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Our research staff accompanied four specialists on the second home visit. The residence was small with only two rooms with beds, a bathroom and a kitchen. One specialist interviewed the mother in the back bedroom, while the three specialists divided up the seven children. There was also an infant present, unrelated to the mother and children, for whom the mother was caring. The second specialist worked with the two older children, approximately ages 17 and 14, at a table in the kitchen. She conducted age appropriate assessments through interviews with them. The third specialist worked with the two middle children, aged about 7 and 9 years old, conducting assessments with them. In the same room, the fourth specialist worked with the remaining three children, between the ages of 3 and 6, using play and sand therapy. The infant was passed between the adults in the room. Thirteen people in all were in the living quarters. The environment was orderly and calm. The children seemed to enjoy the attention and answered the long lists of questions posed by the specialists. The visit took approximately an hour.

The specialists made an appointment to return. They indicated that they will continue working with the family until the appropriate referrals for follow-up services have been made.

The Timeframe The original goal of the program was to conduct three visits within a two week period. However, with larger families, this schedule is often not possible since they must assess each child. They still adhere to the philosophy that the quicker they can get to these children and provide them the services they need, the better off the children will be.

The Referral and Transition

After meeting with the family three times, obtaining their input on services they are interested in, examining the assessment data, and determining the services available in the community, the community service provider makes a referral for long-term services. One of the biggest challenges that MHS faces is finding treatment openings for their clients due to the high demand for longterm providers.

To ease the transition, the specialists and/or the community service provider accompanies the family to their first referral appointment. MHS acts as the intermediary between the on-going service providers and the evaluators.


The coordinator of the CWWV program reported that they do not have enough on-going services in the county for children exposed to violence. There are currently twelve agencies participating in the program. They are private, not-for-profit agencies that provide mental health and domestic violence services. MHS carefully selects which agencies to which they make referrals. Service providers report a good working relationship with MHS.

Because families too often will not go to the service providers, the program has embraced In-Home Trauma Models where the worker goes to the home and involves the parent in their domain. Many of the agencies were using this type of model with other types of cases before the CWWV program.

Some of their services are play therapy (special coloring books, puppets, or using doll houses), and sand or rice therapy. They also have child, adolescent, and adult therapy groups. It has also been a priority to obtain support services for parents in addition to the children. The on-going service provider continues to collect data on the children for the evaluation, and conducts some of the same assessments on the children that began during the crisis intervention period.

The CWWV program offers monthly training for these agencies and monthly case conferences where the workers present current cases. Some providers have sought additional training outside the program.

Issues and questions that the long-term service providers have encountered include the following.

• If the family is referred to in-home services and the worker has trouble reaching the family, how much outreach does the worker do before the case is closed?

• If the perpetrator is present, does the worker carry out his or her job differently?

• For what length of time is the in-home service provided? What factors determine this length of time?

• How should the number of treatment slots, capacity, and funding sources be determined?

• How can service providers best work with the evaluators?

• How do service providers most effectively engage the family?

• How can they deal with transition difficulties? The child receiving services may bond with the crisis worker. MHS has had success with families during the crisis period. MHS prepares their client that they will only be involved with the family for a short period of time. Sometimes the specialists and the long-term provider work together as a team during this transition period.

However, by the time the on-going service providers reach the family, sometimes families may not need services anymore or be interested in a new service provider. In addition, because of timing and capacity, long-term service providers are not always available when needed. They frequently have waiting lists. This delay can be frustrating for families who do want services.

• How can multiple agencies contacting and placing demands on the family be minimized?

Professionals are often tripping over each other in the home, especially with in-home treatment. Professionals need to understand that families may not be interested in devoting much time and energy on this problem.

• How can multiple demands on the workers be minimized? Providers would like to streamline the paperwork, but there are multiple competing regulations. There are internal and external stipulations regarding paperwork. The different auditing agencies need to agree on the paperwork requirements.

Lessons for long-term service providers include the following.

• The model should be refined to include more than one worker for large families.

• Availability and flexibility of long-term providers needs to be increased. There are not enough long-term providers to service the needs of these children.

• Mental health workers can experience Post Traumatic Stress Disorder (PTSD) symptoms as a result of their work. They also may feel “secondary trauma,” which is when a worker experiences trauma because he or she hears about a traumatic event. MHS has forums for their workers so they can congregate and discuss cases and support each other. Supervisory meetings are also held so workers can talk about cases. Many service providers have found the CWWV program to be an opportunity to gather resources and share techniques with each other. It empowers the worker by encouraging him or her to talk about their experiences with their clients and be supported by others.

• On-going training of workers is critical.

• Regular interaction between MHS and the service providers is important. They have developed a strong working relationship with one another.

• This project has been very time consuming administratively. The number of meetings necessary has been greater than expected.

• It is important to recognize the number of problems in these families. They have multiple needs and have to work with multiple systems. Initially, program planners underestimated the amount of time necessary to spend in the homes and the number of workers needed. Workers have to do much more than treat the child for one problem, and they should focus on underlying issues such as improving parent/child interaction. The ability to address multiple issues is a major outcome goal that is not, but should be, measured.


Although officers are not mandated to call the Department of Child and Family Services when children are exposed to domestic violence, there was initial concern by some in the department that the program would increase the number of calls to the department’s hotline. Thus far, this rise has not occurred. The department has been called in several times when there is exposure to violence, but these were severe cases with child endangerment or when placements were needed for the children exposed. Recently, a mother of six children was murdered by her boyfriend. All six children witnessed the murder. The police called the hotline since the children had no legal guardian. The department found placements for the children.

The current director of the Department of Child and Family Services (also the former Director of Public Safety for Cleveland) was one of the three original CAC co-chairs appointed by the County Commissioners. He is very involved in community affairs and is committed to the program. Two department workers have attended program meetings since January 1997 and participate on the program’s Planning and Development Team. One worker is on the Training Committee and the other worker is on the Community Awareness Committee and the Intervention Services Committee. The workers indicated that they have sorted out some “territorial issues” regarding which organizations can best serve families.

The workers indicated that the Department of Child and Family Services would like to stay involved with the program. However, with the intentions to expand the program, the concern of increased calls to the department remains. The department would like to identify target families and focus on staying involved with these families after follow-up services are in place or concluded.

The workers view the CWWV program as a way of avoiding the department’s intervention in cases of children exposed to violence. Programs in the community are working together to support the CWWV program because they know the Department of Child and Family Services involvement may provide complications for families. Many professionals believe that “Department of Child and Family Services involvement can interfere with a family’s own strengths that can help them.” The program ideally allows the department to focus on children who most need their services.


The evaluation of the CWWV program is being conducted by the Institute for the Study and Prevention of Violence at Kent State University. The effort includes a process and impact evaluation for three primary components of the program: development and implementation of the

program model, training, and the community awareness campaign. Specific objectives include:

• collect and analyze baseline data from the participating communities

• focus on process issues and determine:

• the number of children and families referred to CWWV program

• the number of children and families treated

• reasons for referral

• factors affecting participation

• response time by Mental Health Services, Inc. and follow-up providers

• focus on outcome issues such as:

• trauma symptoms

• child adjustment

• types of violence witnessed

• injuries and health consequences

• impact of receiving on-going services

• number of children identified and treated

• summarize training offered, number of participants, knowledge gained, and reaction to sessions

• document the activities in the community awareness campaign and increased understanding of the effect on children who witness violence.

The Kent State University evaluation team has been involved with the program since the early planning and development stages. They have worked vigorously to build relationships with the sites, attended training, and participated in ride-alongs with the officers. They view this study as a long-term project that will need to be adjusted as it progresses. The team stressed the heavy burden the data collection process has placed on the specialists, who have to complete seven assessment instruments (often for each child) during their three visits.

Challenges for the evaluation team include the following.

• Providing Feedback. The team is often under pressure to provide constant feedback to the players involved with the program. Providing feedback is time consuming and for efficiency should be done at specific points in time.

• Managing Data. The evaluators are receiving and managing large amounts of data from many sources. There are many different forms that need to be completed correctly by numerous individuals.

• Defining Outcomes. Answering questions such as the following can be difficult. Is it possible to show the outcome of a crisis intervention? How much time is needed to show the outcome?

• Funding Issues. Conditions and terms of funding have not always been clear to the evaluators.

The program is dependent on multiple sources of funding pieced together and it can be difficult for the program to commit to a long-term and costly evaluation when funding is not stable.

FUNDING The program coordinator estimates the costs to run the program for a year is about $1.8 million.

For the year 2000, the projected budget includes $750,000 for intervention services, $545,000 for crisis response, $160,000 for program staff, $140,000 for community awareness, $120,000 for evaluation, and $100,000 for training.

The program has been very creative in piecing together funding. The County Commissioners provide a large part of the funding at $250,000 each year. Other funders include the Family Stability Incentive Fund, the Violence Against Women Act, the Cleveland Foundation, Wellness Block Grant, Bryne Memorial, Victims of Crime Act, Children’s Trust Fund, the Mental Health Board, Sisters of Charity, and the Sihler Mental Health Foundation. New funding is being sought for additional pilot sites. Discussion has ensued about making the current pilot program a model for the state.


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