Mental Health and Laaoceetw Enforcement : A Unique Partnershipja.cuyahogacounty.us/pdf_ja/en-US/DefendingChildhood/ChildrenExp… · leaves handwritten note in envelope with brochure

Mental Health and Mental Health and Law Enforcement : A a o ce e tUnique Partnership

Initial Collaboration: Child Wh Wit Children Who Witness

Violence ProgramViolence Program

Rainbow Babies and Children’s Hospital form Task Force to study rates of exposure to violence among Force to study rates of exposure to violence among children in 1997 after noticing sharp increase of child exposure to violence in ERp

Task Force convened of community leaders from the religious safety forces government physicians and religious, safety forces, government, physicians and citizens to conduct study of issue and develop plan

S d f h 1999Start date set for March 1999.

K D i iKey Decisions

Law enforcement will be the only referent

Program available 24/7 365 days per yearProgram available 24/7 365 days per year

Crisis Response

Aggressive outreach efforts

Evaluation thru out every aspect of project

I l t tiImplementation

Education on impact of trauma on children provided to police officers during roll calls utilizing training films of local experts and in person question and answer

CWWV Director conducted roll call trainings around new protocol in each of five districts, every roll call around the clock

Referrals begin to pour in prior to official start date of b g p p d 3/1/99

Children Who Witness Vi l PViolence Program

Hallmarks of ServiceHallmarks of Service

Provide crisis services to children and families impacted by domestic violence community impacted by domestic violence, community violence, and self inflicted violence

W ll b l d f ll Will be voluntary and free to all participants

Services will be delivered in home to reduce impediments to receiving service

Clinicians will ACCEPT and MEET women where Clinicians will ACCEPT and MEET women where they are at in their journey to a violence free life

CWWV P t lCWWV Protocol

Keep it Simple

Officer on scene of DV becomes aware of children present

Offi t t C i i T 623 6888Officer contacts Crisis Team 623-6888

24/7/365 availability from trained clinicians who take demographic information

Crisis team alerts CWWV Program ManagerCrisis team alerts CWWV Program Manager

Aggressive outreach protocol begins

O t h P t lOutreach Protocol

CWWV staff contacts family by phone immediatelyy

Family responds to call explains h DCFS program, insures who we are not DCFS sets

first appt.

No response on phone following steps to engage are takenengage are taken

Clinician team drives to home

Explains services, offer services

P t lProtocol

Clinician team drives to home

Explains services, offer services E p a s serv ces, o er serv ces

Family has no phone or , not home, crisis worker leaves handwritten note in envelope with brochure leaves handwritten note in envelope with brochure requesting call

CWWV staff does second drive by within 24 CWWV staff does second drive by within 24 hours, continues calling

CWWV staff sends letter to home requesting call CWWV staff sends letter to home requesting call from family, provides number

S i P id dServices Provided

Safety Planning

Crisis Intervention shelter relative’s home immediate Crisis Intervention: shelter, relative s home, immediate needs addressed

Psycho social education: Impact of violence on children development, short and long term impact, Cycle of violence violence,

Rapport building

Cli i l I t tiClinical Interventions

CBCL, DOSE, PEDS, TSCC

Linkage to Witness Victim Services / Domestic Linkage to Witness Victim Services / Domestic Violence Project

Linkage to agencies providing ongoing trauma services to children

Education about impact of trauma on children and adolescent’s

Referrals for DV ongoing support for victim

B fit t Vi tiBenefit to Victims

Immediate response to family after trauma

S d l d h / l bServices delivered in home/ eliminate barriers

Services are without cost to familyServices are without cost to family

Services provided to children and caregiver

Clinicians are Master’s prepared, many independently licensedindependently licensed

Access to both child and adult psychiatry p y y

24 hour availability to project 365 days per year

B fit t OffiBenefits to Officers

Confident when they leave scene that family will be contacted and have opportunity for high quality mental health services brought to victims at no cost to them

Receive letter from CWWV, thanking them for r f rr l p t C mm nd r g int referral, copy to Commander goes into personnel file

Officers updated in roll call 3-4 times per year about project and project activitiesp j p j

B i / L L dBarriers/ Lessons Learned

Families concerned we are linked to DCFS

F l d l b f l Families are in denial about impact of violence on children

Crisis period resolves family “ wants to move on” forget eventon forget event

Families do not respond to aggressive outreach efforts

Children Exposed to Intimate pPartner Homicide

Understanding Issues and Enhancing Response to these Children and Familiesp

Some Facts of Living in the gUnited States

4 Women per day are killed by Intim t P rtn r r EIntimate Partner or Ex

8 Children per day essentially left 8 Children per day essentially left orphaned

Mom is dead, Dad in jail or has d dcommitted suicide

SilSilence

“ When the headlines fade, why do we hear so little about this we hear so little about this population of children?”D h f h h b k d Despite the fact that they outnumber kids affected by leukemia--- a condition familiar to most Americansto most AmericansIVP affected 4,150 children in 2000

Leukemia impacted est. 3,500 children

P h it iPerhaps it is:

Stigma associated with family violence

Our current fragmented social service systemsOur current fragmented social service systems

Culture of difficulty addressing issues of death and dying especially deaths resulting from an intentional act versus an accident or illness

Our own feelings of inadequacy at finding the right words to talk about the “ unspeakable” acts

I ti t P t H i idIntimate Partner Homicide

Bureau of Justice Assistance defines an intimate partner to include: spouse ex-intimate partner to include: spouse, ex-spouse, boyfriend or girlfriend

Homicide= Act of killing another human being: not always an illegal act ex Death being: not always an illegal act ex. Death penalty. Self defense, accidental d h ili ideaths, military action

Affili t d TAffiliated Terms

Criminal Homicide= Murder

Mariticide= Killing one’s spouseMariticide= Killing one s spouse

Uxoricide= Killing one’s wife

Femicide=Killing of women

Familicide=Killing entire or portion of family

Suicide= Killing one’s self

Bl S i id C lli P li Blue Suicide=Compelling Police to use deadly force

I ti t P t H i idIntimate Partner Homicides

United States 2007

1,800 per year

64 529 IP H i id 1976 200564,529 IP Homicides 1976-2005

5 400 attempted 3 times actual rate of 5,400 attempted 3 times actual rate of homicides completed in this category

32,637 suicides

750,000 completed suicides

Gender Difference in Overall Homicide Rates

Men more likely to murder then m n 10 1women 10:1

Men are more likely to be murdered Men are more likely to be murdered 4:1

IPV: Gender Difference Suicide Gender Differences

Women most likely to be killed by intimate Women most likely to be killed by intimate partner

33 3 vs 3%33.3 vs. 3%

32,637 in 2005

Men 25,907

Women 6,703

Wh t D it MWhat Does it Mean

You are more likely to lose your Mother at the hands of your Fatherat the hands of your Father

You are more likely to lose your primary y y p ycaregiver

Because men more likely to also commit suicide following an IPV murder, you g , ymay also lose your Dad

For children who do not lose their Dad, they are likely to go to jail/prison

Impact of IPV Homicide in 121 pFemicide cases in 2004

35% children witnessed the h mi idhomicide

62% witnessed attempted homicide 62% witnessed attempted homicide previously

37% discovered body

A f I t ChildAreas of Impact on Children

Physical Injury and Death

Trauma and mental health issues

C l i f d M l i l lComplex grief and Multiple losses

Criminal Justice System implicationsCriminal Justice System implications

Custody and Other legal issuesy g

Social Challenges

Unknown

T d M t l H lthTrauma and Mental Health

Risk of PTSD

Sleep Disturbance

H /A l A iHyper/Arousal Anxiety

Long term risk of DepressionLong term risk of Depression

Behavioral– Extreme aggression/ gg /passivity

Psychosomatic Disorders

C l G i fComplex Grief

Loss of Parent ( physical and emotional)

Complex grief related to the nature and manner of Co p e gr e re ated to the ature a d a er o death and chronic exposure to domestic violence prior to homicide

Parental incarcration

Sibling Seperation ( physical and thru loyalty Sibling Seperation ( physical and thru loyalty conflicts)

Extended Family ( conflict between victim/offender Extended Family ( conflict between victim/offender families)

C l G i f Complex Grief

Home ( Crime Scene or permanent move and destruction)and destruction)

School, Neighborhood, Peers ( , g , (Relocation/ Shunning)

“ The length of time it takes to kill i h l di ti t someone is hugely disproportionate

to it’s ramifications.”

Esther Levy age 20, witnessed father kill her mother at age 5mother at age 5

Vi l L R TViolence Loss Response Team

RFP issued by Office of Victim’s of Crime

MHS meets with CPD Chief Michael McGrath MHS meets with CPD Chief Michael McGrath discusses RFP

MHS h H d U M MHS meets with Homicide Unit Management Team

MHS meets with homicide detectives, gathers reactions, responds to questions and concerns

Witness Victim invited to join as partner

G t S b i iGrant Submission

MHS takes lead in writing the proposal after receiving input from two partnersg p p

CPD provides strong letter of support and all necessary statistics

Witness Victim brings impactful letters from Witness Victim brings impactful letters from Cuyahougha County Prosecutor's to support applicationapplication

City officials provide numerous letters of support

Excellent proposal submitted

A dAward

One grant awarded in the country

Cl l d l l dCleveland proposal selected

Two primary goals:Two primary goals:

Provide intensive case management services to victims of homicides families and friends

Replicate this project in another cityReplicate this project in another city

Service Utilization and Homicide Survivors

Among those who do need treatment, only a small percentage get needed treatment.

Numerous barriers exist to initiating treatment and remaining in treatment in the general population.g g p p

Numerous barriers for survivors residing in rural areas

VLRT P t lVLRT Protocol

Homicide, occurs in the City of Cleveland

H d D 623 6888 Homicide Detectives contact 623-6888 24/7/365

Crisis Social workers take demographics, next of kin information brief synopsis of of kin information brief synopsis of homicide, needs of detective

On-call VLRT Program Manger or Associate Director Trauma Services responds immediately

H i id i Cl l d OhiHomicides in Cleveland, Ohio

2005 – 114

2006 1192006 – 119

2007 – 1342007 134

2008 – 102

2009 – 120

2010 – 72

2011 58 d2011 – 58 to date

Vi l L R C ll b iViolent Loss Response Collaborative

Mental Health Services, Inc.

Cl l d D f P l H d UCleveland Division of Police, Homicide Unit

Witness Victim Service CenterWitness Victim Service Center

Recent Addition to Collaborative

Cornerstone of Hope

P f th C ll b tiPurpose of the Collaborative

The Collaborative offers comprehensive services that address both the practical services that address both the practical and psychological needs of family

b ft th i l t l f l d members after the violent loss of a loved one.

Mental Health Services, Inc.,Violent Loss Response Team

Received the federal grant to provide intensive case management to co-victims of homicide in gan urban setting

C l h l h h Community mental health agency with established 24 hour hotline for crisis response requests

Established history of providing community Established history of providing community and home based services

MHS – Violent Loss Response Team p(continued)

Licensed mental health workers are available 24 hours a day to respond to new referrals and y pto assist families in crisis and with ongoing needs

Goal of immediate response to families

MHS – Violent loss Response Team p(continued)

Initial interventions may includeAssistance with notificationAssistance with notificationPersonal safety issuesB i d hi h i l d id if i Basic needs which may include identifying where families can stay, getting food and

if d d b i water if requested, advocacy to obtain medication, obtaining items the family feels h d b bl they need but are not able to get

themselves, arrangements for pets

MHS – Violent Loss Response Team p(continued)

Initial interventions continued:Obtaining information regarding questions g g g qthey have about what happened to their loved oneAssistance with funeral planningCrime Scene clean up informationpIntroduction of Victims of Crime Compensation

MHS – Violent Loss Response Team p(Continued)

Initial Interventions continued:Assistance with needs of childrenAssistance with needs of children

Filings for guardianship / custody

Coordination with the Department of Children and Family Services

Enrollment in school / day care

MHS – Violent loss Response Team p(continued)

Ongoing / Long term interventionsOngoing grief supportOngoing grief supportSupport through criminal justice processT i iTransportation to appointmentsAssistance with estate and property issues of the deceasedLinkage to community resources based on needs the survivor identifies

MHS – Violent Loss Response Team p(continued)

Addressing mental health needsCrisis and/ or full diagnostic assessments completed when necessarywhen necessaryLinkage to emergency psychiatric services with MHS doctorsCrisis intervention services/ Psychological First AidPsycho education on trauma and lossLinkage to ongoing therapy for grief or other Linkage to ongoing therapy for grief or other conditionsCapacity to provide Trauma Focused Cognitive B h i l Th hildBehavioral Therapy to children

Cleveland Division of Police, ,Homicide Unit

Referral source for the Violent Loss Response Team

Briefly explain services to survivors and provide brochureC ll 24 h h l d b Call to 24 hour hotline to provide basic information and where response should be mademadeOngoing collaboration as requested by families with VLRT so appropriate information can be V pp pshared

Wit Vi ti S i C tWitness Victim Service Center

Victim advocates are available to:Assist with Victims of Crime application processCommunicate with detectives and prosecutors about case status and keep families informedabout case status and keep families informedEducate survivors about the criminal justice process and their rights as a crime victimAccompany survivors to hearings and trial datesAssist with formation of victim impact t t tstatement

C t Of HCornerstone Of Hope

Received a grant from local foundation to provide more accessible grief counseling to p g ginner city survivors of traumatic loss

VLRT ff f d l d VLRT staff refer directly to an experienced therapist who is willing to have initial linkage

h h d f ll ff sessions in the home and follows up at offices within the city. Groups specific for survivors of h i id il bl llhomicide are available as well.

P t lProtocol

At the scene of a Homicide, the detectives identify family members, close friends, and / or y y , , /witnesses that may need assistance

Th f d f h d The survivors are informed of the program and brochures are given. The detectives then call h 24 h h l f MHS d the 24 hour hotline of MHS to provide

demographic info and where the response h ld b d should be made to

P t l ( ti d)Protocol (continued)

VLRT staff receive the referral and prepare for as close to immediate response as called for or pas appropriate

F f h d Face to face outreach attempts are made to address provided by police

Services are briefly introduced and families can decide if this is a good time to meet or not –decide if this is a good time to meet or not their wishes are always honored

P t l ( ti d)Protocol (continued)

Initial informal needs assessment is conducted at first contact with familyy

Survivors receive concrete information on the types of practical needs VLRT may be able to types of practical needs VLRT may be able to assist with and identified needs are then addressedaddressed

P t l ( ti d)Protocol (continued)

To ensure collaboration from the beginning:Witness Victim also forwards the Witness Victim also forwards the information they get on survivors to VLRT

Homicide Unit Lieutenant forwards a copy f h i f h h i id VLRT of the synopsis of the homicide to VLRT

staff as soon as available

P t lProtocol

Quarterly meeting are held with the Collaborative members and other stakeholders

Protocols are reviewed and alterations are made as needed made as needed

C b i d h Cases may be reviewed to ensure that involved agencies all have same information

S i P id dServices Provided

On-Scene response for family members/ friends

If requested by homicide detectives assistance h fwith notification

Coroner identification of bodyCoroner identification of body

Immediate crisis intervention for family/friends

Funeral planningFuneral planning

Media management

S i C ti dServices Continued

Financial assistance

V f C lVictims of Crime applications

Liaison to Homicide DetectivesLiaison to Homicide Detectives

Grief Support/ Education

Linkage to on-going therapy

Camp Bridges

O i h k i ’On going check in’s

S i C ti dServices Continued

Assistance in obtaining basic needs, housing, food, clothing, g, , g

Linkage to spiritual counseling

Linkage to Witness Victim: who act as advocates for victim’s during prosecutionadvocates for victim s during prosecution

Social Security information

Wh h it W k d?Why has it Worked?

Homicide detectives are outstanding, willing to engage with us, acknowledge time limitations g g , gthey have to respond to families

MHS h h ff CWWV PMHS history with officers CWWV Project

Quickly recognized assistance MHS could Quickly recognized assistance MHS could provide to them and the bereft families

Observed MHS clinicians, do exactly what they said they would do, every time, we are very committed to this project

Responded to all request always gave it our

Wh ti dWhy continued

Willing to learn from the detectives

NEVER f h h NEVER interfere with the investigations

Homicide Unit leadership encouraged to join Homicide Unit leadership encouraged to join us presenting at national conferences

Constant communication

Th U t dThe Unexpected

Dealing with infant deaths

Number of suicidesNumber of suicides

West 89th

Imperial Avenue

Media

Community relationsCommunity relations

Politics

Cold cases

St ff I d S l ti Staff Issues and Solutions

Vicarious trauma

V l dVary caseload

Develop vicarious trauma group with our Develop vicarious trauma group with our medical director, Cynthia Vrabel M.D. meets every other week to discuss how work impacts every other week to discuss how work impacts them

Flexible schedule

Keep close eye on number of hours workingKeep close eye on number of hours working

C ti dContinued

Open Door Policy

A k l d h d ff l k Acknowledge how difficult work is

Accompany them on callsAccompany them on calls

Continuing Education opportunities provided

Encourage creativity

Involvement at macro level

P li A i t d R f lPolice Assisted Referrals

Response to families and individuals residing in CMHA Housingresiding in CMHA Housing

Similar to CWWV Model however includes referrals with issues other then domestic violencedomestic violence

Initiated 2 years ago y g

P tPartners

CMHA

Partnership Safer Cleveland

CWRU CWRU

MHS IncMHS Inc.

PPurpose

Address the social problems p ri n d b CMHA r id nt experienced by CMHA residents

quickly

Bring services to them

Overcome barriers

P t lProtocol

Utilize CWWV aggressive Outreach ProtocolProtocol

24 hour responsep

Master’s prepared clinician’s

Where and when families want services

Ch ll t PARChallenges to PAR

Families Scared

“ Might lose m place” Might lose my place

“ You are DCFS”

“ Don’t want people knowing my business”business

“ That’s the way it is women get y gwhooped down here”

Q ti d AQuestions and Answers