. from Advisory Council members, Saint SafeStart staff and local evaluator did not Francis Memorial Hospital, and the monitor the extent to which policy adoption California Attorney General’s Office) for its and implementation actually occurred public education campaign. (Association for the Study and Development of Community, 2005c). SafeStart Advisory Council members also contributed an extensive amount of SafeStart increased family access to time, in-kind support, and meeting space. services through a policy that required family advocates to respond to requests for help within two days. If a child had been 7. Institutionalization of harmed in any way, the family was asked to Change go directly to the Child Trauma Research

Project at the San Francisco General Changes were institutionalized at Hospital or to the Department of Behavioral different levels and to varying degrees, as Health Services’ Child Crisis Center for described below. immediate assistance. The clinician to whom the family was then referred was required to 7.1 System-wide and Agency respond within 24 hours. The clinician was Changes expected to provide parenting support (i.e.,

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The initiative changed the way incidents improved significantly. The police young children exposed to violence were officers were not only more diligent about identified, assessed, and treated by: submitting the required forms, the forms were generally more completed (Shields, • Bringing together representatives 2006). from different systems that interact with young children and their The Department of Public Health’s families to review related policies, Community Behavioral Health Services procedures, and practices (i.e., reorganized their clinical assessment through the Advisory Council), and procedures to include assessment of to coordinate the assistance provided exposure to domestic violence as an to children and their families (i.e., additional determinant for the level of through the Service Delivery Team); mental health services required. • Enabling agency partners to view themselves as part of a support The recent studies on 1) police system for children exposed to reports of domestic violence and 2) family violence and their families, to follow court and child welfare practices are standard procedures for referring anticipated to effect systems change in the clients to the next level of assistance upcoming year by identifying gaps in the (e.g., from the Support Line system. Directors of the respective agencies coordinator to a family advocate to a will have an opportunity to consider clinician), and to share confidential strategies for filling the gaps. case information; and • Institutionalizing knowledge about The above changes, in turn, had an the impact of exposure to violence impact on the point-of-service providers on young children through the who participated in the SafeStart SafeStart Academies and annual collaborative. conferences and the exchange of information among Service Delivery 7.2 Within Point-of-Service Team members, as indicated by all Providers the collaborative members and point- of-service providers who met with Family resource center staff the National Evaluation Team in developed the capacity to identify and 2004 and 2005. respond to the needs of children exposed to violence because of a dedicated staff person Further, San Francisco Police trained in related issues (i.e., the family Department officers began to document the advocate). As SafeStart partners, these number of children present during a centers expanded their historical support for domestic violence incident, along with their families experiencing violence by ages and names, and to provide the victim developing a special focus on exposed with SafeStart information. The SafeStart children six years and younger and their police liaison then reviewed officers’ reports families. At the same time, however, these and followed up with families, as well. centers experienced frequent staff turnover, Between 2003 and 2005, SafeStart's local causing periodic gaps in service provision evaluator found that police officers' for children exposed to violence and their documentation of domestic violence families. The service gaps were filled once

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positions were refilled, and the new staff the issue. Another campaign will be person attended SafeStart training. Such implemented in April 2006. turnover was certainly challenging for the centers; on the other hand, several collaborative members believed that 8. Increased Community outgoing staff people were able to apply Supports SafeStart knowledge and skills in their new jobs. SafeStart resulted in a community support system for children exposed to Some organizations were more violence and their families. This system willing to work with people with whom they consisted of professionals, family advocates, typically had not worked in the past, as a and people who had experienced violence, result of the collaboration promoted by including the Parent Team, Service Delivery SafeStart. For example, WOMAN, Inc. and Team, and all the agency leaders and staff other domestic violence advocacy groups participating in SafeStart’s Advisory were more willing to train men to deal with Council. Families that received support from domestic violence. the Service Delivery Team were satisfied with the quality of services and believed that 7.3 Community their children were safer due to SafeStart. The families also reported that staff The San Francisco SafeStart created members were sensitive to their cultural a community of service providers and background (religion, language, race, etc.), professionals knowledgeable about issues treated them with respect, and kept their related to children exposed to violence and personal information confidential. In skilled in identifying and responding to addition, the family resource centers were these children. Between 1,000 and 1,500 conveniently located (Shields, 2006; White people attended SafeStart trainings or were & Shields, 2005). trained by SafeStart’s Service Delivery Team, as mentioned in Section 6.2. Post- The Parent Team received and used a training evaluations of SafeStart Academies $5,000 grant from the First 5 Commission to and annual conferences showed that service develop a parent-to-parent mentoring providers were more aware of the impact of program. The mentoring program was violence on young children and believed that established in response to a lack of support they were able to provide more informed for people who were transitioning back into services, including referrals to high-quality their family and community after a crisis. assistance for children and their families The first program activity occurred in (White & Shields, 2005). October 2004; seven new parent mentors attended and were trained on mentoring and The larger community in the city and on issues related to children and violence in county of San Francisco also gained in their communities. awareness of the impact of violence on young children. This was evident through In November 2005, SafeStart staff the increased number of inquiries that and partners developed a manual of the SafeStart staff received in 2005, particularly initiative’s materials, to disseminate the from schools. The 2004 public education SafeStart model, beliefs, values, and guiding campaign helped increase the visibility of principles to the larger community. Over

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500 copies of this document were printed, and distribution began at the end of 2005 Further, the SafeStart local (Shields, 2006). evaluator’s examination of police reports indicated that the number of calls from families rose steadily in 2004 and 2005. This 9. Reduced Exposure to might indicate decreased tolerance for Violence domestic violence, which is a pre-condition to reduced violence and hence, reduced The San Francisco SafeStart local children’s exposure to violence. According evaluator collected data about satisfaction of to some police personnel, this trend may families who used SafeStart services and reverse in 2006, as families begin to realize child and family outcomes among SafeStart the harm of exposure to violence on their service recipients. Consent was obtained children, perhaps because of SafeStart and from families at the beginning of services, other efforts to increase public awareness of before any data were collected. the issue (Shields, 2006). On the other hand, the SafeStart It was difficult for the local evaluator local evaluator also found that as domestic to collect uniform data for the client violence calls and arrest rates increased satisfaction survey, Child Behavior during 2005, the number of formal Checklist (CBCL), and behavioral health investigations of reported incidents tracking form, as turnover of family decreased, undermining the criminal advocates required ongoing training and prosecution of offenders. This pattern could technical assistance to orient new staff to affect the confidence of victims and recording these data. In 2005, a new advocates in the law enforcement system's electronic form-based system was created, ability to protect the former and their requiring family advocates to “catch up” children. This finding reinforces the need for with their data entry. This hindered the local a more coordinated response to domestic evaluator’s ability to obtain and report on violence victims and their children that client characteristics and outcomes in a emphasizes prevention and longer-term timely manner (Shields, 2006). support, and not just crisis intervention (Shields, 2006). The results reported in this section and the next reflect preliminary findings. 10. Reduced Impact of The final findings and analysis are expected Exposure to Violence in October 2006. With regard to reduced impact of Families who used SafeStart services exposure to violence, all 55 families who were asked to complete a client satisfaction completed a questionnaire agreed that their questionnaire upon termination of services. child felt better emotionally, could better Of the 172 clients who consented to handle daily activities, and got along better participating in this survey, 55 returned with family and friends. completed questionnaires (response rate, 32%). Preliminary survey findings showed In addition to the client satisfaction that 94% of the respondents felt safer, and survey, data were collected via the Child 92% agreed that their children felt safer Behavior Checklist, administered by the (ETR Associates, 2006). family advocate at intake for each child aged

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18 months to five years who received SafeStart services. The behavioral health The above accomplishments service provider administered a second expanded and improved the support system CBCL at the end of services. A total of 84 for children exposed to violence and their CBCLs had been completed by the end of families. The extent to which SafeStart 2005. SafeStart also developed a behavioral reduced children’s exposure to violence and health tracking form, which was the impact of the exposure, however, implemented in early 2005. This form remains undetermined until final analysis of tracked treatment dosage and changes in findings in October 2006. Preliminary behavioral health for all children who finding have been positive thus far. received SafeStart behavioral health services (San Francisco SafeStart Initiative, 2005c). The Advisory Council and SafeStart Analysis of family and child outcomes based staff’s leadership played a critical role in on CBCLs and behavioral health tracking SafeStart’s progress and success. Their forms will be completed in October 2006. commitment, stable participation, credibility, and influence enabled them to overcome the challenges posed by external 11. Conclusion changes and organizational differences among partners. The collaborative’s formal The San Francisco SafeStart structure also ensured a clear and systematic accomplished the following: process for engaging partners, reviewing information, and making decisions. The • Generated increased knowledge of majority of agencies remained committed to the characteristics of children SafeStart throughout its lifespan, even exposed to violence and their needs; though some agency representatives • Established a community of agency changed. leaders, professionals, policymakers, and domestic violence survivors SafeStart’s future remained uncertain knowledgeable and skilled in at the time of this report. The values and responding to and assisting children principles of SafeStart may be sustained exposed to violence and their through the involvement of its staff and families; Advisory Council members in other efforts, • Promoted information exchange and the infusion of what they learned from across disciplines and sectors, the initiative into these efforts. For instance, resulting in more comprehensive SafeStart staff and some Advisory Council knowledge of issues related to members were involved in 1) redesigning childhood exposure to violence; the child welfare system; 2) the San • Built on an existing infrastructure of Francisco Family Support Network; 3) family support services and created a implementation of the Mental Health service pathway for identifying, Services Act; and 4) two initiative-driven referring, assessing, and serving efforts to develop an in-class, post-crisis children exposed to violence and response to children six years and younger their children; and exposed to community violence, and to • Developed and distributed policies to improve cultural competency of services for guide agency responses to this same-gender couples with children exposed particular population.

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to violence (San Francisco SafeStart certificates and divorce filings to provide Initiative, 2005b). stable, permanent, local funding for the The Advisory Council met in May initiative’s family support intervention. The 2005 (27 of its members and over 20 Service San Francisco SafeStart Progress Report Delivery Team members attended) to ending July 31, 2005, however, indicated discuss the initiative’s future. A committee uncertainty among Advisory Council on sustainability was established and met members about the initiative’s future three times in the fall of 2005 to develop direction, including whether or not it was recommendations for the initiative’s future. sustainable and should continue to be The Advisory Council approved proposed located in the Department of Children, legislation to increase fees on birth Youth, and Their Families.

12. References

Association for the Study and Development of Community (2005a). Site visit report: San Francisco SafeStart Initiative January-December, 2004. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2005c). Case study: San Francisco SafeStart Initiative 2004. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2006). Site visit report: San Francisco SafeStart Initiative January 1 through December 30, 2005. Gaithersburg, MD: Author.

Department of Children, Youth, and Their Families (2003). Children’s Services Allocation Plan. (Public draft) San Francisco, CA: Author.

ETR Associates (2006, February 28). San Francisco SafeStart Client Satisfaction Survey Results Summary. San Francisco, CA: Author.

Fox, A.S. (2005a, February 2). Analysis of Data on Violence Incidents in the Vicinity of SFUSD Elementary Schools (Unpublished memo). San Francisco, CA: SafeStart Initiative.

Fox, A.S. (2005b, September 7). Memorandum on recommendations from semi-annual evaluation report. San Francisco, CA: SafeStart Initiative.

San Francisco Safe Start Initiative (2000). San Francisco Safe Start community assessment. San Francisco, CA: Author.

San Francisco SafeStart Initiative (2002). San Francisco SafeStart progress report phase II implementation. San Francisco, CA: Author.

San Francisco SafeStart Initiative (2003a). San Francisco SafeStart progress report implementation year 2: July 1, 2005-December 31, 2002. San Francisco, CA: Author.

Association for the Study and Development of Community 194 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

San Francisco SafeStart Initiative (2003b). San Francisco SafeStart Strategic Plan. San Francisco, CA: Author. San Francisco SafeStart Initiative (2004). San Francisco SafeStart progress report implementation year 4: January 1, 2005-June 30, 2004. San Francisco, CA: Author.

San Francisco SafeStart Initiative (2005a). Strategic goals, objectives, tasks, and performance. San Francisco, CA: Author.

San Francisco SafeStart Initiative (2005b). San Francisco SafeStart progress report implementation year 5: January 1, 2005-June 30, 2005. San Francisco, CA: Author.

San Francisco SafeStart Initiative (2005c). Local evaluation report form. San Francisco, CA: Author (Available from the Association for the Study and Development of Community).

Shields, J. (2006). San Francisco SafeStart Initiative annual evaluation report (reporting period: April, 2005 to March, 2006). San Francisco, CA: ETR Associates.

White, R. & Shields, J. (2003). Police Reports of Children’s Exposure to Domestic Violence in San Francisco. San Francisco, CA: ETR Associates.

White, R. & Shields, J. (2005). San Francisco SafeStart Initiative: Semi-annual evaluation report (reporting period: October, 2004 to March, 2005). San Francisco, CA: ETR Associates.

Association for the Study and Development of Community 195 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Exhibit VIII-A Timeline of San Francisco Safe Start Initiative Activities and Milestones

Major Milestone 7/01-12/01 1/02-6/02 7/02-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05

SafeStart Advisory Council (formed & ongoing) Steering Committee (formed & ongoing) Parent Team (formed & ongoing ) • Parent Team Parent-to-Parent Mentoring Program Safe Start Service Delivery Team trainings Safe Start Advisory Council retreats SafeStart Domestic Violence Referral & Support Line, 415-565-SAVE (established & ongoing) • Support Line Guidebook developed and published • Support Line Coordinator

position filled • TALK Line Family Resource Center chosen as the new service provider for the Support Line SafeStart Service Utilization Database (established & ongoing) Awarded local annual funding from the San Francisco Department of Children, Youth, and Their Families Safe Start Public Education Campaign SafeStart’s research report on police response to domestic violence released SafeStart Police Liaison resigned

Association for the Study and Development of Community 196 July 2006 DRAFT This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Major Milestone 7/01-12/01 1/02-6/02 7/02-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05

SafeStart Police Liaison position filled

Sources: San Francisco Progress Reports: January – June 2002, July – December 2002, January – June 2003, July – December 2003, January – June 2004, January – June 2005; Measuring Progress, 2005; Local Evaluation Report Form, 2004 and 2005.

Association for the Study and Development of Community 197 July 2006 DRAFT This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Exhibit VIII-B San Francisco SafeStart Service Delivery Model

Family Resource CPS Schools Centers

SafeStart Support Line Parent Team

Identification and Referral San Francisco Families and Friends Police Department

Family Court Assessment

by family advocate at Family Resource Center

Treatment

Department of SafeStart Family Child Trauma Service Public Health clinician Resource Research Delivery Team Behavioral Center Project Health services

Association for the Study and Development of Community 198

July 2006 DRAFT This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

IX Sitka Safe Start Initiative

1. Overview people) received treatment services from the clinician for the SSI. Parent-Child Prior to the Sitka Safe Start Interaction Therapy (PCIT) was the Initiative (“Sitka SSI” or “SSI”), led by primary intervention approach. the Sitka Tribe of Alaska (STA), family and child services were fragmented, with The anticipated co-location of all no coordinated system for identifying family and child services for domestic and serving children exposed to violence victims within a central Family violence. While the SSI was intended to Justice Center by spring 2006 will help serve the entire Sitka community, it has institutionalize the initiative’s goals after focused primarily on the Native its federal funding ends. The Center community, because of the would not have been possible if not for disproportionately high incidence of the foundation laid by the Sitka SSI domestic violence among the Native (e.g., relationships, knowledge, and population. Its purpose was to end the commitment). cycle of violence in Native families and establish cross-agency collaboration for The commitment of key identifying, assessing, referring, and institutional leaders to collaborate and treating young children exposed to change their procedures and practices violence and their families. facilitated the progress of the initiative. In addition, tangible and successful As a result of the Sitka SSI, actions arising from the initiative (e.g., agencies that respond to domestic CID-COPS) fueled further collective violence situations have developed and action. implemented protocols that describe how they work together. The Sitka SSI’s The implementation of treatment child development-community policing services, however, was delayed because team (known as CID-COPS, pronounced of inadequate staff support to follow up “kid cops”), led by the Sitka Police with families and to coordinate all Department, Sitkan Families Against referrals from various agencies. Its Violence (domestic violence victim primary focus on the Native community advocate and shelter), and the STA, has revealed problems that restricted the served as the primary referral source for initiative’s progress, including: the the SSI, identifying 188 children from divide between Natives and non-Natives 80 families in need of help. Not all of permeating every aspect of daily life, these families and children required from personal mental health to service treatment; some were therefore referred provision; the role of historical trauma to other agencies for specific assistance and oppression in the cycle of domestic (e.g., employment and housing). Six violence among Native families; the lack families and their children (a total of 24 of interventions tailored to the socio-

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cultural context of the Native Native/Native lines. The non-Native community; and the limited human community (primarily European resource pool in the Native community. American) and the Native community The location of the Native community make up approximately 69% and 19% of within the city of Sitka intensified these the total population, respectively, issues. according to the 2000 U.S. Census. The Native community is governed by a Three conditions in need of tribal council, and the rest of Sitka is greater attention when addressing governed by a municipal government. domestic violence issues and the impact While residents from the two groups of exposure on young children in a may interact because they share the same Native community are as follows: 1) physical space, their governments, friction over race, power, and cultural organizations, and leaders typically competency of services, which needs to operate on independent and parallel be addressed to create a sustainable and paths (Sitka Safe Start Initiative, 2004). coordinated system that effectively serves every child and his/her family, The two groups are further regardless of heritage; 2) the need for divided by differences in cultural intentional design and early traditions, histories, and other implementation of a healing process for socioeconomic characteristics (e.g., the Native families afflicted by violence; median household income for Sitka is and 3) underdeveloped staff capacity, almost twice the income reported for the especially in the Native community. Native community alone), and mistrust of non-Native agencies is prevalent 1.1 Mission among Native citizens (Sitka Tribe of Alaska, 2005). Conversely, according to The mission of the Sitka SSI, both Native and non-Native individuals spearheaded by the STA, was to end the who met with the National Evaluation cycle of violence in Native Sitkan Team, some non-Native service families and establish cross-agency providers’ negative perceptions about collaboration for identifying, assessing, Native people inhibit their ability to referring, and treating young children provide culturally competent assistance, exposed to violence and their families. further fueling the latter’s wariness. How did STA accomplish this mission and with what success? What factors The Native community has contributed to and impeded success? experienced decades of “historical These questions are addressed in the trauma” (Dauenhauer & Dauenhauer, following sections, and a timeline of 1987; Whitbeck et al., 2004) as a major events is attached. consequence of losing their land to early Russian and European settlers; being prohibited from practicing their spiritual 2. Contextual Conditions and cultural traditions; and subsequently, facing racism at the individual, Located on an island, Sitka is community, and systems levels. The accessible only by boat or airplane. The Native people often feel a deep sense of Sitka community is divided along non- powerlessness. Further, the death of

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every elder brings the Native language, example, the community did not have a and hence the culture, closer to single licensed or trained Native mental extinction (Dauenhauer & Dauenhauer, health professional. Clinicians were 1987). available through the SouthEast Alaska Regional Health Consortium Conditions such as those (SEARHC);2 however, these clinicians described above for Native citizens can were of European descent, and their cause conflicts within the self and the clinical interventions were perceived by community, which in turn affect a the STA Social Services staff as rooted person’s mental health (Nofz, 1988; U.S. in Western approaches—neither Dept. of Health and Human Services, considerate of the historical and cultural 2001). In Sitka, these effects are context of the Native community, nor manifested in disproportionate rates of sensitive to the multiple needs (e.g., substance abuse and domestic violence housing, jobs) that affect Native clients. in Native families, and a weak sense of belonging to the larger community Coordination of services. (Association for the Study and Further, agencies with direct and indirect Development of Community, 2005a; contact with victims of domestic Sitka Tribe of Alaska, 2005). Because of violence employed a wide array of these disproportionate rates and the role policies and procedures related to the of the Sitka Tribe of Alaska (STA) as treatment of these victims. This lead agency for the Sitka SSI,1 the SSI assortment suggests a fragmented system has understandably focused primarily on of screening, assessing, referring, and Native children and families. The treating families and children who expected outcome was an end to the experience violence in their homes cycle of violence in Native families. (Alfrey, 2003).The community Because of this focus and anticipated assessment conducted by the SSI during outcome, it was necessary for the its planning phase confirmed the need initiative to include a process for healing for a continuum of coordinated services and for addressing cultural competency for children exposed to violence and issues as part of its overall strategy to their families. reduce children’s exposure to violence. Existing community collaboratives. There were two major 3. Community Capacity existing community collaboratives intended to reduce high risk factors for 3.1 Before the Sitka SSI children and youth (Advancing Our Community and Communities That Knowledge and skills. Before the Care). These collaboratives, however, Sitka SSI, the capacity of the Native did not have a specific focus on young community to address the threat of domestic violence was limited; for 2 SEARHC is a consortium of twenty Alaska Native tribes from throughout the region that 1 Sitka Tribe of Alaska’s Department of Social operates a hospital that serves primarily Alaskan Services’ director acted as the initiative’s project Native and American Indian citizens, but is open director and oversaw the daily implementation of to other people who are referred by a private the grant. health practitioner.

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children, especially Native children, and 4. Integrated Assistance had not generated any action, according to several agency leaders. Consequently, 4.1 Types of Assistance prior to the Sitka SSI, there had been no Received credible venue in the Native community for dealing with domestic violence and Throughout the initiative, the its impact on children. STA received continuous assistance from the National Center for Children 3.2 After the Sitka SSI Exposed to Violence regarding the Child Devleopment-Community Policing Since the inception of the Sitka strategy,3 from National Council of SSI, the Native community has Juvenile and Family Court Judges about developed improved capacities to establishing a tribal court, from the address domestic violence and its impact Institute for Educational Leadership on young children by: initiating a about overall program needs, and from healing process for the community; the Systems Improvement Training and focusing attention on the impact of Technical Assistance Project about exposure to violence on young children sustainability issues. The University of and developing an initial pathway for California Davis provided assistance identifying and referring these children; regarding the PCIT model specifically. hiring a clinician who, although not Sitka SSI staff also attended a Native, is considered familiar with sustainability workshop in San Diego in Native traditions; improving 2003; the workshop was facilitated and relationships between non-Native and conducted by the Institute for Native agencies; supporting the Sitka Community Peace. These organizations Police Department (SPD) in increasing and their assistance were part of the its capacity to focus on violence National Safe Start Demonstration prevention and community policing; and Project’s support system. providing a forum for tribal and municipal government leaders to Aside from the expertise interact. The following sections describe available from the above organizations, these capacities and their development in the Sitka SSI received technical more detail. assistance from an expert at the University of Oklahoma on adapting Four years after its inception, the PCIT for Native families. Sitka SSI has not clearly succeeded in While the STA found the reducing Native children’s exposure to assistance they received valuable, some violence and the impact of the exposure. assistance providers lacked knowledge The foundation for doing so, however, about models and approaches has been laid. The raised awareness and appropriate for Native communities, availability of treatment for Native according to some STA representatives. families is expected to lead eventually to Nonetheless, Sitka SSI staff have used decreased exposure and reduced impact the knowledge obtained to help agencies of exposure.

3 The Sitka Safe Start Initiative’s Child Devleopment-Community Policing strategy is called CID-COPS (pronounced “kid cops”).

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in Sitka. For example, recognizing that the assessment conducted by Sitkan Families Against Violence (SAFV)4 for 5. Local Agency and young children exposed to violence was Community Engagement not age-appropriate, the STA clinician and Collaboration facilitated a conference call between

SAFV and a domestic violence shelter in 5.1 During the Planning Phase Oklahoma to help the former learn from the latter. STA representatives invited key individuals from the mental health, domestic violence, and education sectors 4.2 Additional Technical to form the Sitka SSI collaborative. Assistance Needed Additional representatives from a wide

variety of sectors, including law The STA did not seek adequate enforcement, public health, the judicial technical assistance in cultural system, family and child services, competency. In the first two years of the substance abuse prevention and Sitka SSI, the TODOS Institute treatment, and Native cultural programs, conducted trainings on building were also invited to provide input on the relationships across lines of gender, race, strategic plan for the Sitka SSI. A class, etc., and how to create more community assessment was conducted in inclusive institutions. Some training spring 2002, and the findings were used participants found these trainings useful to prioritize goals and objectives. This in raising their consciousness, and assessment included Native and non- wished that the trainings had continued. Native citizens. A similar assessment for Addressing the subject of cultural Native citizens only was planned for competency is critical for systems later; it was eventually conducted in change in communities where service 2004 for the first time in the tribe’s providers and service recipients are history. predominantly from the majority and minority groups, respectively. Because the Tribal Council and the municipal government recognized this need, two tribal staff member conducted a training session for the police department in early 2005. Some of the police officers responded positively to the training, and others negatively. Overall, the lack of follow-up after each of the above trainings and the inconsistent engagement of participants resulted in a loss of momentum to deal with the subject more assertively.

4 Sitkan Families Against Violence is the only advocate and shelter for domestic violence victims in Sitka.

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5.2 During the Implementation exchanged new information about Phase previous cases, and worked together to determine the best course of intervention Composition of collaborative. As for a family. People in high-level the SSI process shifted from planning to decision-making positions (i.e., Chief of implementation, the core participating Police, Director of the STA Department agencies in the collaborative were the of Social Services, and Director of STA, the Sitka Police Department, SCAPS) attended the meeting when SEARHC, SAFV, the Office of necessary to discuss severe cases or Children’s Services (OCS, formerly the address issues that required their input. Department of Family, Youth and Children), and Sitka Counseling and The relationships among Prevention Services (SCAPS, which agencies improved over time. offers intervention services for Representatives of the STA Department batterers). School district representatives of Social Services and representatives of were sporadically involved. Between SEARHC initially experienced a tense 2002 and 2004, the collaborative met relationship because of mutual regularly to discuss administrative issues dissatisfaction with the capacities of the related to the initiative. opposite agency to adequately serve Native children exposed to violence and Function of collaborative. The their families. The tension diminished in collaborative’s function changed late 2004 when the STA hired a clinician between 2004 and 2005, as 1) the who was considered credible and number of administrative meetings knowledgeable by SEARHC clinicians. decreased because of everyone’s busy The increasing strength of the schedules, 2) the initiative’s child relationship between the STA and the development and community policing Sitka Police Department is worth noting strategy (i.e., CID-COPS) developed and because it eventually led to their joint became the primary focus of the SSI, application for a Family Justice Center and 3) bimonthly case-conferencing grant.5 A new Chief of Police, hired in meetings became possible with the 2005, contributed significantly to the hiring of a clinician by the STA strengthening of the relationship. The Department of Social Services. new Chief not only had extensive experience working in Native Collaborative processes. By the communities, he also was committed to end of 2005, the same representatives expanding the responsibilities of police who met for the collaborative officers beyond basic law enforcement administrative meetings also were to violence prevention and community meeting for the case-conferencing support. meetings; as a result, the collaborative meetings stopped. Agency representatives began to refer to the CID-COPS meetings as the SSI 5 The Family Justice Center Initiative collaborative meetings. During the case- implemented by the U.S. Department of Justice supports the establishment of domestic violence conferencing meetings, participants victim service and support centers. These centers discussed new domestic violence cases, are expected to co-locate all services within a central place.

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By the end of 2005, the case- • Increased awareness and conferencing and collaboration process dialogue about domestic violence was working more smoothly than ever among Native citizens; because working together over time had • An initial process and procedures allowed agency representatives to: for identifying, referring, assessing, and to a lesser extent, • Develop a better understanding treating young children exposed of each agency’s role in to violence; and supporting families and children • Improved capacity of the Sitka (e.g., the domestic violence Tribe and participating agencies victims’ advocate, child (i.e., SAFV, SEARHC, SPD, protective services, and police OCS) to address issues related to department no longer viewed young children exposed to each other as “enemies,” but as violence. part of a larger support system for families and children exposed 6.1 Community Action and to violence); Awareness • Increase their confidence in each other’s abilities, as their Community awareness. collaboration generated tangible Domestic violence is a painful subject actions that benefited the for Native citizens (as described in community and their respective Section 2), and many non-Native agencies (e.g., the Sitka Police providers have limited knowledge of Department and STA how the historical trauma and oppression collaborated to apply for and experienced by the Native community obtain a Family Justice Center impact the design and delivery of grant; SEARHC agreed to accept services. The Sitka SSI was responsible non-Native clients referred by for helping Native citizens talk about the SAFV); subject, and at the same time, raising the • Establish clear memoranda of consciousness of non-Native institutions agreement that described how and providers to provide culturally they would work collaboratively competent services. in the Sitka SSI and protect the confidentiality of the cases To start a dialogue about disclosed (ten memoranda on domestic violence among Native general participation were citizens, the Director of the STA established, and five were Department of Social Services (also the developed specific to CID- director of the initiative) used her COPS). knowledge of the Native tradition of totem pole carving to raise the issue in a natural and permitted way. A group of 6. System Change Activities youth told their story about domestic violence through the carving process, Sitka SSI activities have resulted bringing attention to the issue and in: prompting participating elders to acknowledge the youth’s pain. The

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raising of the totem pole was a • Protocols, in the form of a significant community event in 2005, a memorandum of agreement symbol of the community’s commitment among STA and first- responder to stop the violence that affects each agencies (i.e., SPD, SAFV, generation. Since the raising of the totem SEARHC, and SCAPS), about pole, several people have contacted the how the agencies and their staff initiative’s director to follow up, a sign should work together to respond of willingness among Tribal members to to a domestic violence situation. talk about their pain and begin the healing process. 6.3 New and Enhanced Programming Community assessment. As mentioned, in 2004, STA conducted the The Sitka SSI streamlined and first-ever needs assessment of its established an initial pathway for community, including several questions identifying, referring, assessing, and about domestic violence and children treating young children exposed to exposed to violence. STA participants violence (see Figure 1). Before the reported that these questions were initiative, standard protocols for included in the assessment because of identifying these children across the awareness raised by the Sitka SSI. agencies did not exist. Instead, Approximately 83% of the respondents individual cases were referred to indicated that domestic violence and SEARHC for mental health services; children’s exposure to it was a problem. however, many families did not complete the full course of therapy. Trainings. The Sitka SSI According to focus groups convened sponsored two system-wide trainings on by the SSI, Native families had oppression and its impact on violence, difficulty attending all of the therapy and one training on cultural competence sessions because they had no for the Sitka Police Department. childcare or transportation to the Approximately 100 people from a clinic, or because they had more variety of agencies and organizations in urgent needs (e.g., finding a job, Sitka attended the system-wide trainings. shelter). This affirmed the These trainings raised the consciousness importance of a more holistic of some individuals, but did not lead to approach to mental health services any changes in organizational policies, for Native families, further procedures, or practices for working motivating the STA to build its with the Native community. capacity to better serve its citizens.

6.2 Development of Policies, Identification and referral. Protocols, and Procedures Identification and referral components of the care pathway The Sitka SSI has developed: were developed more rapidly than were assessment and treatment • A policy to respond to a child components. As described in greater exposed to violence and his/her detail below, procedures and family within five days; and practices for identifying and

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referring children exposed to well as an SSI case manager, to violence were put in place first the CID-COPS team; because there was staff capacity to • The Police Chief’s agreement to do so; the result was CID-COPS and train all police officers about the protocols related to it. CID-COPS.

By the end of 2005, CID-COPS To date, all police officers had identified a total of 188 children (except new hires in 2005), a domestic from 80 families; the number of violence advocate from SAFV, and children identified doubled from representatives from the District 2004 to 2005, and the average age Attorney’s Office and the Alaska State decreased (from 8.5 years in 2004 to Troopers have been trained in the 7.8 years in 2005). Identified identification and referral pathway. families were referred to different agencies for specific assistance. Assessment and treatment. The Participation of clinicians from assessment and treatment procedures and SEARHC and SCAPS in the CID- practices were established about a year COPS team was initially very limited later than the identification and referral because it was too expensive for pathway, after the STA Department of these agencies to pay clinicians to be Social Services hired a clinician in late on-call after working hours. 2004. This clinician’s expertise in child Clinicians from these agencies trauma and relationships and his became more involved when case- presentation to Head Start teachers conferencing meetings began to be helped expand referral sources beyond scheduled during the day and not the agencies directly involved in CID- after working hours. COPS (i.e., SPD and SAFV). The new sources included SEARHC, SCAPS, and The relatively rapid development OCS. The clinician used primarily the of the identification and referral PCIT model for assisting six families component of the pathway was and their children (a total of 24 people) facilitated by: exposed to violence.

• The enthusiasm of Sitka Police Strengths of new service Department representatives and pathway. The new service pathway Sitka SSI staff about the potential proved more responsive to Native of the child development- families because: community policing strategy and their immediate decision to adopt • The SSI case manager, a Native, it; provided personal outreach to • The availability of technical families in services, to ensure assistance from the National that they had transportation and Center for Children Exposed to childcare. Clients initially Violence; thought to be resistant to • The immediate assignment of treatment began to show up representatives from SAFV and regularly for appointments. The the Sitka Police Department, as personal outreach, however,

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stopped when the case manager leadership position representing the left in mid-2004; Native community’s social services sector in many community-wide • The STA clinician designed the collaboratives. Consequently, there was treatment plan to include two no one dedicated to following up with sessions per week, to enable each family to remind them of families to complete their appointments and ensure that they had treatment within a shorter period transportation and childcare assistance. of time, given that Native families typically dropped out of Second, Sitka has a limited pool treatment after several weeks. of clinicians with knowledge of the Such accommodation was not impact of exposure to violence on young possible with more traditional children. The STA clinician could service providers like SEARHC; manage only so many cases before he exceeded his capacity. • STA established a policy of responding within five days to a Third, therapeutic models that fit referral, whereas SEARHC the historical and socio-cultural context responded within ten days; and of Native communities are lacking. The illness and conflicting schedule of a • The Healing House where Native researcher at the University of treatment took place was a more Oklahoma who had adapted PCIT for familiar and accessible setting for Native families further delayed the Native families than SEARHC or adoption and implementation of a SCAPS. culturally appropriate intervention (including the training of Native Challenges. While the Sitka SSI paraprofessionals to deliver the led to a systematic process for intervention). Nevertheless, the STA responding to and assisting young psychologist continued to conceptualize children exposed to violence, the and develop culturally appropriate successful implementation of the process intervention models, including the use of has been challenged by limited staff traditions such as drumming. capacity and expertise. Finally, STA’s engagement of First, the initiative’s case SEARHC to provide PCIT to families manager resigned in 2004; this position fell through, which delayed the provision still had not been filled as of January of treatment services. Two Native 2006, because no qualified Native persons were trained as person had been identified. The absence paraprofessionals to provide of a coordinator made it difficult to Relationship Enhancement Training attend to the daily implementation of the (RET) during the first phase of the initiative; the initiative’s project director family treatment plan (the first 12 to 18 was already stretched beyond her weeks). After completing RET, families capacity in her role as Director of the were referred to SEARHC to complete Department of Social Services and as the the second phase of their treatment, only Native person in an institutional which required the involvement of

Association for the Study and Development of Community 208 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

certified clinicians. Families stopped matters; now it plays a leading role in going to SEARHC after a few sessions discussions about social issues. for reasons mentioned previously; consequently, STA terminated its 6.5 Development, contract with SEARHC. The Identification, and paraprofessionals could not continue Reallocation of Resources their assistance without the supervision of a certified clinician from SEARHC. The To Encourage Arrest and The STA is hopeful that their clinician Family Justice Center grants provided will train and supervise additional resources for Sitka to address paraprofessionals after he completes the issues of violence, including domestic necessary requirements for certification. violence. A total of $210,000 was received in FY 2004 as part of the To 6.4 Service Integration Encourage Arrest grant. The Family Justice Center grant, which amounted to Service integration across $1.1 million, provided funds not only for agencies occurred in the form of case remodeling the Healing House, but also conferencing meetings twice a month for three new positions to work with (previously described in Section 4) and domestic violence victims and their establishment of the Family Justice families, including a community Center. The Family Justice Center grant, outreach person. This person will be received in fall 2004, was used to responsible for designing new public remodel the Healing House (location of education materials. This responsibility the STA Department of Social Services); was added to the position description the remodeled building will house the after STA staff realized that there were SPD’s Domestic Violence Coordinator, no brochures or other educational the STA Department of Social Services, materials geared towards Native and other services for domestic violence families. victims. The successful receipt of the grant and its progress is evidence of the strengthened relationship between the 7. Institutionalization of STA and the Sitka Police Department, as Change a result of the commitment of the leaders of both institutions and their earlier 7.1 System-Wide and Agency collective action that benefited everyone Changes (i.e., CID-COPS and their joint application for and receipt of the To There has been one system-wide Encourage Arrest grant). These efforts change as a result of the Sitka SSI: an also have increased communication interagency protocol that describes how between the tribal and municipal each participating agency in CID-COPS governments, leading to a perception of should respond to a child exposed to the STA Tribal Council as an equal violence. Under the protocol, all children partner to the General Assembly, are expected to complete a trauma according to STA government staff. assessment administered by the STA Prior to these grants, the STA Tribal clinician. Council was involved only in cultural

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Changes also have occurred less inclined to tolerate domestic within agencies, including: violence). Trainings, case conferencing meetings, and the raising of the totem • All police officers are expected pole have contributed to this change. to participate in an annual training about CID-COPS, to increase their reporting of young 8. Increased Community children present in a domestic Supports violence situation; and • SAFV added issues related to The Sitka SSI has helped to children’s exposure to violence increase community supports for to all of its training sessions. services to address violence exposure through: The above practices were made possible, and will likely be sustained, • Additional victim services made because of the commitment of the possible by the grant To agency decision-makers. Encourage Arrest, and eventually by the Family Justice Center 7.2 Point-of-Service Change grant; • Strengthening relationships When participating agency staff across agencies, thereby identify through their services a child improving service coordination exposed to violence, they are expected to (i.e., CID-COPS and case- refer the child to the STA clinician, conferencing meetings); along with background information • Bringing the issue of domestic about the child. This expectation has violence to the attention of been met thus far, simply because staff elected leaders and Native now understand that the child needs citizens (e.g., the Tribal Council help, and the procedures established by agreed to include questions about the Sitka SSI represent the best solution domestic violence in its first for the child, given the expertise of the tribal community needs STA clinician. assessment; the totem pole raising led to follow-up 7.3 Community Change inquiries). • Raising the consciousness of The level of knowledge of the agencies in Sitka about the impact of exposure to violence on young adequacy of existing services children in the Native community and (e.g., Advancing Our within participating agencies has Community, a major community increased as a result of the Sitka SSI. collaborative in Sitka, decided to Increased knowledge was evident in conduct a survey about existing follow-up inquiries about the totem pole services for young children project to continue the dialogue that this exposed to violence and barriers project started, as well as increased to service access); reports of domestic violence incidents in • Establishing an initial process for 2005 (a sign that the community may be identifying, referring, assessing,

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and treating children exposed to violence, which in turn, has the potential violence; and to reduce children’s exposure and • Improving the capacity of STA ultimately, to reduce the impact of to serve its own community and exposure. implement programs. The Sitka SSI contributed The community’s improved directly to the increased capacity of the capacity to address children’s exposure Sitka Police Department and the STA to to violence was reflected in the work jointly to design and develop the following story told by several agency Family Justice Center; in applying for leaders in 2005. A child molester was and implementing the Family Justice arrested, and after his arrest, 44 Center grant, these agencies additional reports were made to the Sitka implemented many of the lessons Police Department regarding incidents learned through the initiative about related to the same perpetrator. The services needed and how to administer a Director of the STA Department of large federal grant. A focus on the Social Services called an emergency impact of exposure to violence on young meeting; with one day’s notice, a total of children will be integrated into the 15 people representing different agencies Family Justice Center’s mission and attended the meeting. Three individuals service delivery system. volunteered to review existing materials (e.g., brochures) for child and adult The changes brought about by survivors of sexual assault. Each agency the Sitka SSI were possible because of also agreed to share information with the the following conditions: families it served (e.g., the schools set up counseling sessions for their students). • Support from decision-makers in According to some participants, they key agencies that have a stake in would not have been able to act so the issue (e.g., police, domestic quickly in the past and fewer agencies violence victim advocate and would have attended the meeting. Many shelter, child protective services); participants attributed the successful • Staff knowledge and skills in action to the support system established mobilizing resources and through the Sitka SSI. relationships and initiating programming (e.g., CID-COPS and case-conferencing); 9. Conclusion • Staff knowledge and skills in designing and providing Sitka, especially the Native treatment services that encourage community, has increased its capacity to use by Native families (e.g., address domestic violence and its impact location of services at the on young children. Initial changes at the Healing House, which is more system, point-of-service, and community accessible and familiar to Native levels have occurred. Native citizens’ citizens); increased awareness of the impact of • Tangible and successful exposure on young children has the collective action (e.g., through potential to discourage domestic CID-COPS and the Family

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Justice Center grant), which the community’s diminishing capacity to fueled further collective action; endow future generations with Native and cultural assets. • A shared sense of responsibility for the problem between Native Additionally, human resources and non-Native agencies. for designing and managing any initiative are very limited in the Native At the same time, the progress community, because of low levels of and full potential of the Sitka SSI were education; as a result, the Sitka SSI took hindered by challenges common to any more time than anticipated to identify, systems change initiative, including: hire, and retain Native staff and consultants (e.g., local evaluator, case • A limited pool of local experts manager). who specialize in childhood trauma and impact of exposure to An initiative that addresses violence on young children (e.g., domestic violence in Native the STA clinician was not hired communities must, therefore, design and until late 2004); implement a healing process as part of • Difficulty in initiating a its programming. This strategy must community-wide dialogue about consider ways to raise and discuss the domestic violence; and issue through a process that feels safe, • Staff turnover (e.g., loss of the familiar, and natural (such as the totem Sitka SSI coordinator). pole carving project). Staff and leaders must continuously pay attention to this The above challenges were process to encourage and support the exacerbated by conditions unique to a healing, and sustain the benefits. Native American community, including: In Sitka, non-Native and Native • The historical and socio-cultural citizens cannot avoid the need to context of the Sitka tribe; and function simultaneously in each other’s • Limited knowledge in the mental worlds. This creates stress for some health field about interventions because of prejudice on both sides. Such effective for Native American prejudice and negative perceptions can families, much less Native affect organizational cultures. From a American children exposed to European-dominated perception, for violence. example, Native organizations did not run their programs in the same Decades of psychological, professional way as did non-Native political, and economic oppression have agencies (e.g., Native agencies made contributed to the cycle of violence in accommodations for families who did Native families. Domestic violence not show up on time for their elicits feelings of shame at the appointments, in a way that non-Native individual, family, and clan levels. For agencies would not consider part of their the Native community as a whole, the professional responsibility); from a occurrence of domestic violence Native standpoint, non-Native agencies represents a loss of Native traditions and did not run their programs in a way that

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was culturally responsive and sensitive to the experiences of Native people (e.g., Finally, the search for and many families who did not show up on adoption and adaptation of a culturally time for appointments could do so only appropriate mental health intervention with additional help with childcare and model for young Native children transportation). exposed to violence were time- consuming processes. The adaptation of A dialogue about power the PCIT model by an expert at the differences is essential for any systems University of Oklahoma presented the change initiative in a community in most promise; however, time constraints which most service providers are from on the expert’s part and the need to the majority group, while most service certify the STA clinician to implement recipients are from a minority group that the model (making it possible for him to has experienced decades of oppression. train and supervise paraprofessionals) The Sitka SSI did not have a deliberate delayed the model’s implementation. strategy for promoting this dialogue The national technical assistance throughout its lifespan. This limited its providers were not fully prepared to potential to impact the capacity of the address this gap in the field, causing the larger community (i.e., both Native and Sitka SSI staff to feel somewhat non-Native citizens) to sustain an unaided. integrated support system for young children exposed to violence, regardless of cultural background.

10. References

Alfrey, C. (2003). Sitka Safe Start Initiative Policy Analysis Report. Sitka, Alaska: Sitka Tribe of Alaska Social Services Department. Association for the Study and Development of Community (2005a). Site Visit Report: Sitka Safe Start Initiative January 2002- December 2004. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2005b). Site Visit Report: Sitka Safe Start Initiative January 1 through August 31, 2005. Gaithersburg, MD: Author.

Dauenhauer, N. M. & Dauenhauer, R. (1987). Haa Shuká, Our Ancestors. Seattle, WA: University of Washington Press.

Nofz, M. (1998). Alcohol abuse and culturally marginal American Indians. Social Casework: J. Contemporary Social Work.

Sitka Safe Start Initiative (2004). Local evaluation report form. Sitka, AK: Author (Available from the Association for the Study and Development of Community).

Association for the Study and Development of Community 213 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Sitka Safe Start Initiative (2005). Local evaluation report form. Sitka, AK: Author (Available from the Association for the Study and Development of Community).

Sitka Tribe of Alaska (2005). 2004 Tribal Needs Assessment. Sitka, AK: Author.

U.S. Dept. of Health and Human Services (2001). Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration.

Whitbeck, L.B., Adams, G.A., Hoyt, D.R., and B Chen, X. (2004). Conceptualizing and measuring historical trauma among American Indian people. American Journal of Community Psychology, 33 (3/4), 119-130.

Association for the Study and Development of Community 214 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Exhibit IX-A Timeline of Sitka Safe Start Initiative Activities and Milestones Major Milestone 1/02-6/02 7/02-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05

Collaborative meetings Monthly meetings until September 2003; first quarterly Monthly meetings changed to meeting occurred in December 2003 focus on case-conferencing Staff and other internal changes Hired new Hired Social SPD DV Response local Services Unit Coordinator evaluator Deputy resigned Director

Sitka SSI (also served SAFV liaison to Coordinator as SSI the Sitka SSI left STA clinician) resigned Community assessment (Tribal community assessment) Training by the TODOS Institute Cultural competency training for SPD Technical assistance from NCCEV on (training CDCP in New X Haven) Implementation of CID-COPS, including trainings for law enforcement officers Technical assistance from NCFJCF on judicial system (first Tribal X Court order issued) Training for PCIT (two staff trainings attended Training at Technical assistance from Dr. by Univ. of PCIT (by Univ. of Univ. of Subia Bigfoot at the Univ. of California conference Oklahoma Oklahoma Oklahoma via telephone at Davis in staff) staff) Sacrament

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Major Milestone 1/02-6/02 7/02-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05

o) Implementation of PCIT New funds To Family Encourage Justice Arrest Center grant grant received received

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Exhibit IX-B SITKA SSI Service Delivery Model

STA Social SCAPS Services Court

OCS

SPD

CID-COPS STA CHIILD TRAUMA PROGRAM • STA case manager completes intake and SEARHC obtains information from other agencies if needed • Consent for release of information is obtained Other Services (e.g., • Case-conferencing occurs substance abuse

treatment, housing) Families may be referred to other services as STA Clinician necessary • Works with the family for 1 to 3 sessions • Determines trauma level while engaging the family in: o PCIT o Heart Beat (not fully developed) SEARHC o Family Circle (not fully developed) If there are neurological • After 3 sessions, family either continues in complexities the same intervention or gets additional help depending on type of trauma (crisis, partial

PTSD, full PTSD, complex PTSD)

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X Spokane Safe Start Initiative

1. Overview violence. Yet, gains were made, illustrating the importance of Spokane Safe Start was designed partnerships, sector-by-sector change, to create a crisis response team to and strategic purpose. address the needs of children and families exposed to violence while The Spokane Safe Start grantee integrating these families voluntarily modeled the New Haven Child into services, and to create a Development-Community Policing neighborhood-based capacity for early (CDCP) approach and formed intervention. While working to achieve partnerships among law enforcement, their vision, Spokane Safe Start staff and Spokane Mental Health, Partners with community partners served as a catalyst Families and Children, and the NATIVE for the development of both information Project to form the Child Outreach Team around the topic of children’s exposure (COT), a group of five clinicians on-call to violence and a way to bring attention 24 hours a day and seven days a week to to a segment of the community whose respond to officers who identified needs were not being met. children exposed to violence. Through the Child Outreach Team, Spokane Safe Spokane Safe Start staff Start identified, referred, and assessed identified and sought to address over 700 families and over 1000 children opportunities for systems change in what between 2001 and 2005. they viewed as essential child-serving sectors: mental health, law enforcement, To promote sector-by-sector child welfare, the dependency court systems change, the Spokane Safe Start system, and social service agencies grantee collected and analyzed data involved with domestic violence and relevant to the context of the system substance abuse. Systems change being addressed. The grantee through early identification, coordination successfully launched systems change of services, assessment, and treatment initiatives in three key sectors of its was viewed as critical and central to partnership: 1) Juvenile Court through realizing positive outcomes for children the Court Improvement Program (CIP), exposed to violence and their families in 2) law enforcement through the Spokane. Converging circumstances, implementation of CDCP, and 3) mental however, principally a downturn in the health services through training and economy at the state and local levels, improved screening for children exposed challenged the ability of the Spokane to violence. Each of these sectors Safe Start grantee to generate the developed a protocol for identifying comprehensive change needed to bring children exposed to violence, a process about a coordinated and sustainable for asking the right questions of children system of care for children exposed to and parents involved in a crisis (e.g.,

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domestic violence) situation, and an The mission of Spokane Safe understanding of the ways to promote Start was to prevent and reduce the change within its sector. Furthermore, impact of exposure to violence on young between 2001 and 2005, the Spokane children and their families by enhancing Safe Start grantee provided trainings for and integrating the supports and services approximately 3,000 professionals in offered by community providers, different fields such as law enforcement, agencies, and institutions, and by mental health, and education to increase creating a community culture of keeping awareness and knowledge at the children valued, cared for, and safe. community level around issues of How did Spokane Safe Start accomplish children’s exposure to violence and the this mission and with what success? impact of violence in the lives of What factors contributed to and impeded children. success? These questions are addressed in this report. Over the course of program implementation, the Spokane Safe Start 1.2 Spokane County, grantee worked through many economic Washington and political obstacles facing Spokane County social and mental health service Spokane County is located on the providers and community residents in eastern border of the state of the past several years. Chief among Washington, adjacent to Pend Oreille these obstacles were the severe budget County, Whitman County, Lincoln cuts which impacted education, child County, and Stevens County in welfare, mental health, law enforcement, Washington, and to Bonner County, juvenile justice and the entire non-profit Kootenai County, and Benewah County child service community. Additionally, in Idaho. The county spans 1,764 square several of the original initiative planners miles of land, with an average of 237 have either retired or left their positions, residents per square mile. According to including the Spokane Police Chief and the Washington State Office of Financial the Spokane County Sheriff, the Director Management, the estimated 2003 of County Community Services, the population of Spokane County was Juvenile Court Administrator, the 428,700, with 308,756 and 119,844 presiding Dependency Court Judge and residents in incorporated and the Director of the Spokane County unincorporated areas respectively. The Domestic Violence Consortium. population of the city of Spokane is Although these factors hampered the 196,624; that of the newly incorporated progress of sustaining a coordinated city of Spokane Valley is 82,005; and system of care for children, the Spokane that of the remainder of the county is Safe Start grantee successfully 150,966. Spokane County (in total) is developed and enhanced partnerships 92.1% white, 1.7% Black, 1.5% Native between organizations and successfully American/Alaskan Native, 2.2% gathered data that will impact the child Asian/Pacific Islander, 0.8% other, and and family service system in other ways. 2.4% mixed race (U.S. Census Bureau, 2000). 1.1 Mission

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According to U.S. Census cuts (described further in other sections Bureau (2000) estimates, approximately of this case study). Thus, both the 27,583 children under the age of five political and economic contexts for the were living in Spokane County in 2003, implementation of Safe Start in Spokane accounting for approximately 6.6% of County presented significant challenges the total population. The median to the success of the initiative. household income for 1999 was between $36,177 and $41,083. Approximately The strategies that the Spokane 12% of the county’s population lives Safe Start grantee hoped to implement below the poverty line, slightly more were grounded in system changes than the nation’s overall percentage of supported by proactive policies for 10.6%. children and families, for example:

• Increased funding for key child- 2. Contextual Conditions serving agencies, particularly children’s mental health services; The state of Washington is • Restructuring of the child welfare divided into two distinct economic, system to address children’s cultural, and political regions. Western issues in a more family-friendly Washington is far more urban than and less bureaucratic manner; eastern Washington and accounts for and about 75% of the state’s population and • Developing the capacity of social 40% of its land mass. The politics in the service agencies and the court Spokane region range from conservative system to share data about to libertarian, and the overall philosophy children exposed to violence and toward government can be characterized their families across agency by an absence of trust and a belief that boundaries (Association for the “less is more.” Other political, economic, Study and Development of and social conditions are described Community, 2006, p. 6). below. In an effort to create a 2.1 Political Context sustainable policy foundation for addressing child and family issues, the Prior to 2000, when Spokane Spokane County Children’s and Safe Start began, Spokane County Adolescents Initiative was launched on lacked a community master plan for September 1, 2004, as a direct outgrowth children and youth services, as well as of Safe Start. Spokane County legislative or administrative policies Community Services, through its specifically supporting assistance to Regional Support Network, tasked children exposed to violence, or Washington State University and Eastern requiring collaboration of services to Washington University (both Safe Start help children exposed to violence. Over university partners) with facilitating a the course of the implementation of two- to three- year process for the Spokane Safe Start, the infrastructure development of an outcome-driven, that did exist for the support of children family-centered system of care for and families underwent severe budget children. Although this process focused

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initially on Medicaid providers and manufacturing play only a minimal role. recipients, the ultimate design of the Education, health, and social services are system of care was expected to the principal sources of employment. accommodate the needs of all children in the Spokane County community. The city of Spokane and Spokane Various organizations and systems, both County operate separate law formal and informal, were to participate enforcement agencies. The most in the process, thus ensuring that the common crimes in the city of Spokane development of the system of care would are larceny/theft (63.21% of all crime), be community-based, inclusive, and burglary (18.16%), vehicle theft representative of all those impacted by (10.37%), aggravated assault (5.17%), mental health. While funding for the robbery (2.58%), rape (0.46%), and Initiative was provided through Spokane murder (0.04%). Approximately 16,000 County Community Services, the incidents of domestic violence-related university partners withdrew from the crime are reported to law enforcement relationship after 14 months of work due annually in Spokane County. In fiscal to a 25% reduction of funding to the year 2004, there were approximately Spokane County’s mental health system. 98,000 new requests statewide for This 25% reduction was principally service from the Children’s taken from mental health services Administration (Child Protective provided to children and families. The Services, Child Welfare Services, etc.), university partners chose to return the including 80,000 referrals for abuse or funds so that they could be used to neglect and 18,000 voluntary requests support these child and family serving for services. Statewide, 38,000 referrals agencies (Spokane Safe Start Initiative, were accepted for Child Protective 2005, p. 14). Services investigation, affecting nearly 47,000 children. There were 7,300 new 2.2 Social Context placements, and more than 6,800 children exited out-of-home care. Of Spokane is the trade and cultural these 6,800 children, 4,887 went home, center of a large area of the Northwest, 1,110 children were adopted, 434 including the state of Washington east of children were placed in new the Cascade Mountains, northern Idaho, guardianships, and 369 children had western Montana, and northeastern other exits (Spokane Safe Start Initiative, Oregon. Due to changes in its industrial 2005, p. 7). Spokane County child base, Spokane has seen a growth in welfare data is represents approximately poverty and now has disproportionately 13-15% of the statewide totals. high rates of poverty. Approximately 37% of all Spokane children live in By statute, all children with significant economic deprivation and are serious emotional disorders in the state clearly the poorest residents of the of Washington are eligible for publicly region (Spokane Safe Start Initiative, funded mental health support. 2005, p. 4). Unfortunately, the extension of eligibility to caregivers is not automatic, Spokane has a service-based creating potential eligibility barriers for economy, in which technology and family-centered care. There is also

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evidence that service rates for eligible children in Spokane lag significantly The cumulative effect of behind those of other Washington urban concurrent reductions in federal and areas. Further, the state mental health state funding, described by some Safe system budget is only adequate to serve Start staff as “the roof falling in,” 30% of the identified child population in challenged the ability of the three major need of mental health services (Spokane Safe Start partnering sectors (substance Safe Start Initiative, 2005, p. 10). abuse, mental health, and child advocacy) to continue to implement the 2.3 Economic Context vision and goals of Spokane Safe Start.

Economic conditions in the state Cuts in funding had a particularly of Washington can be described as significant impact on the non-profit tumultuous. During the implementation service delivery infrastructure in of Spokane Safe Start, several major Spokane, which serves as the primary economic events at the source of care for children and families. state level severely impacted the The non-profit infrastructure is heavily availability of resources for children and dependent on state and local funding. families, including: According to Safe Start staff and partners, this infrastructure can no longer • Reduction in state revenues provide the level of services it provided impacting all early intervention five years ago, eroding the concept of capacity in social service; interagency interdependency • Over-expenditures in child (Association for the Study and

welfare resulting in interim cuts; Development of Community, 2006). • The Braam lawsuit and settlement plan; and The bulk of the state budget • Over 62,000 children in shortfall disproportionately affected Washington State lost medical children’s mental health and trauma insurance (from 2003 to 2005) services. Spokane Mental Health, the (Spokane Safe Start Initiative, area’s largest provider and a Safe Start 2005, p. 3). subcontractor, cut 20% of its workforce (65 individuals) in 2005. Lutheran At the state level, the 2005 fiscal Community Services, the largest forecast was more promising than in provider of children’s mental health and recent years, because increased revenue trauma services, experienced a 40% enabled the legislature to appropriate reduction in funding and subsequently additional funding for the state reserves. laid off 15 therapists and eight support However, little of that additional revenue staff. The county eliminated all funding was used to provide or restore services to provide mental health services in the to children that had been cut earlier in schools. Other local budget cuts the biennium budget. Instead, the state included the layoff of 17 city police government focused on economic officers and a loss of $800,000 in Head development and higher education Start funding. The Children’s (Spokane Safe Start Initiative, 2005, p. Administration experienced a $13 2). million budget shortfall in 2005, which

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resulted in a regional budget reduction of and families. “Integrated services” in $3.1 million in the Spokane area. Spokane refers to cross-disciplinary and Partners with Families and Children– often co-located service delivery Spokane (PFC), the lead Safe Start strategies using a client-empowerment contractor, incurred a $142,000 annual strategy referred to as Individualized and reduction in funding from the Region 1 Tailored Care (ITC) (Spokane Safe Start Children’s Administration, as well as a Initiative, 2005, p. 7). This capacity was $10,000 per month reduction in mental important in the development of the health funding due to other budget cuts. Spokane Safe Start service delivery Together, these funding reductions model. In addition, other types of hampered the functioning of PFC, which capacities supported the mission and has been operating since 1988 as the goals of Spokane Safe Start. only program in the region providing wraparound, family-based services to 3.1 Spokane County high-risk families experiencing abuse, Community Network neglect, and trauma (Spokane Safe Start Initiative, 2005, p. 4). During planning phases, the Spokane Safe Start grantee partnered Local agencies have made efforts with the city of Spokane and the to address the cuts from state resources. Spokane County Community Network. In November 2005, the Spokane County Spokane maintained a relationship with Commissioners proposed a three-year a state child welfare entity known as the (time limited), 0.1% sales tax increase, Family Policy Council (FPC), and was potentially raising $6.5 million in one of a diminishing number of local revenue per year. Collection of the governments in the state to receive a revenue, however, will not begin until small ($220,000) two-year grant from July 2006 and is not expected to provide the FPC to address generic child abuse sufficient resources to fully restore issues among children six to 12 years of mental health services. age. In administering this grant, the Spokane County Community Network chose to limit its request-for-proposal to 3. Community Capacity the two Safe Start catchment areas, requiring collaborative partnerships Spokane non-profit among applicants and mandating that organizations, community-based successful applicants identify how they organizations, social service agencies, would prioritize the issue of trauma and research universities (Washington exposure. As a result of the consequent State University and Eastern Washington funding of two partnerships, the Spokane University) have historically worked County Community Network/Family together, partnering on multiple projects Policy Council provided Spokane with focused on children and families, as a the capacity to engage all but one of its result of the limited resources available publicly funded mental health providers in the Spokane area. Spokane has had into direct relationship with Safe Start. significant success in developing local Safe Start’s relationship with the applications of integrated service Spokane County Community Network treatment models for high-risk children continued to support the initiative

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throughout its implementation, including 1970. The agency provides quality providing funds to develop Teen Peace, treatment and rehabilitation for those an intervention targeting adolescents with mental illness and co-occurring who had been victimized by and had disorders. These services include: crisis perpetrated violence. Teen Peace was response services; individual, family, developed by the NATIVE Project, one and group therapy; case management of Spokane Safe Start’s key partners. and support; vocational rehabilitation; psychiatric and psychological services; 3.2 Child and Family Research medication management; consumer Unit (Washington State education; and a family support program University) to expedite access to assessment and services for families with children The Child and Family Research involved in Juvenile Court dependency Unit (CAFRU) was developed to proceedings. Spokane Mental Health identify and respond to opportunities for tailors services to the unique needs and improving and expanding services in the strengths of each person seeking care. Spokane community. CAFRU works to Co-located partners include substance strengthen and nurture children and abuse staff (Spokane Mental Health, families, by conducting theoretical n.d). service outcome and public policy research that contributes to improved 3.5 The NATIVE Project quality of life for children and their families (Child and Family Research The NATIVE Project is an urban Unit, n.d.). Indian non-profit organization that has served Spokane County since 1989; it is 3.3 Partners with Families and the largest outpatient substance abuse Children–Spokane program in eastern Washington for adolescents. The NATIVE Project Partners with Families and advocates for children and families of all Children is an accredited, hospital-based races, ethnicities, sexual orientations, children's advocacy center that provides and religions, but serves in particular as treatment to children and families a resource on Indian issues. The affected by acts of child maltreatment organization promotes a drug- and (abuse, neglect, and exposure to drugs alcohol- free lifestyle; spiritual, cultural, and violence). The organization uses a and traditional Native values; wellness model of collaboration and partnership and balance of mind, body, and spirit for with other community agencies to each person; respect and integration of provide the services necessary for all healing paths to wellness for self and restoring children and their families to others; lifestyles that encourage and are healthy, productive lives. supportive of prosperity; education; and awareness (N.A.T.I.V.E. Project, n.d.). 3.4 Spokane Mental Health

Spokane Mental Health is a not- for-profit organization that has been serving children, families, adults, and elders throughout Spokane County since

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3.6 YWCA-Alternative to and Prevention (CDC). The Domestic Violence Consortium, with a membership of over 200 professionals and The YWCA’s Alternative to organizations, is now an Domestic Violence program is the acknowledged leader in the primary domestic violence service region on policy and professional agency for Spokane County, receiving development efforts related to approximately 3,000 duplicated client- domestic violence. Part of its initiated requests for help annually. In its mission is to conduct extensive partnership with the courts, the YWCA media (television, radio, print) has helped to provide legal advocacy to campaigns to educate the obtain approximately 700 protection Spokane community about orders and 1,200 no-contact orders. family violence and children exposed to violence. Dr. 3.7 Other Community Blodgett, principal investigator Resources for Safe Start, is also principal investigator for the Domestic At the time of the development Violence Consortium. of the first strategic plan, the following • A number of noteworthy were noted as strengths and resources for programs in Spokane use Spokane Safe Start: integrated service program models on smaller scales. • Spokane County Head Start is a Breakthrough for Families countywide program providing provides integrated services to early childhood education and homeless teens and their social services through nine families. The West Valley neighborhood sites. This county School District employs program was one of the original Individualized and Tailored Care Early Head Start sites and principles in its multidisciplinary continues to provide Early Head teams for complex children. The Start services under continuing YWCA has participated in co- grants. location strategies with city • Deaconess Medical Center co- schools for homeless children located 10 staff for mental health and remains a principal partner in and substance abuse services in the team strategies of the two school districts, representing Regional Domestic Violence a significant commitment of Team (Spokane Safe Start internal resources to co-location Initiative, 2005, p. 29). strategies and out-stationing of staff. • The Spokane Domestic Violence 4. Community Engagement Consortium is a grantee of and Collaboration Coordinated Community Response to Prevent Intimate Spokane Safe Start was an Partner Violence, an initiative of outgrowth of coordinated community the Centers for Disease Control work directed through the Breakthrough

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Community Coalition. Breakthrough The Spokane Safe Start grantee was formed after the brutal murder of a did utilize formal work groups to plan young teen, Rebecca Hedman, who had the work of the initiative to achieve its been living on the streets in Spokane. goals across seven assigned dimensions. Breakthrough is a voluntary, informal Initially, work groups were named for coalition that includes participation of the planning functions they were to senior management and line staff from serve, for example, Family the principal regulatory and service Identification, Service Integration, agencies addressing children’s issues in Family Support, Professional Spokane. Leaders from education, Development, Policy, Data Integration, advocacy, and the nonprofit service and Resource Development. Individuals sectors, as well as private citizens, also with current or recent leadership participate. Using an informal collegial experience associated with administering strategy, Breakthrough has brought publicly funded systems served as work significant resources to Spokane, playing group facilitators. For example, the a direct role in the planning and director of the Spokane County partnerships that have garnered more Domestic Violence Consortium provided than $10,000,000 in new direct service leadership and expertise to the Service resources for children and families over Integration Committee in the area of an eight-year period. Breakthrough family support. In the area of served as the sponsoring community professional development, the Dean of coalition for Spokane Safe Start, and the Eastern Washington University’s School Breakthrough Executive Committee of Social Work served as group served as the primary advisory body for facilitator. A former director of Spokane Safe Start (Spokane Safe Start Initiative, County Corrections served as leader of 2005, p. 8). the Policy Committee (Spokane Safe Start Initiative, 2005, p. 22). A formal collaborative process, however, was not the driving force for Prior to Safe Start, Lutheran Spokane Safe Start partners and Community Services provided the only community members. Although formal program for children exposed to memoranda of agreement were signed in domestic violence. This center-based a limited number of cases (as described program had the capacity to serve below), the Spokane Safe Start grantee approximately 100 children per year. did not rely upon this or other typical During the implementation of Spokane collaborative mandates to implement Safe Start, approximately 260 children change for children and families exposed per year received services. to violence. Instead, the grantee relied upon data-driven decision making, The Spokane Safe Start grantee information dissemination, and training developed sub-contractual relationships to promote and fulfill Safe Start goals between Washington State University (Association for the Study and and three agencies (Partners with Development of Community, 2006). Families and Children, NATIVE Project, These activities are described in later and Spokane Mental Health), to provide sections. services to children exposed to violence and their families. These types of formal

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functional relationships between mental Spokane Safe Start indicated that the health agencies to provide services to community had only anecdotal children exposed to violence and their knowledge of children exposed to families did not exist prior to Spokane violence, and lacked a mechanism to Safe Start. conduct surveillance of this issue. The Spokane County Domestic Violence Although federal funding for Consortium was chosen to serve as the Spokane Safe Start has ended, Safe Start entity that would provide community staff report that agencies continue to awareness activities regarding children collaborate with the demonstration exposed to violence. Over the course of project, particularly by making their staff the implementation of Spokane Safe available for ongoing trainings regarding Start, the Domestic Violence children exposed to violence and family Consortium significantly increased its violence. For example, the Spokane education outreach to the community, County Sheriff’s Office allowed Safe providing training and written materials Start staff to train 209 deputies during a to a variety of non-profit service recent quarterly in-service rotation. agencies, Head Start, childcare Similarly, a number of mental health providers, and public and parochial providers requested and received schools. In addition, the U.S. training for nearly 125 clinicians. Safe Department of Health and Human Start staff plans include future training Services/Centers for Disease Control and of chemical dependency professionals Prevention awarded federal funding to and paraprofessionals in treatment of the Consortium, which used these children exposed to violence and family resources for community education, a violence. Spokane Safe Start has moved small juvenile perpetrator treatment into the area of early learning and has program, and a small child witness to participated in developing a venue for domestic violence treatment program— mobilizing the private sector into all in support of the goals of Spokane partnership with child care providers Safe Start. around this issue. Safe start has also completed trauma training to 109 Indications are that community separate child care provider agencies. knowledge about children exposed to Further, Safe Start personnel are violence significantly increased due to working with the Spokane Public the efforts of the Spokane Safe Start Schools and the Education Services grantee. As a direct outcome of the District (Spokane County) to implement grantee’s community awareness and the Safe Schools/Healthy Students grant outreach activities, over 70 agencies where the topic of trauma has been with nearly 3,000 individuals from the adopted as the central organizing core fields of law enforcement, mental health, priority of the program. substance abuse, education, child welfare, and the justice system received training in children’s exposure to 5. Community Awareness violence in the state of Washington. Trainings and knowledge dissemination The community assessment and led to a number of collaborative planning process initiated at the outset of partnerships, studies, and programs in

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service of children exposed to violence activities. Memoranda of understanding and their families. with these partners resulted in 1) increased case sharing and collaboration between the Safe Start grantee and child 6. System Change Activities welfare, 2) referrals made to the Safe Start grantee by child welfare, and 3) Spokane Safe Start staff and invitations from child welfare to Safe partners described their systems change Start staff to participate in child approach as a process for sector-by- protective staffing meetings, during sector change based on collection and which cases and information about analysis of data relevant to the context of clients were shared. the system being addressed. The situating of Spokane Safe Start within According to Safe Start staff, Washington State University (viewed by however, true partnerships and the community as a “neutral convener”) collaborations in Spokane are fostered allowed the staff of Safe Start to serve as through the long-term development and conveners and facilitators of systems maintenance of relationships between change. The university setting also agencies, rather than through formal provided the capacity for Spokane Safe memoranda, due to the fact that Spokane Start to implement a data-based is a small community where one’s word approach to systems change. Salient and handshake are paramount, and features of how the sector-by-sector partnerships may be characterized as approach was operationalized are being “relational” and horizontal in described below. nature (Spokane Safe Start Initiative, 2005, p. 32). 6.1 Memoranda of Understanding 6.2 Screening Studies

Although Spokane Safe Start To facilitate systems change, staff and partners did not rely heavily Spokane Safe Start staff developed a upon the use of formal agreements (i.e., process of sector-specific screening memoranda of understanding), several studies to make the case for a focus on strategic agreements with key child- children exposed to violence. In serving agencies provided a basis for addition, the screening studies provided generating partners for the delivery of much needed information on child and services to children exposed to violence family issues in the target population, for and their families. Key partnership which little current information was agreements were developed with available. Two major studies were Partners with Families and Children, undertaken and are described below. Spokane Mental Health, and the NATIVE Project (see the section on The Mental Health Family community capacity for a description of Violence Screening Study for families these partnering organizations). These receiving mental health services was the key partners represented the three first sector-based screening study sectors considered by Safe Start staff as undertaken by the Spokane Safe Start essential to engage in systems change grantee. The study was a descriptive

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study of a representative sample of domestic violence as part of their families engaged in publicly funded standard screening protocol. mental health services in Spokane, designed to screen for family violence As a result of a request from the prevalence, to identify types of violence, chemical dependency (i.e., substance and to identify the prevalence of child abuse) sector, Spokane Safe Start staff exposure to violence and associated anticipated conducting a second child maltreatment—information vital to screening study, to gather information shaping a community response to the about the presence of violence in a issue of children’s exposure to violence. chemical dependent population. Spokane Further, the study attempted to identify Safe Start staff recognized from the any correlation between mental health outset that substance abuse is a key risk diagnosis, service utilization, and factor in the lives of families with treatment outcome. Prior to the children exposed to violence, and sought screening study, no published studies independent verification of this problem addressed the issue of the prevalence of in the Safe Start clinical population. family violence and child exposure in Findings from the substance abuse the history of families seeking mental screening study will provide data to health services; therapists in Spokane “prove” the point that violence is an did not collect any data on children’s integral part of the cycle of chemical exposure to violence and collected only dependence and to establish substance minimal information about domestic abuse as a visible issue in the discussion violence. With the inception of the of children’s exposure to violence. In study, 95% of therapists in the four main addition, the screening study will child-serving agencies (Spokane Mental provide the major system responsible for Health, Family Services Spokane, addressing substance abuse with Lutheran Community Services, and information on how violence and Children’s Home Society) began to violence exposure affect its population. screen clients for children’s exposure to As of December 2005, seven of the violence. Initial analyses of the data largest Spokane area chemical collected indicated that the level and dependency providers receiving public severity of exposure in children and their funding had agreed to participate in the caregivers were extensive (Spokane Safe initial screening study to identify Start Initiative, 2005, p.34). Several of violence and violence exposure. CAFRU the therapists involved in the study staff (at Washington State University) stated that they were surprised by the will provide training on intimate partner level of violence exposure in their violence and children’s exposure to clients, and used this information in violence to all clinicians employed by planning treatment interventions. The these providers. This study is expected Regional Support Network planned to to have major policy and practice use the findings from the surveillance implications, as the public substance study to support a requirement for all abuse authority and its providers already mental health providers receiving have expressed interest in having Medicaid funding to screen for violence exposure questions children’s exposure to violence and permanently included in their data collection and intake assessments

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(Spokane Safe Start Initiative, 2005, p34).

The Safe Start grantee’s data- driven decision-making process (i.e., screening studies and tools) provided organizations and agencies with the capacity to make the case for systems change in serving children exposed to violence. The early successes of these efforts convinced Spokane Safe Start leadership and partners of the effectiveness of this approach.

6.3 Child Outreach Team

Citizen groups participating in the Safe Start planning process recommended that the initiative address the ability of the Spokane community to provide crisis intervention to

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reduce trauma due to violence exposure. major agencies provided identification of The six-month planning process within children exposed to violence: 1) law the community generated the following enforcement, 2) YWCA– Alternative to themes: Domestic Violence (domestic violence shelter), and 3) Child Protective • Crisis response services must be Services. (See Exhibit X-B for a diagram mobile and immediately of the Spokane Safe Start service available to families around-the- delivery model.) In the assessment and clock; treatment of children exposed to • Services must center on the violence, the Child Outreach Team needs of the child, but include (COT) played a major role. COT was the entire family, with safety as composed of Safe Start collaborative the paramount consideration; partners (i.e., Partners with Families and • A co-located, neighborhood- Children, Spokane Mental Heath, and based, wraparound approach the NATIVE Project). COT child should be used; outreach specialists provided early • Once safety has been established, intervention services and treatment to the purpose of initial contact families with young children identified must be voluntary engagement by law enforcement or other community with a focus on child and family agencies. Four child outreach specialists assessment; and one part-time clinical supervisor • All contacts with the family must were funded for service provision during be culturally sensitive and implementation of Spokane Safe Start. responsive; Each clinician was an experienced • While substance abuse and professional in working with children mental health assessment and and families. Child outreach specialists treatment services must be worked days, weekends, and flexible immediately available, they shifts based on client needs and calls for cannot serve as a proxy for service. Clinicians had rotating on-call addressing violence and its schedules to provide round-the-clock immediate impact on family crisis-response capacity. All members; participation in the program was • Services to the primary victim voluntary for all families. Four levels of and the child should be treatment services were available: acute integrated; and crisis contact, crisis intervention, engagement/brief treatment support to • Ongoing, supportive case link clients to resources within the management services must be community, and intensive treatment available to the family when the support based on a wraparound family is ready to engage treatment model. (Spokane Safe Start Initiative,

2005, p. 30). Crisis contact involved obtaining

information available from the agency As a result of the community (e.g., law enforcement) that identified planning process and outcomes, the the family for possible clinical Spokane Safe Start grantee developed a intervention; because contact with the service delivery model in which three

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COT was strictly voluntary for families, information for a large, but unknown, The Spokane Safe Start percentage of families was limited to identification process succeeded for a what the referring agency knew and number of reasons. First, Spokane’s law could legitimately share with the Safe enforcement agencies (both city and Start grantee. Crisis intervention county) had a history of implementing involved actions/outcomes with community policing. This history, which voluntarily engaged families to address provided entrée for Spokane Safe Start, the crisis events that brought the family included working with university to the attention of Safe Start. Following partners to implement a Neighborhood crisis intervention, some families were Resource Officer program along with the willing to receive ongoing support from S.A.R.A. (scanning, analyzing, the crisis response team specialists responding, assessing) model of data through an engagement/brief treatment analysis to improve the effectiveness of support set of activities. policing. Utilizing the S.A.R.A. method, Safe Start leadership worked with key In the identification process, leadership in both city and county law police officers responding to crisis calls enforcement to look at Spokane 9-1-1 played a key role. In most situations systems of crime reporting, to effect involving family and other violence, change in policy regarding how officers only the officer at the scene sees the respond to domestic violence and child child. Therefore, using law enforcement abuse cases. This analysis resulted in as the gateway for identification and change to police officer practice when referral provided Spokane Safe Start responding to family violence calls. with access to families that had no prior connection with the social service Second, after officers were system through Child Protective trained on issues of children exposed to Services. The Safe Start grantee was violence and how to respond to calls to initially unprepared for the types of protect children present during a violent children and families identified through incident, Safe Start leaders participated law enforcement. Of the first 132 in police roll call periodically, to share families identified, only five had CPS accomplishments with children and involvement. Most of these children and families identified by police, thereby families were “invisible” because child reinforcing training concepts. As one welfare and other child serving systems law enforcement official stated, “This are organized around legal definitions of education and training of police has no a “problem”. The vast majority of additional cost to the police or the Spokane Safe Start’s children exposed to program (Association for the Study and violence were, as a result, hidden in the Development of Community, 2006, p. system. They became visible through 13).” The result of the Spokane Safe the work of the COT whose definitions Start grantee’s history, collaboration, of the “problem” were not restricted to and training was buy-in from law solely addressing the legal issues enforcement, particularly mid-level children and families faced (Association administration (i.e., lieutenants), who for the Study and Development of became “cheerleaders” for children Community, 2006, p. 10). exposed to violence. These mid-level

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officers made significant inroads into the Dependency Court judges and child police culture, increasing the number of welfare and 2) incorporating information referrals by law enforcement to the Child on children’s exposure to violence into Outreach Team. the training for a recently funded statewide initiative focused on judicial Finally, Safe Start was leadership (i.e., the Court Improvement instrumental in increasing the level of Project [CIP]). regard between law enforcement officers and clinical personnel. Over the course An initial joint proposal of the of the initiative, these groups developed Spokane Juvenile Court and the Spokane mutual respect, which led to a team Child Welfare Office to the U.S. approach to identification, referral, and Department of Justice to develop data ultimately treatment of children exposed systems within Juvenile Court to track to violence. For example, to satisfy the and support the Adoption and Safe needs of law enforcement officers, Families Act (ASFA) implementation Spokane Safe Start’s COT members was unfunded. Nevertheless, CAFRU- agreed to provide response times to Safe Start moved forward with a scaled crisis calls “faster than a tow truck.” down version of the original plan. Safe (Association for the Study and Start, the Child Welfare Office, and Development of Community, 2006, p. Juvenile Court pooled funds to plan and 13). Evidence suggests that the create a web-based system to enhance relationship between the law the capacity of judges to make more enforcement and clinical sectors holistic decisions on behalf of children provided the key to success for in the dependency system, where implementation of the Spokane Safe children’s exposure to violence is an Start service delivery model, by offering historical issue in Child Protective law enforcement a trusted entity to Services cases. As of this writing, which to refer children and families. Juvenile Court had completed work on a conceptual design for a web-based 6.4 Juvenile Court System information system that will combine information from multiple sources Restructuring of the child welfare involved in dependency proceedings and system at the local level encountered make that information available to significant barriers during the judges in real time. The majority of this implementation of Spokane Safe Start. work was vetted with the Dependency While Safe Start staff and partners Policy Review Committee, a group viewed the child welfare system as an whose endorsement will be necessary to important sector to engage, they move the project toward approval and determined that critical strategies for adoption. National Council of Juvenile child welfare reform would not be and Family Court Judges (NCJFCJ) feasible at the time of the initial worked closely with Safe Start partners implementation of the initiative. An as a consultant to this process. While alternative approach to the child welfare development of the database is currently system, however, was undertaken on hold, future efforts to complete this through 1) development of a web-based project are planned. database to be shared between

Association for the Study and Development of Community 233 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

As a by-product of the web- Spokane County Regional based database project, the Washington Domestic Violence Team State Office of Administrator of Courts provided a significant number of selected Spokane as one of its five Court referrals for Safe Start. At the Improvement Project sites. The CIP time of this writing, the primary provided consultations with Serena domestic violence provider in Hulbert (NCJFC consultant), which were Spokane, the YWCA, was in a major factor in the development of discussion with Safe Start staff judicial leadership within Spokane about co-location of advocacy Juvenile Court. Judges and and Safe Start services. commissioners began to embrace an • Expansion of family enhanced role at the local level in setting programming. In a departure standards and enforcing accountability from the traditional center-based among all parties to dependency actions. model, the Spokane Safe Start Court review schedules changed, and grantee provided a family- there was discussion of other focused, child-centered program adjustments in local court rules, intended with the capacity to meet with to force more expeditious resolution of families in their homes and in the permanency goals for children in state community. custody. As a result of the Safe Start • Increased funding for children grantee’s consultation with Juvenile exposed to violence services. In Court and abuse/neglect training partnership with the Safe Start provided to its commissioners, the sitting grantee, the Spokane County judge mandated that dependency reviews Community Network received a change from every six months to every $220,000 grant from the Family two months. These changes at the local Policy Council. This grant level are expected to drive a similar targeted children six to 12 years review of current dependency policies at of age exposed to violence, and the state level (Spokane Safe Start served 185 children in 61 Initiative, 2005, p. 33). families in 2001 and 2002. Services included counseling, 6.5 Other Systems Change tutoring, in-home visits, and Activities respite services. Most of this work occurred in the Spokane As a result of the work of the Valley catchment area and Spokane Safe Start grantee, several involved partnerships with the additional activities laid the groundwork Children’s Home Society, local for future systems change for children schools, and the Spokane Valley and families, particularly children Community Center. exposed to violence: Although Spokane Safe Start • Expansion of domestic violence staff and partners made gains in programming. All Safe Start sensitizing child- and family- serving child outreach specialists were agencies to the needs of children trained in safety planning by a exposed to violence and their families, domestic violence advocate. The the political and economic conditions in

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the state of Washington, and particularly in Spokane County, could thwart these gains. During 2005, there was almost no dialogue between the state system and the community about core community concerns. Despite repeated attempts by the Safe Start grantee to engage formally with the state system, only line staff and supervisors demonstrated interest in making referrals to Safe Start. The state child welfare agency resisted engagement with a comprehensive agenda for children exposed to violence. The Children’s Administration experienced a $13 million budget shortfall, which resulted in a regional budget reduction of $3.1 million in the Spokane area (Spokane Safe Start Initiative, 2005, p. 52). All of these factors led Spokane Safe Start staff and partners to describe the state of affairs in 2005 as a “free fall of funding” and put the future of Safe Start in limbo.

Association for the Study and Development of Community 235 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

7. Institutionalization of participated in Spokane Safe Start. Change Specifically, through the Mental Health Family Violence Screening Study Despite the “free fall of funding,” described above, over 90 therapists in the vision for carrying out the work of four agencies received training on the Spokane Safe Start focused on effects of chronic violence exposure on continuing screening studies to assist children and the use of an appropriate local agencies in using data-driven screening protocol. It is anticipated that decision-making, through data analysis these efforts will result in a plan to and economic impact analysis, to create create a universal screening protocol for the case for sector-based systems children’s exposure to violence within change. Spokane Safe Start developed a the mental health system of Spokane, product (i.e., the screening study) and allowing all children seeking services tools (i.e., training) to take the work of through the public mental health system the initiative to other sectors to be screened for chronic violence (specifically, early childhood education exposure. In addition, training providers and substance abuse agencies). Evidence in treatment methods for children points to the funding of the Teen Peace exposed to violence and their families program as an example of the efficacy of has been identified as critical to this approach. In addition, according to institutionalizing change for these Spokane Safe Start staff and partners, children and families. this approach increased awareness within local agencies of the impact of Although the Spokane Safe Start exposure to violence on children. As a grantee made significant strides within direct outcome of the Spokane Safe Start the mental health, juvenile justice, and collaboration, over 70 agencies with substance abuse arenas, outside the nearly 3,000 individuals from the fields scope of the Mental Health Family of law enforcement, mental health, Violence Screening Study and an substance abuse, education, child upcoming screening study for the welfare, and the justice system received chemical dependency/substance abuse training in children’s exposure to system, the grantee was unable to violence in the state of Washington document the extent of follow-up by (Spokane Safe Start Initiative, 2005, p. staff within each agency/system 27). Other institutionalized changes are (Spokane Safe Start Initiative, 2005, p. outlined below. 42). Therefore, the long-term impact on children and families receiving Safe 7.1 Point-of-Service Change Start services cannot be determined.

According to Spokane Safe Start 7.2 Service Integration staff and partners, systems change activities at the point-of-service level To promote service integration, (i.e., delivery of treatment for children the Spokane Safe Start grantee adopted exposed to violence) resulted in several strategic approaches. Rather than improved identification, assessment, and attempting widespread service referral of children exposed to violence integration immediately, a sector-by- within each agency/system that sector approach for systems change was

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undertaken, with service integration as an endpoint. The Spokane Safe Start Spokane Safe Start worked to grantee, through its convening capacity, develop several multi-system protocols. promoted relationship building as a The following efforts are examples of means through which services could be the types of multi-system protocols integrated. Training served as an directed at agencies serving children and effective means of increasing the families: knowledge and awareness of children exposed to violence across categorical • The Mental Health Family systems and institutionalizing a desire Violence Screening Study was for increased integration. In addition, intended to lead to the cross-agency protocols were developed. development of a universal screening protocol for children’s Over 70 agencies in the Spokane exposure to violence within the region received training through mental health system. (See the Spokane Safe Start. During planning and section on systems change for a implementation phases, the Safe Start description of this screening grantee conducted three community- study.) wide trainings/meetings; a week-long • Despite barriers and limitations, training at Yale for collaborative the Spokane Safe Start grantee partners, including law enforcement; and experienced significant success an immersion training for clinical staff in developing local applications and law enforcement prior to of integrated service treatment implementation of the service delivery models for high-risk children and model. Other trainings included ongoing families. ”Integrated services” in child witness trainings with the Spokane refers to cross- Domestic Violence Consortium and disciplinary and often co-located trainings on attachment and the service delivery strategies using a developing mind. In addition, a number client-empowerment strategy of mental health providers requested and referred to as Individualized and received training for nearly 125 Tailored Care (Spokane Safe clinicians. Chemical dependency Start Initiative, 2005, p. 28). professionals and paraprofessionals also were trained in children’s exposure to 7.3 Policy Change violence and family violence issues (Spokane Safe Start Initiative, 2005, p. While efforts to promote change 22). at the state level were unsuccessful due to the political and economic conditions The Spokane County Sheriff’s in Washington during the Office allowed Safe Start staff to train implementation of Spokane Safe Start, 209 Sheriff Department employees the Safe Start grantee was able to during their quarterly in-service rotation. develop child- and family- friendly Additionally, all law enforcement policies at the local level, for example: personnel in the county and city were provided training in the purpose and use • The Spokane Safe Start grantee of Safe Start. was instrumental in the

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development of a model juvenile practice of rotating judges into court agenda and the Juvenile Court for one-year development of a prototype for assignments. The current judge is an integrated management committed to finding ways to information system for the work more closely with child Spokane County Juvenile Justice welfare and is asserting her Administration. leadership to move the • Due to Safe Start, 9-1-1 dispatch dependency agenda in that operators began to record the direction. presence of children at domestic • The Office of the Administrator violence incidents and report this of Courts (OAC) database was information to the dispatched validated, and work to analyze officer. In addition, reports 1,100 prosecutions was electronically transferred to completed. This research into sheriff and police dispatch were prosecution/sentencing outcomes annotated to remind officers to carries specific implications for make referrals, as appropriate, to decision-making among judges. Safe Start. • The Juvenile Court administrator and the presiding judge adopted a 8. Increased Community policy structure for decision- Supports making within Juvenile Court. Juvenile Court also committed to Prior to Spokane Safe Start, developing information systems services for children living with that will be used to provide domestic violence were limited. As a judicial officers with better result of the work of the Spokane Safe information about the movement Start grantee, all families, particularly of children through the system. “invisible” families, gained access to The collaborative relationship services for children exposed to between the Safe Start grantee violence, whenever the family is “ready” and the juvenile justice system to engage in services. The Spokane Safe assisted in this overall process Start grantee also contributed to a and will be tapped to provide general sense of heightened awareness ongoing training and technical of the impact of exposure to violence on assistance to judicial officers children, particularly among law within the juvenile system. In enforcement, clinicians, social service addition, Juvenile Court and providers, and the judicial system. child welfare agencies are working to find ways to share The presence of Safe Start in the data related to case movement Spokane community significantly and the Adoption and Safe increased the availability of services to Families Act (ASFA)compliance. families and children affected by An ongoing major strategic domestic violence. The majority of Safe objective for the Safe Start Start families were previously unknown grantee is to convince Spokane to the formal social service system, and Superior Court to end the many were unaware of the services

Association for the Study and Development of Community 238 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

available to them. By contrast, the Safe In fall 2002, the Child and Start Child Outreach Team engaged Family Research Unit, in partnership families in multiple services in the areas with the Spokane County Domestic of trauma, mental health and counseling, Violence Consortium, Spokane Police substance abuse, health, education, Department, and Spokane Sheriff’s career development, subsistence needs, Office, received a grant from the Centers domestic violence advocacy, and legal for Disease Control and Prevention to assistance. study the effects of domestic violence in the workplace; the collaboration to The Safe Start grantee received obtain this grant was a result of Spokane referrals from law enforcement, child Safe Start and it funded portions of the welfare, public health, Head Start, study. More than 1,000 employee education, domestic violence advocates, surveys were completed via a random and the justice system. The Child digit dial process. Specific interest in Outreach Team and CAFRU staff outcomes from the National Institute of actively conducted outreach to program Occupational Safety and Health resulted providers and law enforcement about in application for a separate grant to Safe Start. As of this writing, Safe Start create a companion effort in Boise, remained the only program in Spokane Idaho as a control community. County specializing in serving children Dissemination of information from this exposed to violence. Juvenile justice, study’s findings will work to strengthen child welfare, and Safe Start, however, broader system change efforts. In have discussed the development of addition, this study offers evidence of future programs. success in creating the means for corporate engagement in the Safe Start Several funding opportunities mission. resulted from the work of Spokane Safe Start staff and partners. In partnership Evidence from the random digit with the Safe Start grantee, the Spokane dial survey demonstrated that County Community Network received a interpersonal violence is a widespread $220,000 grant from the Family Policy event with significant health, Council. This grant targeted children six employment, and legal impact in the to 12 years of age exposed to violence, lives of a significant minority of and served 185 children in 61 families in residents. In both Spokane and 2001 and 2002. Snohomish Counties, 41% of participants reported minor children Leaders in the Spokane human living in their household in the past 12 services and law enforcement months. Based on estimates of lifetime communities consistently demonstrated prevalence and annual incidence of support for Safe Start through continued interpersonal violence, children in these participation in community meetings. counties live with an adult lifetime Leaders in the fields of juvenile justice, victim of interpersonal violence in an mental health, child welfare, and estimated 15% of households. On an Spokane County committed to annual basis, 6% to 9% of the partnership and program development. community’s households with children have an adult who has been a victim of

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intimate partner violence in the past 12 family- serving agencies. Safe Start staff months. Spokane Safe Start staff identified that multiple systems often suggested that the research findings collected the same data for broadly support the contention that community disparate purposes; organization and awareness has increased due to the storage problems confounded efforts to media campaigns produced by the retrieve even the most common Spokane Domestic Violence elements. While some pieces of data Consortium. collected by county-administered systems (e.g., mental health) were Within the professional comparatively accessible, data from community, specifically among child- corresponding systems administered at serving agencies, there was a significant the state level (e.g., child welfare) were increase in awareness of Safe Start not accessible at all at the local level. services for children exposed to violence Therefore, according to Safe Start staff, over the course of the initiative, as it was impossible to engage in a basic reflected in the steady increase in pathway analysis or aggregated referrals from program inception. descriptive study of families exposed to violence (Spokane Safe Start Initiative, 2005, p. 29). 9. Reduced Exposure to Violence 10. Reduced Impact of The Child Outreach Team Exposure to Violence engaged approximately 991 children in Safe Start services between 2001 and Spokane was not able to study 2005. A total of 36 families was referred the effectiveness of its intervention to the longitudinal study; of these, 18 approach to reduce the impact of families participated, with only a single violence exposure on children. Although family completing the study. Therefore, the Child Outreach Team was able to no meaningful post-treatment data could engage many families in services be obtained, and there is no evidence of through its voluntary engagement reduced exposure to violence. Factors approach, not all of these families chose that contributed to clinicians’ inability to to participate in the Spokane Safe Start refer families to the longitudinal study grantee’s longitudinal study. Of 18 are explained in Exhibit X-C. families referred to the study and assessed at baseline, only one completed Spokane Safe Start staff the study. Therefore, the Spokane Safe attempted to analyze outcome data from Start grantee described this study as systems with some level of unsuccessful. responsibility for the issue of family violence. While an incredible volume of data was collected, most of the data were not immediately or easily retrievable to answer the simplest of questions regarding children and families documented in the records of child- and

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11. Conclusion the goals of the Safe Start implementation plan. Safe Start staff and partners identified four areas of significant • Social Informatics Strategy accomplishment: " Spokane Safe Start • Training leveraged its resources to gather information (e.g., " The Spokane Safe Start needs assessment, trends, grantee, over its five and descriptions). years of implementation, Analysis of community trained 4,000 to 5,000 trends provided useful people (professionals, information about what clinicians, and conditions existed at the community members) on community level and the implications of, established a baseline for symptoms of, and implementing and treatment options for measuring change. children exposed to violence. " The social informatics strategy process included: " The grantee implemented 1) defining the data two full cycles of training design process with a for every law joint committee enforcement officer in the composed of key city of Spokane and stakeholders, 2) Spokane County. systematically collecting data, and 3) using data in " Every mental health discussion with key provider in Spokane stakeholders and agencies County received at least where change would be three cycles of training, initiated. including five full-day trainings and one half-day " A social informatics training. These trainings strategy was perceived as brought together over 250 the most effective means leaders in the field of of promoting systems children exposed to change in Spokane. The violence in Spokane and Spokane Safe Start Spokane County. grantee indicated that a dual strategy of systemic " Every conference and grassroots delivered by the Spokane mobilization for change Safe Start grantee was difficult to included a planning accomplish with the component that followed resources available. The

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grantee anticipated a next successfully served as a step with greater gateway for the grassroots involvement, identification and referral particularly with regard to of children involved in examining the early care domestic violence and education sector as a incidents. The model gateway for identification garnered the support and and referral for children buy-in of both senior exposed to violence. administration and mid- level administrators " The Spokane Safe Start within law enforcement. grantee will collected six years of data on Spokane • Significant systems change County to compare with similar sectors in western " The Spokane Safe Start Washington, which can grantee successfully be used to leverage and launched systems change increase state funding for initiatives in three key children and families. sectors of its partnership: 1) Juvenile Court through • Adaptation and the Court Improvement implementation of Child Program, 2) law Development-Community enforcement through the Policing adaptation of CDCP, and 3) mental health services " The Spokane Safe Start through training and grantee, according to improved screening for project leaders, developed children exposed to the largest single violence. Each of these adaptation of CDCP sectors developed a outside of New Haven, protocol for identifying Connecticut, primarily children exposed to because Spokane and violence, a process for Spokane County law asking the right questions enforcement could not of children and parents bring the same level of involved in a crisis (e.g., personnel to the domestic violence) application of CDCP and, situation, and an therefore, implemented understanding of the CDCP in a larger ways to promote change population with fewer within its sector law enforcement (Association for the resources. Spokane Safe Study and Development Start effectively of Community, 2006, implemented and adapted pp7-9). the CDCP model, which

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The Spokane Safe Start grantee • Engage a maximum of 75 received referrals for 669 families and corporate and civic leaders in 1,214 children between December 2001 education and discussion of these and December 2005. Of these families, issues, and begin the process of approximately 72% or 482 families and creating consensus about the their children received services from the financial impact of reductions, Child Outreach Team in the form of at cost shifts, and cumulative losses least one contact. The COT only referred to capacity and human capital; 36 families for participation in the • Create task groups made up of longitudinal research study (7.5% of corporate and civic leaders those eligible). Of these families, only whose responsibility it will be to 18 families participated in the outcome develop models for local support research. and governance of social and health service support systems, Although the law enforcement, which do not rely on current juvenile court, public health, and categorical funding for core substance abuse systems have embraced support; the Safe Start agenda, Spokane Safe • Use data gathered by CAFRU Start staff and partners lack a cohesive related to Safe Start, criminal vision for future funding and program justice prosecution, workplace development around the major issues domestic violence, and other affecting the healthy development of information developed by the children and the capacity to support and Spokane Regional Health serve their families. Outlined below are District, to demonstrate not only the proposed activities to be conducted how the funding paradigm has by Safe Start partners to enhance the changed, but also how the former future implementation of the mission paradigm for funding and and goals of Spokane Safe Start: categorical programming no longer fits the most current • Gather information from all understanding of marginalized relevant systems to determine populations; specific reductions to capacity, • Conduct an initial one-day including regulatory changes that conference to define core issues have occurred over the last five and create consensus about years; response (late January 2006); and • Develop a specific problem • Create a single plan for the statement related to the impact of development of local support and these changes on marginalized local governance of a unified populations that share risk factors funding stream to create for children’s exposure to interventions for children violence (e.g., family violence, exposed to violence whose substance abuse, mental illness, families share a combination of poverty) and demonstrate how risk factors that include poverty, reductions in one system create family violence, substance abuse, specific cost shifts to other and mental illness (Spokane Safe systems; Start Initiative, 2005, p. 20).

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to identify and provide services to over During the five-year 1,100 children and their families. Strong implementation of Spokane Safe Start, relationships were developed among the partners tackled critical tasks to partnering agencies, resulting in the change systems and provide services for funding of one partner for a program children exposed to violence. To create focused on adolescents. In addition, long-term systems change, they Safe Start staff collected a large database implemented a sector-by-sector of information regarding children approach. Sector-specific data, exposed to violence. combined with training around issues of children exposed to violence, was the Spokane Safe Start partners basis of this approach. The major recommend that federal partners find a learning from this approach is the added way to continue funding for this type of value of gathering information for program longer, without a competitive decision-making for social problem re-granting process, particularly if solving. Further, a sector-by-sector projects are demonstrating success. The approach has impact across sectors, as Safe Start partners also suggest re- evident in the impact of training court ordering the priority for the discussion of officers in judicial leadership on child children exposed to violence at the welfare system reform. professional (clinical) and community levels (i.e., discussion at the community Despite economic and political level should come first). obstacles, Spokane Safe Start was able

12. References

Association for the Study and Development of Community (2005). Site visit report: Spokane Safe Start Demonstration Project January through December, 2004. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2006). Site visit report: Spokane Safe Start Demonstration Project January 1st through December 15th, 2005. Gaithersburg, MD: Author.

Child and Family Research Unit (n.d.). Washington State University Spokane Child and Family Research Unit. Retrieved June 14, 2006 from http://www.spokane.wsu.edu/research&service/cafru/. N.A.T.I.V.E. Project (n.d.). The N.A.T.I.V.E. Project. Retrieved June 14, 2006 from http://www.nativeproject.org.

Spokane Safe Start Initiative (2005). Local evaluation report form. Spokane, WA: Author (Available from the Association for the Study and Development of Community).

Spokane Mental Health (n.d.). Spokane Mental Health. Retrieved June 14, 2006 from http://www.smhca.org/.

Association for the Study and Development of Community 244 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

U.S. Census Bureau. (2000). U.S. Census Bureau Spokane County, Washington quickfacts. Retrieved June 14, 2006 from http://quickfacts.census.gov/qfd/states/53/53063.html.

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Exhibit X-A Timeline of Spokane Safe Start Initiative Activities and Milestones Major Milestone 1/01-6/01 7/01-12/01 1/02-6/02 7/02-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05

DC: 0–3 Mental Health Staff Trainings Early Childhood Education Assistance Program at Millwood Elementary School Children Exposed to Violence Trainings for State Child Protective Services Workers • Partnered with Eastern Washington University (EWU) to develop Children

Exposed to Violence Training Curriculum Stipend program created for Master of

Social Work (MSW) students at EWU Teen Peace Program Spokane Police Department Children Exposed to Violence Trainings Case Studies of Spokane Safe Start

Families Neighborhood Engagement Strategies (implemented & ongoing) Crisis Response Volunteer Resident-Based Programs Crisis Response Team (formed & ongoing) Pilot Study : The Incidence of Violence Exposure for Children Ages 0-13 Years Entering the Mental Health System Community Assessment Effort The Child and Family Research Unit (CAFRU) (established & ongoing)

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Major Milestone 1/01-6/01 7/01-12/01 1/02-6/02 7/02-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05

Children Exposed to Violence Data Collection, Training, and Curriculum Development Initiative with the Spokane Police Department Multi-agency Trainings & Discussions of Children Exposed to Violence for Line Staff Male Involvement, Fathering, and Batterer Accountability Collaborative Initiative • Male Involvement Task Group formed • Fathering Conference Outreach Program with Spokane Domestic

Violence Coalition Entered Agreement with Spokane County’s 9-1-1 Emergency Calls Dispatch Center Mental Health Family Violence Screening Study (ongoing)

Sources: Spokane Progress Reports, January-June 2002, July-December 2002, July-December 2003, July-December 2004, January-June 2005; Spokane Safe Start Strategic Plan, 2002; Spokane Case Study 2004; Local Evaluation Form, 2004, 2005.

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Exhibit X-B Identification and Referral Identification Law and Referral

Enforcement Alternatives to

Domestic Violence

Assessment & Treatment

Spokane Safe Start Child Outreach Service Delivery Team •Spokane Mental Health •Partners with Children & Families Model •NATIVE Project Identification Identification and Referral and Referral Child Protective Other •Self referrals Services* •Schools Hospitals

Judicial •Dependency Court

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Exhibit X-C Spokane Safe Start Intervention Research

Overview

The Spokane Safe Start grantee adapted the New Haven Child Development- Community Policing (CDCP) model and established a clinical team known as the Child Outreach Team (COT). Through the COT, Spokane Safe Start funded five clinicians housed within the Spokane Safe Start partner organizations: two positions in Partners with Families and Children, two positions in Spokane Mental Health, and one position at the NATIVE Project. The COT’s primary purpose was to respond to crisis calls as reported by the police and the 9-1-1 call center. The response included treatment and follow-up services to families who engaged in services voluntarily. Common treatment used by clinicians included acute crisis contact, crisis intervention, brief treatment support to link clients to resources within the community, and intensive treatment support based on a wraparound treatment model. Families were to be assessed on nine different occasions through their participation in the study: at baseline and 3, 6, 9, 12, 15, 18, 21, and 24 months after baseline.

Intervention

Families that engaged in treatment with the COT were approached by a COT clinician to participate in a follow-up longitudinal study with the Spokane Safe Start grantee. The longitudinal study sought in-depth descriptions of the impact of Safe Start services; the children and families identified through the COT; the type and intensity of the services developed for the families; and the program and participant characteristics that influenced access, acceptability, and impact of the program. Families who agreed to participate in the study received ongoing support from COT clinicians, who created a support plan for the families and engaged them in brief or intensive treatment support services.

Methods

Caregivers and children were assessed in four areas: demographic and historical information, adult affective and behavioral measures, child affective and behavioral measures, and child-caregiver relationship measures. A variety of tools were used to assess each of these areas, including: Starting Early Starting Smart (SESS); Brief Symptom Inventory; Conflict Tactics Scale; Post-Traumatic Stress Scale for Family Violence; Alcohol and Other Drugs (AOD) Screener; Addiction Severity Index; SESS Services Access Utilization and Satisfaction (SAUS) survey; Battelle Developmental Inventory; Achenbach Child Behavior Checklist (CBCL); DeGangi Infant Toddler Behavior Checklist; Social Skills Rating System; Parent-Infant Relationship Global Assessment Scale; Conflict Tactics Scale Parent-Child; Family Adaptation and Cohesion

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Scales III (FACES III); Parenting Stress Inventory; Parenting Discipline Index; and HOME. Sample

During a four-year period, the COT referred only 36 families out of a total of 669 to the research study. Of these 36 families, only 18 participated in the study.

Results

The COT referred only 36 families to participate in the research study. These 36 families represented only 7.5% of those eligible for the study. A total of 18 families agreed to participate in the study, receiving the baseline assessment. Only one family completed all nine assessments. Other families received assessments at the following marks: twelve families were assessed three months after baseline, five were assessed at six and nine months after baseline, six families were assessed 12 months after baseline, four were assessed 15 months after baseline, and only two families were assessed 18 and 21 months after baseline.

Discussion

The Spokane Safe Start grantee pointed to the following factors that affected the low referral of families:

• Spokane Safe Start’s recruitment strategies via clinicians were not effective (e.g., clinicians were requested to approach families about the study during the third or fourth visit, but most families were approached as early as the second visit); • Many families discontinued services prior to being approached about the study; and • Clinicians failed to understand the importance of the research for sustainability efforts.

The Spokane Safe Start grantee acknowledges that the data gathered are not sufficient to conduct statistical analysis and, as a result, the longitudinal study was not successful.

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XI Washington County Safe Start Initiative

1. Overview follow through, limiting the effectiveness of the intervention. Washington County Safe Start, better known as Keeping Children Safe Furthermore, KCSD’s goal to Downeast (KCSD), has been the leader increase awareness of children exposed in Washington County in raising to violence was met by providing a awareness around issues of children’s series of trainings with the latest exposure to violence. Prior to KCSD, information on children exposed to talking about issues of domestic violence violence for service providers, teachers, and child abuse and neglect was a taboo. law enforcement, and community The KCSD has created the foundation members and successfully managing for systems change and service several public awareness campaigns integration in Washington County by targeting parents and children improving the way that key throughout the community. While the organizations and agencies that serve results of these trainings and campaigns children and families work together, cannot be measured, a total of 3,779 enhancing existing services to more service providers were trained and a effectively identify, and respond to great number of community members children exposed to violence. were reached through media vehicles such as radio announcements, posters, KCSD’s efforts to improve brochures, etc. (Keeping Children Safe services for children exposed to violence Downeast, 2005a). included identifying a point of entry into mental health treatment for children six The KCSD was instrumental in years of age and younger. The KCSD the development and implementation of contracted with Washington County both state and local policies focused on Psychotherapy Associates (WCPA) by creating community based resources for reserving slots for children referred for families to address children’s exposure services through KCSD. These children to violence. For example, both the Child were treated as soon as they were Abuse Network Council and the Maine identified instead of being placed on a Department of Health and Human waiting list. This method was intended Services adopted a mandated reporter to improve services in various ways: 1) trainer curriculum statewide developed children were to be linked to services by the KCSD . Through KCSD’s within 72 hours of being identified and advocating efforts, Washington County 2) children were to be immediately seen became the second county in Maine to by a clinician. However, families viewed adopt a 211-info line. Through the the process as too bureaucratic and support of the District Attorney’s office invasive of their privacy and did not the Passamaquoddy Tribe championed forensic interviewing as a tool for

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interviewing children exposed to violence. Forensic interviewing prevents Children Safe Downeast was re-victimization of the child and planned and implemented within the promotes faster prosecution of the unique context of Washington County, perpetrator. This tool has been accepted Maine. This snapshot of Washington by law enforcement and court personnel County is intended to help others who in Washington County. Five forensic may be interested in replicating Safe interviewing rooms have been instituted Start compare their own communities to in different locations around the county. Washington County.

With KCSD’s funding coming to Washington County, also known an end, its staff, board members, and as “Sunrise Country,” runs along the collaborating partners have worked to eastern shore of Maine and is the most create a sustainable plan so that the work northeastern point of the United States. of the KCSD will carry on. Two Adjacent counties in Maine include agencies, Regional Medical Center- Hancock County, Aroostook County, Lubec and Washington Hancock and Penobscot County, and in New Community Agency, signed a Brunswick, York County and Charlotte Memorandum of Understanding to County. With a population of about manage KCSD’s trainings and 33,941 residents, the county has a total campaigns, search for funds to sustain area of 3,255 square miles of which KCSD, and to keep the issue of children approximately 2,568 square miles is exposed to violence at the forefront of land. There are 47 towns in Washington everyone’s minds. County, ranging from as many as 4,000 people to as low as only 10 individuals. 1.1 Mission Although a large percentage of The mission of KCSD is “to the county population is European advocate for, and respond to, children American (93.4%), the county has two exposed to, or impacted by, violence by Native American communities: committing to, or supporting, Passamaquoddy Pleasant Point prevention, intervention, and treatment Reservation (population 640 with 88% strategies” (Keeping Children Safe Native American, according to the 2000 Downeast, 2004). How did Washington Census) and Passamaquoddy Indian County Safe Start accomplish this Township (population unknown), mission and with what success? What together accounting for 5% of the factors contributed to and impeded county’s population. The two success? These questions are addressed Passamaquoddy reservation sites share a in the following sections of this report, tribal council and are located in two and a timeline of major events is different parts of the county (Princeton attached (Exhibit XI-A). and Perry).

1.1 Washington County, Maine1 Approximately 8% of Washington County’s population is

1 The information in this section was reported in children under six years of age. The the local evaluation report form (Keeping Children Safe Downeast, 2005b, p. 3-7).

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median household income as reported in and forestry industries. Many of these 1999 was $25,869 or 38% less than the jobs are seasonal and depend on seasonal median household income for the entire workers, which include immigrants, who United States. Approximately, 14.2% of come and go based on the need. The families in Washington County or 19% service sector is also a main source of of the individuals in the county live income for many. People in the service below poverty level, compared to 9.2% sector tend to work for non-profit and 12.4%, respectively, for the United organizations, hospitals, health care States. Of the families that live below centers, the county’s university or the poverty line, at least 4.2% have college, and industries such as retail, children under five years of age. transportation, and construction, among others.

2. Contextual Conditions As a result of statewide economic problems and changes in state Several factors had a significant level leadership, the Department of impact on the implementation of the Health and Human Services (DHHS) is KCSD demonstration project. in the process of restructuring. As part of Washington County differs greatly from the restructuring process, DHHS has other Maine counties. The large size, reduced their programming and staffing rural character and low population levels, resulting in overburdened staff. density of Washington County impacts A decrease in state Medicaid funding service delivery, particularly services further reduced resources and staffing of that address issues of responding to behavioral and mental health services for instances where children are exposed to children. An example of this is the recent violence. Lack of a strong economic merge between the Department of infrastructure in Washington County Human Services and the Bureau of contributes to increased poverty. A lack Behavioral and Developmental Services of official statewide policies regarding to form the Department of Health and children exposed to domestic violence Human Services (DHHS). Overall, it is contributes to increased harm for perceived that the merging of these key children. Other political, social, and social service agencies reduced the economic contextual conditions amount of resources available for all affecting the development and social services in Maine leading to implementation of KCSD are explained competition between agencies for below. limited resources. Competition for resources has created tensions between 2.1 Economic and Political agencies in the past, which has resulted Context in lack of cooperation.

Washington County is among the poorest counties in Maine and in the nation. It relies heavily on its natural resources as a base for its income. Many people work in the blueberry and cranberry fields, as well as in the fishing

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2.2 Social Context Many contextual conditions described above contribute to the lack of Geographic isolation of community capacity in Washington Washington County families contribute County. Site visit participants indicated to the underreporting of issues of that although there are social services for domestic violence and children exposed families and children, these services are to family and community violence. located in larger towns of the county and According to site visit (2005) not easily accessible. During one of participants, families in Washington KCSD’s initial strategic planning County tend to be very private about meetings (2000), participants discussed their lives. Seeking help outside of the the system of care that was in place in family is considered taboo. Linking Washington County. They concluded families to KCSD services, therefore, that while families were receiving was a challenge because of a resistance services from multiple agencies, there to reporting family violence incidents was a lack of communication and and seeking professional help from coordination between agencies about either law enforcement or child and these families. This lack of family serving agencies. communication and coordination often resulted in barriers to identification and A more recent problem in treatment. Other barriers that could Washington County, however, has been impede coordination included: a rapid increase in the use and abuse of prescription narcotics or OxyContins. • Incompetent and overburdened This has exacerbated the already staff problematic co-occurrence of substance • Frequent staff turn-over abuse and domestic violence because • Lack of funding OxyContins are highly addictive and • Turf between agencies induce extremely violent behavior in • Lack of integrated case users. Because the use of OxyContins managements has increased rapidly, statistics are not yet available; however, the Regional Following this meeting, the Medical Center at Lubec, a key partner KCSD invited key agencies to give in KCSD’s collaborative, recorded that educational presentations around the “…between 1997 and 1998-99 the type of services they provide and the clientele of the Regional Medical Center work they do, and they identified key at Lubec (RMCL) substance abuse trainings around topics of children’s programs throughout Washington exposure to violence that were needed in County changed from primarily alcohol the community. The Passamaquoddy abusers with 9% synthetic narcotic Tribe, the largest Native American Tribe abusers to 39% exhibiting abuse of in Maine, also invited collaborative synthetic narcotics” (Keeping Children members to an educational forum where Safe Downeast, 2004, p. 43). they explained the types of services available for tribal members. It was at this point that participants realized how 3. Community Capacity much work they had ahead of them regarding their cultural histories and

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differences, and the interface of service child and expediting the process by delivery systems on and off reservation. which the District Attorney’s office processed child abuse cases. Training and technical assistance was not part of KCSD’s plan until Throughout the project, the collaborative members realized that it KCSD partnered with Rapid Response, was an important factor missing in the local first responder team for Washington County. After conducting a domestic violence calls, to receive needs assessment, the initiative had a training and technical assistance on better understanding of the type of Child Development-Community trainings that were needed in the county, Policing (CD-CP) from the National which included: lack of understanding Center for Children Exposed to Violence agency functions, effects of neglect, and (NCCEV). James Lewis and a team from parenting courses, among others. the Yale Child Study Center traveled to Throughout the life of the initiative, Washington County and met with law KCSD trained approximately 3,500 enforcement and first responders to professionals in the fields of law discuss how CD-CP works in rural areas enforcement, education, social work, and such as Chatham County in North direct service providers in Washington Carolina. Also, the Rapid Response County. However, the big question that Team director attended a cross-site lingered throughout the strategic meeting in Sitka, Alaska where he met planning process was finding out the with police officers and reviewed the best way to reach a community that lived CD-CP program implemented in the in such a big area and in such isolation. rural city of Sitka. KCSD achieved this with its various campaigns, such as the Blue Ribbon In addition, in October 2003 and public awareness campaign, that January 2004 the Interdisciplinary Team involved local restaurants, as well as (IDT), KCSD’s cross-disciplinary group churches, and other local businesses. (described in more detail in later The KCSD also transmitted radio sections), held a conference with Dr. announcements that raised awareness Tom Wolff, an expert in community around issues of child abuse and neglect. collaboration, development, and sustainability. In this conference the Furthermore, the KCSD made team explored its organizational capacity available small grants for people and structure and identified several areas interested in attending trainings and that needed strengthening, such as conferences around topics of children’s decision-making, recruitment of new exposure to violence and abuse and members, and making the effort to work neglect. These small grants made it together outside the IDT. As a result, the possible for three professionals to attend IDT dissolved in order to develop a the Finding Words training that focused subcommittee structure to support the on forensic interviewing; an integration of activities among KCSD interviewing technique supported by service providers and incorporate Dr. Washington County’s District Attorney Wolff’s recommendations. The resulting and the Passamaquoddy Tribe as a way subcommittees formed were: of preventing re-traumatization of the

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• The Child Abuse Response Team of the KCSD . By the end of the federal (CART), which works on funding cycle for the KCSD , indications increasing the number of were that communication and successful prosecution of child understanding among key professionals abuse cases and assuring that in Washington County had improved children are not re-traumatized and commitment to continue the project by litigation processes. was evident (Association for the Study • The Mental Health Collaborative and Development of Community, (MHC), which examines the 2005b). emotional and mental health impact of violence on children Key child and family serving and families and works toward agencies and organizations and improving the referral process. professionals were initially engaged • The Multidisciplinary Team through the assessment and planning (MDT), which reviews recent phases and continued participating child abuse cases/calls and through the KCSD collaboration. Local brainstorms different ways to professionals were also engaged through improve the intervention process. cross-disciplinary and specialized training. Community stakeholders (e.g., Washington Hancock Community 4. Local Agency and Agency, Child Development Services, Community Engagement law enforcement) participated in the initial community assessment that was and Collaboration used to inform planning efforts and were engaged throughout the demonstration The KCSD used a diverse board project through social marketing combined with the subcommittee campaigns. structure described above to create opportunities for child and family 4.1 Engaging Key Child and serving institutions to build Family Serving Agencies relationships. They focused on and Organizations communication and understanding among key professionals in the system The KCSD Collaborative Board of care in Washington County. The consisted of 17 members and ability to bring together these key subcommittees including the individuals was cited as the single Multidisciplinary Team, Child Abuse biggest achievement of the KCSD , as Response Team, Training captured in the words of a KCSD community partner “if we can get all the same players at the same table communicating, then the Initiative will have made a huge difference for the children in Washington County.” Engaging key child and family serving agencies and organizations, professionals, and community stakeholders was critical to the success

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Collaboration, and Mental Health The environment of collaboration Collaboration. KCSD board and information sharing developed by membership included representation the KCSD helped decrease duplication from the following sectors: of services and brought to light gaps in services, which KCSD addressed • Passamaquoddy tribe through their systems change activities. • Child welfare As part of their collaborative efforts, the • Law enforcement KCSD developed a strategic plan and • Physical and behavioral health used their community assessment and • Domestic violence the diverse representation of their • Education collaborative members to identify existing barriers to services for children • Substance abuse and families in the community. The • Home visiting • KCSD worked to minimize the lack of Community members and inconsistent/inaccurate information • Community collaboratives regarding individual agency services among professionals and community The KCSD provided a members by increasing formal and mechanism for collaborating that did not informal links between agencies serving exist prior to the Safe Start families. This increased Demonstration Project. The KCSD communication identified the following collaboration structure created barriers to and gaps in services in opportunities for key professionals to Washington County: develop the trust needed to share their concerns and frustrations and become • Differences in philosophy of key knowledgeable about their peers organizations/agencies involved responsibilities and program restrictions. in the system of care for children This was a significant accomplishment and families in Washington because before Safe Start, organizations County in Washington County lacked a • Competition and turf issues mechanism for collaborating. An created by limited financial especially noteworthy accomplishment resources was that the KCSD developed a strong • Lack of tribal and non-tribal partnership with the Passamaquoddy agency cooperation Tribe through shared decision making • and joint planning and implementation Lack of knowledge about the of the forensic interviewing efforts, impact and appropriate response bridging tribal and non-tribal to children exposed to violence communities of Washington County for in the community • the first time. The KCSD also held Misperceptions of the monthly Board meetings about how Department of Human Services KCSD funds were being spent to make and the court system created the financial processes of KCSD reluctance to report incidents of transparent to all partners. This family violence involving transparency helped to create trust children among mandated between KCSD collaboration partners. reporters

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The KCSD planned to address parents in Washington County, primarily these barriers to and gaps in service by distributed by Family First Home developing an integrated case Visiting Nurses. The KCSD provided management system, in-home supports resources to other home visitors through and parent education, and best-practices the WIC program, and DHHS public programs to enhance and expand health nurses, pediatricians, hospitals services for children exposed to and other practitioners in the county in violence. KCSD’s initiation of the an effort to reach additional parents. Multidisciplinary Team, the Mental Health Collaborative team, as well as the “Parent education” was further Child Abuse Response Team established addressed through KCSD’s support and a foundation for a developing case promotion of the Second Step Violence management model currently being Prevention Curriculum in the county’s promoted and developed for statewide Head Start and K-3 programming. The implementation by Maine’s Department USDOE has recognized this program as of Health and Human Services (DHHS). a model intervention and prevention DHHS will support the piloting of a curriculum. The KCSD introduced this “Wraparound” model of integrated case curriculum into 25 preschools, Early management in the coming fiscal year Care and Education Programs, (ECEP), (2007); a model that relies upon the Family Child Care Homes (FCCH) and collaboration of service domains head start classrooms throughout represented by mental health, child Washington County. The Resource protection, domestic violence advocacy, Development Center (RDC), Family corrections, education and early child Resource Center (FRC) and RMCL have care providers. Washington County is committed to promoting and supporting poised to support the implementation of this curriculum as it is further introduced the Wraparound model due to the to K-3 classrooms to sustain the effort in structural systems enhancements the coming 3-5 years. Trainers have attributable to the sustained elements of been trained to provide on-going support the Multidisciplinary Team and the to new classrooms. Child Abuse Response Team. These enhancements improve the Washington The KCSD further addressed County’s prospect of successfully parent education by supporting Head developing, with the cooperation and Start and private childcare providers’ support of DHHS, a structurally sound development and implementation of a integrated case management system fatherhood curriculum for classroom within a 2 to 3 year period. teachers to address and enhance the parenting skills of fathers. The new The KCSD worked with existing Fatherhood Project serves families home visiting programs to improve whose children are enrolled in county outreach to new parents by developing Head Start and childcare programs and is the “Welcome Baby Bags” resource. estimated to have impacted 350 families This effort provided informational and 630 children. packages, including parenting education materials and new-parent resource 4.2 Engaging Professionals linkages to approximately 500 new

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The KCSD engaged and Mother’s Day cards and professionals from mental health, first other materials. responders, education, domestic violence, health and human services, law These efforts resulted in a slight enforcement, faith based organizations increase (7% from 2003 to 20052) in the community sectors through cross community’s perception that children’s disciplinary and specialized training. As exposure to violence is a major problem a result, 3,500 professionals in in Washington County3. Washington County are knowledgeable about the identification of and response The KCSD also engaged in to children exposed to violence. efforts to improve the system of care for children. These activities are discussed 4.3 Educating Parents and next. Community Residents

In order to engage parents and 5. System Change Activities community residents, The KCSD used social marketing campaigns to increase The KCSD has created the community awareness and knowledge foundation for systems change and about children exposed to violence and service integration in Washington resources available for addressing this County by improving the way that key issue. KCSD social marketing child and family serving organizations campaigns included: work together, improving the identification and referral of children • A Blue Ribbon Campaign to exposed to violence, and expanding and provide information on enhancing services at the local and state children’s exposure to violence level. As a result, 79 children exposed to in a variety of media including violence were identified by community newspapers, op-ed pieces, public agencies and referred to and treated by presentations, flyers on Washington County Psychotherapy developmental issues (birth to Associates between 2003 and 2005. six), resource information and community engagement Additionally, the KCSD was activities. In support of the instrumental in establishing forensic campaign the KCSD distributed interviewing to help keep children from wreaths with a single blue ribbon being re-victimized and improve the to churches and businesses to ability of the court system to hang in support of the campaign. successfully prosecute child abuse cases. The campaign was begun by the Regional Medical Center-Lubec (RMCL) during 2004 and continues by popular demand. 2 • Distribution of informative Seven percent represents a total of 28 people. 3 This information reflects the result of the placemats to restaurants, parent follow-up telephone survey to determine the packs, baby bags, and Father’s impact of these and other community engagement activities with households across Washington County.

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5.1 Creating a Culture of traumatizing children exposed to Collaboration violence. Forensic interviewing also contributed to the ability of the court The KCSD was successful in system to successfully prosecute child changing the culture of isolation to one abuse cases using the evidence provided of collaboration, and improving by children through the forensic communication between agencies and interviewing process. The use of forensic organizations. Site visit (2004 and 2005) interviewing in prosecution of child participants consistently cited abuse cases was the result of work by the collaboration as an important KCSD and through the support of accomplishment of KCSD. Organization Washington County District Attorney and agency staff became familiar with (CART chairperson). The each other’s roles and responsibilities Passamaquoddy Tribe provided through relationship building and resources to help the KCSD fully networking opportunities provided by implement forensic interviewing by the KCSD , the newly developed KCSD providing a location for the interviews to subcommittee structure (as previously be held. The adoption of forensic described) and cross-disciplinary interviewing as a standard practice in training opportunities provided by the Washington County is one of the most KCSD . The process of bringing together significant impacts resulting from the people from different agencies and new culture of interagency collaboration disciplines took longer than anticipated created by the KCSD . because of the long history of isolation that existed within Washington County. 5.2 Improved Identification However, evidence indicates that after and Referral of Children five years the culture in Washington Exposed to Violence County has changed. The culture of collaboration For example, forensic created by the KCSD set the stage for interviewing4, championed by the improved identification and referral of Passamaquoddy Tribe, was successfully children exposed to violence by implemented and will continue beyond partnering agencies. Training was used the federal funding cycle. Forensic as a strategy to improve the interviewing focused on preventing re- identification and referral of children in Washington County. A total of 3,500 4 Forensic interviewing is an investigative direct service providers were trained on process that safeguards the emotional, physical how to appropriately identify and and developmental needs of the child. The respond to children exposed to violence. investigative process includes two core As a result, 79 children exposed to components. First, investigators are trained to address the emotional, physical and violence were identified by five developmental needs of the child while obtaining community agencies (Child admissible evidence. Second, the interview with Development Services, Head Start, the child is videotaped and this recording is Family Counseling Services, Department admissible in court. Together, these components of Human Services, Rapid Response) reduce the number of times a child has to describe the traumatic event and participate in and referred to Washington County public testimony which could further traumatize Psychotherapy Associates for the child.

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assessment and services(Keeping slots increased the capacity of WCPA to Children Safe Downeast, 2005b). (See treat children exposed to violence XI-B for a diagram of the KCSD service through the KCSD referral process. This delivery model). is important because WCPA is the largest psychiatric treatment provider in The KCSD used another key Washington County and therefore strategy to improve the identification of typically has a waiting list for families children exposed to violence. This with a variety of mental health issues. strategy was the development of a Waiting lists for services are commonly mandated reporter curriculum that was two months or longer5. These reserved adopted state-wide. The curriculum slots provided critical services more developed by the KCSD for mandated quickly for children exposed to violence. reporter trainer was adopted statewide by both the Child Abuse Network Between May 2002 and Council and Maine Department of December 2005 KCSD served Health and Human Services. This state- approximately 5% of the children under wide on-going training effort will five years of age in Washington County contribute to improved identification (Keeping Children Safe Downeast, children exposed to violence in the 2005b). This represents a small number future. considering the KCSD estimate that approximately one third of the In order to improve community households in Washington County members’ ability to identify and respond experience some sort of family violence, to children exposed to violence KCSD with media and television perceived by engaged in social marketing campaigns, parents as the biggest sources of as previously mentioned, which exposure. The KCSD attributes the consisted of the development and small number to challenges created by a distribution of materials on issues related large county with limited resources, lack to children’s exposure to violence. of knowledge about organizations and agencies in the community, and a limited 5.3 Existing Services number of agencies knowledgeable about issues related to children’s The KCSD improved existing exposure to violence. services by infusing additional resources to enhance the number and quality of The KCSD records also may not existing local services. They also used reflect the full number of referrals made their strong leadership and working to the program because some referrals relationships with child-serving agencies for services were made without notifying to advocate and successfully implement changes in services at the state level. 5 This information is from the Muskie Evaluation Team Washington County Mental Health At the local level, the KCSD Capacity Assessment Report, May 2003. The improved the responsiveness of survey identified some 13 agencies that provide Washington County Psychotherapy child mental health services in Washington County although WCPA is the largest. WPCA Associates (WCPA) by funding slots for also may refer children for psychiatric services to children exposed to violence. Funding providers in the city of Bangor, a two hour drive from most towns in Washington County.

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KCSD. KCSD and Washington County Psychotherapy Associates tried to amend this issue by meeting with the referring 6. Institutionalization of agencies on several occasions and trying Change to improve the accountability of the referring/reporting system. However, System change activities inconsistencies between the number of implemented by the KCSD were families referred to services and the institutionalized in Washington County number of notifications of referrals in a number of ways. Most significantly, KCSD received were still found. KCSD began to make inroads into the culture of isolation that existed in In addition, the KCSD provided Washington County by bringing service training opportunities that focused on providers to the table to work together. ways to educate mental health The KCSD achieved this by facilitating professionals about changing referral the Interdisciplinary Team (IDT). As and treatment practices which was described before, the IDT dissolved expected to result in increased because of a need to form smaller sub- engagement of parents/caregivers with committees according to each agency’s the KCSD referral process. Finally, the interest and discipline. Some of these KCSD enhanced the capacity of local groups still continue. The Child Abuse criminal justice officials by providing Response Team (CART), for example, funds for digital cameras used for has been working with the District collecting evidence to support the Attorney in Washington and Hancock forensic interviewing process. County to institutionalize forensic interviewing and set a goal to train law At the state level, the KCSD enforcement and child protective increased the number and quality of workers on interviewing children in services available in Washington County Washington County and statewide. The by advocating for the implementation of Multidisciplinary Team (MDT) also Maine 2-1-1. The KCSD was continues to meet regularly to review old instrumental in the implementation of and current Child Protective Services Maine 2-1-1 in Washington County, a cases. The MDT has been using the toll free number where residents will be revision of cases as an educational tool able to call for help or receive to increase communication between information regarding domestic violence agencies. This practice has reduced the and other resources for children and isolation of practitioners and allowed families. Washington County is only the them to participate in a cross- second county in Maine to implement 2- disciplinary approach to address the 1-1. This resource is especially needs of children exposed to violence important for Washington County and their families. because of its scarce community resources and geographical barriers to 6.1 Point of Service Change access care. Originally, the KCSD did not plan to incorporate training in its strategic plan. However, after various

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meetings with its collaborative, the community awareness activities KCSD identified a need for training (e.g., the Blue Ribbon service providers around issues of Campaign), incorporating issues exposure to violence. The KCSD related to children exposed to offered more than 20 different trainings violence in the trainings of 13-15 from 2003 until 2005. More than 3700 agencies, and promoting the 2-1- people in the community participated in 1 call center as the single point of these trainings around issues of entry to appropriate services. children’s exposure to violence. Some of the trainings include: Forensic Digital • Continue to strengthen and Photography, Brain Development— enhance the provider network formerly Baby’s Blossoming Brain, at the local, state, tribal and Child Abuse and Neglect, Forensic county levels to sustain KCSD Interviewing, and Impact of Media by engaging various agencies Violence, among many others. including Head Start, the Department of Health and 6.2 System and Agency Change Human Services (DHHS), Family Resource Centers and The Regional Medical Center- Resource Development Centers. Lubec (RMC-L) and the Washington Collaboration with the Hancock Community Agency (WHCA) Passamaquoddy Tribe will agreed and formed a partnership to continue. Training at the state continue looking for funding for KCSD. level for mandated reporters and Jointly, they wrote a five-year logic first responders will be model with systems change activities, continued. intermediate outcomes, and long term outcomes. The RMC-L is concentrating • Partner with state, local, its efforts doing the community outreach county, and tribal service component, while WHCA is responsible providers to promote systems for the initiative as a whole and reform by enhancing he conducting the committee meetings. understanding of children Both organizations have agreed to exposed to violence among key undertake the financial burden, but they stakeholder groups including are committed to write grant proposals domestic violence advocates and together in order to receive more funding parent. Sustainable resources will for the initiative. be identified. And barriers to access will continue to be The five-year (2005-2009) addressed. Community Sustainability Plan was 7. Reduced Exposure to developed and agreed to by Violence collaborating agencies. The three main goals of the plan include: The KCSD identified a total of 79 children as exposed to violence • Increase Washington County’s between 2003 and 2005, but the KCSD knowledge of children exposed funded service provider only assessed 37 to violence by continuing children (Keeping Children Safe

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Downeast, 2005b). No post-treatment data could be obtained; therefore, there 8. Reduced Impact of is no evidence of reduced exposure to Exposure to Violence violence. Many factors contributed to clinicians’ inability to collect data. For The KCSD was not able to get example, families’ considered the information on impact of services assessment as an invasion of privacy offered by the Washington County and, after the first therapy, did not return Psychotherapy Associates and their for services. Also, after being identified, families because of limited participation many families were left to contact by families and limited buy-in and services for appointments on their own; supervision of the clinicians and many opted not to go in for services. counselors responsible for assessing Additional factors, such as physical families (Keeping Children Safe barriers (e.g., long travel distances, lack Downeast, 2005b). of transportation, weather), contributed to the site’s inability to engage or retain In regard to the clinician “buy- clients in services. It can be noted, in”, it’s important to recognize that however, that narratives of play therapy clinicians expressed (during interviews in a limited number of post-assessment conducted by the Muskie Evaluation cases indicate that aggressive behaviors Team) a conflict in devoting time to were reduced and sociability with the administering the structured 2-3 clinician showed improvement over measurement tools of the evaluation, time. In addition, at least one case while maintaining their primary focus on reported improved school behavior providing services to families during the during the multi-session play therapy initial assessment visit. In clinicians’ intervention view, addressing the presenting needs of

families, often in crisis, took precedence KCSD, however, impacted over administering the evaluation service providers with their trainings in a measures to parents. Offers of assistance very positive way. Trainings made regarding further training by the service providers realize the impact that evaluation staff on study implementation exposure to violence has on young techniques did not resolve this children. Therefore, two agencies “conflict”. (RMC-L, WHCA) formed a partnership to keep finding ways to keep KCSD’s After families received the initial legacy alive and other agencies made referral for services, parents and families certain to keep meeting in their were left to make the linkage on their respective committees to find ways of own and follow up with appointments improving the system of care for for assessment. This process limited children. Understanding the issue creates parental participation. Families were an awareness within a community about also required to give their consent to the need to address children exposed to participate in follow-up data collection violence which may ultimately exposure. and most declined. This unwillingness

also created difficulties for KCSD to access case records and required a new Institutional Review Board approval

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process and lengthy legal review. This Through trainings and delayed the data collection significantly community awareness campaigns, the and by the time these issues were KCSD demonstration project increased resolved, KCSD was only able to gain agency-based professionals and access to the last ten case records for community members knowledge of the review. impact that exposure to violence has on children in Washington County. The These ten records provided KCSD has also identified the barriers to descriptive information about children creating a coordinated system of care to exposed to violence in Washington identify, refer, and treat children. These County. Key descriptive information barriers included the large size, rural included: character and low population density of Washington County. Another barrier • Most violent incidents occurred was the stigma and invasions of privacy in the child’s home issues families associate with receiving • For most violent incidents, mental health services. The KCSD also children were witnesses and helped to break down an existing culture not victims of isolation by encouraging a system of • The child’s mother was the most collaboration between child-serving frequently reported victim agencies and providers that will continue • The child’s father was the most after federal funding ends. In addition to frequently reported a spirit of collaboration, the KCSD perpetrator focused on creating permanent and lasting changes in Washington County. KCSD efforts did not improve The KCSD was instrumental in the response time to refer children for institutionalizing effective practices and assessment within 72 hours of resources to help families with children witnessing violence. Between April that have been exposed to violence. 2003 and July 2005 the KCSD analyzed Forensic interviewing, mandated the referral process for 48 cases reporter training, Maine 2-1-1, and involving children ranging from two to community resources (e.g., a library) ten years of age (M=4.8) and it took an will continue to be used to reduce the average of 10 days for a child to be exposure and impact of exposure to referred for treatment. More information violence for children and families. The about KCSD’s intervention research can KCSD will also continue as outlined in be found in Exhibit XI-C. their sustainability plan and as a result of KCSD’s efforts, Washington County can continue to develop a stronger 9. Conclusions infrastructure to support children exposed to violence.

Association for the Study and Development of Community 265 July 2006 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

10. References

Association for the Study and Development of Community (2005a). Site Visit Report: Washington County Safe Start Initiative January-December 2004. Gaithersburg, MD: Author.

Association for the Study and Development of Community (2005b). Site Visit Report: Washington County Safe Start Initiative January 1 through September 15, 2005. Gaithersburg, MD: Author.

Keeping Children Safe Downeast (2004). 5-year community strategic plan. Milbridge, ME: Author (Available from the Association for the Study and Development of Community).

Keeping Children Safe Downeast (2005a). Progress report: January 1, 2005-June 30, 2005. Milbridge, ME: Author (Available from the Association for the Study and Development of Community).

Keeping Children Safe Downeast (2005b). Local evaluation report form. Milbridge, ME: Author (Available from the Association for the Study and Development of Community).

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Exhibit XI-A Timeline of Washington County Safe Start Initiative Activities and Milestones Major Milestone 7/01-12/01 1/02-6/02 7/02-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05

Inter-Disciplinary Team Multi-Disciplinary Team (formed & ongoing) Child Abuse Response Team (formed & ongoing) Mental Health Collaborative (formed & ongoing) KCSD Collaborative Board (formed & ongoing) KCSD Community Awareness Campaign • April Child Abuse and Neglect Council Awareness Campaign • October Domestic Violence Awareness Campaign Second Step Violence Prevention

Trainings Mental Health Assessment Pilot Project with Washington County Psychotherapy Associates (WCPA) Digital Camera Project • Digital Forensic Photography Training

Training Scholarship Program Welcome to the World Baby Bag Program DownEast Batterer’s Intervention Program (DEBIP

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Major Milestone 7/01-12/01 1/02-6/02 7/02-12/02 1/03-6/03 7/03-12/03 1/04-6/04 7/04-12/04 1/05-6/05 7/05-12/05

Mandated Reporter Training Program Downeast Sexual Assault Response Team (SART): Baby’s Blossoming Brain Training Fatherhood Training Project KCSD newsletter (established & ongoing) 2-1-1 Web Database and Call Center Project Head Start Training Program Children Exposed To Violence (CEV) Training Program - Dr. Bruce Perry Video Series Cross Disciplinary Training Peaceful Choices Non Violent Early Childhood Training Internet Pornography Crimes Project Rapid Response First Responder Training Zuni/Passamaquoddy/KCSD Peer Exchange KCDS Project Director resigned Project Director Position filled Community Educator Position filled Community Educator resigned

Sources: Washington County Progress Reports: January – June 2002, January -June 2004, July-December 2004, and January-June 2005; Washington County Semi-Annual Progress Report: July-December 2003; Local Evaluation Form 2004, Local Evaluation Form 2005, and KCSD Semi Annual Report 2005.

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Exhibit XI-B Washington County Safe

Start Service Delivery Washington County, Maine Developing CEVModel Service Pathway

KCSDKCSDKCSD IDENTIFICATION REFERRAL ASSESSMENT FACILITATION TREATMENT Child Care Providers COORDINATION TRAINING Mental Health Faith Based Organizations COMMUNITY AWARENESS PLANNING Providers Community Providers Community •WCPA ( Set aside Law Enforcement slots for KCSD referrals) Rapid Response Team •Child Domestic Violence Development f Services ( Provides Agency Providers Agency non-KCSD Maine DHHS subsidized services Child Development Svcs for children and families)

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Exhibit XI-C Washington County Safe Start Intervention Research

Overview

KCSD contracted with the Washington County Psychotherapy Associates (WCPA) to provide services to children ages zero to six that were exposed to violence in Washington County. Families who accepted treatment received up to three sessions with WCPA paid for by KCSD or they could be referred to other services depending on their needs. Play therapy was the most common treatment used by WCPA.

KCSD’s intervention research was divided into two phases. Phase I tracked the referral of children and caregivers by five local agencies to WCPA that volunteered to take part of the study. Phase II intended to track the impact of the effectiveness of treatment on children and families exposed to violence. Assessment information such as the child’s exposure to potentially traumatic experiences was collected at baseline. No post-intervention data were obtained, however, because most families were hesitant to accept services. For the purpose of this summary, we will only focus on Phase II of KCSD’s intervention research explained in further detail below.

Method

WCPA was required to conduct an initial assessment on the child using a standardized interview protocol that incorporated the Trauma Events Screening Inventory (TESI) and the Trauma Symptoms Checklist for Young Children86 (TSCYC). A post intervention assessment of the child, using the same instruments, was required as well, but no data could be obtained.

Sample:

Phase II had a sample size of 10 cases that were referred for assessment between April 8, 2005 and June 10, 2005. Information about these 10 cases included the following: Characteristics of children referred to the KCSD Pilot Assessment; Sources of referral; Potentially traumatic events and occurrences experienced by the child; and Follow up referrals and diagnoses.

Procedures

Initially, WCPA collected baseline assessment data using the interview protocols, the TESI, and the TSCYC. WCPA was also expected to collect post-intervention data. No post-intervention data were collected because parents were unwilling to participate during the initial stages of the research. In the absence of post-intervention data, WCPA agreed to de-identify the last 10 cases and gave the data to the Muskie Evaluation Team. The Muskie Evaluation team entered into no contact with children and families.

86 As reported in the LERF, “both trauma measures are parent-reported” (Keeping Children Safe Downeast, 2005b, p. 51).

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Results

Descriptive analyses were performed for the 10 cases. Of these cases, six were girls and 4 were boys. The children ranged from two to seven years of age; four children were four years old, one was two years old, two were five year olds, another two were six years of age, and one was seven years old. DHHS Child Protective Services referred 60% of the cases, while other referrals came in from the domestic violence shelter and Head Start, for a total of two referrals each. The majority of the incidents, 5 in total, occurred in the child’s home, either in their usual home or in their other home if the child’s parents were separated. Other incidents occurred in a relative’s home, in a day care setting, or in some other unreported location. In many instances the child witnessed a domestic violence incident, but in other cases they child put him/herself in danger. The most common diagnoses were adjustment disorder, posttraumatic stress disorder, and disturbance of emotions. Play therapy was the most common treatment provided by WCPA. In one other case, the child received further counseling from Child Development Services, while in another case they therapist worked with the mother in her ability to redirect the child.

Trauma was measured with two instruments, the TESI and the TSCYC. Results showed that 71% of the children had been victims of sexual assault, another 71% had experienced the death of someone close to them, 43% experienced an attempted suicide from a person close to them, and 57% had experienced some type of media violence such as seeing war episodes or terrorism attacks. Children exposed to violence also exhibited aggressive behavior (i.e., yelling). However, other types of trauma symptoms were infrequently reported by parents in the Trauma Symptom Checklist, such as: having bad dreams (reported in one case only), crying at night or not being able to sleep (reported in one or two cases), and increased startle (reported in two cases).

Discussion

Washington County Safe Start’s intervention research was designed to analyze the treatment’s effectiveness in reducing the effect and impact of children’s exposure to violence through their intervention method. The data collection was not successful mainly because families were not willing to participate in the study. The data that was collected, however, provides an informative description of the characteristics of the children referred, the nature of the trauma, and the trauma symptoms presented by children.

Reference

Keeping Children Safe Downeast (2005). Local evaluation report form. Milbridge, ME, AK: Author (Available from the Association for the Study and Development of Community).

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