Family & Corrections Network

The Fourth North American Conference on the Family & Corrections

Table of Contents

October 10-12, 1993 Quebec City, Quebec, Canada

HOW COMMUNITY VIOLENCE AFFECTS CHILDREN, PARENTS AND PRACTITIONERS

Les sequelles de la violence collective sur les enfants, leurs parents et les intervenants

Betsy McAlister Groves, LICSW

Division of Departmental and Behavioural Pediatrics, Boston City Hospital

Margot Kaplan-Sanoff, Ed.D

Director, Steps for Kids Outreach Project, Boston University School of Medicine

818 Harrison Avenue Boston, MA, 02118 (617) 534-4767

Cet atelier presente des informations sur les effets qu'eprouvent, pour avoir ete les temoins de violences, des enfants, leur pere et leur mere et les fournisseurs de soins. Des elements proviennent du Child Witness To Violence Project, qui fournit des services aux jeunes enfants exposes a la violence et a leur famille.

On donne un apercu du stress post-traumatique et des renseignements sur la facon dont ce dernier differe chez les enfants et les adultes. Le Child Witness To Violence Project est presente comme un modele d'intervention. Les resultats de la premiere annee d'application sont examines.

Dans l'examen des besoins des parents et des fournisseurs de soins, on accorde une attention particuliere au cout psychique que comporte le role de pere et de mere dans des milieux dangereux. Des strategies pour aider ceux-ci et les fournisseurs de soins sont presentees.

I would like to share with you the work that I and my colleagues, Barry Zuckerman and Laura Taylor have been doing at Boston City Hospital on the issues related to young children's exposure to violence in the community. I am a social worker in the Division of Developmental and Behavioural Pediatrics and as a part of my work, I am the mental health consultant to a day care centre for young children from high risk families.

I, like all of you, have been made aware of the increasing amounts of violence on the streets of our cities. My colleagues who work in the hospital see these victims daily. However, the issue was brought home to me on a much more personal and visceral level by an incident that I heard about at the day care center.

One day, in the supervision group that I run for teachers at this center, one of the teachers related the following incident: She had been on the school van with the children, 3 & 4 years olds, as they were driven home at the end of the day. As the bus made its way through the city streets, it swerved and was forced to stop suddenly. A man who was bleeding profusely staggered out of a storefront and collapsed in front of the bus. He apparently had been stabbed and was attempting to flee from his assailant. Since the man lay in front of the bus, it could not move until police came and took him away on a stretcher. It was several minutes before the bus could move again and during that time the children were mostly quiet, asking a few questions, "Would the police come? Was the man hurt?"

As the teacher reported this incident to us in the group, her voice began to tremble, she appeared increasingly anxious and agitated, and she started to cry. We spent the rest of the session discussing our own reactions to this gruesome event. The teacher's reactions were both understandable and appropriate. However, I was left with many questions about how the children who witnessed this event would react. What did they perceive? What did they understand? Were they scared? Many of these children had either been victimized by or had witnessed violence at home. Did this affect how they perceived this incident? Curiously enough, the children had very little to say about it the next day when they returned to school. Why was this so? Had they simply put it aside or forgotten or was it because the child care staff did not ask?

Based on these questions that arose from this encounter, from similar reports from colleagues and with support from the Harris Foundation I have begun more focused exploration of the problem of young children's exposure to violence. As you know, there are many complicated questions that arise when one begins to unravel this problem. First there is the issue of definition: What is violence? We would probably all agree that shooting or stabbing qualifies as violent behaviour. But what about pushing or shoving? Or yelling? Is this violence? Does it affect children in the same way? Secondly, how do we separate chronic violence from acute violence episodes in children's lives? What does it mean to grown up in an environment where one hears gun shots constantly? Can we compare the children on our bus who saw the severely wounded man to the child who witnesses a family member being assaulted? Thirdly, what is the role of other risk factors among children who witness violence? These children may also witness or be victimized by domestic violence. And fourthly, how can we identify and understand protective factors for these children? The research questions are plentiful if not overwhelming.

It is at this point in my own thinking that I express my admiration and gratitude to people like Joy Osofsky and John Richters who are attempting to study these questions systematically. Their work is yielding valuable information on many of these issues. However, since I am a clinician and not a researcher, I would like to share with you from a clinical perspective some of what we are beginning to learn from our initial explorations.

The theoretical framework we are using comes from research about stress and coping in children. Briefly stated, the greater the stress, the greater the coping resources that are required to successfully meet the stress. For children, the ability to cope with trauma varies by age, developmental stage, by the ability to utilize other resources and by the availability of these resources. By nature of age and developmental stage, pre-school children are the most vulnerable to the effects of exposure to violence. Developmentally, pre-schoolers are still struggling with the formation of secure attachments and with achieving a basic trust in the world around them. That violence and uncontrolled aggression shakes this basic trust is an obvious statement. Not only are pre-schoolers the most vulnerable, they are also the least able to communicate their feelings and vulnerability. They can not verbalize to us how they react to trauma, nor do we as adults wish to hear it. Sometimes it is too painful for us to hear.

Since age and developmental stage cannot be changed, it makes sense to focus on children's ability to use resources and the availability of these resources as the points for intervention. We have decided to focus on three areas of intervention as a way to learn more about the problem. These areas include direct intervention with children themselves, intervention with childcare providers, and intervention with parents. What follows is preliminary information from these efforts.

Let me first address the issue of direct clinical work with young children who have witnessed violence. As a part of my work in the childcare center, I have received referrals of specific children who have been exposed to violence. I would like to highlight material from two of these cases. I believe they give us valuable information about how young children may respond to violence, and in both of these cases to the loss of a parent through violence.

The first case involves a 5 year old boy who witnessed the murder of his mother in an attempted burglary in their apartment. Sam, who is one of six children in this family was sleeping in the same room as his parents when awakened to see three intruders in the bedroom. His father awoke at the same instant and attempted to intervene as one of the intruders reached down to snatch a gold chain off his mother's neck. The burglars fired a shot which ricocheted off the father and struck the mother in the eye, killing her instantly.

The second case involves a three year old boy, Tony, whose father was shot and killed by policemen when Tony was 9 months old. Tony did not witness the death. However, the mother, believing that her child should know everything about his father, has told Tony in excruciating detail about how his father was killed - how many bullet holes there were, where the bullets entered, and how much blood there was. She has also shared her belief that this was an unprovoked homicide on the part of the police. This case is remarkable because it tells us about the power of trauma for children even if it is not witnessed first hand.

Both children, in play therapy, have elaborated in great detail upon the specifics of the trauma and its on-going impact in their lives. Their play is striking in its similarity with regard to several major themes.

First, both children have communicated their sense of increased vulnerability and fear of annihilation following the trauma. Sam, the 5 year old, recounts the specifics of his terror of the assailants. He described how he kept his eyes closed while his mother was shot. "if I don't open my eyes", he explained, "they won't see me and then they won't kill me." This statement, revealing both egocentric thinking and a poignant sense of vulnerability, is clear in its message. Sam's early drawings were of boys with gaping mouths, silently screaming. He would tell some seemingly benign story to accompany the drawings, but the stark terror revealed in these screaming figures spoke louder than his words.

A second theme that emerged for both boys was their sense of anger at the failure of adults to protect them from loss. Sam once said, "My father should have stopped the bullet." He plays out scenes where the father protects the mother. He expresses anger that his father had argued with his mother a couple of days preceding her death. Tony, the 3 year old has endless repetitive play where policemen are called to come help, then they shoot everyone. Tony carefully wipes blood from the heads of all the dolls who are shot. Policemen are not helpful. They kill people.

A third theme is the fear of repeat trauma. Sam builds elaborate prisons to house the thieves who kill people. Even with walls, iron bars, and guards, the thieves managed to escape. They are rounded up, put back in prison, only to escape again. After several rounds of this game I begin to sense the invincibility of the thieves: they cannot be locked away. We are not safe. Tony starts when he hears police sirens. "Why are the police coming?" he inquires. I have a sense with Tony that he lives in constant apprehension unsure of what will happen next.

The intractability of these themes for both children, their fear of annihilation, their anger at the failure of adults to protect them, their fear of repeat trauma, has been impressive. One wonders if they can every feel safe again and what this will mean for their future development.

The second phase of our consultation has involved day care centers and child care providers. We have met with providers in groups for the purpose of training and support. In talking with these providers, we have found that they feel frightened, overwhelmed, and occasionally hopeless about the violence that affects the lives of the children they work with.

As they hear story after story about incidents children witness at home or on the streets, they report that they begin to feel numb about these events. Furthermore, child care providers find that they sometimes begin to avoid the issue, because they feel helpless to respond once they have the information.

In our consultation, we have attempted to give child care staff the tools to talk to young children about violence. We believe this is a two-step process. First, we have helped them process their own emotional reactions, thereby freeing them to be able to talk with children more effectively. Secondly, we have given them specific information about what is known about children's exposure to violence and the symptoms associated with post traumatic stress disorder.

Using specific cases that emerge from the centers, we have assisted child care centers in responding more appropriately and sensitively to incidences of violence and trauma that have arisen. Let me give you an example which the staff of one day care center brought forward: The parents of one of their children had been struck and killed by a hit-and-run driver. The staff was in a panic about how to respond to this child when she returned to the center, and how to deal with the issues that would surface in the classroom. The child's teacher stated that she could not face the child without crying. There were many questions about how the child understood death, how to deal with the issues of religious belief and death. As we discussed this tragedy, I began to sense a covert wish that this child would not come back because her presence was too unbearably painful for the staff. They felt that they could do nothing to help this child and that they had somehow failed to protect her from this unimaginable loss.

My work with the staff in this instance was to assist them in venting all of these feelings, to help them name the horror they felt. The staff shared memories of the family and talked about their anger at the murderer who was still at large. We made a list of all the questions the staff had raised: questions about how this child may behave upon her return, what her emotional state may be; questions about how to handle discussion of issues of loss and death in the classroom; and questions about how the staff would handle their own feelings. Then we began to work on these issues one at a time. At the close of this meeting, the staff reported feeling more confident and prepared. It seemed that the process of providing the staff with the opportunity to express their feelings freed them to better prepare for this child's return.

From this intervention we have leaned that it is crucial to help the teachers of young children be able to talk about violence. It is also important to be cognizant of the fact that these teachers have to deal with issues of violence and safety in their own lives. Many of them come to work daily to centers that are in dangerous neighborhoods - or they live in dangerous neighborhoods. Some teachers have histories of abuse and victimization in their own lives. For these teachers, especially, helping a child talk about violence may involve a painful reenactment of their own traumas of abuse. So, their understandable tendency is to minimize the issues of violence and victimization with children. However, if childcare workers can themselves feel supported to cope with the trauma they will, in turn, provide the support to children and families.

The third phase of our intervention has been to talk with the parents to better understand how violence is affecting their families. I have met with parents both in focus groups and individually as part of my clinical work with children. Parents report their perception that their young children are confused between the images of violence they see on television and what they see on the streets, believing that violence on the streets is not real or that the gunshots they hear won't really hurt them. The line between fact and fantasy is blurred.

This lack of awareness stands in contrast to the parents' reports of their own chronic fears for the safety of their children. Parents tell us about the many ways they attempt to mediate the environment for their children. I am particularly struck with the number of parents who don't allow their children to play outside at all or who only allow children outside under special circumstances. One parent told us about her system of allowing her child outside on her front steps and sidewalk only if she (the mother) was free to sit in the window and monitor the streets for any unusual movement or activity. At the slightest sign of change on the street, she would immediately pull her child inside. I wonder what this means for a child's development. Both in terms of how her drive for exploration and learning is affected and about what it means to be taught at such an early age that the outside world is an unsafe place.

I have also learned about the heroic and at times creative efforts parents make to keep their children safe and to protect them from fear and worry about their own safety. I think the most vivid example of this comes from a parent that I interviewed as part of a child evaluation. This parent brought her daughter in to see me after this child awakened one night to see (as she expressed it) "hands and a face" at the window next to her bed. As she sat up in bed the face disappeared. Her mother later discovered that the screen had been slashed and there was clear evidence of an attempted break-in. Following this frightening incident, this girl was afraid to sleep in her bed and was having some difficulties separating from her mother.

As we discussed this incident in my office, the mother offered the speculation that this attempted break-in was probably connected to the group of drug dealers who lived next door. She (the mother) then began to tell me about her efforts to take care of the situation. In extremely graphic language, this mother described how she had gone outside and yelled at the people next door, grabbing one of them and pushing him up against the door. She told them she didn't want them coming near her kid, that she knew what they were doing, and that she was going to call the police. As she talked, I watched the little girl who began to settle back in her chair. She looked quite relieved and relaxed. Her relief stood in great contrast to my growing discomfort. I, of course, was afraid this mother was going to get killed - that such a risk was foolhardy and dangerous. But what occurred to me was that this mother was providing exactly what her daughter needed to cope with this scary event. She was providing a rational explanation - an absolutely totally convincing explanation that of course it was those crazy drug dealers next door who were responsible for this; and she was stating unambivalently that she was not going to allow this to happen anymore. She had made her daughter's world safe again, and that was crucial for this little girl.

We have also conducted focus groups in the community. Parents in these groups tell us that having connections in the neighborhood are critically important. One parent who initially stated to the group that she felt hopeless about the magnitude of the problem of violence in the community commented at the end of session that "Talking makes me feel better. At least I'm not alone". Parents in the group discussed the sections of the streets where they lived, rating them in terms of how many neighbours they knew and how extensive was the network of other parents who would watch out for children on the streets. Once again we felt that the parents' ability to feel empowered was extremely important. However, it did not negate the threat of violence, both their feelings of fear and the real danger that exists.

In summary, I would say that our initial explorations into this area of young children's exposure to violence have convinced us that it is a critical social problem that demands more careful study. We need to better understand how to help parents and children cope with their feelings of fear. The observations I have shared with you today probably raise more questions than have been answered. On the one hand I have learned that it is critical for parents and caretakers of young children to avoid feeling paralyzed and hopeless about he situation, in part because this hopelessness is so easily communicated to children. On the other hand how can parents make children feel safe when they themselves have been assaulted, murdered or victimized? And what about the larger issue of pathologizing neighborhoods of high crime? One of my colleagues addressed this problem eloquently as she took me to task for my definitions of violence in her neighborhood. "What are you saying that I as a parent should do?" she asked. "I live in a neighborhood where we hear gunshots all the time. Am I supposed to stop every time I hear a shot and process my son's reactions? No! We go about our business. I get him dressed, we eat our meals, we go to school. We're doing all right." She makes a crucial point. By labeling entire urban communities as war zones, we overlook what is positive and strong and health promoting in those communities.

I think there are lessons in this experience for us. We need to support parents and families. If parents can be validated for their heroic efforts to help their children feel safe, even in dangerous neighborhoods then we know children will benefit. Particularly for young children, their parents' abilities to give their children some freedom from the chronic worries about safety will make a difference.

Finally, I could not end this talk without adding my own critique of the points I have covered. These intervention efforts are essentially a band-aid approach to a terribly complex and pervasive problem in our society. The quantity and quality of violence that we all live with - on television, in our homes, and on our streets is a national outrage. I am reminded of the saying "We have met the enemy and he is us." Our inability to secure tougher gun control laws is but one example of this country's failure to come to terms with the violence that surrounds us all. As we struggle to develop appropriate intervention strategies, we must not fail to address the larger social policy issues that emerge.