Trauma Informed Care for Children Exposed to Violence

Tips for Agencies Working With Immigrant Families

Why focus on immigrant families?

Children born to immigrant parents are a large and 

rapidly growing segment of the Nation’s population 

of children. Most of these children (93 percent) are 

American citizens. Children of immigrants are more likely 

than children of U.S.-born citizens to face economic 

hardships and significant barriers to healthy social and 

emotional development. These barriers include exposure 

to violence and can affect children’s readiness to 

succeed in school and beyond. 

Immigration is a process that includes the initial decision 

to migrate, the process of migration, and acclamation 

to the new environment. This process impacts several 

generations. Despite their need for services, immigrant 

families face unique challenges that affect their ability 

and willingness to seek assistance—especially mental 

health services. If they are undocumented, they may 

not qualify for certain services. In addition, they may be 

unable to access services because of language barriers 

and poverty. Many immigrants live in rural, impoverished 

areas where public transportation is unavailable. 

Instability in the lives of immigrant families may also 

prevent them from seeking or following through with 

services. 

Furthermore, many State and local agencies are 

voicing concerns related to the impact of Immigration 

and Customs Enforcement (ICE) raids on children and 

families. ICE raids in workplaces, neighborhoods, or 

homes are a method of enforcing U.S. immigration laws. 

Those who are suspected of being undocumented are 

arrested, and deportation proceedings are initiated. 

ICE raids have resulted in the involuntary separation of 

children from parents/caregivers, placing children and 

adolescents at risk for long-term family separation, 

psychological and economic distress, poor health, and 

developmental delays. The development of infants, 

toddlers, and preschoolers can be negatively impacted 

while parents/caregivers are in detention and cannot 

attend to their children’s biological needs (for example, 

breastfeeding). For many families, this situation 

represents yet another traumatic event in their lives.

A greater understanding of the impact of lifetime 

exposure to violence, as well as the current stressors 

that immigrant families may experience, plays a crucial 

role in improving outcomes for children in all systems.

What happens when children are exposed 

to violence?

Children are very resilient—but they are not unbreakable. 

No matter what their age, children are deeply hurt when 

they are physically, sexually, or emotionally abused or 

when they see or hear violence in their homes and 

communities. When children see and hear too much 

that is frightening, their world feels unsafe and insecure. 

Each child and situation is different, but exposure to 

violence can overwhelm children at any age and can 

lead to problems in their daily lives. Some children may 

have an emotional or physical reaction. Others may 

find it harder to recover from a frightening experience. 

Exposure to violence—especially when it is ongoing 

and intense—can harm children’s natural, healthful 

development unless they receive support to help them 

cope and heal.

Violent or traumatic events can cause ongoing and 

overwhelming feelings of hopelessness and fear. Those 

feelings are compounded by other stressors that are 

unique to immigrants and refugees. For example, the 

loss of familiar surroundings, family networks, and 

support systems; the struggle to understand a new 

language; and the inevitable stressors of acculturation 

can increase feelings of hopelessness and fear. Even 

daily routines that often help families cope with stress 

cannot be replicated in the new country. 

Early and effective interventions that are culturally 

competent and family centered can help immigrant and 

refugee children begin a healing process and ultimately 

thrive. Service providers can be more responsive to 

the needs of these families once they understand 

the impact of exposure to violence and become more 

knowledgeable about the symptoms to watch for. An 

effective response gives children the opportunity to 

regain a sense of safety and ultimately recover from the 

effects of exposure to violence.
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What are some of the warning signs of exposure to violence?

Children’s reaction to exposure to violence can be immediate or appear much later. Many studies have documented 

mental health symptoms in immigrant and refugee children that are linked to exposure to violence before migration. 

Reactions differ in severity and cover a range of behaviors depending on the frequency, intensity, and closeness of 

the traumatic events. People from different cultures may have their own ways of showing their reactions. How a child 

responds also varies according to the child’s age.

Young Children (5 and younger) 

Young children bear a disproportionate share of violence and abuse in the home. 

Exposure to domestic violence (abuse between adult partners in the home) 

affects many young children. When very young children are exposed to 

violence, their expectations for a predictable world are shattered and they 

may lose the basic trust that a caregiver will emotionally and physically 

protect them. 

Children in this age range may respond in a variety of ways. They may: 

■ Be irritable or fussy or have difficulty calming down

■ Become easily startled

■ Resort to behaviors common to being younger (for example, 

thumb sucking, bed wetting, or fear of the dark)

■ Have frequent tantrums

■ Cling to caregivers

■ Experience changes in level of activity

■ Repeat events over and over in play or conversation

■ Become passive and lose interest in playing

■ Become over-compliant

Elementary School-Age Children (6–12 years)

Elementary and middle school children exposed to violence may show problems 

at school and at home. They may:

■ Have difficulty paying attention 

■ Become quiet, upset, and withdrawn

■ Be tearful and sad and talk about scary feelings and ideas

■ Fight with peers or adults

■ Show changes in school performance

■ Want to be left alone

■ Eat more or less than usual

■ Get into trouble at home or school
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What can staff in agencies serving immigrants do?

Service providers including teachers, early care and 

education providers, child welfare staff, and public 

health workers can play a critical role in preventing and 

reducing the impact of exposure to violence on immigrant 

children and their families. The first step is to recognize 

that a lifetime of exposure to violence is pervasive in 

immigrant families. Rates of exposure to different types 

of violence—including family, school, and community 

violence—vary across different groups. Families from 

different ethnic and linguistic groups may express the 

impact in different ways. However, it is critical to be 

sensitive to the ways in which exposure affects current 

behavior, treatment, and outcomes for each family. 

Agencies may: 

Screen for exposure to violence symptoms 

and mental health needs of children and their 

families on an ongoing basis 

Routine screening for safety and risk in cases of 

exposure—especially exposure to domestic violence—

and the possible impact on children is recommended 

for staff working in every system. In addition, it is critical 

for staff to screen for the ongoing mental health service 

needs of immigrant families throughout their involvement 

with agencies (especially child welfare agencies).

Refer families for comprehensive mental 

health assessments that include lifetime exposure to violence and acculturation stressors

 An assessment of a family’s history of exposure to 

violence and its impacts, as well as current acculturation 

stressors, provides a solid basis for the development 

of interventions for adults and children in immigrant 

families. An area of critical importance to explore is 

the rate of acculturation between generations (children 

acculturate faster than adults), which may lead to 

additional problems and distress. The interventions and 

services plan should assist the family in resolving the 

impact of this exposure and, at the same time, support 

each child’s development and well-being.

Plan for individualized interventions that take 

into consideration traumatic experiences for 

both caregivers and children, which may be 

affecting the current family situation

Children’s responses to violence differ based on age, 

gender, and life history. Treatment plans must be 

adjusted to ensure individualization, age appropriateness, 

and family history. In every case, however, it is critical that 

treatment plans help the child and caregivers reestablish 

a normal routine, safety, and predictability. In addition, it 

is important to realize that families and other caregivers 

may have been exposed to violence themselves and may 

display signs of reaction to trauma. In such cases, it is 

important to develop specific plans and structures that 

help caregivers address their own needs so that they can 

become a powerful anchor to the child’s treatment.

Expand the definition of “trauma-informed 

care” and “evidence-based interventions” 

Exposure to violence and other stressful life experiences 

of immigrant families may differ from those experienced 

by native-born American citizens. It is important for 

providers to consider the socio-cultural, ethnic, linguistic, 

and other contextual variables (for example, immigration) 

that may compound the impact of exposure to violence.

Teenagers (13–18 years)

During these years, the most rapidly developing brain areas are those crucial for success 

in forming interpersonal relationships and solving problems. Exposure to violence impedes 

this development and can lead to difficulties in behavior, cognition, and identity formation. 

Teenagers exposed to violence may:

■ Talk about the event all the time or deny that it happened

■ Refuse to follow rules or talk back with greater frequency

■ Complain of being tired all the time

■ Engage in risky behaviors

■ Sleep more or less than usual

■ Increase aggressive behaviors

■ Want to be alone, not even wanting to spend time with friends

■ Experience frequent nightmares

■ Use drugs or alcohol, run away from home, or get into trouble with the law
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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

Currently, several evidence-based interventions are 

available for children exposed to violence. These 

interventions include evidence-based treatment 

approaches that usually aim at improving child outcomes 

through the use of clinical practices informed by the 

best available research and program expertise in the 

context of the family’s culture and preferences. The 

report Evidence-Based Practices for Children Exposed 

to Violence: A Selection from Federal Databases 

describes several interventions that have shown success 

in decreasing negative symptoms in children who 

have been exposed to violence. In addition, this report 

provides information on several common characteristics 

of effective treatments for children. Some research 

indicates that ethnic minorities in general—including 

immigrant populations—respond well to evidence-based 

treatments when they are modified to include specific 

provisions for cultural groups. 

Research on the efficacy of interventions with immigrant 

populations is scarce. Practitioners working with 

populations that are underrepresented in mainstream 

efficacy studies (such as immigrant populations) 

should recognize the potential value of data collected 

through different research designs (for example, clinical 

observation, qualitative research, systematic case 

reviews) and in practice-based approaches to treatment. 

However, these evidence-based interventions are not a 

substitute for other needed services.

Become familiar with immigration laws, 

policies, and resources

Immigrant children and families—whether they are 

documented or not—may be eligible to receive various 

services if they have been victims of crime or violence. 

Undocumented families need assurances that they will 

not be deported for receiving services and that staff 

will not report their citizenship status to immigration 

authorities. 

During intake, service providers might ask questions 

about immigration and documentation status because 

these issues may prevent families from accessing or 

continuing with services. If families are undocumented, 

the providers are in a unique position of being able to 

help the families connect with available services.

Increase cultural responsiveness to families

Service providers should ensure that they have a clear 

understanding of all family members’ perspective 

about their exposure to violence. Agencies can 

establish protocols to assess the impact of violence on 

current problems and mechanisms to select the most 

appropriate interventions for each family. To do this, 

service providers should:

■ Ask the family which language it prefers

■ Gather information about the family’s ethnic 

background before meeting with family members

■ Have a list of qualified interpreters—preferably with 

a mental health background—rather than use family 

members to translate

■ Partner with case management services that 

facilitate access to culturally relevant agencies 

that are knowledgeable about the challenges of 

immigrant families

■ Refer families to community- and ethnic-based 

organizations that have the infrastructure and 

resources to deliver and adapt evidence-based 

practices within cultural contexts
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Additional Resources

Bridging Refugee Youth and Children’s Services (BRYCS) Clearinghouse. http://www.brycs.org

Cohen, E. (2010). Healing the Damage: Trauma and Immigrant Families in the Child Welfare System, A Social Worker’s 

Toolkit for Working with Immigrant Families. Denver, CO: American Humane Association. http://www.americanhumane.org/

assets/pdfs/children/pc-execsummary-trauma-immigrant-families.pdf

Cohen, E., McAlister Groves, B., & Kracke, K. (2009). Understanding Children’s Exposure to Violence. Moving from Evidence 

to Action: The Safe Start Series on Children Exposed to Violence, Issue Brief #1. North Bethesda, MD: Safe Start Center, 

Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice. 

http://www.safestartcenter.org/pdf/IssueBrief1_UNDERSTANDING.pdf

Workgroup on Adapting Latino Services. (2008). Adaptation Guidelines for Serving Latino Children and Families Affected by 

Trauma. San Diego, CA: Chadwick Center for Children and Families. http://www.chadwickcenter.org

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1 The report is available at http://www.safestartcenter.org/pdf/Evidence-Based-Practices-Matrix_2011.pdf.

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