Coordinated Community Response (CCR) is a systemic, multi-layered approach to domestic violence that employs collaborative and integrated service delivery. In recent years, more and more agencies and states have adopted the CCR approach in order to improve outcomes in cases of domestic violence and sexual assault.It seems like a basic idea—communities who work together to close gaps in their systemic response to domestic violence will see greater justice for victims and accountability for offenders. In practice, though, developing this type of systemic approach takes constant compromise, creative thinking, and always putting the victim’s needs at the center of everyone’s approach.The official term for this type of system—in which all the players are working together as they should—is a Coordinated Community Response, or CCR. Ellen Pence, one of the leading minds in the domestic violence movement, coined the CCR approach many years ago, and since then, countless communities across the US have implemented CCRs and drastically changed the way victims and offenders interact with the criminal justice system.
Today we explore the CCR concept including the model in Harris County, Texas and, more specifically, the value of the sexual assault nurse examiner role with the CCR. Our guests are Carvana Cloud and Dr. Khara Breeden, experts in the fields of coordinated community response (CCR) and forensic nursing programs. Carvana Cloud is a former prosecutor and the executive director of Community Empowerment Solutions, a legal services collaborative designed to support and empower victims and communities affected by crime. Dr. Khara Breeden is a registered nurse who serves as the executive director of the Harris County Forensic Nurse Examiners and is actively engaged in a large number boards related to strangulation and crimes against women. Content warnings for this episode include: physical and sexual violence, emotional abuse, child abuse
Coordinated Community Response (CCR) is a systemic, multi-layered approach to domestic violence that employs collaborative and integrated service delivery. In recent years, more and more agencies and states have adopted the CCR approach in order to improve outcomes in cases of domestic violence and sexual assault.It seems like a basic idea—communities who work together to close gaps in their systemic response to domestic violence will see greater justice for victims and accountability for offenders. In practice, though, developing this type of systemic approach takes constant compromise, creative thinking, and always putting the victim’s needs at the center of everyone’s approach.The official term for this type of system—in which all the players are working together as they should—is a Coordinated Community Response, or CCR. Ellen Pence, one of the leading minds in the domestic violence movement, coined the CCR approach many years ago, and since then, countless communities across the US have implemented CCRs and drastically changed the way victims and offenders interact with the criminal justice system.
Today we explore the CCR concept including the model in Harris County, Texas and, more specifically, the value of the sexual assault nurse examiner role with the CCR. Our guests are Carvana Cloud and Dr. Khara Breeden, experts in the fields of coordinated community response (CCR) and forensic nursing programs. Carvana Cloud is a former prosecutor and the executive director of Community Empowerment Solutions, a legal services collaborative designed to support and empower victims and communities affected by crime. Dr. Khara Breeden is a registered nurse who serves as the executive director of the Harris County Forensic Nurse Examiners and is actively engaged in a large number boards related to strangulation and crimes against women. Content warnings for this episode include: physical and sexual violence, emotional abuse, child abuse
Maria MacMullin: The subject matter of this podcast will address difficult topics, multiple forms of violence, and identity-based discrimination and harassment. We acknowledge that this content may be difficult, and have listed specific content warnings in each episode description to help create a positive safe experience for all listeners.
Voice Over: In this country, 31 million crimes are reported every year. That is one every second. Out of that, every 24 minutes there is a murder, and every 5 minutes there is a rape. Every 2 to 5 minutes there is a sexual assault. Every 9 seconds in this country, a woman is assaulted by someone who told her that he loved her, by someone who told her it was her fault, by someone who tries to tell the rest of us, it's none of our business, and I am proud to stand here today with each of you, to call that perpetrator a liar.
Maria: Welcome to the podcast on Crimes Against Women. I'm Maria MacMullin. Coordinated Community response or CCR is a systemic multi-layered approach to domestic violence that employs collaborative and integrated service delivery. In recent years, more and more agencies and states have adopted the CCR approach to improving outcomes in cases of domestic violence and sexual assaults. It seems like a basic idea. Communities that work together to close gaps in their systemic response to domestic violence will see greater justice for victims and accountability for offenders. In practice though, developing this type of systemic approach takes constant compromise, creative thinking, and always putting the victims' needs at the center of everyone's approach. The official term for this type of system in which all the players are working together as they should is a Coordinated Community Response.
Ellen Pence, one of the leading minds in the domestic violence movement, coined the CCR approach many years ago. Since then countless communities across the United States have implemented CCRs and drastically changed the way victims and offenders interact with the criminal justice system. Harris County, Texas is one such place. Today, we explore the CCR concept including the model in Harris County, Texas, and more specifically, the value of the forensic nurse examiner role within the CCR. Our guests are Carvana Cloud and Dr. Khara Breeden experts in the fields of Coordinated Community Response and forensic nursing programs.
Carvana Cloud is a former prosecutor and the executive director of Community Empowerment Solutions, a legal services collaborative designed to support and empower victims and communities affected by crime. Dr. Khara Breeden is a registered nurse who is the founder and CEO of Texas Forensic Nurse Examiners and is actively engaged in a large number of boards related to strangulation and crimes against women. Carvana, Khara, welcome to the show.
Kahra: Thanks for having us.
Carvana: Thank you, Maria.
Maria: So, I had to abbreviate your bios in our introduction because they are just so tremendously robust. I would love for each of you to tell our listeners more about your background and experience. So, Khara, let's go ahead and start with you.
Khara: I became a nurse in 2002, and have done various types of nursing. I kind of fell into forensic nursing on accident in 2012, and pretty quickly knew that's right where I was supposed to be. I didn't know what it was going to look like now even as things moved forward, but I loved the specialty. So, I just really engrossed myself and everything I could. I got involved in lots of different committees and things like that.
In 2016, I finished my doctorate and knew that the community had a role gap in forensic nursing services in Harris County. I knew that I had ideas to fix it, but I didn't know what that was going to look like. Really and truly, just by luck and grace, I met Carvana. We started working closely on fixing a lot of the issues here in Harris County, and through that, we developed this community-based program that I run today. So, that's kind of a quick rundown of my bio.
Maria: Yeah, that's a great run down. Carvana, how about you?
Carvana: Sure. Well, I am an attorney, and I began my career as a prosecutor here in Harris County. I, very quickly, took a liking and real appreciation for prosecuting crimes of interpersonal violence, especially with domestic violence cases. So, as a prosecutor, our goal was to seek justice, make sure that victims were safe, and make sure that offenders were held accountable. So, when I returned to the DA's office in 2017, I led the family criminal law division there at the DA's office, and began to work on training prosecutors, and giving them the tools and skills that they need to prosecute domestic violence cases.
When you begin to nearly discover that we were not giving or doing due diligence about our strangulation cases, which in Texas is also called or known as impeding breath cases, our prosecutors were struggling with how to prove the cases. They didn't understand them, and then we also noticed that the law enforcement agencies were having issues with investigating them. I always say that it was a godsend that sent Khara Breeden our way as well as Chelsey McKay, who was able to educate and enlighten me about the importance of making sure we got it right when we were investigating and prosecuting those cases.
The strangulation cases were only just the tip of the iceberg as to how we were trying to determine what other high modality factors existed that were causing the high rates of domestic violence homicides in our community. So, I was able to take that position and create strategic partnerships with Dr. Breeden and others in the community to focus on making sure that we had everybody in line, and that we were using all of our resources together collaboratively to prevent domestic violence. Most importantly, to save lives. So, I've used my career as an attorney and coalition builder to do just that. I'm very excited about it.
Maria: Both of you are working on Coordinated Unity Response in Harris County, Texas. Can you tell us what Coordinated Community Response means to you, and how Harris county is doing it differently from other areas?
Carvana: Okay. I think Coordinated Community Response is not to make anything difficult, it's just a real focus on systems and community-based agencies collaborating and working together. What we saw in Harris County as I alluded to earlier, was that the right hand often didn't know what the left hand is doing. Law enforcement was doing a very good job at what they were doing. The DA's office was prosecuting the cases. We have shelters in our community-based agencies that were supporting the survivors outside of the Criminal Justice System, but there was no real connection. There was no real collaboration or collaborative effort to support survivors.
So, after reading through several homicide cases, and going back to the files of many of those victims who had lost their lives, what I quickly saw was that we were letting victims fall through the cracks because we didn't offer a community response. There was no one responsible for them to be able to receive the help they were needing. Some victims didn't even realize there was a such thing as a protective order, or that the DA's office offered them for free, for example. Sure, I alluded to this earlier, but even I and many other prosecutors didn't even realize that forensic nursing played a role in domestic violence prosecution.
So, what we were able to do was bring everybody to the table to talk about their strengths, and what they provided, and figured out a way to unite us all together so that we can have more of a one-stop-shop approach instead of the victim trying to access services, and navigate a system that is very difficult to navigate. So, it's more importantly a way to provide victims with what they need so they don't have to aggravate the existing trauma and challenges that they're already facing as a result of being a victim of domestic violence.
Khara: Right? I don't have too much to add to that, but I know when I started on this adventure, if you will, Barbie Brashear, who's one our mentors in all of this said, "Focusing on the victim, always leads you to the right direction." I think through this, as we focus on the community, and focus on efforts that improve this response and what victims' actual needs are, I think that's helped propel the response in Harris County because I think collectively everyone has had the victim as their focus. What is best for the victim at all times? I think that takes away how it impacts me, what it does to the DA's office or all of the other nuances that might impact change. I think that when you focus on what you're here for, I think it helps propel whatever those efforts are collective to make a real impact.
Carvana: Khara, just jogged my memory about something. Harris County, you asked also, how is Harris County different, right? How are we doing it differently? We're doing it differently. For example, we have many initiatives that we started, but one of the initiatives we started was the domestic abuse response team. That particular team was funded by a grant that we received from the office of the Governor. Even though the grant was written by the DA's office, it included partners like Texas Forensic Nurse Examiners and the Houston Police Department, funding for all of those agencies as well as the DA's office to be able to run the team.
It's no longer us focusing or fighting over funds, but figuring out how we can collectively work together to leverage the resources that we have to make things work. I don't think you see that very much in communities. I know you didn't see it in Harris County before, but with our renewed commitment, like Khara said to focus on the survivor, it was just a natural reaction for us. So, we're putting our money where our mouth is, and I think that's a really big difference.
Maria: Yeah, for sure. Tell us more about the culturally sensitive CCR, how it's for specific interventions, and the role of forensic nursing within that.
Carvana: I'll start it, and then I'll hand it off to Khara, but the culturally-specific prong is dear to my heart. As a child victim of domestic violence, I grew up in a home where I watched my mom struggle with trying to find the resources that she needed to be able to recover from her abuse and the harm that was created as a result of that. So, what I learned, of course after going to law school, being a prosecutor, and working with the amazing group of advocates and nurses that we have in Harris county, is that if you've met one domestic violence survivor, you've met one domestic violence survivor. There is no cookie-cutter approach to serving a survivor, specifically when it comes to domestic violence in Harris County.
I think, nationally, the research bears this out. Women of color are disproportionately affected by domestic violence. There are several factors including lack of education, housing, substance abuse, and poverty that contribute to that being the case. Nevertheless, it showed that we needed to be more culturally sensitive and inclusive in providing services. So, what that means is an African-American woman might not respond the same as a Muslim woman to an advocate, or police officers showing up to provide her services.
So, we need to make sure we understand the cultural norms, and the societal issues that they're facing within those different communities, and tailor services so we can be able to speak to the victim. That specific victim and not just assume that she has a place to go or an established support system, a job to go to, or education to fall back on, if her partner leaves, for example.
Not passing judgment on people who are different, but understanding who and how they operate. Making sure we have folks who are delivering those services in that way that look like them, that speak the same language, and that can relate to them. We're finding that that's opening up a lot of different doors for us to be able to provide a different level of healing and support. That's where Dr. Breeden and her crew are extremely important.
Khara: I don't know if I can add much to that because a lot of these things that we did, we kind of did them at the same time, right? So, how that works and plays out for us is that we have funds to help people get from place to place. We have interpretation services as needed. We try to tap into each other's resources so that it's not taxing on any one agency. So, if we have a language barrier, we might utilize services together instead of, reinventing the wheels. So, I think just again like Carvana said, focusing on what that specific victims' needs are, and how to collectively best address those needs as a community together versus again, everybody is on their own.
Maria: Yeah, to those points, Carvana, are there victim-centered approaches versus service-centered approaches? What might the difference be, and what might the preference be, victim-centered versus service-centered?
Carvana: I'll take a stab at this, so this is something that Khara probably has a lot more experience with because she's an actual practitioner, but I, for example, just kind of going back on my experience as a prosecutor, I was a prosecutor when I was a younger lawyer in the early 2000s, and then, of course, a leader in an office from the last 3 years. The difference that I could tell, was that the first go-round, the DA's office was more concerned with the system working, providing the prosecution going through the motions, just giving the victim the criminal justice service as they've done traditionally, right? Bring the victim, we prosecute the case. The abuser either goes to jail or gets probation and then that's it.
That didn't always take into account the other needs of the survivor because we all know that justice extends beyond the criminal case. Many times, there's not a criminal case for a lot of folks. Some people don't even report domestic violence. So, it changed the way we think. So, now at the DA's office, I'm no longer there of course, but I know I worked hard to create a victim-centered approach. Again, going back to what Barbie Brashear is always telling us, stay focused on the victim and understand that each victim is going to need certain things, so they can transition to becoming a survivor. From a victim to a survivor, that means you have to actively listen.
Being victim-centered means you have to actually listen. You have to understand, then you have to tailor your service plan to them versus them having to adjust to whatever the needs of the agency are. So, I think that's the difference as far as the criminal justice system.
Khara: I think from a victim-centered approach, yes, we all have jobs we have to do, and we're all focused on making sure the community's safety is, we're taking that into account, and the victims' safety, and what we think is best for them, but what we sometimes think is best for them isn't really what they want or what they think is best for them. So, those times can often be hard to play through as a practitioner in taking care of victims in that way. But one thing I think, being victim-centered in this environment now that we've created, changes the game because as my nurses are caring for victims, and they're doing their job and all the things that forensic nurses do, we easily can identify ones that we think may be at risk, may need a protective order, or may have something happen that we don't want to fall through the cracks.
Maybe we get information that we don't think somebody else might have, and because we've broken down these walls, and we figured out how to communicate with each other, I know in each agency who I can call to make sure like, "Hey, this happened. We saw this patient, this happened." From a practitioner's standpoint, it's huge because you used to just feel helpless. You didn't know how to help that victim get to that next stage. Go to that next place. Were they going to be safe when they left you? I didn't know, so now I know. Like I know all the things I can do to help make sure people are safe and they have a roof over their heads and that if they need a meal, we can get them some food. All of those things make a big difference in I think their outcomes overall and trust in the system as well.
Maria: So then, are there changes that can be easily incorporated into an existing program to make the response more victim-centered?
Carvana: I think the first thing that the community should recognize when they're trying to make that change is that they all speak different languages. I didn't understand the role of a forensic nurse till I sat down and I listened to Khara. Khara didn't necessarily understand all of the dynamics of a protective order, and what that entailed until she was able to sit down with us and we went through it. So, I think active listening is the key. One of the things we did, Khara and I, were able to, with the help of the Domestic Violence Coordinating Council here, we're able to put together a round table in December of 2017, and we brought all the partners together. Everybody in the community would potentially touch or have access to or respond to a domestic violence survivor.
So, I think by bringing those folks together, we were able to understand each other better and listen. One of the main things that we did was encouraged people to leave their egos at the door. So, that for me is a critical piece that I'd like to share with communities. I think it might be hard because people don't always want to get together and chat and talk, but even if you did it on a smaller basis and got people together kind of like in smaller groups, eventually just starting that dialogue, I think is important.
Khara: I, 100% agree. I think that that roundtable was the very beginning of all of the other great things that have happened. Again, being able to speak each other's language, knowing who you can communicate and ask questions to, when you're feeling vulnerable and unsure about things, I think that's a big key that's very victim-focused. I have always said that I think everybody feels like their role is the most important, right? Like I'm a nurse. I think what I do is crucial and it has to happen. As a prosecutor, I'm sure they feel the same way.
So, when we look at all the players, when we look at law enforcement, we look at advocacy, we look at the DA's office, and we look at the medical side because that's the 4 pillars of who touches this victim the most, we can't do it alone. We all have to come together. I and Carvana would present, we would always say it's like completing the circle because we had this diagram. I think that's just all so true because we can't do any of this work without each other. If we put the victim in the center, and we continue to work as a team, everybody wins.
Maria: Let's talk a little bit more specifically about Harris County and the work you've done there because you both have put an incredible amount of work into crafting CCR that can serve many populations, and many different needs in that area. So, what happened to convince you, both of you, or each of you, that Harris County needed to do a better job of coordinating services for survivors of domestic violence?
Carvana: We are twins. I don't know if you can tell, but we, think alike, and we share the same passion. So, we don't mean to talk to each other. We just are very excited about this work. I will tell my Ashanti's story, Khara, and then, well, obviously just hand it over to you. A woman by the name of Ashanti Hunter was killed on April 30, 2017. She had 3 children, and she was trying to escape from her abuser who had been abusing her for about 4 years prior. No charges and no arrests had ever been made against her abuser. Even though she called the police, she didn't get any assistance. She was killed on April 30, 2017, after there was an outcry that he had been abusing sexually one of her daughters.
So, that was it. She decided to leave. She had enough, and so she left, and she got into her cousin's car to leave, and he killed her in front of her cousin and her children. Shot her four times at point-blank range as they sat in the car trying to leave. That to me was the game-changer. The loss of life is the catalyst of change. I say that in every training that I do because for me, having been on the job, only 4 months at that point, it was evident that my job was no longer to just continue to prosecute the way we had always been prosecuting, but it was a wake-up call that we needed to do more because I read all of the instances where she called police. I read those police reports, and there were opportunities for charges and/or arrests to have been made.
A protective order had been put into place, but it wasn't. But instead of pointing fingers, I did was immediately began to galvanize the troops, and start having conversations about how we can do this to prevent the next homicide. Everything that I've done and that I have been privileged to be a partner with other community partners have been about preventing domestic violence homicide. So, that was my catalyst.
Khara: I think for me, I worked at a hospital before creating this community practice program that we have now. Just the frustrated victims seeking medical care, then going from place to place trying to find an exam on what was likely the most horrific day of their life. This doesn't happen one time. This was on a once-a-week occasion that victims had gone to 3 and 4 hospitals before being able to find a place that would take them in, and do this medical forensic exam on them. That, while they're being told that they can't eat, they can't drink, and they'll likely still need clothes. They feel like they just need to get out of it, and it's just the feeling that a victim has to go through this thing over and over and again before getting to the right place to get something that is a basic need.
For me, that was unacceptable, and it was something that I was passionate about making sure we did better because I knew that victims deserve better. I didn't know what it was going to look like in the end, but I certainly knew that that had to change.
Maria: Thank you both for sharing those really powerful stories. I think it's important too, we, then that human element to what we're talking about with the CCR, and all the topics really on the podcast because there is the sense sometimes that we're looking at this abstract concept of over-creating this Coordinated Community Response. But really, we're doing it because we need to help people, and specifically, in this case, we need to help women. Carvana, I love your quote about the game-changer being the loss of life, and that's it. I think you're right, and Khara, thank you for kind of leading us into the conversation a little bit more about forensic nursing. So, I wanted to dive into that area, and let you talk more specifically about the role of the forensic nurse within the Coordinated Community Response.
Khara: So, I think that this is a concept that is still somewhat not utilized in communities as well as it should be. I think that the forensic nursing role is so important because obviously, we have to worry about the victims' help. What are the baseline needs? When we talk about Maslow's hierarchy of needs, we need to make sure that their health is, okay, right? Food, water, health, breathing, all of those things. So, when we talk about what primary needs are, an initial medical forensic exam is crucial for that.
So, I think SANE nursing or forensic nursing it's still a fairly new concept. It hasn't been around for a long time. It's been 20, or 30 years since its conception, and we've grown a lot. Things have improved, but I think there's just so much more area for growth and improvement as we talked about the community. I think people don't understand that because they haven't seen it in a different light. So, I know here, once Carvana and I began started working together, I started talking about doing a medical forensic exam on victims of domestic violence. I'll never forget that day. She was like, "You mean, you can do a medical forensic exam on a victim that hasn't been strangled? They don't have to be strangled to come to see you?" I was like, "No. We'll do a medical forensic exam on any victim of violence. We see everybody."
It was just like this light bulb went off, and from then on it helps to see clearly in regards to the purpose of why we're there. So, from a medical perspective, when we can tell a victim that this is their health. We think this is what we've assessed. This is your plan of care, and then you're going to be okay. Then let's connect you to these other resources." It helps put that patient on the path of healing and recovery because they know that their body, their person is going to heal.
Maria: So, before the SANE program or a sexual assault nursing examiner opportunity for these women, what was happening? What type of exam or experience were women having after they've experienced domestic violence or sexual violence?
Khara: When Carvana and I sort of worked together, this was the fall of 2017. Now, Carvana, can you tell me how many square miles Harris County and surrounding areas are? Is that something you know off the top of your head?
Carvana: It is not. It's really big.
Khara: Barbie can.
Maria: Everything in Texas is really big. Yeah.
Carvana: It's really big.
Khara: Third most populous county in the United States. I can say that. Look that up recently. We had 8 facilities. Not all of them work 24 hours, which could take care of the victim of sexual assault, adult victims of sexual assault. There were 8 facilities. Okay?
Maria: in Harris Country?
Khara: And surrounding areas. We had two that were able to take care of children of sexual assault. We had two that could take care of a victim of domestic violence. The problem here was huge, right? Like victims weren't getting this service. Like just absolutely, we're not getting this service. Figuring out how to, again, when I was in the hospital-based program, we expected victims to travel to us, right? Like the victim had to come to us for us to be able to take care of them. So really, for me and the goal as we started was, how do we meet victims where they're at, right? How do we meet them there so we don't expect them to find us? I need to be where they're at.
I think that's what changed how we do things here, but yeah, the problem was significant. I think the women that didn't give up after being turned away at one or two hospitals, were broken. They would come defeated, and they were just frustrated and didn't believe in the system from the very beginning. So yeah, it was a significant problem.
Carvana: Dr. Breeden mentioned that two agencies provided forensic exams to domestic violence victims, right? Two, well, I will tell you, I've been a prosecutor for a total of 7 or 8 years, right? Now, I never saw a police report with a supplemental forensic exam for domestic violence victims. I never saw or heard of a police officer linking up with the hospital, one of those two hospitals, to take that victim to receive a medical forensic exam. Neither were we ever trained that medical forensic exams were even available to victims of domestic violence. We just thought of them as exams for folks or women specifically who had been sexually assaulted.
So, there was a great level of ignorance, and lack of awareness about what a forensic exam could do. Even though they had those two agencies we weren't using them. So, when you say what were women doing especially women who had been abused in a domestic violence situation? They were getting no treatment. They were getting absolutely no treatment. That is unacceptable. It is unacceptable, and only until Dr. Breeden started and launched her community-based forensic program did this become a reality for survivors. Because domestic violence has such devastating consequences on folks in their health care, their mental health care, and their physical ability to move and move forward. It exacerbates underlying conditions.
So, this exam allows women to be able, and I'll say individuals because we know domestic violence is not just limited to women, but it allows individuals to be able to have those tests in those exams done so they can maintain their health. That is so important. Domestic violence is not just a criminal issue. It's a public health issue, and Dr. Breeden's work and the work of forensic nurses are exposing that and teaching communities how to incorporate that. Not only to make our cases better but to keep people safe and healthy.
Maria: With this being a public health issue then, are you seeing the program replicated anywhere else either in Texas or across the country?
Khara: When we started, I essentially, again, what I did is I took the program out of the hospital. I knew that if I didn't have as many barriers, I could be more flexible and meet patients where they were, or victims where they were at. So, when we launched we were actually in three clinic locations. Two of them were women's centers that we partnered with, and one was our own home office where I'm sitting today. I didn't know how we were going to grow, but we have quickly grown, and in that, as we've grown, we've partnered with universities so we can go respond to the University Health Center if a victim shows up to their health center for care.
We've, again, continued to partner with our women's centers. We partner with hospitals, which hospitals, generally, want to do the right thing. So, when we talk about the lack of service, it wasn't because hospitals don't care about these victims necessarily. Developing and sustaining a program, a forensic nursing program is costly. It's cumbersome. It's complicated. There are just so many factors that go into just the day-to-day management of a forensic nursing program that hospitals get started on it, and they realize how difficult it is. They're like, "This is not financially worth it," and they pull out. They decided it was not worth it.
When you take a community-based program that can contract with the hospital system, it's the best of both worlds for them because when a patient shows up, that they call us, and we go into their facility. We manage the medical forensic piece. They manage the healthcare piece that they were already there for. We build them a simple patient rate, and it's very affordable for them. So, they can get this service that they need to provide anyway without having to deal with all of the chaos of creating a program. So, I think that's what our biggest success has been regarding making it community-wide. We're now in 9 counties in over 33 locations, and we're still growing.
So, it's crazy one year later how fast we've expanded. I think we're covering 13,000 square miles as our coverage area right now. So, to answer the question, continued expansion is something I certainly anticipate, but I also think this is a replicable model. I'd love to see other communities in Texas, especially I guess National maybe. But Texas, especially, I think this would be very easy to replicate. I'd like to be able to oversee programs in different areas of Texas, and train and host those nurses, but then still give them a robust program that they can be overseen by because I think there are a lot of grants that fund forensic nursing education. I think that's great. I think forensic nursing education is something that needs focus.
But I think one of the bigger issues is that these nurses, they're excited. They feel strongly about this population, and they get this education, and then there's nowhere for them to practice. There's no program. There's nowhere for them to take care of these victims. So, if we can get them the education, and get them connected into a program and help build a community model, then we're doing the best of all things.
Maria: For our listeners who might want to investigate replicating this program, what's the website or best way to reach you?
Khara: TXFNE.com. So, it's texasforensicnurseexaminers.com. There's a link, you can email straight from the website. I'd love to talk to anybody interested in trying to take this program to their community, for sure.
Maria: I'm sure we'll put that link up on our website as well. Trying to wrap up both these very robust topics with two very astute experts, couple of questions, Carvana, what advice do you have for other counties who are starting CCR, or want to make their CCR more holistic and culturally aware?
Carvana: Well, I have a 5-point blueprint, okay?
Maria: Oh wow.
Carvana: If they're interested in doing this, I will give them 5 points. Here we go.
Maria: Where can we find that? Do you have a website?
Carvana: I don't have a website, but I will give it to Khara, and will probably put it on her website.
Maria: Perfect. Okay, go ahead. What are the 5 points?
Carvana: The first is to find a champion in your community. Find a champion in your community that's going to be able to advocate for the change that's needed. Okay? I've recommended that'd be someone in your county or your county or local government, and not a specific agency. Okay? The second is to understand that domestic violence and sexual violence are not just criminal cases. Being holistic provides an opportunity for practitioners to go beyond the criminal case.
Third, prioritize victims' physical and mental health. Understanding that when domestic violence and sexual violence occur, that trauma is going to affect the victim, physically and via their mental health. So, you want to make sure that that's prioritized as well, and not just an afterthought because that will allow them to properly recover. The fourth is to provide long-term therapy via community-based agencies such as your local women's centers, other therapy, or mental health providers because that's where the healing and the true empowerment begin.
After the criminal case, after the medical exam, linking them to therapy will allow them to become strong and healthy and able to live a life free of violence and abuse. Then, the fifth prong is to figure out a way to establish strategic partnerships to encourage economic and financial independence. Many of our victims are in abusive relationships because they lack the economic opportunities or financial independence to be able to leave their abuser by working with workforce commissions or establishing relationships with employers in the community who can employ victims. They can be able to stand up on their own and be able to leave their abuser.
All of these things are why we are working on, and calling our approach holistic because it does go way beyond the criminal justice perspective, and it allows survivors to have true healing, and to be empowered. Of course, we want to make sure that we're incorporating, or that communities are incorporating, then culturally specific. Each one of those prongs because again, is key because there's certainly no one cookie-cutter approach.
Maria: Perfect. Khara, how can counties without forensic nurses in their jurisdiction involve their medical partners?
Khara: I'm hoping there's at least one SANE nurse in a community, but I, for sure, would recommend that they reach out, figure out who those experts are in their community, and become friends with them. Make sure that when there's something difficult going on that they reach out to them. So, each community is going to look different, of course, but just building collaborations, and however that is going to look like for each community, I think is key.
Maria: Thank you for that. I understand both of you are going to participate in the 2020 CCAW web series. How can we find out more information about you?
Carvana: I am doing with HPDs at Houston Police department Lieutenant Julie Pleasant. She and I are presenting during the web series it's called Beyond The 911 Call. Achieving holistic Justice for domestic violence survivors. The information about that topic can be found on my Facebook page called The Empowered Survivor. If you go to Facebook called The Empowered Survivor, information about that series will be there, as well as information about the different legal services that The Empowered Survivor supplies to victims of domestic violence such as divorce protective orders, help with evictions, free or reduced costs. Again, you can find me on Facebook at The Empowered Survivor.
Maria: Thank you. Khara, give us your website one more time.
Khara: T-X-F-N-E.com.
Maria: Okay, great. Onto the final questions, lightning round last few seconds. What is one word or term that each of your wishes people would stop using when we're talking about CCR, victims of sexual violence, forensic nursing, and so on, unrelated topics, or what would you prefer was in our vocabulary when talking about these topics?
Khara: I will say, forensic nurse versus SANE. I always will try to hone in on using the word forensic nurse to help grow the profession instead of just utilizing one skill that we have. So, a forensic nurse would be mine.
Carvana: Mine is to transition from using this phrase. We've always done it that way by using the phrase, "What can we do to make it better?" Always challenging ourselves to move forward.
Maria: What's inspiring each of you right now?
Khara: For me, the growth of this program was continuing to expand and offer other services. We'll be starting our forensic interviewing program in June, which is exciting. So, just expanding to continue to offer services to victims. I have always felt that the children's assessment center model had it right, and being able to go to one place to offer all the services that a victim need is a right idea. I've never understood why it wasn't that way for adult victims. So in my mind, I'm inspired by really making that dream a reality for victims of violence in Harris County, to having a one-stop-shop for victims to be able to get all the things that they need to move them forward.
Carvana: I'm inspired by the stakeholders in this community, and their ability to work together. I know for some communities, that is a huge barrier, and we don't fight. We get along. We want to move the ball forward. We share resources. The programs are working. There's demonstrated success, and that in and of itself, inspires me to keep moving forward and keep moving the ball because every day, we have an opportunity to save somebody's life. That's what it's all about.
Maria: Wow. I'm inspired by both of you. Not that you asked me, but would you agree that your work is intense? How do you combat that, or combat the burnout that may come from that? Carvana's laughing. You go first; go ahead. Do you feel is it intense?
Carvana: I'm laughing because yes, it's very intense. When you're on a plane or you're having dinner or a conversation with somebody, and you immediately start talking about interpersonal violence and its effect, because that's our work. I mean that we're always talking about that. People look at us as kind of crazy, right?
Maria: Right.
Carvana: But there's not a day that goes by that - and I speak for Khara as well. She can speak for herself, but we don't wake up thinking about, How can we not only make our programs better but what can we do to make somebody's life better? Because people are going through this, women especially are going through this every day. I have been counseled to step away and to have more balance and I'm working on that, but I am a champion in Harris County, and I don't apologize for that at all. For so many years, we haven't had a champion. So, this issue has a champion nationally. So, I'm very proud of this team here in Harris County, and I'll continue to work on my balance. But at the end of the day, I got to keep grinding.
Khara: For me, a lot of the same. I feel like this work does kind of drive me, so a lot of times, it doesn't feel like something that weighs me down in any way. I feel like I thrive off of it, but I do try to have more boundaries, and work-life balance and all of those things. I have a lot of dogs and I try to take walks and try to be healthy, and all of those things. But this work itself is my life's work, and I don't regret anything. It pushes me forward every day.
Maria: That's beautiful. Ladies, thank you so much for being here. Carvana, Kahra, it's been interesting and informative, and I feel like I've learned a lot. Hopefully, our listeners are here too. If you're interested to learn more about a Coordinated Community Response in your area, visit our website at conferencecall.org. That's conference C-A-W.org, and also check out the 2020 web series featuring today's guests.
Voice Over: To learn more about this topic and other issues impacting crimes against women, visit conferencecaw.org and find us on social media at National CCAW. Thanks so much for listening. Until next time, stay safe.
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