172925 Breaking the Cycle: Addressing Children's Exposure to Violence

Wednesday, October 29, 2008

Elena Cohen, MSW , Safe Start Center, JBS International, Silver Spring, MD
Exposure to violence as a public health issue

Exposure to violence is a central issue for children and adolescents with mental health and a variety of other health, social and cognitive problems. There are huge personal, social and economic costs to ignoring exposure to violence. Children and adolescents can and do heal from the effects of trauma if they receive the right services and support. Most children exposed to violence in their homes, schools, and communities are likely to be identified first by practitioners in systems other than mental health such as schools, health care, and child welfare. The development of culturally competent and community-based responses in a wide array of child-serving systems is fundamental to increasing access and improving the standard of care for children and adolescents.

States, communities and service providers in different systems are in critical positions to influence and/or provide healing opportunities by recognizing and supporting the needs of these children and their families. For example, early care and education programs and schools can reduce the impact of exposure to violence among children and implement strategies that create a climate of safety and security in the school environment for all children and through the identification of children who need more intensive interventions. Law enforcement, child welfare, courts, health/mental health agencies can systematically identify children at risk, screen, assess (as appropriate), refer and coordinate appropriate responses address negative impacts. Enhanced collaboration, planning and implementation across all systems are especially important at this time as children and families look to these systems for their safety and well being.

In addition, effective treatment models been developed and tested. Many have been adapted for use in different social service settings and for special populations. Training programs are also available to help staff understand and respond to exposure to violence.

Safe Start is a Federal, state and local public and private initiative coordinated by the U.S. Department of Justice's (DOJ's) Office of Juvenile Justice and Delinquency Prevention (OJJDP). The goal is to broaden the knowledge of and promote community investment in evidence-based strategies for preventing and reducing the impact of children's exposure to violence.

Eleven Safe Start Demonstration sites received funding during Phase I: These communities improved the system of care for young children exposed to violence and their families by implementing a comprehensive approach across a full continuum of prevention, early intervention, and treatment. A national evaluation broadened our understanding of how communities can successfully implement a comprehensive system of care with policy and practice interventions to minimize the negative consequences of exposure to violence.

Fifteen communities are currently implementing Phase II—Safe Start Promising Approaches. The goal is is to pilot test and measure the effectiveness of promising practices and evidence-based interventions to prevent and reduce the negative impact of exposure to violence. Examples of these interventions include: psychotherapeutic interventions that involve both the parent caregiver and the child or infant, medical home, home visitation; child advocacy centers; specialized curricula; motivational interviewing; family support; cultural competence; service coordination; integrated mental health/case management; domestic violence–child welfare collaborations; support services for kinship care providers; intensive family preservation; partnerships with dependency courts; and the Kids Club intervention.

The San Diego County Safe Start Promising Approaches Community of Care

The San Diego County Office of Violence Prevention in collaboration with the Child Welfare System were funded as a Safe Start Promising Approaches. . This community is currently in the second phase of a four-phased initiative focusing on preventing and reducing the impact of children's exposure to violence. Phase I served to create a continuum of care across the full spectrum of prevention, intervention, treatment and response for children exposed to violence through targeted system-level outcomes and encouraging innovation of practice strategies. Phase II is currently piloting intervention practices that attempt to reduce the harmful effects of children's exposure to violence. In subsequent phases proven strategies will be replicated and, if successful, will be bringing these effective strategies to additional communities.

San Diego County completed a planning process culminating in a blueprint to develop a System of Care Response for children exposed to domestic violence. As part of this system the Office of Violence Prevention is, teaming a Child Welfare Protective Services Social Workers, with domestic violence advocates, and with Trauma-Focused Cognitive Behavioral Therapy licensed staff to improve outcomes for these children and their families. Grounded in a public health prevention framework, the blueprint was developed by representatives of multiple agencies and systems including child welfare, , public health nursing, law enforcement, courts, early care and education, schools, children's mental health, community members and parents. Concurrently, a broad based capacity building effort is building public awareness, educating service providers and families, and expanding the training of licensed mental health providers.

Learning Objectives:
• Reflect on the magnitude of numbers and impact that drive the need for addressing issues related to children’s exposure to violence with a public health approach. • Identify the strategic partnerships put in place by the San Diego County Promising Approaches Program to build community capacity to implement a individualized, community-based and culturally appropriate system of care for children exposed to violence and their families. • Describe the lessons learned by a public system (San Diego County Office of Violence Prevention) to work with child welfare and a range of other public an private agencies to implement promising and evidence-based interventions for children exposed to violence.

Keywords: Youth Violence, Child/Adolescent Mental Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the director of the Safe Start Center Have been working in the field for more than 25 years Several publications on the topic of children's exposure to violence
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.