BUMC program for child witnesses of violence gets grant from AG's office
by Marion Sawey
A Boston University pediatric team's unique program for young children exposed to violence has won the backing of the state Attorney General's Office, which has given the group a grant to share its expertise throughout Massachusetts.
The Child Witness to Violence Program (CWVP) at Boston Medical Center's division of development and behavioral pediatrics targets children eight years and younger who have been bystanders to, as opposed to victims of, violence. The project is staffed by a multicultural, multilingual team of social workers, psychologists, early childhood specialists, and a consulting child psychiatrist.
A federal grant awarded to Attorney General Scott Harshbarger through the Violence Against Women Act will enable the CWVP to expand its counseling, advocacy, and outreach program statewide. Although CWVP treats young children who have witnessed any kind of violence, the state project will focus on domestic violence.
"We are very pleased to have gotten this grant, which we see as a recognition of the program," says CWVP Director Betsy McAlister Groves, who is also an assistant clinical professor of pediatrics at Boston University School of Medicine. "For a pediatrics department to have such a close working relationship with the criminal justice system in this state is a very important factor in crime prevention. After all, one way of helping kids avoid criminal behavior in later life is to address the issues of violence early on in their lives."
She says that the trauma or distress that afflicts children who have seen violent acts is a neglected problem. "While there has been growing recognition of the needs of battered women, for example, the needs of young kids, who are often quite unable to articulate their feelings, have been a little slower to surface."
Symptoms commonly experienced by children in the face of overwhelming trauma, including witnessing violence, are sleep disturbances, greater anxiety about the safety of their loved ones, chronic fear, and behavioral changes such as increased aggression and hyperactivity or increased passivity and withdrawal, says Groves. "We have learned that children, even very young children, carry extremely specific memories of the traumatic incident, at least in the short term. They have, unfortunately, a remarkable capacity to remember the event that horrified them, and so they react with distress to anything that reminds them of it. This really does have an impact on how children learn and on how they form peer relationships."
The CWVP's approach to treating the children is family-focused, she continues, pointing out that often the best way to help children is to help their parents. This may include referrals for court assistance or safe shelter. It also includes giving parents information about symptoms of exposure to violence and tips on how to help their children. "But we also hope to give the children enough space to talk about what has happened to them, allowing them to relive the incident if necessary. That can be an important step in mastering their fear and anxiety, and we help them do this with techniques of play therapy, drawing and art, and dramatic play."
The CWVP in the past 12 months has cared for 162 families, including 242 children, some of them referred by the Boston Police Department, with which the project has had close links since its inception in 1992.
"Our partnership with the police has been a unique aspect of the project," says Groves. "We realized early on that the police were potentially our very strong allies, and in fact, case-finders, because they are the first to respond to violence and they see kids in trouble whom we would never see here at the hospital.
"The wonderful relationship we have forged with them is, I think, an example of how disciplines which on the face of it seem to have nothing in common -- pediatrics and police work -- can collaborate effectively in pursuit of a common goal."
Under the partnership, the CWVP runs a training seminar entitled Children and Violence, which brings small groups of police officers to the hospital for eight weekly sessions in order to teach them the principles of child development, how to interview children, and the impact of trauma on children. "We also bring in the community providers such as representatives from the Department of Social Services and the courts so that the police learn that there are a lot of resources out there for children," Groves explains. "We think it helps improve their direct skills of working with children and in identifying their needs."
Groves is also proud of the fact that the team was called out to Oklahoma in the wake of the 1995 bombing of the Murrah Federal Building to work with preschool teachers there. "I will never forget that experience, working with so many people so terribly traumatized," she says. Another notable achievement has been the group's involvement with the producers of public television's Mr. Rogers' Neighborhood, acting in a consulting capacity in the development of a series of videos for teachers about children who witness violence.
On wider policy issues of violence, she notes that CWVP has lobbied the Massachusetts Office of Victim Assistance to include children who witness violence in the category of crime victims, making them eligible for a wide array of services and compensation. The group has also testified in state hearings for changes in custody laws relating to men who batter and in how courts respond to child witnesses of violence and has provided written testimony on gun-control issues.
"When you take on the issue of prevention, you have to look at the whole spectrum of exposure to violence, including gun control and media violence. It is a very complex, multilevel problem," she maintains. "It is important, therefore, that although we are primarily a clinical service, we also translate what we are learning into the kind of data and information that policy-makers need to take on these larger issues. I think it is very important to have that information available."
One of the most important things she has learned since setting up the project with Dr. Barry Zuckerman, BUSM pediatrics chief, is that collaboration is essential in the face of a problem that is so pervasive in society. "The courts can't deal with violence alone," she says. "Nor can the police, the politicians, or the service professionals. We really have got to work together."