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There is growing concern about the increasing number of children in the USA who are exposed to community violence and the need to remove some of them from their families. This study examines risk factors for out-of-home placement among a large pool of children and adolescents who were referred for general clinical assessment following exposure to violence and/or psychological trauma in their communities or homes. Children with greater familial and environmental support and children exposed to incidents involving a non-parental personal threat were associated with a significantly lower risk of out-of-home placement. A greater likelihood of being placed out of home was associated with older age (adolescents), history of mental health service use, involvement with law enforcement agencies, higher clinical ratings of depression or impaired thought processes, lower clinical functioning and greater exposure to traumatic events. Evidence of maltreatment and a threat to life was associated with 13.6 times greater likelihood of being placed out of the home. This study raises an important issue in respect to the children's past use of mental health service and current symptoms. It is not just the risk of violence but also evidence of psychiatric problem that trigger out-of-home placement. Further studies are needed to assess the quality and effectiveness of mental health services provided to children exposed to violence. © 2007 The Author(s). Journal compilation © 2007 National Children's Bureau. [ABSTRACT FROM AUTHOR]

This study explores the clinical epidemiology of children's exposure to violence as addressed by a program in which mental health clinicians work with law-enforcement agents in 10 U.S. cities. Data were collected on all participants contacted by the Child Development Community Policing Program (N = 7,313 individuals involved in 2,466 community incidents). Multivariate regression was used to examine sociodemographic and clinical correlates of the role of participants (victim, offender, or witness), location, and type of incident. The majority of incidents occurred in participants' homes. Adolescents were at a higher risk than children of being: (a) victimized, (b) involved in incidents outside their home, (c) experiencing a threat to their lives, and (d) suffering physical injuries. Males were more likely to be offenders than females, and to be subjected to physical injuries or involved in incidents that imposed a threat to their life. Females were significantly more likely to be victimized. [ABSTRACT FROM AUTHOR]

A police-advocate home-visit intervention project was conducted with 204 women who were victims of domestic violence requiring police intervention. These women, who resided with their children at the time of the incident, received law enforcement-advocacy services through a home-visit project conducted by neighborhood patrol officers and battered women's advocates.Acomparison group of battered women, receiving the intervention, and a matched group of battered women, receiving standard police intervention, revealed a significant reduction in calls for police service for the intervention group, for a 12-month period following the intervention. Additional investigation is required to fully understand the reason for this difference and the potential utility of this type of domestic violence intervention. [ABSTRACT FROM AUTHOR]

This presentation will describe psychoanalytically informed efforts to deepen and apply our understanding of the phenomena of trauma to the development of successful intervention strategies and treatment approaches that can decrease the immediate suffering and long-term burdens of children who have been victims or witnesses of violence and other catastrophic events.

Objective: We examine factors associated with changes in posttraumatic stress symptoms for children following completion of an early and brief, trauma-focused mental health treatment that engages children together with their caregivers, with the child as the identified patient., Method: The Child and Family Traumatic Stress Intervention (CFTSI), a brief (5-8 session) trauma-focused mental health treatment designed to reduce trauma symptoms in the aftermath of traumatic experiences in children aged 7 years and older. CFTSI has been widely disseminated in Child Advocacy Centers (CAC) and community treatment clinics nationally. We report on results of a naturalistic treatment study of CFTSI implementation without a comparison group that includes 1190 child caregiver dyads from 13 community-based clinical settings., Results: Mixed modeling revealed a significant reduction in child reported posttraumatic stress scores from pre to post-CFTSI. Scores on the Child Posttraumatic Checklist (CPSS) declined an average of 8.74 points from pre to post-CFTSI (p < .0001). There were no statistically significant differences in CPSS score changes based on age, gender, ethnicity, race, number of prior trauma types the child had experienced, caregiver posttraumatic stress symptoms, child relationship to the perpetrator, nature of event or length of time to begin treatment., Conclusion: This study provides further evidence that CFTSI can reduce child posttraumatic stress symptoms when implemented by community-based providers., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Following traumatization, caregiver support is a crucial factor contributing to children's successful management of posttraumatic reactions and their recovery. Caregivers who have been traumatically impacted themselves, however, may be compromised in this posttraumatic caregiving role. Although there are a number of evidence-based child trauma treatments that are effective in reducing children's trauma symptoms, the impact of child treatment on participating caregiver's posttraumatic symptoms (PTS) has received less attention., Objective: Explore PTS reduction caregivers experience through participation in their child's evidence-based trauma-focused mental health treatment., Participants and Setting: 640 Child-Caregiver dyads referred for the Child and Family Traumatic Stress Intervention (CFTSI) following formal disclosure of abuse in a Child Advocacy Center (CAC)., Methods: Data were collected from 10 community treatment sites trained in CFTSI. A multi-site meta-analytic approach was used to evaluate pooled and site-specific therapeutic effect sizes for caregivers and children., Results: CFTSI was associated with significant changes (Hedge's g = 1.17, Child-rated; g = 0.66, caregiver-rated) in children's PTS and with clinically meaningful improvements in PTS for 62% of participating caregivers who had started CFTSI with clinical levels of PTS as measured by the Post Traumatic Checklist-Civilian Version (PCL-C). The overall mean PCL-C change (9.31, SD = 12.9) in paired, pre-post PCL-C scores is close to a clinically meaningful change of 10 or higher. There was a robust moderate pooled effect size (g = 0.70, N = 640, p < 0.0001)., Conclusion: The value of a reduction in caregiver PTS as a secondary outcome of children's trauma-focused treatment is discussed., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

This study examined factors related to children's acute symptoms following a potentially traumatic event (PTE) to more clearly identify domains that should be included in screenings of youth exposed to a PTE. In particular, the authors examined whether trauma category (i.e., sexual abuse/disclosure of abuse, intentionally perpetrated traumas other than sexual abuse, and unintentional traumas) was related to symptoms after controlling for other relevant factors. Participants were 112 youth presenting for clinical evaluation within a month of a PTE and their nonoffending caregivers. Using data from baseline assessments collected as part of a randomized controlled trial of a secondary prevention program, the following factors were tested in 3 hierarchical regression models: index PTE category, history of traumatic exposure, preindex event functioning, and parenting behaviors. Prior trauma exposure, preindex event functioning, and hostile parenting were uniquely related to children's symptoms in the acute posttraumatic period after controlling for time since the event and child age, but trauma category was not. Implications for identifying and referring children at high risk for poor outcomes in the early aftermath of a PTE are discussed. An exclusive focus on the event is insufficient and more comprehensive understanding of the child and family is required., (Copyright © 2013 International Society for Traumatic Stress Studies.)

The Domestic Violence Home Visit Intervention (DVHVI) provides advocate/police officer team home visits following a domestic dispute. Women (52 DVHVI and 55 controls) were interviewed at 1, 6, and 12 months following a police reported domestic incident to assess repeat violence, service utilization, and symptoms. Women who received the DVHVI were more satisfied with the police and likely to call them to report a nonphysical domestic dispute in the 12 months following the initial incident than women in the comparison group. DVHVI participants were significantly more likely to use court-based services and seek mental health treatment for their children.

The domestic violence home-visit intervention (DVHVI) provides home visits by police-advocate teams within 72-hours of domestic incident to provide safety, psychoeducation, mental health, legal, or additional police assistance. Clinical and police record data were collected for 512 cases, and repeat calls to the police were tracked for 12 months. Analyses revealed that women who engaged with the DVHVI were more likely to contact the police for subsequent events than those who received no or minimal DVHVI contact. Hispanic women served by Spanish-speaking advocate-officer teams were the most likely to utilize services and call the police for subsequent incidents.

This study examines factors related to engagement in the services offered by police officer-advocate teams on the basis of police and clinical records for 301 female victims referred to the Domestic Violence Home Visit Intervention (DVHVI) program. The authors find that the severity of intimate partner violence charges and ethnicity of the victim, advocate, and police officer are all significantly related to engagement in the DVHVI, with Hispanic women served by Hispanic advocate-officer teams more engaged in services than African American or Caucasian women. The data suggest that this intervention model may be particularly beneficial for Hispanic victims of intimate partner violence when implemented by a Spanish-speaking officer-advocate team.

Each year, exposure to violent trauma takes its toll on the development of millions of children. When their trauma goes unaddressed, children are at greater risk for school failure; anxiety and depression and other post-traumatic disorders; alcohol and drug abuse, and, later in life, engaging in violence similar to that to which they were originally exposed. In spite of the serious psychiatric/developmental sequelae of violence exposure, the majority of severely and chronically traumatized children and youth are not found in mental health clinics. Instead, they typically are seen as the 'trouble-children' in schools or emerge in the child protective, law enforcement, substance abuse treatment, and criminal justice systems, where the root of their problems in exposure to violence and abuse is typically not identified or addressed. Usually, providers in all of these diverse service systems have not been sufficiently trained to know and identify the traumatic origins of the children's presenting difficulties and are not sufficiently equipped to assist with their remediation. This multiplicity of traumatic manifestations outside the mental health setting leads to the inescapable conclusion that we are dealing with a supra-clinical problem that can only be resolved by going beyond the child's individual clinical needs to enlist a range of coordinated services for the child and the family. This paper will focus on domestic violence as a paradigmatic source of violent traumatization and will (a) describe the impact and consequences of exposure to violence on children's immediate and long-term development; (b) examine the opportunities for, as well as the barriers to, bridging the clinical phenomena of children's violent trauma and the existing systems of care that might best meet their needs; and (c) critique current national policies that militate against a more rational and coherent approach to addressing these needs.

The emergency department child and adolescent psychiatrist is in the unique position of informing and helping emergency department providers address the traumatic impact of the cause of a child's emergency presentation and the potential iatrogenic exacerbation of the acute traumatic response. The child and adolescent psychiatrist must become a clinical traumatologist who provides the necessary consultation and education that lead to practice change in emergency department awareness and procedures and performs the optimal evaluation and interventions for children who present in psychiatric crisis.

Children attempt to negotiate a balance between aggressive urges and moral imperatives in order to protect both themselves and those they love. They must also balance pleasure associated with the reality and fantasy of vanquishing competitors and the dangers of anticipated retaliation. Psychoanalytic work with anti-social and violent young patients affords a special opportunity to explore how the failures in these negotiations can lead to seriously limited and distorted views of self and others. The treatments of Rick, age 8, and Dean, age 16, demonstrate the ways in which dangerous and frightening aspects of enduring psychic reality dictate configurations of both aggressive fantasy and action. Clinical inquiry revealed how each boy's longings, defenses and conflicts found expression in the attacking, destroying, and confrontations of daily life.

This article describes the development, evolution and current status of the New Haven Child Development-Community Policing (CDCP) Program, a partnership between child mental health professionals at the Yale Child Study Center and the New Haven Department of Police Service. The central mission of the program is to intervene early in an attempt to ameliorate the effects of children's exposure to violence. Recent programmatic expansion of the CDCP program into areas of juvenile offenders, specialized protocols for children affected by domestic violence, and school based groups are also explained. There are five core elements of the CDCP program: (1) Seminars in applied child development for police officers; (2) Fellowships for advanced police officers; (3) Fellowships for clinicians who are trained both in seminars and experientially in police practice and procedure; (4) A weekly program conference; and (5) A clinical consultation service in which clinicians are available 24 hours per day, 7 days a week are explicated.

Coordinating responses through the Child Development-Community Policing Program has led to multiple changes in the delivery of clinical and police services. Mental health clinicians and police officers have developed a common language for assessing and responding to the needs of children and families who have been exposed to or involved in violence. Learning from each other, these unlikely partners have established close working relationships that improve and expand the range of interventions they are able to provide while preserving the areas of expertise and responsibilities of each professional group. The immediate access to witnesses, victims, and perpetrators of violent crimes through the consultation service provides a unique opportunity to expand the understanding of clinical phenomena from the acute traumatic moment to longer-term adaptation, symptom formation, and recovery. In turn, the initiative introduces the systematic study of basic psychological and neurobiologic functions involved in traumatization as well as the investigation of psychotherapeutic and pharmacologic therapies. Similarly, program involvement with juvenile offenders has led to a coordinated response from the police, mental health, and juvenile justice systems. This project provides an opportunity to develop detailed psychological profiles and typologies of children engaged in different levels of antisocial behavior as well as to determine the characteristics that might predict with whom community-based interventions might be most successful. A recent survey of New Haven public school students has yielded promising evidence that community policing and the program are having a positive impact on the quality of life. In a survey of sixth-, eighth-, and tenth-grade students there were substantial improvements in students' sense of safety and experience of violence between 1992 and 1996. When asked if they felt safe in their neighborhood, there was an increase in the percentage of positive responses from 57% to 62% for sixth-grade students, 48% to 66% for eighth-grade students, and 53% to 73% for tenth-grade students, and when asked if they had seen someone shot or stabbed there was a decrease in positive responses from 43% to 28% for sixth-grade students, 46% to 31% for eighth-grade students, and 34% to 28% for tenth-grade students. Today, we are all too familiar with the developmental trajectory that leads children into violent crime. Newspaper articles and clinical case reports have taken on a dreary repetitiveness. These young criminals are often poor, minority, inner-city children who are known to many agencies to be at risk because of family disorganization, neglect, and abuse. They are failing in school or are already on the streets. One day they are victims and the very next they are assailants. We are all familiar with the inadequacies in the social response to these children, from their preschool years through the point at which they become assailants themselves. What is shocking is that the age at which children make the transition from being abused to being abusive seems to be getting earlier, and the number appears to be increasing. On the positive side, there is an increased awareness of the need and the ability of the various sectors of society to respond in concert. The institutions that function in the inner city--schools, police, mental health and child welfare agencies, churches--are all concerned about the same children and families. By working together, with a shared orientation to the best interests of the children, they can intervene earlier and more effectively: first, to disrupt the trajectory leading to violence; and, second, to help those children who are already caught in the web of exposure to violent crime and inner-city trauma. The experience with community-based policing and mental health in New Haven, now being replicated throughout the United States, can thus stand as a model of an active social response to an overwhel

Anna Freud's legacy to child psychoanalysis was her understanding and description of the complexities of development and her ability to apply her findings to the care of children both within and outside of the consulting room. In addition to her approach to consultation with nonanalytic professionals concerned with children's development and well-being, she established a model for generations of child analysts and other analytically oriented clinicians. Both of Ms. Freud's concepts of development and collaboration with other professionals have served as a basis for the implementation of the Child Development-Community Policing Program in New Haven, Connecticut. This collaboration between mental health and police professionals will be described in this paper, with particular emphasis on the application of Ms. Freud's work to attempts to intervene on the behalf of children and families exposed to urban violence.

Child psychoanalysts have long viewed play as a reflection of children's inner lives and have used the themes children represent in play for diagnostic and therapeutic work. Given the central role children's play has for clinical work, few studies have addressed play empirically. This paper presents a technique for studying the thematic content of children's play as it emerges during a play session with a child analyst. We report the steps involved in developing this investigative technique and describe the interobserver agreement among four rates using the technique with videotaped play sessions. Implications for future research using such an approach are discussed.

To advance the field of dynamic child psychotherapy research, a shift in emphasis from questions examining treatment outcome only, to those that address treatment process, is required. Child psychoanalytic psychotherapy provides a unique set of factors for assessing what occurs between analyst and child in the consulting room and for exploring the link between the inner life of the child and symptomatic behavior. Continued development of rigorous methods for collecting and evaluating clinical data is needed. Past and current efforts in this area are presented in the description of child psychoanalytic research projects.