Comprehensive Community Action Program

Who are we?

Comprehensive Community Action Program (CCAP) is a non-profit human service agency established under the Johnson Administration’s Economic Opportunity Act of 1964 to ‘ fight the war on poverty in America". All CCAP programs meet the needs and serve the best interests of low-income and disadvantaged populations, as well as other community residents.

Comprehensive Community Action emphasizes community planning, participation and involvement. The Board of Directors (18) consists of one-third public officials, one-third low-income residents, and one-third private sector. This unique structure allows the community to be involved in planning, implementation and evaluation of agency programs. Comprehensive Community Action has been serving a number of communities in Rhode Island since 1965 with a variety of specialized social service programs.

The VOCA program is administered by CCAP’s Doric Center. The Doric Center is the clinical component of CCAP. Within the Doric Center, there are a number of clinical and case management services. The Clinical and case management programs of the Doric Center include the following:

• Outpatient Chemical Dependency
• The Family Life Resource Center (Abuse, Neglect and Trauma)
• Outpatient Gay and Lesbian Victim Assistance Program
• General Psychotherapy Practice
• Adolescent Self-Suff1ciency Collaborative
• Youth Diversionary Program
• Comprehensive Emergency Services
• Family Network Program
• Parent Education Program
• New Opportunity Homes Residential Continuum

These programs work together to provide an integrated continuum of care for all clients. Each program has a role in the development of effective treatment plans for all clients who enter the Doric Center. When appropriate a client may access any service through the Doric Center and is case managed to or co-treated with any other appropriate service.

The Doric Center has many outreach efforts running concurrently. The Youth and Family Programs continually conduct outreach to disenfranchised groups. The Youth Diversionary Program conducts outreach to racial and ethnic minorities in Cranston, Providence and North Providence. The Youth Diversionary Program works collaboratively with schools, police department, and other human service agencies in an attempt to educate teens and reduce the incidence of interpersonal violence, shoplifting, truancy and chemical dependency. The Family Life Resource Center educates the community on the incidence of abuse and neglect, identification and intervention, and the role of treatment with the primary goal of providing access to services. The Chemical Dependency program provides substance abuse education to the community with specific focus on the role of the family and intergenerational effects of dependency. The Gay and Lesbian Victim Assistance Program provides outreach to the Lesbian and Gay community with the primary goal of educating the community on the seriousness of victimization and ways to avoid becoming a victim.

All the outreach efforts, like the services offered and the issues seen at the Doric Center are integrated. Because the philosophy of the Doric Center is to provide comprehensive services, it is difficult to separate the respective issues from the whole system. Thus, even the outreach efforts are well planned with the intention of providing a comprehensive scope of information to a variety of people.

The Doric Center has nineteen clinical and case management staff. Four staff members are racial/ethnic minorities. These two staff members have the capacity to provide services in three languages; English, Spanish and Portuguese. When interpreting services are needed, the Doric Center has the capacity to fill this gap.

Staff who are involved with the direct clinical work associated with this VOCA program are all Master’s Level Social Workers. All have obtained their Rhode Island license as Independent Clinical Social Workers and certified by the State of Rhode Island as Clinical Sexual Abuse Specialists. The therapist providing the direct services is responsible for the assessment and evaluation of individuals and families seeking clinical intervention, assessing the need for other services and connecting individuals and families to these other services. In addition, the therapist is responsible for coordinating either services or consultation with other systems that may be involved in the case. The therapist is also responsible for the preparation of court related testimony.

CCAP employs 121 people in a variety of capacities. Of these, 5% are racial/ethnic minorities. Specifically in the Doric Center, there are nineteen clinical and case management staff members with four being ethic/racial minorities. CCAP is an equal opportunities employer and by philosophy and policy do not discriminate based on race, ethnicity, disability, gender and sexual orientation.

The Family Life Resource Center at CCAP has been providing effective direct services to victims of crime since 1987. The Family Life Resource Center has been providing services to individuals and their families who have been victims of sexual abuse, neglect and trauma. Beyond the direct therapeutic services provided by the staff of the Family Life Resource Center, the Center has been called upon on many occasions to address community concerns regarding child abuse and neglect. The Family Life Resource Center also provides the general and professional communities with forums ranging from early identification of abuse and neglect to training of professional agencies on therapeutic strategies and interventions in working with survivors and their families.

Over the past year, The Family Life Resource Center provided service to 235 unduplicated clients. The services provided involved direct individual and family therapeutic intervention, case management, community coordination of treatment as well as court appearances on behalf of clients seeking personal and legal restitution.

Due to CCAP’s integration of services, the Family Life Resource Center has been able to provide efficient and cost effective service to clients in need. The agency as a whole receives federal, state and municipal funding for a variety of services as well as funding from third party reimbursement for clinical services.

The use of volunteer services in the clinical programs of CCAP has not been utilized. Given the sensitive nature and volatility of many of the cases that involve the Center, the use of individuals who are not specifically trained in the clinical implications of these cases may prove damaging to the individuals and families. In addition, the expertise needed to negotiate the many different community systems requires significant training. Further one of the Center’s primary concerns surrounding treatment of these individuals and families is one of confidentiality. The privacy of these cases needs to be maintained for obvious reasons.

As stated in the above, a significant part of the success of these services depends on a client’s ability to trust the process. This includes trusting that all information, with the exception of both required reporting of abuse and neglect by state law as well as duty to inform, is maintained completely confidential. Clients are made aware of their rights to confidentiality as well as to the exceptions that are supported by the law and are educated on appropriate releases of information. Releases are obtained for coordinating services and information gathering. A client has the right, at any time, to retract any release of information specific to their case.

Comprehensive Community Action is prepared to meet the fiscal match requirements for VOCA funding. At no time is a client, state agency, or third party insurer charged for services under this VOCA project.

The Family Life Resource Center uses a multi-disciplinary approach to treatment of victims of crime. This approach requires a significant amount of coordination with other systems that directly affect the client. As an agency known for its work in trauma with individuals and families, clients are referred solely on that basis. Because the referrals is so specific, the Center is usually the only agency involved in direct treatment services. The coordination of other services that are supportive and necessary is vital for a successful outcome. The Center has on many occasions served as a knowledgeable and professional voice for both the professional and non-professional community.

The role of the Center has always been to provide therapeutic intervention for individuals and families as well as providing consultation to other human services agencies. Assisting victims in seeking compensation is an indirect service that the Center provides. The Center provides case management to the appropriate services for compensation and follow-up on the referral only. Due to the very specific nature of work within the Center, the Center has relied on other agencies to provide direct compensation services. However, the clinical staff of the Center does work directly with the criminal justice system in developing testimony and testifying on behalf of the clients who are enrolled in treatment services.

As mentioned earlier, the Center provides both direct clinical intervention as well as collaborative case management to assist clients in many areas of their lives. Frequently, clients who seek treatment have many other pressing issues that need to be addressed so that the center can focus on direct clinical services. From the onset of treatment, clients systems are evaluated and assessed for other services that might be needed as a foundation for future trauma work. The Center’s ability to access many services, both clinical and ancillary from CCAP make case management easy and timely.

What is our challenge?

There continues to be a strong need for supportive services for victims of crime. The evidence to support continued services include the following:

"According to the Bureau of Justice Statistics’ 1998 Nation Crime Victimization Survey data released in December of 1998, U.S. residents age 12 and older experienced nearly 35 million crimes in 1997. Of these victimization’s, approximately 26 million involved theft, household burglary or car theft, 8.6 million involved the violent crimes of rape, sexual assault; and 0.4 million involved person thefts such as purse snatching." (1998, December). National Crime Victimization Survey. Washing, DC: U.S. Department of Justice.)

"In 1997, students ages 12 through 18 were victims of about 255,00 incidents of nonfatal serious violent crime at school and about 671,000 incidents away from school." (National Center for Education Statistics. (1998, October). Indicators of School Crime and Safety 1998. Washington, DC: Bureau of Justice Statistics, U.S. Department of Justice.)

"The Federal Bureau of Investigation reports that 8,049 hate crime incidents were reported to law enforcement agencies nationwide in 1997. The 8,049 incidents involved 9,861 separate offenses, 10255 victims and 8,474 known offenders." (Federal Bureau of Investigation. (Released November 22, 1998). Crime in the United States, Uniform Crime Reports, 1997. Washington, DC: U.S. Department of Justice.)

In 1987, Comprehensive Community Action’s Family Life Resource Center implemented a specialized treatment program for victims of crime that focused on sexual abuse and their non-offending family members. The programs was started due to a statewide increase in the numbers of reported sexual abuse cases and the limited availability of services available for this population.

Since the inception of the Family Life Resource Center, the program has operated at capacity with a waiting list, at times, more than three months. The need for services continues to grow in this field. Over the past three years, services at the Center have been broadened to include survivors of trauma beyond the specialized scope of sexual abuse. Similar to statistics that report "that approximately 90% of children in violent homes are aware of the violence directed at their mothers, and are present in 41-55% of homes when police intervene in domestic calls..." the Center has seen first hand the great need for services directed toward children and adolescents who experience secondary trauma (Domestic/ Dating Violence: An information and Resource Handbook, Metro King County Courthouse).

In order to address the increasing incidence of violent crimes, the Family Life Resource Center has continued to extend its service delivery to include outreach to a variety of communities as far-reaching as South County. Examples of this include:

• Debriefing and survivor support for staff who worked with a family who were murdered
• Debriefing, support and individual therapeutic intervention for an adolescent partner and mother of a murder victim
• Debriefing, support and individual therapeutic intervention for survivors, and witnesses of a hostage/ murder situation
• Survivor support for a victim of murder as a result of Arson

It should be noted that in all cases, providers and/or families called upon the Family Resource Center to intervene based on the expertise and ability respond quickly in time of crisis. The Family Life Resource Center enjoys a reputation for its capability to provide therapeutic intervention and support to individuals, families and communities in need.

The children who are traumatized by baring witness to familial violence, domestic violence, and loss of a parent, murder, sexual assault, divorce and separation present with a unique set of post traumatic symptoms that require immediate attention. The focus on secondary victimization is relatively new to the trauma field. Because of this, specialized services are not widely available to individuals and families who require immediate intervention.

Individuals/families affected by secondary trauma are frequently in crisis, and usually experience multiple problems. Without appropriate treatment, victims of secondary trauma frequently develop long term difficulties, including depression, isolation, acting out, aggressive and/or violent behavior. Children raised in an abusive environment may develop patterns in their conduct that mimic the behavioral characteristics of batterers and victims. Current research on the etiology of teen violence indicates that witnessing violence in the home is the second highest predictor of aggressive behavior; the first being racial tensions.

Immediate and accessible treatment for secondary victimization is critical to the eradication of the possible long-term effects. Without such intervention, a child/adolescent is left with many unresolved feeling surrounding what s/he witnessed. Depending on the age and developmental stage of the individual who has witnessed a family atrocity, a variety of beliefs, truths to the child, will have developed. There are a number of psychological consequences that may co-exist with these beliefs. Children and adolescents, following a traumatic family event may present in a persistent state of fear. They may also have fragmented the memory of the event lending a child to dysreulation of affect as well as avoidance of intimacy with others. All of these consequences have far reaching effects on how a child and adolescent maneuvers through life.

The continuations of a program that a focus specifically on secondary victimization is not unlike the victimizing experience have long term effects on the individual and the non-offending family members. Immediate intervention with this population is vital to the health and mental health needs of individuals and families. According to Alice Miller, renowned author and analyst specializing in children and trauma, " It is not what happens in the traumatic event that is most damaging, it is what happens after the traumatic event that has long-term effects. A child is left to make many erroneous assumptions about the event that could include self-blame. If the realities of the events are not uncovered in accuracy by the child, he/she will endure a lifetime of dysfunction. This is true for many of the clients who are seen at the Center. The longer a child/adolescent is left to continue their belief systems about the traumatic event, the more damaged he/she becomes. Therefore, it is critical for the child to immediately begin the process of restructuring the traumatic event and slowly, through the help of a therapist, begin to heal.

This program seeks to provide immediate therapeutic intervention, emergency consultation and enhanced clinical case management services for individuals and families effected by secondary victimization. The Center uses an enhanced clinical case management model, which has proven to be effective with this population. For this model to be effective, collaborative relationships with the community are essential. Relationships that are already in place assists in the success of these models include The Department of Children Youth and their Families, Police Departments, and other trauma therapists in the community. Most importantly, it is critical that service delivery is flexible, with a majority of the work taking place in the community and/or in a home setting.

The Family Life Resource Center produces brochures that make the community aware of this specialized service and how to access the service. For emergency consultation for children/adolescents and their non-offending family members, therapists, police departments and DCYF has priority access to staff at the Center. An emergency consultation is scheduled within 48 hours of the traumatic event. Children and adolescents who have been traumatized by secondary victimization are interviewed immediately. Using a variety of techniques, including drawing, storytelling and play, the therapist begins to assess how the child/adolescent is responding to the trauma. Alerted to the various coping skills the child has and information elicited about the traumatic event, the therapist works in concert with the clinical case manager to develop a treatment plan. This treatment plan addresses the therapeutic and concrete needs of the individual and/or family system.

The VOCA clinical case manager provides several critical functions as related to effective treatment. Due to the flexibility of the position, the case manger is able to extend the therapeutic intervention into the community and/or home setting. The clinical case manager can encourage and reinforce recommended interventions and the "work" that continues outside the clinical setting. For example, a child is reinforced for articulating physical and/or emotional reactions and or responses that s/he may be experiencing. Further, the clinical case manager can "process" and/or educate the child/family as to what they may be experiencing. For example, educating the child on bad dreams, feelings of being afraid, etc. can be helpful in helping the child to cope during the aftermath. This is particularly effective when the education is conducted in the home setting.

Sometime de-emphasized, but clearly a critical function performed by the clinical case manager, is the provision of concrete case management services. In order to effectively work with a child or family, first their basic human needs must be met. Safe housing, emergency financial assistance, day care and a host of other issues often need to be addressed in order for the therapeutic intervention to be successful. In addition, the clinical case manager coordinates the delivery of services and/or work with other agencies including: shelters, schools, other case management programs, police departments and criminal justice agencies, to name a few. This coordination of services is extremely helpful to the child/family dealing with a traumatic event, which may be feeling overwhelmed or unable to function.

Finally, the clinical case manager completes comprehensive assessments on all referrals for the VOCA program, which are not received from the Family Life Resource Center. Majorities of these come from internal sources such as the many other CCAP case management programs and the Cranston Police Department. It should be noted that referral come in from all over the state from South County to Woonsocket.

The second strategy to be employed as part of the VOCA enhanced case management program involves training for staff involved in providing direct service to individuals and families who have been victimized. Due to the flexible structure and extensive outreach methods employed by the case management programs under CCAP, case managers and family advocates have, and continue to be the first point of contact with an individual or family who has been victimized. Further, the medical personnel such as our primary care physicians, nurse practitioners and family planners continue to be the professionals to whom clients initially present sympotomology associated with incident(s) of victimization, resulting in discussion of and disclosure of the event(s) and related issues.

After completing a review of programmatic data gathered on an agency wide basis, internal reports indicate that an alarmingly high number of individuals and families served by Comprehensive Community Action Program report being victims of simple assault, physical abuse, sexual abuse and domestic violence. The following data is representative of just a sampling of the programs that have clients reporting victimization in the aforementioned areas:

• Adolescent Self-Sufficiency Collaborative- approximately 60% of clients, totaling 65 persons
• Head Start- approximately 3 0% of active clients, totaling 69 families served annually
• Comprehensive Emergency Services- approximately 60%, totaling 66 families served annually
• Youth Diversionary Program- approximately 40%, totaling 70 families served annually
• Family Network Program approximately 15% of families, totaling 12 families served annually
• Family Health Services- approximately 10% of clients, totaling 450 individuals served annually

726 persons are indicated to have been victimized. Of the many programs currently offered under the auspices of CCAP, these six programs alone serve to illustrate the extent of contact direct service staff have with individuals and families who are the victims of violent crime. As the aforementioned statistics indicate, a realistic estimate is that all staff in our case management programs has contact with individuals/families who have been the victims of violent crime and/or secondary trauma.

Entry level case managers and family advocates, while highly skilled in many areas, frequently have not received specialized training related to working with individuals and families who have been the victims of violent crimes. Likewise, medical personnel, while often recognizing the physical symptomolgy associated with violent crime, may not posses the expertise to engage the client in a discussion that results in a disclosure of the violent crime committed on their person.

Further, they often are not aware of the social service resources and/or providers available in the community in order to make an appropriate referral or recommendation for services.

CCAP proposes to offer comprehensive training to all direct service staff in order to expand the outreach capacity of the VOCA program. This approach increases the project’s capability to adequately identify and assess the needs of victims, in addition to ensuring speedy access to services for those who have been victimized. The direct service staff conducts preliminary assessments and forward formal referrals to the VOCA program, thus facilitating the completion of a comprehensive assessment by the VOCA clinical case manager.

Providers, and most importantly, the direct service staff need to understand that symptoms such as developmental delays, attention problems, anti-social behavior and some physical complaints can all be related to victimization and secondary trauma subsequent to witnessing violence. This training is necessary in order for these direct service staff who are constantly confronted with families who have been victimized to be equipped with the skills to make appropriate identification, referrals and subsequent recommendations for entry into the VOCA enhanced case management program.

The intent of the Training prong is to fully train direct service staff in a variety of areas so that they are well equipped to identify individuals and/or families experiencing trauma or secondary trauma and respond to their needs. As part of the VOCA program, direct service staff in the Doric Center, its two Health Centers; Family Health Services of Cranston and Coventry and Head Start participates in the multi-session Training module. Topics in the Training module includes:

Early detection, identification and intervention with

• Domestic violence
• Child abuse and neglect
• Sexual abuse
• Elder abuse

• Interviewing techniques
• Reporting responsibilities
• Post Traumatic Stress Disorder (PTSD)
• PTSD and substance abuse
• Helping non-offending parents
• Identifying needs of special populations
• (Pre-school, minorities, developmentally challenged)
• Court advocacy
• The legal system’s perspective and its relevance to treatment
• Profile of offenders
• Helping victims of stalking
• Prevalence of violence and violent images in media, culture

The staffs from the numerous programs falling under the auspices of CCAP are frequently called upon to work in concert with the VOCA program. Individuals/families initially opened under case management programs such as CES, YDP or ASSC, upon disclosure of victimization are frequently referred for the specialized services of the VOCA program. Together, the case manager and the VOCA clinical case manager work with the client to formulate an integrated treatment plan that addresses not only any initial presenting problems, but also issues related to the victimization. Furthermore, should the VOCA caseload be at capacity, these trained staff are equipped, under the supervision of the VOCA clinical case manager, to function as a "bridge" until the case is opened to the VOCA program. This may necessitate the direct service staff to function as an temporary liaison when making initial contact with cooperating agencies such as criminal justice and child welfare agencies, and other such public and private service providers.

As Gavin DeBecker notes, in general we prefer to believe that extreme acts of violence "come out of nowhere" rather than learn how to predict such behavior or how to prevent our children from growing up to perpetrate violence (The Gift of Fear, New York, 1997). The public relies on the experts such as police and the criminal justice system to take care of violent offenders. This denial causes low-grade anxiety that we accept as a part of life rather than learning the warning signals and how to protect ourselves.

An added benefit of this Training Series is also to train direct service staff who work with this population that violence is not as random or senseless as typically believed. The consequences of living with violence are predictable and can be treated as long as they are not ignored or pushed out of awareness.

Given that all our direct service staff work with clients who have experienced trauma and secondary trauma, CCAP is charged with the responsibility of providing education and training so that they are able to recognize signs of victimization and secondary trauma and respond accordingly. This approach expands the breadth of the program, while increasing capacity to provide efficient and cost effective service to all those who may be in need.

Finally, this training module is offered to cooperating agencies and professionals who have direct service staff that also work with individuals and/or families that report incidents of victimization. This may include, but is not limited to: sister Community Action Programs, local school department guidance personnel, social workers and medical personnel and criminal justice agencies.

What is our plan of action?

GOALS AND OBJECTIVES

Objective 1.1: To decrease the incidence of children/adolescents at risk for secondary victimization.

Activities:

a. Provide coordination of services with other important agencies and state officials.

b. Produce and distribute agency brochures outlining services and how to access both emergency consultation as well therapeutic intervention and signs of secondary traumatization

c. Work collaboratively with DCYF and local Police Departments to provide immediate services for children and adolescents identified as ask risk for secondary victimization.

d. Work collaboratively with CCAP’s case management programs to provide immediate services for children and adolescents and at risk for secondary victimization.

Indicators of Accomplishments:

• Number of Interagency Agreements
• Number of referrals received
• Number of children and adolescents served

Objective 2.1: Increase families’ ability to provide a safe environment for children and adolescents.

• a. Provide both individual and family therapy for families in crisis.
• b. Educate families who access services on the long-term effects of secondary victimization.
• c. Assist families to stabilize following a violent event or change in family structure.
• d. Coordinate services with other agencies that provide the necessary protection for individuals and families
• e. Assist families in accessing the appropriate services for obtaining legal advise and restitution for the criminal acts.
• f. Provide a therapeutic consultation team for each family.
• g. Assist families in accessing services, which meet their basic human needs (safe housing, food, and emergency financial assistance).

Indicators of Accomplishments:

• Number of individual and/or family counseling sessions
• Type and number of protective services provided
• Family self report survey

Objective 3.1: Decrease symptoms of distress in children and adolescents who are victims of secondary trauma.

Activities:

• a. To provide immediate access to services for children, adolescents who experience secondary victimization
• b. Provide individual, family and emergency intervention (using the enhanced clinical case management Model) for children and adolescents who experience secondary victimization.
• c. Coordinate treatment efforts with other human service systems.
• d. Act as liaison between family and legal system

Indicators of Accomplishments:

• Number of cases seen within 48 hours of referral
• Number of assessments (Pynoos Interview Model) completed
• Number of non-clinical/case management hours provided
• Client self report

Objective 4.1: To increase collaborative efforts between human service agencies, State Departments and Justice.

Activities:

• 1. Act as liaison between systems that are involved with any case.
• 2. Coordinate necessary resources within the community.

Indicators of Accomplishments:

• Number of new or renewed collaborative agreements
• Community needs assessment

How we measure ourselves?

CCAP has an established Management Team that is responsible for efficient administration of this program. The Program Director and/or Assistant Director of the Doric Center supervise the VOCA project. This oversight ensures that all program and fiscal program requirements are met and the reporting of cases, time spent in direct services and statistics are up to date and accurate. CCAP uses a computerized software package (Tracker) to record, collect and report client demographic and descriptive data, type and frequency of services and outcomes. In addition, the Doric Center Program Director and Assistant Director receives month line item fiscal reports to ensure funds are spent according to program requirements.

On a quarterly basis, management staff reviews cases, develop reports and review if the goals stated in this project are effective. Reviewing all completed work to date on the project assesses goals. The number of direct services hours, total hours of collaborative services and case conferences are recorded to ensure that VOCA funds are used appropriately and those goals are being met

The therapist working on the cases seen under the VOCA project is responsible for all clinical intervention, emergency evaluations, case management and the formulation of the reflection team. Staff from the Doric Center provides clinical supervision.

All community coordination with other agencies is the responsibility of the clinician working on the case. Case conferences, meetings with local police and DCYF are also be the responsibility of the clinician assigned to the VOCA project.

For More Information Contact:
Chris Mansfield, Program Director
Comprehensive Community Action Program
311 Doric Avenue
Cranston, Rhode Island 02910
Telephone: (401) 467-9610
Web Page: www.comcap.org