Developing a MultiLevel Intervention to Address Family Violence, Employing both a Community Action a

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Developing a Multi-Level Intervention to Address
Family Violence, Employing both a Community
Action and Systems Change Approach

• Four Concurrent Multi-Disciplinary Collaborative
  Initiatives to Address Family Violence
• Work to raise awareness of family violence and
  make systems change with providers in the
  Philadelphia Healthy Start target area
• Work to raise awareness of family violence and
  make systems change with providers of mens and
  fatherhood services within Philadelphia
• Work to raise awareness of family violence and
  make systems change within the school district of
  Philadelphia
• Work to raise awareness of family violence and
  make systems change within major municipal
  systems serving women, children, and families
• Silvana Mazzella, Cynthia Line,
• Peter Cronholm, Marcy Witherspoon, Amber Crawford

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BACKGROUND / HISTORY

• Needs Assessment conducted in 2000 with service
  providers and community leaders identified
  domestic violence and child abuse as major issues
  within community
• As a result of needs assessment, successful
  application for HRSA Demonstration Grant in 2000
  Developing a System of Care to Address Family
  Violence During and Around Pregnancy in Lower
  North Central Philadelphia

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PREVALENCE OF FAMILY VIOLENCE IN THE PERINATAL
PERIOD

• Pregnant and recently pregnant women are more
  likely to be victims of homicide than to die of
  any other causes and a significant portion of all
  female homicide victims are killed by their
  intimate partners
• 1 in 3 girls and 1 in 6 boys will be sexually
  abused before the age of 18
• Studies suggest that between 3.3 and 10 million
  children are exposed to some form of domestic
  violence annually

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Addressing family violence within our healthy
start program and within the healthy start target
community
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ADDRESSING FAMILY VIOLENCE WITHIN OUR HEALTHY
START CASE MANAGEMENT PROGRAM

• Collaboration with Institute for Safe Families,
  family violence systems change organization
• Review of policies regarding family violence with
  regards to screening, reporting, referral, and
  general practice
• Introduced new assessment with more diverse
  questions, changed case management forms to
  reflect new assessment and additional questions,
  increased frequency of assessments, developed
  formal screening and referral policy, and
  implemented ongoing series of staff trainings to
  improve assessment and coping skills of staff
• Worked to address cultural and attitudinal
  barriers of staff
• Developed multi-disciplinary Family Violence Case
  Review Team and implemented monthly Case Review

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ADDRESSING FAMILY VIOLENCE WITHIN THE HEALTHY
START COMMUNITY

• Developed and convened a Healthy Start Family
  Violence Work Group consisting of community
  participants, community residents and leaders,
  and community based providers
• Developed and convened a Healthy Start Family
  Violence Task Force consisting of domestic
  violence, child welfare, sexual assault, and
  batterers treatment providers
• Goals
• - identifying gaps in services in target
  community and making recommendations to Healthy
  Start Family Violence Task Force to ensure
  effective and coordinated service delivery in
  target community
• - increasing screening, referral, and awareness
  regarding family violence in target community
• making systems change with regards to
  organizational policy re fv

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HEALTHY START FAMILY VIOLENCE WORK GROUP

• Family Violence Work Group
• Contact Silvana Mazzella, Healthy Start, PDPH,
  215-685-5270, Silvana.Mazzella_at_phila.gov
• Rose Ferrell, Ferrell16_at_msn.com
• Congreso (http//www.congreso.net/Site/Home/Home.h
  tm)
• FASST Program (httpwww.FASST.net/)
• Health Federation of Philadelphia Early Head
  Start Program (httpwww.healthfederation.org)
• Institute for Safe Families (http//www.institutef
  orsafefamilies.org/)
• Lutheran Settlement House Bilingual Domestic
  Violence Program (httpwww.LutheranSettlementHouse
  /Bilingual Domestic Violence Program.org/)
• Menergy (http//www.menergy.org/)
• Men United for a Better Philadelphia
• New Joy Missionary Baptist Church
• Philadelphia Fatherhood Practitioners Network
  (http//www.pfpn.org/)
• Project Home (http//www.projecthome.net/)
• Quality Community Health Care (httpwww.qchc.org/)
  
• Women Organized Against Rape (http//www.woar.org/
  )
• Womens Christian Alliance (http//www.wcafamily.o
  rg/)

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IMPLEMENTATION OF WORK GROUP GOALS

• Conducted series of annual trainings with target
  area providers regarding variety of topics
  related to family violence
• Conducted series of annual trainings for
  community residents and leaders
• regarding variety of topics related to family
  violence including communitys role in reducing
  family violence
• Collaborated with Family Violence Prevention Fund
  and local domestic violence, child welfare,
  sexual assault, and batterers treatment
  providers to conduct 2 annual conferences
  Family Violence Its Everybodys Business
• Actively engaged community to develop and conduct
  a year long Family Violence Needs Assessment with
  diverse set of area service providers

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NEEDS ASSESSMENT METHODS

• 17 question survey
• Questions identified extent to which community
  based providers have organizational policies in
  place regarding screening, referral, reporting,
  and follow-up
• Questions identified existence of organizational
  policies regarding family violence, gaps in
  services, types of questions utilized to screen
  for family violence, and awareness of resources
  with which to connect affected clients/families
• Specific questions regarding type of questions
  asked by providers to screen, prevalence within
  client base, resources referred to, reporting
  requirements, types of literature shared with
  clients, type of training offered or mandated,
  and desire for training
• Results descriptive and used to identify gaps in
  family violence services among frontline service
  providers, identify agencies interested in
  receiving specific training to strengthen family
  violence policies, and shape recommendations
  regarding systems change

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NEEDS ASSESSMENT SAMPLE DESCRIPTIVE INFORMATION

• 42 programs responded
• 22 respondents (51) reported that they
  exclusively offer 1 type of service
• 5 respondents (12) offered only 2 types of
  services, while 16 (37) reported 3 types of
  services to clients/families
• Education, health/medical, and after school
  program were the most common types of services
  offered by the agencies that responded
• Type of service(s) respondents provided
• Education, Health/Medical, After School, General
  Information Referral for social services, Case
  Management, Outreach, Education and Remediation
  services related to lead poisoning, Nutritional
  education, Child Development, Social Services,
  Housing Information, Shelter and Transitional
  Housing, Community Service, Employment
  Counseling, Child Care, Nutritional Support,
  Clothing, Fatherhood programs, Clergy Sponsored
  Social Services, Legal Resources
• 33 respondents (49) reported that services
  offered are delivered in office, while 14
  respondents (21) reported that services are
  home-based

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MAJOR FINDINGS OF NEEDS ASSESSMENT

• Agency policy regarding family violence
  screening
• 21 respondents (53) said their program/agency
  does NOT offer family/domestic violence training
  for staff, but 24 respondents (59) expressed
  interest in having the staff trained
• 17 respondents (43) reported their
  program/agency does offer family/domestic
  violence training for staff
• Topics offered
• 12 responses (35) - Dynamics of Domestic
  Violence
• 11 responses (32) - Effects of domestic violence
  on children
• 22 respondents (58) said their program/agency
  does NOT have a domestic violence screening
  policy but do ask certain questions regarding
  family violence
• Top 3 questions agencies asked ADULTS regarding
  exposure to family violence
• Have you ever been hurt and/or threatened by your
  partner?
• Are you afraid of your partner?
• Have your children ever been injured as a result
  of a domestic dispute?
• Top 2 questions agencies asked CHILDREN regarding
  exposure to family violence
• Have you ever been hit, hurt, threatened or are
  you afraid of anyone in your family?
• Do you feel safe in the places you live or visit?
• Of the 11 respondents (29) that do have a
  domestic violence screening policy, the most
  common policy used is RADAR

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MAJOR FINDINGS contd

• Recording client exposure to family violence and
  referral to appropriate family violence services
• 24 respondents (57) reported that staff is
  required to record the of clients reporting
  exposure to family violence.
• 22 respondents (56) did not know or did not
  respond to the percentage of clients exposure to
  family violence.
• 7 respondents (18) reported that at least 20 of
  clients reported exposure to family violence.
• 14 respondents (33) reported that staff is NOT
  required to record the of clients reporting
  exposure to family violence
• 18 respondents (44) stated that their
  program/agency uses a referral tracking system to
  document referral follow-up.
• 30 respondents (70) reported that their
  program/agency does refer families to family
  violence service organizations. These agencies
  referred to include
• Other not offered as choices 20 (14) which
  includes following
• (DHS (3), Social worker who then refers, WOAR
  (9), Behavioral health social worker, MUBP (2),
  PA Coal. Hotline, WCA, ISF, Police
• Women Against Abuse 17 (12)
• Community Legal Services16 (12)
• Women in Transition15 (11)
• Domestic Relations Court12 (9)
• Childrens Crisis Treatment Center11 (8)
• Womens Law Project 9 (7)
• Congreso (Latina Domestic Violence Program) 8
  (6)
• Philadelphia Legal Assistance 8 (6)
• WAA Legal Center 8 (6)
• No response 4 (3)

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MAJOR FINDINGS contd

• Needs of families exposed to family/domestic
  violence
• Adult Mental Health 22 (17)
• Housing 20 (15)
• Safety 19 (14)
• Childrens Mental Health 18 (14)
• Empowerment/Options Counseling 18 (14)
• Childcare 15 (11)
• Financial 13 (10)
• Batterers Intervention 5 (4)
• No response 2 (2)
• Prenatal/GYN 1 (1)
• Barriers families encounter while attempting to
  access family/domestic violence services
• Financial 22 (20)
• Safety 19 (18)
• Lack of shelter beds 16 (15)
• Waiting lists 13 (12)
• Childcare 12 (11)
• Legal Issues 12 (11)

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NEEDS ASSESSMENT RECOMMENDATIONS

• 1. There is a need for a mechanism or process to
  create consistent policies regarding family
  violence within community based organizations,
  and across agencies within the larger Lower North
  Philadelphia community
• 2. Family service organizations and /or child
  service organizations should be providing family
  violence training for staff on an annual basis
  covering topics including, but not limited to
• -The Cycle of Abuse
• -Safety Planning
• -The Effect of Trauma on Children
• 3. Community based clinical and social service
  providers delivering health care services, case
  management services, family services, or child
  development related services should have an
  actual family violence screening policy
• 4. Community based clinical and social service
  providers delivering health care services, case
  management services, family services, or child
  development related services should record the
  number of clients exposed to family violence and
  then track referrals for family violence services
• 5. There is a need for a mechanism and process
  for dissemination of literature regarding family
  violence resources and "Where to Turn" or
  Courage cards for all agencies in the
  community, but particularly for those agencies
  not equipped to conduct screening or referral for
  family violence
• 6. There is a need for improved linkages between
  community based referral sources and family
  violence service providers
• 7. Families affected by family violence face
  additional barriers and needs that are
  challenging to provide, particularly housing and
  referrals for appropriate mental health services
• Additional Discussion
• 1. For those organizations with capacity to begin
  or improve screening, the number of questions
  asked regarding exposure to family violence
  should be increased and include open-ended
  questions
• 2. Because families affected by family violence
  face additional barriers and needs, CBO's should
  refer families to a broader range of services and
  resources

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IMPLEMENTATION OF WORK GROUP RECOMMENDATIONS

• Additional work group and needs assessment
  developed for remaining Healthy Start target area
  
• Focus groups regarding barriers to receiving
  family violence services
• Work with family violence providers to address
  findings specific to their agencies
• Collaborative effort with family violence
  providers to develop series of trainings of
  differing depth specific to types of agencies and
  skill levels of agency staff
• Training module focusing on appropriateness of
  service to situation employing Ecomap model
• Collaborative Family Violence Resource Open
  Houses throughout service area
• Systems change with regards to organizational
  policies to address family violence with a
  limited number of agencies in Healthy Start
  target area

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Addressing family violence within programs
serving fathers and male partners
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WHY SPECIFICALLY TARGET PROVIDERS OF MENS /
FATHERHOOD SERVICES ?

• Family Violence and History of Exposure
  Parenting Issues
• Parenting organizations are likely to be involved
  with families affected by domestic violence
• Therapeutic and privileged nature of the
  relationship
• Unique opportunity to
• Screen
• Diagnose
• Refer
• Prevent abuse and neglect

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RISK TO CHILDREN FROM BATTERERS

• Exposure to threats or acts of violence towards
  their mother
• Undermining mother-child relationships
• Batterer as a role model
• Rigid, authoritarian parenting
• Physical or sexual abuse of the child by the
  batterer
• Abduction
• Neglectful or irresponsible parenting
• Psychological abuse and manipulation
• Exposure to violence in their father's new
  relationships

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PHILADELPHIA FATHERHOOD PRACTITIONERS NETWORK
(PFPN)

• Initially convened in 1999 by Resources for
  Childrens Health in recognition of the need to
  work collaboratively with other agencies and
  programs serving men
• Consortium of more than fifty agencies and
  organizations that provide services to fathers
  and men
• social services agencies
• departments of city government
• schools and universities
• neighborhood councils
• health centers
• criminal justice organizations
• churches
• Initial work focused on networking to share
  information and resources
• Now with an expanded mission to include the
  promotion of collaborative services, education
  and advocacy efforts on behalf of fathers about
  policy and legal issues

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PFPN FAMILY VIOLENCE SUB-COMMITTEE

• Family Violence Sub-Committee
• Contact Silvana Mazzella, Health Start North,
  215-685-5270, Silvana.Mazzella_at_phila.gov
• Willie Ellison, Youth Services, Inc.,
  215-387-2050, wellison_at_ysiphila.org
• Bureau of Child Support Enforcement
• Congreso (http//www.congreso.net/Site/Home/Home.h
  tm)
• Department of Family Medicine and Community
  Health, Hospital of the University of
  Pennsylvania (http//www.uphs.upenn.edu/fampract/)
  
• Healthy Start North Program, Philadelphia
  Department of Public Health, Division of
  Maternal, Child and Family Health,
  (http//www.phila.gov/health/units/mcfh/HS/hs.html
  )
• Impact Services (http//www.impactservices.org/)
• Institute for Safe Families (http//www.institutef
  orsafefamilies.org/)
• Fathers Legal Advocacy Group

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ADDRESSING FAMILY VIOLENCE WITHIN THE FATHERHOOD
PRACTITIONERS NETWORK

• Family Violence Sub-Committee (FVSC) formed
  within Network to raise awareness of issue of
  family violence among fatherhood practitioners
• FVSC developed and conducted needs assessment
  with citys fatherhood and mens service
  organizations identify extent to which fatherhood
  and mens practitioners screen and refer for
  family violence
• Goals
• -Raise awareness of the effect of family
  violence and childhood exposure to violence,
  abuse, and trauma on parenting and childhood
  experience
• -Infuse family violence information into
  existing fatherhood curricula and
• -Develop and implement training modules
  regarding screening and referral for family
  violence that are father-friendly and appropriate
  to male practitioners
• Make systems change with regards to
  organizational policy re fv

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NEEDS ASSESSMENT METHODS

• Survey items were developed with four major
  domains of inquiry
• Individual barriers,
• Agency-level barriers,
• Individual behaviors, and
• Individual demographics
• Our measure of association was the odds ratio
  with p-values calculated for each point estimate.
  
• Logistic regression was used to compute odds
  ratios with chi2-values derived from
  likelihood-ratio estimates

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NEEDS ASSESSMENT SAMPLE DESCRIPTIVE INFORMATION

• A total of 85 providers from 10 CBOs providing
  fathering services completed surveys the sample
  had more men than women (56.5 vs. 40.0) the
  average age was 40.5 (SD13.7) and the majority
  were African American or Black (72.9 11.8
  Latino and 9.4 White).
• The majority of providers reported not routinely
  inquiring regarding DV, CV or perpetration
  (61.2, 58.8 and 67.0 respectively)
• The vast majority of providers reported low
  levels (lt1-5 prevalence) of adult DV, CV or
  perpetration among their clients (76.4, 74.2
  and 81.2 respectively)

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RESULTS SUMMARY PERPETRATION

• lt 1/3 of staff report
• having a standard way of asking or routinely ask
• gt 1/2 of staff report
• Lack of training
• Concerns over victim safety
• Lack of familiarity with resources
• Concerns about asking in their setting
• Not aware of effective treatments

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RESULTS SUMMARY PERPETRATION
Individual Behaviors lt1/2 have never identified
a perpetrator Refer to mental health or
Community-based services Not having identified
perpetration or CV No routine CV, DV, alcohol
or incarceration inquiry Demographics Being a
provider for lt 6 years Having lt 2 hours of
training Women were more concerned about their
own safety and less interested in working with a
perpetrator Men were less interested in knowing
of a client was a perpetrator

• Individual Barriers
• Uncomfortable asking
• Not my role
• Might offend clients
• Wrong setting
• Agency-Level Barriers
• Not having DV protocols
• Lower estimates of prevalence

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RESULTS SUMMARY ADULT VICTIMIZATION

• 1/2 of staff report
• having a standard way of asking
• gt 1/3 of staff report
• routinely ask

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RESULTS SUMMARY ADULT VICTIMIZATION

• Individual Barriers
• No associations noted
• Agency-Level Barriers
• 1/2 report lt1 prevalence
• Not offering DV training
• Lower estimates of prevalence

• Individual Behaviors
• 1/3 have never identified an adult victim
• Refer to mental health or Community-based
  services
• Not having a standard way of asking
• Not having identified perpetration, DV or CV
• No routine perpetration, CV, alcohol,
  relationships or weapon inquiry
• Demographics
• Men were less likely than women

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RESULTS SUMMARY CHILDHOOD VICTIMIZATION

• lt 1/2 of staff report
• having a standard way of asking
• routinely asking

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RESULTS SUMMARY CHILDHOOD VICTIMIZATION

• Individual Barriers
• Lack of training
• Agency-Level Barriers
• 1/2 report lt1 prevalence
• Not offering DV training
• Not having DV protocols for staff
• Lower estimates of prevalence

• Individual Behaviors
• 1/3 have never identified CV
• Not having a standard way of asking
• Not having identified CV
• No routine DV, alcohol, relationships,
  discipline or weapon inquiry
• Demographics
• Having lt 2 hours of training

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CONCLUSIONS BEHAVIORS

• Many staff consider asking, but few do
• The majority of staff already report asking about
  sensitive issues that can impact relationships
  (but not weapons)
• if you are already asking about domestic violence
  exposures or have ever identified an affected
  client you are more likely to ask about
  domestic violence issues
• Most staff report referring clients exposed to
  domestic violence to mental health or
  community-based service providers
• Staff recommended asking when signs or symptoms
  arise

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CONCLUSIONS BARRIERS

• Lack of training
• more is needed
• Safety issues
• What about my safety and the safety of my
  clients?
• Knowing about resources
• What are they and do they work?
• Low estimates of prevalence
• Is this affecting my clients?

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CONCLUSIONS OVERALL

• Our data suggest that screening behaviors are
  complex and shaped at the individual level as
  well as the agency level
• Behaviors, concerns and agency support of clients
  and staff affected by domestic violence issues
  predicted routine domestic violence inquiry

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CONCLUSIONS TRAINING

• Issues shaping screening behaviors can all be
  addressed with proper training
• Training objectives need to
• Address comfort issues
• Address education
• Provide a venue for practice
• Build on and reinforce what staff are already
  doing
• Create environments of sustainability by
  facilitating agency buy-in
• Training curricula must be developed that
  incorporate the specific interests and needs of
  fathering providers and their clients

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NEXT STEPS

• Get this information out
• Generate discussions and form consensus on the
  conclusions and implications
• Assess issues from the clients perspective
• Use results to design and implement training
  curricula for fathering/parenting programs
  regarding identification and treatment of
  domestic violence and domestic violence
  perpetration
• Continue to build collaborations between
  fathering/parenting programs and domestic
  violence agencies

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• Addressing family violence through primary
  prevention with pre-adolescents within the
  philadelphia school district

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OPPORTUNITY 2ND PREVENT INSTITUTE

• Primary Violence Prevention Research and
  Technical Assistance Initiative of the University
  of North Carolina School of Public Health through
  the Centers for Disease Control and Prevention
  (CDC)
• Institute open to teams with a primary violence
  prevention concept and plan to implement concept
• Team convened by Healthy Start and Philadelphia
  Department of Public Health, Division of
  Maternal, Child and Family Health
• 31 teams applied
• 19 teams selected
• 3 teams for DV 3 teams for SV 1 team for Child
  Maltreatment 2 teams for Suicide Prevention and
  1 general violence team

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PHILADELPHIA PREVENT TEAM

• Team assembly multi-disciplinary team consisting
  of representatives from 6 agencies / systems
• Development of primary violence prevention
  concept
• Application process
• Evolution of concept
• Final primary violence prevention project

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PREVENT TECHNICAL ASSISTANCE LEADERSHIP INSTITUTE

• January 30th February 3rd
• Leadership
• Prevention Overview Primary, Secondary,
  Tertiary
• Community Organizing and Activism
• Action Learning
• Using Data
• Effective Program Planning
• Effective Evaluation Methods
• Building Effective Teams
• August 21st August 23rd
• Legislative Advocacy
• Media Advocacy
• Building Effective Collaborations
• Leadership Revisited
• Networking
• Poster Presentations

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PHILADELPHIA PREVENT TEAM

• Gilbert Coleman Fatherhood Initiative Program,
  Executive Director
• Lisa Cordeiro-Kricun Congreso de Latinos Unidos,
  Incorporated, Deputy Vice President
• Amber Crawford-Wagman Women Organized Against
  Rape, Therapist
• Silvana Mazzella Philadelphia Department of
  Public Health, Division of Maternal, Child
  Family Health, Local Health Systems Planner
• Aubrey Powers Philadelphia Department of Human
  Services, Division of Community-Based Prevention
  Services, Director of Family Community Support
• Marcy Witherspoon Institute for Safe Families,
  Director of Children and Youth, and Staff Adjunct
  Department of Human Services
• Program Evaluator- Dr. Peter Cronholm Hospital
  of the University of Pennsylvania, Department of
  Family Medicine, Family Physician

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PHILADELPHIA PREVENT PROJECT WORKING TO EDUCATE
AND EMPOWER YOUTH FOR LEADERSHIP (WEEYL)

• Team identified adolescents as group facing
  greatest barriers to accessing services due to
  consent and other issues
• Pre-adolescents selected as intervention
  population due to ability to make greatest impact
  and prevent primary violence
• Communities for intervention selected based on
  statistics on community violence, female
  homicides, and intimate partner violence events
• 2 public schools selected for intervention, 2
  schools selected as control group
• Collaborative development of Dating Violence
  Prevention Curriculum by team members
• 6th Grade Students
• Curriculum to include monthly workshops sessions
  for 8 months
• Implemented separately for boys and girls during
  the 2006-2007 academic year

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EVALUATION PLAN

• Specific aims of the evaluation
• To assess the acceptability and impact of an
  evidence-based intimate partner violence
  prevention curriculum for sixth graders and
• To assess differences in curricular acceptability
  and impact based on racial/ethnic identity,
  gender and age

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PREVENT CURRICULUM

• Session 1 The Role of Self Esteem
• Session 2 Culture, Social Norms, and the
  Media
• Session 3 Unhealthy Relationships, Power,
  Control, and Danger
• Session 4 Childhood Exposure to Trauma
• Session 5 Healing from the Wounds
• Session 6 Healthy Relationships
• Session 7 Making Choices
• Session 8 Wrap Up

43
NEXT STEPS FOR PREVENT TEAM

• Assessment of feedback from facilitators and
  focus groups with students
• Modification of curriculum
• Completion of entire evaluation
• Meetings with parents and teachers of 2
  additional intervention sites for 2007-2008
  academic year
• MOUs with new sites
• Meetings with school district to expand
  curriculum to greater number of sites and make
  systems change within school system
• Special training for additional facilitators
• Development of tool to measure efficacy of
  program delivery with less skilled facilitators
• Further process and outcome evaluation

44

• Addressing family violence within the
  philadelphia department of public health (PDPH)
  and other major systems

45
TWO EFFORTS TO MAKE CHANGE WITHIN SYSTEMS SERVING
WOMEN, CHILDREN, AND FAMILIES

• MAYORS TASK FORCE ON DOMESTIC VIOLENCE WOMENS
  DEATH REVIEW TEAM AND SOCIAL SERVICES
  SUB-COMMITTEE
• MULTIPLYING CONNECTIONS TRAUMA INFORMED SERVICES
  INITIATIVE

46
MAYORS TASK FORCE ON DOMESTIC VIOLENCE

• Womens Death Review Team- contact Edina
  Ekwerike, Philadelphia Department of Public
  Health, Division of Maternal, Child, and Family
  Health, 215-685-5225
• Law Enforcement Sub-Committee- contact Tony
  Lapp, Menergy, 267-625-6135
• Social Services Sub-Committee- contact Cynthia
  Figueroa, Women Against Abuse, 215-386-1280, and
  Carol Tracey, Womens Law Project, 215-928-9801

47
SOCIAL SERVICES SUB-COMMITTEE

• Multi-disciplinary group convened to effect
  systems change within Philadelphias major
  systems, including PDPH, City of Philadelphia
  Department of Human Services, City of
  Philadelphia Division of Behavioral Health, City
  of Philadelphia Office of Supportive Housing, and
  School District of Philadelphia
• Task Force membership
• City of Philadelphia Department of Human Services
• City of Philadelphia Division of Behavioral
  Health
• City of Philadelphia Law Office
• City of Philadelphia Office of Supportive Housing
• Community Legal Services
• Congreso de Latinos Unidos Latina Domestic
  Violence Program
• Institute for Safe Families
• Lutheran Settlement House Bilingual Domestic
  Violence Project
• Philadelphia Department of Public Health, Health
  Commissioners Office, MCFH
• Philadelphia Legal Assistance
• School District of Philadelphia
• Women Against Abuse
• Women In Transition
• Womens Law Project
• Women Organized Against Rape

48
PDPH ROLE AND EFFORTS TO MAKE SYSTEM CHANGE WITHIN

• Review of opportunities to identify individuals
  at risk, particularly children, that come into
  contact with frontline staff within different
  divisions of PDPH (Ambulatory Health, MCFH, DBH,
  EHS Vector Control Unit, CLPPP, Animal Control)
• Revision and development of formal policies and
  recommendations for screening and/or referral
• MCFH Specific Efforts
• Revision of case management forms for all home
  visiting programs
• Additional staff training
• Review and revision of family violence policies
  of contract providers
• Revision of Womens Health Forms to reflect
  identification of domestic violence and referral
  for services
• Greater scrutiny of identification of domestic
  violence and child abuse, documentation of
  identification and referral for services, and
  tracking of referrals

49
MULTIPLYING CONNECTIONS A POSITIVE DEVELOPMENT
FOR ALL CHILDREN

• Initiative to provide trauma informed services to
  children
• "Childhood Experiences Become Your Biology"
  (Bruce Perry)
• Specific systems change work with systems serving
  children
• Spearheaded by Health Federation of Philadelphia,
  PDPH MCFH integrally involved in planning of
  concept and governance of initiative
  implementation
• Major Systems Involved
• City of Philadelphia Department of Human Services
• City of Philadelphia Division of Behavioral
  Health
• Philadelphia Department of Public Health,
  Division of Maternal, Child and Family Health
• School District of Philadelphia
• Goals
• Strengthen connection between research and
  practice
• More effective collaboration among child-serving
  systems
• Enhance connection between training, practice
  standards, and policies within child-serving
  systems
• Facilitate connection between children in systems
  and their family units
• Promote safer and more nurturing family units
  that support early brain development
• Provide specific skills development and systems
  change training

50
IN CONCLUSION

• EFFORTS TO ADDRESS FAMILY VIOLENCE MUST BE
  COLLABORATIVE, MULTI-DISCIPLINARY, AND
  MULTI-FACETED
• MUCH OF CHANGE MAKING DEPENDS ON GROUPS COALESCED
  AND LEADERSHIP DEVELOPED
• CHALLENGES INCLUDE HISTORICAL DIFFERENCES AMONG
  SYSTEMS AND PLAYERS, LACK OF AWARENESS REGARDING
  FV, AND LACK OF INFRASTRUCTURE TO ADDRESS FV