Children and Polyvictimization: Proactive is Better than Reactive!


When one thinks of children’s exposure to violence and abuse in the home, that is usually as far as our imagery extends. Nothing else. Either it’s a home where instances of abuse, violence or criminal behaviors occur or IT occurs elsewhere. One instance;one type.  Most likely, one accompanies another as co-occurring traumatic experiences for children and family members. Polyvictimization is a much neglected component of child victimization trauma.

Children in the U.S. suffer higher rates of victimization and crime than adults. Actually, 1 in 4 students will experience some type of trauma or victimization before the age of 16, and is directly responsible for a variety of physical and mental health related consequences affecting them well into adulthood.

Efforts to help traumatized and victimized children tend to be fragmented, as they tend to focus on one type of trauma. For example, intervention and prevention programs will focus on bullying, dating violence, sexual abuse, alone. While these are important areas of focus for such programming, it would be most effective to incorporate a holistic and integrated approach to existing and proposed services. By focusing on polyvictimization, teachers, counselors, family and child advocates can provide the best interventions and prevention services.

Children are resilient and many can overcome negative effects of violence and trauma. However, some who are exposed to these events will suffer from traumatic stress long after the trauma has ended. Emotional symptoms such as, depression, anxiety, behavior problems, learning difficulties and attention problems can arise. Physical symptoms including sleep and eating disorders, and even nightmares are often frequent occurrences.

The primary goal of schools is to educate students, and this makes them the most natural places to implement prevention programming strategies,particularly since trauma directly affects the academic achievement of children. Trauma is the greatest cause of underachievement in schools with kids suffering from decreased reading ability, lower GPAs, and higher absences, suspension and dropout rates. Unfortunately, though, not all schools are implementing comprehensive prevention programs-for students AND families/adult caregivers.

It is important to understand that bullying, cyberbullying, sexual assault and abuse, and other types of victimization experienced by kids do not occur in isolation. Trauma-sensitive programming in education usually follows a highly publicized tragic event in a community, as a reaction to a single type of victimization. Focus in school settings should encompass a broad spectrum of victimization and traumatic stress-producing situations and events. Embedded into the guidance program, family engagement services and the general curriculum, as well. Proactive is better than reactive! School staff must become more trauma-sensitive, trauma-focused, and also know what signs to look for, such as:

Young Children (5 and younger)

Young children’s reactions are strongly influenced by their caregivers’ reactions. Children in this age range who are exposed to violence may:
■ Be irritable, fussy or have difficulty calming down
■ Become easily startled
■ Resort to behaviors common to when they were younger (for example, thumb sucking, bed wetting, or fear of the dark)
■ Have frequent tantrums
■ Cling to caregivers
■ Experience changes in level of activity
■ Repeat events over and over in play or conversation

Elementary School-Age Children (6–12 years)

Elementary and middle school children exposed to violence may show problems at school and at home. They may
■ Have difficulty paying attention
■ Become quiet, upset, and withdrawn
■ Be tearful or sad and talk about scary feelings and ideas
■ Fight with peers or adults
■ Show changes in school performance
■ Want to be left alone
■ Eat more or less than usual
■ Get into trouble at home or at school

Teenagers (13–18 years)
Older children may exhibit the most behavioral changes as a result of exposure to violence. Depending on their circumstances, teenagers may:
■ Talk about the event constantly or deny that it happened
■ Refuse to follow rules or talk back with greater frequency
■ Complain of being tired all the time
■ Engage in risky behaviors
■ Sleep more or less than usual
■ Demonstrate increase in aggressive behavior
■ Want to be left alone, not want to spend time with friends
■ Experience frequent nightmares
■ Use drugs or alcohol, run away from home, or get into trouble with the law

What can we do?
Understanding the prevalence and impact of polyvictimization can help families, advocates and practitioners identify the most seriously victimized children and protect them from additional harm. It will also help target intervention and prevention to the full range of trauma-causing events that children are at risk of or have experienced to provide needed services and supports.

Expand Assessment Beyond the ‘Presenting’ Problem
Agencies working with vulnerable children need to ensure that they are not responding only to the “presenting” issue (i.e., sexual abuse) because it is likely that they are also experiencing other types of victimization concurrently (i.e., bullying and physical assaults).
It is critical to recognize the need for more comprehensive assessment to identify them as potential victims of violence and to ensure that their treatment accounts for this possibility.

Emphasize Prevention and Early Intervention

We know that not all children who are exposed to violence require mental health intervention. However, because of their higher vulnerability for problems, children who’ve been exposed to multiple types of trauma, must be formally assessed and referred for intervention when needed. In fact, children and their families should be referred to preventive services, as they may also address individual, relationship and community factors that predict and prevent future exposure.

Provide Comprehensive Services

Treatment and related supports should address the underlying factors for victimization.Reducing stigma and reminders need be strategized and applied to the full range of exposures through developmentally appropriate programming and culturally responsive support services.

Develop Community-Based Partnerships

Services for children exposed to multiple types of victimization and violence must recognize that these kids not only suffer from trauma, but are often stuck in families or environments that may increase the likelihood of repeated victimization. It is therefore best to involve the family, school and work together with other community based providers[e.g. agencies, CBOs, schools, churches…] to assess the environmental conditions Develop strategies to address them, like teaching parenting skills, anger management, self and child advocacy, mental and behavioral health awareness, disseminate information, etc…. Not limited to school or clinical settings, but offer services close to home and in the community. Provide both ‘safe’ and ‘brave’ spaces for children and their families.

Protecting children from abuse and neglect alone is a much too narrow approach to address the ‘whole’ child, because no matter the environmental setting, all children are whole-right then and right there. We mustn’t forget that children are still developing,and their are greatly impacted and influenced by every environment, which includes schools, home, out on the playground. And, whatever happens in one will influence the other.

Break the Cycle
Working with families, the vulnerable and ‘at-risk’ or working with the most vulnerable children and youth, makes it a professional responsibility to help build the protective factors and enhance the capacity of parents, caregivers, teachers, and any adult who may be in a position to intervene and stop the progression toward polyvictimization. Increase awareness of disrupted families, without regard to structure, and be mindful of the communities in which incidents of violence are prevalent. It is under these environmental conditions that we may see early indicators and warning signs of present or future polyvictimization. Proactive is better than reactive!

For more information and resources, please contact the Safe Start Center, a National Resource Center for Children’s Exposure to Violence:

Questions: In the Midst of Life-Threatening Opioid Addictions

Some people are fortunate or ra

The city of New Haven, Connecticut, in an 83 page lawsuit,  is suing the makers of Oxycontin. Their claim is that they hold the blame for the epidemic that has swept the country and boasts responsibility for overdoses, deaths, child abuse and neglect and all other damages associated with opioid abuse. Children are rendered unsafe, unhealthy, adultified and eventually uprooted in its wake.

Without getting into the science of pharmacology, in everyday language, Oxycontin[oxycodone] is a semi-synthetic opioid pain killer. Often referred to as a narcotic, it is used to treat moderate to severe pain symptoms expected to last for an extended period of time. Related to Percocet, Vicodin, and Methadone, in the midst of the present opioid epidemic, declared a national health emergency, it is astonishing that Oxycodone is still being  prescribed by physicians across the country.

The pharmaceutical industry’s primary concern clearly must be about ‘business’, and of course, business is money. Despite the numbers of people dying and overdosing on these ‘legal’ drugs, they are still in production. So, what about the large multi-billion dollar companies, or one in particular, Purdue Pharma, LP, the drug’s manufacturer? This family-owned company makes but one widely prescribed drug-Oxycodone, and has amassed tens of billions of dollars since it hit the market. According to the CDC, over 90 people die every day from opioid use. While people die, companies like this do nothing to curtail or prevent the continuation of the drugs’ devastating impact on the lives of individuals, children and families.

Where is the FDA [Food and Drug Administration], charged with regulating, and approving medically prescribed and over-the-counter medications? Are they fulfilling their role in  determining which drugs are released to the public,  or are they too sitting back and pointing fingers and ‘blaming the victims’? The CDC[Centers for Disease Control and Prevention] collects the data, but is anyone listening?

All I seem to have are questions. Who’s minding the store? At one time, there was a food additive commonly called, Red Dye #2. It was linked to all types of health problems and contained some carcinogenic-cancer causing properties. Ultimately banned, removed from the market and since has ceased production. That was in the 1970’s, I believe.

It’s 2017 and medical science has advanced by leaps and bounds. We have more advanced brain and body monitoring technologies, and the science of addiction, and pain management treatments have also provided us with such detailed data. Yet we have teens, adults, and families being impacted to devastating proportions by a substance which didn’t originate on the black market, an underground delivery system, but from your family physician.

Different from illegal substances,  most people are prescribed opioids because of legitimate physiological pain associated with surgery or some type of injury. Some develop a high tolerance for the medication and experience an increased dependence upon opioids. And as perceived or real somatic need increases, so does frequency and prescribed dosage… until we get to this point. All types of maladaptive behaviors ensue, and though the cost is high, the desire or the need seems to overshadow the risks.
When prescriptions run out, there are ‘druggists’ who stand on street corners and sell opioids to addicts via a black market delivery system. The dangers are greater for overdose and death when they are bought illegally. Counterfeit versions, usually cheaper, are unregulated. Who knows what is being put into the pills sold on the street. But, the demand is there, and as goes supply and demand, someone will always be there to meet the demands.

In the early 1980’s, Quaaludes [Lemmon 714] [a barbituate, also called a ‘downer’] was sung about in the song, ‘SuperFreak’, by Rick James. Another example of a pharmaceutical drug rendered obsolete and banned by the FDA. Why can’t we hit the drug companies where it hurts and prevent them from hurting others. Ban it. Take it off the market, or impose stricter guidelines and regulations regarding its availability. Educate physicians on the potential and real dangers of these drugs. Before a diagnosis indicates treatment modalities in which opioids may prove more effective, doctors must exhaust all alternative treatments first.

In my opinion, the city of New Haven, Connecticut along with a string of other cities and states have the right idea. Progress and change begins somewhere, and if not at the federal level, then states and cities must advocate for its citizens. Bankrupt them or make them pay for deceptive marketing and contributing to the destruction of the lives of families in middle America and from the East to West Coasts. Although there is no magic wand to wave and fix this mess, New Haven is also endeavoring to be a part of the solution. Someone has to step up and proactively prevent more tragedies, before they happen.This is truly a heartbreaking and controversial topic, but what would you do?

How to Put Cultural Competence into Practice

Starting in the late 1980s, the mental health profession responded to the issue of disparity, as does education and other professions and service providers today, , with a new approach to care called cultural competence. Initially defined as a set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals to enable people to work effectively in cross-cultural situations.

Intended to do the following, cultural competence should:

  • Improve access to care
  • Build trust and
  • Promote engagement and retention in care.

Defined in general terms, cultural competence is:

” …the delivery of services, responsive to the cultural concerns of racial and ethnic minority groups, including their language, history, traditions, beliefs and values.”( U.S. Department of Health and Human Services, 2001)

Mainly, cultural competence refers to guiding principles developed to meet the needs of diverse communities, including ethnic and racial minorities. While, in theort, the need and purpose for cultural competence or proficiency is valid and is critical for equitable The Surgeon General says that evidence-based practices are intended for every consumer regardless of his or her culture. Practices need to be adjusted, however, to make them accessible and effective for cultural groups that differ in language or behavior and traditions. There is no ‘one size fits all’ approach, which means that we must ‘tweak’ our evidence-based practices according to the target audience and the mutually-identified goals. This is where cultural competence comes in.

To deliver culturally competent and evidence-based services, we tailor our interventions to the unique communities we serve-either the practice itself or the context in which the practice is delivered. Since the goal of all programs is to be culturally competent, here are a few strategic steps to take which illustrate that responsiveness.

  • Understand the racial, ethnic, and cultural demographics of the populations served
  • Become more familiar with one or two of the groups you most commonly encounter
  • Create a cultural competence advisory committee consisting of consumers, family and community-based organizations
  • Translate your forms and brochures
  • Offer to match a practitioner with a consumer/family of similar background
  • Use bilingual staff when needed
  • Ask your consumers/families about their cultural background and identities
  • Incorporate cultural awareness into assessments, interventions
  • Tap into natural networks of support, such as extended family and community groups that represent the family’s culture
  • Reach out to religious and spiritual organizations to encourage referrals and sources of support
  • Train staff in culturally responsiveness in communication skills
  • Understand that some behaviors that one culture deems psychopathology, maladaptive or disrespectful are perfectly acceptable in another culture

The word competence implies a set of criteria to evaluate a program, but in this context, it means to tailor care, practices, strategies to different cultures, and places THAT responsibility on the system itself, not the consumer. Therefore every provider or program/school/agency administrator bears the responsibility to make programs accessible, appropriate, appealing and effective for diverse communities served.

Many do it naturally, and deliver culturally competent, evidence based and individually tailored services. Within these environments, there is certain to be what we tend to label, ‘quality’ care, education and services accessed and provided to consumers-children, teens, adults and families. In these cross-systems-strengthened communities, the entire population will tend to be healthier, academic achievement and school performance will likely be less problematic, family and community engagement will likewise rest at higher levels.  Services delivered in the absence of intentionally responsive evidence based practices, procedures, strategies and interventions do not support families, children or their respective community. Why?

When services are delivered within the framework of evidence-based practices which reflect cultural responsiveness and competence, the consumers served by that provider will increase empowerment and enhance life quality. Since cultural competent service delivery is a growing concept, there is no definitive formula or standard set of practices to follow. However, with self-awareness preceding cultural awareness and organizational mission and vision of success accompanying evidence-based practices, respect and appreciation for diversity should optimize service delivery. Ultimately, professionals will    equip all consumers with tools, skills and provide the appropriate supports that will lead to stronger, healthier, and more empowered collective.

Last thought: How will you know which practices apply to different ethnic, racial or cultural groups? The answer is that we won’t know if we don’t try, and we keep trying, tweaking, modifying strategies and adapting interventions- until successful goal attainment.