Cincinnati Children’s Joins with Community Agencies to Piece Back Lives Shattered by Abuse
It is early on a summer morning, but the outdoor space is humming in full play mode. Kids zip by on bikes and scooters. Others turn plastic water bottles into squirt guns. Boys scramble to the top of a jungle gym. Girls, braids and ponytails flying, compete to swing the highest. There are lots of happy squeals.
It could be any summer day camp. But the kids are not just any kids.
Every child on this playground is a victim of abuse or neglect. Some have been locked in cages or closets. Others have been beaten, starved or sexually assaulted. Many come from homes where parents are mentally ill, drug-addicted, or victims of domestic violence. Many live in foster care.
Despite their exuberance at play, these children face enormous emotional, intellectual and physical challenges. They might have difficulty talking, problems with motor skills or toileting. They find it hard to trust people. A number suffer from the same post-traumatic stress that plagues veterans of combat. They can be aggressive and abusive, or completely withdrawn.
Describing these 3-, 4- and 5-year-olds as “lucky” might seem preposterous, but it is true. They were fortunate enough to be referred by county children’s services to the TIP (Therapeutic Interagency Preschool) program at Cincinnati Children’s.
It is a step that might very well save their lives.
The TIP program, now in its 25th year, provides educational, developmental, mental health and safety monitoring services to children from age 3 to 5 who have suffered severe abuse and neglect. This year, the program will expand to begin with infancy.
TIP’s goal is to prepare children to succeed in school, and in life.
For 25 years, the TIP program has helped even the most severely abused children flourish, says executive director Jane Sites.
“What happens to a child when his most significant relationship is disrupted by violence?” asks Jane Sites, EdD, LSW, the program’s executive director. It’s the question she asked when she started with the program as a doctoral student, nearly at its inception. Little was known then about the psychological effects of abuse on children.
“Back then, we thought, ‘Their bodies are fine, they can see, they can hear. They might be angry,’ ” she says. “We didn’t think about developmental issues or know what reactive detachment disorder, or PTSD, or bipolar looks like when it starts to express itself at age 4 or 5.”
Treating the Whole Child
But they learned, and that learning became the foundation of a program that cares for the whole child at a most vulnerable and formative stage of life.
Currently, TIP cares for 60 children at a time, with a near constant waiting list. Ninety five percent of the children are referred by Hamilton County Job and Family Services as “open cases” of abuse or neglect. They are never clear cut, says Sites, and never easy.
“They might come in as cases of neglect, but then we get the rest of the story,” she says.
Knowing a Child’s Story
Close relationships with area caseworkers ensure that TIP staff know as much as possible about each child, says program coordinator Ginny Crotte. “So when a child refers to something awful or sad in his life, we are not surprised. We are prepared to respond to what he’s dealing with.”
The stories are often complicated by an overburdened caseload and court system. Decisions on adoptions can take up to four years or more, while children remain with unstable parents or bounce from one foster home to another. One of Crotte’s roles is to testify in court on behalf of the children. “The system itself can be traumatizing,” she says. “We try to advocate for what’s best for the kids.”
Helping children through this is a remarkable staff of social workers, psychiatrists, speech therapists, occupational therapists and physical therapists from Cincinnati Children’s, and teachers from Hamilton County Head Start. There is close collaboration with caseworkers from Hamilton County Children’s Services.
Toys like this wooden courtroom set help therapists prepare kids for difficult and potentially scary experiences. Right: Clinical counselor Thomas Volker observes a child in a therapy session.
Work that Looks Like Play
Much of the therapy provided by the staff is invisible to the untrained eye. Clinical and mental health services are deftly woven into TIP’s daily activities. Therapists make their work look like play, using every opportunity to help children understand and navigate a difficult life.
Everyone is vigilant. Even the program’s bus drivers are taught to look for signs that a child’s safety or well-being is endangered. Coordinators talk with the child’s parents or guardians weekly and visit the child’s home regularly; parents are encouraged to participate in therapy with their children.
Clinical counselor Francoise Pierredon describes her work with the children as “therapy that takes the form of play. It helps the children express feelings they don’t have words for.”
Setting the Stage for Success
Most children stay in the TIP program for a full year, although they can continue if they need more time. The success rate, even for the most severely traumatized children, is remarkable.
“Our data show that children who participate in TIP for one year — even those who begin the program as the most at-risk — make the most developmental progress of any preschoolers in Hamilton County Head Start,” Sites says. “They hold their own with age level peers when they start school.”