Community Violence Exposure in Youth: Intervention Strategies

Introduction

The purpose of this paper is to examine exposure to community violence by school-age children and to explore the intervention methods utilized in addressing the resulting trauma and associated psychological factors. Early intervention is key in assisting school-age children in coping with trauma and its associated symptoms — both emotional and psychological — in order to avoid compounding the condition or causing permanent damage.

The CBITS Program and Its Development

Exposure to trauma and violence is a risk that exists at "disconcertingly high levels," according to the Centers for Disease Control and Prevention. Researchers have noted certain limitations in existing knowledge and have identified a need for more research in this area, along with more comprehensive long-term analysis (Bender, 2003).

A significant study was performed in collaboration with the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program and the Los Angeles Unified School District (LAUSD). In the late 1980s, Marleen Wong, M.S.W., director of mental health services for the LAUSD, sought answers to how schools could intervene for students coping with trauma resulting from exposure to violence. Wong worked with immigrant children through the Emergency Immigrant Education Program (EIEP), created in 1999, which was designed to help children who had lived in the United States for three years or less and had experienced exposure to violence in their communities.

In this study, mental health screening and standardized brief cognitive behavioral therapy (CBT) treatment were provided in schools for students who had been exposed to violence. The CBITS pilot study focused on 1,004 immigrant schoolchildren attending participating schools. The purpose was to develop a trauma program for delivering treatment to those who had experienced violence or trauma. Students ranged from eight to fifteen years of age. Of the 1,004 surveyed, 198 Latino students had histories involving violence exposure and trauma-related depression, with or without accompanying post-traumatic stress disorder (PTSD) symptoms (Wong, 2000).

Evaluation of these symptoms was followed by intervention consisting of a brief manualized group cognitive behavioral therapy approach (CBITS, Jaycox). CBITS developer and RAND researcher Lisa Jaycox, Ph.D., identified three key goals for the program:

1. Reduction of trauma-associated symptoms in students
2. Building of resilience
3. Building parent and peer support

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

Therapy was delivered by bicultural, bilingual school social workers who provided treatment in Spanish, either immediately or through scheduled appointments during the school year. The program was subsequently applied to a broader school population of 126 sixth-grade general-education students. Remarkably, all but twelve percent of these students admitted exposure to violence and trauma. Thirty-two percent of the students showed symptoms of PTSD, and sixteen percent reported depressive symptoms since the incident.

The significance of this finding — that thirty-two percent of students reported PTSD symptoms following traumatic incidents — led to the conclusion that the program was appropriate for implementation in the public school system and that symptoms improved with treatment. In the follow-up study, students who received intervention demonstrated fewer behavioral symptoms compared to the control group, as reported by teachers. The overall findings indicated that CBITS provides evidence-based treatment, and exploration of wider dissemination to schools is ongoing.

PTSD Symptoms Associated with Community Violence Exposure

CBITS is delivered across ten sessions, during which students learn about the link between thoughts and feelings, receive relaxation training, develop problem-solving skills, and discuss their traumatic experiences in a safe environment. Groups are led by social workers and contain between five and eight students; students and parents also participate in individual sessions with social workers. As Jaycox noted: "When something bad happens to us, we tend to believe the world is an extremely dangerous place." CBITS was designed to address precisely these fears. Children frequently blame themselves for traumatic events, believing a different action on their part might have changed the outcome.

The work Children's and Adolescents' Exposure to Community Violence, Post-Traumatic Stress Reactions, and Treatment Implications by L. Berman et al. states: "Individuals' 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 consequences, distress symptoms of the type associated with post-traumatic stress have emerged as a focal point of recent research" (e.g., Davies & Flannery, 1998; Ensink et al., 1997; Glodich, 1998).

The study identifies the following symptoms associated with traumatic stress:

1. Reliving of the trauma — flashbacks
2. Nightmares
3. Avoidance of associated stimuli (including thoughts, feelings, conversations, people, places, or objects)
4. Increased arousal, manifesting as irritability, hypervigilance, an exaggerated startle response, sleep difficulty, and difficulty concentrating

Conclusion

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