Kids get help cop­ing with trauma

New Haven po­lice trained to treat youths ex­posed to vi­o­lence

The Register Citizen (Torrington, CT) - - FRONT PAGE - By Su­jata Srini­vasan CONN. HEALTH I-TEAM WRITER

Shawn was 4 years old when he watched his fa­ther, Jonathan Wha­ley, keel over at their doorstep from a gun­shot wound to his back. He re­mem­bers the pool of blood, the paramedics, and the po­lice.

Wha­ley, 34, didn’t make it. Shawn is now 8 years old. He lives with his grand­mother and five sib­lings in one of Hart­ford’s run­down neigh­bor­hoods. “They got a lot of anger,” said Ish­meal Turner, Shawn’s grand­fa­ther. “It’s been rough. Rough.”

Turner, a cab driver, lives a few streets down and comes by to help. Shawn’s mother had moved out be­fore Wha­ley’s death, and his grand­mother is on chemo­ther­apy for colon can­cer. Turner said he pulled Shawn out of public school for ag­gres­sion. He still wor­ries over the child’s out­bursts of anger, and night­mares in­volv­ing gun­shots and blood.

Like Shawn, thou­sands of chil­dren suf­fer from trauma, or what ex­perts call trau­matic dys­reg­u­la­tion. When chil­dren are over­whelmed by a trau­matic event, their abil­ity to think in a lin­ear fashion is com­pro­mised, and their cop­ing mech­a­nism goes hay­wire. The Na­tional Child Trau­matic Stress Net­work es­ti­mates that 26 per­cent of chil­dren will ex­pe­ri­ence a trau­matic event by age 4.

But they are getting lit­tle or no help. “Imag­ine if you feel small or fright­ened all the time, imag­ine if you can’t get rid of in­tru­sive thoughts about the orig­i­nal trau­matic ex­pe­ri­ence,” said Steven Marans, di­rec­tor of the Child­hood Vi­o­lent Trauma Cen­ter at the Yale Child Study Cen­ter, and pro­fes­sor of psy­chi­a­try at the Yale School of Medicine. “These are bur­dens that the de­vel­op­ing child is not able to ad­e­quately ne­go­ti­ate and master.”

When left un­treated, chil­dren are at a higher risk of post-trau­matic stress dis­or­der, anti-so­cial be­hav­ior, aca­demic fail­ure, dif­fi­culty form­ing re­la­tion­ships and anx­i­ety dis­or­ders. They are also more likely to abuse drugs and al­co­hol. There are phys­i­cal dis­rup­tions too be­cause “our bod­ies are cen­tral to our feel­ings,” Marans said. Symp­toms can in­clude in­creases in the heart rate, changes in the res­pi­ra­tory rate, headaches and gas­tro-in­testi­nal dis­or­ders.

The long-term reper­cus­sions can be dev­as­tat­ing. Doc­tors say

they are frus­trated by the cycli­cal na­ture of how adults ex­posed to trauma in their child­hood end up in the emer­gency room re­peat­edly. Noth­ing has changed, they say, in the last 15 years. “They are show­ing up be­cause they are us­ing sub­stances, for er­ratic be­hav­ior in the com­mu­nity, or are a threat to them­selves,” said Dr. Gre­gory Shang­old, an ER physi­cian and vice pres­i­dent of the Connecticu­t State Med­i­cal So­ci­ety.

Most, Shang­old said, are from inner cities and the ER is their last re­sort. When they go back to their com­mu­ni­ties, they lack ac­cess to ther­apy and are at a higher risk of re­turn­ing to the ER.

The late 1980s were par­tic­u­larly vi­o­lent across the United States. The av­er­age pen­e­trat­ing wound per in­di­vid­ual with a gun­shot wound was 3.5 bul­lets per per­son, Dr. Jonathan Gates, chief of surgery at Hart­ford Hos­pi­tal, pointed out. The volume of ag­gra­vated as­saults ap­pears to be on the rise again, Gates said.

“Young victims pour into the trauma cen­ters night af­ter night, some with lifethreat­en­ing wounds. Those who are saved are faced with long term post-trau­matic stress from the event,” he said.

Hart­ford Hos­pi­tal ad­mits over 2,000 trauma pa­tients per year of which 10-15 per­cent are victims of pen­e­trat­ing wounds.

“Young victims pour into the trauma cen­ters night af­ter night, some with life-threat­en­ing wounds. Those who are saved are faced with long term post-trau­matic stress from the event.” Dr. Jonathan Gates, chief of surgery at Hart­ford Hos­pi­tal

The need, then, is to in­ter­vene swiftly in the after­math of a trau­matic event. “The po­lice can be the first adults for the chil­dren to pro­vide an im­me­di­ate sense of safety,” Marans said.

Un­der Marans’ guid­ance, the New Haven Po­lice Depart­ment will be­come among the first in the country to train all of its of­fi­cers in trauma-in­formed re­sponses to chil­dren ex­posed to vi­o­lence.

The ini­tia­tive builds upon an al­ready ex­ist­ing part­ner­ship with the Yale Study Cen­ter through which men­tal health pro­fes­sion­als re­spond to po­lice calls in­volv­ing child victims or wit­nesses of vi­o­lence. The pro­fes­sion­als of­fer an im­me­di­ate buf­fer and as­sess ini­tial symp­toms — anx­i­ety, dis­com­fort, ir­ri­tabil­ity, dif­fi­culty sleep­ing, easy star­tling, and more — iden­ti­fy­ing a child in need of treat­ment. The chil­dren are then re­ferred for trauma-focused coun­sel­ing at Yale.

Marans says the model is work­ing and po­lice de­part­ments have repli­cated it na­tion­wide. “This is a great ex­am­ple of in­ter­ven­ing early to help chil­dren and their fam­i­lies turn down the volume on symp­toms,” he said.

Yale has sev­eral other treat­ment meth­ods. In a pa­per pub­lished this month in the jour­nal Child Abuse & Ne­glect, Marans and his co-au­thors found that 640 care­givers na­tion­ally saw a 62 per­cent im­prove­ment in post-trau­matic stress un­der the child and fam­ily trau­matic stress in­ter­ven­tion model. Adult well-be­ing has a cas­cad­ing ef­fect on how trau­ma­tized chil­dren re­cover.

But the need is so vast that non­prof­its are fill­ing the gap. Ellen Tracy, ex­ec­u­tive di­rec­tor of Big Broth­ers Big Sis­ters of South­west­ern Connecticu­t, said a child once had a man drive up to her at her bus stop and he tried to get her into his car. The girl ran away but was afraid to take the bus again.

“They see all lev­els of street vi­o­lence — drugs, gang vi­o­lence, do­mes­tic vi­o­lence. They are very used to it and it be­comes part of their life,” she said. It shouldn’t.

A May study in Health Af­fairs found that chil­dren ex­posed to neigh­bor­hood vi­o­lence, and whose par­ents also felt they were un­safe in their neigh­bor­hood, ex­pe­ri­enced nearly three times the rate of chronic phys­i­cal ail­ments and five times the rate of men­tal health con­di­tions com­pared to chil­dren who had not been ex­posed to neigh­bor­hood vi­o­lence and whose par­ents perceived them to be safe in their neigh­bor­hood.

The find­ings high­light the link be­tween chil­dren’s health and neigh­bor­hood safety, and the need for public-pri­vate investment­s in un­der­served com­mu­ni­ties.

Data from the Child Health and De­vel­op­ment In­sti­tute of Connecticu­t, Inc. show that in the next five years across Connecticu­t, 13,000 additional chil­dren will re­ceive an ev­i­dence-based trauma treat­ment. Of these, 2,000 will be un­der the age of 7. More than 700 early child­hood providers will be trained in trauma through the Early Child­hood Trauma Col­lab­o­ra­tive.

For now, though, kids like Shawn need im­me­di­ate help. Though he has a coun­selor, Shawn’s grand­fa­ther is un­cer­tain if he is re­ceiv­ing trauma-focused in­ter­ven­tion, which is what he needs, Marans said.

Shawn re­mem­bers playing bas­ket­ball with his dad. He misses his dad’s grilled chicken. How does he cope? The child shrugged, look­ing at the floor. “Dunno,” he whis­pered.

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