Exposure to Community Violence

Exposure to Community Violence: Intervention

The purpose of this work is to research exposure to community violence by school-age children and further to examine the intervention methods utilized in dealing with the trauma and associated psychological factors.

Intervention being implemented early is key in assisting school-age children in coping with trauma and the associated symptoms and conditions both emotionally and psychologically for avoidance of complicating the condition or other results in permanent damage.

What the Professionals have to Say:

Exposure to trauma and violence is a risk that is at a "disconcertingly high level[s]" according to the Center for Disease Control and Prevention.

Researchers have noted that there are 'certain limitations and knowledge' and that there is need for more research in this area and a more comprehensive long-term analysis.

(Bender, 2003)

Study performed by Cognitive Behavioral Intervention for Trauma in Schools;

A study performed by the Los Angeles School district in a collaborative project with the CBITS, or the Cognitive Behavioral Intervention for trauma in schools. In the late 1980's Marleen Wong, M.S.W., director of mental health services for the Los Angeles Unified School District (LAUSD) sought answers to intervention for students in coping with the resulting trauma of exposure to violence. Wong worked with immigrant children through the EIEP program created in 1999. The Emergency Education Program was to help children who had lived in the U.S. For a period of three years or less in relation to the experience of exposure to violence in the society. In this study mental health screening and standardized brief cognitive behavioral therapy treatment in schools for students who have been exposed to violence were provided. The CBITS pilot study was conducted with focus in studies of 1004 immigrant school children attending schools participating in the survey. The purpose was development of a trauma program for delivery of treatment for those needing treatment from experiencing violence or trauma. The students were between the ages of eight and fifteen years of age. Of the 1,004 surveyed 198 students of Latino heritage students who had histories involving the experience of violence and trauma-related depression with or without accompanying Posttraumatic Stress Disorder symptoms.(Wong, 2000)

The evaluation of these symptoms was performed. Intervention was inclusive of a brief manualized group 'cognitive' behavioral therapy or CBT. (CBITS, Jaycox). CBITS developer and RAND researcher Lisa Jaycox, Ph.D. revealed to Psychiatric News that she had three key goals as follows:

1. Reduction of symptoms associated with trauma in students

2. The building of resistance.

3. Building parent and peer support.

Jaycox reportedly stated that: "One of the things we teach students is that it's O.K. feel fear and anxiety ... that it's not necessary to avoid thinking or talking about the trauma."

The therapy was through the process of bicultural school social workers who were also bilingual delivering in Spanish necessary treatment or intervention immediately or through a scheduled appointment during the school-year. Next the study was school-applied with 126 sixth-grade general population students. Amazingly all but twelve percent of the students admitted to exposure of violence and trauma. Thirty two percent of the students had symptoms of PTSD and sixteen percent reported depressive elements since the event.

The significance of the study was that thirty-two percent of the students reported 'posttraumatic stress disorder' symptoms since the incidents were experienced. The study was deemed appropriate for implementation in the public school system and that the symptoms improved with treatment. In the follow up study in comparison to the control group where the students that received intervention on a random basis demonstrated less symptoms in terms of behavior according to teachers. The findings were that the CBIT this program gives provision of evidence-based treatment and exploration is presently being made in the dissemination of this program to schools in wide-based delivery.

II. Associated Symptoms of Post-Traumatic Stress Disorder:

The work, "Children's and Adolescents' Exposure to Community Violence, Post-Traumatic Stress Reactions, and Treatment Implications, Written by Steven L. Berman, et al. states and backs with citations the following: "Individual's reactions to exposure to crime and violence are complex and multifaceted. Although exposure to extreme acts of crime and violence places youth at risk for a variety of adverse psychological consequence, distress symptoms of the type associated with posttraumatic stress have emerged as a focal point of recent research. (e.g., Davies & Flannery, 1998; Ensink et al., 1997; Glodich, 1998) The study reveals that the symptom associated with traumatic stress are the following:

1. Reliving of the trauma - flashbacks

2. Nightmares

3. Avoidance of associated stimuli (i.e. thoughts, feelings conversations, people, places or things.)

4. Increased arousal in the form of irritability, hypervigilence, easily started sleep difficulty, concentration difficulty.

CBITS is applied in form of ten sessions in order for the students to learn about the "link between thoughts and feelings and in order to receive relaxation training, learn how to problem-solve, and discuss their traumatic experiences in a safe environment."

The groups are led by social workers and contain between five and eight students as well as students and parents having sessions on individual basis with the social workers. Jaycox states that: "When something bad happens to us we tend to believe the world is an extremely dangerous place." CBITS was Jaycox's answer to addressing the fears of these students. Many times children blame themselves for the event that they might have done this or that and then the outcome might be differently.

IV. Children and Adolescent Reaction to Trauma:

Traumatic symptoms sometime show up immediately but there may also be a 'delayed-reaction' type of effect. Quite frequently the child will experience a loss of trust in adults due to the incident. The following charts reveal the reactions by age group that may be demonstrated.

Children and Adolescents Reaction to Trauma

Age 5 and Less

Fear of being separated from parent, crying, whimpering, screaming, immobility and/or aimless motion, trembling, frightened facial expressions and excessive clinging. May exhibit regressive behavior such as thumb-sucking, bedwetting, and fear of darkness.

Age 6 to 11 years old

Extreme withdrawal, disruptive behavior, inability to pay attention. Regressive behaviors, nightmares, sleep problems, irrational fears, irritability, refusal to attend school, outbursts of anger and fighting. Complaints of stomach aches and other physical symptoms with no medical basis, feelings of guilt, depression, anxiety and emotional numbing with schoolwork suffering.

Adolescents 12 to 17-year-old

Flashbacks, nightmares, emotional numbing avoidance of any reminders of the traumatic event, depression, substance abuse, problems with peers, antisocial behavior, withdrawals, isolation, physical complaints, suicide thoughts, school avoidance, academic decline, sleep disturbances, and confusion, possible development of guilt.

Table 1.0

Conclusion:

Treatment and intervention are considered by professionals to be key in assisting children in coping with effects due to violence exposure and should be a consideration of all educators.