1. Exposure to Violence in Early Childhood: Risk, Resilience and Opportunities for Intervention September 13, 2012 Betsy McAlister Groves, LICSW Child Witness to Violence Project Boston Medical Center Harvard University Graduate School of Education

2. Key Points 1.There is no age at which a child is immune to the effects of trauma or violence exposure. Young children are generally more aware than we think 2.Not all children are equally affected by exposure to violence 3.The child’s reaction to the trauma is closely related to the capacity of the caregiving environment to respond sensitively and protectively. Helping the parents may be the best way to help the child

3. Child Witness to Violence Project Boston Medical Center Provides counseling services to children age 8 & younger (and their families) who have witnessed significant violence Provides training/consultation to pediatric providers (and others) who work with children affected by violence. www.childwitnesstoviolence.org

4. Child Witness to Violence Project: The heart of our program 4

5. Trauma & very young children The majority of children who are exposed to domestic violence are under the age of eight (Fantuzzo et. al. 1999; Atkins, & Marcus, 1997)The majority of children who are exposed to domestic violence are under the age of eight (Fantuzzo et. al. 1999; Atkins, & Marcus, 1997) In one study of children aged 2–5, more than half (52.5%) had experienced a severe stressor in their lifetime (Egger & Angold, 2004)In one study of children aged 2–5, more than half (52.5%) had experienced a severe stressor in their lifetime (Egger & Angold, 2004) In a population of children age 2-18 referred for trauma-focused mental health services (n=1700), the average # of traumas was 3, and the average onset of first trauma was age 5.In a population of children age 2-18 referred for trauma-focused mental health services (n=1700), the average # of traumas was 3, and the average onset of first trauma was age 5. (Blaustein, Harrison, Van der Kolk, 2003)

6. Domestic Violence as a Traumatic Stressor for Young Children Infants as young as 3 months of age may show traumatic stress responses following direct exposure to trauma. ( Lieberman, 2004) In children under age four, witnessing domestic violence is stronger predictor of PTSD symptoms than direct abuse. Scheerenga & Zeanah, 1995) PTSD in Pre-school Children –Proposed addition to the DSM V Scheeringa, Zeanah, & Cohen, 2011

7. National Child Traumatic Stress Network: Most Commonly Reported Traumas Percentage of Children & Adolescents CDS September 2010

8. Why Now? ACE Studies The Adverse Childhood Events (ACEs) study demonstrates the impact exposure to violence can have –Increased risk for physical health issues: obesity, heart disease –Increased risk for addiction –Increased risk for mental health issues The impact of violence in childhood is manifest throughout the entire life course. Intervention is most effective when issues are identified and treated in early childhood Felliti V, Anda R, Nordenberg D, et al. Am J Prev Med 1998

9. Why now? Exposure to Violence can Affect Brain Development Early exposure to life stress associated with persistent changes in stress response systemsEarly exposure to life stress associated with persistent changes in stress response systems Nemeroff, 2004; Dozier, 2006; Nemeroff, 2004; Dozier, 2006; Hart, Gunnar & Cicchetti, 1995 Traumatic experiences change the architecture of the brain Shonkoff, 2005; Teicher, 2000; Perry, 1997Traumatic experiences change the architecture of the brain Shonkoff, 2005; Teicher, 2000; Perry, 1997

10. Most frequently reported symptoms found in CWVP referrals: Temper Tantrums/Angry Outbursts60% Aggressive with Peers60% Aggressive with Adults 56% Demanding/Controlling 50% Play re-enactment41% Nightmares/sleep disruptions 40%

11. Clinical themes 1. There is no safe place. 2. Adults can not protect themselves or their children. 3. The child takes on the responsibility of protecting the victim. 4. The child has ambivalent feelings toward the abusive parent. 5. Chronic fear leads to aggression.

12. Not all children are equally affected by violence: Resilience & protective factors

13. Resilience & coping with community & domestic violence: The developmental context

14. Resilience “ The dynamic process of transactions within and among multiple levels of children’s environment over time that influences their capacity to successfully adapt and function despite experiencing chronic stress and adversity”

15. What variables affect a child’s/adolescents’ response to violence? Characteristics of the child/adolescent Age Gender Temperament/personality Characteristics of the Family & Community Quality of parenting Characteristics of the community—cohesion, collective resources Access to outside supports Characteristics of the Violence/trauma Frequency Severity Proximity

16. Resilience in a community-based sample of children exposed to domestic violence N==219 children, ages 6-12 Assessed –Numbers of violent incidents witnessed –Child functioning –Quality of parenting –Family characteristics –Maternal trauma and depression Graham-Bermann, 2005

17. How are these children doing?

18. What factors/variables affected their resilience? Resilient children witnessed less violence The mothers of resilient children did not have a prior partner who was violent Mothers had increased ability to parent effectively and appropriately under stress Families more responsive and cohesive Mothers had lower rates of trauma and depression

19. Community Violence & Child Resilience/Protective Factors Parental support, family coping styles Parents who model effective coping; convey a sense of security and confidence to their children Family cohesion, effective parenting Adult mentoring Positive community organizations

20. Promoting policies /programs to identify and intervene with children who are affected by domestic violence

21. A Continuum of Programs to Help Children Heal Prevention Healthy relationship programs for adolescents Home visiting supports for parents of newborns Training for police, teachers, judges, attorneys, health professionals Screening for exposure to violence in pediatric health settings Parenting programs Intervention High quality childcare and early childhood education Trauma-focused counseling for children and families Batterer intervention programs

22. Important messages for children This must be scary for you. Who can you talk to about this? It’s not your fault. It is not your responsibility to solve the problem. We will do everything we can to keep you safe.

23. Important Messages to Parents You matter the most in your child’s life Your health and well-being are important to your child There is help for you and your family

24. Contact Information & Helpful Websites Betsy McAlister Groves, LICSW Child Witness to Violence Project Boston Medical Center, Vose 4 Boston MA 02118 Tel: 617-414-4247 E-mail: betsy.groves@bmc.org National Child Traumatic Stress Network: NCTSN.org Zero To Three: zerotothree.org Center for the Developing Child: http://www.developingchild.net Child Witness to Violence Project: childwitnesstoviolence.org US-DOJ—Safe Start Center: http://www.safestartcenter.org