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6. Goals and Objectives for Prevention and Reduction of Impact of Exposure
Chicago Safe Start’s project model begins with a relationship paradigm and key risk/protective factors, and is built upon the premise that a strong attachment between caregiver and child is the most important protective factor for a young child exposed to violence. Additional protective factors include strong immediate and extended family support, and safe and supportive community resources. Each of these levels of protective factors can be compromised by different kinds of violence. The caregiver-child attachment is damaged if there is direct child abuse or neglect. The immediate and extended family support system is affected by domestic violence. Safety and support in the community are diminished by public violence. As these protective factors are eroded, a young child’s well-being can also be affected by violence in each of these realms. The Chicago Safe Start project model focuses on two areas of intervention: children who are at risk of or have been exposed to violence are identified either through an incident-based response or a symptoms-based response. The incident-based response is designed to intervene at the earliest point of contact when an incident of domestic violence or child abuse/neglect is reported and is built upon the police, emergency medical and child welfare emergency response systems. The symptoms-based response system is designed to enhance the capability of the existing provider community, who encounter children in the targeted age group, to identify the effects and symptoms of exposure to violence and to refer those children to needed services at the appropriate level of care. Childcare centers, Head Start, early childhood education, health care providers, substance abuse treatment providers, domestic violence service providers, WIC centers, faith-based organizations, community mentors, and family members comprise this system. Identification, Crisis, Chronic and At-Risk There are four broad categories of initial identification points for children exposed. First, in response to an incident of violence, either DCFS, the police, emergency medical services or a hospital emergency room would be the first point of identification. Each of these system points could be the first to respond, either on the scene or not, to a specific event of child abuse or neglect, or domestic and/or community violence. Under the Chicago Safe Start model, police officers, EMTs, or emergency room personnel in the two target areas will refer families of young children exposed to violence to the Domestic Violence Help Line, family support services or, if indicated, directly to mental health services. They will also implement a new protocol to record the demographic information and referral provided for each family. The Domestic Violence Help Line currently serves as a tool for first responders as well as a potential point of initial identification. The Help Line’s referral directory will be expanded to include resources dedicated to young children in the target communities. The Help Line already tracks demographics of callers with children as well as services requested. In the case of an allegation of child abuse, DCFS will be the first to respond. The police may also be the first responders, but they operate under DCFS protocols. If the allegation is substantiated, then the child has prima facie been exposed to violence. Chicago Safe Start will focus on the appropriate intervention described below. Juvenile Delinquency Court will identify teen parents and other youth who may place young children at risk of exposure due to their behavior, and provide referrals to the designated family support service provider. Relevant court staff will be trained to identify and refer, and will also implement new protocols to collect demographic data on children and families identified and referred. Child Protection Court can identify exposure to violence during proceedings and provide referrals to family support services or directly to mental health. The Court will also collect demographic and referral data for each child identified. In a symptoms-based response, it is not a specific crisis event that precipitates identification, but symptoms or risk factors recognized by child care providers, Head Start/Early Head Start staff, school-based early childhood education, health care providers, WIC sites, community mentors, faith-based organization representatives, and/or family members. Each of these groups of people will be trained to recognize sets of behaviors and symptoms, to refer such children and their families to family support services (or directly to mental health, if indicated). The formal system providers will also implement new protocols to collect data on children referred for services. Initial Intervention Initial Intervention services, under the Chicago Safe Start model, will take place through a variety of system partners that now provide little or no intervention for children exposed to violence. These include the child welfare system (for both children remaining at home and those placed in substitute care), domestic violence shelter and service system, the substance abuse treatment system, and the early childhood education and care systems. Intact Family Services are provided by DCFS and DCFS-contracted agencies for families with an indicated allegation of abuse or neglect but the Court has determined that the child can remain safely in the home if services are provided. All Intact Family Service providers will be required to participate in training on the impact of exposure to violence on young children, what to look for, how to refer, and what they can do. They will also implement protocols to collect demographic data for each referral provided. Placement Services are for children who cannot safely remain in their homes because of child abuse or neglect. These services are provided by DCFS and contracted agencies. Training on the impact of exposure to violence on young children, what to look for, how to refer, and what they themselves can do to help will be incorporated into existing DCFS training for foster parents and group care facilities. Domestic violence shelters and Domestic Violence Court are additional points of secondary identification. Shelters can provide basic intervention for young children with art supplies and appropriate toys. Shelter staff and Domestic Court staff will be trained on the impact of exposure to violence on young children, what to look for, how to refer, and what they can do. They will also implement protocols to collect demographic data for each referral provided. Child care providers, Head Start teachers, early childhood educators, health care providers, WIC staff and faith-based organization representatives will all be trained to provide basic play/art activities for children exposed as well as to refer parents to family support services, community mentors, and mental health services. Substance abuse treatment services are another point of access, as many participants are parents of young children. Treatment center staff will be trained to include discussions on the effects of exposure to violence on young children as well as what parents can do to help their children. Service Delivery All points of access and identification will be trained to refer young children exposed to violence and their families to family support services in each community. All points can also refer children and families directly to mental health if indicated. Family support services will be provided initially by a specific organization in each of the two target districts. These services will use a strength- and asset-based approach in working with parent-child interaction, enrichment activities for young children, and skill enhancement for parents. The family support service providers will be trained to educate parents on the impact of exposure to violence on young children, what to look for, and what they can do. The providers will also be trained to provide a basic level of intervention with children and parents, including art and play activities and discussion groups. In addition, the providers will know when and how to refer to a specific mental health service provider in each of the two districts and will collect demographic data on all children identified and referred. Other referrals will be for job training, housing, and other social services. Initially, in each of the two districts, a designated mental health provider will expand their continuum of services and the level of expertise related to children’s exposure to violence. This service continuum will span a range of intensity of services, from individual psychiatric consultations and management to individual therapy with a master’s level counselor to adult groups to art and play therapy for children. This continuum is based upon the four major national models in treating young children exposed to violence.
Children who have been exposed to violence or are at risk of exposure will be identified by organizations (formal or informal) that interact with or serve children. Children in the targeted Chicago Safe Start communities (Englewood and Pullman) are at extreme risk of exposure to violence. We learned from our assessment that the rates of violent crime in the Chicago Safe Start area are disproportionately higher than the rates for the City as a whole. Violent crimes committed against children under the age of 13 are likewise alarmingly high, with these communities representing 13% of such crimes and only 8% of the relative population. Children in these communities are known to be at a much greater risk of exposure to gang-related violence. A significant majority of children under six have heard a gunshot, or were present when someone was shot or attacked with a knife. Likewise, their risk of exposure to domestic violence is disproportionately high relative to the rest of the City, with these communities reporting over 5,600 domestic violence reports in a two-year period. Clearly, the risk of exposure to violence in these communities is so pervasive that it can be considered almost certain that most children will be exposed to violence by the time they are six years old. Given this reality for the children in the Chicago Safe Start area, the Chicago Safe Start project determined that it is necessary to have an approach that has two essential strategies for identifying children exposed to violence. First, we plan an incident-based response system. Because there are so many reported incidents of violence, identification of children exposed to these situations must occur concomitantly with the notification to the authorities or first-response personnel. This includes first responders to community and gang-related crime such as the police, emergency medical personnel and hospital emergency room personnel; and first responders to domestic violence, including the police and Domestic Violence Help Line staff. Second, given the pervasive and chronic nature of violence in these communities, and the overwhelming percentages of children at risk for exposure, it is necessary to identify children through a symptom-based response system. The assumption is that many of the children will go undetected by a system that only focuses on reported incidents of violence, especially when there are so many direct victims of violence to be attended to by the existing system. We believe that exposure to violence in communities where violence is so prevalent is almost taken for granted, and that many children suffer the effects of exposure and will not be identified until they display symptoms. Therefore, a symptom-based response system is a necessary strategy to address the needs of these children. We also know that families plagued by violence populate our court system—juvenile delinquency court, child protection court, and domestic violence court. The courts are therefore a critical system for identifying children exposed to violence. Therefore, our first aim is to increase the identification of young children (ages 0-5) exposed to violence, and their families, through the development of an incident-based response system, a symptoms-based response system, coordination with child protection, domestic, and juvenile delinquency courts, and strategies to link informal and community networks with systems of care. OBJECTIVE A. Develop an incident-based response system that will identify children ages five and younger and their families who have been exposed to abuse or neglect, domestic and/or community violence. Chicago Safe Start will target children and families who have had reported incidents of violence, and thus the children have been exposed to violence. These reported incidents include reported incidents of community violence reported to the police and attended by emergency medical personnel; reported incidents of domestic violence focusing identification efforts on police and the Domestic Violence Help Line; and reported incidents of child abuse/neglect, focusing on the DCFS system. Toward these ends we plan to: · Work with Chicago Police Department and the Chicago Fire Department’s Emergency Medical Services to implement an identification system. The CPD and EMS are the primary first responders for an incident-based response system. As such, their level of awareness of the significance of children exposed to domestic or community violence is critical to identification of these at-risk children. Chicago Safe Start will coordinate with and build upon the MODV’s work in training both the CPD and CFD personnel. · Work with Emergency Rooms in area hospitals to implement screening, referral, and information-sharing for children exposed to violence. Where there are incidents of community violence, or domestic violence resulting in the necessity of ER services to the victim, ER personnel need to become aware that for each adult victim there may be young children at risk of exposure. ER personnel should be able to identify the situations in which young children are at risk, and to make appropriate referrals. · Leverage capacity of the existing Domestic Violence Help Line to respond to children exposed to violence by: a. Screening all DV calls for children exposed, b. Adding ability/capacity, as appropriate, to take new calls from police, EMS, and other emergency responders, and c. Making appropriate referrals The DV Help Line staff are first responders who are essential in identifying at-risk children and families. However, in order to respond to the anticipated increase in referrals, because of Chicago Safe Start’s efforts with police, EMS, and ER personnel, the capacity of the Help Line may need to be increased.· Coordinate with Mayor’s Office of Domestic Violence, Illinois Violence Prevention Authority, and the Department of Children and Family Service in their efforts to avoid unnecessary removal from their parents of children exposed to violence. Chicago Safe Start intends to join with these city and state agencies in the effort to stem any increases in children being removed from their homes which might be due to increased identification of families at risk of having exposed their young children to violence. It is important to anticipate any negative unintended effects of increasing the identification of these families. OBECTIVE B. Develop a symptoms-based response system to identify children, ages five and younger, and their families, who have been exposed to violence and are manifesting some reaction. Statistics on the level of violence in the targeted communities show that violence is pervasive and chronic. Children are perpetually exposed to violence of many types. Much of their exposure cannot be tied to specific incidents because these incidents are either not reported, or are so frequent as to become almost a part of the fabric of life in these communities. Therefore, an incident-only approach is certain to miss many of the children who are in fact exposed to violence in these communities. Unfortunately, many of these children will only come to the attention of caregivers and service providers because they have manifested symptoms. It is our intention to create a response system which identifies these children as well as the children identified because of their exposure to reported incidents. Strategies for identifying these children will need to focus on reaching the adults --caregivers, providers of early childhood education, and other family service providers. The strategy is to increase the awareness of these responsible adults in young children’s lives to the extent that they recognize that exposure to violence puts children at risk; to be able to identify symptoms and situations that may indicate possible exposure; and to equip them with the referral processes and resources to connect these children and families with needed services. Toward these ends we plan to: · Partner with Chicago Public Schools to incorporate screening for exposure to violence in Child Find efforts (reaches 15,000-20,000 children per year). Child Find is an early screening program conducted by the Chicago Public Schools. The purpose of the program is to screen children prior to school-age in order to identify those who may have special needs or developmental delays which can be ameliorated by early intervention prior to entering school, thereby enabling these children to get a better start. By incorporating information and tools for screening for the effects of exposure to violence, we can reach a large number of children through an existing, wide-ranging screening program. · Partner with CPS Cradle to Classroom program to reach teen mothers whose children are at risk of exposure to violence (reaches 6,000 children per year). Again, in partnership with the Chicago Public Schools, through their Cradle to Classroom program, we will be able to identify children who may have been exposed to violence, or who may be at risk of exposure. Targeting teen mothers, this program provides us with the unique opportunity of directly impacting the age group of parents who are predominantly the parents of young children in these communities, and whose children are potentially at greatest risk. · Partner with CPS Youth Outreach Worker program that works with children and families exposed to violence (reaches 6,000 kids per year). · Build capacity of Head Start, Early Head Start, and childcare providers to identify children who have been exposed. Since this age group is 0-5, many of these children will be in some form of childcare or Head Start program. The staffs of these programs do not receive information or training in regards to the effects of exposure to violence and how to identify children who may have been exposed. Chicago Safe Start will build their capacity by educating them and providing them with tools for identifying children exposed. · Increase awareness by faith-based organizations, community-based organizations, families and community members of the risks of children’s exposure to violence. A community-wide increased awareness of the impact of exposure to violence on young children can be achieved to some extent by public awareness campaigns. Additionally, however, it will be necessary to directly educate as many members of the community of adults responsible for the care of young children, as well as those that have informal, extended family relationships with them in order to be most effective at identifying the children at risk. · Work with the Chicago Medical Society, La Rabida Children’s Medical Center, community health centers, local hospitals, and other medical organizations to incorporate identification of exposure to violence in on-going professional development activities. Many of the medical and allied professionals serving children and families in these communities are so overwhelmed with the extent of direct violence and abuse of children that the issue of the effects of exposure to violence may not receive much attention. We want to incorporate this information into the ongoing professional development activities for these professionals as a way to increase the likelihood that they will identify children exposed and refer them for appropriate services. OBJECTIVE C. Through the Child Protection, Domestic Violence, and Juvenile Delinquency Courts identify children, ages five and younger, and their families, who have been exposed to violence.Violence is a frequent characteristic of families who come into the court system. Whether the issues are around child abuse/neglect, domestic violence, or juvenile delinquency, the courts are an integral part of any system designed to identify children who have been exposed to violence in their families or communities. In the targeted communities, the problems of these families are often so severe and long-standing that exposure of young children to violence is a secondary issue. We want to raise the level of importance of this issue in the consideration of how these cases are handled, and thereby increase the number of children identified as having been affected by violence. In order to accomplish this Chicago Safe Start plans to:· Work with appropriate court personnel (judges, social workers, others) to ask questions regarding children’s exposure to violence, to recognize signs and symptoms of exposure, and to incorporate orders for service, as appropriate. Court personnel will need to be aware of the effects of exposure to violence, and understand its significance in order to ask the necessary questions, determine if there is a possibility of risk, and follow through with appropriate referrals. · Work with court-based childcare programs to provide basic information to families on exposure to violence and to make referrals, as appropriate. The importance of community-based childcare programs as identification resources has been addressed. The significance of court-based childcare programs is that they are linked to the system that routinely encounters families who are plagued by violence. This makes them a source for early identification of families at risk. · Identify children at high risk through linkages with programs serving delinquent teen mothers who are on probation. We know from our assessment that the rates of teenaged motherhood in these communities are quite high (29% of the births in these communities were to mothers under age 20). We can also assume that teen mothers involved in the court system are less likely to be able to provide the strong child-caregiver bond that is required for adequate protection for children who may have been exposed to violence. Therefore, programs for delinquent teen moms are an important point of identification of children at risk. OBJECTIVE D. Create avenues for concerned parents, family members, faith-based organizations, and informal networks to reach services for children who have been exposed to violence. We believe that it is important for families, extended families, and informal support networks to be able to seek assistance with identifying and addressing the needs of children exposed to violence independently. For those families who do not come to the attention of first responders to incidents of violence, or who are not involved with the formal child welfare or court systems, there needs to be direct access to agencies who can assist them with understanding the effects of exposure to violence; determine if their child is experiencing symptoms of exposure; and provide them with the necessary information and knowledge to support and protect their children. While we address the network of Family Support Services in later sections (see Goal 3, Objective A), they are a part of the identification system for self-referred families. Likewise, other “natural doors” in the locally-based community of providers become important in providing a non-threatening, non-stigmatizing availability of service to families who seek assistance on their own. Child-serving systems and service providers will implement a formalized and coordinated response for initial intervention and referral for children exposed to violence. The targeted communities have many child-serving agencies, as illustrated in the maps in Appendix G and the tables in Section 5.1. The Department of Children and Family Services contracts with agencies in the Chicago Safe Start communities. Families in these communities have access to domestic violence shelters, though the capacity certainly does not meet the need. In Englewood there are approximately 40 State Pre-k, Head Start, Child Care and other child development sites. In Pullman there are about 45 such agencies. However, the number of agencies does not speak to the critical issues of their capacity to serve the needs of children exposed to violence, and their capability and competence in providing initial assessment and referral for children exposed. Chicago Safe Start intends not to “re-create the wheel” relative to providers of children’s services. Rather, the best use of the resources, and the most effective approach to the community of experienced and indigenous service providers, is to assist them in doing their jobs better in regards to children who have been exposed to violence. In order to increase their ability to respond effectively to these children, Chicago Safe Start plans to work with these agencies to increase their awareness of the impact of violence on children; to give them approaches for initial intervention with these families; and to give them skills and tools to screen for children who may be exhibiting more severe symptoms in order to refer them to appropriate family support or mental health services. Our primary vehicle for increasing awareness, skills, and abilities to intervene with affected children is the Training Institute. Through this cadre of professional experts and university partners, we will be able to reach targeted groups of front line workers from child welfare, domestic violence, and early childhood care. We can ensure accurate and consistent information, develop and provide curricula, and develop and provide observational screening tools for use by workers coming in contact with children at risk. OBJECTIVE A. Increase the capacity, competence and capability of the child welfare system to intervene with children exposed to violence through abuse and neglect. Children in the state’s child welfare system whether they remain at home or are placed in some form of substitute care have been exposed to violence. While the child welfare system is particularly sensitive to the safety, counseling and developmental needs of the children in its care, it does not currently have an explicit focus on the impact of exposure to violence as distinct from victimization. Chicago Safe Start will work with DCFS to incorporate into its policy, practices and training for caseworkers, foster parents and intact family service providers expectations and tools for dealing with children’s exposure to violence. Foster families are a particularly crucial focus for our approach involving the child welfare system. With these families, children have already been removed from their homes due to abuse and/or neglect, and foster children’s exposure to violence can safely be assumed. Workers who train and counsel these families must be aware of the effects of exposure to violence in order to properly train and assist foster families in responding appropriately to these children’s needs. In addition, Chicago Safe Start will support ongoing DCFS efforts to develop abuse/neglect prevention approaches for families experiencing domestic violence (through the new RFP described in Section 5.2.2), where, again, the children exposed may be overlooked in initial intervention and referral procedures. OBJECTIVE B. Increase ability of domestic violence shelters to provide initial intervention services for children exposed to domestic violence. Acknowledging the connection between domestic violence and children’s exposure to violence, we are looking to the domestic violence shelters as an important access point for initial intervention and referral services. As with the other populations that we have discussed, where the primary attention of caregivers and service providers is on the victim of violence, it is necessary to raise the awareness of those who work in and administer domestic violence shelters that abused parents are not the only victims. We know from the research that children’s services are frequently a part of the services provided through these shelters. However, staff may not be up to date on the best research and practices in working with children exposed. Further, linkages for referral to more formal mental health or family support services are not uniformly in place. Since this is a major system of refuge for these families, we plan to: · Expand exposure to violence services for children in domestic violence shelters, including training staff and establishing formal linkage and referral agreements; · Work on a systems level to assure a direct connection between domestic violence shelters and providers of mental health services to assure that children demonstrating more severe symptoms resulting from exposure receive professional treatment. OBJECTIVE C. Target services to teen parents involved with the Juvenile Delinquency Court. It has been established that, in the Chicago Safe Start area, a significant number of children at risk have parents who are teenagers. Further, teen parents involved with the Juvenile Delinquency Court are probably less likely than others to provide the strength of care-giving in the parent-child relationship that can adequately protect young children from the effects of violence exposure. Since the Juvenile Court program for teen parents is a point of identification, it follows that services for initial intervention and referral should be targeted here as well. Family Focus is one of Chicago’s leading family support organizations, specializing in services to teen parents. Family Focus operates an “alternative to detention” program in conjunction with the Juvenile Court. This program will be a partner with us in this endeavor. Chicago Safe Start intends to work with Family Focus to include exposure to violence awareness information and observational screening tools to raise teen parents’ awareness of the issue and assist teen parents and Family Focus staff in determining the need for initial intervention and/or referral to other resources for children in need. In addition, Chicago Safe Start will work with Court personnel to develop formal referral agreements for other families with teen parents to assure that they are linked with appropriate family support network service providers. OBJECTIVE D. Increase capacity, competence, and capability of childcare, early education, and early intervention providers to provide initial intervention services for children exposed to violence. Many of the children in this age group are in some form of childcare, whether home or center-based. Others are in Head Start or Early Head Start, or some other form of early intervention program sponsored independently or through the Chicago Public Schools or the Chicago Department of Human Services. We will partner with these providers to primarily do two things: · Provide training on the effects of exposure to violence and how to provide initial intervention when symptoms present; and · Establish a formal referral process between the childcare providers and family support services network. We will also be engaging in systems-level activities to fully integrate children’s exposure to violence in policy, contracts and funding streams. This is an important strategy to ensure that government systems and programs respond to children’s exposure to violence through regular, ongoing programming and not just through special, targeted initiatives. This, we believe, is the core of systems change. This includes working with the Illinois Department of Human Services and the Chicago Department of Human Services, as well as the Illinois State Board of Education. Our aims are to advocate for dedicated funding streams which would address the need for training on exposure to violence in early childhood education and child care programs and add new services, to assure the competence of staff working with young children at risk to provide initial intervention services, and to recognize the need for referral to mental health or family support services providers. OBJECTIVE E. Increase capacity, competence, and capability of publicly-funded substance abuse treatment providers to recognize the link between substance abuse, violence, and the impact on children of the exposure to violence and to provide initial intervention services for children of parents undergoing substance abuse treatment. The research is clear on the correlation between substance abuse and interpersonal violence of all kinds. Substance abuse is recognized as a primary risk factor for exposure of children to violence. In addition, substance abuse is a debilitating factor for parents responsible for protecting children from violence and impairs their ability to recognize signs and symptoms of the effects of exposure to violence in young children. We know from our assessment that the Chicago Safe Start area is as plagued by substance abuse as it is by violence. We believe that the typical provider of substance abuse treatment is not likely to be fully aware of the effects of exposure to violence for young children, and have little or no training on how to provide initial intervention to children suffering from those effects. We plan to: · Increase the awareness of substance abuse treatment providers of the effects of exposure to violence and train them on how to recognize symptoms, provide initial intervention, and make referrals to mental health or family support service providers; and · Establish a formal referral and linkage agreements between the providers of substance abuse treatment and the family support services network. Additionally, we will be working at the state level (Illinois Department of Human Services, Office of Alcoholism and Substance Abuse) to incorporate the exposure to violence issues in funding considerations and contract expectations and effect systems change. OBJECTIVE F. Establish Training Institute to train on the impact of exposure to violence on young children and to build capacity to provide effective services. Many of our objectives and activities are directed to personnel working in key access points in the system of services available to families affected by violence. They are based on four essential strategies: 1. Increasing the awareness of exposure to violence and its effects on young children; 2. Increasing the competence and capability of those who care for and educate young children to identify those who have been exposed; 3. Increasing the competence and capability of those who care for and educate young children to provide initial intervention services; 4. Increasing their ability to recognize more severe symptoms, which require referral to family support or mental health services. Therefore, a considerable amount of Chicago Safe Start’s work in these communities involves training. Toward that end, we plan to establish a Training Institute. The Training Institute is envisioned not as a facility, but as a cadre of practitioner-partners (professionals in mental health and family support), university partners, and other experts. This cadre of training partners will be involved in working with Chicago Safe Start staff to: 1. Identify existing curricula and training modules for inclusion in existing training curricula for certain audiences (e.g. Training for child care workers, training for foster parents, etc.) 2. Develop training curricula and modules for independent training efforts (e.g. Training for mental health workers and family support workers) 3. Develop and/or identify and modify tools for observational screening of children who may display symptoms of exposure to violence; 4. Develop and/or identify and modify protocols and training support for providing initial intervention services. It is anticipated that training and informational presentations will be conducted through any number of venues including formal education for which participants could receive CEUs; conferences and workshops for interdisciplinary training opportunities; and a speaker’s bureau for on-site informational or training presentations. The Training Institute will need to identify funding for its continuation, as it is planned to become an ongoing resource for the system of child-serving organizations in our communities. The intervention and treatment system will have sufficient capability and capacity to seamlessly serve children who have been exposed to violence and their families. OBJECTIVE A. Expand capacity and strengthen capability of family support agencies to serve children and families identified as having been exposed to violence. As described in Section 5.3, the Chicago Safe Start assessment of Risk and Protective Factors revealed that the primary protective factor is a strong caregiver-child relationship, and the core of our programmatic activities is to strengthen the ability of the caregiver to support the child who has been exposed to violence. We also learned from our assessment that a significant number of the families in our target areas are headed by young parents, indeed are single-parent families headed by young mothers. In fact, 29% of the births in the target communities are to teen parents, exceeding the statewide and citywide rates. Finally, we learned from our assessment that many families are cautious of formalized service programs and are particularly hesitant to seek mental health services. While much of our work will be to increase the capacity of existing systems to identify and provide appropriate services to families and children exposed to violence (as described in Goals I and II, above) these findings lead us to conclude that an important strategy for Chicago Safe Start is to help expand the network of Family Support Services available in the target communities. The Family Support Services programs we will encourage—both by using Chicago Safe Start funds as seed money and by partnering with state and local government to build on-going Family Support capacity—will have a number of core components. All programs will be designed to provide a “soft” front door to reach families who might otherwise be hesitant to seek support. To reach parents, they will offer friendly, drop-in programs, workshops on topics of importance to young parents (e.g. “The Terrible Twos”), snacks, and, importantly, activities for parent-child interaction, where trained program staff can help identify children who may be manifesting symptoms of exposure to violence. The programs will also develop a network of Community Mentors, respected community leaders (perhaps community “grandmothers”) who will help provide outreach to the young families, ensure that they stay engaged with the Family Support programs, and help model appropriate behavior. The goal of these programs will be to build a community resource where families will feel comfortable participating in a range of activities, learn about how to be better parents (reinforcing the key protective factor of strong caregiver-child relationship), and accept advice and referral for more intensive services, if indicated. While there are no family support programs in the Englewood area and limited programs in Pullman, this model has been very successful in other similar communities in Chicago, most notably in North Lawndale, a community with demographics very similar to the Chicago Safe Start target communities. The core components of the Family Support Services Network will include:
Under the second, more intensive model of group supports, the programs will offer specific parent-child interaction. These groups will focus on teaching parents the importance of and “how to” bond with, talk to, hold, touch, and play with their children to stimulate brain development and offset the impact of exposure to violence. Activities will also include infant massage, floor play, and dialogic reading, as developmentally appropriate. An adaptation of the nationally recognized “Baby FAST” model will be considered. The goal here will be to both enhance the parent-child interaction and to identify families where the children are particularly at-risk or demonstrating symptoms from exposure to violence. Seeing the caregiver-child interaction is essential to determining the extent to which that relationship will help ameliorate the effects of exposure or more intensive mental health services are needed. · Home Visiting. Another core component of the Family Support Services Network model will be home visits. We are proposing to build on the Healthy Families national model. This model targets young, first-time mothers with the goals of promoting positive parenting, encouraging child health and development and preventing child abuse and neglect. The home visits will be used to educate parents on caring for their children and preventing violence in the home; help parents improve parenting skills, learn how to bond with their children, and understand how violence can have negative impacts on their child’s development. Of course, home visits will be made only if appropriate and with due sensitivity in cases where domestic violence has been identified or is suspected. · Linkages to Mental Health Services. Family Support Services programs will maintain linkages to a wide array of resources for families (see “Referrals to Ancillary Services,’ below). Because of the importance of having access to mental health services for children exposed to violence, each program will have formal referral agreements, including guaranteed space for emergency referrals, with community mental health providers. The role of the mental health providers is described more fully under Objective B, below. · Community Mentors. Each program will develop and coordinate a network of Community Mentors, so-called “feisty older women” who are natural community leaders and can help ensure that mothers of young children are not isolated and are linked to the Family Support Services Network. The Community Mentors may be identified through partnerships with the faith community, block clubs, service programs, or as community leaders. The Family Support Network will ensure that the Community Mentors have appropriate resources, training, and support to be effective mentors. · General Parent Education. Parent education/outreach will be provided through education and training workshops in various community settings. Chicago Safe Start will encourage Network programs to use nationally-known models, such as MELD, or other evidence-based models that include problem-solving as a key skill. Information specific to the needs of parents and children 0 – 5 will be the focus. Parenting information, safety education, “family days” and other educational and fun activities will be provided in this outreach forum, designed to reach larger portions of the community than might participate in the drop-in program or other components. The goal will be to attract families and link them to more on-going programming, as appropriate. · Referrals to Ancillary Services. As appropriate, Family Support programs will refer families for housing assistance, to food pantries, etc. in the community. Each program will maintain agreements or referral arrangements with appropriate community resources. Chicago Safe Start has worked closely with several well-respected service providers to define the Family Support Services Network program model. While it is anticipated that initially the Network will begin with perhaps one or two selected providers in each community, Chicago Safe Start envisions that as demand is built, various providers will expand their service offering and use the family support model. Those that do so will join the Network, expanding resources available to families in the community, and, ultimately, communities throughout the City and State. An important step in building an on-going Family Support Services Network, rather than just a program or two as part of the demonstration project, is to identify potential governmental funding sources that will support the Network over time. In our Assessment in Section 5.2, we identified several potential resource pools that are not now dedicated to exposure to violence but with appropriate providers and applications could be used to fund programs. The program model that we have outlined for the Family Support Services Network we believe meet the criteria for funding under the Illinois State Board of Education Early Childhood Block Grant Program, in particular the Prevention Initiative, (described in Section 5.2.3) and the Department of Human Services Healthy Families program (described in Section 5.2.6). Our strategy here is two-fold. First, as we discuss in Section 5.2.6 and in the Action Plan, an RFP has already been issued to expand the Healthy Families program to the Englewood community. Chicago Safe Start worked with community providers to develop and submit a proposal for funding that will help achieve the Chicago Safe Start goals for Family Support programming. We received notification just prior to the submission of this plan that the proposal was funded. Thus, our efforts to secure permanent funding in this area are already underway. The second component of our strategy will be to encourage Family Support providers to apply for funding under the Early Childhood Block Grant program. These funds are typically bid by the state in the spring of each year; the amount of funding for new programs varies, but Chicago Safe Start will advocate through the legislative process for additional funds and for providers to apply for existing funds. Chicago Safe Start will also work with currently funded providers to incorporate these family support components and the Chicago Safe Start goals into their next application, again expanding the pool of providers who can become part of the Network. The longer-term, system focus of strategy of changing the RFP and contracting process to require services for exposure to violence as a program component is discussed under Goal II, above. OBJECTIVE B. Expand capacity and strengthen capability of mental health services to children and families needing more intensive support. We learned from our assessment that many children and families will require clinical mental health intervention to address the trauma resulting from exposure to violence. We also learned from our assessment that the capacity of the mental health system to address the needs of very young children is extremely limited. In fact, we learned that the State Office of Mental Health Services allocates no funds for mental health services for children under age three. As a result, there are very few mental health services available for very young children. This is among the most significant gaps that we found as we conducted our assessment and therefore we have developed a number of strategies to begin to address this need. One of Chicago Safe Start’s first steps will be to quickly expand mental health capacity in the target communities. Because there is currently no state or local funding available, we will dedicate a portion of the Chicago Safe Start resources to building this capacity. This will include working with community-based mental health providers to add appropriate staff and to refine their programming so that it is responsive to children exposed to violence. We estimate that approximately 20% of the families who receive Family Support Services may require additional assessment or intervention services as a result of escalating or persistent symptomatic behavior. Depending on the age of the child, these symptoms may include: loss of recent developmental achievements, such as toileting; sleep disturbances; hyper-vigilance and other changes in mood and behavior. Additional assessment and intervention may also be warranted because of on-going stressors the caregiver has experienced either as a result of victimization or other trauma that may have impacted the healthy attachment between the caregiver and child. The specific intervention will be developed in conjunction with the selected providers, but we envision the mental health services to include at least the following program components: § Services to Children and Families. The interventions to be established would include family sessions with caregivers and children to assess and address the impact of witnessing violence. We believe that this is a core component of the program because it will reinforce the important caregiver-child relationship and, ultimately, the caregiver’s ability to protect and foster the development of the child, once services end. We envision that counselors with expertise in working with adult victims and those with expertise in working with children would partner to provide the services. Services would include appropriate evaluations and individual treatment, as needed; referral for psychiatric services, again, as needed, group services. We are considering several models for the group services, including the “Child Witness to Violence Project” developed by Betsy McAllister-Groves at the Boston Medical Center. Our focus will be to draw on research-proven interventions to apply to programs in Chicago. § Services to Caregivers. Master’s level counselors with experience in domestic violence would be available to provide counseling services to caregivers of child witnesses to domestic violence, as appropriate. Counselors would also be equipped to work with caregivers who are experiencing difficulty as a result of other types of violence. § Infant Mental Health. A portion of the families with babies and children up to three years old may need assessment and intervention services of an infant mental health specialist. These services would be geared toward infants and younger children who are experiencing attachments and other relational difficulties with their primary caregiver as a result of exposure to violence. One model being considered is the Early Relational Assessment, designed by Roseanne Clark, which is highly regarded in the field. § Psychiatric Services. We estimate that a small portion of the families will require the services of a child psychiatrist or an adult psychiatrist. These services will be available to families who need them, either through the providers directly or through partnerships with universities, hospitals, or private contractual arrangements. We recognize that Chicago Safe Start can only be the seed money for the development of mental health services in the target communities and that the need is much greater in the two communities and in the State of Illinois. A key part of the work of Chicago Safe Start over the next four years will be to develop dedicated public funding streams for children’s mental health services in Illinois. This effort will be part of a broader coalition working to enhance mental health services. Our work is described more fully in Goal IV, below. A corollary problem to the lack of funding for children’s mental health services is that there are few academic programs that prepare professionals for work with children exposed to violence. Chicago Safe Start will work with universities, faculty, and academic and professional associations to incorporate exposure to violence and its treatment into the curricula of social work, counseling, and other mental health professional preparation programs in an effort to ultimately increase the pool of professionals who are equipped to respond to children and families’ needs. The issue of children’s exposure to violence will be the subject of sustained attention and action by policy-makers. Research has only recently begun to document the negative consequence of exposure to violence and the potential linkages to future delinquency or violent behavior. Not surprisingly, a few policy-makers are only beginning to become aware, through efforts like Chicago Safe Start, of the impact of exposure and the steps that can be taken to offset that impact. We believe that an important goal for Chicago Safe Start is to increase the number of policy makers who see exposure to violence as an important issue for policy action and to shape the agenda of that policy. The strategies and objectives we outline will help us active this goal. OBJECTIVE A. Develop system-wide analytic capacity to understand the impact of children’s exposure and families’ access to services and to widely disseminate findings among key policy-makers. Having access to good data and analysis about the extent and impact of exposure to violence for children in Illinois is essential to persuading policy-makers that the issue is of serious concern. One of our first strategies is to build the data collection and analytic capacity that will allow us to understand the experience of children and families exposed to violence. We will proceed on two fronts. The first will be to develop appropriate data collection tools and protocols for each component of the system that impacts children exposed to violence. These areas, such as the police when they respond to a call, the Domestic Violence HelpLine when they make a referral, the Family Support Network, and the other system and program components, will provide the basic data to inform system improvements and understand child outcomes. Our second front will be to develop a broader analytic capacity, which will be built on the extensive resources of the Chapin Hall Center for Children Integrated Database. Chapin Hall, a children’s policy research center at The University of Chicago, has been working for a number of years to bring together the data from state and local government agencies to understand the experience of children and families who receive government services. Through sophisticated matching techniques they are able to link data from various agencies to determine whether children and families have received services from multiple systems and what services they have received. Currently, they have linked child welfare, mental health, special education, Chicago arrest, Chicago Public Schools, state employment, and a number of other system data. They are currently in the process of securing juvenile court data from the Cook County Clerk’s office. Chicago Safe Start will partner with Chapin Hall to build on this massive data set to incorporate additional data collected from Chicago Safe Start and to begin to identify the research and policy questions which might be answered based on analysis of these data. Information from these analyses will be shared broadly with policy makers to advocate, as appropriate, for changes in policies, practices, or financing. OBJECTIVE B. Conduct public awareness campaign targeted in Chicago Safe Start districts on the impact of exposure to violence on young children. This objective builds on the broad finding that the general public, service providers, and policy makers (at least prior to September 11) were not aware of the extent to which exposure to violence can be developmentally harmful to children. A key strategy for Chicago Safe Start, then, is to increase the general awareness that exposure to violence is an issue. Our public awareness/education strategy underlies several of our other objectives. Objective A, above, describes the importance of informing public policy makers of the importance of addressing exposure to violence. A broad public awareness campaign can help make that case. We also discuss in Goal II the importance of public awareness/education as the foundation to encourage substance abuse treatment providers and some domestic violence service providers to take steps to incorporate services for exposure to violence in their programming. Based on our assessment, we found that we could not begin by offering training to the providers and expect them to provide screening or services without first generating support. The public awareness campaign is one step in that direction. Public awareness will also help build support among the first responders—police and others—who are taking on a significant role in responding to children exposed. Finally, public awareness/education is important to help families understand that their children might be reacting to exposure to violence and that they can seek help. It is another component of our strategy to provide non-threatening avenues for families to learn better how to help their children. We were fortunate to recently have had the opportunity to meet with Dr. Marans of the Yale Child Study Center and Deputy Chief MacDonald of the New Haven Police Department, founders of the CDCP model. Throughout their conversations, they emphasized that they learned throughout the ten years that they have been operating the CDCP program. One of their key lessons, and one thing they would do differently if they were starting over, is to emphasize public education more. They felt that had they done that, they would have been able to build support for their program more quickly and might have avoided some early pitfalls. We take their comments as reinforcement of the importance of public awareness as a fundamental strategy on which to build our other activities. OBJECTIVE C. Coalesce and mobilize a network of child- and family-serving organizations to assure system efficiency, engage in policy advocacy and promote organizational ownership of the issue. Part of our strategy for building on-going support for the policy and program changes developed as part of the Chicago Safe Start demonstration is to build a coalition that provides leadership and that can be mobilized to provide advocacy support, information, or other resources. We envision building this coalition from the existing Chicago Safe Start Steering Committee, which is comprised of policy-makers and statewide leaders, and the Chicago Safe Start Council, which adds to the Steering Committee a broad array of service providers, community organizations, community members, families, and others with an interest in exposure to violence. (See Appendix C for a current list of the members.) We will rely on the Steering Committee to provide senior-level leadership for fiscal, legislative, or significant policy changes, offering guidance, strategies, and access. Both Steering Committee and Council members will also work to institutionalize the commitment of their organizations to serve children who are exposed to violence by providing regular participation on either the Committee or Council; sharing information within their organization and with their parent/advisory groups; and educate their Boards about the issue. As the Committee and Council begin this phase of their work, they will develop a clear policy agenda and a plan for action, which will be included each year in the Implementation Plan. One issue that we will encourage them to focus on is advocating for including issues of exposure to violence in the licensing and continuing education requirements of various professionals, such as social workers and counselors. This may involve working with organizations such as the National Association of Social Workers, the Council on Social Work Education, the American Psychological Association, and the Illinois Department of Professional Regulation, among others, to determine the feasibility and implications of making such changes. OBJECTIVE D. Develop technology-based tools that will serve as a resource for policy-makers, community-based organizations, and family members about children exposed to violence. Chicago Safe Start sees the advantage of developing technology-based tools as resources for service providers, community members, and others, as one of our strategies to increase access to information and awareness and to build an appreciation for the efficiencies of technology. In response to requests from the Council members, we have begun to develop community web sites, to take a small step toward addressing the “digital divide.” While we realize that many individual community members may not have home access to the Internet, the City of Chicago has made a commitment to providing access at public libraries, public schools, and other locations. By helping our community partners develop their own website, we can further our partnership, address one of their unmet needs, and begin to help more community members learn about the power of the Internet. In addition to the community websites, Chicago Safe Start will use its own website, linked to the City of Chicago’s KidStart website (www.chicagokidstart.org, which is being widely promoted by the City) to disseminate current research, best practices, and analysis about children exposed to violence. The importance of this web-based resource became apparent as the Office of Violence Prevention (where the Chicago Safe Start program is housed) received numerous calls after the September 11 incidents about how to talk to children. OBJECTIVE E. Advocate for additional children’s mental health services. As we have highlighted throughout the Strategic Plan, Illinois’ mental health services for children are underfunded. Fortunately, policymakers at the state level understand the importance of providing adequate mental health services for youth and are beginning to take steps to address the situation. Chicago Safe Start will work with other groups and organizations to encourage additional support for these services. The Futures for Kids Advisory Board, chaired by Illinois’ First Lady Lura Lynn Ryan, has taken as one of its main areas of focus children’s mental health. They have recently formed a subcommittee to look at the issue, and are particularly sensitive to the linkages between mental health services, juvenile delinquency, and early exposure to violence. In fact, Futures for Kids was successful in securing an additional $2.0 million in mental health services in the current budget year for youth leaving juvenile detention centers, bringing a three-year total of new funding to $6.0 million. Chicago Safe Start, through joint members on the Steering Committee and the Futures for Kids Advisory Board and through direct participation on the subcommittee, will help advance the goal of increasing access to mental health services for children. At least two other partnerships are organizing to increase the support for children’s mental health. The Community Mental Health Council, a key provider of mental health services in the target community of Englewood, is organizing an initiative to create a children’s mental health infrastructure. One component of this effort is to increase awareness among the state legislature about the need for additional services and the Futures for Kids Advisory Board and Dr. Carl Bell, Director of the Community Mental Health Council (and a member of the Advisory Board) were successful in securing Dr. Satcher to come to Illinois in late November to talk about the Surgeon General’s Youth Violence Report and Public Health. In addition, the Ounce of Prevention Fund and Voices for Illinois Children, two well-known organizations in the state, are working with interested legislators to secure additional funding for early childhood mental health services. These efforts, too, have been discussed with the Futures for Kids Advisory Board (the Executive Director of Voices is also on the Board). Chicago Safe Start will continue to work with these partners to build an infrastructure for children’s mental health in Illinois. Chicago Safe Start will partner with violence prevention and reduction initiatives to reduce overall exposure to violence for at-risk children. Up to this point, the Strategic Plan has primarily outlined strategies to identify and intervene with children and families who have been exposed to violence or to change policies that impact identification or intervention. Chicago Safe Start also recognizes that the most fundamental way to offset the exposure to violence is to prevent violence. While we realize that Chicago Safe Start cannot be the lead organization in developing violence prevention strategies, we are fortunate that Illinois and Chicago have a number of organizations and efforts in place to prevent violence. Chicago Safe Start will partner with these existing efforts. OBJECTIVE A. Partner with Prevent Violence! Chicago to reduce exposure to violence. In 1996 the Chicago Department of Public Health took the lead in developing a comprehensive, broad-based strategy for preventing violence. The Chicago Violence Prevention Strategic Plan was issued in 1998 and in many ways formed the basis for Chicago’s application for the Chicago Safe Start grant. Since then, the Prevent Violence! Chicago effort has focused on implementing the work described in that strategic plan. Five Committees of City agency representatives, service providers, community members, and others have been working together to make that plan a reality. Chicago Safe Start will continue to work with the PV!C efforts to decrease violence in the City. Illinois also has the only state agency devoted to violence prevention, the Illinois Violence Prevention Authority. The Authority, co-chaired by the Director of the Illinois Department of Public Health and the Illinois Attorney General, has been in existence for five years and provides grants, technical assistance, public awareness, and other support to decrease community violence in the state. They so strongly share the goals of the Chicago Safe Start project that they have begun their own, state-funded pilot in four downstate communities of services for children exposed to violence. Chicago Safe Start and the IVPA have a strong working relationship. The Executive Director of the IVPA serves as the co-chair of the Chicago Safe Start Public Awareness Committee and is also a member of the Steering Committee. We have been able to work closely and will continue to work closely with them to draw on their expertise in our own program development and to assist them in advancing their violence prevention goals. Chicago Safe Start will also assist in other community-based violence prevention efforts, particularly in the areas of gang prevention, substance abuse prevention, and parenting. We have already participated in a number of anti-violence parades, community fairs, and workshops, through the schools, community policing activities, and community activities. We will continue to identify such opportunities to work at the state, city, and community level with others who are advancing strategies for violence prevention. |
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