1 Trauma-Informed Care Tips for Pregnancy Prevention Programs

Pregnancy prevention programs can be great allies for adolescents who have been exposed to violence and other 

traumatic events. By keeping in mind the principles of youth development, pregnancy prevention program staffs can 

play a pivotal role in preventing and reducing the negative impacts of that exposure. This tip sheet provides a rationale 

for addressing exposure to violence and recommends strategies to make programs trauma informed.

What happens when youth are exposed to violence?

Youth are very resilient, but they are not unbreakable. No matter what their age, youth are deeply hurt when they are 

physically, sexually or emotionally abused or when they see or hear violence in their homes and communities. Each 

child is different, and each situation is different, but exposure to violence can overwhelm a child at any age and lead 

to problems such as hyperactivity, smoking and drug abuse. We know now that exposure to violence—especially when 

it is ongoing and intense—can harm the natural and healthy development of youth, unless they receive support to 

help them cope and heal.

Not all youth who have experienced violence become teen parents or are involved in abusive relationships in 

adolescence. However, early exposure to violence is associated with an increased risk of being victimized or 

perpetrating violence as an adult. Youth who have been exposed to violence are more likely to be diagnosed with 

eating disorders, psychiatric problems and headaches and have psychosomatic complaints. The emotional, behavioral 

and social impacts associated with this exposure to violence remain poorly understood and are often not recognized 

in most settings serving adolescents.

Why should pregnancy prevention programs build their capacity to address children’s 

exposure to violence and other traumatic events?

Direct and indirect exposure to child abuse and neglect, domestic violence and violence in schools and the 

community are part of a constellation of risk factors linked to poor outcomes in youth.1 Youth exposed to violence are 

more likely to become teen parents. Also, youth who experience physical or sexual abuse are more likely to have a 

rapid repeat pregnancy.2 It is well documented that exposure to violence increases the likelihood of later victimization, 

Teenagers (13–18 years) 

Depending on their circumstances, teenagers (ages 13 to 18) may indicate 

exposure to violence by: 

■ Being hypervigilant (constantly tense and “on guard”)

■ Exhibiting hopelessness

■ Having frequent nightmares and/or sleeplessness

■ Using drugs and alcohol

■ Engaging in violent or other risk-taking behaviors—including getting in 

trouble with the law

■ Feeling intense fear

■ Expressing suicidal thoughts

■ Constantly recounting a traumatic event or denying that it 

happened.

1 Finkelhor, D., Turner, H., Ormrod, R., Hamby, S., & Kracke, K. (2009) Children’s Exposure to Violence: A Comprehensive National Survey. 

Washington, DC: Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice. Retrieved January 30, 2012, from http://

www.safestartcenter.org/about/publications.php

2 Futures Without Violence. (2010, February). The Facts on Adolescent Pregnancy, Reproductive Risk and Exposure to Dating and Family 

Violence. Boston, MA: Author. Retrieved January 30, 2012, from http://www.futureswithoutviolence.org/userfiles/file/HealthCare/Adolescent%20

Pregnancy%20Reproductive%20Risk%20FINAL%202-10.pdf

Trauma-Informed Care for Children Exposed to Violence

Tips for Pregnancy Prevention Programs 
Safe Start: Working Together to Help Children Exposed to Violence

2 Trauma-Informed Care Tips for Pregnancy Prevention Programs

mental health problems and delinquent behaviors. 

Therefore, failure to address lifetime exposure to violence 

compromises the quality and effectiveness of pregnancy 

prevention programs and their outcomes. Addressing 

the consequences of exposure to violence can prevent 

the intergenerational transmission of family violence, 

decrease the risk of experiencing multiple forms of 

victimization and associated risk behaviors and ultimately 

improve outcomes. 

What are some of the 

warning signs of exposure to violence among 

youth?

To prevent first or repeated 

pregnancies, programs 

must screen, recognize, 

and address a history of 

exposure to violence. It is 

important to remember that 

teens are often rebellious or 

may be loud because they 

are finding their voices and 

determining their identities. 

They may react disrespectfully 

when they sense that 

adults do not value them 

as individuals who are 

capable of thinking for 

themselves. Warning signs 

of exposure to violence 

can be distinguished 

from “typical” behaviors 

partly by the associated 

functional impairments 

and partly by greater 

severity, persistence 

and pervasiveness 

of the behaviors. 

For example, the 

signs usually are not onetime occurrences; they persist 

over several weeks and affect a youth’s functioning in 

school or at home. Obstacles to identifying problems 

in youth include staff concerns about labeling them 

inappropriately with a psychiatric diagnosis. For this 

reason, it becomes necessary to recognize when some 

behaviors are cause for concern and the program might 

need to consult with a specialized professional. 

Reactions to a traumatic event or to a lifetime of 

exposure to violence can either be immediate or appear 

much later. They differ in severity and include a range of 

behaviors. People from different cultures may have their 

own ways of reacting. How a young person responds 

depends on risk factors (e.g., drug use, family conflict, 

poverty or child neglect) and on protective factors (e.g., 

stable family relationship, participation in prevention 

programs) in the child’s life.

What can pregnancy prevention programs do?

Most youth who are exposed to violence and other 

traumatic events are not identified as such by the 

systems that serve them. The links between exposure 

to violence and behavior are often hidden or unclear. 

Therefore, few youth receive services for the violent event 

they may have witnessed or experienced. 

If a professional has any concerns about a youth’s 

exposure to violence, the first step is to ask the 

adolescent how she is doing and to be compassionate 

when listening and responding. After discussing 

the experience with the youth, and depending on 

confidentiality policies, information can be shared or 

confirmed with parents or guardians and other adults in 

the youth’s life. To maximize the adolescent’s chance 

of success in the program, the program can address 

the adolescent’s concerns broadly, taking into account 

the possible relationship among traumatic stressors, 

behaviors and pregnancy. When developing a treatment 

plan, special attention should be given to the signs and 

symptoms of post-traumatic stress that might have been 

caused by the violence, pregnancy and the relationship 

between the two. In addition, the program might want 

to refer some youth and their families to local programs 

that work with those who have witnessed or experienced 

violence. 

Seven strategies can be put in place in a pregnancy 

prevention program to help prevent, reduce and address 

the impact of exposure to violence. 

1. Build program capacity to become a 

trauma-informed organization. 

Trauma-informed care is not a standalone intervention. 

The following principles of trauma-informed care can be 

applied across the entire program:

■ Understand the impact of trauma on children and 

their families.

■ Give adolescents the opportunity to talk about what 

happened to them rather than immediately punish 

them for their behavior. 

■ Revisit policies and procedures, such as those that 

address program emergencies, crisis situations, 

reporting child abuse and neglect, community 

partnerships, resources and referrals, to be sure 

that they address issues related to trauma.
Safe Start: Working Together to Help Children Exposed to Violence

3 Trauma-Informed Care Tips for Pregnancy Prevention Programs

■ Have intake, screening, observation and interview 

practices that incorporate strategies relevant to 

trauma and trauma history and that recognize 

trauma signs and symptoms.

■ Refer adolescents who report a history of exposure 

to violence during the initial screening for a 

specialized trauma assessment. Assessments can 

be repeated periodically and used in treatment 

planning.

■ Have guidelines for services that include addressing 

the individual needs of youth affected by trauma, 

providing reminders about avoiding unintentionally 

“re-traumatizing” adolescents in their care and 

supporting these teens in the program.

2. Design and implement strategies to keep adolescents engaged in the program.

Teens often have complex histories and numerous 

problems that make this population particularly difficult to 

treat. Empirically based treatment interventions may offer 

a good chance of success; however, many youth fail to 

obtain treatment, and those who enter treatment often 

end it prematurely. Most adolescents do not believe they 

need help, are unaware of the range of services that are 

available, may be concerned about stigma or are hesitant 

to seek out an adult for assistance. 

The following strategies can increase program attendance 

and engagement: 

■ Make several attempts to get and stay in touch with 

participants and their families. For example, call the 

home the day before an appointment and speak 

with the youth and parent.

■ Establish trust by providing participants with a 

service or resource they need immediately and avoid 

making commitments that cannot be honored.

■ Allow the youth to tell her story, reassure her and 

validate her feelings. 

■ Convey an understanding of the youth’s language 

and culture.

■ Avoid blaming. Reframe current situation in terms of 

relational factors rather than personal failure.

3. Respond appropriately to youth disclosures.

The most meaningful assistance staff can offer youth 

with a history of exposure to violence is to listen with 

compassion and use the power of their relationship to 

correct unhealthful and wrong views that have resulted 

from the violent event. Experts agree that a relationship 

with a caring adult is critical for beginning the healing 

process. Youth must have an opportunity to talk about 

what they have witnessed and how they feel in an 

emotionally safe space, with caring parents or adults 

who can listen and understand. Staff willingness to listen 

to a child’s story can provide the foundation on which to 

increase resilience and personal strength.

4. Set policies and inform adolescents of the 

program’s legal requirements. 

Programs often struggle with how to comply with 

legal requirements without violating the trust of their 

adolescent clients. Programs also have to grapple with 

balancing respect for adolescents’ growing autonomy 

from their families and respecting the important role of 

parents (and other caregivers) in their children’s life. 

The legal definitions of mandatory reporting of abuse 

and neglect, as well as the circumstances under 

which an adult must report 

(e.g., known abuse, suspected 

abuse, reasonable grounds 

to suspect), vary from state 

to state. Mandatory reporting 

requirements apply for youth 

who are vulnerable to abuse. 

Nevertheless, staff members 

may be concerned that 

reporting abuse may prevent 

that teen from ever trusting or 

opening up to another adult.

Staff can take steps to minimize 

the loss of trust in situations 

that require reporting abuse 

to authorities. Program staff 

should clearly state from the 

beginning the circumstances 

under which they must report, 

the purpose of mandatory 

reporting laws and the events 

that typically follow a report to 

authorities. These efforts will 

help ensure that youth are not 

surprised if or when there is 

a need to report.

5. Train and support 

staff members to cope with 

their challenging work. 

For staff working with youth who have been exposed to 

violence and their families, the essential act of listening 

to stories of victimization can take an emotional toll that 

compromises professional functioning and diminishes 

quality of life. Awareness of the impact of this indirect 

exposure—referred to as secondary traumatic stress, 

burnout or compassion fatigue—is a basic part of 
Safe Start: Working Together to Help Children Exposed to Violence

4 Trauma-Informed Care Tips for Pregnancy Prevention Programs

For more information and resources, please contact the Safe Start Center, 

a National Resource Center for Children’s Exposure to Violence:

http://www.safestartcenter.org

1-800-865-0965

info@safestartcenter.org

Mandated Reporting

Many children experiencing crises or violence are also at risk for child abuse and neglect. All 

States have child welfare systems that receive and respond to reports of child abuse and neglect, 

offer services to families, provide foster homes for children who must be removed from their 

parents’ care, and work to find permanent placements for children who cannot safely return 

home.

Domestic violence does not equal child abuse and neglect, and therefore not all cases of 

domestic violence must be reported to child protective services. When responding to families 

affected by domestic violence, it is very important to consider simultaneously the safety of the 

child and the safety of the adult victim.

State by State information on reporting requirements can be found at http://www.childwelfare.gov/

systemwide/laws_policies/state

protecting the well-being of staff members 

and ensuring that youth consistently 

receive the best possible care from those 

who are committed to helping them. 

Supervisors and managers can use a variety 

of assessment strategies to help staff members 

identify and address secondary traumatic 

stress affecting them.

6. Build collaborative relationships 

with community agencies that are 

trauma informed and/or provide 

trauma-related services.

Young people grow up in communities, 

not programs. Pregnancy prevention 

programs can build strong collaborative 

relationships with community resources that 

are trauma informed and/or provide traumarelated services. Collaboration with schools, 

youth-serving organizations, faith-based 

institutions, businesses and government 

agencies, for example, is essential 

to expanding trauma-informed 

services, expertise and resources. 

The more systems involved in creating positive changes, 

the more likely the changes will “stick.”

7. Facilitate access to evidence-based treatment 

programs for children exposed to violence. 

Besides participating in program services and supports, 

adolescents who have been exposed to violence require 

access to specialized interventions. Evidence-Based 

Practices for Children Exposed to Violence: A Selection 

from Federal Databases (http://www.safestartcenter.

org/pdf/Evidence-Based-Practices-Matrix_2011.

pdf) provides a list of evidence-based programs and 

strategies. In addition, several websites describe 

interventions that have been tested with adolescents 

and with groups that share many of the risks of 

adolescents in pregnancy prevention programs: 

Crime Solutions (http://www.crimesolutions.gov), 

National Child Traumatic Stress Network (http://

www. nctsn.org) and Promising Practices Network 

on Children Families and Communities (http://

www.promisingpractices.net).