Report of the Attorney General’s National Task Force on

Children Exposed to Violence
 

Members of the Task Force 

Co-Chairs 

Robert Listenbee, Jr., JD, Chief of the Juvenile Unit of the Defender Association of 

Philadelphia 

Joe Torre, Chairman of the Joe Torre Safe At Home® Foundation; Major League Baseball’s 

Executive Vice President for Baseball Operations 

Members 

The Rev. Gregory Boyle, SJ, Founder of Homeboy Industries 

Sharon W. Cooper, MD, CEO of Developmental & Forensic Pediatrics, P.A. 

Sarah Deer, JD, Citizen of the Muscogee (Creek) Nation of Oklahoma; Assistant Professor at 

William Mitchell College of Law 

Deanne Tilton Durfee, Executive Director of the Los Angeles County Inter-Agency Council on 

Child Abuse and Neglect 

Thea James, MD, Director of the Boston Medical Center Massachusetts Violence Intervention 

Advocacy Program; Associate Professor of Emergency Medicine at Boston Medical 

Center/Boston University School of Medicine 

Alicia Lieberman, PhD, Director of the Early Trauma Treatment Network; Irving B. Harris 

Endowed Chair of Infant Mental Health at the University of California‒San Francisco 

Department of Psychiatry; Director of the Child Trauma Research Program, San Francisco 

General Hospital 

Robert Macy, PhD, Founder, Director, and President of the International Center for Disaster 

Resilience-Boston; Founder and Executive Director of the Boston Children’s Foundation; CoDirector of the Division of Disaster Resilience at the Beth Israel Deaconess Medical Center 

Steven Marans, PhD, Director of the National Center for Children Exposed to Violence; 

Harris Professor of Child Psychiatry and Professor of Psychiatry, Yale University School of 

Medicine; Director of the Childhood Violent Trauma Center at Yale University 

Jim McDonnell, Chief of Police, Long Beach Police Department, California 

Georgina Mendoza, JD, Community Safety Director for the City of Salinas, California 

Retired Major General Antonio Taguba, President of TDLS Consulting, LLC; Chairman of Pan 

Pacific American Leaders and Mentors (PPALM) 
From the Task Force Co-Chairs 

We are facing one of the most significant challenges to the future of America’s children that we 

have ever known. Our children are experiencing and witnessing violence on an alarming scale. 

This exposure to violence is not limited to one community or one group of children. It occurs 

among all ethnic and racial groups; in urban, suburban, and rural areas; in gated communities 

and on tribal lands. 

Advances in neuroscience and child development have taught us that the trauma children 

experience when they are exposed to physical, sexual, and emotional violence harms their 

ability to mature cognitively and emotionally, and it scars them physically and emotionally well 

into their adult lives. 

Some of our children may grow up in safety and stability, but when millions do not, our entire 

society suffers. We pay astronomical costs to the healthcare, child welfare, justice, and other 

systems because we have not yet done what we know works to prevent and treat childhood 

exposure to violence. 

U.S. Attorney General Eric Holder charged this task force with recommending ways our nation 

can prevent, reduce, and treat children’s exposure to violence. We have taken this charge 

seriously. 

We have heard from dozens of people who work to prevent, reduce, and treat children’s 

exposure to violence, as well as from those who have experienced it. Their stories of what they 

had seen and lived through were sometimes horrifying but always inspired us to deeper 

commitment. What we learned from them has changed the way we think about this issue. 

The good news is that we know what works to address children’s exposure to violence. Now we 

must work courageously to find the resources to spread the solutions and implement them 

where they are needed. We must actively engage youth, families, and communities in the 

development of local solutions to these problems. 

We must protect children, and we must not look away when they are in pain. We also must not 

let our own fears and pain stop us from helping. Above all, we must give them hope that their 

future will be better and safer. 

We thank Attorney General Holder for shining a bright light on children’s exposure to violence. It 

has been a tremendous honor to serve on this task force. We stand with the Attorney General 

and you, the reader of this report, ready to begin. When our children are dying, we cannot afford 

to wait. 

Robert L. Listenbee, Jr. 

Joe Torre 
Contents 

Glossary of Key Terms .................................................................................................................. i 

Executive Summary ..................................................................................................................... iv 

Task Force Recommendations ................................................................................................... vii 

Chapter One: Ending the Epidemic of Children Exposed to Violence ..........................................1 

Chapter Two: Identifying Children Exposed to Violence.............................................................30 

Chapter Three: Treatment and Healing of Exposure to Violence ...............................................41 

Chapter Four: Creating Safe and Nurturing Homes....................................................................61 

Chapter Five: Communities Rising Up Out of Violence ..............................................................88 

Chapter Six: Rethinking Our Juvenile Justice System ..............................................................110 

Conclusion ................................................................................................................................ 136 

Acknowledgments..................................................................................................................... 138 

Activities of the Task Force and List of Witnesses ....................................................................141 

Individuals and Organizations That Submitted Written Testimony ...........................................148 

Task Force Member Biographies ..............................................................................................155 

Children Exposed to Violence i 
Children Exposed to Violence ii

Glossary of Key Terms 

American Indian/Alaska Native: As a general principle, an Indian is a person who is of some 

degree of Indian blood and is recognized as an Indian by a Tribe and/or the United States. No 

single federal or tribal criterion establishes a person's identity as an Indian. Government 

agencies use differing criteria to determine eligibility for programs and services. Tribes also 

have varying eligibility criteria for membership. 

It is important to distinguish between the ethnological term "Indian" and the political/legal term 

"Indian." The protections and services provided by the United States for tribal members flow not 

from an individual's status as an American Indian in an ethnological sense, but because the 

person is a member of a Tribe recognized by the United States and with which the United 

States has a special trust relationship. (Please see http://www.justice.gov/otj/nafaqs.htm.) 

Assessment: Determining the specific nature of an individual’s needs or problems using 

professional interviews, tests, questionnaires, or observations. 

Child- and family-serving organizations: Agencies, facilities, and programs that provide 

children or families with services that may include education, assistance, rehabilitation, or 

treatment for medical or mental health, learning, social, financial, child protection, or legal 

needs. 

Child exposed to violence: Any individual who is not yet an adult (threshold age varies across 

jurisdictions, typically birth to either 18 or 21 years old) who is directly or indirectly exposed to 

violence that poses a real threat or a perceived threat to the individual’s or an affiliated person’s 

life or bodily integrity. Children exposed to violence are at much greater risk of developing lethal 

medical illnesses in their early adult years; to utilize disproportionately costly medical, 

psychological, and public health services; and to die prematurely. 

Ethnocultural: Characteristics of individuals or their communities that are related to race, 

ethnicity, or cultural beliefs and practices. 

Evidence-based treatment: Interventions and services provided by a credentialed professional 

or paraprofessional to serve as a therapy or community-based service to promote recovery from 

psychosocial, psychological, or medical problems or to prevent these problems altogether. 

These interventions and services: (a) have been scientifically tested and demonstrated to be 

effective, (b) have clearly defined procedures that can be taught and implemented consistently 

with fidelity, (c) are feasible and useful for clinical practitioners and programs, and (d) are 

credible and acceptable to the recipients. 

Screening: Asking brief questions or gathering existing information to determine if an individual 

should be identified as having a specific need or problem. 

Trauma-informed care: This is a new form of evidence-based interventions and service 

delivery, implemented by multiple service providers, that identifies, assesses, and heals people 

injured by, or exposed to, violence and other traumatic events. 

Trauma-focused services: Services are considered trauma-focused when caregivers (such as 

biological, foster, or adoptive parents, mentors, spiritual advisors, coaches, or line staff in childserving programs) or professionals providing services (a) realize (understand) the impact that 

exposure to violence and trauma have on victims’ physical, psychological, and psychosocial
Children Exposed to Violence iii

development and well-being, (b) recognize when a specific person who has been exposed to 

violence and trauma is in need of help to recover from trauma’s adverse impacts, and (c) 

respond by helping in ways that reflect awareness of trauma’s adverse impacts and consistently 

support the person’s recovery from them (adapted from the 2012 SAMHSA [Substance Abuse 

and Mental Health Services Administration] “Working Definition of Trauma and Guidance for a 

Trauma-Informed Approach”).

Trauma-specific treatment: Medical, physiological, psychological, and psychosocial therapies 

that are (a) free from the use of coercion, restraints, seclusion, and isolation, (b) provided by a 

trained professional to an individual, a family, or a group adversely affected by violence 

exposure and trauma, and (c) designed specifically to promote recovery from the adverse 

impacts of violence exposure and trauma on physical, psychological, and psychosocial 

development, health, and well-being. 

Violence: The World Report on Violence and Health (WRVH) 

(http://www.who.int/violenceprevention/approach/definition/en/) defines violence as “the 

intentional use of physical force or power, threatened or actual, against oneself, another person, 

or against a group or community that either results in or has a high likelihood of resulting in 

injury, death, psychological harm, maldevelopment, or deprivation.” 

Violence exposure: Violence exposure can be direct, where the victim or community of victims 

is the direct target of the intentional use of force or power, but it can also be indirect, where the 

victim or community of victims is witness to the intentional use of force or power or has lost a 

loved one to violence. In both cases, over 20 years of scientific literature on the impact of 

violence demonstrates that violence exposure results in significant short- and long-term 

debilitating and costly impacts on the victim’s physical, emotional, cognitive, and social health 

and well-being. 

Violence exposure variables (magnitude of impact): Scientists and health professionals 

unanimously agree that specific violence exposure variables, whether direct or indirect, 

drastically increase negative health outcomes. Primary exposure variables include duration of

exposure (being repeatedly victimized over months and years), proximity to exposure

(remaining physically close to the perpetrator during the violence), type of violence or

perpetration (combat, kidnapping, sexual assault and rape, assault and battery, torture, being 

buried alive, human trafficking, genocide, homeland displacement, and mass political violence), 

and relationship to the perpetrator (the perpetrator is a known figure of trust and protection like a 

parent, spouse, partner, or trusted authority figure). 

A further critical aspect of violence exposure is the intentional selection of a victim or victims to 

do harm to that victim, that victim’s property, that victim’s family, or that victim’s tribe. When the 

intentional selection to do harm is based on a victim’s age, gender, race, ethnicity, tribal 

affiliation, or beliefs and orientations, the negative health outcomes may be even more 

significant. 

Workforce protections: Adaptations to a workplace’s environment or its policies and 

procedures or to the education, supervision, and supportive services provided to the personnel 

that are designed to foster workplace wellness and provide protection from psychological or 

physical harm. A fundamental adaptation to promote wellness and protect workers is a 

workplace that is free from the use of coercion, restraints, seclusion, and isolation.
Executive Summary 

The Attorney General’s Task Force on Children Exposed to Violence 

Exposure to violence is a national crisis that affects approximately two out of every three of our 

children. Of the 76 million children currently residing in the United States, an estimated 46 

million can expect to have their lives touched by violence, crime, abuse, and psychological 

trauma this year. In 1979, U.S. Surgeon General Julius B. Richmond declared violence a public 

health crisis of the highest priority, and yet 33 years later that crisis remains. Whether the 

violence occurs in children’s homes, neighborhoods, schools, playgrounds or playing fields, 

locker rooms, places of worship, shelters, streets, or in juvenile detention centers, the exposure 

of children to violence is a uniquely traumatic experience that has the potential to profoundly 

derail the child’s security, health, happiness, and ability to grow and learn — with effects lasting 

well into adulthood. 

Exposure to violence in any form harms children, and different forms of violence 

have different negative impacts. 

Sexual abuse places children at high risk for serious and chronic health problems, including 

posttraumatic stress disorder (PTSD), depression, suicidality, eating disorders, sleep disorders, 

substance abuse, and deviant sexual behavior. Sexually abused children often become 

hypervigilant about the possibility of future sexual violation, experience feelings of betrayal by 

the adults who failed to care for and protect them. 

Physical abuse puts children at high risk for lifelong problems with medical illness, PTSD, 

suicidality, eating disorders, substance abuse, and deviant sexual behavior. Physically abused 

children are at heightened risk for cognitive and developmental impairments, which can lead to 

violent behavior as a form of self-protection and control. These children often feel powerless 

when faced with physical intimidation, threats, or conflict and may compensate by becoming 

isolated (through truancy or hiding) or aggressive (by bullying or joining gangs for protection). 

Physically abused children are at risk for significant impairment in memory processing and 

problem solving and for developing defensive behaviors that lead to consistent avoidance of 

intimacy. 

Intimate partner violence within families puts children at high risk for severe and potentially 

lifelong problems with physical health, mental health, and school and peer relationships as well 

as for disruptive behavior. Witnessing or living with domestic or intimate partner violence often 

burdens children with a sense of loss or profound guilt and shame because of their mistaken 

assumption that they should have intervened or prevented the violence or, tragically, that they 

caused the violence. They frequently castigate themselves for having failed in what they 

assume to be their duty to protect a parent or sibling(s) from being harmed, for not having taken 

the place of their horribly injured or killed family member, or for having caused the offender to be 

violent. Children exposed to intimate partner violence often experience a sense of terror and 

dread that they will lose an essential caregiver through permanent injury or death. They also 

Children Exposed to Violence iv 
fear losing their relationship with the offending parent, who may be removed from the home, 

incarcerated, or even executed. Children will mistakenly blame themselves for having caused 

the batterer to be violent. If no one identifies these children and helps them heal and recover, 

they may bring this uncertainty, fear, grief, anger, shame, and sense of betrayal into all of their 

important relationships for the rest of their lives. 

Community violence in neighborhoods can result in children witnessing assaults and even 

killings of family members, peers, trusted adults, innocent bystanders, and perpetrators of 

violence. Violence in the community can prevent children from feeling safe in their own schools 

and neighborhoods. Violence and ensuing psychological trauma can lead children to adopt an 

attitude of hypervigilance, to become experts at detecting threat or perceived threat — never 

able to let down their guard in order to be ready for the next outbreak of violence. They may 

come to believe that violence is “normal,” that violence is “here to stay,” and that relationships 

are too fragile to trust because one never knows when violence will take the life of a friend or 

loved one. They may turn to gangs or criminal activities to prevent others from viewing them as 

weak and to counteract feelings of despair and powerlessness, perpetuating the cycle of 

violence and increasing their risk of incarceration. They are also at risk for becoming victims of 

intimate partner violence in adolescence and in adulthood. 

The picture becomes even more complex when children are “polyvictims” (exposed to multiple 

types of violence). As many as 1 in 10 children in this country are polyvictims, according to the 

Department of Justice and Centers for Disease Control and Prevention’s groundbreaking 

National Survey of Children’s Exposure to Violence (NatSCEV). The toxic combination of 

exposure to intimate partner violence, physical abuse, sexual abuse, and/or exposure to 

community violence increases the risk and severity of posttraumatic injuries and mental health 

disorders by at least twofold and up to as much as tenfold. Polyvictimized children are at very 

high risk for losing the fundamental capacities necessary for normal development, successful 

learning, and a productive adulthood. 

The financial costs of children’s exposure to violence are astronomical. The financial burden on 

other public systems, including child welfare, social services, law enforcement, juvenile justice, 

and, in particular, education, is staggering when combined with the loss of productivity over 

children’s lifetimes. 

It is time to ensure that our nation’s past inadequate response to children’s exposure to violence 

does not negatively affect children’s lives any further. We must not allow violence to deny any 

children their right to physical and mental health services or to the pathways necessary for 

maturation into successful students, productive workers, responsible family members, and 

parents and citizens. 

We can stem this epidemic if we commit to a strong national response. The long-term negative 

outcomes of exposure to violence can be prevented, and children exposed to violence can be 

helped to recover. Children exposed to violence can heal if we identify them early and give them 

specialized services, evidence-based treatment, and proper care and support. We have the 

Children Exposed to Violence v 
 

power to end the damage to children from violence and abuse in our country; it does not need to 

be inevitable. 

We, as a country, have the creativity, knowledge, leadership, economic resources, and talent to 

effectively intervene on behalf of children exposed to violence. We can provide these children 

with the opportunity to recover and, with hard work, to claim their birthright ... life, liberty, and 

the pursuit of happiness. We invest in the future of our nation when we commit ourselves as 

citizens, service providers, and community members to helping our children recover from 

exposure to violence and ending all forms of violence in their lives. 

To prepare this report, the Attorney General commissioned a task force of diverse leaders 

dedicated to protecting children from exposure to violence and to healing those who were 

exposed. The report calls for action by the federal government, states, tribes, communities, and 

the private sector across the country to marshal the best available knowledge and all of the 

resources needed to defend all of our children against exposure to violence. The Attorney 

General’s task force asks all readers of this report to imagine a safe country for our children’s 

creative, healthy development and to join together in developing a national plan to foster that 

reality. 

The findings and recommendations of the task force are organized into six chapters. The first 

chapter provides an overview of the problem and sets forth 10 foundational recommendations. 

The next two chapters offer a series of recommendations to ensure that we reliably identify, 

screen, and assess all children exposed to violence and thereafter give them support, 

treatment, and other services designed to address their needs. In the fourth and fifth chapters, 

the task force focuses on prevention and emphasizes the importance of effectively integrating 

prevention, intervention, and resilience across systems by nurturing children through warm, 

supportive, loving, and nonviolent relationships in our homes and communities. In the sixth and 

final chapter of this report, the task force calls for a new approach to juvenile justice, one that 

acknowledges that the vast majority of the children involved in that system have been exposed 

to violence, necessitating the prioritization of services that promote their healing. 

The challenge of children’s exposure to violence and ensuing psychological trauma is not one 

that government alone can solve. The problem requires a truly national response that draws on 

the strengths of all Americans. Our children’s futures are at stake. Every child we are able to 

help recover from the impact of violence is an investment in our nation’s future. Therefore, this 

report calls for a collective investment nationwide in defending our children from exposure to 

violence and psychological trauma, in healing families and communities, and in enabling all of 

our children to imagine and claim their safe and creative development and their productive 

futures. The time for action is now. Together, we must take this next step and build a nation 

whose communities are dedicated to ending children’s exposure to violence and psychological 

trauma. To that end, the task force offers the following recommendations. 

Children Exposed to Violence vi 
Task Force Recommendations 

1. Ending the Epidemic of Children Exposed to Violence 

1.1 Charge leaders at the highest levels of the executive and legislative branches of the 

federal government with the coordination and implementation of the recommendations in 

this report. 

The executive branch should designate leadership at the highest levels of government to 

implement the recommendations in this report. Working with the executive branch, Congress 

should take legislative action on the recommendations in this report, making these 

recommendations a bipartisan priority. 

1.2 Appoint a federal task force or commission to examine the needs of American 

Indian/Alaska Native children exposed to violence. 

A federal task force or commission should be developed to examine the specific needs of 

American Indian/Alaska Native (AIAN) children exposed to violence and recommend actions to 

protect AIAN children from abuse and neglect and reduce violence. The management of this 

task force or commission, and the selection of its members, should be carried out through an 

equal collaboration between the Attorney General and the Secretary of the Interior. 

1.3 Engage youth as leaders and peer experts in all initiatives defending children against 

violence and its harmful effects. 

Local, state, and regional child-serving initiatives and agencies should be directed to involve 

youth as leaders, planners, problem solvers, and communicators and be given the support they 

need to do this. Engagement with youth is essential in order to develop effective solutions to the 

complex problems leading to and resulting from children’s exposure to violence. 

1.4 Ensure universal public awareness of the crisis of children exposed to violence and 

change social norms to protect children from violence and its harmful effects. 

Precedents exist for solving epidemic and seemingly intractable problems. Federal, state, and 

regional initiatives should be designed, developed, and implemented to launch a national public 

awareness campaign to create fundamental changes in perspective in every organization, 

community, and household in our country. 

1.5 Incorporate evidence-based trauma-informed principles in all applicable federal 

agency grant requirements. 

The federal government should lead the development of standards of care for identification, 

assessment, treatment, protection, and other crucial services for children exposed to violence 

and psychological trauma as well as the development of protocols for monitoring the quality of 

these services as measured against the national standards. 

Children Exposed to Violence vii 
1.6 Launch a national initiative to promote professional education and training on the 

issue of children exposed to violence. 

Standards and a curriculum must be developed to ensure that all students and professionals 

working with children and families are aware of the scope of the problem of children’s exposure 

to violence as well as their responsibility to provide trauma-informed services and traumaspecific evidence-based treatment within the scope of their professional expertise. 

1.7 Continue to support and sustain the national data collection infrastructure for the 

monitoring of trends in children exposed to violence. 

Continued support for the National Survey of Children’s Exposure to Violence (NatSCEV) is 

essential to ensure that the survey is conducted at frequent, regular intervals. The government 

must gather and examine additional data on a regular basis, in concert with the NatSCEV, to 

address related justice, education, health, and human services issues; to establish a clear 

picture of children’s continuing exposure to violence; and to track and demonstrate the progress 

our country makes in ending this epidemic. 

1.8 Create national centers of excellence on children’s exposure to violence. 

To ensure the success of this report’s recommendations, national centers of excellence should 

be established and fully funded to support the implementation of a sustained public awareness 

campaign, reforms to maximize efficiencies in funding, standards for professional education and 

practices, and ongoing monitoring of trends and the translation of data; and to bring together the 

scientific, clinical, technical, and policy expertise necessary to systematically ensure the 

success of each of the foregoing goals. 

1.9 Develop and implement public policy initiatives in state, tribal, and local 

governments to reduce and address the impact of childhood exposure to violence. 

Every community’s governing institutions and leaders should be provided with guidance from 

national centers of excellence to enable them to create local public policy initiatives, regulations, 

and services that ensure that children are protected against the harmful effects of exposure to 

violence and psychological trauma to the fullest extent possible. 

1.10 Finance change by adjusting existing allocations and leveraging new funding. 

The federal government should provide financial incentives to states and communities to 

redirect funds to approaches with an established record of success in defending children 

against exposure to violence and enabling victimized children to heal and recover. 

2. Identifying Children Exposed to Violence 

Every year, millions of children in this country are exposed to violence, and yet very few of these 

children ever receive help in recovering from the psychological damage caused by this 

experience. The first crucial step in protecting our children is to identify and provide timely and 

Children Exposed to Violence viii 
effective help to those who already are being victimized by violence. The recommendations 

below are offered to address identification, assessment, and screening: 

2.1 Galvanize the public to identify and respond to children exposed to violence. 

Sustained public information and advocacy initiatives should be implemented in every 

community in order to create an informed citizenry that can advocate for higher levels of 

services and support from policymakers for both prevention and early intervention for children 

exposed to violence. These initiatives are crucial to challenge the misplaced pessimism that 

makes violence seem like an inevitable part of life. 

2.2 Ensure that all children exposed to violence are identified, screened, and assessed. 

Every professional and paraprofessional who comes into contact with pregnant women and 

children must routinely identify children exposed to (or at risk for) violence, provide them with 

trauma-informed care or services, and assist them and their families in accessing evidencebased trauma-specific treatment. 

2.3 Include curricula in all university undergraduate and graduate programs to ensure 

that every child- and family-serving professional receives training in multiple evidencebased methods for identifying and screening children for exposure to violence. 

It is imperative to equip all professionals who serve children and families with the knowledge 

and skills they need to recognize and address the impact of violence and psychological trauma 

on children. 

2.4 Develop and disseminate standards in professional societies and associations for 

conducting comprehensive specialized assessments of children exposed to violence. 

Professional societies and associations of educators, law enforcement personnel, public health 

workers, providers of faith-based services, athletic coaches, physicians, psychologists, 

psychiatrists, social workers, counselors, and marriage and family therapists — and those 

representing specialists in child abuse and domestic violence prevention and treatment — 

should develop, update, and disseminate standards for training and practice in the specialized 

assessment of children exposed to violence. 

3. Treatment and Healing of Exposure to Violence 

The majority of children in our country who are identified as having been exposed to violence 

never receive services or treatment that effectively help them to stabilize themselves, regain 

their normal developmental trajectory, restore their safety, and heal their social and emotional 

wounds. But help isn’t optional or a luxury when a child’s life is at stake; it’s a necessity. Even 

after the violence has ended, these child survivors suffer from severe problems with anxiety, 

depression, anger, grief, and posttraumatic stress that can mar their relationships and family life 

and limit their success in school or work, not only in childhood but throughout their adult lives. 

Without services or treatment, even children who appear resilient and seem to recover from 

Children Exposed to Violence ix 
 

exposure to violence still bear emotional scars that may lead them to experience these same 

health and psychological problems years or decades later. 

3.1 Provide all children exposed to violence access to trauma-informed services and 

evidence-based trauma-specific treatment. 

Service and treatment providers who help children and their families exposed to violence and 

psychological trauma must provide trauma-informed care, trauma-specific treatment, or traumafocused services. 

3.2 Adapt evidence-based treatments for children exposed to violence and 

psychological trauma to the cultural beliefs and practices of the recipients and their 

communities. 

Federal, regional, and state funding should be dedicated to the development, testing, and 

distribution of evidence-based, trauma-specific treatments that have been carefully adapted to 

recipients’ cultural beliefs and practices in order to reach the millions of children currently in 

need in diverse communities throughout the country. 

3.3 Develop and provide trauma-informed care in all hospital-based trauma centers and 

emergency departments for all children exposed to violence. 

Hospital-based counseling and prevention programs should be established in all hospital 

emergency departments — especially those that provide services to victims of violence — 

including victims of gang violence. Professionals and other staff in emergency medical services 

should be trained to identify and engage children who have been exposed to violence or to 

prolonged, extreme psychological trauma. 

3.4 Share information and implement coordinated and adaptive approaches to improve 

the quality of trauma-specific treatments and trauma-focused services and their delivery 

by organizations and professionals across settings and disciplines to children exposed 

to violence. 

To be effective, trauma-specific treatments and trauma-focused services must be provided in a 

consistent manner across the many systems, programs, and professions dedicated to helping 

children exposed to violence. 

3.5 Provide trauma-specific treatments in all agencies and organizations serving 

children and families exposed to violence and psychological trauma that are suitable to 

their clinicians’ and staff members’ professional and paraprofessional roles and 

responsibilities. 

Agencies and organizations serving children and families should have access to training on and 

assistance in sustained, effective implementation of widely available trauma-specific treatments 

that have been shown scientifically to be effective with young children, school-age children, and 

adolescents. 

Children Exposed to Violence x 
3.6 Ensure that every professional and advocate serving children exposed to violence 

and psychological trauma learns and provides trauma-informed care and trauma-focused 

services. 

Treatment providers should be made available in every setting in which children spend their 

days — schools, youth centers, even the family’s home — as well as where children receive 

care — clinics, hospitals, counseling centers, the offices of child protective services, homeless 

shelters, domestic violence programs — and where they encounter the legal system — on the 

street with police officers, in the courts, in probation and detention centers — to help children 

recover from violence and psychological trauma by providing trauma-informed care and traumafocused services. 

3.7 Grow and sustain an adequate workforce of trauma-informed service providers, with 

particular attention paid to the recruitment, training, and retention of culturally diverse 

providers. 

Trauma-informed care and trauma-focused services should be taught as a required part of the 

curriculum for all graduate and undergraduate students enrolled in professional education 

programs in colleges, universities, and medical and law schools where these students are 

preparing for careers in the healthcare, human services, public health, child welfare, or juvenile 

justice fields. The same recommendation applies to technical and vocational schools in which 

the students are preparing to work in similar fields. 

3.8 Ensure that professional societies should develop, adopt, disseminate, and 

implement principles, practices, and standards for comprehensive evidence-based 

treatment of children exposed to violence or psychological trauma. 

Every professional society in the United States that represents children and families should 

develop and formally adopt principles, practices, guidelines, and standards for evidence-based 

trauma-informed care, trauma-specific treatments, and trauma-focused services for violenceexposed children and their families. 

3.9 Provide research funding to continue the clinical and scientific development of 

increasingly effective evidence-based treatments for children exposed to violence. 

Research and funding infrastructures that encourage the creation and testing of innovative 

practices and programs that allow for the evolution of increasingly effective evidence-based 

treatments for children exposed to violence must be expanded or newly developed. 

3.10 Provide individuals who conduct services and treatment for children exposed to 

violence with workforce protection to prepare them for the personal impact of this work 

and to assist them in maintaining a safe and healthy workplace. 

All providers should receive training and resources in their workplace that enable them to 

maintain their own emotional and physical health and professional and personal support 

systems. 

Children Exposed to Violence xi 
3.11 Incentivize healthcare providers and insurance providers to reimburse traumafocused services and trauma-specific treatment. 

Even evidence-based treatments will fail if they are poorly implemented. Treatment providers 

must be incentivized in their practices to routinely monitor and report on the quality, reach, and 

outcomes of the evidence-based or evidence-informed services they provide using established 

methods for doing so. 

4. Creating Safe and Nurturing Homes 

Each year, millions of children in this country are exposed to violence and abuse in their homes 

or, less often, outside the home. Violence in the home can take many forms, including, but not 

limited to, physical and sexual abuse of children; intimate partner violence; and violence among 

family members, including siblings, grandparents, or extended family. In some cases, family 

members may even lose their lives because of criminal violence. 

Recognizing that the best place for children and adolescents to not only survive but also to 

thrive is in families that keep them safe and nurture their development, the task force offers 11 

recommendations that are described below. 

4.1 Expand access to home visiting services for families with children who are exposed 

to violence, focusing on safety and referral to services. 

Home visitation programs should be expanded to address the dynamics of child abuse and 

domestic violence; to provide evidence-based safety planning for parents, including pregnant 

mothers who are victims of domestic violence and sexual assault; and to strengthen the 

connections between children and their non-offending and protective parent(s), recognizing that 

every violence-exposed child’s well-being is inextricably linked to the safety of that child’s home 

and the well-being of her/his parents and caregivers. 

4.2 Increase collaborative responses by police, mental health providers, domestic 

violence advocates, child protective service workers, and court personnel for women and 

children who are victimized by intimate partner violence. 

We need to enhance coordination between law enforcement and service providers to identify 

children who are traumatized by domestic violence in order to assess immediate and 

subsequent threats and to follow up with visits to evaluate safety and other concerns of victims. 

Coordinated responses must be developed to address safety issues, basic needs, traumafocused assessment, and identification of children needing treatment, to support children’s 

recovery from the impact of exposure to intimate partner violence. 

Models for integrated planning and intervention following initial police responses to domestic 

disturbances to law enforcement, mental health, child protective services, and domestic 

violence services agencies and courts should be disseminated nationwide. 

Children Exposed to Violence xii 
 

4.3 Ensure that parents who are victims of domestic violence have access to services 

and counseling that help them protect and care for their children. 

Parents who have experienced intimate partner violence should be provided with traumainformed services and treatment themselves in order to assist them in providing their children 

with emotional security and support for healthy development. 

4.4 When domestic violence and child sexual or physical abuse co-occur, ensure that 

the dependency and family courts, the child protection system, and domestic violence 

programs work together to create protocols and policies that protect children and adult 

victims. 

When domestic violence and child abuse co-occur in a family, all victims need protection. Adult 

caregivers who are victimized, and their children involved in custody and dependency cases, 

should be provided with coordinated trauma-informed services and trauma-specific treatment 

appropriate to their circumstances and developmental stage. Every reasonable effort should be 

made to keep the violence-exposed child and non-offending parent(s) or other family 

caregiver(s) together. 

4.5 Create multidisciplinary councils or coalitions to assure systemwide collaboration 

and coordinated community responses to children exposed to family violence. 

Every city, county, or tribe should be directed and supported to establish and sustain a 

multidisciplinary network or council that includes every provider and agency that touches the 

lives of children exposed to violence, including key decision makers who affect policy, 

programs, and case management. 

Coordinated multidisciplinary teams that screen, assess, and respond to victims of family 

violence involved in the child protection and juvenile justice systems, and standards and 

procedures to prevent families and children who are exposed to violence in the home from 

becoming unnecessarily involved in those systems, are needed in every community. 

4.6 Provide families affected by sexual abuse, physical abuse, and domestic violence 

with education and services to prevent further abuse, to respond to the adverse effects 

on the family, and to enable the children to recover. 

Programs should be supported and developed to engage parents to help protect and support 

children, ideally working to stop child sexual or physical abuse before it occurs — and also 

enabling parents to assist their children in recovery if sexual or physical abuse does occur. 

Prevention programs that equip parents and other family members with the skills needed to 

establish healthy, supportive, proactive relationships with children should be available to all 

families in every community. 

Children Exposed to Violence xiii 
4.7 Ensure that parenting programs in child- and family-serving agencies, including 

fatherhood programs and other programs specifically for men, integrate strategies for 

preventing domestic violence and sexual assault and include reparation strategies when 

violence has already occurred. 

All agencies, programs, and providers working with fathers who have been violent toward their 

children, partners, or other family members must provide in-depth assessment, diagnosis, 

treatment planning, and educational services that are linked to the specific problems of each 

offender. Fathers who use violence also must be held accountable and monitored, as change 

does not always come easily or quickly. 

4.8 Provide support and counseling to address the unique consequences for children 

exposed to lethal violence, both in the home as a result of domestic violence homicides 

and suicides, and in the community. 

Evidence-based treatments that have been developed specifically to help children recover and 

heal from the traumatic grief of a violent death in their family should be available to all children 

who experience a loss due to violence, in every community in this country. 

4.9 Develop interventions in all child- and family-serving agencies that build on the 

assets and values of each family’s culture of origin and incorporate the linguistic and 

acculturation challenges of immigrant children and parents. 

Evidence-based interventions should be created specifically for immigrant children and their 

families who have been exposed to violence, providing them with a network of services and 

supports that are grounded in the beliefs and values of their culture and language of origin 

rather than forcing them to renounce or relinquish those crucial ties and foundations. 

4.10 Ensure compliance with the letter and spirit of the Indian Child Welfare Act (ICWA). 

Thirty-five years after its passage, full implementation of the ICWA remains elusive. Because 

the ICWA is a federal statute, successful implementation will be best ensured through strong, 

coordinated support from the Department of Interior, Bureau of Indian Affairs; Department of 

Health and Social Services, Administration for Children and Families; and the Department of 

Justice, Office of Juvenile Justice and Delinquency Prevention. 

4.11 Initiate a nationally sponsored program similar to the Department of Defense’s 

community and family support programs that provides military families with specialized 

services focused on building strengths and resilience, new parent support, youth 

programs, and forging partnerships with communities. 

The unique challenges of military families are widely recognized, but military families are too 

frequently underserved. Family support programs developed in concert with the President’s 

“Strengthening Our Military Families” initiative should be expanded to fully provide for the safety 

and well-being of the children of military families and veterans living in civilian communities. 

Children Exposed to Violence xiv 
5. Communities Rising Up Out of Violence 

Every year, community violence affects tens of millions of children in this country. This violence 

can occur in episodic incidents such as shootings in schools or other public places that cause 

children and families to feel terror in their own neighborhoods and schools and leave them to 

recover from the traumatic grief of losing friends or peers who are killed or who never fully 

recover. In addition, countless children are victimized when violence becomes part of the fabric 

of American communities as a result of gangs, or when bullying or corporal punishment is 

tolerated or sanctioned in schools or youth activities. 

To reduce the extent of this pandemic of children’s exposure to community violence, on behalf 

of children not yet exposed to community violence, and to help children who have been victims 

recover and heal from the trauma and grief caused by violence in their neighborhoods and 

schools, the task force proposes the following recommendations: 

5.1 Organize local coalitions in every community representing professionals from 

multiple disciplines and the full range of service systems (including law enforcement, the 

courts, health care, schools, family services, child protection, domestic violence 

programs, rape crisis centers, and child advocacy centers) as well as families and other 

community members, to assess local challenges and resources, develop strategies, and 

carry out coordinated responses to reduce violence and the number of children exposed 

to violence. 

Nationwide, local coalitions should be formed to increase children’s safety and well-being 

through public awareness, wraparound support services, and immediate access to services that 

are tailored to meet the individual needs of children and families exposed to violence in their 

schools, neighborhoods, or homes. 

5.2 Recognize and support the critical role of law enforcement’s participation in 

collaborative responses to violence. 

Child-serving professionals from all disciplines and law enforcement professionals should 

partner to provide protection and help in recovery and healing for children exposed to violence. 

5.3 Involve men and boys as critical partners in preventing violence. 

Initiatives must be supported and expanded to involve men and boys in using nonviolence to 

build healthy communities and to develop a network of men and boys across the country who 

are committed to creating widespread change that will help break the cycle of violence in our 

homes, schools, and communities. 

5.4 Foster, promote, and model healthy relationships for children and youth. 

Community- and school-based programs should be developed and supported to prevent 

violence within adolescent relationships, to promote healthy relationships, and to change social 

norms that tolerate and condone abuse. 

Children Exposed to Violence xv 
 

5.5 Develop and implement policies to improve the reporting of suspected child sexual 

abuse in every institution entrusted with the care and nurturing of children. 

To break the silence and secrecy that shrouds child sexual abuse, every institution entrusted 

with the care and safety of children must improve its policies on mandatory reporting, implement 

them fully, educate its employees about them, and ensure full compliance. 

5.6 Train and require child care providers to meet professional and legal standards for 

identifying young children exposed to violence and reducing their exposure to it. 

Child care providers must be trained and provided with ongoing supervision and continuing 

education so as to be able to recognize children in their care who have been exposed to 

violence and to be able to help their families to access the services and treatment that these 

children need in order to recover. 

5.7 Provide schools with the resources they need to create and sustain safe places 

where children exposed to violence can get help. 

Every school in our country should have trauma-informed staff and consultants providing 

school-based trauma-specific treatment. In addition, these professionals should help children 

who have severe chronic problems to access evidence-based treatment at home or in clinics. 

5.8 Provide children, parents, schools, and communities with the tools they need to 

identify and stop bullying and to help children who have been bullied — including the 

bullies themselves — to recover from social, emotional, and school problems. 

Trauma-informed services and support should be provided to all children who are bullies or 

victims of bullying in order to stop the spread of emotional and physical violence in our schools 

and communities. 

5.9 Put programs to identify and protect children exposed to community violence who 

struggle with suicidality in place in every community. 

Every community in the nation should have immediate access to evidence-based, traumainformed, trauma-specific, community-adaptive suicide prevention and treatment programs for 

children and youth at high risk because of their severe suicidality. 

5.10 Support community programs that provide youth with mentoring as an intervention 

and as a prevention strategy, to reduce victimization by and involvement in violence and 

to promote healthy development by youths. 

All children’s mentoring programs should provide ongoing trauma-informed training and 

supervision to their adult mentors to ensure the children’s safety and maximize the benefits of 

the mentoring relationship. 

Children Exposed to Violence xvi 
5.11 Help communities learn and share what works by investing in research. 

A coordinated national initiative should be created to develop public-private partnerships and 

funding to ensure that scientific research on the causes of children’s exposure to community 

violence, ways to prevent such exposure, and methods of treating its adverse effects is 

translated into effective and efficient interventions that are available to, and used successfully 

in, every community in our country. 

6. Rethinking Our Juvenile Justice System 

The vast majority of children involved in the juvenile justice system have survived exposure to 

violence and are living with the trauma of those experiences. A trauma-informed approach to 

juvenile justice does not require wholesale abandonment of existing programs, but instead it can 

be used to make many existing programs more effective and cost-efficient. By correctly 

assessing the needs of youth in the justice system, including youth exposed to violence, and 

matching services directly to those needs, the system can help children recover from the effects 

of exposure to violence and become whole. 

As a guide to addressing the needs of the vast majority of at-risk and justice-involved youth who 

have been exposed to violence, the task force offers the recommendations listed below. 

6.1 Make trauma-informed screening, assessment, and care the standard in juvenile 

justice services. 

All children who enter the juvenile justice system should be screened for exposure to violence. 

The initial screening should take place upon the child’s first contact with the juvenile justice 

system and should include youth who meet the criteria for diversion from the system. Where 

feasible, juvenile justice stakeholders should develop trauma-informed care and treatment for 

children diverted to prevention, mental health, or dependency programs. 

6.2 Abandon juvenile justice correctional practices that traumatize children and further 

reduce their opportunities to become productive members of society. 

Juvenile justice officials should rely on detention or incarceration as a last resort and only for 

youth who pose a safety risk or who cannot receive effective treatment in the community. 

Facilities must eliminate practices that traumatize and damage the youth in their care. 

6.3 Provide juvenile justice services appropriate to children’s ethnocultural background 

that are based on an assessment of each violence-exposed child’s individual needs. 

Culturally sensitive role models, practices, and programs aimed at healing traumatized youth 

and preventing youth from being further exposed to violence in the juvenile justice system 

should be expanded nationwide and incorporated into statewide juvenile justice systems. 

Children Exposed to Violence xvii 
6.4 Provide care and services to address the special circumstances and needs of girls in 

the juvenile justice system. 

Programs that provide gender-responsive services for girls healing from violence and other 

traumatic events, including sexual and physical abuse, should be supported and developed. 

6.5 Provide care and services to address the special circumstances and needs of 

LGBTQ (lesbian-gay-bisexual-transgender-questioning) youth in the juvenile justice 

system. 

Every individual who works in the juvenile justice system should be trained and provided with 

ongoing supervision in order to be able to deliver trauma-informed care while demonstrating 

respect and support for the sexual orientation of every youth. 

6.6 Develop and implement policies in every school system across the country that aim 

to keep children in school rather than relying on policies that lead to suspension and 

expulsion and ultimately drive children into the juvenile justice system. 

Successful school-based programs that help students develop better ways of handling 

emotional distress, peer pressures, and problems in family and peer relationships and that 

integrate recovery from trauma should be expanded and then embedded into existing school 

curricula and activities to increase students’ abilities to have positive experiences with 

education, recreation, peer relationships, and the larger community. 

6.7 Guarantee that all violence-exposed children accused of a crime have legal 

representation. 

We should ensure that all children have meaningful access to legal counsel in delinquency 

proceedings. Screen all children who enter the juvenile and adult justice systems for exposure 

to violence and provide access to trauma-informed services and treatment. Train defense 

attorneys who represent children to identify and obtain services for clients who have been 

exposed to violence and to help identify and prevent abuses of children in juvenile detention and 

placement programs. 

6.8 Help, do not punish, child victims of sex trafficking. 

Child victims of commercial sex trafficking should not be treated as delinquents or criminals. 

New laws, approaches to law enforcement, and judicial procedures must be developed that 

apply existing victim protection laws to protect the rights of these child victims. 

6.9 Whenever possible, prosecute young offenders in the juvenile justice system instead 

of transferring their cases to adult courts. 

No juvenile offender should be viewed or treated as an adult. Laws and regulations prosecuting 

them as adults in adult courts, incarcerating them as adults, and sentencing them to harsh 

punishments that ignore and diminish their capacity to grow must be replaced or abandoned. 

Children Exposed to Violence xviii 
 

Chapter One: Ending the Epidemic of Children Exposed to 

Violence 

Each year in the United States, millions of children are exposed to violence as victims of 

physical or sexual abuse, witnesses to intimate partner violence, or witnesses to violence that 

occurs in their neighborhoods. Exposure to violence causes major disruptions of the basic 

cognitive, emotional, and brain functioning that are essential for optimal development and 

leaves children traumatized. When their trauma goes unrecognized and untreated, these 

children are at significantly greater risk than their peers for aggressive, disruptive behaviors; 

school failure; posttraumatic stress disorder (PTSD); anxiety and depressive disorders; alcohol 

and drug abuse; risky sexual behavior; delinquency; and repeated victimization. When left 

unaddressed, these consequences of violence exposure and the impact of psychological 

trauma can persist well beyond childhood, affecting adult health and productivity. They also 

significantly increase the risk that, as adults, these children will engage in violence themselves. 

Exposure to violence constitutes a major threat to the health and well-being of our nation’s 

children, ages 0 to 21 years. As a nation, we must protect children from the traumatization that 

results from exposure to violence. 

For far too many children, exposure to violence is a matter of life and death. Eighty percent of 

child fatalities due to abuse or neglect occur within the first 3 years of life and almost always at 

the hands of adults responsible for their care. Every day, we lose five children in this country to 

violent deaths caused by abuse or neglect.1,2 

Homicide is the second leading cause of death for children, youth, and young adults between 

the ages of 10 and 24, and suicide is a close third. Among very young children (ages 1 to 4), 

homicide is the third leading cause of death and accounted for 9 percent of deaths in the United 

States in 2008, an increase of 7 percentage points since 1970. Among children ages 5 to 14, 

homicide is the fourth leading cause of death, causing 2 percent of child deaths in 1970 and 6 

percent in 2008. Suicide is close behind, the fifth leading cause of death in the United States in 

2008 among school-age and pre-adolescent children.3 

In the United States, we lose an average of more than 9 children and youths ages 5 to 18 to 

homicide or suicide per day — a total of 3,000 children each year.4 

In addition to the human costs of unaddressed consequences of children’s exposure to 

violence, the financial costs are astronomical. The predicted incremental cost of violence and 

abuse on the healthcare system alone ranges from $333 billion to $750 billion annually, or up to 

371⁄2 cents of every dollar spent on health care.5 The financial burden on other public systems — 

child welfare, social services, law enforcement and justice, and education, in particular — 

combined with the loss of productivity over lifetimes is incalculable. 

Exposure to violence is a national crisis that affects almost two in every three of our children. 

According to the National Survey of Children Exposed to Violence (NatSCEV), an estimated 46 

million of the 76 million children currently residing in the United States are exposed to violence, 

Children Exposed to Violence 1 
crime, and abuse each year.6

 In 1979, U.S. Surgeon General Julius B. Richmond declared that 

violence was a public health crisis of the highest priority. Although the past 30 years have seen 

dramatic reductions in the prevalence of violent crime, as measured in certain sectors such as 

violent crimes in households with children, children’s exposure to violence and ensuing 

psychological trauma remains a national epidemic. As a nation, we must face the horrors of 

violence and resulting psychological trauma, resist the temptation to turn away, and make sure 

that children are not left to fend for themselves when they have been unable to escape their upclose and personal experiences of that horror. 

We do not need to remain helpless, and our children do not need to remain alone with the 

consequences of their exposure to violence. With greater awareness of the enormous strides 

that have been made in developing effective ways of interrupting and responding to the 

consequences of violence exposure, our country is poised to confront the reality of violence in 

children’s lives and initiate effective and long-lasting changes. It is time, as a nation, to commit 

to the protection of our children and to ensuring that they receive the assistance they need to 

recover when violence enters their lives. 

It is time to use effective, coordinated approaches that address the needs of children 

traumatized by violence — and their families and communities. It is time to ensure that 

interrupting the cycle of costly life-altering consequences of children’s violence exposure 

becomes a national priority. 

To prepare this report, the Attorney General commissioned a diverse group of leaders who are 

dedicated to protecting children from violence and helping them to heal in the wake of violence. 

The task force is issuing this report as a call to action for the federal government, states, tribes, 

communities, the private sector, and people from all walks of life across the country to marshal 

the best available knowledge and the resources needed to defend our children against 

exposure to violence. 

The Traumatic Impact of Exposure to Violence 

When children are exposed to violence, the convergence between real life events and their 

worst fears — about physical injury and loss of life, loved ones, and control of their actions and 

feelings — is an “experience of overwhelming and often unanticipated danger [that] triggers a 

traumatic disruption of biological, cognitive, social and emotional regulation that has different 

behavioral manifestations depending on the child’s developmental stage.”7

 These traumatic 

disruptions of brain functioning, healthy development, relationships, and subjective experience 

often lead to symptoms of distress, including difficulties with sleeping and eating, irritability, 

attention and concentration problems, aggression, depressed mood and withdrawal, relationship 

problems, anxiety and intrusive thoughts, and impulsivity (such as dangerous risk-taking, 

alcohol and drug abuse, delinquency, or promiscuous sexual behavior). 

These symptoms result from abrupt changes in brain activity and altered perceptions of self, 

others, and the environment, leaving the child “stuck” or “frozen” without a way to escape the 

state of fear (and also often shock, anger, grief, betrayal, and guilt or shame) from the original 

Children Exposed to Violence 2 
 

violent experience.8

 Children traumatized by exposure to violence cannot move forward in their 

lives. When parents, caregivers, and others identify the impact of the violence exposure and 

provide adequate support and treatment, affected children are able to heal and recover.9-11 

However, when violence is chronic or sources of support are inadequate, the result can be a 

severe and lasting impact on every aspect of the child’s development.12 

In these situations, exposure to violence may “substantially alter a child’s biological makeup 

through long-lasting changes in brain anatomy and physiology.”7,13-17 These children are at high 

risk of suffering chronic and severe symptoms of traumatic stress, including long-term 

psychiatric problems and lifelong limitations on health, well-being, relationships, and personal 

success.18 These risks are especially high when exposure to violence involves a fundamental 

loss of trust and security, which happens when children are exposed to sexual and physical 

abuse, witness intimate partner violence, or are severely victimized or witness extreme violence 

outside the home.7 

Too many children endure cruel physical and sexual abuse and exploitation — most often by 

adults they know and trust and upon whom they rely, but also by strangers who prey upon them 

on the Internet or in their communities. Also, too many children see one of their parents, usually 

their mother, threatened or beaten by another adult in the home. Others see friends or loved 

ones assaulted in dangerous neighborhoods where violence is part of the fabric of everyday life. 

Others are left feeling helpless and overwhelmed when they are bullied or when they become 

trapped in abusive dating relationships. Their fear, anxiety, grief, anger, guilt, shame, and 

hopelessness are further compounded by isolation and a sense of betrayal when no one takes 

notice or offers protection, justice, support, or help. 

When children’s recovery from these posttraumatic symptoms is delayed or fails, the children 

adopt the attitude of “survivors” who can rely only upon themselves for safety and to cope with 

feelings of despair and helplessness. We know from recent advances in neuroscience that such 

survival coping comes at a high price to developmental achievement and success. Children’s 

emotions, thinking, and behavior become organized around learning how to anticipate, cope 

with, and — for the sake of preparedness — never forget the danger and pain. The violenceexposed brain becomes expert at threat detection and survival, but the areas of the brain that 

engender and support capacities for problem solving, trust, confidence, happiness, social 

interaction, and overall self-esteem and self-control become delayed and compromised and 

may not develop to full capacity.19-21 Survival-oriented biological changes are necessary for the 

traumatized child’s immediate coping and self-protection during the actual violence exposure, 

but when they persist after the danger has subsided, brain and psychological development are 

significantly compromised.22-27 These children’s brains are not faulty or broken; they are stuck in 

a perpetual state of readiness to react without thinking to even the smallest threat. The children 

live in a near-constant state of high alert, a survival mode in which they never trust anyone — 

even people who really are trustworthy — can never relax, and never stop bracing for the next 

assault or betrayal. 

Many of these children meet the criteria for PTSD. However, PTSD is only one of several 

emotional and behavioral disorders that can result from exposure to violence in childhood. 

Children Exposed to Violence 3 
Children exposed to violence and psychological trauma also are at high risk for developing 

anxiety and depressive disorders; becoming socially isolated, depressed, and suicidal; and 

engaging in harmful behaviors — drug and alcohol abuse, self-injury, promiscuous sexual 

activity, and delinquency and crime, in particular — that also increase their risk of being 

victimized or becoming violent themselves.18 

Additionally, research shows that exposure to violence in the first years of childhood deprives 

children of as much as 10 percent of their potential intelligence (IQ), leaving them vulnerable to 

serious emotional, learning, and behavior problems by the time they reach school age.28 In 

adolescence, these children continue to be seriously disadvantaged, often underachieving or 

failing in school; being ostracized or bullied by peers (or turning the tables and victimizing other 

children); and developing serious problems such as addictions, impulsive or reckless behavior, 

depression and suicidality, or delinquency.29 Too often, they are labeled as “bad,” “delinquent,” 

“troublemakers,” or “lacking character and positive motivation.” Few adults will stop and, instead 

of asking “What’s wrong with you?” ask the question that is essential to their recovery from 

violence: “What happened to you?” 

It is important to realize that, although exposure to violence in any form harms children, 

exposure to different forms of violence can have different effects. Sexual abuse places children 

at high risk for serious and often chronic problems with health,30-32 PTSD and other mental 

health disorders,33-37 suicidality,36,38 eating disorders,34,37,39-41 sleep disorders,42,43 substance 

abuse,44-47 and sexuality and sexual behavior.44,48-50 Sexually abused children often become 

hypervigilant about future sexual violation51 and experience a sense of betrayal that breaks 

down the innate trust they feel for adults who should care for and protect them.52 Sexual abuse 

also creates a sense of profound confusion and doubt about the child’s own body and self that 

can develop into severe problems with shame and even self-hatred.53 In the extreme, this can 

lead a child to detach physically and psychologically, leading to symptoms of psychological 

dissociation,54 such as “blanking or spacing out,” or acting on “automatic pilot” without conscious 

thought, as a way of escaping overwhelmingly intense feelings of fear, horror, rage, and 

shame.52,55 Children exposed to sexual abuse also are at high risk for becoming phobic of any 

kind of physical closeness or touch or, alternately, promiscuously seeking intimacy or sexual 

activity.56,57 As a result, sexually abused girls are likely to develop secondary sex characteristics 

and become sexually active earlier than their peers,58 to more often and earlier become involved 

in intimate partnerships involving cohabitation, and to be at risk for intimate partner violence and 

lower investment and satisfaction in intimate relationships.59 They also are vulnerable to 

predators and exploitive adults or older peers who re-victimize them, and they have difficulty 

caring for and protecting their own children.60-62 

Children exposed to physical abuse also are at high risk for severe and often lifelong problems 

with physical health,63-65 PTSD and other mental health disorders,66-69 suicidality,38,70-72 eating 

disorders,73,74 substance abuse,75,76 and sexuality and sexual behavior.57,77,78 In addition, 

physically abused children are particularly likely to develop a sense of powerlessness when 

faced with physical intimidation or threats and to attempt to compensate either by hiding from 

people (for example, by skipping school or becoming socially isolated) or by using anger or 

Children Exposed to Violence 4 
aggression to protect themselves79,80 or seeking relationships with peers or adults who do so 

(including becoming bullies or joining gangs). They are at risk for impairment in memory and 

thinking81-83 and for developing beliefs that lead either to adopting violence as a form of selfprotection and control of other people — reactive aggression — or to developing a phobia of 

even the slightest degree of conflict or anger that can result in avoidance of intimacy. Both of 

these defensive reactions to having been physically abused tend to result in isolation or 

rejection from family and peers, as well as both aggressive behavior and victimization in 

adolescent and adult intimate relationships,84-86 which can result in a lifetime of violent or broken 

relationships87 or no relationships at all. Scientific studies have shown that abused children are 

at risk of engaging in criminal behavior beginning early in life and continuing into adulthood.88 

Children who have been exposed to intimate partner violence in their families also are at high 

risk for severe and potentially lifelong problems with physical health,89-91 mental health,92-97 

school and peer relationships,98-101 and disruptive behavior.102-104 Children who witness or live 

with intimate partner violence are often burdened by a sense of loss105,106 or by profound guilt107 

because they believe that they should have somehow intervened or prevented the violence — 

or, tragically, that they actually caused the violence. They frequently castigate themselves for 

having failed in what they assume to be their duty to protect their parents or siblings from being 

harmed,107 including wishing that they could take the place of their victimized family member 

even if that means being horribly injured or killed themselves. Children exposed to intimate 

partner violence also often feel a sense of terror that they will lose an essential caregiver, such 

as a battered parent who is severely injured and could be killed.94,108-110 To complicate things 

even further, they also often fear losing their relationship with a battering parent who may be 

taken away and incarcerated or even executed,111 and they sometimes mistakenly blame 

themselves for having caused the batterer to be violent.112 These children bring a deep sense of 

uncertainty and fear, as well as grief, anger, and shame, into all of their important relationships 

for the rest of their lives if not helped to heal and recover.113,114 

The harm caused by childhood exposure to domestic or intimate partner violence can put future 

generations of children at risk of family conflict, abuse, neglect, or other exposure to violence 

and psychological trauma, potentially creating an inter-generational cycle of violence: Men who 

witnessed domestic violence in their families growing up are at risk for perpetrating domestic 

violence.115 When, as adolescents or adults, they have children of their own, childhood victims 

of domestic violence often have difficulty being stable and nurturing parents, caregivers, and 

role models despite their best intentions.116 The cycle of domestic violence exposure in 

childhood leading to re-victimization as an adult in intimate partner relationships is a serious 

problem,117,118 but it is important to recognize that witnessing intimate partner violence in 

childhood does not necessarily lead to becoming a victim of domestic violence.119 

Children who are exposed to community violence in their neighborhoods or schools often see 

family members, peers, trusted adults, or strangers (both innocent bystanders and active 

participants in violent activities) being injured or even murdered.6

 Violence can prevent children 

from ever feeling safe in their own schools and neighborhoods, leading them to adopt an 

attitude of hypervigilance — never letting their guard down so they will be ready for the next 

Children Exposed to Violence 5 
outbreak of violence.120-124 They may come to believe that violence is “normal” and that 

relationships are too fragile to trust because one never knows when violence will take the life of 

a friend or loved one. They may feel compelled to resort to violence to avoid being viewed as 

weak and being targeted by bullies or other violent community members.121,124 They may turn to 

gangs or criminal activities due to despair and powerlessness, perpetuating a cycle of violence 

by inflicting violence on others and becoming targets for further violence or incarceration. They 

are at risk for becoming victims of intimate partner violence as adolescents and adults.125 When 

children exposed to community violence can turn to a loving, protective parent in their home126, 

127 or a supportive mentoring adult or peers in their neighborhood or at school 127,129 — and, for 

boys, have a family in which conflict is handled effectively128 — they can be highly resilient in the 

face of community violence, and in many cases they are able to recover and continue to 

develop successfully. However, parenting, family security, and mentoring cannot completely 

compensate for the harmful effects of exposure to community violence on children’s 

adjustment.130 

The picture becomes even more complex when children are exposed to multiple types of 

violence; these children are called “polyvictims.” The Department of Justice and Centers for 

Disease Control and Prevention’s groundbreaking National Survey of Children Exposed to 

Violence demonstrates that as many as 1 in 10 children in this country are polyvictims. The toxic 

combination of exposure to family violence, child physical and sexual abuse, and exposure to 

community violence increases the risk and severity of posttraumatic injuries and health and 

mental health disorders for exposed children by at least twofold and up to tenfold.131-136 

Polyvictimized children are at high risk for losing the fundamental capacities they need to 

develop normally and to become successful learners and productive adults. 

The Adverse Childhood Experiences (ACEs) Study has greatly enriched our knowledge of the 

long-term effects of exposure to violence and trauma in childhood.137-141 This study of more than 

17,000 adults explored the relationship between significantly negative childhood experiences 

and adult health and well-being. Nearly two-thirds of people studied reported having at least one 

adverse experience in childhood (most of which involved some form of violence or threat of 

violence). One in five people reported at least three of the eight types of adversity. Moreover, 

the number of ACEs reported was strongly associated with severe health and social problems, 

including early initiation of smoking and sexual activity; multiple sexual partners and teen 

pregnancy; intimate partner violence; alcoholism and alcohol abuse; depression and suicide 

attempts; liver, heart, and lung diseases; and other problems related to poor health and 

diminished quality of life. 

Poverty Increases Both Risk and Adverse Impact of Exposure to Violence 

Although no community is untouched, the epidemic of children’s exposure to violence does not 

play out evenly across the country. Children living in poverty are far more likely to be exposed to 

violence and psychological trauma, both at home and in the surrounding community.142-144 

Compounding the problem, economically impoverished families and communities typically lack 

the resources needed to protect children. Poverty and scarcity of resources do not occur only in 

Children Exposed to Violence 6 
urban areas. Child welfare agencies in 39 states are unable to fully serve rural communities, 

most often in states that have the fewest public and private economic resources to devote to all 

of their members’ needs.145 

Poverty is a greater problem for minority ethnocultural groups that have historically been 

subjected to political and cultural trauma in this country and in their families’ countries of origin. 

Roughly three times as many African-American, Hispanic, and American Indian/Alaska Native 

children live in poverty compared to White and Asian-American children.146 

Asian-American children and their families who are immigrants from impoverished and violencetorn countries are more vulnerable to violence as a result of racism and the scars of historical 

trauma. Although they are spared the toxic violence of racism in some cases, White children 

whose communities and families have been isolated geographically and culturally — those from 

“the wrong side of the tracks” — often experience the burden of stigma, discrimination, and 

economic poverty. 

Children, families, and communities living with deprivation and marginalization include not only 

the urban and rural poor and isolated tribal communities but also other groups that are at risk for 

exposure to violence in childhood: lesbian, gay, bisexual, transgender, and questioning sexual 

orientation (LGBTQ) youth and adults48,147,148; children and parents with physical disabilities149 or 

mental illness and addictions150,151; and homeless individuals and families.152,153 

In many poor communities, particularly those that are isolated and the victims of historical 

trauma and racism as well as poverty, violence has become the norm for children growing up.143 

On the Pine Ridge Indian Reservation in South Dakota, for example, 70 percent of adults are 

unemployed, and substance abuse, homelessness, rape, violence, and child abuse are 

everyday occurrences — nearly all of the children on this reservation will experience or witness 

violence.154,155 Yet until a few years ago, the reservation had just eight police officers to respond 

to the needs of its 16,986 residents despite having a homicide rate more than five times the 

national average.156 

Although economically impoverished or marginalized communities include many safe homes 

and protective and nurturing caregivers, just as there are violent homes in “mainstream” 

communities, neighborhoods where poverty or discrimination is concentrated often are not safe 

for the children and families who live in them. Those communities also include legions of 

individuals and organizations committed to ending violence and protecting all children. These 

advocates and concerned citizens and the families and children who are at highest risk of 

exposure to violence can help break the toxic cycle of violence if they can break out of the trap 

of isolation that can condemn them to endless poverty and violence. They are not poor in spirit, 

resilience, or courage, but they cannot address the problems associated with exposure to 

violence alone. We need to recognize that these are our children as well, and we all must solve 

this problem or no child will be safe. 

Children Exposed to Violence 7 
Toward a Coordinated National Response 

Children’s exposure to violence represents a national crisis and a threat to the health and wellbeing of our nation’s children and of our country. We cannot afford to be passive in the face of 

this threat. But we can succeed if we commit to a strong national response. We can prevent the 

long-term negative outcomes of exposure to violence, and we can help children exposed to 

violence recover. When these children are identified early and receive specialized services, 

evidence-based treatment, and proper care and support, they can heal. 

It is time to ensure that violence exposure no longer goes unanswered and that the lives of 

children affected by such exposure are not further impacted by our failure to act. We must not 

allow violence to deny any child the physical and mental health; learning, skills, and knowledge; 

and pathways to development that all children need to become successful students, productive 

workers, and responsible family members, parents, and citizens. 

We, as a country, have the creativity, knowledge, leadership, economic resources, and talent to 

effectively intervene on behalf of children exposed to violence. We can provide these children 

with the opportunity to recover and to claim their birthright and that of our nation: life, liberty, and 

the pursuit of happiness. When our children no longer have to bear the traumatic burden of 

violence exposure but are supported by an informed and committed citizenry and well-trained 

and trauma-informed providers and community members, they will have the opportunity to 

contribute to the social capital, productivity, strength, and security of our country, which is still 

looked upon by other nations to lead the world. Every child we help recover from exposure to 

violence is an investment in our nation’s future. 

This report therefore calls for a collective investment nationwide in defending our children from 

exposure to violence and psychological trauma, healing families and communities, and enabling 

all of our children to imagine their safe and creative development and productive futures. The 

Attorney General’s Defending Childhood Initiative asks the readers of this report, including the 

leaders of this country and the citizenry at large, to join together in developing a national plan 

that will allow our country to move steadily toward providing all children with the hope and 

security they deserve — resulting in a country in which every family and community is safe for 

children. 

What Readers Will Find in This Report 

The findings and recommendations of the task force are organized into six chapters, each 

addressing a crucial issue in resolving the crisis of children exposed to violence. 

In the second and third chapters, we offer a series of recommendations to ensure that all 

children exposed to violence are reliably identified, screened, and assessed and then receive 

support, treatment, and other services designed to address the traumatic impact of exposure to 

violence. The first step in defending children against violence is to find the millions of children 

who are exposed to violence and need help in recovering. The second step is to work toward 

Children Exposed to Violence 8 
stopping the exposure itself — making children safe in the future and helping them recover from 

the violence that was not prevented. 

In the fourth and fifth chapters, we focus on prevention, recommending ways to create safe and 

nurturing homes and ways for communities to rise up out of violence. In the sixth and final 

chapter, we call for a new approach to juvenile justice, one that reflects the fact that the vast 

majority of children in the system have been exposed to violence and that prioritizes services 

that promote healing from the trauma of violence. 

The challenge of children’s exposure to violence cannot be solved by government alone. It 

requires a truly national response that draws on the strengths of all Americans. Children’s 

futures are at stake. The time for action is now. Together, we must build a nation whose 

communities are dedicated to ending children’s exposure to violence and psychological trauma. 

To that end, the task force proposes the following foundational recommendations. 

1.1 Charge leaders at the highest levels of the executive and legislative 

branches of the federal government with the coordination and 

implementation of the recommendations in this report. 

The executive branch should designate leaders at the highest levels of government to 

implement the recommendations in this report. Working with the executive branch, Congress 

should take legislative action on the recommendations in this report, making these 

recommendations a bipartisan priority. The task force recognizes that implementation of its 

recommendations will require the assistance of multiple Cabinet offices and federal departments 

to shape and sustain a truly national response to this epidemic. It also recommends that a 

consortium of leaders from all levels of state, local, and tribal government and the private sector 

who are committed to advancing the legislative, regulatory, and programmatic reforms work 

together to implement the recommendations in this report. 

1.2 Appoint a federal task force or commission to examine the needs of 

American Indian/Alaska Native children exposed to violence. 

American Indian/Alaska Native (AIAN) children have an exceptional degree of unmet need for 

services and support to prevent and respond to the extreme levels of violence they 

experience. The federal government has a unique legal responsibility for the welfare of AIAN 

children. It also has a special relationship with Indian tribes based, at least in part, on its trust 

responsibility. In fact, in much of Indian country, the U.S. Attorneys act as the primary 

prosecutors of violent crime. Sadly, federal partners working in Indian country are all too familiar 

with the societal impacts of children exposed to violence. The Defending Childhood Task Force 

heard compelling testimony that underscored this reality. Although this task force could not 

adequately address the complexity of the issues, it recognizes the urgent need for further 

attention. To that end, a federal task force or commission should be developed to examine the 

specific needs of AIAN children exposed to violence and recommend actions to reduce crime 

and violence and protect AIAN children from abuse and neglect. The task force or commission 

Children Exposed to Violence 9 
should explore the additional burdens confronting AIAN communities in meeting the needs of 

children exposed to violence and propose policies and courses of action for addressing the 

current gaps in services. 

Priorities for this task force or commission should include improving the identification and 

appropriate treatment of AIAN children who have been exposed to violence, helping AIAN 

communities and tribes rise out of violence, and involving AIAN youth in solutions. This task 

force or commission also must examine and address the needs of AIAN children living outside 

of reservations, in urban or rural settings off of AIAN lands. The task force should be developed 

through a consultation process consistent with the government-to-government relationship 

between the federal government and tribal governments. The appointment and management of 

the task force or commission and the selection of its members should be carried out through an 

equal collaboration between the Attorney General and the Secretary of the Interior. Special 

attention should be paid to the incarceration of AIAN children who are convicted and sentenced 

in the federal judicial system. 

1.3 Engage youth as leaders and peer experts in all initiatives defending 

children against violence and its harmful effects. 

The National Advisory Committee on Violence Against Women put the case clearly: “Youth 

engagement is critical to preventing violence. Youth are well-positioned to inform efforts that 

prevent teen dating and sexual violence and abuse; creating opportunities for them to do so 

offers lasting benefits and is consistent with the literature on positive youth development.” 

As stated in that report and confirmed by numerous scientific studies,157-159 youth are the most 

credible and motivating spokespersons for children their own age and younger. This is 

increasingly the case with the widespread multimedia Internet and social media communication 

channels that enable children to interact with and influence each other almost constantly and 

instantaneously. Youth’s own experiences also can be powerful sources of new and motivating 

information for adults. Seeing the challenges and dilemmas facing young people through their 

own eyes can produce immediate change in the attitudes and behavior of people of all 

ages.158,160-164 Although trusted adults can serve as credible and influential sources of 

information and guidance concerning children’s safety and well-being, there is no substitute for 

the personal experience and youthful creativity that children can provide. 

Involving youth as planners and problem solvers, as well as communicators, is essential to 

develop effective solutions to the complex problems leading to and resulting from children’s 

exposure to violence. When the voices and minds of young people are included in formulating 

an understanding of these problems and potential solutions, these and other youth are 

motivated to become “advocates in shaping anti-violence and pro-healthy-relationship initiatives 

— turn[ing] youth into dedicated activists who have an enduring commitment to this work [and] 

creating a cadre of positive ‘up-standers.’”165 This positive youth development model has been 

proven to build on and enhance the strengths that youth bring to their families, peer groups, 

schools, and communities, particularly their ability to form and sustain healthy relationships, a 

Children Exposed to Violence 10 
positive work ethic, and leadership skills, which can serve as a foundation for future generations 

for years to come in this country. 

1.4 Ensure universal public awareness of the crisis of children exposed 

to violence and change social norms to protect children from violence and 

its harmful effects. 

The general public has a limited understanding of the extent of children’s exposure to violence 

and its adverse impact on health, social-emotional development, and academic and economic 

achievement. Moreover, the public has even less awareness that solutions to this crisis are 

within our grasp. The destructive consequences of children’s exposure to violence need not be 

inevitable, and healing for children is possible in the aftermath of violence, if children who are at 

risk and those who actually are exposed to violence are identified in a timely manner. An 

informed citizenry can advocate for higher levels of services and support from policymakers for 

prevention and early intervention for children exposed to violence. It can challenge the 

misplaced pessimism that makes violence seem like an inevitable part of growing up for some 

children. It can be the engine to advance good public policy that embraces an alternative 

positive norm that no child’s life and future should be scarred by the fear, mistrust, and sense of 

failure that violence causes. In addition, it can teach children and adults to reject violence as a 

tool or solution and instead to find strength and success through knowledge, responsibility, and 

kindness. 

A national public awareness campaign would open the door to a fundamental change for the 

better in which every organization, community, and household in our country expects that every 

child should grow up safe and achieve his or her unique individual potential, and everyone takes 

responsibility for making this a reality. We all want our children to be safe and successful in their 

families, neighborhoods, schools, and future careers and to be good and productive citizens. 

We do not want to see them punished for making the mistakes that result from not yet having a 

fully formed brain or the maturity and life experience of an adult — yet we also do not want them 

to harm or endanger their peers, families, schools, or communities by acting irresponsibly or 

violently. When children are exposed to violence, they need protection, care, and help in healing 

that restores their trust, so that they do not go astray by resigning themselves to a life of 

violence, either as a victim or as a perpetrator. We can provide that help only if we find those 

children as soon as possible and let none of them fall between the cracks into a life of despair 

and more violence. On the national, state, and local community levels, this will require 

leadership from the federal and state governments, as described in the first recommendation, 

and also from the national and local media; child and family advocacy and services 

organizations; civic and business leaders and organizations; all ethnocultural groups; and 

opinion leaders from entertainment, sports, popular culture, education, politics, and the family 

and child welfare, healthcare, and justice systems. 

There are precedents for solving epidemic and apparently intractable problems. Just a few 

decades ago, smoking was more the norm than the exception. But as mounting research on the 

health impact of firsthand and secondhand smoke became impossible to ignore, the executive 

Children Exposed to Violence 11 
and legislative branches of the federal government acted on the recommendations of the 

Surgeon General to protect the entire nation. Whereas smoking was formerly seen as an 

individual choice affecting only the smoker, it is now understood to be an act with adverse 

consequences for everyone — not only the smoker and those within breathing distance, but 

every citizen as a result of escalating healthcare and insurance costs, losses in economic 

productivity, and the burden of caring for and grieving the loss of others with smoking-related 

illnesses. Through research, education, and the leadership of the federal government, 

coordinated efforts in the public and private sectors at the local, state, and national levels have 

changed the trajectory of that epidemic 180 degrees toward a rejection of the myth that smoking 

is a harmless vice and a massive reduction in smoking, all within the timespan of a single 

generation. 

Violence toward children requires a similar national effort with all hands on deck. Stopgap 

solutions, no matter how well intended and carried out, cannot turn this tide. Federal leadership 

combined with sustained involvement by every state and all local communities is needed to 

prevent violence from marring the lives and undermining the well-being of all of our children. 

Action is needed on many fronts to identify children who are victims of violence or at risk, to 

provide them with help in recovery, and to make them safer and help them heal in their families, 

their communities, and the legal or child welfare systems. The rest of this report describes how 

social norms that tolerate or encourage violence can be changed if we take action now. 

1.5 Incorporate evidence-based trauma-informed principles in all 

applicable federal agency grant requirements. 

The federal government should lead the development of standards of care for identification, 

assessment, treatment, protection, and other crucial services for children exposed to violence, 

as well as protocols for monitoring the quality of these services as measured against the 

standards. The Administration for Children and Families’ blueprint for embedding traumainformed services and trauma-specific evidence-based treatment into all federally funded child 

welfare and children’s health program requirements should be extended to all comparable 

funding programs involving services to children exposed to violence and their families. 

1.6 Launch a national initiative to promote professional education and 

training on the issue of children exposed to violence. 

Federal, state, and local government agencies overseeing post-secondary and professional 

education in colleges, universities, and professional schools should work with the leadership of 

these educational systems and the leadership of their professions. They should establish 

standards and a curriculum ensuring that every pre-professional student and all practicing 

professionals who provide services to children and families are aware of the scope of the 

problem of children’s exposure to violence. The curriculum should also ensure that these 

professionals understand their responsibility to provide trauma-informed services and traumaspecific evidence-based treatment within the scope of their professional expertise. 

Children Exposed to Violence 12 
1.7 Continue to support and sustain the national data collection 

infrastructure for the monitoring of trends in children exposed to violence. 

The groundbreaking National Survey of Children Exposed to Violence has established beyond 

doubt the scope and prevalence of exposure to violence in childhood. The survey has 

conducted second and third waves of interviews to monitor trends that warrant rapid intervention 

when there is evidence of increasing violence or a failure to reduce the prevalence of and harm 

caused by children’s exposure to violence. Continued support is essential to ensure that this 

survey is conducted at regular frequent intervals. 

Surveys of violence conducted using governmental data from the justice system (such as the 

Bureau of Justice Statistics National Crime Victimization Survey), education (such as 

Department of Education monitoring of the Race to the Top program), and health and human 

services (such as the National Survey of Adolescents and the Centers for Disease Control and 

Prevention’s Adverse Behavioral Risk Factor Surveillance program to monitor ACEs) must be 

examined in concert with the NatSCEV on a regular basis to establish a clear picture of 

children’s continuing exposure to violence. 

1.8 Create national centers of excellence on children’s exposure to 

violence. 

The scientific, clinical, and technical expertise necessary to coordinate the implementation of a 

sustained public awareness campaign, reforms to maximize outcomes and efficiencies in 

funding requirements, standards for professional education and practices, and ongoing 

monitoring of trends and translation of the findings into continued progress in all these initiatives 

exist throughout the country. However, they need to be consolidated in centers of excellence to 

systematically ensure the success of these crucial goals. The National Child Traumatic Stress 

Network Treatment and Services Adaptation Centers provide a model for the development of a 

full complement of the needed centers of excellence. 

1.9 Develop and implement public policy initiatives in state, tribal, and 

local governments to reduce and address the impact of childhood 

exposure to violence. 

The ultimate success of the national initiatives outlined in previous recommendations depends 

upon adoption and implementation at the state, local, and tribal level in every community. Every 

community’s governing institutions and leaders should receive guidance from the national 

centers of excellence to enable them to create local public policy initiatives, regulations, and 

services that ensure that children are protected against exposure to violence to the fullest extent 

possible. 

Children Exposed to Violence 13 
1.10 Finance change by adjusting existing allocations and leveraging new 

funding. 

The federal government should redirect funds to proven approaches for defending children 

against exposure to violence by providing financial incentives and encouragement to the states 

and, through them, to communities. Significant budget cuts are a reality at all levels of 

government, but they cannot be an excuse for failing to protect and heal our nation’s children. 

We must use our resources more wisely by seizing opportunities for new funding, like those 

provided in the Affordable Health Care for America Act (AHA); shifting resources to produce 

better outcomes, like spending more to support struggling families than to place children in 

foster care; exploring how best to use federal formula and block grants to stimulate change; and 

pooling resources across government agencies to support common goals. Public-private 

partnerships also are essential. The following examples are illustrative but by no means a 

complete or final path toward enhanced funding. 

In the child welfare system, in 1974, the landmark Child Abuse Prevention and Treatment Act 

(CAPTA) was enacted to fund grants to states for child abuse and neglect investigation, 

prosecution, prevention, and treatment programs. It also funded states, Indian tribes or tribal 

organizations, and public or private agencies and organizations to establish demonstration and 

workforce development initiatives. Additional funding has been allocated through the enactment 

of the Family Preservation and Support Services Program Act (1993) and the Adoption and 

Safe Families Act (1997), as well as a number of specialized child protection, family services, 

foster care, and adoptions legislative initiatives since 2002. Over these decades, funding for 

children’s mental health through block grants to states has underwritten a parallel network of 

therapeutic programs, such as child guidance clinics. In 2001, the Child Traumatic Stress 

Initiative Act established funding through the Department of Health and Human Services 

(DHHS) to create a national network of specialized treatment programs and technical 

assistance centers for traumatized children. Coordinating all programs and initiatives funded by 

these legislative mandates to reduce redundancy could provide the resources needed to 

expand therapeutic services for children exposed to violence to all communities in this country. 

In the field of family and domestic violence, the 1984 Family Violence Prevention and Services 

Act (FVPSA) was enacted to fund formula grants to states and tribal organizations for shelter 

and supportive services and state- and territory-wide domestic violence coalitions, as well as a 

national hotline for victims. Also in 1984, the Victims of Crime Act (VOCA) was enacted to fund 

state and local programs for crisis intervention, counseling, and support services for crime 

victims. VOCA has continued without lapsing, and FVPSA was reauthorized in 2010 (after 

expiring in 2008) as a part of the CAPTA reauthorization. In 1994, the Violence Against Women 

Act (VAWA) was enacted to fund “community-coordinated responses” to domestic violence, 

sexual assault, and dating violence and stalking, including Centers for Disease Control and 

Prevention demonstration projects in several states to end rape (EMPOWER) and prevent 

intimate partner violence (DELTA). Some VAWA programs focusing on prevention and early 

intervention with children and youth have yet to be fully funded. The statutes and funding 

provided by FVPSA, VOCA, and VAWA should serve as a basis for a national infrastructure to 

Children Exposed to Violence 14 
address the needs of children exposed to violence, aiding interruption of and recovery from 

violence. 

Although some movement has been made toward integration of programs and funding across 

systems, initiatives and programs tend to be primarily focused on specific subsets of problems 

for which children’s exposure to violence remains a largely unstated common core issue. At the 

local community level, families and providers often break through the silos with innovative 

initiatives that cut across multiple systems, as described by many testimonials provided to the 

task force. Those efforts must be capitalized upon as templates for a coordinated national effort 

that uses their lessons learned and systematically encourages and funds the dissemination of 

these models (always adapted by each local community based on its unique circumstances and 

resources). 

With the implementation of healthcare reform through AHA, states will have more resources and 

increased pressure to focus on prevention and early intervention services as a way to improve 

health. Funding directed toward evidence-based treatment by AHA should be designated 

specifically to address the psychological and behavioral problems that result from children’s 

exposure to violence. Funding also should go to prevention programs designed to enhance 

children’s and families’ wellness and to reduce healthcare costs associated with inadequate or 

delayed treatment of the effects of children’s exposure to violence. 

VOCA funds can be better allocated to help children exposed to violence. These funds are 

collected from criminal penalties that are designed to serve victims of the crimes committed 

against them. Congress has placed a limit, or “cap,” on the amount of funds that are distributed 

to each state under the mandate of this legislation. If those caps were removed, the states could 

receive more money to provide trauma-informed services and trauma-specific treatment for 

children exposed to violence without any new government outlays. 

Funding formulas in the child protection system can be shifted to allow states to increase 

support services for struggling families and children before the option of foster care. Currently, 

$7 billion annually pays for out-of-home placements for children who have been taken from their 

homes. Of this, only slightly more than 10 percent ($900 million annually) goes to prevention 

and protection services for families instead of funding child welfare agencies. 

Congress can require states that receive formula and block grant funds to develop intervention 

programs that treat children exposed to violence and to develop multidisciplinary training for all 

professionals who work or come into contact with children.166 

Funds available to states through Social Security Act Title 4E waivers can be used to invest in 

national dissemination of innovative community-designed models for sexual assault services for 

victims of child sexual abuse and sexual exploitation, such as those currently funded as limited 

pilot or demonstration projects under the Family Violence Prevention and Services Program at 

DHHS. Tax incentives can be provided to public and private organizations that provide services 

to prevent children’s exposure to violence and treat children who have been victimized. 

Children Exposed to Violence 15 
 

These are important potential sources of funding to accomplish the goals the Task Force has 

set forth to protect children from exposure to violence and its harmful effects – but they are by 

no means the only possible sources of funding for these crucial initiatives. Leadership in all 

levels of government and the private sector, as well as advocates working on the national and 

local levels, must come together to find or create the funding needed in order to defend our 

nation’s children from exposure to violence. 

Children Exposed to Violence 16 
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Children Exposed to Violence 25 
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Children Exposed to Violence 29 
Chapter Two: Identifying Children Exposed to Violence 

Every year, millions of children in this country are exposed to violence,1-4 yet few of these 

children ever receive help in recovering from the psychological damage caused by this 

experience.3,5-11 The first crucial step in protecting our children is to identify and provide timely 

and effective help to those who already are being victimized by violence. 

We all know that children face many kinds of violence in their homes, schools, and 

communities, so why isn’t every child who is victimized by violence identified and helped? The 

main reason is that we — as individuals, as families, and as a society — have not fully 

committed ourselves to identifying and eradicating violence and the deep harm it causes in the 

lives of American children. We have not prepared ourselves to take on the challenge of letting 

no instance of violence in any child’s life go unrecognized. 

We can make and achieve that commitment. We can and we must identify every child who is 

exposed to violence in every community in our country. We can and we must make sure that 

our children are protected from further violence. 

The first step in making the commitment to protect children from violence is to make sure that 

each of us — in every community in this country — knows how to recognize the signs of 

children who have been exposed to violence. This can be difficult because most of us have 

become accustomed to seeing and hearing about violence every day. Too often, violence 

directed at or witnessed by children is ignored or left unquestioned because we make the 

mistake of assuming that it does not cause lasting harm or that it is just a “normal” part of life 

that all children are resilient enough to cope with. We may believe that these “ordinary” acts of 

violence actually help children by “building character” or inoculating them against serious 

assaults they may face as they grow older, but in fact, psychological science has thoroughly 

debunked the myths that violence in any form does not hurt our children and that violence in any 

form can be good for our children.12-18 

Instead, science has shown that what appear to be “minor” forms of exposure to violence (such 

as witnessing violence without being physically touched) can cause substantial harm (see the 

Glossary for definitions of violence). Violence in many forms can cause psychological wounds 

that lead to severe anxiety, depression, anger, aggression, guilt, shame, school and 

employment failure, substance addiction, and criminal behavior.17-27 

Early identification of violence exposure is essential for preventing and addressing these 

problems. If these wounds go unnoticed and the violence is allowed to occur repeatedly, the 

resulting psychological injures can compromise a child’s entire future by creating a lifelong 

pattern of anger; aggression; self-destructive behaviors; academic and employment failures; 

and rejection, conflict, and isolation in every key relationship.26,28,29 

In addition, early identification can save children exposed to violence — and their families and 

communities — from becoming trapped in a tragic revolving door of violence and damaging 

psychological trauma. Once a child has been exposed to violence, she or he is more likely than 

Children Exposed to Violence 30 
other children to be exposed to further violence.27,30-34 This can happen when a bully or predator 

recognizes a child who is vulnerable or unprotected as an easy target for further 

victimization.35,36 It also happens when children live in families and communities or go to schools 

in which violence has become so pervasive that further exposure is inevitable and may even be 

a daily phenomenon.37-39 Finally, it can happen when a family, school, or community becomes 

resigned to tolerating violence and everyone who is exposed becomes paralyzed by a sense of 

unrelenting fear, helplessness, and hopelessness.40 

To break the cycles of children’s repeated exposure to violence, we must watch out for, identify, 

and help every victimized child. That may not eliminate the violence or its root causes, but it can 

build a new sense of watchfulness or gatekeeping, hope, and empowerment that is essential for 

families (see Chapter 3) and communities (see Chapter 4) to rise up out of violence. 

Identification of children exposed to violence begins with teaching everyone in all of our 

communities to be more aware of and better able to recognize any instance and every form of 

violence to which children are exposed, from the “smallest” acts of emotional or physical assault 

or cruelty to the kinds of violence that maim and kill. 

This means educating not only children but also their caregivers and all adults in every 

community in this country; so that everyone invests in and sustains a commitment to be 

watchful and never overlook or ignore any incident in which a child is exposed to violence. 

For many adults, this will be a welcome reminder and encouragement to continue to be 

concerned and watchful on behalf of the children in their family and community. For others, this 

may be an initially unsettling wake-up call, challenging their belief that violence is not really such 

a big problem for children generally or for the children they know and care about. If the message 

is communicated respectfully, consistently, and without criticism or blame, the skeptics (or those 

who simply have not been informed) can become the strongest advocates for this cause. 

All adults in our country need to come together to advocate for the safety of our nation’s 

children. In doing so, we will be advocating for our nation’s social capital — our future 

workforce, educators, innovators, and caretakers. Our ability to protect and support positive 

development of our social capital is critical to our success as a nation and as a world leader. 

If we all get on board and personally commit ourselves to proactively protecting children from 

exposure to violence and psychological trauma, we will achieve a massive shift and positive 

evolution in our country’s fundamental social norms and in the very fabric of our society. 

Recognizing and protecting children from exposure to violence is a way to stand up for a 

universal value that is a foundation for our country: Every human being deserves freedom, 

safety, and security. Every human being deserves to live free from violence. 

This also means formally preparing professionals and childcare workers who work with and 

watch children and families daily to systematically look for any sign that a child has been 

exposed to violence or sustained psychological trauma.41 Many of the national organizations 

that represent professionals who care for, educate, or are legally responsible for children have 

Children Exposed to Violence 31 
made the identification of children exposed to some forms of violence — notably physical and 

sexual abuse and domestic violence — a high priority; many professions have taken the 

additional step of making the identification of children and families exposed to violence a 

fundamental legal requirement and ethical duty.42 This needs to happen in every profession for 

every professional or paraprofessional whose work involves children and families. 

A second crucial step is to learn how to recognize when a child is exposed to violence and 

psychological trauma. Experts have developed thorough descriptions of the precise ways in 

which children are exposed to violence1

 as well as the precise ways in which they express 

psychological trauma after violence exposure, including behavioral, medical, and educational 

and learning problems.18,43,44 These descriptions and surveys are available in non-technical 

terms to the general public (see, for example, https://www.ncjrs.gov/pdffiles1/ojjdp/227744.pdf) 

and can serve as the basis for national and local public information campaigns. They also have 

been converted into practical tools that professionals can use in screening and assessment to 

identify children who need help recovering from violence (see, for example, fact sheets from 

www.nctsnet.org, www.istss.org, and www.ncptsd.va.gov). 

Specialized assessments have been developed and scientifically proven effective in identifying 

the needs of children who have been exposed to different forms of violence, such as neglect, 

witnessing domestic violence, being assaulted during domestic violence, sexual abuse, assault 

and physical abuse, trafficking, dating violence, witnessing homicide and suicide, and 

community violence in neighborhoods and schools and by violent gangs.45 Professionals 

working with children and families must be prepared to use these tools with every child they 

encounter. There is no single one-size-fits-all approach to assessing and designing treatment 

for children exposed to violence, so professional assessors must have specialized expertise in 

working with the unique problems caused by different forms of sexual violence, domestic 

violence, and community violence. The problems experienced by children exposed to multiple 

types of violence, also known as “polyvictimization,” raise further, correspondingly complex 

issues for assessment and treatment service planning.46,47 

A third essential step is to prepare ourselves to know how to help when we see or learn about a 

child who is exposed to violence. Most of us know we should do something, but we do not know 

exactly what, nor to whom we should turn. We also do not want to make things worse by 

pointing out a problem and then failing to help the victimized children become safe and recover. 

Every adult should know how to contact the appropriate agencies and professionals who are 

charged with protecting children — child protective services, law enforcement, Child Advocacy 

Centers, courts and attorneys, pediatric providers, community- and school-based clinics, 

hospitals, and school administrators — when they see or learn about a child who may need 

help. Creating practical pathways to help is essential to ensuring that children who are identified 

get the right help in a timely manner. In the next chapter, we will discuss what kinds of help are 

appropriate and effective, but before that can happen, we need to know how to get children help 

that guarantees recovery and future health. Toward that end, the task force offers the following 

recommendations to ensure that no child exposed to violence goes without help. 

Children Exposed to Violence 32 
2.1 Galvanize the public to identify and respond to children exposed to 

violence. 

The general public has a limited understanding of the extent of children’s exposure to violence 

and its adverse impact on health, social-emotional development, and academic and economic 

achievement. The public has even less awareness that solutions to this crisis are within our 

grasp. Violence against children is not inevitable, and healing for children is possible in the 

aftermath of violence if they are identified in a timely manner. An informed citizenry can 

advocate for higher levels of services and support from policymakers for prevention and early 

intervention for children exposed to violence. They can challenge the misplaced pessimism that 

makes violence seem like an inevitable part of growing up for some children. An informed 

citizenry can be the engine to advance good public policy that embraces an alternative positive 

norm that no child’s life and future should be scarred by the fear, mistrust, and sense of failure 

caused by violence. Research, skills, curricula, and tool kits are available today to help an 

informed citizenry teach children and adults to reject violence as a tool or solution and instead to 

find strength and success through knowledge, responsibility, and compassion. This opens the 

door to a fundamental change for the better in which every organization, community, and 

household in our country expects that every child should grow up safe and everyone takes 

responsibility for making this a reality. 

The White House should take the lead in developing and implementing a national public 

awareness campaign on the impact of children’s exposure to violence, the costs of failing to 

intervene, and effective approaches to trauma-informed services and trauma-specific treatment 

for these children. Such a campaign would be suitably launched with a White House conference 

on children exposed to violence. Regional, state, and local community campaigns to promote, 

advance, and sustain public awareness of the epidemic of children exposed to violence also 

must be mobilized and sustained with leadership from the federal and state governments. 

These public awareness campaigns also require leadership from the national and local media; 

child and family advocacy and service organizations; faith-based organizations; grassroots 

community organizations; civic and business leaders and organizations; and opinion leaders in 

sports, entertainment, popular culture, education, politics, and the justice system. 

2.2 Ensure that all children exposed to violence are identified, screened, 

and assessed. 

Professionals and paraprofessionals working with children and families recognize the vital role 

they play in identifying children exposed to violence. However, most view this as an optional 

rather than core part of providing care and services.48,49 Every professional and 

paraprofessional who comes into contact with pregnant women and children must routinely 

identify children exposed to (or at risk for) violence, provide them with trauma-informed care or 

services, and assist them and their families in accessing evidence-based trauma-specific 

treatment. This includes physicians; nurses; emergency medical technicians; therapists; police 

officers; family and juvenile court judges and attorneys; domestic violence and sexual assault 

advocates; child welfare workers; sexual abuse evaluation specialists; home visitors; childcare 

Children Exposed to Violence 33 
providers; teachers; school counselors; summer camp staff; faith-based organizations; local, 

regional, and national youth group organizations; and the paraprofessional staff working in all of 

these fields. 

To support and sustain this trauma-informed change, screening to identify children exposed to 

violence should be established as required standard by professional organizations and 

government licensure or certification. All child- and family-serving practice groups, agencies, 

and institutions should be required to train their staff to identify, screen, and assess children for 

exposure to violence using tools that are suitable to their professional roles and responsibilities 

and consistent with the standards of the service systems in which they work. 

Evidence-based screening tools for identifying children exposed to traumatic events, adverse 

childhood experiences, and victimization are readily available from those who developed them 

and from technical assistance centers (see, for example, www.nctsnet.org, www.istss.org, and 

www.ncptsd.va.gov). However, most professionals do not know how to efficiently screen for 

children exposed to violence, and they are unaware of the existence of or need for using these 

tools.50 Scientifically proven tools available to professionals include screening instruments for 

the rapid identification of children exposed to violence — such as the Juvenile Victimization 

Questionnaire Screening Version51,52 and the Traumatic Events Screening Instrument for 

Children and Parents53,54 — as well as screening instruments for rapid identification of each 

child’s specific needs for trauma-informed care and trauma-specific treatment, such as the 

UCLA PTSD Reaction Index55 and the Trauma Symptom Checklist for Children.56 

2.3 Include curricula in all university undergraduate and graduate 

programs to ensure that every child- and family-serving professional 

receives training in multiple evidence-based methods for identifying and 

screening children for exposure to violence. 

Most undergraduate education programs and pre-professional graduate-level education 

programs provided by universities, professional schools, colleges, and technical schools include 

at most one or two class sessions or seminars — and often none at all — on children exposed 

to violence or the impact of violence or psychological trauma on development and physical 

health.57 As a result, graduates from these programs lack knowledge about the pervasiveness 

and the impact of exposure to violence among children from birth through adolescence. 

All professionals serving children and families must be equipped with the knowledge and skills 

they need to recognize and address the impact of violence and psychological trauma on 

children. National, regional, and local professional and educational organizations, institutions, 

experts, and other concerned youth and adults must work with government and private-sector 

leaders and agencies to organize a coordinated program of pre-professional and professional 

education and technical assistance centers. The centers must prepare all child- and familyserving professionals to understand the scope and seriousness of the epidemic of children 

exposed to violence and psychological trauma and to effectively screen every child and family 

they serve to identify children exposed to violence. 

Children Exposed to Violence 34 
2.4 Develop and disseminate standards in professional societies and 

associations for conducting comprehensive specialized assessments of 

children exposed to violence. 

Professional societies (such as national associations of educators; law enforcement, public 

health, and faith-based professionals; athletic coaches; physicians; psychologists; psychiatrists; 

social workers; counselors; marriage and family therapists; and specialists in child abuse and 

domestic violence prevention and treatment) should develop, update, and disseminate 

standards for training and practice in specialized assessments of children exposed to violence 

and psychological trauma. 

Special consideration should be given to input from and adaptation by and for special 

populations, including children and families of color; AIAN children and families; LGBTQ youth; 

and children with emotional, cognitive, and physical disabilities. Licensing boards for 

professionals serving children and families should adopt continuing education requirements that 

include children’s exposure to violence and approaches to identifying these children among the 

topics that professionals must complete at least once in the process of renewing their licenses. 

Children Exposed to Violence 35 
 

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Children Exposed to Violence 39 
 

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Children Exposed to Violence 40 
 

Chapter Three: Treatment and Healing of Exposure to 

Violence 

The majority of children in our country who are identified as having been exposed to violence 

never receive services or treatments that effectively help them to stabilize themselves, regain 

their normal developmental trajectory, restore their safety, and heal their social and emotional 

wounds.1-5 But help isn’t optional or a luxury when a child’s life is at stake; it’s a necessity. Even 

when our professionals and community members are able to put in place identification and 

assessment protocols for children exposed to violence, if effective services and treatment are 

not provided, children exposed to violence and psychological trauma become locked into a 

struggle to survive, constantly defending themselves against both real and perceived dangers or 

against further abuse and neglect.6-8 For many victimized children, living in survival mode 

(constantly reacting in the flight-or-fight response, even when danger is not imminent) may 

fundamentally alter the rest of their lives, derailing their psychological, physical, and socialemotional development. Even after the violence has ended, these child survivors suffer from 

severe problems with anxiety, depression, anger, grief, and posttraumatic stress that can mar 

their relationships and family life and limit their success in school or work, not only in childhood 

but throughout their adult lives. Without services or treatment, even children who appear 

resilient and seem to recover from exposure to violence still bear emotional scars that may lead 

them to experience these same problems years or decades later (see www. 

http://acestudy.org).9-16 

Fortunately, appropriately selected evidence-based treatments17-20 and services21-23 provided in 

a timely manner24 can reverse the adverse effects of violence and psychological trauma and put 

children back on a healthy developmental course that allows them to once again resume normal 

academic and social engagements and achieve a healthy and fulfilling life.19,25-29 This chapter 

describes the essential features of successful treatments and services for children exposed to 

violence and psychological trauma, and it makes specific recommendations for how such 

treatments and services can be made more reliably accessible for these children. 

Treatments and services for children exposed to violence actually begin before these children 

ever meet a therapist or counselor. Every professional who comes into contact with pregnant 

women and children can make a vital contribution to the recovery, healing, and safety of 

children exposed to (or at risk for) violence by providing them and their families with traumainformed care and trauma-specific treatments (see Glossary for complete definitions). These 

professionals include tens of thousands of physicians, nurses, emergency medical technicians, 

therapists, police officers, family and juvenile court judges and attorneys, domestic violence and 

sexual assault advocates, child welfare workers, sexual abuse evaluation specialists, home 

visitors, child care providers, teachers, school counselors, and the paraprofessional staff 

working in all of these fields in every community. 

These providers offer trauma-informed care, trauma-specific treatments, and trauma-focused 

services to children and families when, according to an expert consensus panel of providers and 

parents convened by the National Center for Trauma-Informed Care, their work with children 

Children Exposed to Violence 41 
“incorporate[s] a thorough understanding of the prevalence and impact of trauma, the role that 

violence and trauma play, and the complex paths to healing and recovery.” This means 

providing services that avoid “re-traumatizing those who seek assistance,” focus on “safety 

first,” are based on a commitment to “do no harm, ... facilitate the participation of trauma 

survivors in planning the environments in which they live and the services they receive, and ... 

correspondingly ensure the safety, well-being, and meaningful involvement in systemic 

decisions of the providers of services and supports.” 

Roger Fallot and Maxine Harris, who have led the initiative for trauma-informed services in this 

country for more than two decades, summarize the foundation of this approach in 10 values or 

principles that should guide every provider of services for children and their families: preserving 

safety, promoting choice, building resilience, including everyone, empowering with knowledge 

and skills, fostering collaboration, sharing information transparently, moving beyond 

stereotypes, developing a support network for each client, and, of special relevance here, 

promoting nonviolence.23 

When these trauma-informed care principles are applied rigorously in every encounter with 

children and families, providers are able to demonstrate to the children and families they work 

with that it is possible — and actually can change life for the better — to work together on 

healing the social-emotional wounds and damage to relationships caused by violence. This can 

inspire the child and the family to utilize the services to their fullest instead of viewing providers 

as uncaring or insensitive adversaries. And it can fundamentally change the entire program or 

organization, making it a “sanctuary” in which healing can safely occur because the safety and 

well-being of everyone involved — including the providers — is valued and ensured (see 

http://www.sanctuaryweb.com/institute.php). Trauma-informed services can transform entire 

provider organizations and systems as well as the lives of the countless children they serve who 

have been exposed to violence. 

As of 2012, however, the majority of professionals and paraprofessionals who provide services 

to children and families have never received any preparation on how to provide trauma-informed 

care, trauma-specific treatments, or trauma-focused services.30 This means that despite the 

best of intentions, they often will not be aware that even the youngest child or the child who 

appears invulnerable and resilient may have been profoundly affected by exposure to violence 

and ensuing psychological trauma. Professionals and paraprofessionals who provide services to 

children and families normally don’t see the connection between a child’s presentation, 

behaviors, and symptoms and the exposure of that child to violence.6,8 As a result, serious 

misdiagnoses and service and treatment mistakes are made that not only reduce the 

effectiveness of the service or treatment but also may increase the possibility of further 

psychological trauma and a resulting increase in the risk of future exposure to violence.19 

When these misdiagnoses and mistakes are made — even with the best of intentions — the 

willingness of the child and family to work collaboratively with providers often disappears. 

Without approaches that use trauma-informed care, providers and parents may overlook the 

violence and exposures to trauma and thus feel powerless to change a child’s serious socialemotional problems, as they assume that these are the immutable results of “bad” genes, “bad” 

Children Exposed to Violence 42 
 

choices, or “bad” family and peer influences. They may fall back on providing generic advice 

that rarely helps and can cause further alienation or stigma, such as simply diagnosing the child 

with a psychiatric, behavioral, or learning problem, or telling the child that she/he should simply 

stop worrying and misbehaving because “the violence wasn’t so bad or is over now.” 

Frustrated and demoralized with obtaining poor outcomes, providers may see no point in 

helping the child and family who were exposed to violence to access effective treatment. This is 

a tragic mistake that not only violates the provider’s ethical duty to the child and family but also 

costs that child and family the opportunity to heal and recover from violence, and it ultimately 

costs our states and our country hundreds of millions of dollars in ineffective, unsuccessful 

treatments, lost educational opportunities, and inappropriate use and overutilization of medical, 

public health, and law enforcement services.22 

Moving every provider and all programs and organizations that work with children and families 

in the direction of becoming “trauma informed” is essential to preventing children who have 

been exposed to violence from suffering further when they should be — and are absolutely 

capable of — healing the wounds of exposure to violence and psychological trauma. And, 

importantly, expert consensus groups in trauma-informed care have the trauma-informed care 

technology developed and ready for dissemination and implementation now: this includes 

research evidence, tool kits, training curricula, and evidence-based trauma-informed service 

models and trauma-specific treatments29 (see, for example, www.nrepp.samhsa.gov, 

www.crimesolutions.gov, www.ojjdp.gov/mpg/, http://www.colorado.edu/cspv/blueprints). 

For many children exposed to violence, obtaining trauma-focused services is just the first step in 

healing. These are children who need timely and evidence-based trauma-specific treatment in 

order to stop suffering from the symptoms that result when violence interrupts development and 

traps a child in survival mode. A new generation of treatments has emerged and been proven 

highly effective in helping children recover from the severe emotional and behavioral problems 

caused by exposure to violence. These are called trauma-specific treatments. Trauma-specific 

treatments are similar to but also different in important ways from other mental health therapies 

or counseling for children and adolescents.27,29,31 

Violence requires children to become survivors in order to cope with the social-emotional impact 

of experiencing extreme fear, loss, powerlessness, immobilization, and ultimately betrayal at the 

hands of their trusted loved ones or caretakers or both. When children become focused on 

survival, they are likely to develop mental health and behavioral problems as a byproduct of 

feeling extreme fear, being torn apart from loved ones or betrayed by their loved ones, and 

being powerless to prevent or undo the harm that results from being immobilized and unable to 

escape the abuse or the witnessing of violence. 

Tragically, living in a state of fear, grief, and helpless immobilization requires the child to cope 

by worrying and constantly watching for the next danger (a state of anxiety and hypervigilance), 

by giving up on the hope of a safe and happy life and having trustworthy relationships (grief and 

depression), by fighting back to protect themselves and those they care about (anger and 

aggression), by acting without taking the time to think (impulsivity), by never letting down their 

Children Exposed to Violence 43 
 

guard (hyperactivity and sleep problems), and by trying to stay safe by avoiding anything that 

reminds them of the violence and taking whatever they can get from life to provide some relief 

(interrupted development: substance use, high-risk or disruptive behaviors, relationship 

avoidance, school avoidance, delinquency, aggression against peers and authority figures). 

Standard treatments that do not include trauma-informed care components for these socialemotional and behavioral problems are most often not effective.19,27 Current treatment models, 

void of trauma-informed care components, in fact may actually exacerbate the child’s 

symptoms, causing further harm to the child survivor of violence exposure. In order to heal and 

sustain recovery, these children need trauma-focused services and trauma-specific treatment. 

Trauma-specific treatment adds three key ingredients that are missing in other standard 

treatments for children24,31: 

	 First, children and their parents or other caregivers are provided with down-to-earth but 

state-of-the art education about how violence leads to the emotional and behavioral 

problems that have led them to need treatment. 

	 Second, the child and parents/caregivers are helped to use psychological or behavioral 

skills that enable them to feel sufficiently safe and effective enough to be able to 

confidently deal with reminders or distressing memories of past violence instead of being 

perpetually trapped in a state of fear, anger, grief, or depression as a result of their 

exposure to violence. 

	 Third, the child and parents/caregivers are provided with ways of helping, supporting, 

and feeling close to one another that are designed specifically to reduce distressing 

reminders of trauma and memories of violence, and to enable them to feel secure in 

their relationship together when they encounter reminders or memories of trauma and 

violence. 

These ingredients can be provided in multiple settings with numerous service and treatment 

methods that can be customized to the age, gender, and ethnocultural background of the 

survivors of exposure to violence and psychological trauma. Trauma-informed care allows 

trauma-specific treatments to be delivered effectively to help children of different ages and 

stages of psychological development, as well as to be acceptable to and beneficial for both girls 

and boys, children of different ethnocultural backgrounds and sexual identities, and children 

who have different physical or emotional disabilities or who have experienced different types of 

violence. 

In order to ensure that all children exposed to violence have a genuine chance to recover and 

heal from the emotional, social, and physical wounds they experience, the task force proposes 

the following recommendations to develop, support, and sustain existing trauma-informed care, 

trauma-specific treatments, and trauma-focused services as the standard of care nationwide for 

children exposed to violence and psychological trauma. 

Children Exposed to Violence 44 
 

3.1 Provide all children exposed to violence access to trauma-informed 

services and evidence-based trauma-specific treatment. 

Trauma-specific treatments are being provided to thousands of children in this country as the 

result of efforts of government and foundation-funded initiatives — for example, the 

Administration on Children, Youth and Families’ (ACYF’s) Initiative Addressing Trauma Among 

Children and Youth32 and the Substance Abuse and Mental Health Services Administration’s 

National Child Traumatic Stress Network (NCTSN).22 The ACYF initiative leverages regulations 

and funding from many federal programs, links resources to private initiatives sponsored by 

foundations such as the MacArthur and Annie E. Casey foundations and organizations such as 

the Child Welfare League of America with a blueprint for mandating and fully funding traumaspecific treatment for children exposed to abuse and violence. The NCTSN’s more than 75 

centers nationally support tens of thousands of providers in the healthcare, juvenile justice, law 

enforcement, child welfare, education, foster care, mental health, education, law enforcement, 

and military service systems with education and technical assistance on trauma-informed care, 

trauma-specific treatments, and trauma-focused services. 

Despite these important efforts, thousands of communities and millions of children exposed to 

violence and psychological trauma in this country do not have access to trauma-focused or 

evidence-based trauma-specific treatment. Most services and treatment providers in this 

country who help children and their families exposed to violence and psychological trauma do 

not provide trauma-informed care, trauma-specific treatment, or trauma-focused services.1,2 

This must be changed. Many scientifically proven approaches to trauma-informed care, traumaspecific treatments, and trauma-focused services exist for these children, but to fully address 

the epidemic of children exposed to violence and psychological trauma these services and 

treatments must be made available in every community and to every child and family exposed 

to violence and psychological trauma. 

In addition, the challenges of effectively providing services and treatment to these children are 

immense because the emotional wounds and behavioral problems caused by violence are 

severe. To ensure that the best possible services and treatment are received by every child 

exposed to violence, refinements and new models of services and treatment are still greatly 

needed in order to address the complex needs of this population. This requires systematic 

programs of research that are fully funded in order to complete studies that adequately address 

the complexity of the impact of violence exposure and psychological trauma. 

The greatest challenge, however, is to drastically increase the number of treatment providers 

who have the expertise to provide trauma-specific treatment and trauma-focused services to the 

millions of children exposed to violence who currently do not receive trauma-informed care.30 

Meeting this important challenge will require coordinated action by government at all levels, by 

organizations and professionals currently providing services and treatment to children and 

families, and by the professional societies and educational programs that ensure that the 

necessary workforce is available, fully prepared, and consistently and continuously trained. 

Children Exposed to Violence 45 
3.2 Adapt evidence-based treatments for children exposed to violence 

and psychological trauma to the cultural beliefs and practices of the 

recipients and their communities. 

Treatment for the various forms of exposure to violence is not monolithic. Although the number 

of trauma-specific treatments (designed specifically to heal the psychological trauma that results 

from exposure to violence) with clinical and scientific evidence of safety and effectiveness (an 

“evidence base”) is large and continues to grow, few have been tested and proven safe and 

effective specifically with children exposed to violence.17,18,20,24,33,34 Fewer still have been 

adapted and targeted for children exposed to different forms of violence, although we know that 

different types of violence have very different adverse aftereffects and therefore require 

treatments adapted to address those specific aftereffects.24,33,34 We also know that children of 

different developmental stages, different gender (girls versus boys), and children and families of 

different ethnocultural backgrounds and sexual orientations are best helped by treatments that 

are adapted to be consistent with their personal, family, or cultural beliefs and practices.35-46 

Federal, regional, and state funding should be dedicated to the development, testing, 

adaptation, and distribution of carefully adapted, evidence-based, trauma-specific treatments in 

order to reach the millions of children currently in need. 

Unfortunately, some of the most effective treatments are very difficult or impossible to 

implement in remote rural or highly stressed urban areas or with children and families struggling 

with adversities such as homelessness or addictions. These treatments also may be partly or 

wholly incompatible with the cultural beliefs and practices in American Indian/Alaska Native, 

Asian-Pacific, African-American, Latino/Hispanic, or other ethnocultural minority communities. 

The problem is that many of these communities and groups have large numbers of children 

exposed to violence and extreme stress and psychological trauma while having few, if any, 

services. 

Many of the existing trauma-focused services simply have not been implemented in remote and 

underserved locales or have not been translated or adapted to be consistent with the cultural 

beliefs and practices and language(s) of members of those communities. Federal and publicprivate partnership funding should be allocated or developed to establish national, regional, 

state, or tribal task forces and technical assistance centers that engage experts in violence and 

trauma and members of these communities (youth as well as adults) in adapting and delivering 

evidence-based trauma-specific treatments to underserved communities and populations, 

including children and families of color, Native American children and families, children and 

families seeking asylum or that are immigrants, homeless children and their families, lesbiangay-bisexual-transgender-questioning sexual orientation (LGBTQ) families and children, and 

children and families with physical and psychological disabilities. 

Treatments adapted to be acceptable and effective in underserved communities remain 

generally inaccessible to these communities because of shortages in funding, trauma-informed 

professionals, and the technology needed to reach sparsely populated or otherwise inaccessible 

communities.39-46 We must develop portable trauma-informed treatments, harness the power of 

Children Exposed to Violence 46 
digital technologies, and use other strategies to deliver treatment in communities that lack a 

social services infrastructure. The federal government, states, and private philanthropic entities 

all have a role to play in supporting this crucial area of work. 

3.3 Develop and provide trauma-informed care in all hospital-based 

trauma centers and emergency departments for all children exposed to 

violence. 

In 1998, the U.S. Department of Justice’s Office for Victims of Crime (VOC), responding to an 

American Academy of Pediatrics report on youth violence,47 recommended that ”hospital-based 

counseling and prevention programs be established in medical facilities that provide services to 

gang violence victims.” Injured youth arrive in trauma rooms bearing tattoos that read “born to 

be hated, dying to be loved” and “living is hard, dying is easy — to live defeated is to die every 

day.” Injury and death are the norm for children living in violent families and communities. The 

first (and often only) place where they go for any kind of help is the hospital emergency 

department (ED) for urgent medical care. 

Professionals and staff in emergency medical services are uniquely positioned to engage 

children who have been exposed to violence and prolonged extreme psychological trauma who 

may otherwise never be identified. 

At the ED, professionals and staff can provide adult mentoring, needs assessment, and 

immediate access to mental health services with trauma-specific treatments. Model programs 

now in place demonstrate how partnerships sustained between EDs and trauma clinicians; 

hospital-based peer educators; mental health, counseling, and social work professionals; and 

community organizations and public health agencies can use a trauma-informed approach to 

change these children’s lives.48-54 Trauma-informed ED services can empower victimized 

children and youth and their families with skills, support, and resources so that they can return 

to their communities, reject or stand strong in the face of violence, strengthen others who have 

been affected by violence, and contribute to building safer and healthier communities. 

The National Network of Hospital-based Violence Intervention Programs (NNHVIP) is an 

initiative that should be expanded beyond the 20 member programs currently funded in U.S. 

cities to involve EDs across the country in delivering: (1) a comprehensive trauma-informed care 

service model for all youth and their families that begins in the ED, and (2) education to prepare 

emergency physicians and staff to offer trauma-informed health care, trauma-specific 

treatments, and trauma-focused services. 

Children Exposed to Violence 47 
 

3.4 Share information and implement coordinated and adaptive 

approaches to improve the quality of trauma-specific treatments and 

trauma-focused services and their delivery by organizations and 

professionals across settings and disciplines to children exposed to 

violence. 

To be effective, trauma-specific treatments and trauma-focused services must be provided in a 

consistent manner across the many systems, programs, and professions dedicated to helping 

children exposed to violence.22 However, these services and treatments must never be 

conducted in a one-size-fits-all manner that fails to fit the individual needs and circumstances of 

diverse children and their families and communities. 

Services and treatment for children exposed to violence and psychological trauma require 

constant adaptation in order to reach and benefit traumatized children of different ethnocultural 

backgrounds, types of communities (rural, urban, suburban), gender, sexual orientation, 

developmental stage, and types of exposure to violence. Even this brief listing — which is only 

the very beginning of the preliminary and essential factors that must be addressed in order to 

make services and treatment responsive to the needs and circumstances of the many different 

children, families, and communities that are affected by violence — highlights the crucial 

importance of developing coordinated and adaptive approaches to high-quality services and 

treatments across the wide range of systems and professionals working with children exposed 

to violence. 

At the federal and state government level, funding for services and treatment for children 

exposed to violence and psychological trauma should include the requirement that all providers 

develop, implement, and demonstrate the success of collaborative planning and services or 

treatment delivery with other providers and programs locally and nationally. 

Providers also should be required to demonstrate that their delivery of services and treatment is 

accomplished with a high level of quality and fidelity to evidence-based principles of traumainformed care and to the practice guidelines of evidence-based trauma-specific treatments and 

trauma-focused services. A template for these requirements developed by the ACYF can serve 

as a useful model for these initiatives.32 

Within the professions whose members deliver services and treatment to children exposed to 

violence, mechanisms need to be developed to ensure that preprofessional education, 

continuing professional education, and standards and guidelines for professional practice 

explicitly mandate the delivery of trauma-specific treatments and trauma-focused services in 

collaboration with professionals from other professions in a multidisciplinary approach.30 

All national, regional, and state associations of provider organizations serving children and their 

families exposed to violence and psychological trauma should establish standards mandating 

adherence by all participating providers to government regulations and professional ethical and 

Children Exposed to Violence 48 
practice guidelines for the coordinated and collaborative delivery of trauma-specific treatments 

and trauma-focused services. 

3.5 Provide trauma-specific treatments in all agencies and organizations 

serving children and families exposed to violence and psychological 

trauma that are suitable to their clinicians’ and staff members’ professional 

and paraprofessional roles and responsibilities. 

The task force recommends that all agencies and organizations serving children and families 

exposed to violence and trauma undertake a systematic implementation of evidence-based 

trauma-specific treatments that follows the guidelines of dissemination science.55-57 This 

includes providing intensive training and ongoing quality assurance monitoring and quality 

improvement activities to ensure that all providers of psychological, psychiatric, counseling, 

social work, addiction treatment, and marriage and family therapy services consistently and 

effectively utilize those treatments.58,59 

The most recent Issue Brief from the Safe Start Center on Children Exposed to Violence, 

“Victimization and Trauma Experienced by Children and Youth: Implications for Legal 

Advocates” (see http://www.safestartcenter.org/pdf/issue-brief_7_courts.pdf), describes several 

widely available trauma-specific treatments that have been shown scientifically to be effective 

with young children, school-aged children, and adolescents. These and a number of other 

evidence-based or promising trauma-specific treatments have been identified by national 

organizations such as the NCTSN (www.nctsnet.org), the National Registry of Evidence-based 

Practices and Programs, the Department of Justice Office of Justice Programs 

(www.crimesolutions.gov), and the Office of Juvenile Justice and Delinquency Programs 

(www.ojjdp.gov/mpg). The task force recommends that agencies and providers utilize traumaspecific treatments that have a demonstrated scientific and dissemination evidence base that is 

consistent with these consensus guidelines when treating children exposed to violence and the 

families of these children. 

3.6 Ensure that every professional and advocate serving children 

exposed to violence and psychological trauma learns and provides traumainformed care and trauma-focused services. 

Every day, tens of thousands of children who have been exposed to violence receive treatment 

across the nation in hospitals, clinics, child guidance and counseling centers, community mental 

health centers, therapeutic group homes and residential programs, school-based clinics, or the 

offices of private practitioners.60 They are treated by professionals from many disciplines, 

including psychologists, psychiatrists, social workers, mental health counselors, substance 

abuse counselors, school counselors, in-home therapists, family therapists, and psychiatric 

nurses. These treatment providers work in every setting in which children spend their days — 

schools, youth centers, even the family’s home — as well as where children receive care — 

clinics, hospitals, counseling centers, child protective services offices, homeless shelters, and 

domestic violence programs — and where they encounter the legal system: on the street with 

Children Exposed to Violence 49 
 

 

police officers, in the courts, and in probation and detention centers. The task force 

recommends that each of these treatment providers in all of these settings develops expertise in 

helping the children whom they treat to recover from violence and psychological trauma by 

providing trauma-informed care and trauma-focused services. 

3.7 Grow and sustain an adequate workforce of trauma-informed service 

providers, with particular attention paid to the recruitment, training, and 

retention of culturally diverse providers. 

In order to support the recommended mandate for all child- and family-serving treatment 

providers to use trauma-informed approaches to their services and to employ trauma-specific 

treatment if they conduct psychosocial treatment, the task force recommends that a national 

effort be undertaken by professional and educational organizations and institutions in order to 

build a workforce of sufficient size and capacity to achieve this goal. There is a significant but 

addressable gap between the overall number of providers of trauma-informed care services and 

the large number of children and families exposed to violence and psychological trauma who do 

not, or cannot, access evidence-based treatment services. However, there are hundreds of 

graduate and undergraduate professional education programs in colleges, universities, medical 

and law schools, freestanding programs of higher education, and technical or vocational schools 

where tens of thousands of students each year are being prepared for careers in the healthcare 

and human services, public health, child welfare, and criminal justice systems that serve 

children and families. Courses in trauma-informed care and trauma-focused services should be 

a required part of the curriculum for each program and all students.30 

Continuing technical and professional training as well as certification is required or 

recommended for providers in all of these systems, and there are thousands of continuing 

education courses offered online, at training sites in most communities, and in regional and 

national conventions and meetings. Courses in trauma-informed care and trauma-focused 

services should be required for all child- and family-serving providers as a part of their 

continuing education and recertification. In addition, providers who supervise other 

professionals or staff should be provided with training and required to regularly update their 

skills and knowledge in trauma-informed supervision and in ensuring that supervisees provide 

trauma-informed services to all children exposed to violence and the families of these children. 

Additionally, there is a substantial gap between the small number of service providers who are 

from minority ethnocultural groups and the large number of children and their families exposed 

to violence who are of minority backgrounds.61 Professions and technical vocations that serve 

children and their families exposed to violence should monitor, document, and take steps to 

increase the ethnocultural diversity of their membership.62 

It is crucial that our country, at multiple levels, increase and support access to providers for 

children and families of ethnocultural minority backgrounds.61 It is also crucial to develop and 

support the education and advancement of service providers who share the same ethnocultural 

heritage, practices, and languages of the minority service recipients. It is essential that all 

Children Exposed to Violence 50 
providers serving children and their families who are exposed to violence and psychological 

trauma be respectful of, and take responsibility for becoming informed about, the language, 

values, beliefs, and both cultural and traumatic history of every client whom they serve.63 

This will require substantial investment by a cross section of strategic funders and providers of 

technical and professional training in order to recruit and successfully prepare students of 

diverse ethnocultural backgrounds. Equally important, educational and training programs must 

develop socially just protocols that will systematically recruit students from racial, ethnic, and 

cultural minority groups to build a workforce of treatment providers that reflects the population of 

children and families exposed to violence and psychological trauma. 

3.8 Ensure that professional societies should develop, adopt, 

disseminate, and implement principles, practices, and standards for 

comprehensive evidence-based treatment of children exposed to violence 

or psychological trauma. 

Every professional society in the United States and their international partners representing 

providers of services for children exposed to violence recognize that evidence-based treatment 

is the standard for both ethical and effective medical and psychological services, but few have 

developed, formally adopted, and disseminated to their memberships specific principles, 

practice guidelines, and standards for evidence-based trauma-informed care, trauma-specific 

treatments, and trauma-focused services for violence-exposed children and their families. 

Sections or divisions within major professional societies, such as the American Psychological 

Association’s Division of Trauma Psychology, and specialized cross-disciplinary professional 

societies focused on treatment of traumatized children and adults, such as the International 

Society for Traumatic Stress Studies, the International Society for the Study of Trauma and 

Dissociation, and the American Professional Society on the Abuse of Children, have developed, 

adopted, and disseminated detailed practice standards and guidelines that should serve as 

examples for all professional societies and their members that provide services to children and 

their families exposed to violence. 

A federally funded network (or public-private partnership) of regional clearinghouses and 

resource centers on evidence-based treatment for children and families exposed to violence 

and psychological trauma should be established in collaboration with the national centers of 

excellence on children exposed to violence proposed in Chapter 1’s recommendations. 

This network of clearinghouses and resource centers must coordinate closely with the NCTSN 

and other federally funded networks and technical assistance centers engaged in educating, 

training, and disseminating information about evidence-based trauma-informed care, traumaspecific treatments, and trauma-focused services. 

Children Exposed to Violence 51 
3.9 Provide research funding to continue the clinical and scientific 

development of increasingly effective evidence-based treatments for 

children exposed to violence. 

It is expensive, but absolutely necessary, to develop and test new evidence-based practices 

and treatments.44 We must now develop research and funding infrastructures that encourage 

the creation and testing of innovative practices and programs that allow for the evolution of 

increasingly effective new evidence-based treatments. 

Federal government funding through the departments of Health and Human Services, 

Education, Justice, and Defense for research on treatments for children exposed to violence 

and psychological trauma must be either maintained without reductions or increased. To fully 

achieve the greatly needed advancements in this field, state and federal government agency 

partnerships, and public and private foundation and organization partnerships, must be 

encouraged and assisted in developing funding programs specifically designed to sponsor 

continued clinical and scientific innovations in the treatment of children exposed to violence. 

Additionally, state and federal government agency partnerships, and public and private 

foundation and organization partnerships, must be encouraged and assisted in developing 

funding programs specifically designed to partner with higher educational institutions in their role 

as trainers of service providers in evidence-based trauma-informed care, trauma-specific 

treatments, and trauma-focused services. 

3.10 Provide individuals who conduct services and treatment for children 

exposed to violence with workforce protection to prepare them for the 

personal impact of this work and to assist them in maintaining a safe and 

healthy workplace. 

Providing evidence-based trauma-informed care, trauma-specific treatments, and traumafocused services brings professionals face-to-face with the pain, suffering, betrayal, and 

isolation that children and families experience when they are victimized by violence.64 For most 

providers, this is highly stressful and requires careful attention to maintaining their own 

emotional and physical health and professional and personal support systems. Some 

professionals, often (but not only) those who have experienced violence themselves, can 

experience deep emotional distress that requires personal healing for themselves. These 

emotional wounds are not caused by the children and families they treat — with rare exceptions 

— but are old wounds that are inadvertently opened by the intense emotional work involved in 

providing evidence-based trauma-informed care, trauma-specific treatments, and traumafocused services. These wounded healers can nevertheless be highly effective because they 

have a personal understanding of trauma and a unique degree of empathy for the wounded 

children and families they treat. 

Graduate professional training programs often prepare their students to take proactive steps to 

maintain their emotional health and heal emotional wounds that emerge in the course of 

Children Exposed to Violence 52 
 

providing treatment, and this should be mandatory in all professional and paraprofessional 

education programs. However, in most settings where treatment is provided to children who are 

exposed to violence and psychological trauma, little or no time, funding, or therapeutic services 

or supervision is provided to help professionals (and also affected paraprofessionals) to care for 

themselves or to recognize and deal with the inevitable emotional impact of vicarious exposure 

to violence and psychological trauma. 

Federal, state, and local funding for organizations, agencies, and contract professionals who 

treat children exposed to violence and psychological trauma, and public and private health 

insurance that covers this treatment, should designate funds on an ongoing basis to cover 

financial costs to programs and practitioners of therapeutic supervision and support services for 

all professionals treating children exposed to violence and psychological trauma. 

3.11 Incentivize healthcare providers and insurance providers to 

reimburse trauma-focused services and trauma-specific treatment. 

Even evidence-based treatments will fail if poorly implemented.56,57,65 Treatment providers must 

be prepared in their professional education and required and incentivized in their practices to 

routinely monitor and report on the quality, reach, and outcomes of the evidence-based or 

evidence-informed services they provide using established methods for doing so. And the most 

promising new treatments for children exposed to violence and psychological trauma must be 

subject to rigorous evaluations to test their effectiveness.19 

The Centers for Medicare & Medicaid Services should work with consumers and professional 

societies and experts to design (and provide technical support to) provider systems in order to 

encourage rigorous ongoing evaluation of the delivery, quality, and effectiveness of the 

implementation of trauma-informed care, trauma-specific treatments, and trauma-focused 

services for children exposed to violence. 

National professional standards established by a partnership of the federal government and all 

major child- and family-serving professions should be used as benchmarks for evaluations of 

delivery and outcomes of evidence-based trauma-specific treatments and trauma-focused 

services for children and their families exposed to violence and psychological trauma. 

Federal agencies should also fund and facilitate impact evaluations that can reveal the 

strengths, weaknesses, and ultimate merits of new treatment programs and lead to timely 

improvements. Government should expand state block grants and Medicaid and CHIP 

(Children’s Health Insurance Program) programs to reimburse for trauma-informed care, 

trauma-specific treatments, and trauma-focused services. 

Treatment is more successful when all of the professionals involved in a child’s life share 

information as appropriate and coordinate services. Child- and family-serving professionals from 

the mental health, substance abuse, child welfare, juvenile justice, education, and social 

services systems often simultaneously provide services for children exposed to violence and 

their families. However, collaboration across systems and providers typically is done on an ad 

Children Exposed to Violence 53 
 

hoc rather than systematic basis, leading to fragmented, incomplete, inefficient, and ineffective 

services that also result in unnecessary costs and unnecessary re-traumatization. 

Professional policy institutes should be mandated and funded by federal and state legislation to 

bring together professional experts, advocates, and affected children and families in order to 

design and set benchmarks for the implementation and monitoring of standards for crosssystem collaboration in services for children and their families exposed to violence and 

psychological trauma. 

Children Exposed to Violence 54 
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38. Kataoka, S. H., et al. (2003). A school-based mental health program for traumatized 

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42. Rodriguez, M., et al. (2009). Intimate partner violence and barriers to mental health care 

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Therapy, 47(11), 990-3. 

Children Exposed to Violence 60 
Chapter Four: Creating Safe and Nurturing Homes 

Each year, millions of children in this country are exposed to violence and abuse in their homes 

and families. This exposure can take many forms, including experiencing physical and sexual 

abuse; witnessing domestic violence (also known as intimate partner violence) and violence 

among family members, including siblings, grandparents, and extended family; and losing family 

members due to lethal or criminal violence. 

The National Survey of Children Exposed to Violence, supported by the Department of Justice 

Office of Juvenile Justice and Delinquency Programs and the Centers for Disease Control and 

Prevention, provides scientific evidence that millions of children in this country are exposed to 

violence in their families each year. More than 1 in 9 U.S. children were exposed to some form 

of family violence in the past year, including 1 in 15 exposed to intimate partner violence 

between their parents or between a parent and that parent’s partner. Overall, more than one in 

every four children have been exposed to at least one form of family violence before they reach 

adolescence. By the time children have grown into adolescence — specifically, between the 

ages of 14 to 17 years old — almost half (40%) of youths in the United States have been 

exposed to family violence. Exposure to violence in the family is not a rare event that happens 

to only a few highly vulnerable children. It is a crisis that can happen to any child, and it 

happens too often to far too many children. 

Children who are exposed to violence in their homes often experience multiple forms of violence 

concurrently and over the course of their lives.1

 Child sexual abuse often occurs alongside 

physical assault and other forms of maltreatment,2

 and tragically, children are most often 

sexually abused by family members or family friends they know and trust.3

 Research tells us 

that in the United States, one in four girls and one in six boys are sexually abused before their 

18th birthdays.4 

Each form of violence in the family or home or through close relationships has distinct adverse 

effects on children. To preserve and support safe and nurturing homes for all children, we must 

understand how violence of different types harms children when it happens in the home or 

family. 

Family violence refers to any form of violence by or toward members of a family. Children may 

be direct victims of physical assault or sexual abuse, or they may witness domestic violence. 

These children develop levels of anxiety and fear that are much higher than normal and 

experience consistent difficulties in learning how to manage anger and other forms of emotional 

distress.5-12 As a result, they may have problems in school, difficulty making and keeping 

friends, and significant challenges feeling safe and loved in their families even when the 

violence has stopped. As they grow into adolescence and adulthood, children who were victims 

of violence in their homes are more likely than others to have problems with impulsive behavior; 

addictions; depression; conflict and emotional detachment in their relationships with peers, 

family members, and primary partners; and difficulties in school and at work.11,13-33 

Children Exposed to Violence 61 
Sexual abuse by caregivers has been found to place children at risk for additional sexual and 

physical victimization; homelessness; and involvement with peers who use or sell drugs, drop 

out of school, steal, and engage in other delinquent behaviors.5,34,35 Nightmares, anxiety, 

distrust, isolation, problems expressing feelings, dissociation, medical problems, substance 

abuse, self-harm, and difficulty concentrating are just some of the effects of child sexual 

abuse.6,7,28,36-57 One of the most immediate consequences of child sexual abuse is the 

emergence of serious problems at school, including sharply deteriorating grades and 

performance, behavior problems, and an attitude of apparent disinterest in learning or abiding 

by rules in school (this has been described as a disinvestment in education).2,15,58 In addition, 

sexual abuse is often cited as a reason children and adolescents run away from home.28,55-57,59 

The effects of child sexual abuse can persist into and throughout adulthood. Multiple studies 

show that childhood sexual abuse can put children at significant risk for a wide range of 

medical, psychological, behavioral, social, economic, legal, and other struggles over their 

lifetimes. Research also shows that childhood sexual abuse often leads to commercial sexual 

exploitation and substance abuse.6,36,38,41,60-69 Several studies have found that child sexual 

abuse is a common occurrence for homeless women, men, and adolescents and that sexually 

abused children or adolescents often are re-victimized later in life.24,43,70-92 

Children also are exposed to violence as witnesses to domestic violence — a pattern of 

assaultive and coercive behaviors — including physical, sexual, and emotional abuse that an 

adult uses against an intimate partner. This pattern of violence and abuse typically is used as a 

tactic by men against their female partners and sometimes against their children,93-95 and it can 

also arise in same-sex relationships. Witnessing domestic violence can destroy a child’s core 

sense of security and trust and can create deep feelings of helplessness, guilt, and shame when 

children cannot make the violence stop or protect the non-offending parent. Children raised in 

homes with domestic violence are at risk for becoming either victims or perpetrators of violence 

in intimate and family relationships as adults.80,84,89,96-100 Witnessing domestic violence has a 

profound impact on a child’s view of intimate relationships, making future relationships seem 

untrustworthy and undependable at best and like dangerous struggles at worst. This perception 

can lead to a lifetime of avoidance of intimacy or conflict in intimate relationships, which is 

detrimental not only to the child but also to the child’s extended family and future generations. 

Tragically, these varied forms of family violence often occur together. Scientific studies have 

repeatedly demonstrated that children who witness domestic violence are more likely than other 

children to be physically or sexually abused and that children who are abused or neglected also 

are at high risk for witnessing intimate partner or other forms of violence within their 

families.1,101,102 Children whose parents or other primary caregivers are impaired by untreated 

mental health disorders, substance abuse, or legal problems also have been shown to be at 

significant risk for abuse, neglect, and witnessing domestic violence.12,103-116 Therefore, any form 

of exposure to violence in a family should be considered a warning sign that the children in that 

family are at high risk. These children should be assessed for all of the types of violence to 

which they may be exposed. Too often it is assumed that a child has been exposed to only one 

or a few types of violence when they may actually be polyvictims and in need of protection or 

Children Exposed to Violence 62 
healing from exposure to several types of violence in their families and communities (see 

Chapter 5). 

Every form of family violence can cause severe disruption in or loss of essential relationships. 

This is particularly true when violence is lethal, resulting in the permanent loss of a family 

member or loved one. An estimated 3,500–4,000 children witness fatal family violence each 

year in this country.117-120 Children in families in which one parent kills another parent suffer 

unique and severe trauma.121-125 The surviving children may lack official status as a victim. 

Although much has been learned about how to help these children (including evidence-based 

trauma-specific therapy for complicated grief; trauma-informed support for grief and mourning; 

and participation in funerals, grave visitation, and social gatherings to remember the homicide 

victim), they are not typically identified or served. Children who survive fatal family violence are 

often forgotten in the aftermath of such tragedies. And when they are remembered, attention to 

the surviving children may be focused on the few who provide witness testimony. The traumatic 

grief these children experience can remain an unresolved emotional injury for the rest of their 

lives,126-128 because it compromises their core sense of psychological security — a sense of 

emotional well-being that is crucial for every child’s healthy development. If caregivers or family 

members inflict violence, they become sources of fear and anger for children. If caregivers or 

family members are victims of violence in the home, this also impacts children. Simply put, the 

well-being of a child is inextricably linked to the well-being of the adults in his or her life, and 

when these adults harm or kill one another, the child is left with a deep sense of betrayal that 

quickly erodes a foundation for trusting the surviving parent or any caregiver or intimate partner. 

Moving forward, we need to deepen our understanding about the loss of a core sense of 

security and the rapid progression of developmental risks that exposure to family violence poses 

to children and adolescents. We also need to improve our knowledge about how prevention, 

intervention, and resilience can be integrated to improve life success for children victimized by 

and exposed to family violence. Most urgently, we need to re-energize our prevention efforts, 

public service and awareness campaigns, and other critical teaching initiatives that build on and 

enhance each family’s, parent’s, and caregiver’s knowledge and ability to protect and nurture 

children through warm, supportive, loving, and nonviolent relationships. 

Recognizing that the best place for children and adolescents to not just survive but thrive is in 

families that keep them safe and nurture their development, the task force offers the following 

recommendations: 

4.1 Expand access to home visiting services for families with children 

who are exposed to violence, focusing on safety and referral to services. 

Help for families experiencing or at risk for violence is most accessible when it is brought 

directly to the family in their own home. Home visitation programs bring professionals, such as 

nurses, social workers, family educators, and mental health professionals, to meet regularly in 

the home to help parents and children develop ways of communicating together, managing the 

basic routines that are essential to daily family life and healthy growth, and participating in 

Children Exposed to Violence 63 
medical and mental health treatment. These home visiting programs show considerable promise 

in reducing child abuse and promoting healthy development of children in families that are at 

risk due to poverty and lack of access to resources.129-132 However, with one recent exception,133 

home visiting programs have not been found to reduce family or domestic violence or to help 

children in violent or abusive families heal and recover.134 This may be for many reasons, but a 

crucial limitation in most home visiting interventions is that the staff lack specialized training on 

identifying children who have been exposed to violence and assisting in their recovery.135,136 

The task force recommends that home visitation programs be expanded to address the 

dynamics of child abuse and domestic violence and to provide evidence-based safety planning 

for parents, including pregnant mothers who are victims of domestic violence and sexual 

assault. It also recommends that home visitation programs be designed to strengthen the 

connections between children and their non-offending and protective parents, recognizing that a 

child’s well-being is inextricably linked to the well-being of parents and caregivers and that 

maintaining a strong connection between parent and child is a strategy for healing and 

resilience.137 

Home visiting programs and programs that specialize in providing services to children and 

families experiencing domestic violence should collaborate to devise new strategies that 

integrate home visiting with trauma-specific interventions.138 In addition, home visitors should be 

trained to identify children who have been exposed to traumatic abuse, neglect, domestic 

violence, or other forms of family violence, as well as parents and caregivers who may be 

impaired because they were sexually abused or exposed to violence as children themselves. 

4.2 Increase collaborative responses by police, mental health providers, 

domestic violence advocates, child protective service workers, and court 

personnel for women and children who are victimized by intimate partner 

violence. 

Every day, law enforcement agencies around the country respond to calls for service that are 

initiated by intimate partner violence and domestic disturbances. In fact, such calls constitute 30 

to 40 percent of all police calls for service nationally. When trained and partnered with other 

service providers, police are perfectly placed to identify children who are traumatized by 

domestic violence, assess immediate and future threats, and follow up with visits to evaluate 

victims’ safety and other concerns. This kind of engagement delivers a message to victims that 

they are not alone in facing the traumatic aftermath of intimate partner violence or in confronting 

the threat of further violence. In addition, follow-up visits from police and their partners, when 

accepted by victims, may also demonstrate to perpetrators that their abusive behavior is no 

longer hidden and cannot continue in the shadows of the family's isolation. As a result, women 

are more likely to reach out to law enforcement before violence escalates and to feel supported 

and strengthened as they move forward in addressing their families’ needs for safety, security, 

and psychological recovery.139-141 Effective collaborative strategies for responding to domestic 

violence must involve and capitalize on the role of law enforcement. 

Children Exposed to Violence 64 
4.3 Ensure that parents who are victims of domestic violence have 

access to services and counseling that help them protect and care for their 

children. 

Victims of domestic violence need access to resources that can help them safely explore how to 

protect themselves and their children and how to stabilize the family once the violence has 

subsided.93,142,143 Substantial evidence shows that mothers who have been battered by their 

partners develop symptoms of post-traumatic stress, depression, and anxiety.106,144-151 Research 

is providing growing evidence that children and parents benefit from relationship-based 

interventions that help them communicate with each other about the violence they endured.152­

154 These interventions give children the tools to show their parents how frightening the 

experience of violence was for them, and they help parents understand their children’s 

experience of violence and learn strategies to recover from their own traumatic stress reactions. 

Parents who have experienced intimate partner violence are much more likely to be able to 

provide their children emotional security and encourage their development if they receive 

trauma-informed services and treatment. 

4.4 When domestic violence and child sexual or physical abuse cooccur, ensure that the dependency and family courts, the child protection 

system, and domestic violence programs work together to create protocols 

and policies that protect children and adult victims. 

When domestic violence and child abuse co-occur in a family, all victims need protection. Adult 

caregivers who are victimized and their children involved in custody and dependency cases 

should receive coordinated trauma-informed services and trauma-specific treatment appropriate 

to their circumstances and developmental stage. The courts; child welfare agencies; and 

gatekeepers such as custody evaluators, guardians ad litem, and court-appointed special 

advocates (CASAs) should be educated on the dynamics of domestic violence and child abuse; 

trauma-informed service models; and evidence-based screening, assessment, and treatments 

for adults and children that address the adverse impact of domestic violence and child abuse. 

They also should be educated on effective strategies for mediation or couples counseling and 

the considerations for safe access, visitation, and exchange of victimized children by their 

parents. All services provided to adult victims of domestic violence should be designed to 

support their relationships with their children, maintain or enhance their options for safety, and 

support their ability to protectively parent their children. Children recover most fully from 

exposure to violence if other family members who are victimized, especially their primary 

caregivers, receive timely evidence-based treatment and trauma-informed services. 

The task force also recommends that every reasonable effort should be made in dependency 

courts to keep violence-exposed children and their non-offending parents or other family 

caregivers together. Even when children cannot safely remain in the home with their parents 

and siblings, their emotional security and ability to recover from violent trauma is greatest if they 

are able to be with other family members who safely care for them. This recommendation is 

Children Exposed to Violence 65 
consistent with federal regulations that require states to give preference to an adult relative over 

a nonrelated caregiver when determining placement for a child, provided that the relative 

caregiver meets all relevant state child protection standards. 

Disruption of primary caregiving relationships worsens the impact of domestic violence and 

abuse on victimized children. It often occurs when domestic violence offenders are awarded 

custody or when children are reflexively or repeatedly placed outside the home by child 

protective services. Studies show that multiple out-of-home placements add to the severity of 

conduct, attention, and hyperactivity problems caused by physical abuse. Out-of-home 

placements put children at risk for further victimization either directly or because non-kin 

caregivers fail to protect them from aggression or model aggressive behavior,9,12,155,156 which 

increases the risk that the children will develop problems with depression, anxiety, impulsivity, 

and aggression.157-167 Out-of-home placements also are associated with diminished selfesteem,168 which can make a child vulnerable to coping by means of aggression, antisocial 

behavior, and delinquency.10-12,169 Thus, despite being intended to enhance the safety and wellbeing of victimized children, placement away from the family and other primary caregivers can 

compound the adverse effects of children’s exposure to violence. 

Disruption in primary caregiving relationships also may occur with custody or visitation awards 

that promote contact between children and a violent parent or parent’s ex-spouse. When the 

offender continues to use violence or coercion to control or intimidate the other parent or the 

children, physical or shared custody and visitation and exchanges of children create 

opportunities for renewed domestic violence or abuse. Research has shown that physical 

abuse, stalking, and harassment continue at significant rates post-separation and may even 

become more severe.170-172 Legal policies and protocols must be designed to protect children 

from the damaging effects of continuing domestic violence or abuse.173 They also must allow 

adult victims to get the help they need without losing custody of their children to the child 

protection system or their abusers. 

4.5 Create multidisciplinary councils or coalitions to assure systemwide 

collaboration and coordinated community responses to children exposed 

to family violence. 

The crisis of family violence is too widespread to be solved by a single provider, agency, or 

organization. Victims of family violence confront many legal, medical, housing, and safety 

issues, and find themselves at the door of multiple providers, repeatedly telling their stories and 

often receiving conflicting advice.123,125,149,151,174-179 

The task force recommends that each city, county, and tribe establish and sustain a 

multidisciplinary council that includes every agency that may touch the life of children exposed 

to violence. These councils must ensure that violence-exposed children and families receive 

consistent messages and services, that information is shared by all relevant agencies and 

providers, and that services are integrated. They should involve service providers and key 

decision makers who can affect policy, programs, and case management. Multi-agency councils 

Children Exposed to Violence 66 
also provide opportunities for involved agencies to learn their different mandates and core 

responsibilities, thereby establishing an informed and cohesive response based on this 

knowledge. Such a multidisciplinary council of agencies and programs can enable children and 

families to receive more coordinated, humane, and effective services mitigating the long-term 

effects of witnessing or suffering violence. In addition, an established interagency council with 

identified multilevel support can address multiple issues through development of protocols and 

support of multidisciplinary teams, subgroups, and task forces focused on child fatality review, 

domestic violence, sexual assault, sexual trafficking/exploitation, cyber-crimes, abductions, 

substance abuse, and mental health. These groups are available in most communities with 

differing degrees of specialization depending upon the size and infrastructure of the community. 

Community collaboration and coordination across disciplines is critical to ensuring adequate 

identification, assessment, and screening; comprehensive service delivery; and improved 

policymaking on behalf of children and parents who experience family violence. The task force 

recommends active collaboration among mental health, pediatric, child welfare, social and 

family services, and community organizations, including domestic violence shelters; homeless 

shelters; schools; law enforcement; and the judiciary. These service providers and organizations 

should base their decisions on the goal of preventing further exposure to violence and 

promoting the healthy growth and development, and success in school, and peer relationships. 

4.6 Provide families affected by sexual abuse, physical abuse, and 

domestic violence with education and services to prevent further abuse, to 

respond to the adverse effects on the family, and to enable the children to 

recover. 

Families are the first line of defense against children’s exposure to violence and the primary 

source of immediate day-to-day support and nurturance when children are recovering from 

exposure to violence. When families understand how sexual or physical abuse and domestic 

violence affect children and what each family member can do to reinstate the physical and 

emotional security that such violence takes away, they can provide the essential support that 

enables an abused child to begin to heal and recover. Family members also need information 

and guidance to help them deal with their own traumatic shock, fear, anger, and guilt when they 

learn that their child has been abused. Family members of physically or sexually abused 

children should receive trauma-informed education and support services and evidence-based 

trauma-specific treatment to help them recover from their own posttraumatic distress. They will 

then be better able to provide the abused children with a renewed sense of security and hope 

by modeling healthy relationships and behaviors that are grounded in respect and equality. 

Programs that engage parents to help protect and support children, ideally working to stop child 

sexual or physical abuse before it occurs — and also enabling parents to assist their children in 

recovery if sexual abuse does occur — are key. Prevention programs that equip parents and 

other family members with the skills to establish healthy, supportive, proactive relationships with 

children should be available to all families in every community. Parents need knowledge, 

practical advice, and the skills needed to talk with confidence to their children about sexual 

Children Exposed to Violence 67 
development and healthy relationships. They need to know what to do when they suspect 

sexual or physical abuse and how to talk with other adults about child sexual or physical abuse, 

and they need to understand mandated reporting responsibilities. All child- and youth-serving 

agencies therefore should educate young parents and soon-to-be parents on strategies for 

recognizing and preventing physical abuse, sexual abuse, and domestic violence. Because 

parents may have been exposed to violence in their childhoods, they also should be educated 

on recognizing and getting help for their own posttraumatic reactions stemming from their own 

childhood exposure to violence, so that they can prevent those reactions from impairing their 

ability to safely and successfully parent their children. 

When a child is sexually abused, family relationships can make a significant difference in how 

he or she heals. Connections to emotionally supportive adults within and outside of the family 

are critical to a child’s resilience and coping mechanisms. Supportive families and, more 

specifically, healthy, supportive relationships between parents and children can help to prevent 

negative coping mechanisms, such as binge drinking and suicidal thoughts among adolescent 

survivors of sexual abuse. For this reason, the task force supports intervention services that 

recognize the parent-child relationship as a path toward healing, reflect an understanding of the 

complex trauma experienced by children who have been sexually abused, and tap children’s 

innate sources of resilience and strength. Ensuring availability of early trauma-focused 

interventions and longer-term treatment for children seen in Child Advocacy Centers (which 

conduct forensic evaluations of abused children around the country) and Rape Crisis Centers, 

for example, would capitalize on the use of existing settings where abused children can be 

identified and receive the care that they need to recover. 

4.7 Ensure that parenting programs in child- and family-serving 

agencies, including fatherhood programs and other programs specifically 

for men, integrate strategies for preventing domestic violence and sexual 

assault and include reparation strategies when violence has already 

occurred. 

Fathers who perpetrate violence against their partners often are repeating a pattern of violence 

they witnessed while growing up. Many men who use violence are victims of the long-term 

effects of childhood exposure to violence.112,124,180,181 Some men are receptive to programs that 

encourage an end to domestic violence. Whenever possible, agencies that work with affected 

children and families should include those men in their interventions. Help in understanding their 

children’s experience of violence may increase some fathers’ empathy for their children and 

promote motivation to change. 

The task force recommends that all agencies, programs, and providers working with fathers who 

have been violent toward their family members provide in-depth assessment, diagnosis and 

treatment planning, education, and strategies that enhance adequate external controls to 

ensure that no further violence occurs. Too often, violent offenders are court ordered to undergo 

services such as anger management or batterer intervention before diagnostic evaluations have 

taken place. Without a clear link between identified underlying difficulties that lead to intimate 

Children Exposed to Violence 68 
partner violence and specific evidence-based treatment interventions, the strategies used to 

rehabilitate violent family members are likely to be ineffective because they are not matched to 

the specific problems of each offender. Intervention with fathers who use violence is not “one 

size fits all.” Fathers who use violence also must be held accountable and monitored, because 

change does not always come easily or quickly. Every agency, program, or provider working 

with these fathers therefore must offer a complete and evidence-based array of services and 

treatments matched to the specific individual and designed to ensure that no further violence 

occurs. 

4.8 Provide support and counseling to address the unique consequences 

for children exposed to lethal violence, both in the home as a result of 

domestic violence homicides and suicides, and in the community. 

When children lose a family member or other loved one, especially a primary caregiver, to a 

violent death or as a result of injuries from which the family member does not recover 

emotionally or physically, they can experience overwhelming grief. Studies have shown that 

grief that is compounded by violence leads children to feel not just sadness but also terror and 

horror.127,182 Family members are irreplaceable, and their sudden loss due to violence leaves 

children with no way to say goodbye or to understand how or why such an unimaginable event 

could have happened. Traumatic loss leaves children burdened by guilt, believing they should 

have seen the loss coming and stopped it, and unsure about how to continue without that 

person’s presence in their life. 

Violent death of any family member is horrifying and debilitating. Each family member has a 

unique place in the child’s life, and their loss leaves a hole that cannot be filled. When the lost 

family member was at the center of the child’s life and a source of core security and nurturing, 

the grief and terror are not just about the violent death but also about the frightening prospect of 

having to go through life without this caregiver’s unique love, guidance, and protection. The loss 

of a primary caregiver to lethal violence can lead children to withdraw from and distrust even 

healthy relationships with other current or future caregivers — having been hurt deeply once, 

children may detach from or reject other caregivers to protect themselves from any repetitions of 

the loss. They also may have substantial difficulty engaging in intimate relationships with 

partners or in the emotional intimacy of parenting their own children when they grow into 

adulthood. 

Evidence-based treatments that have been developed specifically to help children recover from 

the traumatic grief of a violent death in their family183-185 should be available to all children who 

experience a loss due to violence, in every community in this country. These treatments help 

children communicate the shock and terror that they experienced, first to a therapist and then to 

a supportive caregiver in their family.183-185 They also help children remember their lost loved 

ones and their relationships in ways that enable them to hold on to memories that sustain their 

emotional connections despite their family members’ no longer being physically present. When 

other family members or caregivers also have been traumatized by the violent loss, treatment 

Children Exposed to Violence 69 
helps them to go through a similar process of recovery and healing to enable them to support 

the child emotionally. 

Every child and family exposed to violent death should be identified and provided with access to 

services not just in the immediate aftermath but also over time. Traumatic grief does not end 

quickly, and it often persists for years, although the severity of the emotional injury can be 

greatly diminished with proper treatment and trauma-informed services. Services for children 

and families who suffer traumatic losses due to violence must be designed to be readily 

accessible without arbitrary time limits. 

Unfortunately, systems currently in place do not reliably track and provide services to children 

who perpetrate lethal violence. These children often are survivors of abuse or other family or 

community violence. They often become lost in many legal, family services, mental health, and 

child protection systems, and if not located and helped, they may return to inflict additional 

violence or turn to suicide. These child survivors present an ultimate challenge, but they also 

represent an opportunity to improve public safety by delivering services that help them recover 

from the effects of the violence they have done as well as the violence to which others have 

exposed them. Every community should have trauma-informed services in place to identify, 

track, and promote the recovery of all children who perpetrate lethal violence. 

4.9 Develop interventions in all child- and family-serving agencies that 

build on the assets and values of each family’s culture of origin and 

incorporate the linguistic and acculturation challenges of immigrant 

children and parents. 

Children and families who immigrate to a new country often do so because they have faced 

violence as a result of war, political conflicts, ethnic cleansing or genocide, or natural disasters 

that has traumatized the whole family. Because they may have difficulty forming new social ties 

or face isolation and discrimination in their new communities, they are at risk for exposure to 

domestic and community violence and child abuse. Even if they did not experience violence 

previously, immigrant families often face cultural, language, and economic barriers and 

stressors as well as stigma and discrimination, which can place their children at risk for 

exposure to violence. 

Evidence-based interventions created specifically for immigrant families and children exposed to 

violence provide them with a network of services and supports that are grounded in the beliefs 

and values of their cultures of origin rather than forcing them to renounce or relinquish those 

crucial ties and foundations. The task force recommends that all immigrant families receive 

these interventions from multidisciplinary collaborative teams and networks of providers who 

respect and are informed about the cultural beliefs and practices of the families they serve. 

These interventions can enable immigrant families to avoid or overcome the isolation, stigma, 

and practical barriers that otherwise could make them vulnerable to violence from outside or 

within the family. 

Children Exposed to Violence 70 
4.10 Ensure compliance with the letter and spirit of the Indian Child 

Welfare Act (ICWA). 

Children exposed to family violence particularly need to retain their connection with their 

cultures and communities, which is a key factor that can protect them from the psychological 

harm and insecurity caused by exposure to violence in their families. Remaining in their 

communities and staying involved with cultural, religious, and community activities provides 

children with an indirect connection to their families even when they cannot live in their family 

homes or with family members. This is particularly important but also particularly difficult when 

families live in isolated communities that have been subjected to trauma over many generations, 

such as AIAN communities. 

AIAN women and children face family violence at rates far greater than other groups. This 

tragedy occurs on reservations, in Native communities, and in urban settings and results in 

AIAN children’s experiencing out-of-home placement far more often than other children. In 

1978, with the passage of ICWA, the federal government recognized the importance of keeping 

AIAN children with AIAN families and the important role tribal governments must play in 

protecting their children. ICWA clearly articulates placement preferences for AIAN children 

removed from their homes because of abuse or neglect and the efforts public agencies must 

make to keep AIAN children safe in their own homes, and it also sets clear requirements for 

public agencies and courts on communicating and working with tribal agencies and courts. 

These requirements apply to child custody proceedings regardless of where the AIAN child 

resides in the United States. 

Thirty-four years after ICWA’s passage, full implementation of the act remains elusive. Judges 

and attorneys in the state and the tribal court systems must educate each other and work 

together to ensure the ICWA requirements achieve the stated policy “to protect the best 

interests of Indian children and to promote the stability and security of Indian tribes and 

families.” Tribes must receive direct access to federal foster care funds (Title IV-E) not only for 

the provision of foster care but also for the training of workers and administration of a system 

that will protect their most vulnerable and traumatized members. Movement toward full 

implementation of ICWA must be accompanied by technical assistance to tribes so they can 

effectively enlarge their capacity for family court systems, licensing and monitoring of foster 

homes, and participating in state child protective services cases that involve AIAN children. 

Because ICWA is a federal statute, successful implementation will be best ensured through 

strong, coordinated support from the Bureau of Indian Affairs in the Department of the Interior, 

the DHHS Administration for Children and Families, and the Office of Juvenile Justice and 

Delinquency Prevention within the Department of Justice. 

Children Exposed to Violence 71 
4.11 Initiate a nationally sponsored program similar to the Department of 

Defense’s community and family support programs that provides military 

families with specialized services focused on building strengths and 

resilience, new parent support, youth programs, and forging partnerships 

with communities. 

Military families and their children face unique challenges related to violence, especially when a 

family member such as a father or mother is continually deployed to combat areas or other 

dangerous areas around the world where violence and death are an imminent threat or an 

immediate reality. Military violence can lead to post-traumatic stress problems that make 

parenting difficult even for the most resilient service members and spouses or partners. In some 

cases, it can result in chronic depression, addiction, domestic violence, child abuse, or traumatic 

loss for a child due to a parent’s suicide. These challenges are widely recognized, and the 

Department of Defense has improved its community and family support programs in concert 

with the President’s Strengthening Our Military Families initiative to oversee the safety and wellbeing of military families, especially their children. Because many military families reside in 

civilian communities, military leaders have fostered close partnerships with community leaders 

in coordinating complementary programs for both civilian and military families. These initiatives 

should be continued and expanded to reach the families of all military personnel and veterans. 

Children Exposed to Violence 72 
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Children Exposed to Violence 87 
 

Chapter Five: Communities Rising Up Out of Violence 

Community violence affects millions of children in this country every year.1-8 Such violence can 

occur in episodic incidents such as shootings in schools or other public places, causing children 

and families to feel terror in their own neighborhoods and schools and leaving them to recover 

from the traumatic grief of losing friends or peers who are killed or who never fully recover. 

Increasingly, children are being victimized as violence continues to be part of the fabric of 

American communities as a result of gangs, or when bullying or corporal punishment is 

tolerated or sanctioned in schools or youth activities. 

Community violence affects child victims and witnesses and children whose family members, 

neighbors, friends, or coworkers are harmed or killed. Community violence is especially harmful 

for children and adolescents who are exposed to pervasive violence, such as those youth who 

experience gang intimidation or assaults, hear gunfire, or witness drive-by shootings and 

murders. In communities where violence is endemic, the cycle is perpetuated when child victims 

who are dealing with the fear, outrage, and grief of their own experiences with violence are 

drawn into delinquent and criminal behavior through their relationships or associations with 

violent peers, family members, or friends.4,6,9-28 

Violence in the community or school can attract children into affiliating with peers or adults who 

use violence to intimidate, control, or harm other children. Violence can seem to children who 

are victimized to provide a source of power, prestige, security, or even belongingness when 

they feel powerless, rejected, unsafe, and alone. The negative consequences of exposure to 

violence in the community or school, however, extend well past the point of entering adulthood 

and may include negative outcomes such as disrupted education, lower job prospects, 

fragmented relationships, legal problems, incarceration, serious injury and illness, and even 

death. 

Children can be exposed to community violence as innocent bystanders, but they also may be 

targeted by perpetrators because of their vulnerability. Children may be perceived as “different” 

based on their race or ethnicity, language, sexual orientation, physical or mental disabilities, 

physical characteristics (such as being small for their age or overweight), family economic 

status, either low or high academic involvement or achievement, or belonging to a marginalized 

peer group. Predatory violence toward children often occurs in secrecy — although, as 

evidenced by numerous revelations of institutionally tolerated sexual abuse in religious, 

educational, and youth activity organizations, violence can be a “secret” that is hidden in plain 

sight. Violence against children is especially difficult to detect when the predator is a trusted and 

institutionally protected caregiver outside the home or a community leader, such as a child care 

provider, teacher, coach, activity leader, or religious official. With the explosion of Internet media 

available to children, predators also increasingly target, recruit, and exploit children through 

online contacts. 

Entrapment and exploitation by predators who should be trusted caregivers and role models not 

only directly harms children but also likely leads them to develop severe trust issues even in 

Children Exposed to Violence 88 
trustworthy relationships because of the fear, anger, guilt, shame, and confusion caused by this 

betrayal of the fundamental assumption that adults are protectors. 

Children also are exposed to community violence when adults or youth in their school or 

neighborhood engage in criminal violence using weapons or physical assault, such as in gang 

wars, or when these adults or youth assault children traveling to school or in the school itself. 

Less commonly, riots and terrorist attacks victimize children. Although rarely experienced by 

children in this country, many children who are immigrants from violence-torn countries have 

witnessed or been exposed to horrific community violence in the form of torture, bombings, 

wars, and ethnic cleansing. 

Community networks and systems are integral to a child’s development of psychological health 

and well-being, social opportunity, and a purposeful existence.6,24,26,29-31 Beyond the immediate 

adverse impact on the individual child who is exposed, community violence can warp, fragment, 

or even destroy the child’s community. This is important because effective interventions to 

reduce the occurrence or aftereffects of community violence need to support the recovery of the 

entire community (or neighborhood, or school) in order to protect all affected children and help 

them to heal if actually exposed to violence. 

Child survivors of community violence often struggle with rebuilding trust, finding meaning in life 

apart from the desire for safety and justice, finding realistic ways to protect themselves and their 

loved ones from danger, and dealing with feelings of guilt, shame, powerlessness, and doubt. 

There is also a concern that witnessing violence can lead children to identify with the 

aggressors and to turn to violence as a way to emulate the actions that perpetrators are 

modeling, or to try to protect themselves with aggressive coping behaviors: when children learn 

to use violence based on witnessing violence, this can perpetuate a cycle of escalating violent 

behavior, especially in intimate relationships.6,7,17,18,20,29,32 

In addition, when children witness violence in their communities, it can become an accepted 

norm for them.22 They can learn to think of danger, fear, injury, and death as normal. Instead of 

celebrating life, they too often must mourn losses, creating shrines for their many friends and 

family members who have been killed. These children wait nervously or helplessly for the next 

explosion of violence in their neighborhood or school, or they mourn the all-too-common deaths 

or devastated lives of their families, friends, and community members. Many feel they need to 

fight back against actual or potential perpetrators. These dynamics have become the “new 

normal” for far too many children and far too many communities. 

Creating peaceful communities is essential to rescue children from being trapped in a life of 

violence and allowing them to live a full life free from exposure to violence. Youth exposed to 

community violence are at high risk for developing serious problems such as post-traumatic 

stress disorder (PTSD), depression, social isolation or conflicted relationships, 

underachievement and school dropout, addictions, and perpetrating violence themselves.4,6,7,9­

17,23,24,33-35 The combination of exposure to community violence and developing severe PTSD 

symptoms is particularly strongly associated with problems with aggression.36 Unfortunately, 

children who cope with exposure to violence by engaging in violent behavior tend to be viewed 

Children Exposed to Violence 89 
as “deviant” or “future criminals” rather than as traumatized victims. As a consequence, they 

rarely receive support or assistance to address the trauma-related symptoms that often 

precipitate children’s acts of violence or delinquency. Exposure to violence does not justify or 

excuse acts of violence, but with appropriate trauma-informed law enforcement and judicial 

responses, these children can reform their behavior and attitudes if they receive traumainformed services and trauma-specific treatment (Chapter 2). 

Research indicates that although children of all ages are exposed to community violence, 

adolescence is the developmental period of greatest risk for witnessing or being involved in lifethreatening community violence.1,37,38 Adolescents are grappling with complex questions 

regarding their values and aspirations and are developing a worldview that they will retain for 

the rest of their adult lives. They are uniquely positioned, therefore, to be agents of positive 

change in their communities on behalf of ending violence and healing the harm caused to peers, 

siblings, and children of all ages when violence contaminates the community. Involving youth as 

positive agents of change is vital to all efforts to protect children from violence and to help 

victims to heal from its traumatic aftereffects. 

Exposure to community violence also affects families in profound ways that can diminish their 

ability to provide a safe and nurturing home for their children (see Chapter 4). A common 

parental reaction to children being exposed to violence in their neighborhoods or schools is the 

development of anxiety concerning their children’s health and well-being. Parents may blame 

themselves for not protecting their child adequately and become overprotective or use punitive 

discipline in response to their child’s acting-out behavior. Parents also face the difficult task of 

reassuring their child while trying to cope with their own fears. This is especially difficult when 

community violence is chronic in their child’s school or neighborhood. Thus, ending community 

violence is essential to the health and safety of families and to their ability to ensure the healthy 

development and safety of their children. 

Reducing and preventing community violence depends on understanding its sources and 

perpetuating factors. Different communities face different challenges, and these unique 

challenges are best understood and addressed through collaborative problem assessment and 

strategy development. At the individual level, timely and sensitive care for children and families 

exposed to community violence is needed through trauma-informed psychoeducation, crisis 

hotlines, screening to identify violence-exposed children who are at high risk of developing 

PTSD and related psychosocial and behavioral problems, and referral for trauma-informed 

services and trauma-specific treatment. Progress has been made in developing violence 

prevention programs, especially for gang prevention and conflict resolution with high-risk youth. 

Public health approaches, such as those in the Centers for Disease Control and Prevention’s 

UNITY (Urban Networks to Increase Thriving Youth) program, involve a comprehensive 

approach to community violence that incorporates prevention and treatment. 

The science of treatment for children exposed to community violence has been developed over 

the past two decades. Trauma-specific therapeutic interventions for children and adolescents 

exposed to community violence have been shown to be effective when delivered in mental 

health clinics, in schools, and in home-based and residential programs.7,39-47 Such treatments 

Children Exposed to Violence 90 
require continued development and should be conducted with children of all ages — including 

toddlers and preschool and elementary school students, for whom they can help build a 

foundation of psychological and interpersonal resilience when violence has occurred in their 

lives48-51 — to heal the emotional, behavioral, and social wounds of violence. 

In addition, programs that involve the family, school, and community services such as law 

enforcement, the courts, and child protection, have the strongest evidence base for developing 

children’s resilience.47,52-62 These programs provide supportive relationships and guidance not 

only for children but also for their parents and families. In addition, they are designed to 

increase community safety and to provide families with access to recreational facilities and 

health care. These multidimensional approaches to enhancing children’s psychological 

strengths and social support networks have shown evidence of success with children and 

adolescents who are likely to have been exposed to violence.39,43,47,63 

In order to both reduce the extent of this pandemic of children’s exposure to community violence 

on behalf of children not yet exposed and help children who are victims to recover and heal from 

the trauma and grief caused by violence in their neighborhoods and schools, the task force 

proposes 11 recommendations that are described below. 

5.1 Organize local coalitions in every community representing 

professionals from multiple disciplines and the full range of service 

systems (including law enforcement, the courts, health care, schools, 

family services, child protection, domestic violence programs, rape crisis 

centers, and child advocacy centers) as well as families and other 

community members, to assess local challenges and resources, develop 

strategies, and carry out coordinated responses to reduce violence and the 

number of children exposed to violence. 

When children are exposed to community violence, the entire community is traumatized and 

must join together to restore communal safety. No provider, agency, or program can be fully 

successful when acting alone to help a child recover from community violence. No community 

can rise up out of violence without the coordination of many disciplines, professionals, agencies, 

organizations, businesses, and concerned adults and children in coalitions that take a positive 

stand against violence. With concerted action, children’s lives can be saved or reclaimed, and 

the entire community can be transformed and empowered. Pilot sites implementing the 

Department of Justice Office of Juvenile Justice and Delinquency Prevention’s (OJJDP’s) 

comprehensive strategy found that by developing coalitions of multidisciplinary stakeholders 

they gained a better understanding of their local problems of children exposed to violence and 

were able to comprehensively identify and address gaps in crucial services for these children 

and their families. 

Community coalitions, like those formed through the National Forum on Youth Violence 

Prevention, show great promise for ending children’s exposure to community violence. This 

Children Exposed to Violence 91 
forum is a vibrant national network of federal and local stakeholders that, through the use of 

multidisciplinary partnerships, has developed approaches that combine prevention, intervention, 

enforcement, reentry, and data-driven strategies to strengthen communities, to better prevent 

violence, and to promote the safety, health, and development of our nation’s youth. Similarly, 

the demonstration sites participating in the U.S. Attorney General’s Defending Childhood 

Initiative have embraced multi-agency and multidisciplinary action-oriented approaches to 

building and sustaining coordinated community responses to violence and to children’s 

exposure to violence. Local efforts like these are designed to increase children’s safety and 

well-being by changing behavior and attitudes while also providing intensive case management 

and wraparound support services as well as immediate access to services tailored to meet the 

individual needs of children and families exposed to violence. Across the country, we need to 

build coalitions like these while also emphasizing the need for delinquency prevention, legal 

services, housing services, mental health services, recreational programs, and transitional 

employment programs that provide on-the-job training with an intentional focus on building life 

skills. 

5.2 Recognize and support the critical role of law enforcement’s 

participation in collaborative responses to violence. 

Law enforcement takes the lead when dealing with the perpetrators of violence, but law 

enforcement also can play a unique role in contributing to community coalitions that advocate 

for safety and nonviolence. The contribution that law enforcement can make to protecting and 

defending children against violence is under-utilized when this is limited to 9-1-1 crisis-driven 

responses. Models of community policing have enabled law enforcement to work collaboratively 

with concerned community members and constituencies in many cities, towns, and rural areas 

across the country. This approach recognizes law enforcement personnel as integral members 

of the community who bring special expertise to enhancing the well-being of everyone in that 

community as well as to ensuring public safety. 

Successful national and local models for partnerships of child- and family-serving providers with 

law enforcement build on and expand upon principles of community policing. These model 

programs are a systematic partnership between law enforcement and community agencies and 

providers that bring expertise in child development, violence prevention, and treatment of 

children exposed to violence. The partnership includes an ongoing dialogue in which all of the 

participants share their experience and expertise while working collaboratively with one another 

on the streets, on police calls to respond to violence in homes and schools, and in open forums 

with youth, parents, educators, healthcare providers, child welfare workers, probation officers, 

judges, and other concerned citizens. The role of law enforcement is expanded to include 

serving as a protective source of security and as a gateway for connecting children and families 

to trauma-informed services and trauma-specific treatment. 

The key elements of this collaboration between law enforcement, juvenile justice, domestic 

violence, medical and mental health professionals, child welfare agencies, schools, and other 

community agencies include cross-training for police as well as mental health and other 

Children Exposed to Violence 92 
 

professional specialists on child development, trauma, and policing strategies; acute-response 

services that provide coordinated police and clinical response to violent events; regular 

interdisciplinary case conferencing for case planning, review, and monitoring; follow-up home 

visits by police officers, clinicians, and domestic violence advocates; and evidence-based 

trauma-specific treatment and trauma-informed services that are available to children and 

families exposed to violence in their homes, neighborhoods, or schools.64-70 

Research and program evaluation studies demonstrate that these partnerships of child-serving 

professionals and law enforcement professionals effectively provide protection and help in 

recovery and healing for children exposed to violence.1-6,24,65 They also have helped to mobilize 

community coalitions by bringing together youth and adults from all parts of the community and 

its public and private agencies, institutions, and constituencies to stand up for the safety of 

children on behalf of the entire community. 

Reconfiguring law enforcement’s role to include participation in community coalitions requires 

assigning officers to nontraditional roles. This involves fiscal costs and the increased staffing 

levels needed to fulfill all public safety responsibilities, especially the priority of responding to 

emergency calls for service. Community policing often requires a shift in deployment that can 

reduce the law enforcement agency’s patrol function. It also requires additional time and 

expertise for specialized training of the participating officers, supervisors, and managers. 

Funding through the Department of Justice Community Oriented Policing Services (COPS) 

Office should be expanded to enable every community’s law enforcement agency to undertake 

this shift in responsibilities. This change in perspective can enable both new and veteran 

officers to more fully serve their community by contributing to a community-wide multi-agency 

initiative to maintain public safety and enhance the well-being of all children and adults. 

5.3 Involve men and boys as critical partners in preventing violence. 

While men are more likely than women to perpetrate violence,71-74 men are also leaders and the 

models for changing norms of masculinity that currently tolerate and at times condone violence. 

While some forms of male violence stem from traditional notions that men must prove their 

strength through fighting or that they are entitled to keep women and children in subservient 

roles, some of the violence perpetrated against women and girls, as well as other men and 

boys, may stem from deep-seated suffering and despair, a desire to demonstrate power in the 

face of life circumstances that feel hopeless and depleting. Most men and boys who use 

violence have suffered from abuse themselves. 

In communities across the country, groups of men are organizing to support one another in 

using nonviolence to build healthy communities through civic programs, schools, sports, arts 

programs, businesses, and public-private partnerships. These men are going out on the streets, 

onto the playing fields and recreation centers, into the schools, and into faith-based 

organizations to teach boys as well as other men that violence does not equal strength. These 

initiatives, however, remain isolated and are too often built around the determination of a few 

individuals. The men doing this work need human and financial capital from both public and 

private sources. With those resources, initiatives involving men and boys as critical partners in 

Children Exposed to Violence 93 
 

preventing violence can grow from isolated islands of change into a substantial, growing 

network of men and boys across the country committed to creating widespread change and 

helping break the cycle of violence in our homes, schools, and communities. 

5.4 Foster, promote, and model healthy relationships for children and 

youth. 

Abuse within adolescent relationships is a critical, but often overlooked, type of violence that 

young people experience and to which they are exposed at alarming rates. Research suggests 

that one in five adolescent women have been abused by their dating partners, and two-thirds of 

youth who act violently in dating relationships report witnessing assaults between family 

members.75-81 In addition to the harm that youth may experience as victims, we know that 

exposure to abuse within adolescent relationships and witnessing family violence (Chapter 4) 

increase the risk for violence in adulthood among the children involved. Therefore, it is critical 

that we deepen our understanding of the safety and developmental risks that exposure to abuse 

in adolescent relationships poses to adolescents, and we must improve our knowledge about 

how prevention, intervention, and resilience can be integrated to improve the chances of life 

success for youth. Community and school-based programs and policies that work in tandem to 

prevent relationship abuse and, just as importantly, to promote healthy relationships, have 

shown great promise.82-86 These programs, guided by caring adults and communities and with 

shared leadership from youth as role models for younger children, are succeeding in changing 

social norms that tolerate and at times condone abuse. 

Working collaboratively with young people, adults who are involved in the lives of children can 

take action against all forms of community violence by consciously serving as positive role 

models and engaging children and youth in healthy, nonviolent relationships. Healthy 

relationships are based on mutual respect, honest and sensitive communication, gender and 

racial equity, empathy, compassion, recognition of the different needs and abilities of people of 

different ages and backgrounds, and shared responsibility for success. Modeling healthy 

relationships, and helping youth to develop them with peers and their families, is a direct 

antidote for violence and its toxic effects. Youth-led community and school-based programs 

guided by conscientious adults are succeeding in communities across the country in mobilizing 

children and youth to invest themselves in healthy relationships.87,88 These local initiatives need 

public and private support and sponsorship in order to become the rule rather than the 

exception in communities throughout our nation. 

5.5 Develop and implement policies to improve the reporting of 

suspected child sexual abuse in every institution entrusted with the care 

and nurturing of children. 

When children are sexually or physically abused, the harm that this violence causes is greatly 

exacerbated if the abuse and the perpetrator are not publicly identified and the perpetrator is not 

immediately prevented from further abusing that child or other children. 

Children Exposed to Violence 94 
Communities must work particularly hard to break the silence and secrecy that shroud child 

sexual abuse. When community members talk about sexual violence and ask the right 

questions, they help to break the isolation that many children experience. When community 

members have the skills to identify and report child sexual abuse, they open doors of justice, 

healing, and support that had once been closed for many children. If community members 

intervene when they witness sexual violence, they not only help to prevent that specific 

occurrence; they also protect the abused child victim or other children from further victimization 

and help set social norms and create environments in which sexual violence is not tolerated. 

When community members talk about healthy sexuality and model positive, nurturing, respectful 

relationships and communication, they can work to ultimately prevent sexual violence from 

occurring. 

Institutional protections that shield perpetrators of sexual or physical abuse or other forms of 

violence against children violate both the letter and the spirit of the law as well as moral and 

ethical principles that condemn such violence. When officials in an organization or system 

excuse or condone known acts of abuse or violence against children, they are indirectly but 

substantially contributing to the harm caused to children, past and future, who are exposed to 

violence. 

Most, if not all, of the institutions in this country that are entrusted with the care and nurturing of 

children have policies and procedures for reporting the suspected abuse of children. All of these 

institutions must review these policies and procedures and modify them wherever necessary to 

eliminate their points of uncertainty. In addition, reviews should be undertaken in areas where 

there have been or potentially could be a failure of the institution’s officials, employees, and 

other participating individuals and entities (such as volunteers, contractors, and consultants) to 

comply fully with the specific responsibilities for protecting children defined by these policies and 

procedures. 

The education and supervision provided by the institution to all officials, employees, and other 

participants concerning their specific responsibilities in reporting all forms of suspected child 

abuse or other ways in which children are exposed to violence are an essential but often 

unfulfilled responsibility of every institution in our country, especially those entrusted with the 

care, education, supervision, and nurturing of children. Every institution must provide timely, 

ongoing education and supervision to its agents at all levels to ensure that all incidents of 

suspected child abuse are reported without delay and that appropriate legal authorities outside 

the institution who are responsible for children’s safety and welfare are fully and immediately 

informed. 

Children Exposed to Violence 95 
5.6 Train and require child care providers to meet professional and legal 

standards for identifying young children exposed to violence and 

preventing violence from occurring to any child for whom they are 

responsible. 

Child care providers in center-based programs and in their own or the child’s home have a 

unique opportunity to protect children from exposure to violence. Child care providers must be 

trained and provided with ongoing supervision and continuing education in order to be able to 

recognize children in their care who have been exposed to violence. National, state, local, and 

tribal child welfare departments that set standards for child care providers’ reporting of abuse 

and neglect must establish clear and specific guidelines for all providers of child care and 

monitor adherence to these guidelines. In addition, professional organizations and regional and 

local agencies and programs that train child care providers and set standards for them must 

monitor adherence to these standards, which should be mandatory for all providers and should 

take the form of clear and specific guidelines for identifying and reporting suspected child abuse 

and other forms of exposure to violence. 

Sadly, child care providers can themselves inflict violence on children or expose children to 

violence by perpetrating or condoning physical violence, sexual abuse, or child-to-child bullying 

in the child care setting. Governmental, professional, and private for-profit or nonprofit agencies 

and organizations that oversee child care providers must require all providers to complete 

preservice and ongoing continuing education and supervision in order to prevent the use of 

corporal punishment and incidents of sexually, physically, or emotionally abusive behavior 

toward children in center-based or home-based child care. 

5.7 Provide schools with the resources they need to create and sustain 

safe places where children exposed to violence can get help. 

Violence can spill over from families and the larger community into schools, but it also can be 

inadvertently fostered in schools when students are not taught how to handle conflict and build 

relationships in healthy ways that do not involve violence. Schools play an essential role in 

creating and establishing an environment for healthy and nonviolent behaviors that are both 

taught and modeled on the playground, in the food court, on the playing fields and in the locker 

rooms, in extracurricular activities, and in the classroom. Every adult in our schools is a potential 

positive — or negative — role model for hundreds or thousands of children every day. Programs 

that train all school staff — from teachers, administrators, and personnel to maintenance 

workers to school bus drivers to workers in the food court — to interact with students and one 

another in trauma-informed ways have been developed, scientifically tested, and widely 

disseminated in dozens of rural, urban, and suburban communities in our country.89-98 Every 

school in the U.S. and all of their educational and support personnel should be provided with 

training and ongoing supervision in order to provide trauma-informed school services. 

Schools also are a critical place for the identification of children exposed to violence who need 

immediate help (see Chapter 2) and where evidence-based trauma-specific treatment can be 

Children Exposed to Violence 96 
provided efficiently and in a timely and accessible manner (see Chapter 3) for those children. 

Every school in our country should have trained trauma-informed professionals on staff or 

working collaboratively as consultants to provide school-based, trauma-specific treatment and to 

assist children who have been exposed to violence and have chronic or severe problems to 

access evidence-based school- or clinic- or home-based treatment. 

Corporal punishment is permitted in some schools in this country although it represents the use 

of violence as a means of changing behavior and enforcing discipline. Every school in which 

corporal punishment continues to be used should be provided with education and training for all 

administrators, teachers, and staff on trauma-informed alternatives to corporal punishment that 

have been shown to be effective in maintaining discipline without violence. 

5.8 Provide children, parents, schools, and communities with the tools 

they need to identify and stop bullying and to help children who have been 

bullied — including the bullies themselves — to recover from social, 

emotional, and school problems. 

Bullying is a form of violence that increasingly is recognized as a serious problem for teens and 

for school-age children as young as preschoolers. Bullying can involve verbal as well as 

physical violence and threats. Victims of bullying often are isolated by their peer group and 

shamed and humiliated not only by the bullies but also by other peers and adults (including their 

teachers, coaches, and even their own parents and other family members). Victims of bullying 

also commonly experience serious problems with depression, anxiety, loneliness, and 

hopelessness as well as with school achievement and attendance. For girls, physical, verbal, 

and social bullying have been found to be associated with subsequent body dissatisfaction, 

particularly when verbal bullying led them to experience anxiety and depression.99 

Some bullying victims attempt to turn the tables and regain a sense of power, control, and peer 

acceptance by bullying other children. Bullies are not typically cruel or mean children by nature, 

but they can become cruel and hurtful toward other children as a form of self-protective reactive 

aggression. Children or youth who are bullies may appear successful and popular, but often 

they have been victims of bullying or violence in their own families and are troubled by serious 

emotional problems that can result in serious danger to themselves (such as substance abuse 

or suicidality) as well as to the children whom they bully. 

Providing trauma-informed services and support to children who are bullies as well as to those 

who are victims of bullying is an essential step in stopping the spread of emotional and physical 

violence toward children in our schools and communities. Programs designed based on the 

guidelines described in this chapter’s previous recommendations — building multi-stakeholder 

community and school coalitions, providing healthy adult and peer role models, and teaching 

children healthy and safe ways to build and sustain relationships — have been shown to be 

successful in restoring safety and healthy development to the lives of children who are bullied 

and those who are bullies.100,101 One study in 10 public middle schools found evidence of 

benefits primarily for White children but not for African-American or Hispanic youth, suggesting 

Children Exposed to Violence 97 
a need for careful ethnocultural adaptation of bullying-prevention programs.102 These programs 

embody the principles of restorative justice, which can instill individual and community-level 

accountability and positive action to support healing and resilience as well as demonstrate the 

potential value of meaningful restitution. 

5.9 Put programs to identify and protect children exposed to community 

violence who struggle with suicidality in place in every community. 

The most tragic and severe consequence of children’s exposure to violence is a combination of 

profound hopelessness and suicidality.103,104 Children exposed to violence as a result of physical 

or sexual assault or abuse, pervasive criminal violence committed by gangs in their schools and 

neighborhoods, or bullying by peers or older children can become isolated and tormented by 

anxiety and depression. The violence can seem to be a prison or trap from which the only relief 

or escape is death — directly by self-harm, or indirectly by using drugs or alcohol or engaging in 

reckless, risky behavior in ways that are life-threatening. 

Suicide prevention programs for children and youth have been shown to be successful in a 

small number of community research studies,96-98 but these programs are not available in most 

of our country’s communities. Evidence-based, trauma-informed suicide prevention programs 

and trauma-specific treatments for children and youth who are at high risk due to severe 

suicidality should be adapted for children and communities of varied backgrounds and made 

accessible immediately to every child and family in every community in our country. These 

programs provide education, counseling, support from caring adults, healthy opportunities for 

restorative contacts with peers, and help from a network of multiple providers and agencies 

working as a coalition to protect children exposed to violence who are struggling with suicidality. 

5.10 Support community programs that provide youth with mentoring as 

an intervention and as a prevention strategy, to reduce victimization by and 

involvement in violence and to promote healthy development by youths. 

Adults are crucial role models for nonviolence in many walks of life in every child’s community. 

A meaningful relationship with a positive adult role model has been shown repeatedly in 

scientific studies to be a protective factor against violence even for youth who are growing up in 

very difficult circumstances and violent environments.105-111 Both informally, and formally in 

structured programs, an adult mentor can be the one adult who makes a difference in a child’s 

life — including protecting that child or youth from violence and serving as a role model for 

achieving success without violence. Mentoring programs in the civilian and military communities 

have shown promise in reducing youth victimization by violence as well as the involvement of 

youth in violence and by improving youth’s social, emotional, and behavioral well-being.112-116 

Mentoring is not a panacea, however. It cannot replace interventions for children exposed to 

violence that are provided by multi-provider coalitions and support to the family as well as the 

child. Nor can it replace evidence-based treatment and trauma-informed services for children 

exposed to community violence. However, when included in community-wide programs that 

Children Exposed to Violence 98 
provide professional services and treatments, mentoring can make a unique contribution both to 

preventing children from being exposed to violence and to the recovery of children who are 

victimized by violence. 

Mentoring requires great skill, integrity, and patience when provided to children or youth who 

have been victimized by violence. All mentoring programs for children exposed to violence 

should provide trauma-informed training and ongoing supervision to each adult who serves as a 

mentor in order to ensure the safety of the children they monitor and maximize the benefits of 

mentoring that the children receive. 

5.11 Help communities learn and share what works by investing in 

research. 

Research and program evaluations have immeasurably benefitted the existing interventions and 

programs that scientists, clinicians, and advocates have developed and that communities have 

adapted and put into practice to protect their children from exposure to violence and to help 

victims heal, regain their childhoods, and reclaim their right to develop a healthy, productive, 

and meaningful life. 

Much more research will be needed to build the evidence base as communities adopt, adapt, 

and implement trauma-informed services and trauma-specific treatments for children who have 

been exposed to violence. Services and treatments cannot remain static, or they will become 

stagnant and obsolete. On the other hand, when research infuses services and treatments with 

new knowledge and improved practices, communities can update, refine, or change their 

programs for children exposed to violence based on what works rather than on parochial 

opinions or preferences. 

Scientific research on the causes of children’s exposure to community violence and ways to 

prevent and treat its adverse effects requires a coordinated national initiative to develop publicprivate partnerships and funding in order to ensure that the most effective and efficient 

interventions are available to, and used successfully in, every community in our country. 

Children Exposed to Violence 99 
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24. 

Children Exposed to Violence 109 
 

Chapter Six: Rethinking Our Juvenile Justice System 

The vast majority of children involved in the juvenile justice system have survived exposure to 

violence and are living with the trauma of that experience. If we are to fulfill the goals of the 

juvenile justice system — to make communities and victims whole, to rehabilitate young 

offenders while holding them accountable, and to help children develop skills to be productive 

and succeed — we must rethink the way the juvenile justice system treats, assesses, and 

evaluates the children within it. 

By the time children come into contact with the juvenile justice system, they have almost always 

been exposed to several types of traumatic violence over a course of many years. In a study 

conducted at a juvenile detention center in Cook County, Illinois, 90 percent of the youth 

reported past exposure to traumatic violence, which included being threatened with weapons 

(58 percent)1

 and being physically assaulted (35 percent).2 Another study, this one conducted in 

juvenile detention centers in Connecticut, found that 48 percent of similar youth had 

experienced a traumatic loss.3

 Finally, according to a recent study that used a national sample 

of youth for comparison, youth in detention were three times as likely as those in the national 

sample to have been exposed to multiple types of violence and traumatic events.2 

The relationship between exposure to violence and involvement in the justice system is not a 

coincidence. Exposure to violence often leads to distrust, hypervigilance, impulsive behavior, 

isolation, addiction, lack of empathy or concern for others, and self-protective aggression. When 

young people experience prolonged or repeated violence, their bodies and brains adapt by 

becoming focused on survival. This dramatically reduces their ability to delay impulses and 

gratification, to a degree even beyond that of normal adolescents. Youth who are trying to 

protect themselves from more violence, or who do not know how to deal with violence they have 

already experienced, may engage in delinquent or criminal behavior as a way to gain a sense of 

control in their chaotic lives and to cope with the emotional turmoil and barriers to security and 

success that violence creates. 

Research on brain development over the past two decades has shown that the areas of the 

prefrontal cortex responsible for cognitive processing and the ability to inhibit impulses and 

weigh consequences before taking action are not fully developed until people reach their mid20s.3,4 Adolescents experience heightened emotions and are more vulnerable to stress and 

prone to react without thinking than are adults.5,6 The United States Supreme Court’s recent 

groundbreaking decision to ban the death penalty for juveniles was due in large part to the 

advances in scientific understanding of how a normal adolescent’s brain develops. This 

decision, and the rulings of other landmark Supreme Court cases, acknowledged the 

fundamental developmental differences between the brains of children and adolescents and 

those of adults.7

 Consistent with these legal decisions, science reveals that the developing 

brain, in early childhood and throughout adolescence, is very sensitive to harsh physical and 

environmental conditions.8

 Traumatic violence, in particular, can delay or derail brain 

development, leaving even the most resilient and intelligent child or adolescent with a severely 

diminished capacity to inhibit strong impulses, to delay gratification, to anticipate and evaluate 

Children Exposed to Violence 110 
the consequences of risky or socially unacceptable behavior, and to tolerate disagreement or 

conflict with other persons. 

Children exposed to violence, who desperately need help, often end up alienated. Instead of 

responding in ways that repair the damage done to them by trauma and violence, the frequent 

response of communities, caregivers, and peers is to reject and ostracize these children, 

pushing them further into negative behaviors. Often the children become isolated from and lost 

to their families, schools, and neighborhoods and end up in multiple unsuccessful out-of-home 

placements and, ultimately, in correctional institutions. 

Many youth in the justice system appear angry, defiant, or indifferent, but actually they are 

fearful, depressed, and lonely. They hurt emotionally and feel powerless, abandoned, and 

subject to double standards by adults in their lives and in “the system.” These children are often 

viewed by the system as beyond hope and uncontrollable, labeled as “oppositional,” “willfully 

irresponsible,” or “unreachable.” What appears to be intentional defiance and aggression, 

however, is often a defense against the despair and hopelessness that violence has caused in 

these children’s lives. When the justice system responds with punishment, these children may 

be pushed further into the juvenile and criminal justice systems and permanently lost to their 

families and society. 

By failing to correctly identify and treat children exposed to violence, the system wastes an 

opportunity to alter the delinquent or criminal conduct of the children. This failure makes our 

communities less safe and results in the loss of the valuable contributions of these children — in 

youth and into adulthood — to their communities. 

This is not inevitable. These youth are not beyond our ability to help if we recognize that 

exposure to violence causes many children to become desperate survivors rather than 

hardened criminals. There are evidence-based interventions that can help to repair the 

emotional damage done to children as a result of exposure to violence and that can put them on 

a course to be well-adjusted, law-abiding, and productive citizens. Too often, these interventions 

are not used simply because they are not known or appreciated.2,9,10 

Rethinking how we approach young people in the justice system requires participation from 

everyone in the system. Law enforcement, judges, prosecutors, defense attorneys, probation 

officers, providers, and policymakers must all understand the data about children’s exposure to 

violence that is contained in the ACE (Adverse Childhood Experiences)11 and NatSCEV 

(National Survey of Children’s Exposure to Violence)12 studies as well as the latest research 

about what works for kids.2,13 It also requires people outside the system to accept that children 

in the justice system are not “bad kids” but, instead, are traumatized survivors who have made 

bad decisions but can still turn things around if they have help. The problem is not just confined 

to boys of color in urban communities — it affects youth of varying racial and ethnic 

backgrounds in rural, suburban, and tribal communities as well as girls and LGBTQ (lesbiangay-bisexual-transgender-questioning) youth.14-17 While the challenges of developing services 

for children in small communities are often great, the needs of children in those communities 

Children Exposed to Violence 111 
make it imperative that every community get involved in addressing the need for traumainformed assessment and care in its justice system. 

We must help children in the justice system to heal by responding in developmentally 

appropriate ways and by ensuring that the system itself does no harm. When traumatized 

children break the law and engage in delinquent conduct, even repeatedly, they still need and 

deserve help from adults. The system must recognize the heavy burdens that most young 

offenders carry and help them move into a healthy and productive adulthood by providing 

services that address the damage done by exposure to violence. Too often, the justice system 

relies on judgmental, punitive responses that are both harmful and ineffective. 

Fortunately, the juvenile justice system has undergone tremendous change in recent years, as 

cross-systems collaboration,18-20 evidence-based practices,21,22 and “programs that work”23 have 

moved the system towards better outcomes for children and their communities. An important 

next step in the improvement of the overall justice system is to incorporate what is known about 

children who have been exposed to violence into every facet of the system — juvenile and adult 

— and to incorporate trauma-informed care into decision-making responses for children 

throughout the system. 

Trauma-informed screening and treatment are just as vital, if not more so, for children who have 

committed serious violent offenses. By eliminating the death penalty and an automatic life 

sentence without parole for juveniles, the Supreme Court has created a pathway for children 

who are found guilty of homicide or other very serious violent offenses to be thoroughly 

assessed to determine the causes of their violent conduct. Many of the children who have been 

convicted as adults have experienced tremendous damage from violence that, in the past, 

would have gone unaddressed once they were incarcerated. Providing opportunities for 

assessment and trauma-informed care in both the juvenile and adult justice systems will help to 

repair the damage done by exposure to violence, improve the safety of everyone within the 

system, and increase the safety of communities to which incarcerated and detained children are 

released. 

Unfortunately, residential juvenile justice facilities, which should have the most comprehensive 

services for youth, often lack staff with professional training in mental health or substance abuse 

services.24,25 Research studies show that 65 percent of girls and 70 percent of boys in detention 

have been diagnosed with multiple mental health disorders,26 and nearly a quarter of youth in 

residential placements have attempted suicide.27 These young people have significant needs, 

and yet most secure facilities are not designed and staffed to meet those needs, and for some 

young people, their problems worsen in harsh environments.28 Confinement has been shown to 

exacerbate the symptoms of posttraumatic stress disorder (PTSD) through experiences that 

reactivate memories of past traumatic violence, such as being handcuffed, restrained, and 

searched.29,30 Staff and administrators in juvenile justice programs, however, vary in their 

willingness to even acknowledge the need for mental health and related services.31 Everyone in 

the juvenile justice system, including program staff and administrators, judges, attorneys, and 

probation officers, must be educated about the importance and benefits of providing appropriate 

trauma-informed services to youth in the system. 

Children Exposed to Violence 112 
At worst, involvement in the juvenile justice system does additional harm to children. In one 

study, more than a third of young people in juvenile placement were found to fear attacks from 

staff or other youth.27 Elsewhere, an analysis of data from state agencies responsible for 

overseeing juvenile detention facilities found that between 2004 and 2007 there were roughly 

12,000 documented reports of physical, sexual, or emotional abuse by staff members — nearly 

10 assaults a day, on average.32 And because children are often afraid to report abuse by staff, 

and as facilities may not consistently document the reports they do receive, the actual number 

of assaults is undoubtedly higher. 

Moreover, detention facilities and the justice system, through their routine practices, can bring 

additional harm to already traumatized youth. For example, the use of solitary confinement, 

isolation, and improper restraints can have devastating effects on these youth.33,34 Detention 

facilities must maintain safety without relying on practices that are dangerous and that 

compromise the mental and physical well-being of the youth in their care. 

The harm done to traumatized youth by the justice system is not limited to juvenile facilities. As 

one example, youth who have been forced into the sex trade and trafficked are often arrested 

and criminalized instead of being treated as the victims they are. We must develop traumainformed services unique to these problems so that we can more effectively separate young 

boys and girls from their exploiters and help these youth transition to productive lives. These 

young people should not have to be caught in the justice system and risk further victimization in 

order to get the services they need. Unfortunately, sexually trafficked or exploited children and 

young adults often are not identified unless they come to the attention of law enforcement, and 

so it is essential that judicial and law enforcement professionals have trauma-informed options 

for young people built into their respective obligations to uphold the law and protect public 

safety. 

A trauma-informed approach to juvenile justice does not require wholesale abandonment of 

existing programs; instead, it can be used to make many existing programs more effective and 

cost-efficient. By correctly assessing the needs of youth in the justice system, including needs 

reflecting their exposure to violence, and matching services directly to those needs, the system 

can help children recover from the effects of trauma and become whole. 

As a guide to addressing the needs of the vast majority of at-risk and justice-involved youth who 

have been exposed to violence, the task force offers nine recommendations, which are 

described below. 

6.1 Make trauma-informed screening, assessment, and care the standard in 

juvenile justice services. 

All children who enter the juvenile justice system should be screened for exposure to violence. 

The initial screening should take place upon first contact with the juvenile justice system and 

should include youth who meet the criteria for diversion from the system. Where feasible, 

juvenile justice stakeholders should develop trauma-informed care and treatment for children 

diverted to prevention, mental health, or dependency programs. 

Children Exposed to Violence 113 
Research shows that youth involved in,1,35 and at risk for involvement in,36 juvenile justice can 

provide a thorough description of their exposure to violence and related posttraumatic problems 

when screened with brief, carefully developed, and behaviorally specific questionnaires. These 

include self-report trauma history screens, such as the Traumatic Events Screening Instrument 

(TESI),36 and measures of PTSD symptoms such as the UCLA PTSD Reaction Index37 as well 

as event and symptom screening questionnaires such as the Massachusetts Youth Screening 

Instrument-2 (MAYSI-2), which assesses “traumatic experiences” as well as symptoms such as 

physical health problems, anger and aggression, depression and anxiety, and substance abuse. 

Many youth involved in juvenile justice are not maliciously aggressive but in fact are reacting 

defensively because of their exposure to violence. It is important to screen these youth for 

reactive aggression using a validated measure such as the Inventory of Callous-Unemotional 

(C-U) Traits.38 Those who score below the threshold for severe C-U traits are good candidates 

for therapeutic intervention. However, those who score in the severe range for these traits may 

be youth who are still using aggression systematically but reactively as a way of defending 

themselves. These youth may benefit from interventions that help them develop skills for 

dealing with fear and hopelessness and from behavior management programs that engage 

them actively in making their lives and environments safer. 

6.2 Abandon juvenile justice correctional practices that traumatize children 

and further reduce their opportunities to become productive members of 

society. 

Juvenile justice programs have long struggled with “best practices” for addressing the needs of 

detained and adjudicated youth.24,39 The most recent census of young people in residential 

placement, conducted in 2010, counted roughly 71,000 children nationwide living in juvenile 

institutions.40,41 The total number of juveniles nationally who spend some amount of time in a 

locked facility over the course of a year is much larger, however. Many of these children are 

living with the effects of exposure to traumatic violence, but they are often not given the help 

they need to recover while in custody. 

Most of the young people in custody during the 2010 census were not incarcerated for violent 

offenses. They were highly likely to have been exposed to violence, but most had not become 

perpetrators of violence. Sixty-three percent were confined for committing nonviolent offenses, 

technical violations of probation, or so-called status offenses such as truancy and underage 

drinking.40 It is crucial that incarceration of juveniles not involve sanctions that subject them to 

additional violence, both to protect them from further harm and to avoid teaching them by 

example that violence is an appropriate means to control other people’s behavior. This is also 

important for the slightly more than one-third of confined juveniles who committed a crime 

against another person, mainly robbery or assault, in order to avoid inadvertently strengthening 

the belief of these offenders that using violence is acceptable or effective.40 Establishing firm 

and fair discipline, rules, and standards is an effective way to hold juveniles responsible while 

also teaching them through actions and words that violence is neither an acceptable nor viable 

way to achieve their life goals. 

Children Exposed to Violence 114 
Juvenile justice programs have historically had three primary goals: increasing safety in juvenile 

justice facilities and in the community, bringing about justice for crimes committed, and 

rehabilitation of the youth in the care of these programs. With the growing recognition that many 

youth in these programs have significant exposure to violence and mental health problems,42 a 

fourth goal has emerged: addressing youths’ mental health needs to enable juvenile justice 

programs and facilities to successfully achieve their original goals of safety, justice, and 

rehabilitation.24,43,44 Despite efforts to foster collaboration between mental health and juvenile 

justice leaders, programs, and providers,43,45 numerous barriers have impeded the progress of 

mental health initiatives in juvenile justice facilities.24,46,47 Funding for mental health services 

often is better in the juvenile justice system than in the community,48,49 and yet only one in three 

youths is identified by juvenile probation officers as needing mental health services49 — a 

proportion that is only half that of youth in juvenile justice programs who have a psychiatric 

disorder (close to 70 percent) and well below the proportion of youth who have two or more 

psychiatric disorders (approximately 45 percent).42,50 Similarly, in an Australian study, less than 

half (18 percent overall) of the 40 percent of youth who reported substance abuse received a 

referral for drug or alcohol abuse treatment.51 The importance of providing effective treatment 

for such youth is underscored by findings from the Cook County (Illinois) study that, 5 years 

after being assessed in detention, 40 percent of boys and 30 percent of girls still had psychiatric 

or substance abuse disorders.52 

Punitive sanctions and practices used by law enforcement or juvenile justice personnel lead 

youth who have survived violence in their homes and communities to perceive adults from these 

sectors as a threat rather than a legitimate authority or role model. When these sanctions 

threaten adolescents’ autonomy and personal space, they may fall back on “street rules” and 

resort to aggression, secrecy, deception, and avoidance instead of responsible and safe 

behavior. 

When stressed by scarce resources, rapid staff turnover, threats of lawsuits, and negative 

publicity, juvenile justice and law enforcement personnel can become trapped in a survival 

mindset similar to that of the traumatized child. Preservation of the status quo may become their 

only priority, leading to the use of punitive correctional methods that damage youth rather than 

helping them. 

Nowhere is the damaging impact of incarceration on vulnerable children more obvious than 

when it involves solitary confinement. A 2002 investigation by the U.S. Department of Justice 

showed that juveniles experience symptoms of paranoia, anxiety, and depression even after 

very short periods of isolation.33 Confined youth who spend extended periods isolated are 

among the most likely to attempt or actually commit suicide. One national study found that 

among the suicides in juvenile facilities, half of the victims were in isolation at the time they took 

their own lives, and 62 percent of victims had a history of solitary confinement.34 

Given the environment in most secure facilities for young offenders — the dangers, the lack of 

meaningful activities, and the failure to help these children deal with past trauma — it is not 

surprising that these youth are ill-equipped to change their behavior when they leave. Indeed, 

one longitudinal study following more than a thousand young offenders for 7 years after 

Children Exposed to Violence 115 
conviction concluded that longer stays in juvenile institutions do not reduce recidivism.53 Some 

studies have even found that incarceration increases recidivism among juveniles who have 

lower-risk profiles and less-serious offending histories.53,54 

Facilities and practices can change, however, without any loss of effectiveness. The task force 

heard of examples where dangerous, damaging practices were abandoned and replaced with 

comprehensive trauma-informed programming designed to meet the needs of young residents. 

Facilities must screen the young people who are referred to their care to determine their needs 

and vulnerabilities and must then address those needs with trauma-informed programs. 

Juvenile justice officials should rely on detention as a last resort, and only for youth who pose a 

safety risk or who cannot receive effective treatment in the community. When children are in 

facilities, independent monitors should ensure that they are not abused by peers or staff and 

that they are receiving appropriate services to meet their needs. A clear system for grievances 

should be in place to address concerns of mistreatment or abuse in facilities. 

6.3 Provide juvenile justice services appropriate to children’s ethnocultural 

background that are based on an assessment of each violence-exposed 

child’s individual needs. 

In jurisdictions across the nation, racial and ethnic minority youth are overrepresented in the 

juvenile justice system, resulting in disproportionate minority contact with that system.55 

Involvement of minority youth with the justice system not only potentially perpetuates societal 

stigma and cultural trauma but also places such youth at higher risk for illness55 and violent 

death.56 

The backgrounds and experiences of youth who come into the system can affect the degree to 

which they experience trauma. Furthermore, cultural norms and practices influence how youth 

and families define a traumatic event and posttraumatic symptoms.57 Although most studies do 

not report significant differences in the degree to which youth of different ethnic or racial 

backgrounds have been exposed to violence,1,35 there are differences by background in how 

youth experience and respond to prior trauma. In one study, Hispanic/Latino youth were 

approximately twice as likely as White or Black youth to report a history of traumatic loss, 

neglect, or community violence. In that study, however, White youth reported more risk of 

suicide and of alcohol abuse than did either Black or Hispanic/Latino youth. 

Results from two recent epidemiological studies based on reports from teachers58 and youth59 

suggest that urban African-American youth may be more likely to be chronically engaged in 

physical aggression than youth of other groups. These differences emerge as early as 

kindergarten, and they likely coincide with exposure to violence in early childhood.58 If these 

children become involved in the justice system, it is vital that they be screened and treated for 

prior exposure to violence to help militate against the negative effects of prior trauma. 

Given the overrepresentation of Latino/Hispanic and African-American youth in the juvenile 

justice system and the often-associated negative stereotypes of minority youth, it is imperative 

Children Exposed to Violence 116 
 

that those who work with minority youth have respect for and understanding of the cultural 

differences between themselves and these youth. All youth involved in juvenile justice with prior 

exposure to violence should be identified and provided with help, but to be most effective, 

services and treatment should be adapted to the ethnocultural backgrounds of these youth. 

Not only race/ethnicity per se but also the degree to which ethnic/racial minority youth assimilate 

into the majority culture or identify with their culture of origin may play a role in aggressive 

behavior. When ethnic/racial minority adolescents are in settings of mixed ethnicity (as is typical 

in juvenile justice), they often engage in bullying as a defensive behavior.60 When youth engage 

in cross-ethnic/racial bullying or aggression, it is crucial to assess the potential influence of past 

exposure to violence, which may have led to fears about the threat posed by youth from other 

ethnic and racial groups. The system will be most effective if it identifies ethnic/racial trauma 

and fear and provides youth with skills for managing their stress reactions as a way to reduce 

reactive aggressive behavior. 

The degree to which services and treatments are culturally sensitive influences the expectations 

of both youth and caregivers as well as their acceptance and rejection of those services.58 

Accordingly, culture-sensitive role models, practices, and programs aimed at healing 

traumatized youth and preventing youth who are within the system or at risk for entering it from 

being further exposed to violence are being developed nationwide19 and incorporated into 

statewide juvenile justice systems.61 The importance of integrating widely available and 

culturally adaptive interventions for traumatized children,62 especially those involved in,63,64 or at 

risk for becoming involved in,65 the juvenile justice system cannot be overstated. 

6.4 Provide care and services to address the special circumstances and 

needs of girls in the juvenile justice system. 

According to a recently released report by the Georgetown Center on Poverty, Inequality, and 

Public Policy, “girls make up the fastest growing segment of the juvenile justice system. As a 

group, they are disproportionately ‘high need’ and ‘low risk,’ meaning that they face a host of 

challenges and have a critical need for services, but for the most part do not pose a significant 

threat to the public. The differences between the profiles and service needs of girls and boys 

entering the juvenile justice system present a significant challenge to the professionals who 

serve them. Many girls in the system have experienced traumatic events, including sexual and 

physical abuse and neglect, which have deeply wounded them emotionally and physically.”66 In 

fact, we know that a high percentage of girls in the juvenile justice system have been exposed 

to significant violence and trauma. Ninety percent of incarcerated girls report having 

experienced emotional, physical, and/or sexual abuse.67 

The Georgetown Center report continues to say: “Overall, the juvenile justice system is illequipped to serve girls effectively — particularly those who have been exposed to violence — 

having failed to implement the reforms called for by a growing body of research on the needs of 

the girls in its care.”66 Involvement in the justice system may penalize girls by exacerbating 

existing health and family problems while failing to address underlying issues.68-70 Twenty 

Children Exposed to Violence 117 
 

 

 

 

 

 

 

percent of girls in custody have or are expecting children.71 Girls who are pregnant or parenting 

within the juvenile justice system present their own set of needs. They are more likely to be 

parents than their non-justice-involved peers. Nine percent of girls in custody report that they have 

children,71 compared to six percent of girls in the general population.72 Further, a Crittenton 

Foundation 2012 report on young mothers in the juvenile justice system found that of the girls 

sampled, 49 percent had experienced sexual abuse, 35 percent had experienced physical 

neglect, 67 percent had alcoholism or drug use in their home of origin, 83 percent had 

experienced the loss of a biological parent from home, 46 percent had depression or mental 

illness in their home, 56 percent reported that their mother treated them violently, and 49 

percent reported that a member of their household had been imprisoned. 

Girls present to the juvenile justice system with high rates of mental health problems and 

depression. In their adolescence, girls are more likely than boys to attempt suicide and to selfmutilate. Negative body image, low self-concept, and acute substance abuse aimed at selfmedication, which so often result from stress or trauma, are issues that must be addressed 

differently in the future. 

Girls in the juvenile justice system are in critical need of programming, facilities, and staff that 

are gender responsive. Most youth in the juvenile justice system are detained for nonviolent and 

status offenses. This is particularly true of girls, who are slightly more likely than boys to enter the 

system for minor offenses. Girls are also detained for longer periods of time than are their male 

counterparts when they commit the same crimes.73 

Most youth, and most girls in particular, do not pose a significant public safety risk and would be 

far better served in nonresidential treatment facilities close to their own homes. However, for 

those who pose a serious societal risk, we recommend the utilization of small (i.e., no more than 

20 beds) gender-responsive, culturally competent residential facilities that are staff secure. 

Additionally, there is a need for small, family-style group-living facilities for pregnant and 

parenting girls. Whenever possible, the child should be allowed to reside with the mother, 

ensuring safeguards for the child. Although allowing the mother to be with her child is clearly 

beneficial for the mother, it is even more beneficial for the long-term health and development of 

the child. 

The key elements to trauma-informed, gender-responsive juvenile justice programs exist in 

every community. Very simply, programs that are good for girls, especially those recovering 

from exposure to violence, weave together family, community, and systems of care. These 

programs promote healing from trauma caused by physical and psychological abuse. In 

addition, they address the needs of girls while encouraging them to take leadership roles. 

Further, they promote the personal development of girls’ individual strengths. They are 

community-based to help foster healthy family relationships and sustainable community 

connections, and they support ongoing, positive relationships between girls and older women, 

family, and community.74 

Children Exposed to Violence 118 
 

6.5 Provide care and services to address the special circumstances and 

needs of LGBTQ youth in the juvenile justice system. 

Lesbian, gay, bisexual, and transgender youth, as well as youth questioning their sexual 

orientations (LGBTQ youth), are often targeted by other youth for bullying, increasing their 

likelihood of experiencing despair, isolation, suicidal ideation, and chronic violence in the form of 

bullying. When these youth become involved with law enforcement or the courts, they are often 

placed in close, unsupervised contact with other youth, which in turn often leads to harassment, 

bullying, or assault. The same staff charged with monitoring and protecting these youth may 

exacerbate their trauma by joining in the harassment and assaults as an expression of their own 

homophobia. In order to have the best outcomes for these young people, the justice system 

must respond to their past exposure to violence and trauma in ways that do not perpetuate 

stereotypes or the use of stigma against LGBTQ youth. This includes providing services and 

treatment that support their sexual orientation, lifestyle, and peer group choices while helping 

them to establish a sense of security within themselves and their relationships, enabling them to 

make responsible and safe choices that enhance their development and protect them from 

violence. 

In an effort to protect LGBTQ youth in their care, facilities often isolate them. This can directly 

traumatize these youth, however, or greatly worsen their posttraumatic symptoms from past 

exposure to violence. All juvenile justice personnel and facilities must provide consistent 

therapeutic supervision to ensure the safety of LGBTQ youth and thus protect them from further 

exposure to violence by peers or adults, but without resorting to isolation. Those who work with 

youth in juvenile justice programs and facilities must be trained to deliver trauma-informed care 

while demonstrating respect and support for the sexual orientation of these young people in 

order to end norms based on stigma. 

6.6 Develop and implement policies in every school system across the 

country that aim to keep children in school rather than relying on policies 

that lead to suspension and expulsion and ultimately drive children into the 

juvenile justice system. 

Many children enter the juvenile justice system because schools rely on that system to enforce 

discipline. Harsh, exclusionary school discipline policies funnel children into the justice system 

in large numbers: Of the 3.3 million children suspended from school each year, 95 percent are 

sanctioned for nonviolent offenses like disruptive behavior and violating dress codes.75 

Moreover, according to the American Psychological Association (APA) Zero Tolerance Task 

Force, these policies do not result in improved safety in schools. Especially troubling is the fact 

that the APA Task Force found that children with emotional disturbances are disciplined under 

zero-tolerance policies at a disproportionally high rate. Interestingly, when harsh exclusionary 

policies are discontinued in schools, referrals to juvenile correctional facilities also decrease.28 

School should be a safe place for all children to learn and develop. For children who are 

exposed to violence, schools may be one of the few safe places available to them. Children who 

Children Exposed to Violence 119 
 

have been exposed to violence should be able to receive support and healing measures in 

school rather than being subjected to harsh discipline for failing to adhere to school norms. Too 

many vulnerable children who have been exposed to violence are unnecessarily removed from 

schools through school discipline and referrals to the juvenile justice system. As described by 

the Department of Justice, Office of Juvenile Justice and Delinquency Prevention (OJJDP): 

“Without the structure and supervision that school provides, truants and dropouts often turn to 

delinquent or criminal behavior. A child’s lack of commitment to school has been established as 

a risk factor for a variety of negative outcomes including: substance abuse, teen pregnancy, 

school dropout, and delinquency.” 

The OJJDP has called for changes in school programs to stop the “school-to-prison pipeline,” 

helping all students, including juvenile offenders, “to access quality education, and advancing 

the use of positive discipline and learning policies and practices” on a school-wide basis in 

every classroom and activity. Promising approaches to improving attendance, reducing truancy, 

and preventing dropout must be adopted by all school systems. So, too, must schools develop 

and implement innovative approaches to identify and help students who are at risk for dropping 

out, academic failure, behavioral problems, substance abuse, gang involvement, and 

depression that could lead to thoughts of suicide. 

Optimally, academic environments and communities will provide youth with activities and 

feedback that highlight their strengths and teach them skills to manage intense stress reactions 

without hurting others or themselves. This rarely occurs in practice, however. While existing 

programs show promise in reducing bullying and substance abuse, they alone are insufficient to 

reduce the ultimate involvement of the at-risk students in the juvenile justice system. Most 

school intervention models do not teach students or school personnel how to create a traumainformed school environment by understanding traumatized students’ aggressive, avoidant 

(absenteeism, failure to complete schoolwork), or impulsive behavior as traumatic stress 

reactions, nor do they provide practical skills to enable youth and adults to recognize, prevent, 

or manage stress reactions. As a result, youth who are disruptive in school as an aftereffect of 

exposure to violence often are referred to the juvenile justice system. 

Children Exposed to Violence 120 
Successful school-based programs help students develop better ways of handling emotional 

distress, peer pressures, and problems in their family and peer relationships. These programs 

translate research in brain science into practical knowledge and skills that school personnel and 

students can use in order to achieve the mindfulness and restraint necessary to make good 

choices and decisions.76 The programs integrate trauma recovery into existing school curricula 

and activities, decrease the frequency and severity of dangerous, disruptive, or delinquent 

behavior among youth, reduce disciplinary interventions by staff, and increase students’ abilities 

to have positive experiences with education, recreation, peer relationships, and the larger 

community. 

6.7 Guarantee that all violence-exposed children accused of a crime have 

legal representation. 

All children who enter the juvenile or adult justice system should be screened for exposure to 

violence and provided access to trauma-informed services and treatment. Defense attorneys 

who represent children in both systems are in a unique position to help identify prior exposure to 

violence in the lives of their clients and to help identify and prevent abuses of children in 

detention and placement programs. 

The confidential attorney-client relationship can create a safe place for young people and their 

families to talk about past experiences or ongoing abuse.77 While trust is not built up overnight, 

as attorneys work with their clients to prepare a defense, children often develop a relationship of 

openness and trust. As a result, clients and their families often disclose information about past 

or ongoing abuse and exposure to violence that they would not share with others in the justice 

system. Defense attorneys must be properly trained to respond to these disclosures of 

psychological trauma and exposure to violence so that they can both maintain their ethical 

obligations and help their clients obtain the services they need. 

All children who appear in juvenile and adult proceedings have a constitutionally guaranteed 

right to counsel.78 This is a right that all judges, prosecutors, and defense attorneys are sworn to 

uphold. Defense counsel plays an important role in ensuring fairness and equity in the juvenile 

justice system and protecting children from abuses of power by judges, prosecutors, probation 

officers, and correctional officials. In addition, defense attorneys are the only parties in the 

proceedings required by law to represent the expressed interest of the child.77 They protect the 

due process rights of their clients by filing pretrial motions, petitions for habeas corpus, 

challenges to evidence, and appeals. 

Unfortunately, the right to counsel is often restricted during the process of appointing counsel or 

denied through waiver of counsel. In many jurisdictions, the right to counsel for children is 

determined by family income tests that are established and administered by the offices of public 

defenders.79 Public defenders and government officials should recognize the enormous 

difficulties facing children entering the justice system who are exposed to violence and the large 

number of children affected by exposure to violence. “Financial means” tests for the 

appointment of counsel for children in the adult and juvenile systems should be set aside, and 

Children Exposed to Violence 121 
all children — especially those exposed to violence — should be presumed indigent for the 

purpose of appointment of counsel.80 

The rates at which children give up their right to counsel vary dramatically across jurisdictions. 

Some systems ensure that every child in the system is represented, while others allow 80–90 

percent of youth who are charged with offenses to appear without counsel.81 In many 

jurisdictions, children and their families opt to proceed without counsel because they believe 

that the child will receive a more lenient disposition if she/he appears unrepresented or that the 

case is not serious. Most of these decisions are made without an attorney to explain to the child 

or the family the risks or the potential consequences. In some very serious cases, such waivers 

could lead to lengthy periods of incarceration, lifetime registration for sex offenders, or even 

deportation. In especially troubling cases, parents may pressure their child to waive counsel 

because the parent does not want abuse in the home to be discovered or because the parent 

wishes the child to be sent to placement. 

Defense attorneys also have a vital role in protecting youth from abuse and other forms of 

violence that are often found within the justice system. In the earliest stages of the process, it is 

the role of the defense attorney to ensure that the underlying facts are investigated and that 

children who are wrongly accused are able to challenge the case against them. Defense 

attorneys also ensure that children with legal defenses and mitigating circumstances are not 

coerced into admissions without advice about their legal options. Protecting the due process 

rights of youth at trial is integral to ensuring that children are not further traumatized. 

Some cases involving children’s exposure to violence are better addressed in the mental health 

or child protection system. In appropriate cases, defense attorneys can alert probation officers, 

prosecutors, and judges to such cases and request that their clients be diverted to alternative 

systems that can provide better trauma-informed care and services for youth. 

One of the most vital roles of counsel is to protect children against unjustified placement and 

incarceration and to guard against abuses within facilities. In some states, counsel’s legal 

obligation to represent children terminates upon disposition. But a rethinking of juvenile justice 

requires that serious thought be given to the representation of juveniles as long as they are 

under court supervision. The presence of counsel could help ensure successful placements and 

aftercare programming. When exposure to violence is discovered, defense counsel would have 

the ability to file legal motions to stop the abuse and to remove the child from the facility where it 

is occurring. Children who do not have these protections have no recourse when they are 

mistreated in facilities where they are cut off from their families and other caring adults. 

6.8 Help, do not punish, child victims of sex trafficking. 

Each year, thousands of American children, mainly girls, are coerced into commercial sex 

trafficking. These children are traumatized and exploited through prostitution and pornography. 

Many are compelled to perform sex acts for drugs, shelter, and food. “Sex traffickers frequently 

target vulnerable people with histories of abuse and then use violence, threats, lies, false 

Children Exposed to Violence 122 
promises, debt bondage, or other forms of control and manipulation to keep victims involved in 

the sex industry.”82 

Research shows that the vast majority of victims of domestic minor sex trafficking (DMST) — 

between 70 percent and 90 percent — have a prior history of sexual abuse.83 The resulting 

exploitation is considered a modern-day form of slavery, as human trafficking victims are 

subjected to sexual exploitation or forced labor. The victims’ fear of retribution through physical 

and sexual violence or by threat to families or significant others often prevents them from 

escaping or reporting to authorities. 

While many trafficking networks operate out of urban areas, other traffickers seek the seclusion 

of rural and remote areas to operate without detection. Estimates of the dimensions of the 

problem vary dramatically. According to one estimate, approximately 100,000 to 300,000 

American children are sold for sex each year, with the average age of entry into the commercial 

sex industry between 12 and 14 years.84 

The true dimensions of the problem internationally and within the United States are difficult to 

determine because of the underground nature of the trade. In March 2012, President Obama 

directed his Cabinet to redouble the administration’s efforts to eliminate human trafficking 

abroad and in communities at home through several initiatives: an executive order 

strengthening protections in federal contracts, tools and training to identify and assist trafficking 

victims; increased resources for victims of human trafficking; and a comprehensive plan for 

future action. On September 25, 2012, the President announced further efforts to combat 

human trafficking. At that time he stated: “It ought to concern every person, because it’s a 

debasement of our common humanity. It ought to concern every community, because it tears at 

the social fabric. It ought to concern every business, because it distorts markets. It ought to 

concern every nation, because it endangers public health and fuels violence and organized 

crime. I’m talking about the injustice, the outrage of human trafficking, which must be called by 

its true name — modern slavery. Our fight against human trafficking is one of the great human 

causes of our time, and the United States will continue to lead it ....” 

Today, there is a national spotlight on the newest form of human trafficking, known as DMST as 

indicated above or as CSEC (commercial sexual exploitation of children). Traffickers in these 

crimes are pimps who have increasingly moved away from adult prostitution to the more 

financially lucrative crime of forcing minor children into prostitution. While many of these 

traffickers have a local gang affiliation, increasingly one sees organized crime syndicates begin 

to enter this criminal trade to sexually exploit children. The traffickers have evolved to using 

social network media sites and other technology-facilitated methods to find a steady flow of 

perpetrators who sexually assault these minor victims. They have also become more 

sophisticated in increasing their criminal clientele by transporting U.S. minors to multiple "tracks" 

in and out of other cities, counties, states, and countries. Many travel with their victims to cities 

that are hosting major sporting events or other popular media attractions for the sole purpose of 

prostituting and exploiting the children. 

Children Exposed to Violence 123 
 

 

Unfortunately, many child victims do not seek help or resist intervention from law enforcement 

or social service organizations because they do not know their rights, they feel ashamed, they 

are reluctant to admit to victimization, or they fear their traffickers.85 

In the recent past, law enforcement and other government agencies viewed the majority of 

these victims as teen minors who had independently made the choice to engage in the criminal 

act of prostitution. Correspondingly, the prevailing view of law enforcement, prosecutors, and 

other governmental personnel or agencies was that these minors were not victims of human 

trafficking. As a result, these adolescents were simply cited for solicitation of prostitution and 

provided with little or no services to address their exploitation and their trauma. The problem 

was further exacerbated by the lack of reporting to child welfare and by the agencies’ limited 

resources and outdated training, limiting their provision of effective services to this population. 

The task force, consistent with federal policy, recommends strongly that child victims of 

commercial sex trafficking be treated as victims and not as delinquents or criminals. They 

should not be locked up in juvenile detention facilities, placement programs, or jails but instead 

should be given safe harbor in facilities specifically designed to address their unique needs. 

States and localities need to develop new laws and procedures and imaginatively apply existing 

laws on victim protection to protect the rights of these child victims. State and local officials 

should coordinate efforts with federal officials and social service agencies to provide safe 

housing and other essential services. These children desperately need the benefit of traumainformed assessments, care, and treatment to help them live meaningful lives in our society. 

6.9 Whenever possible, prosecute young offenders in the juvenile justice 

system instead of transferring their cases to adult courts. 

As noted earlier in this report, a majority of U.S. children, an estimated 46 million, are exposed 

to violence, crime, and abuse each year. Many of these children are at increased risk of being 

victimized and/or becoming violent themselves. Too often, these children are labeled as “bad,” 

“delinquent,” “troublemakers,” or “lacking character and positive motivation.” Many commit 

violent acts and enter the criminal justice system. However, enormous strides have been made 

in developing effective ways of interrupting the cycle of violence, responding to the 

consequences of the exposure of these youth to violence, and healing them from its effects. It is 

time to utilize effective coordinated approaches that address the needs of children traumatized 

by violence who commit violent acts. 

We should stop treating juvenile offenders as if they were adults, prosecuting them as adults in 

adult courts, incarcerating them as adults, and sentencing them to harsh punishments that 

ignore their capacity to grow. When properly screened, assessed, and provided with traumainformed care and evidence-based trauma-specific treatment, children who have been exposed 

to violence and are in trouble with the law have the capacity to grow, mature, and become 

productive citizens. 

In the United States, over 200,000 children every year are tried as adults,86,87 and on any given 

day an estimated 6,000 are incarcerated in an adult facility while they are still juveniles.88 

Children Exposed to Violence 124 
However, most adult jails or prisons are ill-equipped to meet the needs of children or keep them 

safe.89 They are much more likely to commit suicide in an adult jail than in a juvenile facility.90,91 

They are also five times as likely to be sexually abused or raped as they would be in a juvenile 

facility.92 Some of these youth are confined in facilities along with adults, where they may 

witness as well as be the target of violence. 

While in adult jails and prisons, children are often housed in solitary confinement to protect them 

from adults. In a 2012 survey in Texas, for example, the majority of jails held juveniles in solitary 

confinement for an astounding 6 months to more than a year — with just 1 hour outside their 

cell per day.93 Nowhere is the damaging impact of incarceration on vulnerable children more 

obvious than when it involves solitary confinement.33 A 2002 investigation by the U.S. 

Department of Justice showed that juveniles experience symptoms of paranoia, anxiety, and 

depression even after very short periods of isolation. 

In September 2009, three guards escorted a 16-year-old Troy to an interview with his lawyer in 

a New Jersey juvenile facility. He wore leg-irons and his body was covered only with a 

"Ferguson gown," a sleeveless-thigh-length robe that bound him with 242 Velcro strips. Selfmutilation scars too numerous to count covered his arms.94 Troy had spent 24 hours a day in an 

isolation cell for approximately 180 of the 225 days he had been confined.95 Citing dangers 

facing youth like Troy, the American Academy of Child and Adolescent Psychiatry recently 

issued a statement flatly opposing solitary confinement for juveniles.96 

Treating young offenders like adults also puts society at greater risk. Children prosecuted as 

adults are 34 percent more likely to commit new crimes than are youth who remain in the 

juvenile justice system.97 

In 2012, 32 members of the U.S. Congress cited these reasons and others in a letter to U.S. 

Attorney General Eric Holder urging him to strengthen federal regulations and essentially 

prohibit states and localities from incarcerating any person younger than 18 in an adult prison or 

jail as a condition of federal funding.98 Current federal guidelines, including the Prison Rape 

Elimination Act standards, already require adult facilities to ensure that youth awaiting trial 

neither hear nor see adult inmates, but those restrictions have the unintended effect of 

promoting the use of solitary confinement. 

On June 25, 2012, the Supreme Court reached a decision in Miller v. Alabama that it is 

unconstitutional for states to require a sentence of life without parole for anyone who is younger 

than 18 at the time of the crime. In writing for the majority, Justice Kagan affirmed that youth, 

and the hallmarks of youth, matter. “... a State’s most severe penalties on juvenile offenders 

cannot proceed as though they were not children.”99 

Although the Court stopped short of an outright ban on life without parole for juveniles, Justice 

Kagan noted, “... we think appropriate occasions for sentencing juveniles to this harshest 

possible penalty will be uncommon. That is especially so because of the great difficulty we 

noted in Roper and Graham of distinguishing at this early age between the ‘juvenile offender 

Children Exposed to Violence 125 
 

whose crime reflects unfortunate yet transient immaturity, and the rare juvenile offender whose 

crime reflects irreparable corruption.’”100 

Children Exposed to Violence 126 
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Children Exposed to Violence 135 
 

Conclusion 

Every day in this country millions of children’s lives are scarred by violence. Not hundreds, or 

thousands — millions. Every one of these children is precious and irreplaceable; they are our 

treasure and our country’s future. When even one child has their childhood stolen by violence, 

the loss is incalculable. The wounds our children endure from exposure to violence must be 

healed. There is no more time to waste — we can no longer wait. Decisive action is required, 

now. 

This report guides the way forward. The actions we must take are clearly stated in each of our 

recommendations. Change can — and must — begin immediately, at every level of government 

and in every community. 

Ultimately, every family must be empowered to join this effort, and every community must rise 

up to protect and heal children who are exposed to violence and ensuing psychological trauma. 

We all know that children should be protected and kept safe from violence. Yet we have not, as 

a nation, firmly repudiated all forms of violence that harm our children. We must now commit, 

unreservedly, to sustained efforts at protecting our children from violence. 

We can protect and heal our children from exposure to violence by mobilizing resources that 

currently exist but are not sufficiently organized and accessible. Steps must be taken nationally, 

regionally, and locally to inform and support every teacher, healthcare professional, police 

officer, judge, attorney, social worker, clergyperson, therapist, advocate, and paraprofessional 

who serves and guides children and their families to implement effective policies, practices, and 

procedures to protect and heal children exposed to violence. 

Children and families in tribal communities, and others in rural or urban settings who live with 

poverty or discrimination because of their race, culture or language, sexual orientation, or 

mental or physical disabilities, have experienced decades and generations of exposure to 

violence and extreme psychological trauma. They require special attention, and they must 

receive it. We must take steps politically, economically, and socially to restore these 

communities and their children and families from the chronic and debilitating exposure to 

violence they face every day. 

Although this is a hard time for countless families in our country who are struggling financially, 

and for all parts of government facing immense economic challenges, we must not let these 

realities diminish our resolve to face and address the ongoing epidemic of children exposed to 

violence. We must continue to identify opportunities for the federal, state, tribal, and local 

governments to redirect the funds currently available and to achieve new efficiencies with this 

funding. We can and must use our resources more wisely to produce better outcomes and to 

defend children against exposure to violence. 

We must actively engage youth, their families, and local leaders in urban, suburban, rural, and 

tribal communities to drastically reduce children’s exposure to violence. 

Children Exposed to Violence 136 
This report is a call to action for every person in America to rise up to defend our children! We 

must dedicate ourselves to creating safe places and healthy relationships in which every one of 

our children can grow, succeed, and carry forward the blessings of liberty, fraternity, and 

equality. 

When we dedicate ourselves as a country to defending our children from violence, we will 

provide hope and a way forward for every person in America to thrive, because we will have 

made our country safe for all. 

Children Exposed to Violence 137 
 

 

Acknowledgments 

During the course of our work, the Defending Childhood Task Force received support and 

assistance from numerous individuals and organizations to whom we would like to express our 

deepest gratitude. 

The U.S. Department of Justice’s Office of Juvenile Justice and Delinquency Prevention, led by 

Acting Administrator Melodee Hanes, provided the funding for this critical work as part of the 

Defending Childhood Initiative. We thank the department for the support it provided and its 

commitment to helping children heal and thrive. 

Our technical assistance provider, the National Council on Crime and Delinquency (NCCD), 

organized four public hearings and three listening sessions spanning the country. The hearings 

and listening sessions formed the backbone of our inquiry. We also would like to thank the 

following individuals and organizations who made it possible, through their generosity and time, 

for us to convene experts and community members to discuss children’s exposure to violence: 

the University of Maryland Francis King Carey School of Law; the City of Albuquerque, New 

Mexico; the Office of the U.S. Attorney for the District of New Mexico; the University of Miami 

Newman Alumni Center; Wayne State University; the Office of the U.S. Attorney for the Eastern 

District of Michigan; the Family Resource Center at Joint Base Lewis-McChord; and the Office 

of the U.S. Attorney for the District of Alaska. 

We also gratefully acknowledge below the many individuals who helped shape our thinking 

about this work and provided us with the support to complete this challenging task well. 

Most importantly, this report and the work of this task force would not be what they are without 

the voices of those who shared their expertise, personal experience, passion, and commitment 

to ending children’s exposure to violence during the course of our hearings and listening 

sessions, as well as those who submitted written testimony. They are acknowledged individually 

in a separate section of this report, but their contributions bear mentioning again here. We are 

greatly indebted to them. We know that ending children’s exposure to violence requires every 

one of us, and the hundreds of people we heard from across this nation have demonstrated 

what profound change can occur when one person accepts the responsibility each of us has in 

ending this epidemic. Thank you for your dedication. 

Children Exposed to Violence 138 
Individuals 

Leon Andrews 

Adora Andy 

Bernard Auchter 

Aaron Auyeung 

Sujatha Baliga 

The Hon. Richard Berry 

The Hon. André Birotte, Jr. 

Steve Boehm 

Bruce Boldon 

Elsie Boudreau 

Michela Bowman 

Akiba Bradford 

Peter Brien 

Col. Thomas Brittain 

Will Bronson 

Bernadette Brown 

Alexander Busansky 

Patricia Campie 

Torey Carlson 

Bethany Case 

Laura Counts 

Antoinette Davis 

Lonna Davis 

Janice Delaney 

Tim Dietrich 

Catherine Doyle 

Karin Drucker 

Kim Ellingson 

Chalece Erixon 

The Hon. Wifredo Ferrer 

Jordan Field 

Julian Ford 

Evan Franco 

Amy Fry 

The Hon. Kenneth Gonzalez 

Donna Grecco 

Debra Greene 

Stacey Greenspan 

Livier Gutierrez 

Phoebe Haddon 

Leslie Hagen 

Melodee Hanes 

Erin Hanusa 

Bill Harvey 

Karel Herrington 

Audrey Hill 

Laura Hogan 

Sabra Horne 

Angela Irvine 

Anna Johnson 

Caitlin Johnson 

Darlene Johnson 

Shania Kapoor 

Liz Kidder 

Angella LaTour 

Mary Lou Leary 

The Hon. Cindy Lederman 

Philip Little 

Jonathan Londino 

Ron Lopez 

Jennifer Lotz 

Diego Lucero 

Vanessa Patino Lydia 

Judith Lynn 

Shawn Marsh 

Lissa Martin 

Anna Martinez 

Elizabeth Martinez 

Karol Mason 

Dave Mathews 

Krista Maynard 

Rhonda McKitten 

The Hon. Barbara McQuade 

Helena Mickle 

Charles Moses, III 

Children Exposed to Violence 139 
Belinda Nip Keely Bell Stotlar 

Angela Noel Sabrina Strauss 

Deirdre O’Connor Peter Taylor 

Charles Ogletree, Jr. Tamara Thompson 

Natalie Ortega Jennifer Trone 

Cynthia Pappas Jennifer Trovillion 

Kathy Park Sarah True 

Debra Paulus Eugenia Tyner-Dawson 

Diane Payne Elaine Valentine 

Bernard Perlmutter Sharon Vandever 

The Hon. Thomas Perrelli Rob Wald 

Anita Perry Alison Waldman 

Catherine Pierce Kevin Washburn 

The Raben Group The Hon. Tony West 

Barbara Raymond Debra Whitcomb 

Dale Rees Pamela William 

Gilbert Reyes Angela Wolf 

Thomas Reynolds Michael Wright 

Bruce Riordan Phelan Wyrick 

Liz Ryan Yue Xu 

Amy Schneider Aishatu Yusuf 

Maureen Sheeran 

Jessica Shore 

Darla Sims 

Starr Stepp 

Kiersten Stewart 

Children Exposed to Violence 140 
Activities of the Task Force and List of Witnesses 

Lists reflect organizational affiliation at the time of participation and may not represent 

participants’ current positions. 

Hearing 1: Understanding the Scope of Children’s Exposure to Violence 

University of Maryland Francis King Carey School of Law 

Baltimore, Maryland 

November 29, 2011 

The task force’s first hearing focused on the scope of children’s exposure to violence from the 

perspectives of law, medicine, law enforcement, and research. The task force heard from 

experts about the prevalence of children’s exposure to violence; the burden on care providers to 

recognize and record children’s experience with violence; the challenge of tracking the 

intergenerational impact of violence; and the lasting effects exposure to violence can have on 

children, from brain development to juvenile justice system contact. Several leaders in the field 

spoke about innovative and collaborative approaches to addressing these problems and 

protecting and healing children exposed to violence. 

Witnesses: Lauren Abramson, PhD, Founder and Executive Director, Community 

Conferencing Center; Rosa Almond, parent of children exposed to violence; Sheila Bedi, Esq., 

Deputy Legal Director, Southern Poverty Law Center; Steven Berkowitz, MD, Associate 

Professor of Clinical Psychiatry, University of Pennsylvania, Department of Psychiatry; Mitru 

Ciarlante, Director of Youth Initiative at National Center for Victims of Crime; Michaele Cohen, 

Executive Director, Maryland Network Against Domestic Violence; Theodore Corbin, MD, 

MPP, Medical Director, Healing Hurt People violence intervention program, Co-Director of the 

Center for Nonviolence and Social Justice; Nigel Cox, Chair, Students Against Violence 

Everywhere National Youth Advisory Board; Howard Dubowitz, MB, ChB, Head of the Division 

of Child Protection, Director of the Center for Families, University of Maryland Medical Center; 

Jeffrey Edleson, PhD, Professor and Director of Research, University of Minnesota School of 

Social Work, Director, Minnesota Center Against Violence and Abuse; Earl El-Amin, Resident 

Imam, Muslim Community Cultural Center of Baltimore; David Finkelhor, PhD, Professor of 

Sociology, Director of the Crimes Against Children Research Center, Co-Director of the Family 

Research Laboratory at the University of New Hampshire; Josh Giunta, member of the public; 

Marshall T. Goodwin, Chief of Police, Baltimore City Schools; Jabriera Handy, youth 

advocate, Community Law in Action; Geraldine Hawkins, PhD, survivor of childhood exposure 

to violence; Ellsworth Johnson-Bey, Founder of Fraternal Order of Ex-Offenders; Jacquelynn 

Kuhn, survivor of childhood exposure to violence; Phil Leaf, PhD, Professor and Director, 

Johns Hopkins Center for the Prevention of Youth Violence; Ellyn Loy, Clinical Director, House 

of Ruth; Hon. Patricia M. Martin, President, National Council of Juvenile and Family Court 

Judges; Patrick McCarthy, PhD, President and Chief Executive Officer, Annie E. Casey 

Children Exposed to Violence 141 
Foundation; Adam Rosenberg, Esq., Executive Director, Baltimore Child Abuse Center; Liz 

Ryan, President and Chief Executive Officer, Campaign for Youth Justice; Sonja Sohn, actor 

and founder of ReWired for Change; Elizabeth Thompson, PhD, Director, Kennedy Krieger 

Institute Family Center, Project Director for the Integrated Trauma Approaches Program; 

Deborah Young, advocate, Justice for Families 

Hearing 2: Children’s Exposure to Violence in Rural and Tribal Communities 

Vincent E. Griego Council Chambers & U.S. Attorney’s Office, District of New Mexico 

Albuquerque, New Mexico 

January 30, 2012 

The task force’s second hearing focused on the unique issues that children, families, and 

service providers in rural and tribal communities face when experiencing or addressing 

exposure to violence. The task force heard from several young people about their own 

experiences, from experts on the relationship between the juvenile justice system and tribal 

courts, and from organization heads about their approaches to serving youth in rural and tribal 

communities. Witnesses also discussed how to use the strengths of these communities to 

address children’s exposure to violence. 

Witnesses: Rochelle A., Vice President, Leaders Uniting Voices Youth Advocates, New 

Mexico; Victoria Amado, New Mexico Victims’ Rights Project; Sharon Basinti, member of the 

public; Dolores Subia BigFoot, PhD, Director, Indian County Child Trauma Center and Project 

Making Medicine, University of Oklahoma Health Sciences Center (OUHSC); Evelyn 

Blanchard, PhD, Tribal Court Advocate for families and children; Maria Brock, LISW, Tribal 

Home Visiting Project Director, Native American Professional Parent Resources, Inc.; Elsie 

Boudreau, LMSW, Alaska Native Justice Center; Shelly Chimoni, Executive Director, All 

Indian Pueblo Council; Lyle Claw, President, Changing Lives Around the World (CLAW) Inc.; 

Kim Garcia, member of the public; Carole Justice, Coordinator, Indian Country 

Methamphetamine Program; Annie Pelletier Kerrick, Idaho Teen Violence Awareness & 

Prevention Project; Walter Lamar, President, Lamar and Associates; Coloradas Mangas, 

Youth Board Member, Center for Native American Youth; Nate Monson, Executive Director, 

Iowa Safe Schools; Anna Nelson, Executive Director, New Mexico Forum for Youth, Professor, 

New Mexico State University; Elaine Nolan, Director of Tribal Programs, Big Brothers, Big 

Sisters of Central New Mexico; Janell Regimbal, Senior Vice President, Children and Family 

Lutheran Social Services of North Dakota; Barbara Romo, Assistant District Attorney, 

Thirteenth Judicial District, New Mexico; Kathleen Sanchez, TEWA Women United; Paul 

Smokowski, MSW, PhD, CP, Director, North Carolina Academic Center for Excellence in Youth 

Violence Prevention; Esta Soler, President, Futures Without Violence; Mato Standing High, 

Attorney General, Rosebud Sioux Tribe; Gil Vigil, National Indian Child Welfare Association 

Board Member, Tribal/Governmental Liaison, Santa Fe Indian School; Ivy Wright-Bryan, 

National Director, Native American Mentoring, Big Brothers Big Sisters of America 

Children Exposed to Violence 142 
Hearing 3: Children’s Exposure to Violence in the Community 

University of Miami Newman Alumni Center 

Coral Gables, FL 

March 19‒21, 2012 

On the first day of its third hearing, the task force heard testimony from experts in addressing 

community violence. Witnesses spoke about addressing the effects of gang violence and of 

violence in immigrant communities and about coordinating first responses to incidents of 

violence. On the second day, the task force participated in an interactive discussion facilitated 

by Professor Charles J. Ogletree, Jr., of Harvard Law School. Professor Ogletree guided the 

task force and two witnesses through a series of hypothetical situations involving children 

exposed to violence, calling on the expertise of the participants to explain their responses. 

Witnesses: Michael Aptman, MD, Vice President, Melissa Institute; Alexis Brimberry, MD, A 

Child Is Missing, Inc.; Dawn L. Brown, former Executive Director, Girls and Gangs; Helene 

Buster, Director of Family Services, Seminole Tribe of Florida; Hon. Donald Cannava, Judge, 

Miami-Dade County Domestic Violence Court; Michael de Arellano, PhD, National Crime 

Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, 

Medical University of South Carolina; Sarah Greene, ACSW, LCSW, Program Administrator of 

Criminal Justice Partnerships, Mecklenburg County, North Carolina; Renita “Biggie Mama” 

Holmes, Executive Director and Founder, Women’s Association and Alliance Against Justice 

and Violence for Empowerment; Keante Humphries, Advocate, Southern Poverty Law Center; 

Charles Hurley, Chief of Police, Miami-Dade County Schools Police Department; Hon. Dwight 

C. Jones, Mayor of Richmond, Virginia; Laura Kallus, Executive Director, PanZOu Project, 

Inc.; Walter Lambert, MD, University of Miami School of Medicine; Lisa Lampkin, parent of 

child exposed to violence; Maj. Eddie Levins, Charlotte-Mecklenburg Police Department, North 

Carolina; Hon. Mark Luttrell, Jr., Mayor of Shelby County, Tennessee; Roy Martin, Program 

Manager, Partnership Advancing Communities Together, Boston Health Commission; Carlos 

Martinez, Public Defender, Miami-Dade County; Ed Mashek, survivor of childhood exposure to 

violence; Charles J. Ogletree, Jr., Director, Charles Hamilton Houston Institute for Race and 

Justice, Harvard Law School Jesse Climenko Professor of Law; Carolyn Reyes, JD, MSW, 

Senior Staff Attorney of Legal Services for Children (LSC); Hon. Michael J. Ryan, Cleveland 

Municipal Court Judge; Bryan Samuels, Commissioner, Administration on Children, Youth, and 

Families, Department of Health and Human Services; Isis Snow, parent of child exposed to 

violence; Shellie Solomon, Project Director, Service Network of Children of Inmates; Vicki 

Spriggs, CEO, Texas Court Appointed Special Advocates (CASA); Lyn Tan, Program Director, 

Youth Gang Prevention, at Immigrant and Refugee Community Organization 

Hearing 4: Protect, Heal, Thrive 

David Adamany Undergraduate Library, Wayne State University 

Detroit, Michigan 

Children Exposed to Violence 143 
April 23–24, 2012 

At its final hearing, the task force heard from experts in research and programming and from 

organization and foundation heads whose work is successfully addressing exposure to violence. 

The task force also heard from young leaders who have taken an active role in encouraging 

their peers and communities to stand against violence. 

William Bell, PhD, President and Chief Executive Officer, Casey Family Programs; Sandra 

Bloom, MD, Associate Professor, Health Management and Policy Co-Director, Center for 

Nonviolence and Social Justice, Drexel University School of Public Health; Distinguished 

Fellow, Andrus Children’s Center; Joron Burnett, Founder and CEO, Green Light Movement; 

Larry Cohen, MSW, Founder and Executive Director of Prevention Institute; Phil Coke, Detroit 

Tigers; Lois DeMott, Co-Founder of Citizens for Prison Reform, Association for Children’s 

Mental Health, parent of child exposed to violence; David Esquith, Acting Director, Office of 

Safe and Healthy Students; Vincent Felitti, MD, President and CEO of California Institutes of 

Preventive Medicine, Clinical Professor of Medicine at University of California, San Diego, and 

Fellow of The American College of Physicians; Jordan Field, Director, Detroit Tigers 

Foundation; Ralph L. Godbee, Jr., Chief of the Police Department, City of Detroit; Carol Goss, 

President and Chief Executive Officer, The Skillman Foundation; Frank Grijalva, Co-Director of 

Midwest Trauma Services Network; Neil Guterman, PhD, Mose and Sylvia Firestone 

Professor, Director of the Beatrice Cummings Mayer Program in Violence Prevention, and Dean 

of the School of Social Service Administration, University of Chicago; Kathy Hagenian, 

Michigan Coalition Against Domestic and Sexual Violence; Jim Henderson, Battered Women’s 

Justice Project, Office of Violence Against Women; Gary Ivory, Youth Advocate Programs, Inc.; 

Cory Jackson, Senior Pastor, Detroit Burns Seventh Day Adventist Church; Hon. Darnell 

Jackson, Circuit Court Judge, Saginaw County Circuit Court; Doncella Floyd Jones, Program 

Administrator, Children’s Aid Society; Candice Kane, CEO, CeaseFire Chicago, University of 

Illinois at Chicago, School of Public Health; Debbie Kane, Executive Director, Michigan 

Domestic Violence and Sexual Assault Prevention and Treatment Board; Mary Lee, Deputy 

Director, PolicyLink; James McCurtis, Director of Crime Victim Services, Michigan Department 

of Community Health; Rodney Nelson, Team Captain and Assistant Instructor, South Shore 

Drill Team; Leslie O’Reilly, Program Specialist, Crime Victim Services, Michigan Department of 

Community Health; Alex Piquero, PhD, Ashbel Smith Professor in the Program in Criminology 

in the School of Economic, Political, and Policy Sciences at the University of Texas at Dallas; 

Karen Rivera, Veteran, US Navy; Héctor Sánchez-Flores, Executive Director, National 

Compadres Network; Vincent Schiraldi, Commissioner, New York City Department of 

Probation; Lawnya Sherrod, youth representative, National Forum on Youth Violence 

Prevention, Founder of Glimpse of Hope and Youth Voice; Pamela Shifman, Director, 

Initiatives for Girls and Women, NoVo Foundation; Aisha Stubbs, Struggling Youth Into 

Successful Adults; Tadarial Sturdivant, Director, Wayne County Child and Family Services; 

Michelle Weemhoff, Senior Policy Associate, Michigan Council on Crime and Delinquency 

Children Exposed to Violence 144 
Listening Sessions 

The task force held three listening sessions to learn about children’s exposure to violence as it 

is experienced and addressed at a local level. Fifteen to twenty local experts were invited to 

each session to discuss the issues that affect them and tell the task force what would help them 

tackle these issues more effectively. At least one task force member attended each listening 

session. 

Listening Session 1: National Council on Crime & Delinquency 

Oakland, California 

January 12, 2012 

Local social workers, child psychiatrists, school administrators, law enforcement officials, and 

doctors shared their experiences and approaches to addressing children’s exposure to violence 

in an urban area with high rates of many forms of violence. Topics included the need to 

incorporate trauma-informed responses to children’s behavior into schools, the juvenile justice 

system, and other institutions that interact with children. Participants also discussed the need for 

inter-agency community partnerships to address children’s exposure to violence and develop a 

holistic approach to the issue. 

Cherri Allison, Esq., Alameda County Family Justice Center; Tatiana Colon, Dating Matters; 

Tony Crear, Alameda County Probation Department; Steve Eckert, LCSW, East Bay Agency 

for Children; Lt. Jason Fox, San Francisco Police Department; George Galvez, Communities 

United for Restorative Youth Justice; Carlos Guerrero, MSW, Children’s Hospital and 

Research Center, Oakland; Joe Jackson, advocate for foster youth; Priya Jaggannathan, 

Measure Y, Oakland; Vassilisa Johri, Ashland Youth Center Project; Lori Jones, Alameda 

County Social Service Agency; Janet King, Native American Health Center; Chen Kong-Wick, 

Oakland Unified School District; Barbara Loza-Muriera, Alameda County Interagency 

Children’s Policy Council; Bert Lubin, MD, Children’s Hospital and Research Center, Oakland; 

Annie Lyles, Prevention Institute; Anne Marks, YouthALIVE! – Caught in the Crossfire; Barbara 

McClung, Oakland Unified School District; Sokhom Moa, Commissioner on Juvenile Justice 

Delinquency Prevention for Alameda County; Chief David Muhammad, Alameda County 

Probation Department; Alisha Murdock, Project WHAT!; Amy Price, Zellerbach Family 

Foundation; Shanta Ramdeholl, RN, BSN, Juvenile Justice Center Medical Services; Ginni 

Ring, CASA of Alameda County; Barbara Staggers, MD, Children’s Hospital and Research 

Center, Oakland; Gary V. Thompson, Alameda Social Services; Tina Wadhwa, Seneca 

Center; Mailee Wang, Project WHAT! 

Listening Session 2: Joint Base Lewis-McChord Family Resource Center 

Tacoma, Washington 

March 13, 2012 

Children Exposed to Violence 145 
At the second listening session, task force members heard about the issues facing children and 

families on U.S. military bases, including high rates of domestic and family violence. The 

participants, including professionals working on base and in the surrounding community, shared 

their experiences in drawing on the unique resources offered by military bases to address 

children’s exposure to violence. Participants spoke about creating a larger network of care for 

children on and off base and working with military employees and community advocates to 

coordinate care for traumatized children. 

Col. Thomas Brittain, Joint Base Lewis-McChord; Ginny Clausen, Office of the Staff Judge 

Advocate; Diane Debiec, OIC, MHS, FAP, Joint Base Lewis-McChord; Yolanda Duralde, MD, 

Mary Bridge Children’s Hospital; Tamara Grigsby, CAPT, MC, USN, General and Child Abuse 

Pediatrics; Billy Harvey, DFMWR, Joint Base Lewis-McChord; Beth Holmes, Pierce County 

Juvenile Court; William Huges, PMO; Emma Jones, Department of Social and Health 

Services; Eleuthera Lisch, Alive & Free Street Outreach Network; Mariko Lockhart, Seattle 

Youth Violence Prevention Initiative; Patty Jo McGill, Family Advocacy Victim Advocacy 

Program; Larry Nelson, Children’s Administration, Department of Social and Health Services; 

Tanya Nowak, Focus Program; Lindsay Paden, MD, Child and Family Assistance Center; 

David Raines, Department of Social and Health Services, Pierce County South Child Protective 

Services; Barb Richards, New Parent Support Program; Nolita Reynolds, Catholic Community 

Services; Jennifer Schott, Young Women’s Christian Association; Holly Shaffer, Clover Park 

School District; Elaine Valentine, Army Community Services, Joint Base Lewis-McChord; Tina 

Wright, IMCOM G-9 FAP Specialist, Joint Base Lewis-McChord 

Listening Session 3: U.S. Attorney’s Office, District of Alaska 

Anchorage, Alaska 

May 7‒8, 2012 

The third listening session provided further insight into rural communities’ and Alaska Native 

villages’ experiences with children’s exposure to violence. Participants discussed the legacies of 

historical trauma experienced in Alaska Native villages and the challenges Alaska and the large 

number of tribes there face. They also discussed cultural strengths and grassroots efforts to 

address children’s exposure to violence. 

Children Exposed to Violence 146 
 

Elsie Boudreau, LMSW, Alaska Native Justice Center; Corinne Bryant, Alaska CARES; 

Barbara Cooper, MD, Providence Hospital; Mary Elam, Alaska Native Justice Center; 

Elizabeth Sunnyboy Elder, Speaking on Grief Issues; Dr. Gary Ferguson, Alaska Native 

Tribal Health Consortium; Yvonne Wu Goldsmith, Alaska Department of Health and Social 

Services; Kim Guay, Alaska Department of Health and Social Services; Pam Karalunas, 

Alaska Children’s Alliance; Alison Kear, Covenant House; Kathy Mayo, Tanana Chiefs 

Conference; Linda McLaughlin, Alaska Native Justice Center; Walt Monegan, Alaska Native 

Justice Center; Shirley Moses, Alaska Native Women’s Coalition on Domestic and Sexual 

Assault; Diane Payne, Alaska Summit Enterprise Inc.; Ann Rausch, Council on Domestic 

Violence and Sexual Assault; Lisa Rieger, Cook Inlet Tribal Council; Margaret Volz, Alaska 

CARES; Emily Wright, Alaska Network on Domestic Violence and Sexual Assault 

Children Exposed to Violence 147 
Individuals and Organizations That Submitted Written 

Testimony 

To ensure that its information-gathering efforts included as many people and perspectives as 

possible, the Defending Childhood Task Force accepted written testimony from any individual or 

organization. Submissions were accepted through April 24, 2012. Through this written 

testimony, the task force was able to see a wide range of perspectives and gain valuable 

knowledge. The task force thanks the individuals and organizations who submitted written 

testimony for their time and expertise. 

This list reflects organizational affiliation at the time of participation and may not represent 

submitters’ current positions. 

Ruth Abeyta 

Nilofer Ahsan, Center for the Study of Social Policy 

M. Victoria Amada, New Mexico Victims’ Rights Project 

Dawn Ammesmaki 

Dr. Michael Aptman, Melissa Institute for Violence Prevention and Treatment 

Zahra Arbelo 

Dora Arey, Native Village of Barrow Tribal Court 

Phil Arkow, National Link Coalition 

Dr. Marilyn Armour, University of Texas at Austin 

Elizabeth Baker 

Melissa Barnett 

William Bedrossian, Olive Crest 

U.S. Senator Mark Begich 

J. Benjamin, Sr. 

Dr. Ronald Beverly 

Children Exposed to Violence 148 
Thomas Birch, Founding Director of National Child Abuse Coalition 

Dr. Evelyn Lance Blanchard 

Dr. Ioakim Boutakidis, California State University, Fullerton 

Ann Brickson, Wisconsin Coalition Against Domestic Violence 

Dr. Alexis Brimberry, A Child Is Missing, Inc. 

Tina Bryant, Trauma Counseling Services 

Dr. Erica Buhrmann, Children’s Hospital and Research Center 

Paul Castillo 

Dr. Michael Chen, Children’s Center 

Capt. D. C. Clayton, Winston-Salem Police Department 

Tom Cochran, United States Conference of Mayors 

Susan Cole, Trauma and Learning Policy Initiative, Massachusetts Advocates for Children and 

Harvard Law School 

Morris Copeland, Miami-Dade Juvenile Services Department 

Rosemary Creeden, Mental Health Services, Inc. 

Sgt. B. E. Creswell, Newport News Police Department 

Kimberly Dalferes, Child Sexual Abuse Prevention Alliance 

Dr. Betty Lee Davis 

Dr. Frank G. DeLaurier, Melissa Institute for Violence Prevention and Treatment 

Lois DeMott, Association for Children’s Mental Health and Citizens for Prison Reform 

Elaine Diserio, Massachusetts Department of Children and Families 

The Hon. Byron Dorgan, Center for Native American Youth 

Children Exposed to Violence 149 
Stephanie Doyle, Boston Defending Childhood Initiative 

Erin Fairchild, Multnomah County Domestic Violence Coordination Office 

Elaine Flowers 

Brian Foster 

Andrew Gammicchia, L.E.A.N. On Us 

K. Garcia 

Jerry Gardner, Tribal Law and Policy Institute 

Adrienne Gasperoni, Turning Point, Inc. 

Dr. Ellen Gerrity, National Center for Child Traumatic Stress 

Kelley Gilbert, Big Brothers Big Sisters of America 

Amy Gilvary 

Det. John Gomez, Fresno Police Department 

Josh Gonze 

Jakolya Gordon, Cuyahoga County Defending Childhood Initiative 

Christine Gradert, Family Resources, Inc. 

Georgia Green, Police Action Counseling Team 

Cheryl Greene 

Paul Griego 

Dr. Frank Grijalva, Midwest Trauma Services Network 

Dr. John Grych, Marquette University 

Kathy Hagenian, Michigan Coalition Against Domestic and Sexual Violence 

Patricia Duncan Hall 

Children Exposed to Violence 150 
Dr. Sherry Hamby, Sewanee, the University of the South 

Jabriera Handy, Community Law in Action 

David J. Hearndon, Sr. 

Dr. Judith Herrman, University of Delaware 

Dr. Arthur Horton, Lewis University 

Laura Huot, the Guidance Center 

Gary Ivory, Youth Advocate Programs, Inc. 

The Hon. Darnell Jackson, Saginaw County (Michigan) Circuit Court 

Sue Ellen Jackson, Aware Central Texas 

Edward G. Jacoubs, Plymouth County (Massachusetts) District Attorney’s Office 

Sarah Jakiel, Polaris Project 

Cathi Kelley, Washtenaw Child Advocacy Center 

B. Kennedy Kent, Justice for Kids Now 

Faye Kihne, Community Violence Intervention Center 

Suzanne Koepplinger, Minnesota Indian Women’s Resource Center 

Kristina Konnath, Metrowest Behavioral Health Center 

Janet Kronenberg, Cuyahoga County Defending Childhood Initiative 

Barbara Laman 

Walter Lamar, Lamar Associates 

Maria Larrison, Sheltering Wings 

Jessica Lawmaster, Alaska Children’s Alliance 

Children Exposed to Violence 151 
Dr. Phil Leaf, Johns Hopkins Bloomberg School of Public Health (addendum to written 

testimony provided for Baltimore hearing) 

Sara Leathers, Sheltering Wings 

Devorah Levine, Contra Costa County Zero Tolerance for Domestic Violence Initiative 

David Llewellyn, Conscious Care Counseling 

Greg Loughlin, Georgia Commission on Family Violence 

Dr. Jane Isaacs Lowe, Robert Wood Johnson Foundation 

Annie Lyles, Prevention Institute 

Helen Lynn, Safe Child Coalition 

Lawrence Lynott 

Sgt. Daniel Macias, Fresno Police Department 

Doris Maya 

Cathy McClain, Safe Streets Cherry Hill 

James McCurtis, Crime Victims Services Commission, Michigan Department of Community 

Health 

Matthew Melmed, Zero to Three 

Crystal Miller 

Betsy Morrison, Portland Maine Defending Childhood Initiative 

Diane Moyer, Pennsylvania Coalition Against Rape 

Dara Munson, Big Brothers Big Sisters of Metropolitan Detroit 

National Sexual Violence Resource Center 

Chuck Noerenberg, National Alliance for Drug Endangered Children 

Terry Nowakowski, Connecticut Department of Children and Families 

Children Exposed to Violence 152 
Cheryl O’Neill 

Maureen O’Neill-Davis 

Leslie O’Reilly, Michigan Crime Victims Services Commission, Michigan Department of 

Community Health 

Tony Ostos, Gang Resistance Is Paramount 

Jeannette Pai-Espinosa, the National Crittenton Foundation 

Donna Pendergast, Michigan Department of the Attorney General 

Pennsylvania Coalition Against Rape 

Dr. Frank Putnam, University of North Carolina 

Efrain Ramirez 

Wayne Rawlins, Miami-Dade Anti-Gang Strategy 

Barbara Raymond, The California Endowment 

Earl Richards 

Cassandra Richerson 

Wendy Running Crane, Bureau of Indian Affairs Victim Assistance Program 

Khalilah Sabra, Muslim American Society Immigrant Justice Center 

Debra Scelsi 

Cynthia Schneider, Multnomah Teen Parents Branch 

Joni Silverstein, Delaware Girls Initiative 

Jill Smialek, Cuyahoga County Defending Childhood Initiative 

TuLynn Smylie, WomenShelter of Long Beach 

Beth Snedeker, Sheltering Wings 

Children Exposed to Violence 153 
 

Mark Soler, Center for Children’s Law and Policy 

Shellie Solomon, Service Network for Children of Inmates 

Christina Stallings 

Thomas Susman, American Bar Association 

The Hon. John Suthers 

Amita Swadhin 

Lawrence Swalley, Oglala Lakota Court Appointed Special Advocates 

Joyce Thomas, Center for Child Protection and Family Support, Inc. 

Linda M. Thomas, Sheltering Wings 

Dr. Cynthia Thompson-Randle, Children’s Institute, Inc. 

Cora Tomalinas 

Beverly Tran 

Steve Trubow, Olympic Behavior Labs 

Gregory Volz, Stoneleigh Foundation Fellow 

Becky Webber, Big Brothers Big Sisters of Yellowstone County (Montana) 

James A. Whitaker, Justice for Kids Now 

Hallie Bongar White, Southwest Center for Law and Social Policy 

Bao Yang, Marjaree Mason Center 

Deborah Young, Justice for Families and Children 

Children Exposed to Violence 154 
Task Force Member Biographies 

Task Force Co-Chair: Joe Torre 

Joe Torre is Chairman of the Joe Torre Safe At Home® Foundation, whose mission is “educating 

to end the cycle of domestic violence and save lives.” In the 10 years since its inception, the 

Foundation has educated thousands of students, parents, teachers, and school faculty about 

the devastating effects of domestic violence. Margaret’s Place, a tribute to Mr. Torre’s mother, 

Margaret, provides middle and high school students with a “safe room” to talk about violencerelated issues with each other and a professional counselor trained in domestic violence 

intervention and prevention. The program currently reaches kids in 10 schools and two family 

justice centers in the New York City metropolitan area and Los Angeles. 

Mr. Torre also serves as Major League Baseball’s Executive Vice President for Baseball 

Operations. Previously, he was a Major League manager for 29 seasons, 12 of them with the 

New York Yankees, whom he led to 12 playoff appearances, six World Series appearances, 

and four World Series Championships. During his 17-year playing career, Mr. Torre compiled a 

.297 batting average, 2,342 hits, 252 home runs, and 1,185 RBIs. He hit over .300 five times in 

his career, was a nine-time All-Star, and was named the 1971 National League MVP. 

Mr. Torre is the coauthor of three books: The Yankee Years (Doubleday, 2009), Chasing the 

Dream: My Lifelong Journey to the World Series (Bantam, 1997, 1998), and Joe Torre’s Ground 

Rules for Winners: 12 Keys to Managing Team Players, Tough Bosses, Setbacks, and Success 

(Hyperion, 1999). 

Task Force Co-Chair: Robert Listenbee, Jr., JD 

Robert Listenbee, Jr., JD, has been a trial lawyer at the Defender Association of Philadelphia 

since 1986 and Chief of the Juvenile Unit since 1997. He is a member of the Juvenile Justice 

and Delinquency Prevention Committee (JJDPC) of the Pennsylvania Commission on Crime 

and Delinquency, which advises Pennsylvania’s governor on juvenile justice policy. He also is a 

member of the Disproportionate Minority Contact Subcommittee of the JJDPC. In this role, he 

has worked collaboratively to develop the Youth/Law Enforcement Curriculum that is used 

throughout Pennsylvania to reduce negative contact between youth and law enforcement. He 

served on the Interbranch Commission on Juvenile Justice, which examined the “kids for cash” 

scandal in the juvenile courts of Luzerne County, Pennsylvania, and recommended major 

reforms to the statewide system. 

Mr. Listenbee serves on policy committees of the National Legal Aid and Defender Association 

and the National Center for Juvenile Justice and on the advisory board of the National Juvenile 

Defender Center (NJDC). He has participated in NJDC-sponsored statewide assessments of 

the juvenile justice systems in Indiana and Louisiana. He is actively involved in the MacArthur 

Foundation’s Models for Change initiative and is a board member and former president of the 

Juvenile Defenders Association of Pennsylvania, a statewide nonprofit professional organization 

that advocates for the rights and interests of children and speaks on behalf of juvenile defenders 

Children Exposed to Violence 155 
throughout Pennsylvania. Finally, he is a consultant for the International Association of Chiefs of 

Police on juvenile training programs, and in 2011, he was appointed to the Federal Advisory 

Committee on Juvenile Justice, which advises the president and Congress on juvenile justice 

policy. 

Mr. Listenbee received his BA degree from Harvard University and his juris doctor from the 

Boalt Hall School of Law at the University of California, Berkeley. 

The Rev. Gregory Boyle, SJ 

The Rev. Gregory Boyle, SJ, has been an advocate for at-risk and gang-involved youth in Los 

Angeles and around the world for more than 25 years. In 1988, Father Boyle launched Jobs for 

a Future (which later became Homeboy Industries) to create an environment that provided 

training, work experience, and, above all, the opportunity for rival gang members to work side by 

side. Today, Homeboy Industries’ nonprofit economic development enterprises include 

Homeboy Bakery, Homeboy Diner at Los Angeles City Hall, Homeboy Silkscreen & Embroidery, 

Homeboy/Homegirl Merchandise, and Homegirl Café & Catering. 

Father Boyle is also a consultant to youth service and governmental agencies, policymakers, 

and employers. He serves on the advisory board of the National Gang Center, a program of the 

U.S. Department of Justice (DOJ) Office of Juvenile Justice and Delinquency Prevention. He 

also is a member of the advisory board for the Loyola Law School Center for Juvenile Law and 

Policy in Los Angeles. 

Father Boyle entered the order of the Society of Jesus (Jesuits) and was ordained a priest in 

1984. He received his BA degree from Gonzaga University and MA degrees from Loyola 

Marymount University, the Weston School of Theology, and the Jesuit School of Theology at 

Berkeley. His first book, Tattoos on the Heart: The Power of Boundless Compassion, was 

released March 2010 and received the 2010 SCIBA (Southern California Independent 

Booksellers Association) Non-Fiction Book Award and the 2011 PEN Center USA Literary 

Award for Creative Nonfiction. Publishers Weekly named it one of the Best Books of 2010. 

Among numerous accolades on behalf of Homeboy Industries and for his work with former gang 

members, Father Boyle received the 2000 California Peace Prize from The California Wellness 

Foundation and was inducted into the California Hall of Fame in December 2011. 

Sharon Cooper, MD 

Sharon Cooper, MD, is the CEO of Developmental & Forensic Pediatrics, P.A., a consulting firm 

providing medical care to victims of child maltreatment and children with developmental 

disabilities, research and training, and expert witness experience in child maltreatment cases. 

She holds faculty positions at the University of North Carolina at Chapel Hill School of Medicine 

and the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. 

Cooper serves as a consultant and board member for the National Center for Missing and 

Exploited Children. 

Children Exposed to Violence 156 
Dr. Cooper spent 21 years in the U.S. Army, retiring as a colonel, and for the past several years 

has worked in both the civilian and military arenas to help identify and prevent child abuse. She 

also has served as a lecturer and board member for the American Professional Society on the 

Abuse of Children and is a member of the International Society for the Prevention of Child 

Abuse and Neglect. She is on the national advisory board for safety and protection for the Boy 

Scouts of America and has served for 5 years as the appointed chairperson for the Cumberland 

County Child Homicide Identification and Prevention Council. She has testified as an expert 

witness in several hundred child maltreatment cases in numerous courts of law. She also has 

provided testimony on child sexual exploitation before the U.S. Congress, the Russian Duma 

(parliament), the European Commission, and the Italian Senate. 

Dr. Cooper is the lead author of one of the most comprehensive texts on the medical, legal, and 

social science aspects of child sexual exploitation and has contributed many chapters to other 

texts on this subject. 

Sarah Deer, JD 

Sarah Deer, JD, is a citizen of the Muscogee (Creek) Nation of Oklahoma, and her scholarship 

focuses on the intersection of tribal law and victims’ rights. She is an associate professor at 

William Mitchell College of Law in St. Paul, Minnesota, and has taught at the University of 

California, Los Angeles, School of Law; the University of Minnesota; and Lewis & Clark Law 

School. 

From 1999 to 2002, Ms. Deer was employed by DOJ in the Office on Violence Against Women. 

In 2002, she began working with the Tribal Law and Policy Institute, a Native-owned and 

-operated nonprofit organization, to strengthen tribal responses to violent crime. Ms. Deer has 

served on advisory boards for several anti-violence organizations and projects, including the 

American Bar Association Commission on Domestic & Sexual Violence and the National 

Alliance to End Sexual Violence. From 2005 to 2007, she worked with Amnesty International 

USA to develop research strategies and outreach for the “Maze of Injustice” report. 

Ms. Deer received her BA degree in women’s studies and philosophy from the University of 

Kansas. She received her juris doctor with a Tribal Lawyer Certificate from the University of 

Kansas School of Law. In addition to authoring several articles on the issues facing Native 

women in the United States, Ms. Deer is a coauthor of two textbooks on tribal law, Introduction 

to Tribal Legal Studies and Tribal Criminal Law and Procedure, and a co-editor of Sharing Our 

Stories of Survival: Native Women Surviving Violence. She received the 2010 Sheila Wellstone 

Award and was named one of 12 Emerging Scholars class of 2011 by Diverse: Issues In Higher 

Education. In April 2011, Ms. Deer received the Allied Professional Award from DOJ for her 

work on victims’ issues. 

Deanne Tilton Durfee 

Deanne Tilton Durfee is the executive director of the Los Angeles County Inter-Agency Council 

on Child Abuse and Neglect (ICAN). ICAN is the largest county-based child abuse council in the 

Children Exposed to Violence 157 
nation and includes heads of 32 city, county, and state departments and professional experts in 

all human services fields. ICAN’s work has had national impact in many areas, including child 

death review, child abduction, multidisciplinary child abuse evaluations, and legislation. In 

addition to directing ICAN, Ms. Tilton Durfee serves as the chairperson of the National Center 

on Child Fatality Review and is a member of the Board of Commissioners for First 5 LA, the Los 

Angeles County Commission on Children and Families. 

Ms. Tilton Durfee, a former child welfare administrator, is past chairperson of the U.S. Advisory 

Board on Child Abuse and Neglect. This board declared child abuse to be a “national 

emergency” in 1990 and subsequently issued comprehensive reports recommending a major 

local and federal focus on child abuse prevention. In 1995, Ms. Tilton Durfee presided over the 

release of the board’s report “A Nation’s Shame: Fatal Child Abuse and Neglect in the United 

States.” This report was the culmination of 21⁄2 years of study and public hearings throughout the 

nation. 

Ms. Tilton Durfee is past president of Prevent Child Abuse–California and was a member of the 

board of directors of the National Committee to Prevent Child Abuse. She also served on the 

California Attorney General’s Commission on the Enforcement of Child Abuse Laws and was 

appointed by California’s governor to the Child Abuse Prevention Committee of the State Social 

Services Advisory Board and to the California Child Victim Witness Judicial Advisory 

Committee. 

Ms. Tilton Durfee served on the U.S. Attorney General’s Commission on Pornography, chairing 

the committee on child pornography. She has received commendations for her work from the 

President’s Child Safety Partnership; the Commissioner of the Administration on Children, 

Youth and Families; the Disability, Abuse and Personal Rights Project; and the Los Angeles 

Latino community. She was recognized in 1992 as an honorary member of the National 

Association of African American Grandmothers. In 1999, she received the Humanitarian Award 

from the Child and Family Guidance Center, and in 2007, she was honored as a “Woman of 

Distinction” by Soroptimist International of Los Angeles. 

Thea James, MD 

Thea James, MD, is an associate professor of emergency medicine at Boston Medical Center 

and Boston University School of Medicine and immediate past president of the Medical-Dental 

Staff at Boston Medical Center. She has served on the Board of Trustees and the Quality and 

Patient Safety Committee of Boston Medical Center. She also is the director of the Boston 

Medical Center Massachusetts Violence Intervention Advocacy Program. Dr. James is a 

founding member of the National Network of Hospital-Based Violence Intervention Programs 

(NNHVIP). She serves on the steering committee and the research group of NNHVIP. 

Dr. James is an assistant dean for the Office of Diversity and Multicultural Affairs and a member 

of the Admissions Committee at Boston University School of Medicine. In 2009, Dr. James was 

appointed to the Massachusetts Board of Registration in Medicine, where she now serves as 

chair of the board’s Licensing Committee. Dr. James has chaired and served on national 

Children Exposed to Violence 158 
committees within the Society for Academic Emergency Medicine (SAEM), was appointed to the 

SAEM Women in Academic Emergency Medicine Task Force, and chaired the Diversity Interest 

Group for 3 years. 

A graduate of Georgetown University School of Medicine, Dr. James trained in emergency 

medicine at Boston City Hospital, where she was a chief resident. Dr. James is a supervising 

medical officer on the Metro-Boston Disaster Medical Assistance Team (MA-1 DMAT), under 

the Department of Health and Human Services, which has responded to disasters in the United 

States and across the globe. For many years, Dr. James has traveled to Haiti with teams of 

emergency medicine residents. In 2006, she and a colleague co-founded a nonprofit 

organization called Unified for Global Healing, and for the past 3 years this multidisciplinary 

team has worked in Ghana, West Africa, India, and Haiti. Dr. James received the David H. 

Mulligan Award for Leadership and Public Service from the Boston Public Health Commission in 

2008 and the Boston District Attorney’s Role Model Award in 2012. The Boston Business 

Journal honored her as one of its 2012 Champions in Health Care. 

Alicia Lieberman, PhD 

Alicia Lieberman, PhD, is the Irving B. Harris Endowed Chair of Infant Mental Health, professor 

and vice chair for academic affairs, and director of the Child Trauma Research Program at the 

University of California, San Francisco, Department of Psychiatry. 

Dr. Lieberman directs the Early Trauma Treatment Network, part of the Substance Abuse and 

Mental Health Services Administration (SAMHSA)–funded National Child Traumatic Stress 

Network, which aims to increase access and raise the standard of care for traumatized children, 

families, and communities across the United States. She serves on the board of the Irving 

Harris Foundation and is a member of the board of directors and past president of Zero to 

Three: The National Center for Infants, Toddlers and Families. She developed Child-Parent 

Psychotherapy, an evidence-based treatment for children ages 5 and under exposed to trauma 

or multiple adversities. She served on the National Research Council and Institute of Medicine 

Committee on Integrating the Science of Early Childhood Development, whose work resulted in 

the publication of the influential From Neurons to Neighborhoods: The Science of Early 

Childhood Development, and has been a member of National Institute of Mental Health grant 

review committees. Her areas of special interest are the impact of traumatic exposure and 

adversity on infants and young children and cultural issues in child and family well-being. 

Dr. Lieberman received her BA degree from the Hebrew University of Jerusalem and her PhD 

from Johns Hopkins University. She is the author or senior author of several books for parents 

and clinicians, including The Emotional Life of the Toddler; Psychotherapy With Infants and 

Young Children: Repairing the Effect of Stress and Trauma on Early Attachment; Losing a 

Parent to Death in the Early Years: Guidelines for the Treatment of Traumatic Bereavement in 

Infancy and Early Childhood; and Don’t Hit My Mommy: A Manual for Child-Parent 

Psychotherapy with Young Witnesses of Domestic Violence, as well as numerous articles and 

chapters. She is senior editor of DC: 0–3 Casebook: A Guide to ZERO TO THREE’s Diagnostic 

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Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood in 

Assessment and other books on early trauma. 

Robert Macy, PhD 

Robert Macy, PhD, is a trained martial artist, dance movement therapist, clinical psychologist, 

traumatologist, and neuroscience researcher with more than 30 years’ experience in the field of 

psychological trauma response and in violence prevention, intervention development, and 

trauma-informed care development and dissemination. Dr. Macy is a founder and director and 

the president of the International Center for Disaster Resilience and the founder and executive 

director of The Boston Children’s Foundation. He also is the founder and director of the Midwest 

Trauma Services Network. As a member of the SAMHSA Disaster Technical Assistance Center, 

Dr. Macy works nationally to assist SAMHSA in disaster response and recovery. 

Dr. Macy is a pioneer in the field of psychological trauma, psychosocial recovery and resiliency 

research, and interventions and violence prevention initiatives for children and youth, their 

families, and adults and communities exposed to traumatic events, including large-scale 

disasters; terrorist events; and political, school-based, community, and armed conflict violence. 

Dr. Macy has devoted a significant portion of his career to working with local, state, and federal 

court systems and law enforcement agencies to develop customized protocols for reducing 

posttraumatic stress disorder and vicarious trauma among field officers and in the SpecOps 

community. 

Dr. Macy co-directs the Division of Disaster Resilience at the Beth Israel Deaconess Medical 

Center, a Harvard Medical School teaching hospital, and is an instructor in the Division of 

Emergency Medicine at Harvard Medical School. Dr. Macy designs, implements, and evaluates 

trauma-focused psychosocial resiliency initiatives, violence prevention programs, and traumainformed care initiatives in the United States, Europe, the Middle East, Eurasia, and Africa. 

Steven Marans, PhD 

Steven Marans, PhD, is the Harris Professor of Child Psychiatry at the Yale Child Study Center 

and a professor in the Department of Psychiatry at Yale University’s School of Medicine. He 

directs the National Center for Children Exposed to Violence, established by the White House 

and DOJ in 1999, and the SAMHSA-funded Childhood Violent Trauma Clinic at Yale. Dr. 

Marans is the founder of the Child Development Community Policing Program, a pioneering 

collaboration between mental health and law enforcement professionals that provides 

collaborative responses to children and families exposed to violence that occurs in homes, 

neighborhoods, and schools. 

Dr. Marans co-developed the Child and Family Traumatic Stress Intervention, a brief model of 

treatment for children and families that has demonstrated effectiveness in reducing long-term 

posttraumatic disorders. Over the past 20 years, Dr. Marans has worked closely with the White 

House, DOJ, the U.S. Department of Health and Human Services (HHS), the U.S. Department 

of Education, the state of Connecticut, and the city of New Haven to shape policy and response 

Children Exposed to Violence 160 
plans around issues of violence exposure, terrorism, and disasters. He has served as part of a 

national advisory group regarding children and violence and was a member of an HHS 

commission on children, terrorism, and disasters. 

Dr. Marans received his MA degree in clinical social work from Smith College and his PhD in 

psychology from University College at London University. He trained in child and adolescent 

psychoanalysis at the Anna Freud Centre in London and received his adult psychoanalytic 

training at the Western New England Institute for Psychoanalysis, where he is on the faculty. In 

addition to numerous academic publications in the areas of trauma, mental health–law 

enforcement partnerships, child development, and clinical treatment, Dr. Marans authored a 

book titled Listening to Fear: Helping Kids Cope, From Nightmares to the Nightly News, 

published by Holt in 2005. 

Jim McDonnell 

Jim McDonnell is the chief of the Long Beach Police Department. He has held the position for 

almost 3 years, and he previously served with the Los Angeles Police Department (LAPD) for 

29 years. He worked a wide variety of assignments at LAPD and served as second in command 

for his last 7 years. 

Chief McDonnell serves on numerous boards of directors that focus on furthering the interests 

of local youth and leadership in the policing profession on local, statewide, and national levels. 

He is an active member of several organizations, including the International Association of 

Chiefs of Police, Major Cities Chiefs, California Peace Officers’ Association, California Police 

Chiefs Association, Los Angeles County Chiefs of Police, the Peace Officers’ Association of Los 

Angeles County, and the Southern California Leadership Network. He was recently appointed 

by the California governor to the state’s Commission on Peace Officer Standards and Training. 

Chief McDonnell holds a BS degree in criminal justice from Saint Anselm College and an MPA 

degree from the University of Southern California. He also is a graduate of the FBI’s prestigious 

National Executive Institute and the Senior Management Institute for Police, and he has 

completed executive education programs at Harvard’s Kennedy School of Government. 

Georgina B. Mendoza, JD 

Georgina B. Mendoza, JD, currently serves as Community Safety Director for the city of Salinas, 

California. In this role, Ms. Mendoza is leading an effort to develop and implement a 

comprehensive strategic work plan that incorporates evidence-based strategies for gang 

prevention, intervention, suppression, and reentry. She represents the city in multi-jurisdictional 

efforts to coordinate funding and leverage community resources. 

Ms. Mendoza has been involved in the California Cities Gang Prevention Network as a city point 

member for the past 5 years and serves as the Salinas lead in the National Forum on Youth 

Violence Prevention, a new pilot initiative launched by the White House. She received her BA 

Children Exposed to Violence 161 
degree in history and political science from Santa Clara University and her juris doctor from 

Loyola Law School Los Angeles. 

Major General Antonio M. Taguba 

Major General Antonio M. Taguba, U.S. Army (Retired), has served in numerous command and 

staff positions from platoon to General Officer level. His service tours included assignments in 

the continental United States, South Korea, Germany, and Kuwait. He retired on January 1, 

2007, after serving on active duty for 34 years. He is president of TDLS Consulting, LLC, and 

chairman of Pan-Pacific American Leaders and Mentors, a national, volunteer, nonprofit, taxexempt organization committed to mentoring and leadership development of military and civilian 

leaders. 

During Operation Iraqi Freedom, Major General Taguba served as Deputy Commanding 

General for Support, Coalition Forces Land Component Command Third Army/ARCENT, 

forward deployed to Kuwait and Iraq. He oversaw the logistical and support services to U.S. and 

coalition forces, totaling more than 150,000 troops conducting combat operations. His duty 

included the coordination of host-nation support from the government of Kuwait and security 

cooperation and training requirements with Saudi Arabia, Jordan, Egypt, and Qatar. Upon his 

redeployment, Major General Taguba served as Deputy Assistant Secretary of Defense for 

Reserve Affairs in the Office of the Secretary of Defense. In his final assignment on active duty, 

he served as Deputy Commanding General for Transformation in the U.S. Army Reserve 

Command. 

Major General Taguba is a graduate of Idaho State University with a BA degree in history, 

Webster University with an MA degree in public administration, Salve Regina University with an 

MA degree in international relations, and the U.S. College of Naval Command and Staff with an 

MA degree in national security and strategic studies. He also is a graduate of the U.S. Army 

Command and General Staff College and the U.S. Army War College. He was conferred the 

degree of doctor of humane letters from the University of San Francisco on May 17, 2008. 

Children Exposed to Violence 162