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Service Delivery Innovation Profile

Police-Mental Health Collaboration Provides Immediate and Ongoing Services to Children Exposed to Violence and Trauma, Leading to Enhanced Quality of Life


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Snapshot

Summary

The Child Development Community Policing Program is a community-based collaboration between police and mental health professionals, with additional support from child-focused service providers such as child welfare and protective services, juvenile probation and justice personnel, and schools. The program provides crisis intervention services, clinical services, and coordinated case planning for children, adolescents, and families who are exposed to violence and other traumatizing events. The program has provided immediate access to services for thousands of children who have been exposed to violence over the past 18 years. The program has resulted in improvements in children's quality of life, as well as increased satisfaction and service utilization among victims of violence.

Evidence Rating (What is this?)

Moderate: The evidence consists of post-implementation data on number of children served, a follow up longitudinal study on outreach and control groups of women, and student quality-of-life surveys.
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Developing Organizations

New Haven Department of Police Service; Yale Child Study Center
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Use By Other Organizations

Over the past 16 years, the Child Development Community Policing Program has been implemented in many communities. The program is currently being used in the following Connecticut locations: New Haven founding site, Bridgeport, Guilford, Madison and Stamford. The program has also been implemented in Baltimore, MD;  Charlotte, NC;  Chelsea and Framingham in MA; Clearwater, FL; Nashville, TN; Providence, RI;  Raleigh, NC; Rochester, NY; Sitka, AK; Wilmington, DE; Zuni, NM.

Date First Implemented

1991
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Patient Population

Vulnerable Populations > Children; Mentally illend pp

Problem Addressed

Each year, millions of children are exposed to violence and trauma in their homes and communities, which can have a significant negative impact on their health and well-being. These children often lack access to mental health care services that can help in minimizing the impact of this exposure.
  • Millions exposed to violence and trauma: It is estimated that 15.5 million American children live in families in which partner violence had occurred at least once in the previous year, with approximately 7 million children being exposed to severe partner violence.1
  • Negative health consequences: Exposure to violence and trauma can lead to a range of behavioral health problems, including but not limited to anxiety, depression, school failure, antisocial behaviors, and alcohol and substance abuse, which are especially prevalent among youth facing social and family adversity. Chronic exposure may lead to maladaptation and impairment across cognitive, emotional, and physiological domains of development.2
  • Failure to identify problem and access needed services: Too often, children's traumatic responses are not recognized or attended to by parents, family members, or mental health professionals. Acutely traumatized children are often not seen by mental health professionals until months or years later (if at all), by which time chronic symptoms and maladaptive behaviors may already have become entrenched.3 Many of these children's families must also deal with the chronic and acute effects of violence, poverty, social disadvantage, and comborbid psychopathology. Financial constraints and psychosocial barriers often prevent children and families at greatest risk from accessing traditional mental health care or the most beneficial aspects of police and other social service responses even when they are available.2

What They Did

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Description of the Innovative Activity

The Child Development Community Policing Program is a collaboration between law enforcement and mental health professionals on behalf of children and families exposed to violence and trauma. As a part of the program, cross-trained police officers and mental health clinicians provide direct clinical services and referrals to additional, collateral services that can assist these children and families. Key components of the program include the following:
  • Cross-training and education for police officers: All police officers participate in multi-hour seminars that focus on applying the principles of child development and trauma to the daily tasks of community policing. Mental health clinicians and senior police officers co-lead these seminars. Participating officers are able to discuss various aspects of clinical interventions, as well as the behaviors they deal with on a regular basis. Supervisory officers also observe and discuss various aspects of clinical interventions such as inpatient units, outpatient evaluations, and forensic facilities. To date, more than 500 rank and file police officers and 100 supervisory police officers have received training in the principles of child development and acute traumatic response.3
  • Cross-training and education for clinicians: Clinicians receive multiple hours of classroom training about community policing and the principles of investigation, arrest, use of force, and rules of evidence. In addition, clinicians spend a minimum of 40 hours accompanying police officers on ride-alongs, during which clinicians experience police practice as it actually occurs.
  • Weekly meetings: Police officers, probation officers, clinicians, child protective services, and other interested child-focused agencies meet on a weekly basis to discuss and strategize about clinical, law enforcement, and other interventions for children and families caught up in situations involving violence and other catastrophic events. In addition, clinicians meet separately to focus on the details of clinical assessments and treatment planning.
  • 24-hour consultation service: Clinicians provide around-the-clock service in which they are available by pager to police officers who are concerned about children, families, and communities with whom they have contact. Clinicians respond immediately to the page, engaging in a "triage" process with police officers to determine the appropriate method of response, including whether to come to the site (e.g., crime scene, community venue, or neighborhood/home) or speak by phone with the officer and/or family, and whether to intervene immediately or wait one or more days to meet with the family.
  • Ongoing clinical services and case coordination: In addition to acute crisis interventions, the program provides parents and children with guidance, information about the potential results of exposure to violence or trauma, and a range of clinical services, including pharmacotherapy, consultation with schools and pediatric staff in hospitals, and brief and long-term psychotherapeutic interventions for individual children (often in conjunction with their parents and other family members as well). The program also provides case coordination with law enforcement, community-based mental health advocates, housing agencies, and employment agencies that can help reestablish order, safety, and predictability in families' lives.

Context of the Innovation

The Child Development Community Policing Program launched in 1992 as a partnership between the City of New Haven, the New Haven Department of Police Service, and the National Center for Children Exposed to Violence at Yale University's Child Study Center. The impetus for the program came in 1991, when the New Haven Chief of Police, the director of the Yale Child Study Center, and a few key members from each of the other organizations involved held an initial meeting to discuss their mutual concern about the consequences of exposure to violence and trauma. Police recognized that they could not "arrest their way" out of violent crime, and mental health clinicians recognized they were only seeing and treating a very small percentage of all children and families exposed to violence and other traumatizing events. This initial meeting led to acceptance of the idea that police are often in the best position to first recognize exposure to violence, because they routinely make house calls. Collaborations between police and mental health clinicians in the past had been sparse, making this a nontraditional alliance.

Did It Work?

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Results

The Child Development Community Policing Program has provided immediate access to needed services to thousands of children who have been exposed to violence over the past 18 years. Survey data suggest that the program has resulted in improvements in children's quality of life, while a longitudinal follow up study found the program to be associated with increased satisfaction and service utilization among victims of violence.
  • Referrals to needed services: Police have referred thousands of children who have witnessed or experienced violence, as well as dozens of children who have committed serious violent offenses. These children were often seen by clinicians within minutes of police responses to murders, stabbings, beatings, maiming by fire, death by drowning, and gunfire.2
  • Increased satisfaction and service utilization: In 2009, a soon-to-be-published longitudinal study of the outreach service provided to female victims of domestic violence found that women who received the follow up visits from officers and clinicians/advocates felt more respected by the police officers and felt safer after the intervention than a control group of domestic violence victims that received traditional emergency police response only. Participants were also overwhelmingly positive (92 percent) about the intervention and were more likely to call police earlier before repeat domestic disturbances escalated to previous or increased levels of violence. With greater trust in the response, women who received services reached out for support sooner and were thus better able to protect their children from repeated and escalating levels of violence exposure.4,5
  • Enhanced quality of life: Periodic surveys of New Haven public school students suggest that the program has had a positive impact on quality of life. Surveys of 6th-, 8th-, and 10th-grade students between 1992 and 1996 show substantial improvements in students' sense of safety and experience with violence.3

Evidence Rating (What is this?)

Moderate: The evidence consists of post-implementation data on number of children served, a follow up longitudinal study on outreach and control groups of women, and student quality-of-life surveys.

How They Did It

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Planning and Development Process

Key steps in the planning and development process included the following:
  • Development of cross-training program: In order for police officers and clinicians to collaborate, they first had to learn from each other, which led to the notion of cross-training as a key component of the initiative. After issues of time, money, and staffing were discussed, a small working group of police officers and clinicians spent several months engaged in on-the-job cross-training. Police officers spent time making clinical observations, and clinicians spent time in squad cars making house calls. These early activities eventually led to the development of the formal training program, including police and clinician seminars.
  • Collaboration with Federal government and replication: The Department of Justice became very interested in the program in its early years of implementation and helped support it. In 1999, the Department of Justice and the White House launched the Children Exposed to Violence Initiative, of which the Child Development Community Policing program became an integral part. The National Center for Children Exposed to Violence was established as part of the initiative and became the program's new home. Numerous other communities around the country have replicated the program.

Resources Used and Skills Needed

  • Staffing: The program requires a senior clinician and a senior police officer to serve as program coordinators. A team of social workers, child psychologists, and child psychiatrists staff the 24-hour consultation service. The number of clinical staff needed depend on specific characteristics of the community implementing the program, such as population, rates of violence, and particular criteria for referrals defined by the implementing team.
  • Costs: The most significant expense is staff time for training seminars, weekly meetings, and the consultation service. These staff costs include salary support for seminar leaders, police officers, and clinicians. Most of the program work involves redeployment of existing resources, rather than additional funding.
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Funding Sources

Substance Abuse and Mental Health Services Administration (U.S.); U.S. Department of Justice; New Alliance Foundation; Community Foundation for Greater New Haven; Connecticut Health and Development Institute (University of Connecticut)
The Department of Justice, Office of Violence Against Women provided funding for the development of services specifically targeted to children and families exposed to domestic violence. The Department of Justice, Office of Juvenile Justice and Delinquency Prevention provided funding for the development of the National Center for Children Exposed to Violence.end fs

Adoption Considerations

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Getting Started with This Innovation

  • Get institutional investment: A critical first step is convening a meeting between the police chief, the head of the mental health agency, and a representative of the municipality. It is important to establish mutual concern for the problem being addressed and to discuss program funding, staffing, expectations, and evaluation.6
  • Form small workgroups to prepare for inception of program: Form an initial workgroup consisting of three to five supervisory police officers and three to five mental health clinicians in supervisory roles. This group should spend at least a week away from their regular duties, immersing themselves in field training to develop a shared body of knowledge and experience.6

Sustaining This Innovation

  • Hold regular meetings for continuous learning: Collaborative partnerships require constant learning and translation of what is learned into practice. One way to overcome traditional barriers across disciplines (e.g., mental health clinicians and police officers) is the use of weekly meetings during which key challenges can be discussed and strategies for overcoming these challenges shared. 
  • Keep records of program activities: Keeping detailed records of key program activities (e.g., referrals, contacts) can be a useful way to identify the need for adjustments (e.g., in staff deployment) and to plan for additional program components. These records are also useful in facilitating reporting on the program's impact, which in turn can help secure additional funding.6
  • Share information about successes with partners: In 2009, developers highlighted the importance of finding ways to share data from program activities back with partners to keep participants at all levels invested.
  • Continually seek ongoing funding: Funding has been the biggest challenge faced by the program. Funding constraints have led the program to shift the focus and scope of training over time.

Use By Other Organizations

Over the past 16 years, the Child Development Community Policing Program has been implemented in many communities. The program is currently being used in the following Connecticut locations: New Haven founding site, Bridgeport, Guilford, Madison and Stamford. The program has also been implemented in Baltimore, MD;  Charlotte, NC;  Chelsea and Framingham in MA; Clearwater, FL; Nashville, TN; Providence, RI;  Raleigh, NC; Rochester, NY; Sitka, AK; Wilmington, DE; Zuni, NM.

Additional Considerations

  • In both acute and follow up care, police officers can play a therapeutic role for children and families, both because of their authority and their ability to restore stability. This program has provided police officers with a new way to "take control" in traumatizing situations.6

More Information

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Contact the Innovator

Steven Marans, MSW, PhD
Harris Professor of Child Psychiatry
Professor of Psychiatry
Director, National Center for Children Exposed to Violence/Childhood Violent Trauma center
Child Study Center
Yale School of Medicine
Phone: (203) 785-3377
Fax: (203) 737-5104
E-mail: steven.marans@yale.edu

Innovator Disclosures

Dr. Marans has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this profile.

References/Related Articles

Marans S, Murphy R, Casey R, et al. Mental health–law enforcement collaborative responses to children’s exposure to violence. In: Lieberman A and De Martino R (eds). Interventions for Children Exposed to Violence. Johnson and Johnson Pediatric Institute; 2006. p. 111-134.

Marans S, Berkman M. Police–mental health collaboration on behalf of children exposed to violence: the child development–community policing model. In: Lightburn A and Sessions P (eds). Handbook of Community Based Clinical Practice. Oxford University Press; 2005. p. 426-440.

Footnotes

1 McDonald R, Jouriles EN, Ramisetty-Mikler S, et al. Estimating the number of American children living in partner-violent families. J Fam Psychol. 2006;20(1):137-42. [PubMed]
2 Murphy RA, Rosenheck RA, Berkowitz SJ, et al. Acute service delivery in a police-mental health program for children exposed to violence and trauma. Psychiatr Q. 2005;76(2):107-21. [PubMed]
3 American Academy of Child & Adolescent Psychiatry. Interrupting the Cycle of Violence: The Child Development Community Policing Program [Web site]. Available at: http://www.aacap.org/AACAP/Medical_Students_and_Residents/Mentorship_Matters/DevelopMentor
/Interrupting_the_Cycle_of_Violence.aspx
4 Stover CS, Rainey AM, Berkman M, et al. Factors associated with engagement in a domestic violence home-visit intervention. Violence Against Women. 2008 Dec;14(12):1430-50. [PubMed]
5 Stover CS, Berkman M, Desai R, et al. The efficacy of a police-advocacy intervention for victims of domestic violence: 12-month follow-up data. Violence Against Women. (In Press)
6 Marans S, Adnopoz J, Berkman M, et al. The police-mental health partnership: A community-based response to urban violence. New Haven: Yale University Press, 1995.
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Original publication: June 09, 2008.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: January 29, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: January 12, 2012.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.