Working with Families Impacted by IPV IPV-FAIR · 01-01-2016 · Abusive Behavior Inventory . Episodes of IPV during treatment: How do you know the IPV occurred? Next steps working

Working with Families Impacted by IPV IPV-FAIR

SUSIE DIVIETRO, PHD INJURY PREVENTION CENTER CONNECTICUT CHILDREN’S MEDICAL CENTER

MARY PAINTER, LCSW, LADC DEPARTMENT OF CHILDREN AND FAMILIES

Overview of Presentation

IPV in CT Agency IPV Practice Transformation IPV Service Array Evaluation & Outcomes Recommendations

Families Impacted by IPV & Children Exposed to Trauma: In families where there is IPV children are at a

higher risk for maltreatment…from both parents In a study of preschoolers (N=397), mothers who

endorsed physical IPV were more than 4 times more likely than non-victims to endorse behaviors characteristic of physical (31% vs. 10%) and emotional (61% vs. 18%) maltreatment of children

40-60% of men who abuse their partner also abuse their children

6138 5760 6322

22667 23303 24244

0

5000

10000

15000

20000

25000

30000

2012 2013 2014

# of DCF Intake Reports

IPV indicated No IPV indicated

21% 20% 21%

Age of Victims Associated with Reports w/ indicator of IPV

46% 44% 45%

36% 38% 37%

18% 18% 18%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

2012 2013 2014

Age 0 - 5 Age 6 - 12 Age 13 - 17

• Office of

IPV/SA Established

• RFI Released • IPV PDOC • Internal IPV

Specialists • Expand

Access POR

• Evaluation by IPC Starts • EBPS Launched

(MOMS Empowerment, Kids Club)

• Develop & Start IPV-FAIR

2012 2013 2014 2015 2016

• Expand FAIR • Develop MST-IPV • Offer Safe Dates

@ Solnit • Promote Safe

Sleep @ Shelters

• Intensive Case Review Complete

• Seek Funding for MST-IPV

• Cross Training in CT • Present @CWLA

In 2012, DCF, after assessing CT’s current IPV landscape, set forth a vision for what a comprehensive and holistic approach to an IPV service system should look like that was grounded in literature and best practice.

PE 1: Office of IPV and SU Intimate Partner Violence Service System Development

Working with the IPC on IPV

Evaluation and Recommendations of Service Array

Procedure IPV-Specialist Utilization Training Strategies Assessment tools and strategy

Policy Reviewing National Best Practices Training competencies Update IPV Policy at DCF

Data Collection and Analysis

PE 1: Office of IPV and SU - Intimate Partner Violence Service Array

Age Prevention

Low Moderate

High Capacity

Fathers for Change 0-10

IPV-FAIR 0-18

MOMS Empowerment/Kids Club 0-18

SAFE DATES 10-18

MST-IPV* 6-18

Risk

220-330 220-330

All schools

shelters

21

• Fathers for Change – Innovative model designed in CT – Emphasizes engaging & serving men.

• FAIR – Connecticut designed model based on best practice – Unique design – CT in forefront.

• Moms Empowerment & Kids club – Collaboration with CCADV Shelters. • Safe Dates – Collaboration with CCADV – Training provided to Ct Municipal Schools. Plus

one group run at Solnit North. • MST-IPV – Collaboration with Casey Services and Model developers of MST-BSF. Funding

needed for Implementation (development pending)

8

IPV-FAIR: Family Assessment Intervention Response Statewide, Voluntary Intensive community based intervention Engage and Assess all family members Individualized treatment & safety plans (EBP: VIGOR) Direct services for all family members: in home and clinical setting Care coordination & Family Navigation to other services Fathers for Change

Intimate Partner Violence

►15.5 million children in the US live in households were IPV occurred in the last year

►16% have witnessed IPV at least once ►Adjustment problems, cycle of violence

McDonald et al. 2006; Finkelhor et al. 2015

IPV in CT 90% of women seeking shelter services are

mothers 75% of children involved with DCF have

documented IPV exposure 57% of IPV-related arrests involve children

present 50% of youth involved with juvenile justice

services have a history of IPV exposure 25% of women receiving prenatal services

report ongoing IPV

DCF Reports (2014) Total Reports: 29,313

Reports with allegations of IPV: 6,324 (20.7%)

Substantiation Rates All reports: 22.7% IPV reports: 48.0%

Case reviews have shown up to 70% of families have a history of IPV

IPV-FAIR Model 4-6 month intervention; 1-3x/week Assessment and engagement of ALL

family members Priority: children 0-5

Individual and family interventions based on assessed needs

Began July 2015

Safety Planning: VIGOR Developed by Sherry Hamby, Ph. D. and

Sarah Clark Personalized, detailed safety plan Can be used/revisited multiple times Identifies goals, risks, strengths,

resources, and protective strategies http://www.thevigor.org/vigor-safety-

planning-tool/

Clinical Interventions May include, but not limited to:

Fathers for Change Cognitive Behavioral Therapy Genograms Trauma Focused Cognitive Behavioral

Therapy Psychotherapy “Beyond Trauma” (Stephanie Covington) “Seeking Safety” (Lisa Najavits) “Child and Family Traumatic Stress

Intervention” (Berkowitz, Stover, & Marans)

Fathers for Change One aspect of IPV-FAIR Acknowledges status of men as

fathers in delivery of IPV intervention Addresses co-morbid substance

abuse disorders and IPV perpetration

Emphasis on paternal parenting

Non-Clinical Interventions for Family Navigators Case management Psycho-education Family engagements Skill-building Addressing logistic barriers to

accessing treatment Connections to community resources

FAIR Data: Year 1 168 families, 237 children 133 Moms, 70 Dads

46 youth assessments completed 14 post assessment completed for youth 24 post assessments completed for Dads 36 post assessments completed or Moms

113 discharges 58% meet all treatment goals

Demographics

Black 18%

Latino 34%

White 41%

Other 7%

Dads’ Ethnicity

Black 12%

Latino 33% White

44%

Other 11%

Moms’ Ethnicity

Mom Age: 19-52 (ave. 30, median 29) Dad Age: 21-66 (ave. 33, median 32)

Youth Assessments

0

2

4

6

8

10

12

14

16

18

20

under 7 7 to 9 10 to 11 12 orover

Youth Ages

male 67%

female 33%

Youth Gender

Prior Experience With IPV (%)

AttendedFamily

Violence orAnger

management

Police tohome for IPV

incident

Children athome whenpolice came

for IPV

Arrested forIPV

Childrenhome when

arrested

Protective/restraining order

Dad 65 81 59 70 60 86Mom 33 87 83 34 74 70

0

10

20

30

40

50

60

70

80

90

100

Child Exposure to Violence Have adults in your home ever slapped, punched, shoved, or kicked you?

25.6% yes Have you ever thought someone was going to hurt or kill someone you love?

16.3% yes Have adults in your home ever hit you so hard you had bruises or red marks?

14% yes Has anyone ever made you feel so scared that you thought they might badly hurt or kill you?

11.6% yes Has anyone ever told you they were going to hurt or kill you?

9.3% yes

Home and Office Based Intervention

0%

10%

20%

30%

40%

50%

60%

70%

80%

Home Office Other A mix of all

Where were most of your sessions held?

Dads Moms

Intervention Sessions 68% of clinicians reported conducting

sessions with dad and children together

58% of dads and 29% of moms attended sessions with their partner

40% of dads and 35% of moms are reported to have stopped engaging in treatment

Engagement

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Never Rarely Sometimes Often All of the time

How often did the client cancel appointments?

Dads Moms

Engagement, by race How often did this client cancel an appointment with you?

0

5

10

15

20

25

30

35

40

45

Black White Latino Other

Percent of clients who have met treatment goals, by race

[VALUE]% (n=6) [VALUE]%

(n=4)

[VALUE]% (n=9) [VALUE]%

(n=22)

[VALUE]% (n=6)

[VALUE]% (n=19)

[VALUE]% (n=5)

[VALUE]% (n=7)

0

10

20

30

40

50

60

70

80

Dads Moms

Black White Latino Other

Emotional Regulation

0

10

20

30

40

50

60

Pre Post

Difficulties in emotional regulation (Dad)**Difficulties in emotional regulation (Mom)**

PTSD: Full and Partial

0

10

20

30

40

50

60

Partial (Moms) Partial (Dads) Full (Moms) Full (Dads)

Pre Post

% of sample who meet clinical criteria for PTSD

Parental Functioning

0

20

40

60

80

100

120

140

Pre Post

Parental Rejection (Mom)**Parental Rejection (Dad)**Parental Reflective functioning (Mom)**Parental Reflective functioning (Dad)**

Hostile Automatic Thoughts (Dad)

13

4

20

3

17

4

46

10

Physical Aggression** Derogation of Others**Revenge** Total**

Youth Strengths and Difficulties

PrePost

0

5

10

15

20

25

30

Pre Post

Abusive Behavior (self)**Abusive behaviors (partner)**

0

2

4

6

8

10

12

14

16

18

20

Pre Post

Abusive Behavior (self)**Abusive behaviors (partner)**

Abusive Behavior Inventory

Episodes of IPV during treatment

How do you know the IPV occurred?

Next steps working with DCF families impacted by IPV Strengthen workforce capacity Increase cross agency collaboration &

communication Improve data infrastructure Support the implementation of data driven practice Increase public awareness Case Review Analysis Feedback from IPV-FAIR participants Model refinement

Questions?

DCF: [email protected] [email protected]

IPC: [email protected] [email protected]