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Childhood exposure to violence.

Little boys trying out for the local football team expect to get tackled. They don't expect to get shot. Yet that's what happened to 11-year-old Jenry Gonzales in August as the Boston youngster was running drills with nearly 100 other young football-star wannabes.

Jenry was the unintended victim of a shooting that stemmed from an argument on a nearby basketball court. The stray bullet that hit Jenry in the chest also struck fear among all the children who witnessed the violence. And although Jenry's physical injuries have since healed, his emotional wounds will be raw for years to come.

Just as involvement in violence can disrupt the normal development of children and adolescents, exposure to violence can have profound effects on their mental, physical, and emotional health.

"Research reveals that some of the symptoms these children may display include aggressive behavior, reduced social competencies, depression, fears, anxiety, sleep disturbances, and learning problems," said Betsy McAlister Groves, a social worker with experience in this area.

"Underlying many of these problems are the children's emotional responses to the violence, such as intense terror, fear of death, and fear of loss. In addition, children may harbor rage, feelings of guilt, and a sense of responsibility for the violence," said Ms. Groves, director of the Child Witness to Violence Project at Boston Medical Center. (See sidebar at right.)

Millions of American children are second-hand victims of violence. The National Survey of Adolescents in the United States, sponsored by the National Institute of Justice, found that 9 million youth in the survey witnessed serious violence during their lifetimes.

Especially vulnerable are children who witness domestic violence, because they are often the hidden victims of what appears to be a growing problem. Studies estimate that 10%-20% of children are at risk for exposure to domestic violence (Trauma Violence Abuse 2000; 1:321-42). "Data indicate that children who live in households affected by domestic violence may suffer extensively and are vulnerable to developing a host of short- and longterm problems," Ms. Groves said.

The Adverse Child Experiences Study--a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's department of preventive medicine in San Diego--examined the cumulative effects of multiple adverse childhood experiences on physical and mental health.

The study found that multiple or chronic trauma is associated with significantly increased risk of serious health problems in children and adolescents. The findings confirm that childhood trauma is a public health problem requiring immediate and sustained intervention.

When violence happens in schools or in the community, predetermined "disaster" teams can mobilize to triage the emotional injuries. But the not-so-obvious places to look are everywhere else, especially when domestic violence is involved.

Clinicians need to be vigilant for the emotional signs of family abuse among all children. Toward that end, the American Academy of Pediatrics, the American Academy of Family Practice, and the American College of Obstetricians and Gynecologists have recently joined in recommending routine screening of all families for the presence of domestic violence.

As awareness of the emotional toll has grown, so have efforts to intervene before violence happens or after. In recent years, several exemplary prevention/action programs have been developed. Among most successful:

* The Child Witness to Violence Project at Boston Medical Center. Cofounded by Boston University pediatrician/community activist Barry Zuckerman, M.D., this program encourages children to discuss the trauma they've experienced, to identify feelings, and to manage symptoms.

* The Child Development-Community Policing (CDCP) program in New Haven, Conn. The brainchild of Steven Marans, Ph.D., and his colleagues in the Yale Child Study Center, this program is a partnership with the New Haven Police Department. The CDCP clinicians are available 24 hours a day, 7 days a week to respond to police calls involving children.

* The Child Trauma Research Project at the University of California. San Francisco. Directed by Alicia Lieberman, Ph.D., this program is built around a partnership with the San Francisco Unified Family Court.

* The Violence Intervention Program for Children and Families at the Louisiana State University Health Science Center. Joy Osofsky, Ph.D., and her colleagues work with a juvenile court judge, who asks for help from clinicians for help in the disposition of certain cases.

The federal government has begun to address the issue as well. The Substance Abuse and Mental Health Services Administration's Center for Mental Health Services provides funding for the National Child Traumatic Stress Network.

This network seeks to improve the "quality, effectiveness, provision and availability of therapeutic services delivered to all children and adolescents experiencing traumatic events."

RELATED ARTICLE: Boston Project Advocates for Children

As a pediatric resident at Boston City Hospital in the 1970s, Barry Zuckerman, M.D., was haunted by what he saw one day. It was the height of the anti-busing riots against racial integration in the city's public schools, and the emergency room was filled with kids whose school bus had been stoned by angry rioters. The children were physically fine, he said, but the emotional damage was palpable.

In 1992, with that image still burned in his memory, Dr. Zuckerman cofounded the Child Witness to Violence Project (CWVP) with social worker Betsy McAlister Groves to help young children cope with the aftermath of traumatic experiences. As part of its charter, the project identifies, provides counseling to, and advocates for young children who have witnessed severe acts of domestic and community violence.

The project is staffed by a multicultural, multilingual team of social workers, psychologists, early childhood specialists, and a developmental pediatrician who, with the help of local law enforcement and community agencies, attempt to intervene right after the child experiences the trauma. "The goal is to stabilize the child's environment as soon as possible and to counsel the child, the family, and others who encounter the child on a regular basis," Dr. Zuckerman said.

If the trauma is not addressed immediately, symptoms that may emerge in children who witness violence include "a diminished ability to concentrate in school because of intrusive thoughts and images; persistent sleep disturbances; disordered attachment behaviors with significant caretakers; and nihilistic, fatalistic orientation to the future, which leads to increased risk-taking behaviors," he noted.

The CWVP receives hundreds of referrals each year. In addition to face-to-face counseling services, the CWVP provides telephone-based services and referrals.

As part of the project, a child protection team provides 24-hour consultation for Boston Medical Center staff about child-protection issues. The team also oversees all reports of abuse and neglect filed by pediatric providers at the institution and runs a weekly clinic offering child victims medical and psychosocial evaluations.

Much of the CWVP's work is local, but it has also been called upon to respond to national emergencies. For example, the group counseled children after the Oklahoma City bombing and the events of Sept. 11, 2001. The CWVP trains agencies and providers across the country who work with children affected by violence.

The group has developed a curriculum called "Shelter From the Storm," which seeks to train mental health clinicians in treating children who have witnessed domestic violence.

All these efforts help the project achieve its charter goals.

BY DIANA MAHONEY

New England Bureau
COPYRIGHT 2004 International Medical News Group
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Copyright 2004 Gale, Cengage Learning. All rights reserved.

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Title Annotation:PREVENTION IN ACTION
Author:Mahoney, Diana
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Dec 1, 2004
Words:1188
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