Both clinical experience and research have clearly demonstrated the relationship between childhood traumatization, maltreatment and exposure to violence, and psychopathology. Although primary prevention is clearly the best and most preferred method, inevitably there will be children who experience traumatic events and require intervention. The Child Development-Community Policing Program (CD/CP), begun in 1991, under the leadership of Dr. Steven Marans, between the New Haven, Connecticut Department of Police Service and the Yale University, School of Medicine's Child Study Center is one such intervention. At that time, New Haven and many cities around the country were experiencing a dramatic increase in violent crime. Studies across the country reported that childhood exposure to violence and its psychiatric sequelae had reached epidemic proportions.
Though police officers come in daily contact with children who are victims, witnesses, and perpetrators of violence, they generally do not have the professional expertise, the time, or the other resources necessary to meet these children's psychological needs. Conversely, clinic-based mental health professionals may be professionally equipped to respond to children's psychological distress following episodes of violence. However, those acutely traumatized children who are most in need of clinical service are often not seen in existing outpatient clinics until months or years later, when chronic symptoms or maladaptive behavior brings them to the attention of parents, teachers or the juvenile courts. When there are no collaborative responses immediately following violent incidents, valuable opportunities to intervene may be lost at precisely the moment when concerted police and mental health contact could provide both immediate stabilization and bridges to a variety of ongoing services for affected children and families. Clinical services alone are unequal to the tasks of intervening on behalf of the large number of children whose development may be compromised by their acute and chronic trauma. The CD/CP program has provided a two-way path in which child psychiatrists and other mental health clinicians can also turn to law enforcement as the professionals who have the greatest amount of immediate and sustained contact with the children and families in the line of fire. The program involves five central components:
- Seminars for Police Officers: Seminars are co-lead by a clinician and senior officers on the application of principles of child development and human functioning to policing.
- Fellowship for Police Officers: Available to supervisory officers who, in addition to participating in the above seminars, observe and discuss various aspects of clinical interventions such as inpatient units, outpatient evaluations and forensic facilities.
- Fellowship for Clinicians: Clinicians participate in seminars on community policing theory and practice and accompany officers on ride-alongs during which clinicians experience police practice as it actually occurs.
- Consultation Service: A 24 hour per day, 7 days per week service in which clinicians are available by pager to officers who are concerned about children with whom they have contact. Clinicians respond to children and families at crime scenes and other community venues when appropriate.
- Case Conference: A weekly conference in which police, probation officers, clinicians, and other interested parties meet to discuss and strategize about clinical and law enforcement interventions for victims and perpetrators.
The CD-CP collaboration is based on the premise that while a violent event may precipitate a host of responses which compromise children's developmental potential, it may also provide a window of opportunity for introducing psychiatric interventions and the application of what we have learned in the consulting room to the coordination of diverse services that have an impact on the daily lives of children and their families. Over the past eight years, more than 500 rank and file officers and more than 100 senior, police supervisors have been trained in the principles of child development and acute traumatic response. Working collaboratively with mental health professionals, police in New Haven have referred more than a thousand children who have witnessed and experienced violence, as well as dozens of children who have committed serious violent offenses. These children have often been seen within minutes of the police response to murders, stabbings, beatings, maiming by fire, death by drowning, and gunfire. The children and their families have been seen individually and as part of larger groups in their homes, at police substations, at school, in their neighborhoods, and at the Child Study Center. In the aftermath of violent events, child psychiatrists, psychologists and social workers have provided acute crisis intervention, parent guidance, pharmacotherapy, consultation with schools and pediatric staff in hospitals, and long-term psychotherapy for individual children. As the effects of exposure to violence are more clearly understood, collaborative early intervention programs such as Child Development-Community Policing program provide for new hope for effectively intervening and treating patients. This initiative places child and adolescent psychiatry at the forefront of collaborative efforts at preventing violence and its sequelae.