A key aim of the Violence Prevention Initiative is to reduce early exposure to violence whenever possible and to utilize appropriate mental health interventions to mitigate the impact of violence when a child is victimized.
Risk factors associated with youth violence include a history of being a bully or victim, exposure to violence, experiencing family conflict, and being diagnosed with an externalizing disorder such as attention deficit hyperactivity disorder (ADHD) or oppositional defiant disorder. Exposure to violence affects a child’s long-term health and well-being, making it an important pediatric issue to address.
Adverse childhood experiences, especially the threat of a violent injury, can have lasting effects on children as they develop and age. Exposure to violence is associated with long-term physiologic and brain changes that impact behavior and long term health. In adolescence, this can manifest as higher risk for school failure, drug abuse, delinquency and an increase in violent behavior.
There are ways to steer youth away from this traumatic cycle through early identification of assets, risks and provision of support as well as providing trauma-informed care training to adults who regularly interact with children from communities that are plagued by violence.
Screening for Risk and Referring Children for Services
Primary care clinicians, child care providers and school-based personnel are in a position to identify families who may need extra support to help children who are at risk due to exposure to violence. In turn, healthcare providers often need support to help at-risk youth and families, such as knowledge of and access to relevant resources. Providers also need training on the words to use and manner in which to use them, known as trama-informed care. Healthcare providers within CHOP's Pediatric Care Network can access these referral services for their patients.
Two programs currently underway address these needs, providing training to healthcare professionals and resources for families and youth exposed to violence:
- Joel Fein, MD, MPH, Co-Director of Violence Prevention Initiative
Promoting Safety and Wellness in Young Children and their Families
Children have the greatest chance at happy healthy childhoods if they have the encouragement of loving, supportive adults who can provide a safe and stable home environment. Communities and healthcare providers can provide training and education to first-time parents to support them in developing positive parenting skills.
Children from birth to age 3 from families with income below the poverty line are eligible for Early Head Start services, a national program that is community-based. Early Head Start is focused on helping to build a strong parent-child bond and promoting school readiness by enhancing the social, emotional, and cognitive development of children. Enrolled children and families can access educational, health, nutritional, social and other services. These programs engage parents in their children's learning and help children make progress toward their educational, literacy and employment goals.
Recognizing Behavior Changes in Children Exposed to Violence
Following exposure to violence (including witnessing community or domestic violence or being a direct victim of violence), children often exhibit behavioral changes. The National Child Traumatic Stress Network summarizes signs to monitor in children exposed to trauma. These signs vary based on the child’s age.
Examples of behaviors to watch for include the following:
- Frequent crying or clinging to caregivers
- Increases in sleep difficulties (i.e., falling asleep, staying asleep, nightmares)
- Changes in eating behaviors
- Failure to meet developmental milestones or regressing to an earlier stage
- Decrease in school performance
- Expressing fear or worries about safety
- Avoiding places out of fear of another traumatic event
- Exhibiting psychosomatic symptoms (i.e., headaches, stomachaches)
- Difficulty paying attention
- Exhibiting aggressive behavior (i.e., hitting, biting, or kicking)
- Feeling depressed and isolated
- Specific to adolescents: increase in risky sexual behavior and likelihood of drug/alcohol use
Why Emotional and Behavioral Problems May Lead to Violent Behavior
While mental and behavioral health issues do not cause youth to become violent, they increase the risk of violence for children, especially those who have diagnoses that include ADHD, oppositional defiant disorder, major depression and others. These children may be more impulsive and have difficulty accurately reading social cues, which are important in interpersonal peer relationships and negotiating social situations. These and other factors place them at greater risk for reacting impulsively and aggressively in challenging social situations.
To reduce the risk for individuals with emotional and behavioral challenges to become violent, VPI at CHOP supports programs and policies that have the following aims:
- To reduce the day-to-day aggression and the many forms it takes (e.g., physical, social, cyber) within schools and communities. Experts feel that this type of toxic school and community stress, combined with the vulnerabilities of youth, can lead youth with emotional and behavioral problems to be more at risk for future violence, delinquency, and even depression and suicidal acts.
- To decrease the isolation these children and youth often feel by actively integrating them into peer activities. Schools promoting an inclusive school climate in which at-risk youth are also supported in learning better problem-solving and conflict resolution skills are more likely to provide a safe and productive atmosphere.
- To close gaps in mental health services for children with emotional and behavioral problems and to provide a broader continuum of mental health care.