County, City, and other agencies county-wide have been concerned about increasing violence in the Mecklenburg community for several years, gun violence in particular, spawning projects such as the "Violence Prevention Data Collaborative," co-chaired now by the CDCP Program Director/Public Health, and partners representatives from City and County govenment including The Office of Violence Prevention, DSS, the Police, Sherriff's Office, and representatives from both major hospital systems, our local domestic violence services, several local universities and researchers, among others. The goal is to strategize opportunities and design or replicate collaborative projects that can effectively reduce violence in our community usng a public health lense, and reduce, in particular, those impacts on the most vulnerable. CDCP is a critical partner, in identifying the scope of the needs with regard to local children.
The Mecklenburg County CDCP Program has received an average of 637 monthly referrals for families impacted by violence in the first quarter of fiscal year 2023. Our fiscal year 2022 total was 7,783 referred families that included a total of 11,855 children. Of those children, 30% were witnesses to intimate partner violence in their homes, and 30% of all referred families had at least one child age 5 or under. 15% of all referred families speak Spanish as their primary or only language. CDCP's referrals overwhelmingly overlap with what Mecklenburg County refers to as our "Public Health Priority Crescent," a cross-setion of the county most impacted by poverty, food instability and decreased access to fresh healthy food, lower educational attainment, lower rates of livable-wage employment, and higher rates of neighborhoods impacted by violent crime. Parallel initiatives to improve health outcomes in this part of our community in particular, include not only the CDCP program to address childhood trauma, but the creation of the state's first Public Health Office of Violence Prevention, that is looking at large-scale projects for violence interruption and community involvement in the development of viable solutions to community violence, the "Healthy Corner Stores" initiatives engaging the smaller convienence outlets in our identified food deserts to stock fresh vegetables and fruits and participate in the WIC and SNAP programs, and many others.
For Fiscal Year 2022, of the 6,329 families referred and meeting criteria for an immediate clinical response, 80% of those parents/guardians were successfully contacted, with 72% being contacted in 72 hours or less following the violent event. 72% of families accepted one or more clinical tools being used to measure the presence and severity of their children's early and emerging trauma symptoms. 87% of parents received child trauma psychoeducation and coaching around at-home strategies for support. 12% of referred children received short-term acute trauma intervention while 22% needed additional long-term therapy referrals. 10% of guardians were provided with referrals for their own therapy. All of those services were provided by clinican-police officer teams, in a family's own home. All of those services were offered immediately to impacted families, either by on-call clinical contact or through the referral process built directly into the police reporting system, immediately connecting police and public health service providers.
CDCP ensures that ACEs and trauma are addressed immediately, before they can fester into a chain reaction that could include chronic disease and does so prioritizing a diverse staff to serve a diverse community. 24% of CDCP clinical staff are bilingual Spanish-speaking, and 65% of CDCP clinical staff identify as POC. We want to give every violence-impacted family the best opportunity to connect well with our staff and be provided services in their own homes, or wherever they and their children are most comfortable. We reduce the struggles many families face when seeking assistance in our community, due to sprawl and economics, by brigning the trauma clinic to their door, at no cost to any family. Service linkages and referrals are individualized and based on each families situation, reducing impacts of social determinants of health or other risk factors. Families in need of services in a native language other than English or Spanish receive services with their clinician and a live interpreter on the clinician's smart phone.
While Mecklenburg's CDCP Program is now over 25 years old, responding to child trauma in this way, swiftly and in partnership with law enforcement, is being done in just a few other communities nationally. Mecklenburg's CDCP Program is the largest program of its kind in the nation, by service volume, and our service delivery model is unique in that we had to make a significant shift from the original program model of our parent program the Yale Child Studies Center/New Haven Police CDCP. Charlotte-Mecklenburg is comprised of 527 square miles, with an urban high-density center surrounded by extended urban sprawl as well as more rural outlying communities, many that lacked access to public transportation at the time of program inception. Public transportation access remains a challenge for many in our Charlotte-area community, as does therapy provider locations that are accessible and affordable to all in our community. The Yale model of immediate trauma response followed by services delivered in a centralized urban trauma clinic was perfect for New Haven, but it was not going to be effective in our community in facilitating equitable access to the service. Our CDCP partners decided to create and committ to an intensive and comprehensive model that took the trauma clinic on the road, in police cars, to every child. And that is what we've done for over 25 years. No child has to wait for the best possible coordinated clinical care or safety response, no child has transportation as a barrier, or a cost.
One of the unique advantages of a CDCP response for children, is the specialized measures used to determine if the earliest emerging indicators common in the development of longer-term trauma symptoms, are present after an incident, and when they are present, symptom mitigation and parent education and coaching are offered right away, in the hopes of preventing the worsening of symptoms, or need for any longer-term therapy services whenever possible. In order to do this, Mecklenburg County CDCP had to create a measure that did not exist before, based on what is known about how stress impacts the nervous system and other related body systems in the first few minutes and hours post-exposure in children. Clinicians are trained to look for these earliest indicators, make note of them, apply targeted interventions and strategies such as grounding techniques, relaxation breathing, and here-and-now body awareness, coupled with support and parent education and coaching. This "Autonomic Nervous System" or ANS symptom indicatopr tool can be used within the initial 12-hour window post-trauma, and we believe is an effective way to determine which children are more likely to suffer on-going, lenthier symtoms, and attempt to stop them before they start. At the 12-hour point up until the 29th day post-trauma, so still within the acute trauma pre-diagnostic period, CDCP uses another measure that has been updated over many years from the form initially used by the Yale New Haven CDCP program, becomming the CDCP Acute Trauma Questionnaire or ATQ, a series of trauma measures that are age and developmentally specifc, to track the physical, psychological, and behavioral trauma responses most common in children, to help guide our clinical interventions and inform our parent supports. The most common symptoms are looked at specific to the following developmental categories: Infant/Toddler, Preschool, and School-Age, and can be tracked over the course of several days or weeks in order to determine the effectiveness of the interventions, or the need for longer-term therapy referrals or other services. Both the CDCP ANS and ATQ forms are currently under research review by the University of North Carolina at Charlotte with preliminary results showing good reliability and the validity study to follow.
Our hope is that eventually, responding to childhood trauma as quickly as possible, and doing so in an informed, collaborative way, using a Public Health home vsiting approach, will be the national standard of care for all children impacted by trauma and violence. While nationally, the initial CDCP model has been deemed a "Promising Practice" by the National Child Traumatic Stress Network, and a seperate research review of our Mecklenburg County CDCP trauma measures is underway, we believe that the most simple and effective components of this response: police and clinicians working together to better respond to children and families, in a developmentally appropriate and informed way, is in and of itself a model practice that should become the best first response for all children impacted by violence or other trauma.
Working this way is cost-effective, utilizies the strenghts of multi-disciplinary professionals to the benefit of our most vulnerable community members, and lies at the very heart of the missions of both the Public Health and the Policing professions. This work is collaborative, protective, and preventative. It weaves what we have learned from decades of community-based work into the fabric of families, to strengthen their ability to recover when violence has occurred. With a simple shift towards collaboration, and funding for the needed clinical staff, many communities with committed police agencies and public health departments could make this service model a reality for children and families.
Furthermore, the time is right for this practice model which allows police agencies in particular, a powerful opportunity to communicate through their work, their true committment to the most vulnerable, as their top priority. The participating police agencies in Charlotte-Mecklenburg provide this care to all children and families, regardless of the parent or caregiver's legal history, legal or documentation status, housing status, history of substance misuse, and on and on. This work is done through a trauma-informed lense, with completely open access to all families desiring the help.
Mecklenburg County CDCP recently was awarded the 2022 North Carolina GlaxoSmithKline Foundation Child Health Recognition Award, in support of the program's desire to ensure clinican access to a variety of the nation's best evidenced-based trauma intervention training and education opportunities. Interventions such as EMDR, Brainspotting, A.R.T., TF-CBT, and others can be costly, and this year's award will support our long-standing belief that children receiving our immediate, no-cost response should be getting an expert level of care equal to, or better than, any other avaialbale in our community. If our aim is to prevent potential long-term, even lifelong symptoms and life-altering negative consequences of ACEs in our community, we have to be the best.
nctsn.org/interventions/child-development-community-policing-program