Report of the Attorney General’s National Task Force on

Children Exposed to Violence 

Report of the Attorney General’s National Task Force on

Children Exposed to Violence

December 12, 2012

Robert L. Listenbee, Jr.

Joe Torre

The Rev. Gregory Boyle, SJ

Sharon W. Cooper, MD

Sarah Deer

Deanne Tilton Durfee

Thea James, MD

Alicia Lieberman, PhD

Robert Macy, PhD

Steven Marans, PhD

Jim McDonnell

Georgina Mendoza

Maj. Gen. Antonio Taguba

This project was supported by Grant No. 2011-DD-BX-K037 awarded by 

the Office of Juvenile Justice and Delinquency Prevention, Office of Justice 

Programs, U.S. Department of Justice. Points of view or opinions in this 

document are those of the authors and do not necessarily represent the 

official position or policies of the U.S. Department of Justice. 
Eric H. Holder, Jr.

Attorney General

Mary Lou Leary

Acting Assistant Attorney General

Melodee Hanes

Acting Administrator

 Office of Juvenile Justice and Delinquency Prevention

U.S. Department of Justice 

This report was created as part of the Defending Childhood Initiative created by Attorney General Eric H. 

Holder, Jr. This initiative strives to harness resources from across the Department of Justice to:

•	 Prevent children’s exposure to violence;

•	 Mitigate the negative impact of children’s exposure to violence when it does occur; and

•	 Develop knowledge and spread awareness about children’s exposure to violence.

U.S. Department of Justice

Members of the Task Force

Co-Chairs

Robert L. 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 ResilienceBoston;	Founder	and	Executive	Director	of	the	Boston	Children’s	Foundation;	Co-Director	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)
Acknowledgments

During	the	course	of	our	work,	the	National	Task	Force	on	Children	Exposed	to	Violence	 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.
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

Belinda Nip

Angela Noel

Deirdre	O’Connor

Charles Ogletree, Jr.

Natalie Ortega

Cynthia Pappas

Acknowledgments
Kathy	Park

Debra Paulus

Diane Payne

Bernard Perlmutter

The Hon. Thomas Perrelli

Anita Perry

Catherine Pierce

The Raben Group

Barbara Raymond

Dale Rees

Gilbert Reyes

Thomas Reynolds

Bruce Riordan

Liz Ryan

Amy Schneider

Maureen Sheeran

Jessica Shore

Darla Sims

Starr Stepp

Kiersten Stewart

Keely Bell Stotlar

Sabrina Strauss

Peter Taylor

Tamara Thompson

Jennifer Trone

Jennifer Trovillion

Sarah True

Eugenia Tyner-Dawson

Elaine	Valentine

Sharon	Vandever

Rob Wald

Alison Waldman

Kevin Washburn

The Hon. Tony West

Debra Whitcomb

Pamela William

Angela Wolf

Michael Wright

Phelan	Wyrick

Yue Xu

Aishatu Yusuf
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	H.	Holder,	Jr.,	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.

Joe Torre Robert L. Listenbee, Jr.
Contents

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Task Force Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Chapter One: Ending the Epidemic of Children Exposed to Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Chapter Two: Identifying Children Exposed to Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Chapter Three: Treatment and Healing of Exposure to Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Chapter Four: Creating Safe and Nurturing Homes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

Chapter Five: Communities Rising Up Out of Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

Chapter Six: Rethinking Our Juvenile Justice System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203

Glossary of Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

Activities of the Task Force and List of Witnesses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

Individuals and Organizations That Submitted Written Testimony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

Task Force Member Biographies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231

EXECUTIVE SUMMARY E

EXECUTIVE SUMMARY | 3

The Attorney General’s National 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	

EXECUTIVE SUMMARY
4 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 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.
EXECUTIVE SUMMARY | 5

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 longterm 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 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,	 U.S.	 Attorney	 General	 Eric	 Holder	 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 
6 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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.
TASK FORCE 

RECOMMENDATIONS T

TASK FORCE RECOMMENDATIONS | 9

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.	

TASK FORCE 

RECOMMENDATIONS
10 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED 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.

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 trauma-specific 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 
TASK FORCE RECOMMENDATIONS | 11

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 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.
12 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 evidence-based 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 evidence-based 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	exposure	to	violence	still	bear	emotional	scars	that	may	lead	them	to	

experience	these	same	health	and	psychological	problems	years	or	decades	later.	
TASK FORCE RECOMMENDATIONS | 13

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, traumaspecific treatment, or trauma-focused 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.
14 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 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. 

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 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 traumafocused	services	for	violence-exposed	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.
TASK FORCE RECOMMENDATIONS | 15

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.

3.11 Incentivize healthcare providers and insurance providers to reimburse 

trauma-focused 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	nonoffending	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.
16 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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, 

trauma-focused 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.

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	

trauma-informed 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	violenceexposed	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	
TASK FORCE RECOMMENDATIONS | 17

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. 

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. 
18 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO 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. 

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.

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 
TASK FORCE RECOMMENDATIONS | 19

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	wellbeing 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. 
20 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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, 

trauma-informed, trauma-specific, community-adaptive suicide prevention and 

treatment	 programs	 for	 children	 and	 youth	 at	 high	 risk	 because	 of	 their	 severe	

suicidality.
TASK FORCE RECOMMENDATIONS | 21

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.

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	traumainformed 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. 
22 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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.

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. 
TASK FORCE RECOMMENDATIONS | 23

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.

CHAPTER ONE: 

Ending the Epidemic of 

Children Exposed to Violence 1

CHAPTER 1: ENDING THE EPIDEMIC OF CHILDREN EXPOSED TO VIOLENCE | 27

E

ach	 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	wellbeing	 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 

CHAPTER ONE: 

Ending the Epidemic of 

Children Exposed to Violence
28 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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,	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	up-close	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 

“When	placed	in	the	most	devastating	context	—

the loss of innocence and the loss of innocent 

lives	—	the	impact	of	this	proliferation	of	violence	

against children is overwhelming. Faced with such 

a reality, it may be easy to become overwhelmed 

to the point of inaction. But doing nothing can 

never be considered a viable option. We must 

meet these overwhelming circumstances with 

deliberate and intentional action.”

— Dr. William Bell, President and CEO, Casey Family Programs
CHAPTER 1: ENDING THE EPIDEMIC OF CHILDREN EXPOSED TO VIOLENCE | 29

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, U.S. Attorney General Eric Holder 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	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, 
30 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	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	
CHAPTER 1: ENDING THE EPIDEMIC OF CHILDREN EXPOSED TO VIOLENCE | 31

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
32 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	 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	 self-protection	 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	
CHAPTER 1: ENDING THE EPIDEMIC OF CHILDREN EXPOSED TO VIOLENCE | 33

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	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 school127,129	—	

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	

“Being hurt and hurting people was part of 

everyday life for us growing up.... There was no 

day	or	place	where	the	threat	of	violence	wasn’t	

ever-present and entirely possible. From my 

perspective, that has not changed in the lives of 

the young men I serve today.”

— Roy Martin, Sr., Program Manager, Partnership Advancing 

Communities Together, Boston Health Commission 
34 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	 longterm	 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 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’	

“The ACE Study reveals how...adverse life 

experience[s]	in	childhood	are	lost	in	time,	and	

then protected by shame, secrecy, and social 

taboos	against	exploring	certain	areas	of	human	

experience,	ultimately	costing	us	heavily	in	health,	

humanity, and dollars.”

— Dr. Vincent Felitti, Co-Principal Investigator of the ACE Study; 

President and CEO, California Institutes of Preventive Medicine; 

Clinical Professor of Medicine, University of California, San Diego; 

and Fellow, American College of Physicians
CHAPTER 1: ENDING THE EPIDEMIC OF CHILDREN EXPOSED TO VIOLENCE | 35

countries of origin. Roughly three times as many African-American, Hispanic, and 

American	Indian/Alaska	Native	children	live	in	poverty	compared	to	White	and	AsianAmerican children.146

Asian-American children and their families who are immigrants from impoverished 

and violence-torn 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.

“For us in Rosebud, our reservation, the question 

is	not	who	has	been	exposed	to	violence,	it’s	who	

hasn’t	been	exposed	to	violence?”

— Mato Standing High, Attorney General of the Rosebud 

Sioux Tribe
36 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

Toward a Coordinated National Response

Children’s	exposure	to	violence	represents	a	national	crisis	and	a	threat	to	the	health	

and	well-being	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.

“Fortunately, there is strong and growing evidence 

that	violence	is	preventable....	The	next	step	

for	the	field	requires	expanding	the	overarching	

dialogue, moving from a focus on the individual 

and after-the-fact efforts to an approach that can 

prevent	children	and	youth	from	being	exposed	to	

violence in the first place.”

— Larry Cohen, Founder and Executive Director, Prevention 

Institute
CHAPTER 1: ENDING THE EPIDEMIC OF CHILDREN EXPOSED TO VIOLENCE | 37

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	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.
38 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	 National	 Task	 Force	 on	 Children	 Exposed	 to	

Violence	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	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 
CHAPTER 1: ENDING THE EPIDEMIC OF CHILDREN EXPOSED TO VIOLENCE | 39

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	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	
40 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	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	

“All	of	the	work	that	we	need	to	do	is	a	shared	

responsibility. From a public health standpoint, this 

is our opportunity to redefine the unacceptable 

in our communities. It begins with us learning our 

cultural way of life. It begins with respect, courage, 

and tolerance. It begins by us being the change 

we wish to see.”

— Coloradas Mangas, Mescalero Apache Tribe and Youth Board 

Member for the Center for Native American Youth
CHAPTER 1: ENDING THE EPIDEMIC OF CHILDREN EXPOSED TO VIOLENCE | 41

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	 trauma-informed	 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.

“We need an infrastructure to support developing 

evidence-based	practices;	a	variety	of	them	that	

are	out	there	—	that	are	great	—	don’t	have	

the evidence behind them to test out and then 

translate what we find to the field, and there is very 

little support for that at this point.”

— Dr. Jeffrey Edelson, Director of Research, School of Social 

Work, University of Minnesota, and Founding Director, Minnesota 

Center Against Violence and Abuse
42 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 trauma-specific evidencebased	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.

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.

“The Department of Justice, through the National 

Institute of Justice and the Office of Juvenile 

Justice and Delinquency Prevention, has helped 

to create and publicize an outstanding body of 

research	about	what	works	in	preventing	juvenile	

delinquency and offending.... We need that same 

highly evolved body of research about how to 

prevent and intervene in juvenile victimization, 

abuse,	and	exposure	to	violence.”

— Dr. David Finkelhor, Director, Crimes Against Children Research 

Center; Co-Director, Family Research Laboratory, and Professor of 

Sociology, University of New Hampshire
CHAPTER 1: ENDING THE EPIDEMIC OF CHILDREN EXPOSED TO VIOLENCE | 43

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.

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. Publicprivate	partnerships	also	are	essential.	The	following	examples	are	illustrative	but	by	

no means a complete or final path toward enhanced funding.
44 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 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	
CHAPTER 1: ENDING THE EPIDEMIC OF CHILDREN EXPOSED TO VIOLENCE | 45

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 traumainformed	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.
46 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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.	
CHAPTER 1: ENDING THE EPIDEMIC OF CHILDREN EXPOSED TO VIOLENCE | 47

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124.		Janosz,	M.,	 et	 al.	 (2008).	 Are	there	 detrimental	 effects	 of	 witnessing	 school	

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127.		Rosario,	M.,	et	al.	(2008).	Intervening	processes	between	youths’	exposure	to	

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128.		McKelvey,	 L.	 M.,	 et	 al.	 (2010).	 Growing	 up	 in	 violent	 communities:	 Do	

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129.		Aisenberg,	 E.,	 &	 Herrenkohl,	 T.	 (2008).	 Community	 violence	 in	 context:	 risk	

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130.		Spano,	R.,	Vazsonyi,	A.	T.,	&	Bolland,	J.	(2009).	Does	parenting	mediate	the	

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CHAPTER TWO: 

Identifying Children 

Exposed to Violence 2

CHAPTER 2: IDENTIFYING CHILDREN EXPOSED TO VIOLENCE | 65

E

very	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 

CHAPTER TWO: 

Identifying Children 

Exposed to Violence
66 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	 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.
CHAPTER 2: IDENTIFYING CHILDREN EXPOSED TO VIOLENCE | 67

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 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	

“We	must	acknowledge	that	we	are	all	related.	

When one child is hurt, we all hurt. And the 

opposite is true as well: When one child is 

protected and loved, put in a place of honor, 

we all benefit.”

— Elsie Boudreau, LMSW, Alaska Native Justice Center

“We need routine screening and assessment 

to identify individuals and communities who are 

suffering	from	exposure	to	violence.	Not	every	child	

needs intensive therapy or case management, but 

our healthcare system, educational institutions, 

and child- and youth-serving institutions and 

organizations need to be able to identify the children 

who are being hurt and are in need of help.”

— Esta Soler, President of Futures Without Violence
68 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	

“Since all children are required to attend school, 

specially trained counselors should be available 

to	work	with	children	to	help	them	process	what	

is occurring in their lives. The goal...would be to 

identify	stress	and	trauma	symptoms	in	students;	

identify unsafe or potentially harmful situations in 

the home, school, or community that are creating 

trauma;	and	broker	[appropriate]	community	

services.”

— Vicki Spriggs, CEO of Texas Court Appointed Special 

Advocates
CHAPTER 2: IDENTIFYING CHILDREN EXPOSED TO VIOLENCE | 69

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.

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.

“We need public awareness and prevention 

education.... The number of...children who will be 

abused	over	the	next	18	years	dwarfs	anything	else	

that	we’re	doing,	and	[violence	and	abuse	become]	

the root causes for all the other ailments that 

we’re	throwing	money	at	right	now,	bullying	and	

childhood obesity and truancy in school.”

— Adam Rosenberg, Executive Director, Baltimore Child Abuse 

Center
70 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 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 childand family-serving practice groups, agencies, and institutions should be required to 

“Child-serving agencies should be trauma-informed, 

understanding	the	impact	of	trauma	exposure	

and trauma-related problems on children and 

adolescents. Children and adolescents engaged 

in either inpatient or outpatient treatment services 

should	be	routinely	screened	for	trauma	exposure	

and trauma-related problems utilizing evidencebased assessment approaches.”

— Dr. Michael de Arellano, National Crime Victims Research 

and Treatment Center, Department of Psychiatry and Behavioral 

Sciences, Medical University of South Carolina
CHAPTER 2: IDENTIFYING CHILDREN EXPOSED TO VIOLENCE | 71

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 family-serving 

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.
72 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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.

“The first step, if anything is going to be done 

usefully on a large scale, is professional recognition 

of the problem, whether that be in a prison, whether 

it be in a medical office, whether it be in the foster 

care system...”

— Dr. Vincent Felitti, Co-Principal Investigator of the ACE Study; 

President and CEO, California Institutes of Preventive Medicine; 

Clinical Professor of Medicine at the University of California, San 

Diego; and Fellow of the American College of Physicians
CHAPTER 2: IDENTIFYING CHILDREN EXPOSED TO VIOLENCE | 73

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50.	 	Courtois,	 C.	 A.,	 &	 Gold,	 S.	 (2009).	 The	 need	 for	 inclusion	 of	 psychological	

trauma in the professional curriculum. Psychological Trauma, 1(1),	3–23.

51.	 	Finkelhor,	D.,	et	al.	(2005).	The	Juvenile	Victimization	Questionnaire:	reliability,	

validity, and national norms. Child Abuse & Neglect, 29(4),	383–412.

52.	 	Finkelhor,	 D.,	 et	 al.	 (2005).	 Measuring	 poly-victimization	 using	 the	 Juvenile	

Victimization	Questionnaire.	Child Abuse & Neglect, 29(11),	1297–312.

53.	 	Daviss,	W.	B.,	et	al.	(2000).	Predicting	posttraumatic	stress	after	hospitalization	

for pediatric injury. Journal of the American Academy of Child & Adolescent 

Psychiatry, 39(5),	576–583.

54.	 	Ford,	 J.	 D.,	 et	 al.	 (2000).	 Child	 maltreatment,	 other	 trauma	 exposure,	 and	

posttraumatic symptomatology among children with oppositional defiant and 

attention deficit hyperactivity disorders. Child Maltreatment, 5(3),	205–17.

55.	 	Steinberg,	A.	M.,	et	al.	(2004).	The	University	of	California	at	Los	Angeles	Posttraumatic	 Stress	 Disorder	 Reaction	 Index.	 Current Psychiatry Reports, 6(2),	

96–100.

56.	 	Lanktree,	 C.	 B.,	 et	 al.	 (2008).	 Multi-informant	 assessment	 of	 maltreated	

children: convergent and discriminant validity of the TSCC and TSCYC. Child 

Abuse & Neglect, 32(6),	621–5.

57.	 	Courtois,	C.	A.,	&	Gold,	S.	N.	(2009).	The	need	for	inclusion	of	psychological	

trauma in the professional curriculum: A call to action. Psychological Trauma: 

Theory, Research, Practice, and Policy, 1(1),	3–23.

CHAPTER 3: TREATMENT AND HEALING OF EXPOSURE TO VIOLENCE | 79

CHAPTER THREE: 

Treatment and Healing of 

Exposure to Violence 3
80 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE
CHAPTER 3: TREATMENT AND HEALING OF EXPOSURE TO VIOLENCE | 81

T

he 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 social-emotional 

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 

CHAPTER THREE: 

Treatment and Healing of 

Exposure to Violence
82 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 trauma-informed 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, traumaspecific 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	 “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

“What	you’ve	seen	around	trauma	interventions...

is that we have evidence-based strategies that 

cut across all age groups and have the capacity 

to	work	with	adoptive	families,	foster	care	families,	

and biological families to really change the 

trajectory of outcomes for young people.... The 

gap is that those evidence-based strategies are 

rarely in use across systems.”

— Bryan Samuels, Commissioner, Administration on Children, 

Youth and Families, U.S. Department of Health and Human 

Services
CHAPTER 3: TREATMENT AND HEALING OF EXPOSURE TO VIOLENCE | 83

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 traumafocused 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	social-emotional	problems,	as	they	assume	that	these	

are the immutable results of “bad” genes, “bad” 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	
84 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	 socialemotional	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	
CHAPTER 3: TREATMENT AND HEALING OF EXPOSURE TO VIOLENCE | 85

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	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 social-emotional 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-toearth 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 

“If one accepts [the ACE Study] data...one 

recognizes that this calls for a paradigm shift in 

primary care medical practice, moving from our 

current symptom-responsive mode to the more 

comprehensive style that we originally conceived 

for primary care but clearly never attained.”

— Dr. Vincent Felitti, Co-Principal Investigator of the ACE Study; 

President and CEO, California Institutes of Preventive Medicine; 

Clinical Professor of Medicine at the University of California, San 

Diego; and Fellow of the American College of Physicians
86 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	 traumafocused	services	as	the	standard	of	care	nationwide	for	children	exposed	to	violence	

and psychological trauma. 

3.1 Provide all children exposed to violence access to 

trauma-informed services and evidence-based traumaspecific 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, trauma-specific 

treatments,	 and	 trauma-focused	 services	 exist	 for	 these	 children,	 but	 to	 fully	
CHAPTER 3: TREATMENT AND HEALING OF EXPOSURE TO VIOLENCE | 87

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	traumafocused	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.

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 
88 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 public-private 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,	

lesbian-gay-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 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.

“The implementation of cultural relevancy and 

sensitivity increases the effectiveness of the 

practitioner, program, and treatment by giving 

a sense of trust, respect, humility, and identity. 

Recommendation: Increase support and incentives 

for programs that are culturally relevant, sensitive, 

and balanced.”

— Lyle Claw, President of Changing Lives Around the World
CHAPTER 3: TREATMENT AND HEALING OF EXPOSURE TO VIOLENCE | 89

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”;	 “Living	 is	

hard,	dying	is	easy”;	and	“Death	is	nothing,	but	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. 

“Without intervention, hospitals discharge violently 

injured patients to the same violent environments 

where they were injured, without a prescription for 

staying	safe	and	with	community	pressure	to	seek	

revenge. Too often, this results in a revolving door 

of violence, causing even more injuries, arrests, 

incarcerations, and, sadly, deaths.”

— Dr. Theodore Corbin, Medical Director of Healing Hurt People, 

and Co-Director of the Center for Nonviolence and Social Justice
90 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

3.4 Share information and implement coordinated and 

adaptive approaches to improve the quality of traumaspecific 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 trauma-informed care and to the practice guidelines of evidencebased 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 
CHAPTER 3: TREATMENT AND HEALING OF EXPOSURE TO VIOLENCE | 91

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 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 traumaspecific 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	 trauma-specific	

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. 
92 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

3.6 Ensure that every professional and advocate serving 

children exposed to violence and psychological trauma 

learns and provides trauma-informed care and traumafocused 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 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 traumainformed care and trauma-focused services.

3.7 Grow and sustain an adequate workforce of traumainformed 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, 
CHAPTER 3: TREATMENT AND HEALING OF EXPOSURE TO VIOLENCE | 93

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 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.

“Augment	the	workforce	of	tribal	people	to	

become mental health professionals with an early 

childhood specialty by providing tuition supports, 

student loan forgiveness, and promotion of mental 

health professions by the Indian Health Service.”

— Maria Brock, LISW, Tribal Home Visiting Project Director, Native 

American Professional Parent Resources, Inc.
94 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

3.8 Ensure that professional societies 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 traumafocused	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	crossdisciplinary 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, trauma-specific treatments, and trauma-focused services.

3.9 Provide research funding to continue the clinical and 

scientific development of increasingly effective evidencebased treatments for children exposed to violence.

It	 is	 expensive,	 but	 absolutely	 necessary,	 to	 develop	 and	 test	 new	 evidencebased practices and treatments.44 We must now develop research and funding 

infrastructures that encourage the creation and testing of innovative practices and 
CHAPTER 3: TREATMENT AND HEALING OF EXPOSURE TO VIOLENCE | 95

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 traumainformed 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 

trauma-focused 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, 

“While there is some evidence for the use of 

evidence-based treatments among ethnic minority 

youth, these findings are very preliminary.... 

More	work	is	necessary	to	evaluate	the	efficacy	

of additional interventions, including those for 

violence-exposed	youth,	with	children	from	a	

broader range of cultural groups.”

— Dr. Michael de Arellano, National Crime Victims Research 

and Treatment Center, Department of Psychiatry and Behavioral 

Sciences, Medical University of South Carolina
96 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

and trauma-focused 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 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, traumaspecific 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 
CHAPTER 3: TREATMENT AND HEALING OF EXPOSURE TO VIOLENCE | 97

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 familyserving 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 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 cross-system collaboration in services for children and 

their families exposed to violence and psychological trauma.
98 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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41.	 	Chorpita,	B.	F.,	Daleiden,	E.	L.	(2009).	Mapping	evidence-based	treatments	for	

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42.	 	Rodriguez,	M.,	et	al.	(2009).	Intimate	partner	violence	and	barriers	to	mental	

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CHAPTER FOUR: 

Creating Safe and 

Nurturing Homes4

CHAPTER 4: CREATING SAFE AND NURTURING HOMES | 107

E

ach	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

CHAPTER FOUR: 

Creating Safe and 

Nurturing Homes
108 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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

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
CHAPTER 4: CREATING SAFE AND NURTURING HOMES | 109

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	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),	
110 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 

“The event that affected me the most was when 

my	sister	was	shot	and	killed	by	her	son’s	father	

while her three children (ages 9 months, 2, and 

5)	and	other	nieces	and	nephews	watched.	On	

March 24, 2007, I lost my sister to domestic 

violence.”

— Aisha Stubbs, Struggling Youth Into Successful Adults
CHAPTER 4: CREATING SAFE AND NURTURING HOMES | 111

daily family life and healthy growth, and participating in 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, 

“Early childhood, and particularly the perinatal 

phase of life, represents a wholly unique and 

consequential	window	of	both	risk	and	opportunity	

when we consider policies and strategies to 

reduce crime, protect children from violence and 

harm, and strive to preserve health and strengthen 

the wider social fabric.”

— Dr. Neil Guterman, 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
112 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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.

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.

“We	need	to	take	a	multiple-generation	approach	

to	ending	abuse	and	violence.	We	know	that	

children	are	more	likely	to	experience	or	witness	

violence	or	abuse	if	their	parents	experienced	

it. Providing resources so parents can get the 

services they need to heal from childhood trauma 

is essential.”

— Jeannette Pai-Espinosa, National Crittenton Foundation
CHAPTER 4: CREATING SAFE AND NURTURING HOMES | 113

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 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 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 outof-home placements add to the severity of conduct, attention, and hyperactivity 

problems	caused	by	physical	abuse.	Out-of-home	placements	put	children	at	risk	
114 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 self-esteem,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 well-being 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 

“[When my father was arrested for abusing my 

mother] you ripped me away from the mother 

I wanted to protect and to be with [and] the 

siblings who I loved and wanted to protect.... You 

moved us into foster homes outside of our own 

community, which ripped me away from every 

teacher who supported me and understood what 

was going on, from any friends...who supported 

us	and	knew	what	was	going	on.”

— Jim Henderson, Battered Women’s Justice Project
CHAPTER 4: CREATING SAFE AND NURTURING HOMES | 115

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 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 

“I	think	the	nature	of	this	problem	really	requires	

the	different	disciplines	and	fields	to	work	together.	

It’s	not	just	a	nice	idea,	it’s	a	necessity.”

— Dr. Howard Dubowitz, Professor of Pediatrics and Head, 

Division of Child Protection, and Director, Center for Families, 

University of Maryland School of Medicine
116 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO 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	 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 childand 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 
CHAPTER 4: CREATING SAFE AND NURTURING HOMES | 117

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 familyserving 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 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.

“When	we	bring	men	together	[who]	are	working	

on	healing	from	past	traumatic	experience,	they	

begin	to	recognize	something	that	they	know	at	

their core: that they actually influence their children 

profoundly. And the question is how. And in those 

círculos	[circles]	where	they	get	acknowledged,	

where their trauma is addressed and recognized, 

where they get a chance to decide what they want 

to	move	toward,	do	they	want	to	remain	stuck?”

— Héctor Sánchez-Flores, Executive Director, National 

Compadres Network
118 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 helps them to go through a similar process of recovery 

and healing to enable them to support the child emotionally.
CHAPTER 4: CREATING SAFE AND NURTURING HOMES | 119

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 
120 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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.

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 
CHAPTER 4: CREATING SAFE AND NURTURING HOMES | 121

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. 

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 well-being 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. 
122 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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134.		Paulsell,	D.,	et	al.	(2010).	Home Visiting Evidence of Effectiveness Review.

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139.		Stover,	 C.	S.,	Berkman,	M.,	Desai,	R.,	&	Marans,	S.	 (2010).	 The	 efficacy	 of	

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143.		Sturge-Apple,	M.	L.,	et	al.	(2009).	The	role	of	mothers'	and	fathers'	adrenocortical	

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147.		Lacey,	 K.	 K.,	 et	 al.	 (2012).	 The	 impact	 of	 different	types	 of	 intimate	 partner	

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149.		Cho,	H.,	&	Kim,	W.	J.	(2012).	Intimate	partner	violence	among	Asian	Americans	

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Latino victims. Journal of Immigrant and Minority Health, 14(5),	809–15.

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152.		Ghosh	Ippen,	C.,	et	al.	(2011).	Traumatic	and	stressful	events	in	early	childhood:	

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PTSD (pp.	370–387).	New	York,	NY:	Guilford.

154.		Van	Horn,	P.,	&	Lieberman,	A.	(2008).	Using	dyadic	therapies	to	treat	traumatized	

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155.		DeGue,	S.,	&	Spatz	Widom,	C.	(2009).	Does	out-of-home	placement	mediate	

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156.		Taussig,	 H.	 N.	 (2002).	 Risk	 behaviors	 in	 maltreated	 youth	 placed	 in	 foster	

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157.	Xing,	X.,	et	al.	(2011).	Gender	differences	in	the	reciprocal	relationships	between	

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158.	McKinney,	 C.,	Milone,	M.	 C.,	&	Renk,	K.	 (2011).	Parenting	 and	 late	 adolescent emotional adjustment: mediating effects of discipline and gender. Child 

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166.	Miller,	 C.	 J.,	 et	 al.	 (2006).	 Family	 and	 cognitive	 factors:	 modeling	 risk	 for	

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Clinics of North America, 17(3),	585–604,	ix.

CHAPTER FIVE: 

Communities Rising 

Up Out of Violence5

CHAPTER 5: COMMUNITIES RISING UP OUT OF VIOLENCE | 141

C

ommunity 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 

CHAPTER FIVE: 

Communities Rising 

Up Out of Violence

“As a teenager I joined one of the most organized 

and dangerous street gangs in Chicago because 

I wanted to be a part of something.... I remember 

the pain of having to cope with the deaths of my 

closest friends.... I also recall the cold sweats at 

night and being unable to sleep, and having to get 

high in order to better cope with the inner pain.”

— Alfredo Barraza, Youth Advocate, Latino Organization of the 

Southwest
142 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 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,	

“Even	many	of	those	who	acknowledge	the	

existence	of	child	abuse...fool	themselves	into	

thinking	that	these	horrible	crimes	happen	to	

somebody	else’s	kids	at	the	hands	of	some	

stranger, somebody unrecognized in their world. 

It’s	hard	for	people	to	realize	the	truth	—	that	

children from all sectors of society are abused 

every day by people they should be able to trust.”

— The Hon. John Romero, Children’s Court Division, Second 

Judicial District Court, State of New Mexico
CHAPTER 5: COMMUNITIES RISING UP OUT OF VIOLENCE | 143

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 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	trauma-informed	services	and	trauma-specific	treatment	(Chapter	2).
144 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 life-threatening 

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	traumainformed	 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. 

“When it comes to LGBT youth, the biggest thing 

that	I	find	is	a	lot	of	these	kids	are	looking	for	a	

straight	ally	out	there,	like	straight	role	models,	

people	who	are	going	to	say,	‘It’s	okay,	and	I’m	

okay	with	it.	I’m	not	going	to	condemn	you,	and	

I’m	going	to	stick	up	for	you	when	other	people	

don’t.’”

— Nate Monson, Executive Director, Iowa Safe Schools
CHAPTER 5: COMMUNITIES RISING UP OUT OF VIOLENCE | 145

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 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 
146 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	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	
CHAPTER 5: COMMUNITIES RISING UP OUT OF VIOLENCE | 147

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 traumaspecific 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 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;	followup	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. 

“A sense of safety is paramount in having a safe 

community. The police have always dealt with the 

children	exposed	to	the	violence	and	trauma,	but	

we needed help when it came to saving them from 

the	harm	caused	by	this	exposure....	Together	

we	can	help	restore	a	sense	of	safety	in	children’s	

lives, so they can grow to be happy and productive 

members in society.”

— Major Eddie Levins, Charlotte-Mecklenburg Police Department
148 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	

“In	a	previous	time,	men	were	linked	by	our	

connectedness and reliance on one another in 

order to raise and nurture our children and families 

and prepare them for an evolving future. In many 

communities...these attributes have been replaced 

with complete opposite notions of maleness that 

are rooted in the struggle for power, dominance, 

and control over the children and partners we say 

we love. And our children suffer.”

— Héctor Sánchez-Flores, Executive Director, National 

Compadres Network
CHAPTER 5: COMMUNITIES RISING UP OUT OF VIOLENCE | 149

private sources. With those resources, initiatives involving men and boys as critical 

partners in 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 

“Adolescence is a time when young people are 

gaining	their	independence.	They’re	beginning	

these relationships that will form what their 

relationships	look	like	in	the	future.	Middle	school	

is an absolutely critical time to engage parents, 

teens, caregivers, and other adults to support the 

development of healthy relationships.”

— Annie Pelletier Kerrick, Program Manager, Idaho Teen Dating 

Violence Awareness & Prevention Project
150 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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.

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	
CHAPTER 5: COMMUNITIES RISING UP OUT OF VIOLENCE | 151

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.

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.
152 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	 traumaspecific treatment can be 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	evidencebased 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.
CHAPTER 5: COMMUNITIES RISING UP OUT OF VIOLENCE | 153

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 

“Kids	can’t	go	to	school	ready	to	learn	when	

they’re	full	of	fear	or	they’re	dealing	with	the	

emotional baggage of what violence has brought 

to	their	life.	They	can’t	concentrate	when	they’re	

being bullied.”

— Janell Regimbal, Senior Vice President, Children and Family 

Services, Lutheran Social Services of North Dakota
154 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

of benefits primarily for White children but not for African-American or Hispanic 

youth, suggesting 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.

“How	does	suicide	intertwine	with	violence?	

Sometimes youth turn to suicide to escape the 

violence	that	exists	in	their	families	and	between	

their peers.... These perpetuating cycles of 

violence lead to depression and destructive 

behaviors that oftentimes have violent endings.... 

Suicide,	in	times	like	this,	is	one	of	the	first	things	

to come to the mind of most Native youth.”

— Coloradas Mangas, Mescalero Apache Tribe and Youth Board 

Member for the Center for Native American Youth
CHAPTER 5: COMMUNITIES RISING UP OUT OF VIOLENCE | 155

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 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 

“If you are going to recommend more mentoring... 

I	really	encourage	you	to	look	at	the	social	and	

emotional connections between trauma and adult 

outcomes	and	the	programs	that	you	are	likely	

to support, so that, in combination, they produce 

outcomes that individually they could not.”

— Bryan Samuels, Commissioner, Administration on Children, 

Youth and Families, U.S. Department of Health and Human 

Services
156 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 public-private 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.
CHAPTER 5: COMMUNITIES RISING UP OUT OF VIOLENCE | 157

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89.	 	Crooks,	 C.	 V.,	 et	 al.	 (2011).	 Impact	 of	 a	 universal	 school-based	 violence	

prevention program on violent delinquency: distinctive benefits for youth with 

maltreatment histories. Child Abuse & Neglect, 35(6),	393–400.

90.	 	Walker,	 S.	 L.,	 &	 Smith,	 D.	 J.,	 Jr.	 (2009).	 “Children	 at	 risk”:	 development,	

implementation, and effectiveness of a school-based violence intervention and 

prevention program. Journal of Prevention & Intervention in the Community, 

37(4),	316–25.

91.	 	Park-Higgerson,	H.	K.,	et	al.	(2008).	The	evaluation	of	school-based	violence	

prevention programs: a meta-analysis. Journal of School Health, 78(9),	465–

79;	quiz	518–20.

92.	 	Multisite	Violence	Prevention	Project.	(2008).	The	multisite	violence	prevention	

project: impact of a universal school-based violence prevention program on 

social-cognitive outcomes. Prevention Science, 9(4),	231–44.

93.	 	Gorman,	 D.	 M.,	 Conde,	 E.	 (2007).	 Conflict	 of	 interest	 in	the	 evaluation	 and	

dissemination of “model” school-based drug and violence prevention programs. 

Evaluation and Program Planning, 30(4),	422–9.

94.	 	Task	Force	on	Community	Preventive	Services.	(2007).	A	recommendation	to	

reduce rates of violence among school-aged children and youth by means 

of universal school-based violence prevention programs. American Journal of 

Preventive Medicine, 33(2	Suppl),	S112–3.

95.	 	Modzeleski,	W.	(2007).	School-based	violence	prevention	programs:	offering	

hope for school districts. American Journal of Preventive Medicine, 33(2	Suppl),	

S107–8.

96.	 	Freedenthal,	S.	(2010).	Adolescent	help-seeking	and	the	Yellow	Ribbon	Suicide	

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40(6),	628–39.

97.	 	Wyman,	P.	A.,	et	al.	(2010).	An	outcome	evaluation	of	the	Sources	of	Strength	

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schools. American Journal of Public Health, 100(9),	1653–61.

98.	 	Waldvogel,	J.	L.,	Rueter,	M.,	&	Oberg,	C.	N.	(2008).	Adolescent	suicide:	 risk	

factors and prevention strategies. Current Problems in Pediatric and Adolescent 

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99.	 	Farrow,	 C.	 V.,	 &	 Fox,	 C.	 L.	 (2011).	 Gender	 differences	 in	 the	 relationships	

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100.		Ttofi,	M.	M.,	&	Farrington,	D.	P.	(2012).	Risk	and	protective	factors,	longitudinal	

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101.		Schroeder,	 B.	 A.,	 et	 al.	 (2012).	 The	 implementation	 of	 a	 statewide	 bullying	

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102.		Bauer,	N.	S.,	Lozano,	P.,	&	Rivara,	F.	P.	(2007).	The	effectiveness	of	the	Olweus	

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104.		Belshaw,	 S.	 H.,	 et	 al.	 (2012).	 The	 relationship	 between	 dating	 violence	 and	

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27(4),	580–91.

105.		Hawkins,	J.	D.,	et	al.	(2012).	Sustained	decreases	in	risk	exposure	and	youth	

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106.		Fagan,	A.	A.,	et	al.	(2011).	Effects	of	Communities	That	Care	on	the	adoption	

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107.		Fagan,	A.	A.,	et	al.	(2009).	Translational	research	in	action:	implementation	of	

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108.		Hawkins,	J.	D.,	Catalano,	R.	F.,	&	Miller,	J.	Y.	(1992).	Risk	and	protective	factors	

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childhood aggression: results of a primary prevention program. Journal of the 

American Academy of Child & Adolescent Psychiatry, 30(2),	208–17.
CHAPTER 5: COMMUNITIES RISING UP OUT OF VIOLENCE | 167

110.		Shaw,	D.	S.,	et	al.	(2006).	Randomized	trial	of	a	family-centered	approach	to	

the	prevention	of	early	conduct	problems:	2-year	effects	of	the	family	check-up	

in early childhood. Journal of Consulting and Clinical Psychology, 74(1),	1–9.

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113.		Horner,	M.	S.,	et	al.	(2008).	Mentoring	increases	connectedness	and	knowledge:	

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Health, 95(3),	518–24.

CHAPTER SIX: 

Rethinking Our Juvenile 

Justice System 6

CHAPTER 6: RETHINKING OUR JUVENILE JUSTICE SYSTEM | 171

T

he 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	

CHAPTER SIX: 

Rethinking Our Juvenile 

Justice System
172 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 mid-20s.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	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 

“When you live in a world that is never safe, where 

you feel abandoned and uncared for, numbing the 

pain	and	finding	some	kind	of	support	becomes	

an	essential	survival	skill.	This	is	how	I	became,	

and how many children today become, easy prey 

for pedophiles. This is why our young people 

create the nurturance they so desperately need 

by forming and joining gangs. This is why many 

children enter into the drug world at an early age. 

This	is	why	the	sex	trade	begins	to	seem	like	

a viable option. And this is how we lose our 

nation’s	future.”

— Sonja Sohn, actor and founder of ReWired for Change
CHAPTER 6: RETHINKING OUR JUVENILE JUSTICE SYSTEM | 173

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	

(lesbian-gay-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	make	it	imperative	that	every	community	get	involved	in	

addressing the need for trauma-informed assessment and care in its justice system.

“We need to redefine the terms that can lead 

a young person into a correctional facility and 

protect the public by detaining the most violent 

felons, not the young people who, with the proper 

supports,	could	be	promising	members	of	the	next	

generation.”

— Dr. Patrick McCarthy, President and CEO, Annie E. Casey 

Foundation
174 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 

“If our aim is to nurture healthy children within 

safe communities, we need to change our 

approach and the values that drive our responses 

to violence. The reliance on highly punitive 

approaches	[is]	not	working	—	they	make	people	

more alienated and angry, they feed cycles of 

revenge, and, as if that is not enough, they 

are costly.”

— Dr. Lauren Abramson, Executive Director, Community 

Conferencing Center, Baltimore
CHAPTER 6: RETHINKING OUR JUVENILE JUSTICE SYSTEM | 175

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.

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 trauma-informed 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	

“In one particularly brutal and corrupt private, forprofit prison that houses young men ages 13 to 

22 who were tried and convicted as adults, young 

men	endure	particularly	unspeakable	abuses.	Staff	

physically	assault	youth	and	sexually	abuse	them.	

Youth who are handcuffed and defenseless have 

been	kicked,	punched,	and	beaten	all	over	their	

bodies.”

— Sheila Bedi, Deputy Legal Director, Southern Poverty Law 

Center
176 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 traumainformed 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	 justiceinvolved	 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. 

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 

“A judicial system that understands the effects 

of trauma will render very different disposition 

decisions and effect different and individualized 

services at an early point of contact.”

— Tadarial Sturdivant, Director, Wayne County (Michigan) Child 

and Family Services
CHAPTER 6: RETHINKING OUR JUVENILE JUSTICE SYSTEM | 177

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.

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 
178 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	
CHAPTER 6: RETHINKING OUR JUVENILE JUSTICE SYSTEM | 179

trauma	—	it	is	not	surprising	that	these	youth	are	illequipped to change their behavior when they leave. 

Indeed, one longitudinal study following more than a 

thousand young offenders for 7 years after 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	

“I’ve	always	felt	that	one	of	the	problems	with	

the	way	the	public	experiences	these	types	of	

institutional	abuses	is	that	the	public	experiences	

them episodically, when, in fact, there is ample and 

growing evidence that they are endemic to the very 

nature	of	large,	distant,	locked	training	schools	for	

delinquent youth.”

— Vincent Schiraldi, Commissioner, New York City Department of 

Probation
180 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	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.
CHAPTER 6: RETHINKING OUR JUVENILE JUSTICE SYSTEM | 181

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	ill-equipped	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 percent of youth in custody have or are 

expecting	 children. 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,	compared	to	six	percent	of	girls	in	the	general	population.71 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 self-mutilate. Negative body image, low self-concept, and acute 

substance abuse aimed at self-medication, which so often result from stress or 

trauma, are issues that must be addressed differently in the future. 
182 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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.72

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,	 genderresponsive	 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.73

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,	

“A comprehensive continuum of care must be 

available to girls and young women who are 

survivors of violence or abuse. Services must be 

gender and culturally responsive, trauma-informed, 

age-appropriate, and strength-based. A variety of 

settings...must be offered. Services must focus 

on mental and physical recovery, health, selfesteem	building,	life	skills	development,	academic	

achievement, career development, and more. For 

young parents, bonding and attachment programs, 

parenting	skills,	and	childhood	education	are	

essential pieces of the puzzle.”

— Jeannette Pai-Espinosa, National Crittenton Foundation
CHAPTER 6: RETHINKING OUR JUVENILE JUSTICE SYSTEM | 183

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 traumainformed	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	

“The goal is to ensure that institutions serving 

youth (and the communities and families in which 

they	live)	are	safe	for	and	promote	the	healthy	

development of all young people. LGBT youth 

do	not	have	‘special	needs’	requiring	‘special	

treatment’	or	separate	systems;	their	needs	are	

the same as all other youth, but they are faced 

with unique challenges as a result of living with a 

stigmatized identity.”

— Carolyn Reyes, Senior Staff Attorney, Legal Services for 

Children
184 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

behavior and violating dress codes.74 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	 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	

“As public schools increasingly adopt harsh and 

extreme	disciplinary	policies	and	practices,	greater	

numbers of boys and young men of color fill 

the	ranks	of	suspended	and	ultimately	expelled	

students.	Once	suspended	and/or	expelled,	

many	boys	seem	to	vanish	into	thin	air	and	don’t	

show	up	on	anybody’s	radar	screen	again	until	

they resurface, all too often, in the criminal justice 

system, branded as predators and sent to 

adult jails.”

— Mary Lee, Deputy Director, PolicyLink
CHAPTER 6: RETHINKING OUR JUVENILE JUSTICE SYSTEM | 185

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 trauma-informed 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.

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.75

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.76 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.77 This is a right that all judges, prosecutors, and defense 
186 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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.76 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.78 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 all children 

—	 especially	those	 exposed	to	 violence	—	 should	 be	 presumed	 indigent	for	the	

purpose of appointment of counsel.79

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.80 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.
CHAPTER 6: RETHINKING OUR JUVENILE JUSTICE SYSTEM | 187

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 traumainformed 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 promises, debt bondage, or other forms of 

control	and	manipulation	to	keep	victims	involved	in	the	sex	industry.”81

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.82	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	

“These	kids	are	bought	and	sold,	used	and	

abused. For the vast majority of these children, 

the	violence	of	prostitution	—	the	daily	rapes	by	

customers, beatings by police, harassment by 

bystanders,	and	control	by	pimps	—	is	not	their	

first	experience	of	violence.”

— Pamela Shifman, Director, Initiatives for Girls and Women, NoVo 

Foundation
188 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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.83

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.

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.84
CHAPTER 6: RETHINKING OUR JUVENILE JUSTICE SYSTEM | 189

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 trauma-informed care and evidence-based trauma-specific 
190 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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,85,86 and 

on any given day an estimated 6,000 are incarcerated in an adult facility while they 

are still juveniles.87 However, most adult jails or prisons are ill-equipped to meet the 

needs	of	children	or	keep	them	safe.88	They	are	much	more	likely	to	commit	suicide	

in an adult jail than in a juvenile facility.89,90	They	are	also	five	times	as	likely	to	be	

sexually	 abused	 or	 raped	 as	they	 would	 be	 in	 a	 juvenile	facility.91 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.92 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.	 Self-mutilation	 scars	too	 numerous	to	 count	 covered	

his arms.93	Troy	had	spent	24	hours	a	day	in	an	isolation	cell	for	approximately	180	

of the 225 days he had been confined.94	Citing	dangers	facing	youth	like	Troy,	the	

American Academy of Child and Adolescent Psychiatry recently issued a statement 

flatly opposing solitary confinement for juveniles.95

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.96

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.97 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.
CHAPTER 6: RETHINKING OUR JUVENILE JUSTICE SYSTEM | 191

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.”98

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 whose crime reflects unfortunate yet 

transient immaturity, and the rare juvenile offender whose crime reflects irreparable 

corruption.’”99
192 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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89.	 	Memory,	 J.	(1989).	 Juvenile	suicides	 in	secure	detention	facilities:	 correction	

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90.	 	Mumola,	C.	J.	(2005,	August).	Special Report: Suicide and Homicide in State 

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91.	 	Prison	Rape	Elimination	Act	of	2003.	(2003,	September	4).	PL	108-79,	117	Stat.	

972–973. Retrieved from http://www.gpo.gov/fdsys/pkg/PLAW-108publ79/

pdf/PLAW-108publ79.pdf

92.	 	Deitch,	M.,	 et	 al.	 (2012,	May).	LBJ school releases report on conditions for 

certified juveniles in Texas county jails. Lyndon B. Johnson School of Public 

Affairs,	 University	 of	 Texas	 at	 Austin,	 p.	 TK.	 Retrieved	 from	 http://www.

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Juveniles%20in%20Texas%20County%20Jails-FINAL4.pdf

93.	 	Simkins,	S.,	Beyer,	M.,	&	Geis,	 L.	M.	(2012).	The	 harmful	 use	of	 isolation	 in	

juvenile facilities: The need for post-disposition representation. Washington 

University Journal of Law and Policy, 38(241),	18.

94.	 	Troy	 D.	 and	 O’Neill	 S.	 v.	 Mickens	 et	 al.,	 No.10-2903,	 3.	 (US	 District	 Court,	

State	 of	 New	 Jersey	 2010).	 Retrieved	 from	 http://docs.justia.com/cases/

federal/district-courts/new-jersey/njdce/1:2010cv02902/242291/50/0.

pdf?1314451414;	Simkins,	S.,	Beyer,	M.,	&	Geis,	L.	M.	(2012).	The	harmful	use	

of isolation in juvenile facilities: The need for post-disposition representation. 

Washington University Journal of Law and Policy, 38(241),	1.

95.	 	Solitary	Confinement	of	Juvenile	Offenders.	(2012,	April).	American Academy 

of Child & Adolescent Psychiatry: Policy Statements. Retrieved from 

http://www.aacap.org/cs/root/policy_statements/solitary_confinement_of_

juvenile_offenders

96.	 	Task	 Force	 on	 Community	 Preventive	 Services.	 (2007,	 April	 13).	

Recommendation against policies facilitating the transfer of juveniles from 

juvenile to adult justice systems for the purpose of reducing violence. American 

Journal of Preventive Medicine, Vol. 32, No.4S, S5–S6. Retrieved from www.

thecommunityguide.org/violence/taskforcearticle3.pdf

97.	 	Rush,	B.	L.,	et	al.	(2012,	April	3).	House members to Holder: Remove children 

from adult jails and prisons. U.S. House of Representatives. Retrieved from 

http://www.njjn.org/uploads/digital-library/HRLetter-to-AG_PREA_032012-

Remove-Youth-from-Adult-Prisons-Jails.pdf

98. Miller v. Alabama,	No.	10-9646.	(2012,	June	25).	pp.	11–12.	Retrieved	from	

http://www.supremecourt.gov/opinions/11pdf/10-9646.pdf

99. Miller v. Alabama.	No.	10-9646.	(2012,	June	25),	p.	17.	Retrieved	from	http://

www.supremecourt.gov/opinions/11pdf/10-9646.pdf

CONCLUSION C

CONCLUSION | 205

E

very	 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	his	or	her	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.

CONCLUSION
206 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON 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.

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.
GLOSSARY OF 

KEY TERMS G

GLOSSARY OF KEY TERMS | 209

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

is	of	some	degree	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.	

GLOSSARY OF 

KEY TERMS
210 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	child-serving	programs)	or	professionals	providing	

services	(a)	realize	(understand)	the	 impact	that	 exposure	to	violence	 and	trauma	

have	on	victims’	physical,	psychological,	and	psychosocial	development	and	wellbeing,	 (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, 
GLOSSARY OF KEY TERMS | 211

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.

ACTIVITIES OF THE 

TASK FORCE AND LIST 

OF WITNESSES A

ACTIVITIES OF THE TASK FORCE AND LIST OF WITNESSES | 215

Lists and quotations from witnesses in the report 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 

ACTIVITIES OF THE 

TASK FORCE AND LIST 

OF WITNESSES
216 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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	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 31, 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 
ACTIVITIES OF THE TASK FORCE AND LIST OF WITNESSES | 217

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 

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.
218 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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

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.
ACTIVITIES OF THE TASK FORCE AND LIST OF WITNESSES | 219

Witnesses: 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
220 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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.

Witnesses: 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!
ACTIVITIES OF THE TASK FORCE AND LIST OF WITNESSES | 221

Listening Session 2: Joint Base Lewis-McChord Family Resource Center

Tacoma, Washington

March 13, 2012

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.

Witnesses: 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.
222 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

Witnesses: 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
I

INDIVIDUALS AND 

ORGANIZATIONS 

THAT SUBMITTED 

WRITTEN TESTIMONY

INDIVIDUALS AND ORGANIZATIONS THAT SUBMITTED WRITTEN TESTIMONY | 225

INDIVIDUALS AND 

ORGANIZATIONS 

THAT SUBMITTED 

WRITTEN TESTIMONY

T

o ensure that its information-gathering efforts included as many 

people	 and	 perspectives	 as	 possible,	 the	 National	 Task	 Force	 on	

Children	Exposed	to	Violence	 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 and quotations from written testimony in the report reflect 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
226 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

Melissa Barnett

William Bedrossian, Olive Crest

U.S.	Senator	Mark	Begich

J. Benjamin, Sr.

Dr. Ronald Beverly

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
INDIVIDUALS AND ORGANIZATIONS THAT SUBMITTED WRITTEN TESTIMONY | 227

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

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
228 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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

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
INDIVIDUALS AND ORGANIZATIONS THAT SUBMITTED WRITTEN TESTIMONY | 229

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

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
230 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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

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
TASK FORCE MEMBER 

BIOGRAPHIEST

TASK FORCE MEMBER BIOGRAPHIES | 233

TASK FORCE MEMBER 

BIOGRAPHIES

Task Force Co-Chair: Robert L. 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	 NJDCsponsored 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 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.
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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.

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	violence-related	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).

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	
TASK FORCE MEMBER BIOGRAPHIES | 235

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.

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.
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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	 InterAgency	 Council	 on	 Child	Abuse	 and	 Neglect	(ICAN).	 ICAN	 is	the	 largest	 countybased child abuse council in the 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 
TASK FORCE MEMBER BIOGRAPHIES | 237

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 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.
238 | REPORT OF THE ATTORNEY GENERAL’S NATIONAL TASK FORCE ON CHILDREN EXPOSED TO VIOLENCE

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 evidencebased	 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 
TASK FORCE MEMBER BIOGRAPHIES | 239

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 

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,	 schoolbased, 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 trauma-informed 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	
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Violence,	 established	 by	the	White	 House	 and	 DOJ	 in	 1999,	 and	the	 SAMHSAfunded	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 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.
TASK FORCE MEMBER BIOGRAPHIES | 241

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	 evidencebased 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 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,	tax-exempt	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.
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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.