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Back to Archives | Back to July 2009 Contents 

Improving Law Enforcement Response and Mental Health Services for Child Trauma Victims in North Carolina

By Jim Bjurstrom, Assistant Chief of Police, Durham, North Carolina; and Robert Murphy, Executive Director; George Ake, Psychologist; and Karen Appleyard, Psychologist, Center for Child and Family Health, Durham, North Carolina

very year, the United States sees a significant number of children become victims or witnesses of violent crime.1 The evidence in the mental health literature demonstrates that children who are exposed to violence are at a heightened risk for behavioral and/or emotional problems. Officers who respond to violent crimes often encounter children on the scene, but historically they have not been trained to assist children with the immediate aftermath of trauma.2 In response to the need to provide safety and security to the families in Durham and citizens’ increasing interest in how first responders meet the community’s needs, the Durham Police Department (DPD) has partnered with mental health professionals to provide a more comprehensive response to violent crime. This partnership has resulted in the development of a program called the North Carolina Child Response Initiative (NCCRI), which allows DPD officers to identify signs and symptoms of child trauma victims, to respond differently when children are present at the scene of a violent crime, and to serve as a liaison to mental health services. The roles of DPD officers have expanded to allow for more participation in multidisciplinary teams to identify child victims and get them connected to the services they need to minimize emotional damage.

How Does the NCCRI Help?

The NCCRI, developed jointly by the Center for Child and Family Health (CCFH) and the DPD, represents collaboration between law enforcement and mental health professionals on behalf of children and families exposed to violence. Components of the program include a system of coordinated mental health and police outreach to and consultation with children and families in the acute aftermath of violence exposure. Officers and clinicians engage in joint outreach to children, families, and community groups in the aftermath of crime. Mental health professionals on the NCCRI team provide immediate, on-scene services to help children and families following traumatic incidents and connect them to needed services after the incident. Clinicians join DPD officers on regular ride-alongs to follow up on cases that patrol units and investigative units refer to them, and they also respond to cases that occur during the ride-along shift. The DPD, which can contact these individuals by telephone or pager, receives training from them during its regularly scheduled officer in-service sessions on signs and symptoms of child trauma as well as ways to respond effectively to violent calls with children present. Officers and clinicians then meet on a weekly basis to review cases and develop joint response plans.

Cross-disciplinary training is designed to familiarize each profession with the skills and responsibilities of the other. As a component of training, officers attend seminars related to child development and traumatic stress, observe clinical sessions involving the delivery of evidence-based mental health programs, and receive consultation regarding local resources for families in crisis. Officers in turn provide training to mental health clinicians about the integrity of crime scenes, police protocol with certain types of violent calls, and the functions of specialized units. During follow-ups with families, officers provide a wealth of knowledge about personal safety, referrals to city or county agencies, and updates on the status of offenders or suspects with outstanding warrants.

Police officers play a central role in NCCRI interventions, capitalizing on their roles as representatives of control, authority, and security in the face of traumatic or overwhelming circumstances. In responding to trauma that can leave both children and their families feeling overwhelmed and helpless, officers working together with clinicians may enhance physical and psychological security and predictability. Although the NCCRI helps children and families on an individual family level, it is also making positive changes in the community. Before this program, some families may have perceived officers only as “enforcers” despite the appropriateness of officers’ responses to crime, which sometimes leads to disjointed relationships between police and the community. This program is one example of the DPD’s many efforts to help educate parents about the roles of officers and to communicate to children that officers respond to keep them safe and that they care about what happens after traumatic events are over.

Program Funding

Funding for the pilot program came from the North Carolina Governor’s Crime Commission (GCC) to begin providing services to families in two of the DPD’s five police districts. Funds were used to support mental health clinicians’ time for acute response, urgent follow-up, and coordinated police-clinical outreach and education, as well as for educational materials for line officers and for families. After conducting the initial program for two years in a single district, the DPD was able to secure further funds through the GCC for expansion into another district. The department selected the two districts based on statistical analyses showing high levels of service calls for violent and gun-related crimes in residential areas. The plan is to extend the program to all districts when funds become available.

Figure 1. Nature of incidents referred to the NCCRI
Note: "Other includes runaways,
missing persons, neglect, and other types
of sex offenses.

Program Results

Of the cases referred to the NCCRI since May 2005, 195 have data ready for analysis. The nature of incidents (that is, the types of crimes) referred to the NCCRI most frequently included simple assault, aggravated assault, and sexual assault. A breakdown of the types of crimes is provided in figure 1. Referred incidents typically occurred in family homes (77.0 percent of cases). Approximately 21.5 percent of cases referred involved a weapon. The majority of the cases were referred to NCCRI clinicians through the NCCRI mailbox in each police district (47.7 percent of cases) or the weekly case review meeting (34.4 percent). Additional common referral sources included in-person referrals (9.2 percent) or acute page (3.6 percent). Response time for cases was prompt: 28.2 percent of families were seen within 24 hours of the referral.

Various services have been provided to families through the program. The primary services related to safety issues included education about the effects of trauma on children (66.2 percent of families received this service), officer follow-up/education (56 percent), and safety planning (29.2 percent). Additional services provided included child protection assistance (a child protection report was made in 24.6 percent of cases) and concrete assistance (17.9 percent of cases received a mental health referral; 7.7 percent received assistance with benefits; and 3.6 percent had a medical appointment coordinated). Regarding legal assistance, an offender was arrested related to NCCRI work in 5.1 percent of cases, and a protective restraining order was filed as a result of NCCRI activities in 1.5 percent of cases.

In reference to case dispositions, 36 percent of the cases were lost to follow-up. For a variety of reasons, the families referred to the NCCRI can be difficult to locate due to the transient nature of their lives, relocation or seclusion following violent incidents, and so on. Approximately one-quarter of the families (26 percent) declined follow-up services beyond visits provided by the NCCRI. Of the families with whom the DPD conducted follow-up services (the 65 remaining families), 43 percent were already in treatment, 29 percent were referred to community providers, and 10 percent were referred to the CCFH for medical evaluation or mental health services. Some cases (11 percent) were determined not to have clinical needs beyond the visits provided by the NCCRI.

Effects on Police Practice

The collaborative work performed as part of the NCCRI has resulted in numerous changes in officer knowledge and practice in the community. Through both informal and formal interactions, officers have expanded their framework for understanding the effects of violence on children and have developed alternative strategies for responding to the often challenging behaviors of those whom they expect to protect and serve. Officers have increased their ability to recognize situations where referral for mental health consultation is warranted for children who have witnessed and experienced violence and/or who have committed serious violent offenses. Similarly, officers have become sensitized to the varied responses of children to their presence. For example, they recognize that school-age children may express a desire for reassurance through withdrawal or inquiries about equipment or weaponry. Additionally, they have developed more nuanced approaches to adolescents who, out of a desire to retain newfound feelings of independence and autonomy, may respond to authority with defiance and hostility—especially in the company of peers. As officers have become regular fixtures in neighborhoods, they have replaced anonymous responses to the groups of youth who congregate on street corners with interactions that are informed by familiarity and individual relationships.

There has also been a paradigm shift in approaching and responding to violent events: whereas officers and investigators used to focus just on the victims of crimes and the apprehension of criminals, they now determine if children were present, either as victims of or witnesses to a violent event, and the possible negative consequences that may follow. Officers have become more aware of youth involvement and hence have become more concerned about the effects of violence on children. Officers have also learned to trust the mental health clinicians through the continued follow-up on cases and the sharing of information between officers and clinicians. Officers do not consider the NCCRI to be just another resource or program; they have taken ownership and now truly believe in it.

Next Steps

Recently, the NCCRI has secured funding to expand its target population to youths at risk for gang involvement, specifically siblings of gang members. The program is also seeking to enhance its services by carefully evaluating them and drawing on lessons learned from the data reported in this article. For example, program participants brainstorm on how to reach the 36 percent lost to follow-up, increase referrals to appropriate services, and decrease the number of families who decline follow-up services. The goal is to expand the NCCRI citywide and seek any funding that becomes available. As the program grows, the DPD is looking for ways to sustain it and may seek to secure funding through the department’s line-item budget. Future plans include assigning dedicated officers and hiring mental health professionals to work in the department itself. The DPD has also been working with peer agencies across the state through its partnership and involvement with Project Safe Neighborhoods to replicate the program in other communities in North Carolina. Since the beginning of the program, the NCCRI has presented at the National Project Safe Neighborhoods conference and has hosted its own training program.

The partnership between the DPD and the Center for Child and Family Health has led to a much better response to the Durham community as the two agencies work together to assist and support families after an experience of violence or another trauma. With continued support from the community and the state, the agencies hope to expand and sustain efforts to serve child trauma victims and their families in Durham.

For further information on the NCCRI, readers can contact Chief Bjurstrom at or Dr. Ake at


1Katrina Baum, Juvenile Victimization and Offending, 1993–2003, U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics Special Report, August 2005, NCJ 209468, (accessed May 15, 2009).
2Ilan Harpaz-Rotem et al., “Out-of-Home Placement of Children Exposed to Violence in Ten Communities,” Children & Society 22, no. 1 (2008): 29–40; Ilan Harpaz-Rotem et al., “Clinical Epidemiology of Urban Violence: Responding to Children Exposed to Violence in Ten Communities,” Journal of Interpersonal Violence 22, no. 11 (2007): 1479–1490; and Robert A. Murphy et al., “Acute Service Delivery in a Police–Mental Health Program for Children Exposed to Violence and Trauma,” Psychiatric Quarterly 76, no. 2 (Summer 2005): 107–121.

IACP Hosts National Policy Summit on Improving Police Response to Persons with Mental Illness

Providing better police response to individuals suffering from mental illness is a priority not just in North Carolina but across the United States. In May 2009, the IACP, in collaboration with the Bureau of Justice Assistance of the U.S. Department of Justice, the JEHT Foundation, and the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services, convened the National Policy Summit on Building Safer Communities: Improving Police Response to Persons with Mental Illness.

The goal of the summit was to begin a dialogue that would result in recommendations for local, state, federal, and tribal organizations that improves the safety of community members and law enforcement officers when responding to crisis calls involving a person with mental illness. The recommendations are intended to reduce trauma, injury, or death during mental health crisis calls and to promote dialogue between law enforcement agencies, community providers, and partners that will sustain short- and long-term improvement in crisis call response, treatment, and recovery around the United States.

The summit assembled subject matter experts representing the law enforcement community, courts and corrections, law enforcement psychologists, policy makers, mental health advocates, mental health service providers, and adult and youth mental health consumers from across the country. This group of approximately 100 disparate subject matter experts worked together for two days to identify challenges and barriers—as well as potential solutions—to improving police response to persons with mental illness. The summit focused on five major areas for recommendations: children, youth, and young adults; reentry into the community; policy and legislation; cross-systems collaboration; and crisis intervention/first responders.

Within and across each of these topics several themes quickly emerged, including the following:

  • Communication
  • Collaboration

  • Building partnerships

  • Funding/resource development

  • Training

  • Community trust building

All of the summit participants were in agreement that, despite their differing viewpoints, they all had a common goal: developing safer communities through community partnership and collaboration.

The final summit report, including the final recommendations offered by summit participants, is expected to be available later this year. For more information, readers can contact Elaine Deck, senior program manager, at 1-800-THE-IACP, extension 843.



From The Police Chief, vol. LXXVI, no. 8, July 2009. Copyright held by the International Association of Chiefs of Police, 515 North Washington Street, Alexandria, VA 22314 USA.

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