Domestic Violence and Mental Health Policy Initiative, National Center on Domestic Violence, Trauma and Mental Health

Domestic Violence and Mental Health Policy Initiative, National Center on Domestic Violence, Trauma and Mental Health

Project Summary
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DVMHPI began in 1999 as an innovative project designed to address the unmet mental health needs of domestic violence survivors and their children in Chicago and to transform the systems that survivors turn to for safety and support. After six years of working at the state and local level in Illinois, DVMHPI opened the National Center on Domestic Violence, Trauma & Mental Health to expand its activities nationwide. Our overarching goal is to ensure that all survivors of domestic violence and their children who are experiencing abuse-related trauma and/or living with mental illness can access the mental health, advocacy, and other services that they may need to enhance their safety and well-being.

We feel that these are attainable goals that can be reached in three ways. First, we provide opportunities for dialogue and facilitate collaboration among advocates, mental health professionals, disability rights organizations and community-based service providers, as well as state domestic violence coalitions, state agencies, and other policy organizations. Second, we share information on program models and provide training and technical assistance to service providers and policymakers. Third, we work to improve policy that affects women, particularly as it relates to trauma, domestic violence and mental health, by producing policy reports and issuing recommendations on emerging issues for domestic violence programs and mental health systems.

Our mission is preventive in several ways. Our work on behalf of children who witness violence seeks to interrupt the cycle of violence by supporting both children and their mothers. We have developed curricula and conduct trainings to help mental health and DV advocacy systems develop trauma-informed, parent-child services for children exposed to DV and other interpersonal violence. Our work on behalf of survivors is also preventive because when systems are sensitive to the impact of trauma on survivors of violence and are better able to respond to survivors’ needs they are more likely to be able to help women achieve lasting safety. Thirdly, our work in developing an understanding of intersection of the social, political, economic, cultural and psychological underpinnings of abuse and violence will hopefully stimulate strategies to transform these conditions.

About You
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Your idea
Focus of activity

Other

Year the initiative began

1999

Position your initiative on the mosaic of solutions
Which of these barriers is the primary focus of your work?

Insensitive & Unresponsive Systems

Which of the insights is the primary focus of your work?

Personalize Responsibility

If you believe some other barrier or insight should be included in the mosaic, please describe it and how it would affect the positioning of your initiative in the mosaic
Innovation
Description of Initiative

DVMHPI began in 1999 as an innovative project designed to address the unmet mental health needs of domestic violence survivors and their children in Chicago and to transform the systems that survivors turn to for safety and support. After six years of working at the state and local level in Illinois, DVMHPI opened the National Center on Domestic Violence, Trauma & Mental Health to expand its activities nationwide. Our overarching goal is to ensure that all survivors of domestic violence and their children who are experiencing abuse-related trauma and/or living with mental illness can access the mental health, advocacy, and other services that they may need to enhance their safety and well-being.

We feel that these are attainable goals that can be reached in three ways. First, we provide opportunities for dialogue and facilitate collaboration among advocates, mental health professionals, disability rights organizations and community-based service providers, as well as state domestic violence coalitions, state agencies, and other policy organizations. Second, we share information on program models and provide training and technical assistance to service providers and policymakers. Third, we work to improve policy that affects women, particularly as it relates to trauma, domestic violence and mental health, by producing policy reports and issuing recommendations on emerging issues for domestic violence programs and mental health systems.

Our mission is preventive in several ways. Our work on behalf of children who witness violence seeks to interrupt the cycle of violence by supporting both children and their mothers. We have developed curricula and conduct trainings to help mental health and DV advocacy systems develop trauma-informed, parent-child services for children exposed to DV and other interpersonal violence. Our work on behalf of survivors is also preventive because when systems are sensitive to the impact of trauma on survivors of violence and are better able to respond to survivors’ needs they are more likely to be able to help women achieve lasting safety. Thirdly, our work in developing an understanding of intersection of the social, political, economic, cultural and psychological underpinnings of abuse and violence will hopefully stimulate strategies to transform these conditions.

Innovation

The products and services being offered by DVMHPI and The Center are innovative in many ways. Despite awareness of the impact that victimization can have on the emotional well-being of women and girls and the pervasiveness of abuse in the lives of women seen in DV and mental health settings, collaborative models for addressing both advocacy and mental health needs have been slow to develop. Significant barriers that include both practical and philosophical concerns have hindered a meaningful exchange of ideas, which leaves large numbers of women and girls without safe ways to address both advocacy and mental health needs. The absence of dialogue and collaboration also leaves providers without the necessary resources to support them in doing this complex and difficult work.

Rather than working within a single arena to address the intersection of domestic violence, trauma and mental health, DVMHPI and The Center seek to transform existing service systems by bringing people together across disciplines and constituencies to bridge philosophical differences and to address complex, cross-cutting issues in an open, respectful atmosphere. Trauma theory provided an initial vehicle for this kind of innovative, collaborative work. We have found that adding a trauma lens to existing intervention models allows us to better understand and respond to the complex needs and issues of women and children who have experienced trauma and violence over the course of their lives. Working within a framework that combines both trauma and social justice perspectives provides a vehicle for addressing both the impact of trauma and the social conditions that perpetuate violence against women and girls.

Delivery Model

We reach our target population by working with service providers, coalitions of providers, disability rights organizations, and policymakers. Creating lasting systems change requires intensive training and follow-up that is focused within the context of a particular community. For example, we will pilot a curriculum for domestic violence and mental health providers in West Virginia and Connecticut that involves extensive preparation with key stakeholders to create local teams and foster partnerships, three days of training, additional provision of post-training technical assistance and ongoing evaluation. In addition to these focused local and regional efforts, we develop tools and documents for widespread distribution, such as training curricula and research reports. We share information nationwide through training workshops, conference calls, individual consultations, and through our website. Further, we raise awareness and facilitate dialogue through annual conferences. For example, in the Center’s first year, we held a symposium entitled “Responding to the Mental Health Needs of Survivors and their Children: The Role and Implications of Trauma Theory for the Domestic Violence Movement.” In our second year, we will hold a joint symposium on Trauma and DV with the Institute on Domestic Violence in the African American Community.

We measure the impact of our work with a variety of evaluation tools. DVMHPI has conducted evaluations of local training programs to examine the impact of the training on changes in policy and practice. Participants in all DVMHPI/Center events also complete evaluation forms at the end of the event. The Center has developed a database to log technical assistance requests and to ensure that all requests are fully addressed to the best of our ability. In addition, the Center has hired an evaluator who is currently developing tools to measure the effectiveness of our technical assistance and training programs.

Key Operational Partnerships

We have established partnerships with numerous local and national agencies and organizations. We have strong relationships with individuals and organizations in Illinois, including city and state policymakers, the Illinois Coalition Against Domestic Violence, and local mental health, peer support and disability rights organizations. All of these organizations are critical to our success. Government agencies have the capacity to implement widespread changes in policy and practice while local agencies bring new skills and insights into their work with survivors and their children. They also keep us informed about what they need to better serve women and children who have experienced domestic violence and other lifetime trauma.

The National Center is a member of the Domestic Violence Resource Network, which is made up of several resource centers and cultural institutes (e.g., the National Domestic Violence Resource Center and the Asian and Pacific Islander Institute on Domestic Violence, among others). The Center also works with national domestic violence policy organizations, such as the National Coalition Against Domestic Violence, the Family Violence Prevention Fund, and state domestic violence coalitions across the U.S. Additionally, we work with national mental health organizations such as the National Association of State Mental Health Program Directors. These organizations provide avenues for enhancing policy & practice and inform our perspective on the issues.

Impact
Financial Model

DVMHPI and the Center are grant-funded organizations. All of our products and services are either free of charge or provided at a very low cost.

What percentage, if any, of the total operating costs does earned income (from products, services, or other fees) represent?

0%

How is the initiative financed? Is it financially self-sustainable or profitable? How much do beneficiaries contribute?

DVMHPI and its National Center are funded by a mix of public and private funds, including city, state and federal grants and contracts, as well as foundation grants. The Center is primarily funded by the U.S. Department of Health and Human Services, Administration for Children and Families, while DVMHPI is funded in part with grants and contracts from city and state government and by foundation grants, such as the Chicago Community Trust, the Chicago Foundation for Women, the MacArthur Foundation, and the Irving B. Harris Foundation. Overall, 52% of our funding comes from city/state/national government funding, and 48% comes from private foundations.

Effectiveness

It is difficult to estimate the total number of people who have benefited from DVMHPI and The National Center’s services because we are not, ourselves, direct service providers, and the people we do work with return to their organizations and work with any number of survivors or mental health consumers each day. However, judging from the number of training and technical assistance requests we have received, DVMHPI and The Center have succeeded in promoting dialogue and raising awareness of the intersection of domestic violence, trauma and mental health through several conferences and training workshops, and we will continue to facilitate these conversations. We have also succeeded in building capacity in some local programs through training and intensive on-site and off-site consultations. One training evaluation found that 94% of project participants incorporated training into their individual practice and supervisory activities; 67% of mental health agencies and 100% of domestic violence programs have begun to integrate domestic violence and trauma-sensitive services agency-wide; and 100% of participating agencies have incorporated into routine practice some form of screening assessment for the presence and impact of domestic violence and other lifetime trauma. There is still much to be done both locally and nationally in this regard, however. Participants in the local program as well as information from other programs around the state and the nation report that effecting more in-depth change will require additional resources, such as more extensive on-site training, technical assistance, and staff capacity. Finally, one major policy achievement was a change in Illinois’ Medicaid rule to require assessment for current and past abuse and ongoing safety needs. This has led to the incorporation of DV screening and safety questions into an assessment tool being developed for all Illinois Department of Human Services programs as well as into assessment tools for state psychiatric hospitals. We continue to work towards greater impact on policy and practice.

How many people have benefited from your program over the last year? Which element of the program proved itself most effective?

Due to the volume of training programs and presentations conducted by DVMHPI and The National Center, it is difficult to identify the total number of participants in each program, and we have not yet had the capacity to develop a sophisticated tracking system. In the last week alone we trained 265 people in three separate venues. In 2006, DVMHPI conducted four statewide trainings in Illinois at which over 400 domestic violence advocates and mental health providers received training on developing trauma-informed services. DVMHPI also held training programs for child welfare professional in which 378 people participated.

The National Center’s first symposium, designed specifically for state domestic violence coalitions, was held in 2006 and had 60 attendees. The Center has also received over forty technical assistance and/or training requests since it began just over a year ago.

We typically train service providers who will apply the lessons learned to their daily work with survivors and their children, which further extends the reach of our services.

Evaluations of these efforts are ongoing, but, as noted above, our training efforts have already yielded positive outcomes, and we continue to receive more training requests than we can currently handle.

Scaling up Strategy

For the next three years, DVMHPI and the Center will continue to pursue our multi-tiered approach to developing new models to address the advocacy and mental health needs of survivors of domestic violence and their children. That is, we will continue to engage in our three primary activities: 1) to engage domestic violence, mental health and other relevant service organizations, policy-makers and survivor/advocacy groups in productive dialogue; 2) to help local agencies, state coalitions, and state mental health systems increase their capacity to provide effective assistance to survivors of domestic violence and other forms of violence who are experiencing the traumatic effects of abuse and/or who are living with psychiatric disabilities; and 3) to improve policy affecting the complex life circumstances of survivors of domestic violence and other lifetime trauma.

Another area of focus for the next three years involves sustainability. Both the mental health system and the network of domestic violence service providers are under-resourced, and we ourselves do not yet have sufficient resources to provide training and technical assistance at the level for which it is needed. Thus, we plan to work with our partners across the country to generate support for state and local capacity-building activities as well as to expand our own capacity to provide needed training, TA and policy development in these areas.

In addition, we are committed to building stronger partnerships with state mental health systems and national mental health organizations to both facilitate collaboration with state DV organizations and to ensure that the publicly funded mental health system as well as mental health professional organizations and accrediting bodies incorporate appropriate responses to both trauma and DV.

Lastly, we will continue to focus on generating new thinking, practice and policy on cross-cutting issues that affect survivors and their children.

Stage of the Initiative

1

Origin of the Initiative

Carole Warshaw, MD, founded DVMHPI in 1999. After working at the intersection of health care and domestic violence for 15 years and seeing the improvements in practice made by domestic violence advocates and health care practitioners, it became clear that there had been no concurrent, systematic approach to domestic violence in the mental health system. Similarly, domestic violence advocates had not developed consistent strategies for addressing the traumatic effects of abuse. Thus, survivors of domestic violence who interacted with the mental health system were often unable to access domestic violence advocacy and resources, and survivors who made use of domestic violence programs often did not have access to mental health services. DVMHPI and The National Center were thus developed to ensure that all survivors can access services that are essential to their safety and well-being.

Sustainability
How did you hear about this contest and what is your main incentive to participate?

A colleague informed us of the competition, and we wanted to participate to raise awareness of these issues and of our work.

Main Obstacles to Scaling Up

The two main obstacles to scaling up our innovation are financial and organizational. First, both the public mental health system and the network of domestic violence programs in Illinois and across the nation are severely under-resourced. Consequently, fostering successful collaboration and creating lasting systems change—which require that organizations have both time and money—can be quite challenging. Secondly, under-resourced systems often have a high level of staff burnout and, consequently, high staff turnover. This makes it more difficult to implement and maintain changes in policy and practice.

Main Financial Challenges

The two main challenges we face in financing our organization are 1) the lack of funding for basic operating expenses, and 2) locating funders who will support educational and policy-related activities, rather than direct service. Most funders want to support specific programs or projects, rather than administrative or operational costs. It can be difficult to find financial support for the salaries of staff who are not dedicated to a particular program or project. Additionally, we do not provide direct services, and it can be challenging to locate funding sources that can be used to provide training and technical assistance. These activities are extremely important, but because they do not have immediate outcomes (e.g. the number of victims served), they may be less attractive to funding agencies.

In order to scale up operations, we would need at least an additional $2 million. This funding level would allow us to plan for gradual growth, to hire additional staff, and would ensure that we could adequately and effectively address these issues simultaneously at the local, state and national levels.

We are interested in investors of any type.

Main Partnership Challenges

Our primary partnership challenge stems from the lack of resources within both the domestic violence and mental health service systems. The advocates, clinicians, and policymakers that work in these arenas have extremely limited time availability because they are overburdened with other responsibilities. Consequently, though many express a great interest in (and recognize the need for) collaboration and partnership, it is often difficult to implement and sustain collaborative endeavors over time.

In addition, there are philosophical barriers that prevent collaboration between systems. Attention to mental health issues risks giving credence to the notion that there is something wrong with the woman, rather than with the perpetrator or with a society that tolerates domestic abuse – an idea that is often promoted by batterers and reinforced by a variety of mental health models. Moreover, because safety and practical assistance are such critical priorities, domestic violence programs rarely have the resources to respond to mental health needs. Many advocates are also wary about addressing mental health issues within their own agencies and compromising their grassroots, social justice approach. At the same time, they are concerned about the ways mental health diagnosis and treatment can inadvertently place women in jeopardy and increase abusers’ control over their lives.