Addressing Gun Violence to Combat PTSD in Children

Children exposed to violence, especially gun violence, are at great risk of developing symptoms associated with Post-Traumatic Stress Disorder (PTSD). In fact, nearly 100% of children who have witnessed the violent death of someone they know, especially a family member, develop these debilitating symptoms. Exposure to violence can cause intrusive thoughts about the traumatic event and sleep disturbances. These symptoms can dramatically affect a child’s ability to successfully function at home, school, and with peers. It is not surprising that children and youth exposed to gun violence commonly experience difficulty concentrating in the classroom, declines in academic performance, and lower educational and career aspirations.

If left untreated, PTSD can also lead to alcohol and drug abuse, gang involvement, or inability to sustain healthy relationships or jobs.

School-aged children (ages 5-12) may not have flashbacks or problems remembering parts of the trauma, the way adults with PTSD often do. Children, though, might put the events of the trauma in the wrong order. They might also think there were signs that the trauma was going to happen. As a result, they think that they will see these signs again before another trauma happens. They often bear a sense of responsibility resulting in a sense of guilt for the violence. They may believe that if they pay attention, they can avoid future traumas.

Children of this age might also show signs of PTSD in their play. They might keep repeating a part of the trauma. For example, a child might always want to play shooting games after he sees a school shooting, but these games do not make their worry and distress go away. Children may also fit parts of the trauma into their daily lives. For example, a child might carry a gun to school after seeing a school shooting.

Teens (ages 12-18) are not children, yet not adults. Some PTSD symptoms in teens begin to look like those of adults, but there are differences. For example, teens are more likely than younger children or adults to show impulsive and aggressive behaviors. As a result, they have less ability to manage the fear, stress and anxiety associated with violence. They may try to numb these feelings with alcohol or drugs. Or, they may try to control their circumstances by being the perpetrators – rather than the victims – of violence, through gang activities and the like. Some youngsters may become severely depressed or suicidal.

We know that Staten Island youth are in trouble, and much of that trouble may be due to violence and PTSD. Alarming is the prevalence of alcohol abuse and substance use/abuse among adolescents and young adults. According to the New York City Department of Health and Mental Hygiene and the New York State Department of Health, rates of smoking, binge drinking, alcohol consumption and marijuana use are higher among Staten Island youth than among youth throughout the city and state.

Sadly, there are limited services to address the needs of these disconnected and at-risk youth. On Staten Island, of the 15-outpatient treatment and rehabilitation services licensed by the NYS Office of Alcoholism and Substance Abuse Services, only the Staten Island Mental Health Society (SIMHS) offers services exclusively for youth.

To help close the gap in services for youth suffering from violence-related PTSD, the SIMHS has received a grant of $83,000 from Staten Island Council Member Debi Rose to provide the mental health component of a comprehensive approach to combating the epidemic of gun violence on our borough’s North Shore. The SIMHS will partner with other Island stakeholders as part of a citywide coalition that will shift the discourse toward the view of violence as a disease and place the emphasis on finding solutions to end this epidemic. Modeled after the evidence-based “Cease Fire” program that has been implemented successfully across the country, this initiative will work towards responding and reducing gun violence in our community. We plan to provide a full range of evidence-based mental health and related services to children and their families impacted by the epidemic of gun violence.

Targeting youth ages 11 through 21, our program is to be located in the St. George area of Staten Island – the hub of the North Shore community – near the Family and Criminal Courts as well as the Department of Probation and the Center for Court Innovations’ Staten Island Youth Justice Center. Funding will be used to support a Spanish-speaking clinical social worker, a part-time psychiatrist, and a part-time coordinator – who is both a clinician and a seasoned administrator – to oversee the implementation of the project. SIMHS clinicians will also undergo training to provide culturally sensitive and appropriate services to children and families affected by gun violence.

One of the treatment approaches that has proven successful in alleviating PTSD is Trauma- Focused Cognitive Behavioral Therapy (CBT), in which the child is encouraged to talk about his or her memory of the trauma and includes techniques to help lower worry and stress. The child may learn how to assert him or herself. The therapy may involve learning to change thoughts or beliefs about the trauma that are not correct or true. For example, after a trauma, a child may start thinking, “the world is totally unsafe.”

Some may question whether children should be asked to think about and remember events that scared them, but research has shown it to be safe and effective for children with PTSD. The child can be taught at his or her own pace to relax while thinking about the trauma. That way, the child learns not to be afraid of the memories. CBT may also use training for parents and caregivers, because it is important for adults to understand the effects of PTSD and to learn coping skills that will help them help their children.

Another treatment approach, Psychological First Aid (PFA), has been used with school-aged children and teens that have been through violence where they live. PFA can be used in schools and traditional settings. It involves providing comfort and support, and letting children know their reactions are normal. PFA teaches calming and problem-solving skills and also helps caregivers deal with changes in the child’s feelings and behavior. Children with more severe symptoms may be referred for added treatment.

Play therapy can be used to treat young children with PTSD who are not able to deal with the trauma more directly. The therapist uses games, drawings, and other methods to help children process their traumatic memories.

Another promising approach is therapeutic group intervention. Trauma-focused group interventions have successfully treated violence-exposed and victimized children and adolescents. In these settings, youth learn that they are not alone in their feelings and reactions; they are able to draw strength from those with whom they can identify, and, under the skillful guidance of a therapist, begin to find healthy ways to manage their stress, anxiety, and fears.

The SIMHS is committed to working with our local community and with New York City to prevent gun violence in our neighborhoods, and to offer therapeutic healing to those children and families who have been emotionally/psychologically impacted by gun violence and PTSD.

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