New data shows U.S. children still being exposed to serious violence and trauma

Two surveys released this week provide new data showing that children in the U.S. are still being exposed to serious levels of violence and childhood trauma.

The National Survey of Children’s Health (NHCS), closely aligned with the Center for Disease Control’s Adverse Childhood Experiences (ACE) Study, interviewed almost 100,000 people across the U.S. Surveyors asked participants about nine kinds of adverse experiences including physical abuse and witnessing domestic violence (read more about the scoring here). Almost half of the children were reported to have experienced at least one out of the nine adverse experiences. The survey also found that youth ages 12 -17 had experienced at least two or more types of childhood trauma that may impact their mental and physical health in adulthood.

An update on the National Survey on Children’s Exposure to Violence (NatSCEV) mirrored this information. Released Monday, the survey that interviewed more than 4,500 children, conducted by Finkelhor et al 2013[1] found that although the rate of violence against children has decreased since the first survey conducted in 2008, children are still regularly exposed to multiple types of violence and abuse.

Data on the rate of victimization remains unchanged 3 in 5 children are being physically assaulted every year and 10.1% are injured because of assault.  Additionally, more than 13% of the children were harmed by a parent or caregiver in the last year and sometimes that maltreatment included physical abuse. Additionally, 22% witnessed community and family violence. There were some declines in rates of exposure to things such as sibling assault and school bomb threats.

In light of this new data it is vital we remember that although children are often resilient in the face of violence and traumatic events, more must be done to respond to building that resilience. This means using studies like the NHCS and NatSCEV to nurture resilience through the provision of health-based evidence-based interventions and public awareness about the impact of trauma and exposure to violence.

Additionally, these studies highlight the need for continued efforts in collecting more detailed data, the creation of enhanced comprehensive tools to collect that data, and the need to correctly identify these experiences and their related effects.

[1] David Finkelhor, PhD; Heather A. Turner, PhD; Anne Shattuck, MA; Sherry L. Hamby, PhD JAMA Pediatr. 2013;():1-8. doi:10.1001/jamapediatrics.2013.42.


The importance of good emotional and mental health for children and youth

Many people are aware of the importance of teaching their children about safety. These conversations typically center on teaching kids how to protect their physical safety and prevent accidents.

What is less well-understood is the importance of also teaching children and young adults about the importance of good emotional and mental health. These conversations are so important because understanding how to prevent or protect against the potential negative effects of experiencing violence and trauma can go a long way in preventing the early onset or severity of mental heath issues and disorders early in life.

According to the National Institute of Mental Health (NIMH) 50 percent of mental illnesses are developed before age 14, and about 80 percent of people with both mental health and substance abuse disorders reported the onset occurring before the age of 20. Data from 2008 also shows that the prevalence of serious mental illnesses is highest among youth 18-25.

Another dangerous problem that may inhibit discussions with youth about mental health is a misunderstanding about what good mental health and awareness actually means. Data from a U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) report states that over 45 million people suffer from different mental illnesses in the U.S. and less than 40 percent receive help or treatment. It also shows that there is a cultural stigma associated with discussing mental health and a significant percentage of Americans that may have needed treatment have not received any. There is the assumption that they will suffer negative social consequences for discussing their issues.

Disorders and problems linked to mental health and substance abuse are shown as a serious public health issue affecting youth and adults across the United States. The emotional and monetary costs and burden of treating mental health problems are high for the individual, family and community. Data from the Agency for Healthcare Research and Quality’ (AHRQ) spanning a ten year period from 1996-2006 shows this significant rise in Americans paying for and using mental health services. The total expenditure on services also rose 63.4% over this period.











These rising costs have placed a greater focus on methods and practices promoting prevention across different settings. Interventions and best practices to help younger populations combat this threat have emerged in environments like schools and the child welfare system to address the broader needs of the diverse populations that they serve.

The Children’s Trust Partnership summarizes the need for action in promoting the emotional well-being of youth in the following ideas:

  1. The good emotional health of children and young people is vital to them as individuals
  2. The good emotional health of children and young people is vital to society
  3. We know what works in improving emotional health
  4. Developing these approaches and interventions should save money later
  5. Developing these approaches should help meet other priorities in communities
  6. This is not a new policy area

Read more about this case for action here.

The Safe Start Center also supports the promotion of interventions to improve positive behavioral and emotional health in children and young adults.

Understanding Children’s Exposure to Violence Brief #1 shares some ideas about program types and interventions that can both enhance resilience and reduce risks for children and young adults exposed to violence and traumatic events.

  • For all children, participation in high-quality early care and education programs can enhance physical, cognitive, and social development and promote readiness and capacity to succeed in school.
  • For at-risk families, early identification of and intervention with high-risk children by early education programs and schools, pediatric care and mental health programs, child welfare systems, and court and law enforcement agencies can prevent threats to healthy development by detecting and addressing emerging problems.
  • For children and families already exposed to violence, intensive intervention programs delivered in the home and in the community can improve outcomes for children well into the adult years and can generate benefits to society that far exceed program costs.
  • Outcomes improve when highly skilled practitioners provide intensive trauma-focused psychotherapeutic interventions to stop the negative chain reaction following exposure to traumatic stressors (e.g., child abuse and neglect, homelessness, severe maternal depression, domestic violence).

For further information check out the full issue brief here. Please continue to join us this week and month as we continue to promote awareness about the importance of good mental and emotional health!

Promoting children’s mental health awareness: An Interview with Gregory Zimmerman

The Safe Start Center is participating in several Mental Health Awareness Week 2013 activities and today we’ve done a short question and answer with an expert in the areas of mental health and children’s exposure to violence (CEV) to promote the mental, emotional and behavioral health of children and youth.

Gregory M. Zimmerman, Ph.D. is a member of the faculty at Northeastern University’s School of Criminology and Criminal Justice. His research and teaching interests include an examination of the interrelationships among individual-level factors of crime, social context, and criminal offending. His other research involves juvenile justice, social sciences and sociological theory. He is also the co-author of a recent study published in the American Journal of Public Health, ‘Individual, family background, and contextual explanations of racial and ethnic disparities in youths’exposure to violence.’ You can read more about it here.

1. Why do you feel children’s exposure to violence and mental health issues are such important issues and how did you get involved with your work?

Exposure to violence is an all too common occurrence among children and adolescents that leads to an array of adverse mental health and behavioral consequences. My involvement with exposure to violence as an outcome began with the study of exposure to violence as a predictor of criminal behavior. After recognizing the link between violence exposure and violent offending, I moved to the study of exposure to violence as an outcome.

2. What do you think are some of the most valuable things you have learned through your work?

Exposure to violence is an amalgamation of experiencing and witnessing violence in the family, school, and community context. It is important to disaggregate exposure to violence in order to understand the different mechanisms leading to the different kids of violence exposure.

3. What do you think would have the most impact on improving the overall mental health of children at risk for exposure to violence?

Only by closing the gap between youths’ experiences with violence and parents’ perceptions of their children’s experiences can parents adequately aid in their children’s coping strategies.

4. How would you like to see research and policies shaped to address mental health awareness and exposure to violence?

I think that policies need to better address the link between what parents know and what children experience. I believe that one aspect of Safe Start is to work with schools to notify parents of incidents with violence at school. In addition, getting the school and the community to aid in addressing this problem by educating parents about how to best help their children cope with violence is key.

Impact of Exposure to Violence on Development

Other than the role of “every person, every day,” this CEV Week we’re focusing on the impact of exposure to violence on children’s mental, physical and emotional development. To that end, we developed a new resource providing ways to prevent and address the impact of exposure to violence on a child’s development—from early childhood through adolescence.

Devel chartThe Impact of Exposure to Violence on Stages of Development chart provides an overview of the developmental process and ways to help children successfully achieve developmental milestones even in situations where violence and toxic stress intrude in the child’s life.

A developmental approach is based on the concept that as children grow and mature they are faced with emotional and physical tasks they must master before moving along to the next stage. The tasks build upon one another: a toddler learns to explore his world, which provides the foundation for school-aged children to make friends; this ability, in turn, allows an adolescent tries to form a separate identity and become more independent from his family.

When exposed to violence or other traumatic events, a child’s energy is diverted and they have less capacity to master the developmental challenges on which they are currently focused at their stage of development. We know that many children rebound from traumatic experiences and continue to achieve expected developmental milestones.

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Safe Start in the Community: Honolulu, Hawaii

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Throughout the month we will feature the 10 Safe Start Promising Approaches grantees and the work they’re doing in their communities to help children exposed to violence and their families.

Kaipo, a 12-year-old boy, is in seventh-grade regular and special education classes at Hawaii Middle School. Kaipo and his younger brother Jordan enrolled in Haupoa Enhanced Safe Start (Haupoa) services with their mother, Luanne. During the comprehensive intake assessment interview, Luanne tearfully reports that she feels tremendous guilt, shame, and inadequacy as a mother because, during the 3 years she was married to the boys’ father, her children witnessed physical and other forms of violence toward her, as well as ongoing verbal and emotional abuse. For example, their father told the boys that their mother was a whore. Luanne expresses that Kaipo is “scared” and more cautious because of his long exposure to the intimate partner violence. Although Luanne enrolls both children for Haupoa treatment services, she identifies Kaipo as the focus of her individual work in the program.

Luanne and her sons faithfully attend the seven initial group sessions of Haupoa. Luanne learns about positive parenting, and Kaipo demonstrates problem-solving skills. At the conclusion of the Haupoa group cycle, Luanne requests to continue with individual services.

With the Haupoa counselor advocate and Kaipo, she collaboratively develops several individualized goals for treatment including decreasing conflicts between herself and Kaipo, decreasing conflicts between Kaipo and Jordan, and decreasing Kaipo’s concerns about becoming a “cool kid” at school. The Haupoa counselor meets with the family regularly and tracks these behaviors using Modular Cognitive Behavior Therapy tools. Over the course of eight sessions, they discuss parent management training and with Kaipo discuss problem solving and goal setting. Conflicts between Luanne and Kaipo decrease from 1+ times per week to less than once per week, conflicts between Kaipo and Jordan decrease from every day to only once per week, and Kaipo begins to use his problem-solving skills more frequently to address “drama” at school.

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Safe Start in the Community: El Paso, Texas

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Throughout the month we will feature the 10 Safe Start Promising Approaches grantees and the work they’re doing in their communities to help children exposed to violence and their families.

At age 13, Jessica has experienced community violence most of her life. With Sandra, her mother, she lived at her grandmother’s in a very dangerous neighborhood of Ciudad Juarez, Mexico, a border town adjacent to El Paso, Texas. One morning, Jessica awoke to gunshots and found out her neighbor had been killed. Soon after, Jessica’s brother was kidnapped and released only after Sandra paid a ransom.

This extreme exposure to trauma and violence prompts Sandra to move to El Paso, Texas, where she enrolls Jessica in school. Although Sandra feels safer, Jessica exhibits anxiety, irritability, fear, loneliness, and loss of trust. Because of the dramatic change of behavior, Sandra looks for help for Jessica. St. Peter and Paul Catholic Church refers Sandra to Aliviane, Inc., Behavioral Health Clinic where a case manager from the Safe Start program assesses Sandra and Jessica and refers them for services under the Safe Start program.

Safe Start case managers conduct weekly groups using the “Dando Fuerza a la Familia” curriculum. The curriculum covers communication styles of Mexican and Mexican-American families living in the border regions of the United States and focuses on the types of violence families experience within the family system and in the community, as well as the conflict between drug cartels in Mexican border states. Sandra participates in the parent training program while Jessica attends the children’s social skills training program. After an hour each week in their separate programs, Sandra and Jessica come together for the family training session and practice the new skills they learned.

Sandra and Jessica are comfortable in the program because the case managers use Mexican colloquial Spanish and they seem to understand Sandra and Jessica’s background and culture. After the 14 weeks of group sessions, the Safe Start program continues to provide case management services to the family for 1 year from the time of enrollment. Jessica now smiles, participates more in school, has friends, and feels a sense of belonging.

Aliviane, Inc.

Behavioral Health Clinic
7722 North Loop, Suite 5
El Paso, TX 79915


Adapts interventions by providing special sensitivity to the strengths and stresses facing Mexican American families. Helps families decrease behavior problems in their high-risk children by strengthening family functioning and relationships, and building better communication. Works with children to improve protective factors and with parents to improve their child-rearing and relationship skills.  Allows families to practice skills and strengthen relationships.

Target Population:

Children and their parents with demonstrated exposure to trauma

Age Range:



  • Strengthening Families Program with a cultural adaptation called “Dando Fuerza a la Familia”*
  • Case Management

*Evidence-based or promising practice

Women Making an Impact on CEV: Sherry Hamby

This month the Safe Start Center is honoring National Women’s History Month by profiling women who have made an impact on the issue of children’s exposure to violence.

hamby2012Dr. Sherry Hamby is currently Research Professor in the Department of Psychology at Sewanee, the University of the South and part of the team who developed and conducted the National Survey of Children’s Exposure to Violence (NatSCEV). A licensed clinical psychologist, Hamby is founding editor of the Psychology of Violence journal, published by the American Psychological Association, and has written a variety of publications on family violence and youth victimization.  With Mary Beth Skupien, she also conducted the first reservation-based study of intimate partner violence among American Indians.

Why do you feel children’s exposure to violence is an important issue and how did you get involved?

Starting with children is our best chance to break the cycle of violence and reduce the psychological, physical, and financial burdens of violence.  Like virtually everyone, I have seen the price that loved ones pay when they are exposed to violence. My own work in the anti-violence movement started with domestic violence, which is also a key part of the solution to reducing the societal burden of violence.  David Finkelhor knew I liked questionnaire development and he asked me to help develop a measure that could assess the full spectrum of violence.  That turned into the Juvenile Victimization Questionnaire (JVQ).  More personally, having children of my own has changed the way I view the problem of violence.  Becoming a mother has been a big part of my developing a focus that is more child-centered and family-centered and less oriented around institutional categories.

What have you learned through your work on NatSCEV?

I learned that the interconnections among all forms of violence are stronger than I ever even imagined.  Who knew that victims of sexual assault are also at higher risk for property crime?  Early work tended to look for connections across seemingly similar types of violence, such as domestic violence against an intimate partner and physical abuse against a child.  It turns out this “matchy-matchy” approach is wrong.  Other forms of child maltreatment, such as neglect, are more closely tied to domestic violence, for example.  Most of the underlying vulnerabilities that lead to poly-victimization (multiple victimizations) are not specific to any one type of violence.

What would you like to see develop in research, policy and/or communities regarding children’s exposure to violence?

I would like to see a more developmental approach.  In many ways, the needs of a 6-year old who has been maltreated are more like the needs of a 6-year old who has been bullied than they are like a 16-year old who has been maltreated.  Services would be better organized around the main developmental stages of childhood, not by specific types of violence.  Zero-to-Three is one such model.  Why stop at 3?


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