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Prevention/Early Intervention in Domestic Violence Situations (PEiD-V)

This initiative innovates to fill a crucial gap in services for children zero to three following an experience of domestic violence.

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Written by

Name or Organization

Mental Health Center of Denver

Geography

Metro Denver

What is your stage of development?

  • New Innovator, with less than one year of experience in ECD

Type

  • Non-profit

What is the stage of your proposal?

  • Research & Early Testing: I am exploring my idea, gathering the inspiration and information I need to test it with real users.

Describe how your solution could be a game-changer for your selected Opportunity Area (600 characters)

This proposal is founded on the insight that children zero-to-three are extremely vulnerable to trauma associated with witnessing domestic violence. In fact, witnessing violence against a caregiver, rather than experiencing violence, is the number one trauma experienced by children. Early intervention is crucial to minimizing and potentially even eliminating bad outcomes. The trauma and its consequences experienced by children zero-three in domestic violence situations goes largely unrecognized. We will help insure that children zero-to-three receive the vital interventions they urgently need.

Select an Innovation Target

  • System design: Solutions that target changing larger systems.

Tell us more about your innovation (1500 characters)

Children zero to three are an unserved population in the context of domestic violence. Typically, the survivor of a domestic violence incident receives a referral to behavioral health supports. We know that all too often the survivors do not follow through on referrals, for a number of very understandable reasons. In the intensity of the immediate situation, when basic needs such as housing and safety take top priority, the survivor is not in a good place – physically or figuratively – to access the needed care. Significantly, survivors typically are unaware that a child zero-to-three urgently needs behavioral health support as well. Responders likewise, may not even be aware that the child needs such support. Our solution to this challenge is two-fold. First, it makes available our expertise in infant mental health to all participants along the continuum of response to a domestic violence situation – the survivor, first responders, law enforcement, victims’ advocates and other providers. All of the relevant entities that are targeting their efforts to support survivors of domestic violence are coordinated at and through the Rose Andom Center – a one-stop shop for domestic violence survivors. Second, it commits to proactively and persistently engage the survivor to optimize the initiation and continuation of needed services.

What problem are you aiming to solve? (3 sentences)

Studies show that domestic violence occurs more frequently in homes with younger children and that 25% of children referred for exposure to DV are age 0-3 years. Research also indicates that witnessing harm befall a caregiver is the best predictor of an infant or toddler experiencing PTSD. Despite this knowledge, within the systems most likely to come into contact with young families experiencing DV, literacy around these issues is scant and engagement in services is minimal.

Explain your idea (5000 characters)

Over the past decade, we have learned from breakthrough brain science that one way to ensure that young poor children get on the pathway to success is to ensure that their earliest relationships are nurturing and supportive (Shonkoff & Phillips, 2000). Being a child witness to domestic violence at very young age can have extremely deleterious impacts upon infant development and psychological functioning. Given this knowledge, the timely referral of very young children to effective, evidence based treatment is paramount. Our project seeks to increase the identification and successful referral of very young children and their caregivers to needed infant mental health services by partnering with two entities that are most likely to come into contact with this young traumatized population: (1) our local family justice center that serves victims of domestic violence (the Rose Andom Center) and (2) our local first responders to incidents of domestic violence (Denver Police Department). The project will have several more specific aims in service of our larger goal of increasing the service utilization of available IMH service. First, we would seek to provide in-service “infant mental health 101” trainings to responding officers within DPD, police detectives, victim advocates and Rose Andom staff who interface with the caregivers of these very young children exposed to DV. The trainings would aim to increase knowledge of infant mental health and dispel the widespread beliefs that infants are unaffected by domestic violence, that they are too young for it to affect them or that they will simply forget about it. Trainings would also inform the above individuals about the services available to treat these young victims and how services can be accessed. Second, in addition to providing in-service trainings, we would seek to embed an infant mental health specialist within the Rose Andom Center where infants, toddlers and their caregivers who have experienced DV are naturally seen. This integration of IMH within a family justice center follows integrated care models of behavioral health service provision within primary care settings that have been shown to facilitate early identification and treatment of mental health and behavioral issues in primary pediatric care. Similarly, integrating an IMH clinician onsite at the Rose Andom Center would allow for organic relationships to be built between the IMH clinician and family justice center staff, as well as DPD detectives who are housed within the Rose Andom Center building. This integrated set up would serve to increase the appropriate identification of mental health issues in very young children who come to the center as well as increase effective engagement/ uptake in mental health service provision. Given the significant challenges families face when experiencing domestic violence including: lack of financial resources when leaving a perpetrator, lack of housing if escaping from DV, and physical health concerns and/or injuries related to DV, the co-location of IMH services onsite at a safe location that families are already familiar and comfortable with will decrease a barrier to accessing services elsewhere. Third, given successful education of first responders and effective referral and engagement of families in IMH services, the final aim of this proposal would be to provide timely, trauma-specific infant mental health intervention to relive the psychological suffering and trauma symptoms these young children are experiencing. MHCD has a history of providing high quality, relationship based dyadic IMH services including the evidence based treatment Child Parent Psychotherapy, which was specifically developed to treat very young child witnesses to domestic violence (ages 0-5). This treatment as well as other trauma-informed, IMH interventions would be offered to identified victims and their families.

Who benefits? (1500 characters)

1. Who are the beneficiaries of your idea? The young children and families who experience domestic violence would benefit from this idea. How will they benefit from your idea? We know that timely mental health interventions for the young child who has experienced domestic violence mitigates the effects of these traumatizing events. Young children who do not receive the appropriate mental health interventions early often experience difficulties in school, and physical and behavioral health problems well into adulthood. Untreated PTSD can interfere with a child’s normal brain development and can increase the risk for other psychiatric conditions. Additionally, children who experience domestic violence and who do not receive treatment are at increased risk of victimization as adults. By increasing awareness of the impact of domestic violence on young children and closing the gaps between referral and service delivery we significantly increase positive health and mental health outcomes and decrease the generational cycle of domestic violence. 2. What experience do you have interacting with your beneficiaries? Please explain. The Mental Health Center of Denver’s Right Start for Infant Mental Health program provides specially trained early childhood mental health clinicians who provide evidenced based interventions for children who experience domestic violence.

What kind of impact will your idea have? (1500 characters)

The Denver Police Department automatically reports domestic violence to Denver Human Services (DHS), which often does not open a case. Absent an open case, there is no follow up on referral to services. The ability of the family to follow through is compromised by the chaos and crisis nature of domestic violence situations. Basic needs must be met before a family can practically and meaningfully engage in mental health services. Closing the gaps in the system and providing much needed education on early childhood mental health will increase the number of children receiving these crucial services and improve outcomes. By engaging children in services following experiences of domestic violence, we not only alleviate suffering in the short term but also a) change the trajectory of the child’s life, and b) help break the cycle of violence through which abused children often become abusers as adults. Ultimately, we impact the prevalence of domestic violence in our society. Currently, the system fails to recognize the impact domestic violence has on young children and does not provide sufficient follow through for a successful referral and treatment process. Addressing the lack of education, the gaps in the referral process and the way in which families are approached for services will result in a system that reaches more young children and result in better outcomes for the entire family and for all of society.

How does or how could your idea impact low-income children? (1500 characters)

While domestic violence occurs in families across the socio-economic spectrum, those who avail themselves of the services provided through the Rose Andom Center are disproportionately of low income.

Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)

We know that children zero to three are unserved in the context of domestic violence and that the need is dramatic. This innovation blazes new territory in raising awareness and making the vital connections that are not yet recognized in our communities. By sensitizing and training partner entities, we will vastly raise the level of appreciation for the benefit of such services. Moreover, a key element of this innovation is to establish connections between our infant mental health providers and the survivors to optimize the successful engagement in and completion of services. We will close the loop by persistently keeping engaged with the survivors. Our concept is to remain engaged for as long as the survivor needs to get settled and receptive to this kind of help. This innovation will promote the large-scale adoption of vital infant mental health services.

Feasibility: Where are you with understanding the feasibility of your idea? Describe what you’ve done so far and your plans. (3000 characters)

This initiative builds upon an earlier partnership between the Mental Health Center of Denver and the Rose Andom Center to provide crucial mental health services to the youngest children of survivors of domestic violence. It takes learnings from that earlier experience to promote greater awareness of the need for such services across the continuum of response to domestic violence and to promote more proactive and persistent referral and follow up to domestic violence survivors. We believe that our concept has the potential to be broadly feasible and viable. As a new stage innovator, we are eager for mentoring and collaboration that will help us to achieve our innovative vision.

Tell us more about you (3000 characters)

This project addresses the challenges that we identified in the course of an earlier collaborative effort between the Mental Health Center of Denver and the Rose Andom Center, which recently opened as the first family justice center in the Rocky Mountain region. Chief among the challenges that arose from our previous collaboration was the low volume of engagement, which is a consequence of two factors: 1) People don’t recognize that children zero to three need this service. 2) Survivors typically are not ready to engage in services. We are inspired to overcome the pitfalls that arose in our previous collaboration. The Early Childhood Innovation Prize presents an opportunity for this innovation. The Rose Andom Center brings together over 20 criminal justice, civil justice and community-based agencies to better serve domestic violence victims and their children. By co-locating staff and services from multiple community agencies in one central location, the Rose Andom Center provides comprehensive screening, intervention and supports to Denver’s parents, children and youth who have been impacted by domestic violence. Founded in 1989, the Mental Health Center of Denver is known locally and nationally as a model for innovative and effective community behavioral healthcare. Our three main branches are: Child & Family Services, offering programs for infants, children, adolescents, and families living with mental illness and emotional disturbance; Adult Recovery Services, providing outpatient treatment services to individuals with mental illness and substance abuse disorders; Rehabilitation Services, supporting individuals in their recovery, promoting their well-being, and assisting them in attaining education, employment and personal development goals. Our mission of “Enriching Lives and Minds by Focusing on Strengths and Well-Being” is the guiding force behind our strengths-based, recovery-oriented treatment philosophy. Our success has earned us the Community Provider of Excellence Award from the National Council for Behavioral Health and the Science to Service Award from the Substance Abuse and Mental Health Services Administration. The Mental Health Center of Denver’s Right Start for Infant Mental Health is a program for families with children ages birth to five years and pregnant women. It provides help when there are concerns about a child’s development or when parenting becomes difficult. It’s crucial early intervention can avert and mitigate the impact of early childhood trauma and set the child on a healthy developmental trajectory. The team of psychologists and therapists offers comprehensive, trauma-informed, relationship-based interventions, including: • Child and Family Therapy • Child-Parent Psychotherapy (CPP) • Parent Child Interaction Therapy (PCIT) • Trauma Focused Cognitive Behavioral Therapy (TF-CBT) • Parent Child Groups • Case Management • Psychiatric Evaluation

Do you have the people and partners you need to do what you’ve described? (600 characters)

We have coordinated on this proposal with the Rose Andom Center and expect to coordinate with its partner agencies, which include: SafeHouse Denver Project Safeguard Colorado Legal Services Colorado Coalition for the Homeless Servicios de la Raza Denver Domestic Violence Coordinating Council Denver City Attorney’s Office Denver County Court Probation Victim Assistance Denver District Attorney’s Office Denver Human Services Denver Police Department (DPD) Domestic Violence Investigation Unit DPD Victim Assistance Unit Denver Children’s Advocacy Center Project PAVE

As you consider your next steps, what kinds of help could you use? Is there a type of expertise that would be most helpful? (1800 characters)

We are embarking on new territory in the urgent mission of creating a comprehensive continuum of care for children. Especially challenging is the reality that many of the long-term benefits that we know would accrue from this project in terms of reduction in chronic and persistent disease and increased health, well-being and longevity are not subject to demonstration by a pilot project. Another challenge we anticipate is in establishing structures and workflows that will optimize efficiency over the course of changing caseloads. We eagerly welcome support in establishing structures, workflows and payment mechanisms to overcome these challenges.

Would you like mentoring support?

  • Yes

If so, what type of mentoring support do you think you need? (1200 characters)

We would welcome mentoring support in establishing structures, workflows and payment mechanisms that promote long-term financial sustainability.

Are you willing to share your email contact information submitted on OpenIDEO with Gary Community Investments?

  • Yes, share my contact information

[Optional] Biography: Upload your biography. Please include links to relevant information (portfolio, LinkedIn profile, organization website, etc).

Shannon Bekman, Ph.D., IMH-E® (IV-C) is a licensed clinical psychologist and the Associate Director of Child & Family Outpatient Services at the Mental Health Center of Denver (MHCD). She developed Right Start for Infant Mental Health, which is an outpatient infant mental health program that treats children 0-5 and their caregivers, with an emphasis on the amelioration of trauma. Shannon.bekman@mhcd.org https://www.linkedin.com/in/shannon-bekman-83800153/ www.MHCD.org

Updates: How has your idea changed or evolved throughout the Prize? What updates have you made to this submission? (1500 characters)

Our submission has not changed.

Innovation: What makes your concept innovative? (1500 characters)

Providing mental health services to infants and families impacted by domestic violence is not a new concept; however, raising awareness and making vital connections between the systems interacting with these families would pioneer a new way of successfully engaging families in services. This idea not only addresses systemic road blocks to receiving services but looks carefully at the individuals involved in the system. First responders in domestic violence situations can be the catalyst needed for the infants involved to receive necessary therapy services. Unfortunately, due to a lack of education, this opportunity is often missed. Our idea addresses this road block in a unique way by thinking about the opportunities missed and the potential for connections. As the individual families move through this new system of services, they are supported every step of the way. Currently, families often leave the system due to crises and a lack of support around basic needs. With this innovation, families remain engaged and supported until ready to move into more intensive therapy services. The fractured system of service provision for very young children and their families involved in domestic violence fails to meet their needs. Creating continuity within the system would break new ground in assuring the successful provision of infant mental health services.

Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)

We are a new stage developer

Business Viability: How viable is your business model? (1500 characters)

We are able to provide vital mental health services to persons in Denver with funding from Colorado’s Medicaid program as well as state general funds. The proposed line of services at the Rose Andom Center would be new programming that is not currently figured into our reimbursement rates. IDEO funds would allow us to cover the first year or two of services, thus establishing a billing history that would increase our rates moving forward. An injection of money up front as funded by this successful IDEO proposal would allow us to provide necessary services to these young children and families for the first year or two, so that eventually we negotiate to get these vital services written our sub-capitated Medicaid agreement. Survivors of domestic violence who seek out services at the Rose Andom Center are often experiencing a number of interpersonal and concrete crises. Given these challenges and Maslow’s hierarchy of needs, we anticipate that victims will need significant care navigation support to access services. However, care navigation and coordination currently are unbillable services by Medicaid and State General Funds. Sustaining the mental health therapist position will be more readily accomplished in the long term, and sustaining the care navigator position will be more challenging given the lack of a clear funding stream. It is our hope and goal that the entire program of services can be negotiated into a future Medicaid contract.

HCD: How have you used human centered design to build or refine your concept? (1500 characters)

Our concept grows out of the learnings that we and our partners at the Rose Andom Center have obtained through our independent and collaborative work in support of caregivers and their zero-to-three children in the context of recovery from domestic violence. In our earlier work we heard directly from the caregivers whom we served and from Rose Andom Center personnel that our services were highly valuable and urgently needed. At the same time, for a number of reasons only a small proportion of caregivers and zero-to-three children who would have benefitted from our services actually availed themselves of those services. Our experience with caregivers, Rose Andom Center personnel, first responders and others gave us valuable insight as to why that was so. We learned from first responders the ways in which first response in domestic violence situations has neglected and dismissed the trauma that zero-to-three witnesses have experienced. Caregivers who were unaware of the need for services did not gain vital information from first responders. And we observed ourselves that the lack of stability that caregivers experience in all aspects of their lives in the aftermath of domestic violence constitutes a critical barrier to obtaining vital care for themselves and for their zero-to-three children. Through conversations with the Rose Andom Center and other partners we have devised a system-change solution to bring greater awareness of the need, and to meet it.

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Photo of Jacquelyn Rose
Team

Good Morning Eric -
Thank you for sharing this innovation! I appreciate the systems approach you are taking to address this very complex problem. I am wondering what the intended outcomes of the innovation are and how you will assess whether or not they are being achieved.
Thanks,
Jacquelyn

Photo of Eric
Team

Hello, Jacquelyn!

Through this system change we expect to markedly increase the degree to which survivors of domestic violence engage their 0-3 children in treatment to avert and reduce the impact of trauma. As described in the proposal, we will accomplish this by a) educating those who are in the continuum of response to domestic violence about the importance of conveying to survivors the necessity of treatment, and b) persistently following up with survivors over weeks or even months to engage them in treatment as soon as their life circumstances permit. We propose to keep careful track of survivors about whom we learn to determine what proportion do engage in treatment within six months and to survey them as to whether advice from responders in the continuum of response and/or the persistent/proactive engagement of the PEID-V team were factors in their decision to engage in treatment.

We also are interested in tracking prevalence of PTSD diagnoses in the young children and successful resolution of PTSD diagnoses after a completed episode of treatment.

Additionally, we would like to track the number of families referred to infant mental health services, and the number that successfully engaged.

Finaly, we have in mind to do a pre-/post survey at our trainings to assess increased knowledge of infant mental health among the trainees (i.e. victim advocates and Denver Police Department officers).

Thank you for your question!

Photo of Jacquelyn Rose
Team

Thank you so much for such a comprehensive answer! I manage the Connecticut Children's Advancing Kids Innovation Program, which seeks to collaborate with individuals and agencies developing innovative strategies to promote children's optimal healthy development, strengthen families, and support communities. We offer a variety of services to innovators to support the evolution of social innovations. If we can ever be of assistance to you, please do not hesitate to reach out, jrose01@connecticutchildrnes.org.

Best,
Jacquelyn