AW-308472784
National Plan to End Interpersonal Violence Across the Lifespan

 WHY DOES VIOLENCE HAPPEN?

We used to think that child abuse, teen sexual assault, intimate partner violence, and elder abuse (as examples), were unique types of interpersonal violence. We searched for answers for why each of these types of violence happened and what we could do to stop them from happening. What we have learned through more than thirty years of research is that all these forms of violence have common underpinnings including having adverse childhood experiences growing up such as child abuse, sexual abuse, emotional abuse, neglect, witnessing violence, having a parent incarcerated, having a family member addicted to alcohol or substances, having a parent with a serious mental illness and other things that make it more difficult for children to develop secure positive attachments to adults and have adults in their lives who will positively guide them in learning how to understand and control their thoughts, emotions and behavior. 

About thirty percent of us are fortunate and grew up without experiencing adverse events in our childhood. However, about 2/3 of us have experienced one or more of these adverse events. Looking into this more closely, 25% of us have at least one exposure to adversity, and 11% had at least six; all while trying to learn to walk, learn to read, and learn how to relate to other people. 

Adolescents indicate they have been exposed to many different forms of interpersonal violence over the course of the past year such as sibling assault, child abuse, bullying, sexual harassment, street violence and other forms of violence (Finkelhor et al., 2015).  In looking at gun violence, 17% of youth have heard gunshots or saw someone shot in the past year and 59% said they had these experiences during their lifetimes.  How much violence overall have adolescents experienced? Surveys indicate that 48.4% of them reported having more than one exposure to violence over the course of one year and 15.1% reported experiencing six or more exposures (Finkelhor, Turner, Shattuck, & Hamby, 2013). 

Children exposed to violence have more problems in school, increased emotional and behavioral problems and more problems developing social relationships, and are more likely to become involved in early sexual behavior and alcohol and substance use (Borofsky et. al. 2013; Lovallo et al. 2019). Children and teens with repeated exposure to violence are more likely to have parents who have abused substances (Dube et al. 2003) and are more likely to spend time with peers who abuse substances (Connolly & Kavish, 2019). Those with the highest rates of adverse experiences were the most likely to have problematic or addictive use of alcohol and drugs as adults (Bellis et al. 2019; Hughes et al. 2017; Wiehn et al., 2018). Use of substances decreases everyone’s judgement and thus will be just one more risk that they will be victimized yet again as they may not recognize the warning signs of violence and may not know what to do when they do recognize they are in danger. Exposure to violence can also lead to children and adolescents victimizing others (Connolly and Kavish 2019). This can include assaults on siblings, bullying, sexual assault, delinquent and violent criminal behavior (Brumley et al. 2017). 

Thus, one answer to “why did this violent event happen,” is that those who commit violent acts were exposed to violence during their childhood and/or adolescence. Please review the charts below to see the rates of adverse events in three cities in Pennsylvania.


Adverse Childhood Experiences (Expanding the Concept of Adversity). Downloaded September 24, 2021 from: https://txicfw.socialwork.utexas.edu/wp-content/uploads/2017/02/Philly-ACES-revised_2015-1.pdf


How do Adverse Events Start in Childhood?

People are not born to be violent. However, engaging in an act of aggression is not unusual or rare. National surveys find that 32% of us indicated doing at least one aggressive thing and 30% of us say we engaged in two or more acts of aggression before we reached age 18 (Klevens et al., 2012). Most of us don’t engage in serious acts of aggression. However, the more adverse experiences someone has in their childhood, the more likely they may either be victimized by violence again, be the victimizer of others or both (Hamby & Grych, 2013). 

Adults in the family are responsible for ensuring a safe environment for everyone to develop adaptive skills. However, adults are often the cause of violence erupting in the family. One adult in the family might be the only one to use violent tactics; for example, an adult who uses violence and coercive control in their relationship with an adult partner. However, both adults in the relationship may use violent tactics against each other. Across the lifespan approximately 35.6% of women and 28.5% of men will report experiencing a violent assault from an intimate partner (Black et al., 2011).

Adults using violent tactics against each other may also use violence in child rearing, and children in the family may learn to use violent tactics against each other. Thus, while it is possible that violence is a one-time event in the family, it is more likely that several forms of violence occur in the family, possibly across all generations including children, parents, and grandparents. There may be one or more members of the family that want the violence to stop but they don't take action because they don’t realize violence has no place in family life, because they do not know how to intervene to end violence, or they are prevented from doing so by a more powerful, violent family member (Hamby & Grych, 2013, Miller-Graff et al., 2018). 

An adult trying to leave an abusive partner or trying to prevent an abusive partner from harming someone else are in danger of injury or death (Reckdenwald & Parker, 2010). Legal statutes label partner abuse as battery despite some being more dangerous and showing more lethality than others. Overall, men use more dangerous tactics than women when violence erupts. Women are more likely to indicate they are afraid of their partners than men. When someone dies, 1 in 3 women are killed by their male partners while 1 in 20 men are killed by their female partners (Reckdenwald & Parker, 2010). Adults who abuse their partners are not all alike, the frequencies of their assaults, the types of assaults, and the intensity of the assaults can vary. The most dangerous have been labeled by Frieze (2005) as engaging in intimate terrorism.

What makes the dynamics of family violence, more complex than that of stranger initiated violence, is that the victim might love the perpetrator and thus want the violence to end but not want to be separated from the perpetrator: for example, the person who engages you in sex against your will may also be the person who taught you how to swim and takes care of you when you are sick. As another example, victims might be terrified of those who hurt them yet need them to provide housing and food. There is short and long-term harm to children whether they are the ones being physically hit or emotionally abused or are witnessing this happening to someone else in the family (Felitti & Anda, 2010). 

It is not always an adult in the family who starts the violence. Sometimes it erupts from a child or adolescent, such as in a sibling assault, with a ten-year old attacking his eight-year- old brother. It is the parents’ or adult caregivers’ responses to this assault that sets the stage for whether this violence reoccurs or is replaced by adult support for the ten-year-old learning to control strong negative emotions and urges as well as for learning problem solving strategies that don’t involve aggression or violence.

The answer to the question, “how do adverse experiences start in families," is simple in the sense that it is most likely to start with a family member, not a stranger. However, it is complex in the sense that it can start with any family member and involve many different types of violence. Different types of violence often happen together. For example, a parent calling a child a loser (emotional abuse) while hitting them with a belt (physical abuse). There may only be one act of violence in a family. However, it is most likely that there are many times when the violence has erupted. Whoever commits an act of violence within the family, it is always the adults who are responsible for taking the necessary steps to ensure a safe environment. 

Please review the charts below to see the rates of different forms of adverse events in three different cities in Pennsylvania.


Child Protective Services Annual Report (2019). Retrieved September 24, 2021 from: https://www.dhs.pa.gov/docs/Publications/Documents/2019%20child%20prev.pdf


Why are Different Forms of Violence Related to Each Other?

There are common risk factors for all forms of interpersonal violence including childhood exposure to adversities such as physical abuse, sexual abuse, neglect, emotional abuse, witnessing intimate partner violence, having a parent with a substance abuse problem and/or mental health problem, a parent in prison or involved in criminal activity, and parental divorce, exposure to racism and discrimination as examples. An accumulation of any of these types of adverse events can lead to toxic stress resulting in children and youth having delays in cognitive, emotional, social and behavioral development. 

These delays can result in children and youth being more vulnerable to involvement in risk taking behavior such as alcohol and drug use, early engagement in sexual behavior and a lack of attention to academic skills and involvement in prosocial behavior. These children and youth are more likely to engage in social relationships within a deviant peer group as they withdraw from or are rejected by more prosocial peers. All of this makes it more likely that they will have further exposure to violence. In these violent episodes, they may either be the victims, the perpetrators, or across different types of violence sometimes be the victim and sometimes the perpetrator of violence (Brown et al., 2009; Felitti & Anda, 2010; Felitti et al. 1998; National Scientific Council on the Developing Child, 2014).  It is the frequency of exposure, not the type of violence experienced that predicts future victimization or engaging in perpetration against others. Engaging in one type of perpetration leads to increased odds (1.5 to 4 times) of engaging in another form of perpetration (Klevens et al., 2012).

Thus, many types of violence can occur within the same people including as examples: the adult who physically assaults friends in a bar when drunk and abuses intimate partners when at home; a twelve-year-old who is physically abused by a parent, may assault younger siblings when “babysitting” and be a bully at school. A ten-year-old who was sexually abused by a parent may be submissive towards a bully at school, may as a teen be submissive towards dating violence and not be effective at stopping a partner from abusing their children when an adult.

Living with violent adults in the family or within a community where there is a great deal of violence provides role-models for violent behavior and the development of internalized norms that violence is acceptable within close relationships or to achieve status, or to solve problems. There are also cascading negative impacts to repeated exposure to violence. This type of toxic stress can literally change the architecture of the brain making it more difficult for children and adolescents to make adaptive decisions later on in life (Appleton et al. 2019; Bellis et al. 2018; Oh et al. 2018; Larkin et al. 2014; Manyema et al. 2018). We all have areas of our brains that are designed to help us take actions such as fleeing or fighting for the sake of our immediate survival. We also have areas of our brains that help us with impulse control, stopping and thinking, and review of the consequences of our actions for the sake of achieving long-term vs short-term goals. 

The areas of the brain concerned with our immediate survival develop first. However, as we move through childhood and adolescence these areas come more and more under the influence of the areas of the brain that support our long-term well-being. However, toxic stress or chronic trauma from violence during childhood and adolescence can overload our “survival” system and impact our ability to regulate our thoughts, emotions, and behavior for the long term. With enough overstimulation, dysregulation of our stress system can occur. This leads to responses in the moment rather than responses that lead to longer term survival and well-being.

The overuse of our survival system, and/or dysregulation of our stress system can have a broad impact on our development, making it harder for us to learn from experience and more likely to experience emotional, social and cognitive delays in comparison to our peers (De Bellis, Woolley, & Hooper 2013; Gunnar & Quevedo, 2007; Lupien, McEwen, Gunnar, & Heim, 2009). Thus, toxic stress resulting in developmental delays may help explain why children and youth who have been repeatedly exposed to violence may literally have more difficulties learning from their experiences and thus continue to make the same bad decisions despite not likely the consequences they are getting.

How might toxic stress directly impact the behavior of children and adolescents? It can lead children to be either under (hypo) or over (hyper) responsive to signs of potential threat in the environment. Children who are hypo-aroused may not take steps to protect themselves in potentially dangerous situations. For example, Kevin, who has been beaten up on the playground after asking a bully if he can join a baseball game, might do the same thing the next day and get beaten up again. 

How might Kevin behave if he was hyperresponsive to signs of threat?  Children who are hyper-aroused may find neutral situations to be threatening and respond with flight or aggression. Thus, if a classmate stepped backward in line and accidentally stepped on Kevin’s foot, he might assume it was intentional and immediately punch this classmate. Children who are hyper-aroused may also spend so much time scanning the environment for signs of danger that their brains are less attuned to new aspects of the world they should be learning about. Thus, a hyper-aroused Kevin might be failing or underperforming in school because he doesn’t have the freedom to let his mind pay full attention to what a teacher is saying during class lessons. In efforts to remain safe, hyper-aroused Kevin might engage in verbally or physically aggressive behavior in class that leads him to spend time sitting outside the classroom or in the principal’s office; this again can lead to decreased academic achievement as he is being separated from classroom experiences where he could learn important skills (National Scientific Council on the Developing Child, 2014). 

People may show numbing of their emotions after repeated exposure to violence. Numbing of fear responses was found to occur as a result of exposure to violence in a variety of settings whether they were the direct victim of the violence or witnessing it.  Numbing of fear responses, can prevent children and youth from being able to weigh the risks of personal harm if they engage in high-risk behaviors (Horan, Allwood & Bell; 2011).  Numbing of sadness has also been found to occur. In this type of numbing, children and youth may not feel sad when someone they care about is very ill or dies. This type of numbing has been found related to engaging in aggressive and delinquent behavior (Allwood et al., 2011).

The answer to why different forms of violence may be interconnected is that the same risk factors exist across most forms of violence and the same factors that support us learning not to be violent are also the same across most forms of violence.


Children Show Complex Responses to Adverse Events

Children respond in diverse ways to being exposed to violence. How might a particular child respond to adverse circumstances? It will be a complex blend of innate tendencies for responding to stress, the positive influences in their lives, past negative influences and so forth (National Child Traumatic Stress Network, 2012). Responses to adversity, violence, and trauma are complex. Children have been found to respond by blaming themselves, blaming others, or showing the world only their best behavior.

Children who blame themselves

Children can turn inwards and blame themselves for the bad things that happen and may feel anxious, depressed and/or withdraw from others. This may reduce the likelihood of them noticing any positive and supportive responses from others. If others actively reach out to these children, this can help them recover their emotional balance after exposure to adversity. Without enough help, these children can develop mental health problems such as anxiety and depression and experience prenatal and postpartum depression, as well as engage in self-harm or suicidal behavior (Mersky and Janczewski 2018; Slavich et al., 2019; Wiehn et al. 2018).

Children who blame others

Children can look outside themselves and look at others as causing their problems. These children may feel angry, frustrated, and wish to punish others. These children might go to school and throw a chair when frustrated, feel they must control what happens in the classroom to be safe, and/or engage in other behaviors that can make adults and children withdraw from contact with them. This acting up behavior can make it less likely that other children or adults will respond positively to these children, despite this being what they need. Instead of helping these children develop positive attachments, they may reject or punish these children. These reactions, while understandable, further reinforce the lessons they learned from adversity- that they are alone in dealing with it. These children may develop externalizing behavior, delinquent, and criminal behavior (van Duin et al. 2019).

Children who show the world their best behavior

There are some children who seem resilient in the face of adversity in their lives. They may work hard at home and in school- being adult pleasers who do whatever they can to earn praise (National Child Traumatic Stress Network, 2012).  While these children and youth may earn good grades in school and achieve jobs that other people envy, the adversity in their past has left its marks and no one knows they need help to end episodic nightmares, fears of being alone, lack of trust in intimate relationships and other possible negative consequences of their past. 

Commonalities Across Types of Reactions

While children show complex responses to their past experiences with adversity, there may be some common responses. For example, they may have more difficulty responding adaptively to their emotions, controlling how emotional they get, and learning from experiences that occur within highly emotional contexts. They are more likely to have disordered use of substances or substance abuse and higher rates of poor self-esteem, lower rates of global well-being, and more pessimistic views of their lives (Brumley et al. 2017; Cole et al., 2013; Weiler and Taussig 2019).

Please review the charts below to see the rates of different forms of dysfunctional behavior and violence in three different cities in Pennsylvania.


These charts were developed from: safe2Say Something Annual Report (2019-2020 School Year) Downloaded September 24, 2021 from: https://www.safe2saypa.org/wp-content/uploads/2021/01/2019-2020-S2SS-Annual-Report-FINAL.pdf

How does Violence Travel Across Generations?

About 1/3 of individuals who have been the victims of abuse and neglect by their parents do not go on to abuse and neglect their own children. However, it takes commitment to both “not wanting to be like their parents” as well as the effort needed to learn the skills needed to raise children adaptively. Adults need to help children and adolescents learn how to control their emotions, stop and think, as just a few of the skills that are critical to academic and employment success, as well as the ability to form and maintain stable and adaptive relationships with others.

It is both the exposure to violence as well as the other consequences of living in violent families that begins the cascading negative impacts that lead children and adolescents to follow the same path forward their parents took. The direct impact of exposure to violence includes being physically harmed by violent acts, observing violent acts, and being ignored when needing help. The indirect impacts include having parents who may be using alcohol or substances to enjoy life or to escape feelings of hopelessness and depression. Thus, rather than teaching their children how to deal with negative feelings and problems using adaptive mechanisms, they are role models for harmful strategies.

Living with violence can lead children to becoming numb to emotions or overreacting to them. This lack of appropriate emotional regulation can lead these children to be socially isolated or rejected by peers. It is also associated with similar difficulties controlling thoughts and behaviors. Taken together these factors are related to poor school performance and later difficulties with employment success and having stable adult relationships (Borofsky et al., 2013; Eisenberg et al., 2014; Sunirose, 2017). 

Children learn social skills through interactions with others. Whether it is due to being overly aggressive and impulsive, or overly controlled and withdrawn, these children are not receiving the type of social feedback that will help them further develop the emotional, cognitive, and social skills needed to have strong and healthy interpersonal relationships. Research has shown that exposure to any form of violence increases the likelihood of being exposed to other forms of violence. Children who come to school already abused and/or neglected are at greater risk for: being a bully or being bullied; associating with deviant peers; being sexually or physically assaulted as they begin to date; becoming involved in intimate partner violence as adolescents; becoming involved in intimate partner violence within adult intimate relations; having poor child rearing skills and thus beginning to abuse or neglect their own children; and, continuing to experience violence even as older adults by their partners, their own adult children, or others (Acierno et al., 2010, Espelage et al., 2018; Foshee et al., 2016; Parker, Debnam et al., 2016; Wilkins et al., 2014; Vagi et al., 2015).

Thus, why someone might become a violent parent when they set out not to be is that they didn’t get the help and support they needed to learn adaptive parenting skills. 




Social, and Political Supports for Interpersonal Violence


There are many social environments and political policies that can increase the likelihood of interpersonal violence occurring. Individuals at lower ends of the socioeconomic status continuum are exposed to environments where more violence occurs. Those who live in poverty within urban settings may be exposed to street violence, illegal drug use on the streets, neighbors who are more suspicious of the community, and less positive police support. Exposure to a violent event while on the way to school, walking to the store and so forth can make violent behavior seem more common or natural. Poor children often attend poorer quality schools where teachers may have less time and energy to help them engage in resilient behaviors that make violence less likely. For example, helping the child struggling in school to persist, set goals and achieve academically. Having academic success sets the stage for later success as an adult in the workplace (Masten, 2014). 




Other sources of toxic stress from growing up in areas of concentrated poverty may include frequent food or housing insecurity, lack of adequate medical care, living in deteriorating neighborhoods that may be close to environmental hazards or exposure to community violence, illegal substances, and few opportunities for positive recreation or employment (Anderson, 2011; Sampson, 2012). In addition, exposure to racism and discrimination in the community has been found to be a significant form of adversity that can cause chronic stress in children and adolescents (Cronholm et al., 2015). 




Institutional forms of oppression such as sexism and racism have been found to increase the sense of hopelessness in the future that fuels interpersonal community and other forms of violence. Institutional forms of oppression that lead to the school to prison pipeline further decrease the sense of hope in a future free of violence. For example, people of color who have been found to use any substances represent 13% of all drug users, yet they are almost half of those convicted of a crime related to drugs (Mauer, 2009). People of color are over- represented at every step of the criminal justice system and White individuals with higher incomes are much less likely to serve time for their offenses than people of color who commit similar offenses. In addition, drug policies have led to 20-fold increased incarceration of drug offenders- mostly people of color (Brucknor & Barber, 2016; Green, 2012; Schmitt, Warner, & Gupta, 2010). This leads to community wide loss of hope and increases in anger that can fuel interpersonal violence.




Raising children and adolescents is hard for everyone and contains many different types of challenges. Trying to do this, while having a less than optimal educational background, vocational, health, and income inequality, and food and housing insecurity makes raising children in a healthy and supportive manner extremely difficult. Adults exposed to adversity in childhood may start out as new parents trying not to be like their own parents - they have the will to be different. However, if they don’t have the needed education or income, they may lack the skills needed to make this wish a reality. Therefore, they may unintentionally continue to transmit violent or neglectful parenting practices to their own children.



Parents can take many different pathways that result in harm to their children. For example, a parent who fears losing control and abusing their children, may instead avoid setting any limits on their children’s behavior. Without any rules to guide themselves, these children may get into dangerous situations, be repeatedly injured, fail in school, get involved in sex and drugs in their early years and so forth; the fear of being abusive has led these parents to seriously neglect their children. On the other hand, parents may start out trying to be more patient with misbehavior than their own parents but hit roadblocks to doing this. Children repeatedly make the same mistakes prior to learning how to behave differently. In addition, they need to know “what to do”, not just “what not to do”. Thus, a parent who has repeatedly told a child to not take money left on the counter, can find the child still taking money over and over. Not recognizing the child needs help learning impulse control, the adult may come to the conclusion that the child’s behavior is a sign of serious immoral behavior that requires serious consequences; potentially leading to physical and emotional abuse.  This type of mistaken conclusion comes from a lack of understanding of child development. There are many “normal problems” of development that can seem like serious problems to an unaware parent. For example, it is typical that two-year-old children will attempt to push boundaries and discover what they can and cannot do. It is typical that they will have temper tantrums when prevented from doing what they want. However, without a knowledge of child development, this behavior can be perceived as intentionally disrespectful to the parent and a sign of refusing to accept limits from the parent- which may trigger a loss of control (Hamby & Grych, 2013). 



If parents who experienced violence in childhood want to escape the traps that lead to the intergenerational transmission of violence, we must reach out and provide comprehensive services to all members of an abusive and/or neglectful family. Each family member needs support to learn the skills that are necessary for adaptive living. These will include learning skills that reduce the risks of being involved in future acts of violence as well as the skills that support resilient functioning.




Should We Help Perpetrators of Violence?


Hearing about someone who abused, neglected, assaulted, raped, or neglected someone else might fill you with feelings of anger and thoughts of revenge. How could a parent intentionally starve a child to death? How could a teen beat his younger brother up? How could an adult rape or sexually assault someone in need of their care?  What is your gut reaction to this person? Do you feel they should receive help?

When we look at the backgrounds of those who get harmed and those who do the harming, we find similar risk and protective factors. Risk factors include a lack of support in learning how to control emotions and behavior, exposure to family conflict including adults engaged in violent behavior towards family members and other factors that result in the growing person not developing safe and secure attachments to adults (Fowler & Dillow, 2011). When we don’t have secure attachments to adults, it leads to cascading emotional problems that could involve having a restricted range of emotions, being numbed to our emotions so we don’t recognize cues that we are in danger, or experiencing overarousal so we become aggressive to protect ourselves when in fact we aren’t in danger (De Bellis et al., 2013)  

If we look at the symptoms of adults who get harmed and those who do the harming, we find they show similar problems. This can include problems such as anxiety, depression, post-traumatic stress disorder, antisocial personality disorder and borderline personality disorder (Spencer et al., 2019). 

People who engage in violence can change. As they were developing, there were times where interventions could have taken them off the path of engaging in violence to solve their problems. It might be easier to see how different forms of help could make a significant difference, if we examine a hypothetical case. Let’s assume that 35-year-old adult, White male Jeff has been found guilty of sexually assaulting a cognitively impaired person who he was paid to take care of.  What is your gut reaction to Jeff? What you think should happen to him? 

Now, let’s go back in time to when he was 14. Jeff is socially isolated in High School. The only other peers who interact with Jeff are the other troubled teens at school. He has not started dating yet, but he and his male peers have begun sharing aggressive sexual fantasies with each other and may enjoy playing video games that include sexual violence or watching movies that involve men sexually controlling others. They don’t understand how to engage in the type of relaxed, social exchanges that build positive relationships with possible dating partners. Jeff and these other teens are at high risk for acting out their aggressive sexual fantasies if things continue as they are.

Today, Jeff has come to school after receiving abusive discipline from his father who also has emotionally berated him to start acting like a “real man”. Jeff's gym teacher, who hasn’t paid much attention to him in the past, notices pain across Jeff's face when a teammate touches his shoulder during a basketball game. The gym teacher approaches Jeff and tries to ask him about this, but Jeff just tries to walk away. Not put off by this, the gym teacher sends Jeff to the nurse who discovers huge welts from a belt scoring Jeff's back.  What is your gut reaction to Jeff? What you think should happen to him? 

The nurse is a mandated reporter of suspicions of child abuse and calls Child Protective Services. Assume that a well-trained interviewer talks to Jeff about the welts on his back. Jeff has now had three contacts with adults who appear to be showing concern for his welfare. He tried to just throw the coach’s concern away, but he was sent to the nurse anyway. Jeff tried to show how tough he was to the young, attractive nurse at school, by showing his back. While praising his courage, the nurse said Jeff deserved help and called in more help. A well-trained Child Protective Services worker gained even more traction with Jeff, who then began telling him about the regular physical and emotional abuse he received at the hands of his father. He also indicated that despite asking for help from his mother when he was younger, he has given up asking for this. It only seemed to make her dive deeper into alcohol abuse and turn her back on his situation. What is your gut reaction to Jeff? What you think should happen to him?

Jeff’s behavior as an adult has been to sexually assault an impaired adult who needed his help; this is totally unacceptable. However, he has not engaged in the most extreme forms of abuse of others seen by Child or Adult Protective Services. Approximately 1-2% of children evaluated for child maltreatment meet criteria for being tortured (Knox et al. 2014a). Children who are tortured may have been denied food or water, not allowed to use toilet facilities, bound or restrained, locked in small spaces, forced to eat excrement and so forth.  

Perpetrators of child torture are not like those who episodically lose control and physically harm a child or dependent adult because they don’t know what to do. The perpetrator of torture engages in a program of psychological and physical assault including intense humiliation and terror. The acts are intended to cause serious harm and/or death; the victims are often programmed to believe the torture is their own fault. The perpetrator does not seek out any medical help for the victim however severe the physical injuries; the victims may die without intervention (Allasio & Fischer 1998; Knox et al., 2014 a). Behavior of the perpetrator may get worse and worse over time (Turner et al. 2010). It is important to do careful investigations to make sure that cases of child torture are not misidentified as child abuse as the child’s live is literally in danger if left with the torturer. It is not safe to send a child back home to someone who tortured them, and the torturer is not safe left out in the community, despite their current victim having been removed from the home (Ratnayake Macy, 2020).

If we want to end interpersonal violence, then the answer to, “should we help the perpetrators of violence,” is clearly yes. However, the level of risk a perpetrator represents to others, needs to be taken into account as to whether they can receive services and remain in the community, or if they need to be within a contained environment such as a jail or prison while they receive opportunities to learn how to live without violence.

The charts below show just how common it is for incarcerated men (N=3,895) to have experienced trauma in their childhoods, as adults, and both as children and as adults:



Wolff, N., & Shi, J. (2012). Childhood and adult trauma experiences of incarcerated persons and their relationship to adult behavioral health problems and treatment. International Journal of Environmental Research and Public Health, 9, 1908-1926; doi: 10.3390/ijerph9051908

Factors that Support Resilience


Children and adolescence are not always traumatized or harmed in the long run by adverse experiences. Healthy development requires what Masten (2004) called ordinary magic. This includes an environment in which there are adults who helped them learn to:  form positive emotional bonds with others; control their thoughts, feelings, and behaviors; succeed in school; develop a belief that they can succeed and achieve even when things are very hard; and develop faith or hope that life has meaning and that a positive future is possible. An important way we can help children and adolescents recover from adverse circumstances is to increase and support these forms of ordinary magic. Achieving at school is a struggle for students who are raised within poor communities where parents may work very long hours to keep their families housed and fed. In addition, schools are provided funding by property taxes. This leaves poor communities with poorly funded schools. When programs are funded in poor communities that help children develop school readiness skills, it has been found to reduce later problems with the criminal justice system by 75 % (Heckman, 2013). Ending institutional racism, sexism, and other forms of oppression through accurate history education in schools, dismantling judicial practices that have made prisons into warehouses, and political practices that serve to maintain disadvantage can help to renew hope and optimism within communities and support resilience.

How might you answer the question, “how will Kayla respond to exposure to violence”?  The unsatisfactory answer is, “it depends.” This is because everyone has a complex blend of innate tendencies for responding to stress. In addition, recovery from exposure to violence requires support for understanding what has happened and how to build a positive future. Thus, the more factors supporting resilience Kayla has in her life, the more likely she will behave adaptively following an exposure to violence. 



TO LEARN ABOUT EFFECTIVE HELPING STRATEGIES click here




TO LEARN ABOUT PREVENTING VIOLENCE click here




This is funded with PA Tax dollars.  The opinions, findings and conclusions expressed within this publication are those of the author(s) and do not necessarily reflect the views of PCCD. 

How Can We Help?

People who have been exposed to violence and trauma need help to move away from the thoughts, feelings, and actions that make them less safe and less confident in themselves and towards the actions that help them recover and grow stronger. How do you find the right type of help for yourself or someone else? There are so many treatment providers and treatment services out there claiming they help people; yet, they may not have any valid proof that they do help. The National Partnership to End Interpersonal Violence recommends that people follow two basic guidelines in seeking help. The first, is that the provider is offering services that have concrete evidence that support their effectiveness and/or are based on the best available evidence that they should help. The treatments should reduce the critical risk factors for violence and/or enhance the critical protective factors that promote resilience. The second, is that the provider is using trauma-informed practices. This refers to the helper having a background in how to recognize the warning signs of violence and trauma and how to provide services that are unlikely to trigger further trauma. 

There are many evidence-informed treatment services available. The following ones are provided as examples and should not be considered in any way part of an exhaustive list.

WHAT TREATMENTS WORK BY HELPING PARENTS DURING INFANCY?


Taking care of very young children can be hard and exhausting; particularly if you have not had many experiences that helped you understand what babies and toddlers do that can be hard to handle. With infants, parents are dealing with a lack of sleep, a severely disrupted schedule, new financial strains, and often great uncertainty about what the best parenting techniques may be. Everyone needs help from caring for others during this time but some do not get enough of it and face overwhelming stress and strained resources which can lead to unintentionally or intentionally doing something that harms the infant. Toddlers are learning just how much they can do and don’t understand that adults need to be in charge of their world. While they can irritate us with their constant use of the word no or attempts to ignore us, their challenging behavior is actually what helps their brains develop. Thus, we need to both encourage them yet teach them to listen to us at the same time; it is not an easy task for anyone.

Luckily, new parents do not need to navigate this time alone. There are many resources available that research has shown are effective in helping new parents manage their own well-being, and learn to provide their infant with the best care they can. 

Here are a few Examples of Treatments that Work

The Nurse-Family Partnership is an organization dedicated to keeping children healthy and safe and improving the lives of moms and babies. The program works by having trained nurses regularly visit first-time moms-to-be, starting early in the pregnancy and continuing until the child is 2 years old. By getting the care and support they need, these new mothers can be confident they are providing their babies a healthy and safe start to life. To learn more, or to find an NFP program near you, click here: Nurse Family Partnership

Early Intervention is a system of services that helps babies and toddlers with developmental delays or disabilities. It can be very upsetting to notice that your child is falling behind. This program focuses on helping babies and toddlers learn the skills that typically develop during the first three years of life, such as walking, talking, learning, and forming relationships. Also, in Pennsylvania, Early Intervention services are free to eligible families. Learn more about this service by clicking here: Early Intervention

If you have questions about your child's development, call the CONNECT Helpline: 1-800-692-7288 or email help@connectpa.net, to speak with someone who can provide helpful information about available services.

Triple P-Positive Parenting Program consists of simple, practical strategies to help parents raise happy and confident children. This program helps parents set and maintain rules and routines to give structure to a family. New parents can gain skills to support their baby’s learning and social-emotional development. This program is available online for convenient access. Learn more and get started here: Triple P.

Maternal Addiction Treatment is a life-saving intervention for pregnant women who struggle with a drug addiction. Substance use in pregnancy can be very dangerous for both the unborn child and mother. Thankfully, there are services available that will help soon-to-be-mothers get healthy enough to take care of themselves and their child. Programs like these celebrate the courage of women who come into treatment and make the daily commitment to create better lives for themselves their families. Click the following links to learn more about some of the treatments available in Pennsylvania. 

Pittsburgh: The Sojourner House is a drug and alcohol treatment center in Pittsburgh that provides in-patient residential treatment to addicted mothers and their children. 

Philadelphia: Thomas Jefferson University has “one of the oldest, largest and most comprehensive substance use disorder (SUD) programs for pregnant and parenting women in the country,” the Maternal Addiction Treatment, Education and Research (MATER).

Harrisburg: High quality, effective drug use disorder treatment is available at UPMC Addiction Medicine Services

Helpers wanting to learn more about the best practice for treating mothers with Opioid addictions can click this link: Clinical Guidance 

Scared an infant is in danger- call: 

  • ChildLine (State Child Abuse Registry) 1-800-932-0313

  • Childhelp National Child Abuse Hotline: 1-800-422-4453 (1-800-4-A-CHILD)

  • Call 911 in case of emergency or risk of immediate harm

What Treatments Work by Helping Young Children?

Early childhood can be a wonderful time of learning and growth, but it can also come with intense stress and frustration for parents as children go from copying everything their parents do to pushing back against family rules and listening to parents; they want to see if they can make their own rules rather than follow the rules of others. They may do things such as refuse to put their clothes away, have a temper tantrum when not given the cookie they asked for, and refuse to share their crayons with another child. While this provides a challenge to parents, this behavior is part of children learning who they are as individuals and what they are capable of doing.  There are many evidence-based programs that exist to help parents navigate this exciting and challenging time, and help young children develop essential skills that will set them on a path for success. 

Here are a few Examples of Treatments that Work

Head Start is a government funded preschool program targeted at families facing difficult life circumstances. This means it is completely free to the families who qualify. In addition to language, literacy and math skills, children attending Head Start learn how to socialize with other kids, follow the rules of a classroom, as well as lessons about living a healthy lifestyle. They also provide home visits to families to ensure health and safety in all of a child’s environments. To learn more about the benefits Head Start programs can provide, click here.

To find a Head Start center near you, click here: Pennsylvania Head Start 

Parent-Child Interaction Therapy is a form of family therapy that works through real-time coaching to help parents manage their child’s behavior. A therapist guides parents moment-to-moment interactions with their child . If you have felt at a loss for how to deal with your child’s behavior, or are feeling overwhelmed, PCIT may be a good fit for you. Learn more about the program here.

To find a provider near you, click here: Parent-Child Interaction Therapy

Second Step is a social emotional learning program that can be integrated into the preschool curriculum. It helps students learn to listen, pay attention, get along with others, and follow directions. Skills and concepts are taught through short, daily activities that take 5–7 minutes each, with little or no preparation time needed. Learn more about this effective learning tool, and find teaching materials here: Second Step (Early Learning).

Triple P-Positive Parenting Program consists of simple, practical strategies to help parents raise happy and confident children. This program helps parents set and maintain rules and routines to give structure to a family. This program has specific material for all ages of children. Parents can gain skills to support their toddler’s learning and social-emotional development. This program is available online for convenient access. Learn more and get started here: Triple P.

Scared a preschool child is in danger call:

  • ChildLine (State Child Abuse Registry) 1-800-932-0313

  • Childhelp National Child Abuse Hotline: 1-800-422-4453 (1-800-4-A-CHILD)

  • Call 911 in case of emergency or risk of immediate harm

What Treatments work by Helping School-Aged Children 


School can be a challenging environment for children who cannot always blend in or are targeted for teasing or bullying by other students or by adults in the school. While school has the potential to let children learn so many skills that prepare them to be self-confident and skilled adults, school also provides an environment out of a parent’s control; bullying can make a school environment emotionally, physically, and sexually unsafe. Bullying can target any potential difference between the bully and the victim whether it is abilities, gender, national origin, religion, sexual orientation, size, race, religion and so forth. Children who struggle at home or school are also at risk for becoming bullies themselves. Thankfully, programs exist that can help guide children toward success in this setting, and teach them skills that will help them form healthy relationships with other students.  Here are a few examples of programs that can help your children.

Here are a few Examples of Treatments that Work

Olweus Bullying Prevention Program: Olweus has a bullying prevention program designed to reduce and prevent school bullying in elementary, middle, and high schools. It works through teaching the teachers, children, and parents about behaviors that harm others. It helps adults develop clear rules against bullying and provides support and protection to keep children from being harmed by words and actions that keep them from learning fully in school and developing positive relationships with other children. There have been studies around the world that demonstrate this comprehensive programming works in the short and long run.  Does your child’s school implement this program or another one that has similar evidence that it works? If not, use the following links to gain more information and encourage your local school district to utilize this resource: Olweus Bullying Prevention Program. This source is very comprehensive and useful for school superintendents and principals.

If your school is looking for someone who could help guide them in using this program, here is a list of Pennsylvania contacts

Training Active Bystanders helps train school-aged children to know how to help reduce conflict by stepping up rather than being passive when they witness a conflict brewing. At some point in their lives, most people will witness an act of violence or aggression, and most of us will automatically be passive in the face of it because we literally don’t know what to do. The active bystander program helps children learn how to intervene in situations to prevent conflicts from escalating. By using creative problem solving and learning how to form specific action plans when faced with harmful situations, this training program can help children learn how to feel confident they have skills they can use when faced with conflict. 

To get in contact and bring this program to your area, click here.

Learn more by clicking here: Training Active Bystanders 


Second Step is a comprehensive set of social emotional learning program that can be integrated into regular school curricula. There are programs available depending on the age of the children being targeted, programs designed to support the effectiveness of the teachers, as well as programs designed to help parents. All of the programs are centered around effective social and emotional learning. A variety of skill building is provided. For example, students will learn to recognize and stand up safely to bullying, achieve goals, learn from challenges, recognize their personal strengths, and much more. Each teacher-led unit has interactive, 25-minute lessons and discussion-based activities that are easy to use. Learn more and access these resources here: Second Step (Middle School).

PATHS is a program designed to prevent the development of conduct problems (aggressive or disruptive behaviors) in elementary school aged children.  By improving their social and academic skills and intervening in their family environment, this program ensures that your child will be on the path for a happy, successful life. Learn more about this program here: PATHS Program.

Scared a school-age child is in danger call:

  • If you have concerns about risks in schools, get in touch with your local school district 

              Contact Harrisburg School District 

Superintendent: Dr. Eric Turman 

              Contact Pittsburgh School District 

Superintendent: Dr. Anthony Hamlet

              Contact Philadelphia School District 

Superintendent: Dr. William R. Hite, Jr.

If this doesn’t work, contact: the State of PA Department of Education Call 911 in case of emergency or risk of immediate harm

What Types of Treatment are Effective with Teens?


Teens can look like adults, but their brains are still developing and while in academic subjects and familiar territory they may act adult-like, in areas that are new- such as understanding their sexuality- they are still likely to react in the moment rather than plan for the longer term. Changing bodies, fluctuating hormones, and the stress that comes with being given heavier responsibilities and held to higher standards can increase conflicts between parents and their teens. Emotions can run high as teens strive to deepen their relationships, figure out the differences between friendships, crushes, long-standing romantic commitments, and their own identity. Luckily, there are a wide range of programs, backed by research, that can educate teenagers on how to build strong relationships, and to respect themselves and others. 

Here are a few Examples of Treatments that Work

Coaching Boys into Men is a violence prevention program that trains and motivates high school coaches to teach their young athletes healthy relationship skills and that violence never equals strength. Coaches are in an ideal position to be a powerful and positive influence in a young boy or man’s life. Studies have shown that those who participate in the program are more likely than their peers to intervene when they witness abusive or disrespectful behaviors, and less likely to perpetrate abusive behaviors themselves. To learn more about the effectiveness of the program, click here: CBIM Effectiveness. To become a CBIM Coach, click here: Coaching Boys into Men.

Dating Matters is a program designed to teach teens smart relationship skills and prevent relationship violence. This program was designed so that it could be used in many different settings with young teens. Individuals in the program learn effective communication skills, how to build healthy relationships, as well as ways to support their friends who may be struggling with unhealthy relationships. To learn how you can get involved and help end teen dating violence, click here: Dating Matters. To further explore the different components of the program click here Dating Matters Toolkit  

Our Whole Lives (OWL) is a positive sexual education programs designed at different developmental levels across the lifespan. It covers topics and skills that children, teens, and adults need to know but often do not get help mastering. Our Whole Lives recognizes and respects the diversity of human experience with respect to biological sex, gender identity, gender expression, sexual orientation, and disability status in addition to cultural and racial background. This program was developed by two religious organizations however, it contains no religious references or doctrine. The program offers accurate information presented in developmentally appropriate ways. Activities are provided that help people clarify their values and improve their decision-making skills, and much more.  Learn more by clicking here: Our Whole Lives 

Multi-Systemic Treatment (MST) is a comprehensive program designed to help struggling teens. It takes a family-centered approach. Typically, MST is used when a teen has become involved in drug use, violence, or severe criminal behavior. This treatment approach is designed to explore the teen’s home environment and family relationships to get at the root of the problem behaviors that the teen is showing. To see research on how effective this approach can be, and to learn more about MST, click here

To learn how to access Multi-Systemic Treatment in Pennsylvania, follow these links:

Pittsburgh

Harrisburg

Philadelphia

Scared a teen is in danger call:

  • The Trevor Project - Crisis intervention and suicide prevention for LBGTQ youth: 1-866-488-7386

  • Youth America Hotline - Counseling for Teens by Teens: 1-877-968-8454  (1-877-YOUTHLINE)

  • Suicide Hotline: 1-800-273-8255 (1-800-273-TALK) 

  • National Hopeline Network: 1-800-784-2433 (1-800-SUICIDE)

  • Call 911 in case of emergency or risk of immediate harm

What Types of Treatment have been found Effective in Adulthood?


Children dream about reaching what they imagine is the freedom of adulthood. Adults know that navigating the “grown-up” world is no easy task and may feel their freedom constricted by responsibilities. As adults get older, their world gets increasingly complicated. They have responsibilities including financially supporting themselves, paying bills and taxes, and maintaining the place where they live. Most are also responsible for supporting others, whether these dependent others be children, disabled individuals, or older adults in their lives. In addition, adults may have been exposed to violence and trauma in their childhood, adolescence or in their adult life; no age group is immune to traumatic experiences that can shake them off their prior track of healthy development. Without appropriate help, violent and/or traumatic experiences can stay with people throughout their lives, changing how they view themselves and the world. These damaging experiences can make adults feel very isolated and alone. Fortunately, there are many evidence-informed resources have been developed to help adults regain a positive trajectory through life.

Here are a few Examples of Treatments that Work

Relationships: People marry expecting their relationship to be happy and help them throughout life. When problems come up that they feel are unsolvable, they may decide to divorce. Ending a relationship that started with the belief it would be life-long is stressful for everyone involved, especially when there are children or other dependent people in the family. While a painful process, divorce doesn’t have to be an ugly or horrific experience. There are ways to make divorce a healthy process for all family members through cooperation, communication, and self-care. 

Check out these tips from the American Psychological Association that are designed to help people who are divorcing: Healthy Divorce 

For further help, you could find a psychologist near you who can help you through this process: Psychologist Locator  

Domestic Violence: When someone you love is hurting you, it is time to get help. You deserve to be safe. The Pennsylvania Coalition Against Domestic Violence can help get you connected to safe places to live, trustworthy people to talk to, as well as free and reliable legal information. You can learn more and get the help you need by clicking here.

Group Treatment for Survivors of Trauma can help individuals who have been abused and/or traumatized within intimate partner relationships. In these groups, people with common issues can get together to talk and are guided and supported by a professional. This has proven helpful for many different problems including trauma and Post Traumatic Stress Disorder. Group therapy provides peer support for overcoming and gaining strength from working through the pain and suffering together. If you are interested in finding groups in the following three cities, click on the links below: 

Pittsburgh

Harrisburg 

Philadelphia   

Exposure therapy for Veteran Survivors of Trauma has been found helpful for people who have gone through traumatic experiences before or during their active duty. It works by breaking up the traumatic experience into its small component parts, helping the individual face each part at a pace they can tolerate. Individuals progress through every aspect of the experience until it no longer controls them or their reactions to the world. Adults with symptoms of post-traumatic stress might find this website from the VA helpful: Prolonged Exposure 

Treatment for Substance abuse

Drug addiction is a public health problem that often severely damages the lives of those involved. Many people think of addiction in overly simple terms because of past social strategies that emphasized “just saying no” to drugs. These overly simply explanations fail to help people understand how violence, trauma, and other forms of adversity can lead a person to use substances for respite from physical and emotional pain. Simple explanations also fail to help people understand how drug addiction involves creating new brain connections that creates strong cravings for the substances whenever any trigger for use occurs- such as seeing someone drinking at a party or seeing someone across the street that they know sells substances. Simple explanations also don’t address the social shame that can make an individual hide their problems rather than reaching out to caring others for help.  

When someone is suffering from an addiction, their loved ones suffer as well. Addictions can break apart families, but there are ways to repair these bonds. One form of therapy found to be helpful for those struggling with addiction is Family Therapy. It works through a trained therapist working with all family members as a unit to support the addicted individual recover, heal, and move towards long-term sobriety; loved ones learn the complex factors that are supporting the addiction and learn to break family patterns that may unintentional support addiction. If you or a loved one are battling addiction, learn more about how family therapy could help by visiting this website: Family Therapy

Help is available; find treatment options near you. 

Scared an Adult is in danger call:

  • Domestic Abuse Hotline 1-800-799-7233 (1-800-799-SAFE)

  • Suicide Hotline: 1-800-273-8255 (1-800-273-TALK)

  • National Hopeline Network: 1-800-784-2433 (1-800-SUICIDE)

  • Veteran's Crisis Line: 1-800-273-8255, press 1

  • Call 911 in case of emergency or risk of immediate harm

What Types of Treatment have been found Effective for Older Adults?


As we age, our bodies change. Simple tasks may become more difficult such as bending enough to easily tie shoes or being able to read the small type on a medicine bottle.  This time might feel scary or upsetting, as if you are losing the freedom and ability to control your own life. For loved ones, it can be difficult to know when to step in and help. Thankfully, no one needs to figure these issues out in isolation. There are many services that can help provide care, reassurance, and support for those who need it. For example, are you looking for resources and live in Pennsylvania? Then, you can find more information on the PA government website

Here are a few Examples of Treatments that Work


Transitioning to assisted living: Older adults who need more help with the tasks of daily living, could get help by moving to a assisted living community. Confusion, mobility concerns, or increased injuries all might be signs that an older adult needs long term support. Check out this website for more signs and suggestions for how to step in if you notice an older adult who might need help: When to Help 

Transitioning a loved one into the proper care facility can be a stressful time. How can you know they will be receiving the best care? One way to be sure their needs are met is through a citizen advocacy group like the Ombudsman program. The name may be tricky to say, but the idea is simple. This program ensures that no one is alone in this process. Community volunteers dedicate their time and attention towards serving long term care communities and ensuring everyone has their needs met and is being listened to. They will also step in to resolve any issues or concerns that may arise.   

To learn more about the program, watch this video: About Ombudsman  

Find a program near you: Ombudsman Pennsylvania  

Support for caregivers: Older adults or adults with disabilities can be at risk of being harmed or mistreated. Thankfully there are resources that can help. The National Caregiver support program connects communities with resources and educational services and provides assistance to caregivers to ensure they receive the support they need. Learn more here: Caregiver Support Program

Alzheimer’s versus Depression: In older adults, signs of depression are too often mistaken for early signs of brain problems like Alzheimer’s Disease. Unfortunately, this can lead to older adults not receiving the mental health treatment they need. How can you help?  As a caregiver or family member, you do not have to make it your job to figure out what is wrong, but you can recommend that the individual arranges a meeting with their Primary Care Provider and make sure this professional knows import events, problems or illnesses that are going on in the person’s life that might make their current ability to care for themselves related to depression versus incipient brain problems.

If provider is new to the issues facing older adults, a valuable resource for them is this information freely available to download. It is called, “Key Issues pdf of EBP for depression in adults

Substance Abuse in Older Adults: If you are a provider of mental health care for older adults, this Treatment Improvement Protocol provides guidance on how to better identify, manage, and prevent substance misuse in older adults. Learn about the unique ways in which the signs and symptoms of substance use disorder (SUD) manifest in older adults; drug and alcohol use disorder screening tools, assessments, and treatments specifically tailored for older clients' needs; the interaction between SUDs and cognitive impairment; and strategies to help providers improve their older clients' social functioning and overall wellness. To access this resource, click here

Older Adult Maltreatment: Do you wonder if an older person you know might be suffering harm? As at all other ages, the perpetrator of abuse or neglect of older adults is most likely a family member. Intimate Partner Violence that began at an early age may be continuing. New partners gained in older adulthood might bring a new perpetrator into the older adult’s life. Brain injuries and other cognitive difficulties may lead violence to erupt suddenly. Children who were abused by a parent might engage in this same type of behavior towards their now older adult parent who needs help.

Common signs that might indicate abuse, neglect, or financial exploitation of and older adult include:

  • Bruises or broken bones

  • Weight loss  

  • Memory loss  

  • Personality changes  

  • Social isolation  

  • Changes in banking habits  

  • Giving away assets such as money, property, etc.  

However, these behaviors could be a result of other factors such as health or emotional issues. The National Partnership to End Interpersonal Violence recommends that it is better to ensure the safety of a person, and possibly make an error, than leave someone in harm’s way.

Worried an Older Adult or a Dependent Adult is not safe:

  • PA Older Adult Protective State Hotline: 1- 800-490-8505

  • Older Adult Protective Services by County:

Harrisburg 

Pittsburgh

Philadelphia 

  • Call 911 in case of emergency or risk of immediate harm

TO LEARN MORE ABOUT WHY VIOLENCE OCCURS click here

TO LEARN MORE ABOUT HOW TO PREVENT VIOLENCE click here

TO REVIEW ALL THE RESOURCES DESCRIBED IN THIS DOCUMENT click here



This is funded with PA Tax dollars.  The opinions, findings and conclusions expressed within this publication are those of the author(s) and do not necessarily reflect the views of PCCD.  



What Can You Do? Advocacy and Public Policy

What is advocacy?

Advocacy requires taking direct action to change something in your own life, in your family life, in your social environment (neighborhood, work, school, religious setting etc.) or in your local, state or federal politics to encourage positive change. There has been research to guide us on what is effective in helping reduce violence at each of these levels. Effective strategies to end violence requires a comprehensive approach, they don’t just involve reacting to one part of the complex environment that encourages violence. Instead, they involve providing the resources that communities need to intervene at the personal through political levels of change. In addition, effective strategies are fully implemented. For example, having more police officers in the community is only one part of a specific strategy for reducing violence in that community. These police officers also need to be taught effective communication skills, how to deescalate aggressive situations, and how to show respect and value for diverse community members. It is a huge burden on families and communities when a family member is incarceration. Thus, police officers need to recognize when incarceration is truly needed versus when referrals for mental health services, drug services, relocation away from violent family members, or resources to address problems such as housing and food insecurity would be more effective responses. Neighborhoods that contain access to good quality schools, medical centers, mental health services, drug treatment centers, employment opportunities and safety nets for the poor have shown lower rates of violence.

As you read through this page you will see many different examples of advocacy steps you could take to help build a safer world for everyone. It is important, when considering taking any of the action steps described, that you consider your own personal safety in deciding which steps to take. If speaking up to a spouse, or neighbor, or member of your religious group could lead you to be physically, sexually, or emotionally abused, then you want to ensure your own safety and that of other vulnerable family members as your first advocacy steps.

TO READ ABOUT EFFECTIVE STRATEGIES FOR GETTING HELP click here.

Individual advocacy

Individual advocacy means you take a step personally to do something to reduce interpersonal violence. It could start with a self-assessment of your own strengths. You might realize that you are a highly compassionate individual who has had significant experience helping children with their homework as one of your children struggled with math and another with learning to read. After learning how often abused children and teens need help learning how to do well in school, make friends, and apply for jobs, you could decide to:

Provide one hour a week, two hours a week or more helping a foster child develop good academic and social skills. You could take this specific advocacy step, by clicking on the link below:  

https://www.pivotalnow.org/volunteer 


If you work full time, and have our own family, this might not be the best advocacy step for you. Instead, every four months you might send a care package to a foster youth that contained items like books on how to get into college or clothing teens could wear when they go for a job interview. You could take this specific advocacy step, by clicking on the link below: 

https://www.fc2success.org/programs/student-care-packages/  


These are just two examples of the many different action steps you could take to do something personally to try to show an abused or neglected child or teen that you value them as a person and wish to help them build a safe and successful life.

Social Advocacy

Social advocacy involves you taking on the role of a leader through encouraging actions in your social network, religious organization, PTA, neighborhood organization and so forth that could help reduce the risk factors for violence or encourage resilience in those harmed by violence.  There are many types of social advocacy you could engage in. Some require a lot of time, but some require just taking advantage of brief moments in your day. For example, you could start a social media campaign to encourage more families to take care of foster children by using hashtags in your activities on social media. You could click on the link below:

https://nfpaonline.org/fostercare 



This website takes you to a volunteer organization that provides everything you need to know about becoming a foster parent. To start your social media campaign, you need to write a brief paragraph that says why you think becoming a foster parent is important to help children in need and then put this paragraph into all the social media you use such as Facebook, Instagram, and Snapchat as possible action step examples.   

Adding hashtags to your paragraph can increase its spread to people who might need to hear your message. You can read about effective use of hashtags in social media campaigns at: Social Media Today

https://www.socialmediatoday.com/smt-influencer/3-examples-social-media-campaigns-social-good 


If you have a school that has no tolerance policies, these have been found harmful. You might go to a PTA meeting and share this information and encourage your school or community to become a No HIT ZONE instead. In No HIT ZONES, the pledge from adults includes that: No adult shall hit another adult; No adult shall hit a child; No child shall hit an adult; and, no child shall hit another child. At a school, all adults in the school are trained in how to pre-empt or de-escalate conflict. The No-Hit Zone Toolkit includes materials for the school, the staff, and the parents in how to help build positive communication and problem solving within the school community.


An example of what you might say is: “It may sound good to be highly punitive to anyone showing any sign of aggression, but actually, creating an environment that has resources and help for learning how to communicate and solve problems does more to create a safe and positive learning environment.”

You could also use information like this to write a letter to the editor for your local newspaper.

An example might say, “We all feel horrified when we read a news article that says an adult or child was beaten to death, however, the answer to violence is not just that we have an effective police force. We also need social norms where are community is a No Hit Zone. In this type of community, we all would learn to recognize the warning signs of violence building up and act before the violence occurs. This might involve helping people receive mental health or medical services if they need it. Helping people in need of food and housing get it. Friends and families using social pressure on those they love to indicate that solving problems never involves hitting anyone.”


Other social advocacy steps could be things like:



  • Talk to your Iman/Priest/Minister/Rabbi about positive actions to make violence less likely

  • Providing a talk at one of your clubs about positive actions to make violence less likely

  • Giving a talk at public library about positive actions to make violence less likely

  • Tweet or retweet information about No Hit Zones

  • Go on local radio station and provide information about the harm no tolerance policies have in schools

Political Advocacy

When you take a political advocacy step, you are working to support or change public policies at the local, state, or federal level. Public policies are government legislation. They are intended to support both our economy and our society. We don’t all agree on how much our government should be involved in our personal and family lives. However, we have supported our government in developing legislation aimed at preventing child abuse and neglect, elder abuse and financial exploitation, violence against women and other forms of violence. Unfortunately, public policy has sometimes created conditions that allow violence and/or trauma to occur. For example, public policy at the southern border of the US separated children from their parents and had detained children living in cages. These children and parents were harmed if not traumatized by these experiences.


Some public policies have given power to some groups over others either intentionally or unintentionally thus, leading to potentially traumatic events. For example, the Dakota Access Pipeline’s route was scheduled to travel over a route that would have endangered Lake Oahe, which is the primary source of water for Standing Rock Sioux Reservation in North Dakota as well as endanger sacred sites near the lake which would violate treaty rights. The US has a long history of violating treaties made with Native American Indians. 


Public policies behind the “war on drugs” for example, made it less likely that middle and upper-class White users of cocaine would be arrested or incarcerated than Black users and poor users. What users need is trauma-informed treatment. When incarceration is considered vital, then rehabilitation needs to occur in prison settings and help in gaining employment after release as not finding employment is a risk factor for reengaging with drugs. It is important to provide our political leaders with accurate information about the complex causes of interpersonal violence, how to provide evidence-informed treatment services to those who are harmed or who cause harm, and how to prevent future violence without intentionally or unintentionally heightening the impact of racism, income inequality, sexism and other factors that lead to increases in violence.


The National Partnership to End Interpersonal Violence, along with the Centers for Disease Control, the Zero Abuse Project, and others have recommended a comprehensive, public health approach to ending interpersonal violence. This involves recognizing that many challenging human problems may cluster and that early intervention with child abuse and neglect, intervention with mental health problems, intimate partner violence, bullying, and substance abuse can all involve reducing the same risk factors for violence and increasing in society the factors that support resilient development.


Passing legislation that supports a comprehensive approach to a social problem is not enough in itself. For example, the Elder Justice Act was passed at the Federal level in 2010. However, it was funded at approximately 13 million a year when experts recommended 771 million. In addition, the act was allowed to expire as if there was no longer a need for it.


A comprehensive approach to preventing violence would include changes in our educational systems, criminal justice systems, social welfare systems to strengthen family relations, and build safety within a family unit. The approach would strengthen communities through increased employment opportunities, quality educational services, medical services, and mental health services to prevent the risk factors that can lead to interpersonal violence and increase the protective factors that build a resilient population.   

If you want to find your representatives and senators in the Commonwealth of PA to send them information about preventing violence you can go to:  

https://www.legis.state.pa.us/cfdocs/legis/home/findyourlegislator/

You will then have an opportunity to send a letter.

Here are sample letters that you could send:

Dear Senator,

I have read about a case involving child abuse, substance abuse, and intimate partner violence that led to the death of a two-year-old child. There are common risk factors for interpersonal violence, teen pregnancy, dropping out of school, and substance abuse including: abuse and neglect during childhood; exposure to violence between adults in the family or in the community; lack of support for learning emotional control and either numbing or enhancing of the response to warning signs of dangerous risks. Whether treatment starts with an infant when she is an abused and neglected child, or later when she is entering her teen years and starts to date, or even later when she starts parenting, child abuse and neglect has been found to be passed on from one generation to another due to a lack of proper education and resources provided when the first warning signs occurred. Please support legislation that would provide all at risk family members with trauma-informed assessments and treatment to help end the intergenerational transmission of violence. Without this lifespan approach, an infant might be taken from a neglectful teen mother who doesn’t know how to be a responsive parent and put in the custody of a grandparent who also doesn’t know how to be a responsive parent.


Common treatment strategies have also been found to help those involved in violence, whatever their age for example: increasing emotional intelligence, increasing impulse control, increasing the ability to form positive and deep attachments with others, and increasing problem solving skills. These represent the common factors that support resilient development and building these can also be an effective strategy for ending the intergenerational transmission of violence. 

Please fund programs that take a comprehensive approach to reducing risk and increasing resilience.

Thank you,



Your name



If you want to find your representatives  and senators at the federal level, you can go to: 

https://www.govtrack.us/ 


Sometimes it can be hard to know what to say to one of your political leaders. You can get nervous as you wait on the phone before having the opportunity to say something. One strategy that can help with this could be writing a brief paragraph to read in advance of the call that you could read out loud as a whole, or to just get you on a roll.


An example could be:


“I am really concerned about how much bullying there is my school district. They have had a few programs at the school, but my son says they are boring and stupid. In California, they have passed a Mental Health Student Services Act. This act funds county behavioral health departments to partner with publicly- funded mental health care to provide services in the schools. This helps respond proactively to signs of mental illness, depression, homelessness, suicidal or violent behavior through funding a psychologist or other mental health person full time at every school. This person could earn the trust of the students by being there all the time and helping with many other problems that children and teens have such as questions about their sexuality, anger over a dating breakup, worry about a parental divorce. Having mental health services in the school might reduce all sorts of problems including school failures, violence in the schools, teen pregnancy, and early experimentation with drugs and alcohol.”



If you were sending a letter, an example could be:

Dear Representative,   

I am really concerned about how much bullying and drug abuse are occurring in my school district. They have had a few programs at the school, but my son says they are boring and stupid. Research in California has investigated the impact of providing mental health services in the school instead of bringing in ad hoc programs. I understand that Congresswoman Grace Flores Napolitano represents California’s 32nd District in the Federal House of Representatives. She has been working since 2001 on providing mental health and suicide prevention services in the schools. The success of the program in four schools led to it being expanded to 35 K-12 schools throughout the San Gabriel Valley and Southeast LA County. Please look into her work and California’s H.R. 721, the Mental Services for Students Act to see if legislation like this could be started to help bullied, and other distressed children and teens in Pennsylvania.


Thank you for your time,  

 

Your Name


Developing advocacy steps that work requires you having information that is based on scientific evidence to share.

TO LEARN ABOUT WHY VIOLENCE HAPPENS click here

TO LEARN ABOUT WHAT CAN BE DONE TO HELP THOSE INVOLVED IN VIOLENCE click here

TO REVIEW THE RESOURCES DESCRIBED IN THIS DOCUMENT click here


This is funded with PA Tax dollars.  The opinions, findings and conclusions expressed within this publication are those of the author(s) and do not necessarily reflect the views of PCCD. 


RESOURCES: CHECK OUR FACTS


 Why Does It Happen Resources

Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H., Steve, K., Muzzy, W., & Kilpatrick, D. G. (2010). Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The national elder mistreatment study. American Journal of Public Health, 100(2), 292-297.

Appleton, A., Kiley, K., Holdsworth, E. A., & Schell, L. M. (2019). Social support during pregnancy modifies the association between maternal adverse childhood experiences and infant birth size. Maternal and Child Health Journal, 23, 408–415.

Allasio, D., & Fischer, H. (1998). Torture v. clinical child abuse: What’s the difference. J. Clinical Pediatrics, 37, 267.

Allwood, M. A., Bell, D. J., & Horan, J. (2011). Posttrauma numbing of fear, detachment, and arousal predict delinquent behaviors in early adolescence. Journal of Clinical Child and Adolescent Psychology, 40(5), 659-667. doi:10.1080/15374416.2011.597081.

Anderson, R. (2011). Dynamics of economic well-being: Poverty, 2004-2006. Current Population Reports. (pp. 70-123). Washington, DC: U.S. Census Bureau.

Bellis, M. A., Hughes, K., Ford, K., Hardcastle, K. A., Sharp, C. A., Wood, S., Homolova, L., & Davies, A. (2018). Adverse childhood experiences and sources of childhood resilience: A retrospective study of their combined relationships with child health and educational attendance. BMC Public Health, 18, 792–803.

Bellis, M. A., Hughes, K., Ford, K., Rodriguez, G. R., Sethi, D., & Passmore, J. (2019). Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: A systematic review and meta-analysis. The Lancet Public Health, 1–12. https://doi.org/10.1016/S2468-2667(19)30145-8.

Black, M. C., Basile, K. C., Breiding, M. J., Smith, S. G., Walters, M. L., Merrick, M. T., …Stevens, M. R. (2011). The national intimate partner and sexual violence survey (NISVS): 2010 summary report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

Breiding, M. J., Basile, K. C., Smith, S. G., Black, M. C., Mahendra, R. R. (2015). Intimate partner violence surveillance: Uniform definitions and recommended data elements, Version 2.0. Atlanta ,GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. 

Borofsky, L. A., Kellerman, I., Baucom, B., Oliver, P., & Margolin, G. (2013). Community violence exposure and adolescents’ school engagement and academic achievement over time. Psychology of Violence, 3(4), 381-395.

Brown, A. (2017). Younger men play video games, but so do a diverse group of other Americans. PEW, FACTTANK: News in the Numbers. Retrieved from http://www.pewresearch.org/fact-tank/2017/09/11/younger-men-play-video-games-but-so-do-a-diverse-group-of-other-americans.

Bucknor, C. & Barber, A. (2016, June). Economic costs of barriers to employment for former prisoners and people convicted of felonies. Washington, DC: Center for Economic and Policy. Retrieved from http://cepr.net/images/stories/reports/employment-prisoners-felonies-2016-06.pdf.

Brumley, L. D., Jaffee, S. R., & Brumley, B. P. (2017). Pathways from childhood adversity to problem behaviors in young adulthood: The mediating role of adolescents’ future expectations. Journal of Youth and Adolescence, 46, 1–14.

Centers for Disease Control and Prevention. (2014). Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization. National Intimate Partner and Sexual Violence Survey, United States, 2011. Retrieved November 28, 2016, from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6308a1.htm?scid=ss6308a1_e


Cole, S. F., Eisner, A., Gregory, M., & Ristuccia, J. (2013). Helping traumatized children learn, Volume 2. TLPI Publications. Retrieved from https://traumasensitiveschools.org/tlpi-publications.

Connolly, E. J., & Kavish, N. (2019). The causal relationship between childhood adversity and developmental trajectories in delinquency: A consideration of genetic and environmental confounds. Journal of Youth and Adolescence, 48, 199–211.

Conte, J. R. & Donfeld, S. (2010, Fall). Vicarious Trauma and its Management, APSAC ALERT, 1(3). 

Cronholm, P. F., Forke, C., Wade, R., Bair-Merritt, M. H., Davis, M., Harkins-Schwarz, M., Pachter, L.M., & Fein, J. A. (2015). Adverse Childhood Experiences: Expanding the concept of adversity. American Journal of Preventive Medicine. 49(3), 354 361. doi.10.106/j.ampere.2015.02.001 

De Bellis, M. D., Woolley, D. P., & Hooper, S. R. (2013). Neuropsychological findings in pediatric maltreatment: Relationship of PTSD, dissociative symptoms, and abuse/neglect indices to neurocognitive outcomes. Child Maltreatment, 18(3), 171-183. doi:10.1177/1077559513497420. 

Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles,W. H., & Anda, R. F. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study. Pediatrics, 111, 564–572.

Eisenberg, N., Hofer, C., Sulik, M. J., & Spinrad, T. L. (2014). Self-regulation, effortful control, and their socioemotional correlates. In J. J. Gross (Ed.), Handbook of emotion regulation. Guilford Press.

Espelage, D. L., Basile, K. C., Leemis, R. W., Hipp, T. N., & Davis, J. P. (2018). Longitudinal examination of the bullying-sexual violence pathway across early to late adolescence: Implicating homophobic name-calling. Journal of Youth and Adolescence, 47, 1880-1893. 

Felitti, V., Anda, R., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., Koss, M. & Marks, J.S.. (1998). The  relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine, (14), pp. 245-258. 

Felitti, V. J., & Anda, R. F. (2010). The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behavior: Implications for healthcare. In R. A. Lanius, E. Vermetten, & C. Pain (Eds.), Impact of early life trauma on health and disease (pp. 77-87). Cambridge, UK: Cambridge University Press

Finkelhor, D., Hamby, S., Ormrod, R., & Turner, H. (2005). The Juvenile Victimization Questionnaire:  reliability, validity, and national norms. Child Abuse & Neglect, 29(4), 383-412. doi:10.1016/j.chiabu.2004.11.001 

Finkelhor, D., Ormrod, R., & Turner, H. (2007). Poly-victimization: A neglected component in child victimization. Child Abuse and Neglect, 31, 7-26. 

Finkelhor, D., Turner, H.A., Shattuck, A.M., and Hamby, S.L. (2013). Violence, crime, and abuse exposure in a national sample of children and youth: An update. JAMA Pediatrics, 167(7):614–621.

Finkelhor, D., Turner, H., Shattuck, A., Hamby, S., & Kracke, K. (2015). Children's exposure to violence, crime, and abuse: An update. Juvenile Justice Bulletin–NCJ 248547. Washington, DC: U.S. Government Printing Office. Retrieved from https://www.ojjdp.gov/pubs/248547.pdf?ed2f26df2d9c416fbddddd2330a778c6=vjctfzkbj-vbvkbvjt.

Foshee, V. A., McNaughton Reyes, H. L., Chen, M. S., Ennett, S. T., Basile, K. C., DeGue, S., … Bowling, J. M. (2016). Shared Risk Factors for the Perpetration of Physical Dating Violence, Bullying, and Sexual Harassment Among Adolescents Exposed to Domestic Violence. Journal of youth and adolescence, 45(4), 672–686. doi:10.1007/s10964-015-0404-z

Fowler, C. & Dillow, M.R. (2011). Attachment Dimensions and the Four Horsemen of the Apocalypse. Communication Research Reports, 28(1), 16-26, doi:10.1080/08824096.2010.518910

Frieze, I. H. (2005). Female violence against intimate partners: An introduction. Psychology of Women Quarterly, 29, 229–237. 

Green, A. P. (2012, February). The disproportionate impact of the criminal justice system and people of color in the capital region. Albany, NY: The Center for Law and Justice. Retrieved from http://www.cflj.org/wp-content/uploads/2012/05/The-Disproportionate-Impact-of-the-Criminal-Justice-System-on-People-of-Color-in-the-Capital-Region.pdf.

Gunnar, M., & Quevedo, K. (2007). The neurobiology of stress and development. Annual Review of Psychology, 58, 145–73. doi:10.1146/annurev.psych.58.110405.085605.

Hamby, S., & Grych, J. (2013). The web of violence: Exploring connections amongdifferent forms of interpersonal violence and abuse. New York, NY: Springer.

Heckman, J. J. (2013). Giving kids a fair chance. Cambridge, MA: MIT Press.

Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., Jones, L., & Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2, e356–e466.

Klevens, J., Simon, T.R., & Chen, J. (2012). Are the perpetrators of violence one and the same? Exploring the co-occurrence of perpetration of physical aggression in the United States. Journal of Interpersonal Violence, 27(10), 1987–2002.

Allwood, M. A., Bell, D. J., & Horan, J. (2011). Posttrauma numbing of fear, detachment, and arousal predict delinquent behaviors in early adolescence. Journal of Clinical Child and Adolescent Psychology, 40(5), 659-667. https://doi.org/10.1080/15374416.2011.597081

Knox, B. L., et al. (2014a). Child torture as a form of child abuse. Journal of Child and Adolescent Trauma, 38, 46–49.

Larkin, H., Felitti, V. J., & Anda, R. F. (2014). Social work and adverse childhood experiences research: Implications for practice and health policy. Social Work in Public Health, 29, 1–16.

Lovallo, W. R., Cohoon, A. J., Sorocco, K. H., Vincent, A. S., Acheson, A., Hodgkinson, C. A., & Goldman, D. (2019). Early-life adversity and blunted stress reactivity as predictors of alcohol and drug use in persons with COMT (rs4680) Val158Met genotypes. Alcoholism: Clinical and Experimental Research, 43, 1519–1527.

Lupien, S. J., McEwen, B. S., Gunnar, M. R., & Heim, C. (2009). Effects of stress throughout the lifespan on the brain, behavior and cognition. Nature Reviews Neuroscience, 10, 434-445. http://dx.doi.org/10.1038/nrn2639.

Manyema, M., Norris, S. A., & Richter, L. M. (2018). Stress begets stress: The association of adverse childhood experiences with psychological distress in the presence of adult life stress. BMC Public Health, 18, 835–846.

Masten, A. S. (2014). Ordinary Magic: Resilience in Development. New York, NY: Guilford Press.

Mersky, J. P., & Janczewski, C. E. (2018). Adverse childhood experiences and postpartum depression in home visiting programs: Prevalence, association, and mediating mechanisms. Maternal and Child Health Journal, 22, 1051–1058.

Miller-Graff, L. E., Howell, K. H., & Scheid, C. R. (2018). Promotive factors of mothers’ social ecologies indirectly predict children’s adjustment. Psychology of Violence, 8(4), 427–437. https://doi.org/10.1037/vio0000145

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Parker, E. M., Debnam, K., Pas, E. T., & Bradshaw, C. P. (2016). Exploring the link between alcohol and marijuana use and teen dating violence victimization among high school students: The influence of school context. Health education & behavior: The official publication of the Society for Public Health Education, 43(5), 528–536. doi:10.1177/1090198115605308. 

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TO LEARN MORE ABOUT WHY VIOLENCE HAPPENS click here


How Can We Help Resources

WEBSITES ABOUT TREATMENTS THAT WORK:

https://www.samhsa.gov/resource-search/ebp

http://www.ori.org/research

https://www.childwelfare.gov/topics/management/practice-improvement/evidence/

SPECIFIC TREATMENTS THAT WORK

Nurse Family Partnership

Eckenrode, J., Campa, M., Luckey, D. W., Henderson, C. R., Jr, Cole, R., Kitzman, H., Anson, E., Sidora-Arcoleo, K., Powers, J., & Olds, D. (2010). Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial. Archives of pediatrics & adolescent medicine, 164(1), 9–15. https://doi.org/10.1001/archpediatrics.2009.240 

Miller T. R. (2015). Projected Outcomes of Nurse-Family Partnership Home Visitation During 1996-2013, USA. Prevention science : the official journal of the Society for Prevention Research, 16(6), 765–777. https://doi.org/10.1007/s11121-015-0572-9

Olds, D.L., Kitzman, H., Anson, E., Smith, J.A., Knudtson, M.D., Miller, T., et al., 2019. Prenatal and infancy nurse home visiting effects on mothers: 18-year follow-up of a randomized trial. Pediatrics 144 (6).

Early Intervention

Guralnick M. J. (2011). Why Early Intervention Works: A Systems Perspective. Infants and young children, 24(1), 6–28. https://doi.org/10.1097/IYC.0b013e3182002cfe

Mattern, J.A. A Mixed-Methods Study of Early Intervention Implementation in the Commonwealth of Pennsylvania: Supports, Services, and Policies for Young Children with Developmental Delays and Disabilities. Early Childhood Educ J 43, 57–67 (2015). https://doi.org/10.1007/s10643-014-0633-x

Scarborough, A. A., Spiker, D., Mallik, S., Hebbeler, K. M., Bailey, D. B., & Simeonsson, R. J. (2004). A National Look at Children and Families Entering Early Intervention. Exceptional Children, 70(4), 469–483. https://doi.org/10.1177/001440290407000406

Triple P-Positive Parenting Program

Nowak, C. & Heinrichs, N. (2008). A comprehensive meta-analysis of Triple P - Positive Parenting Program using hierarchical linear modeling: Effectiveness and moderating variables. Clinical Child and Family Psychology Review, 11, 114-144.

Prinz, R.J., Sanders, M.R., Shapiro, C.J., Whitaker, D.J., & Lutzker, J.R. (2009). Population-based prevention of child maltreatment: The U.S. Triple P system population trial. Prevention Science, 10(1), 1-12.

Sanders, M.R., Ralph, A., Sofronoff, K., Gardiner, P., Thompson, R., Dwyer, S., & Bidwell, K. (2008). Every Family: A population approach to reducing behavioral and emotional problems in children making the transition to school. Journal of Primary Prevention, 29, 197-222.

Maternal Addiction Treatment

Gannon, M. A., Mackenzie, M., Hand, D. J., Short, V., & Abatemarco, D. (2019). Application of a RE-AIM Evaluation Framework to Test Integration of a Mindfulness Based Parenting Intervention into a Drug Treatment Program. Maternal and child health journal, 23(3), 298–306. https://doi.org/10.1007/s10995-018-02715-y

Hand, D. J., Fischer, A. C., Gannon, M. L., McLaughlin, K. A., Short, V. L., & Abatemarco, D. J. (2021). Comprehensive and compassionate responses for opioid use disorder among pregnant and parenting women. International review of psychiatry (Abingdon, England), 1–14. Advance online publication. https://doi.org/10.1080/09540261.2021.1908966 

Jones, H. E., Martin, P. R., Heil, S. H., Stine, S. M., Kaltenbach, K., Selby, P., ... Fischer, G. (2008, October). Treatment of opioid-dependent pregnant women: Clinical and research issues. Journal of Substance Abuse Treatment, 35(3), 245–259. doi:10.1016/j.jsat.2007.10.007

Head Start

Bauer, L. and D. W. Schanzenbach. (2016) The Long-Term Impact of the Head Start Program. The Hamilton Project, the Brookings Institution.

Green, B.L., Ayoub, C., Bartlett, J.D., Von Ende, A., Furrer, C., Chazan-Cohen, R., Vallotton, C. & Klevens, J. (2014) The Effect of Early Head Start on Child Welfare System Involvement: A First Look at Longitudinal Child Maltreatment Outcomes, Children and Youth Services Review. 

Karoly, L. A. and A. Auger. Informing Investments in Preschool Quality and Access in Cincinnati: Evidence of Impacts and Economic Returns from National, State, and Local Preschool Programs. Santa Monica, CA: RAND Corporation, 2016.

Parent Child Interaction Therapy

Chronis-Tuscano, A., Lewis-Morrarty, E., Woods, K. E., O’Brien, K. A., Mazursky-Horowitz, H., & Thomas, S. R. (2016). Parent–child interaction therapy with emotion coaching for preschoolers with attention-deficit/hyperactivity disorder. Cognitive and Behavioral Practice, 23(1), 62–78.

Kaminski, J. W., & Claussen, A. H. (2017). Evidence Base Update for Psychosocial Treatments for Disruptive Behaviors in Children. Journal of Clinical Child & Adolescent Psychology, 46(4), 477–499.

Karoly, L. A. and A. Auger. Informing Investments in Preschool Quality and Access in Cincinnati: Evidence of Impacts and Economic Returns from National, State, and Local Preschool Programs. Santa Monica, CA: RAND Corporation, 2016.

Second Step

Kim, S., Nickerson, A., Livingston, J. A., Dudley, M., Manges, M., Tulledge, J., & Allen, K. (2019). Teacher outcomes from the Second Step Child Protection Unit: Moderating roles of prior preparedness and treatment acceptability. Journal of Child Sexual Abuse, 28(6), 726–744. https://doi.org/10.1080/10538712.2019.1620397

Low, S., Cook, C. R., Smolkowski, K., & Buntain-Ricklefs, J. (2015). Promoting social–emotional competence: An evaluation of the elementary version of Second Step. Journal of School Psychology, 53, 463–477. https://doi.org/10.1016/j.jsp.2015.09.002

Low, S., Smolkowski, K., Cook, C., & Desfosses, D. (2019). Two-year impact of a universal social-emotional learning curriculum: Group differences from developmentally sensitive trends over time. Developmental Psychology, 55(2), 415–433. https://doi.org/10.1037/dev0000621

Olweus Bullying Prevention Program

Black, S. A., & Jackson, E. (2007). Using Bullying Incident Density to Evaluate the Olweus Bullying Prevention Programme. School Psychology International, 28(5), 623–638. https://doi.org/10.1177/0143034307085662

Limber, S. P. (2004). “Implementation of the Olweus Bullying Prevention Program in American Schools: Lessons Learned from the Field.” In Bullying in American Schools: A Social-Ecological Perspective on Prevention and Intervention, edited by Dorothy L. Espelage and Susan M. Swearer, 351–63. Mahwah, NJ: Lawrence Erlbaum Associates.

Schroeder, B. A., Messina, A., Schroeder, D., Good, K., Barto, S., Saylor, J., & Masiello, M. (2012). The Implementation of a Statewide Bullying Prevention Program: Preliminary Findings From the Field and the Importance of Coalitions. Health Promotion Practice, 13(4), 489–495. https://doi.org/10.1177/1524839910386887

Training Active Bystanders

Gubin, A., & Habib, D. (2007).  Executive Summary: Program Evaluation and Research Findings. Training Active Bystanders. 1-10.

Quabbin Mediation (2018). Training Active Bystanders Pioneer Regional School: Quantitative and Qualitative Assessment Data. Training Active Bystanders. 1-5.

PATHS

Averdijk, M., Zirk-Sadowski, J., Ribeaud, D., & Eisner, M. (2016). Long-term effects of two childhood psychosocial interventions on adolescent delinquency, substance use, and antisocial behavior: A cluster randomized controlled trial. Journal of Experimental Criminology, 12, 21-47.

Burcu, T. (2012). Social Competence and Promoting Alternative Thinking Strategies - PATHS® Preschool Curriculum* Educational Sciences: Theory & Practice - 12(4) • Autumn • 2691-2698. Educational Consultancy and Research Center. www.edam.com.tr/estp

Kam, C. M., Greenberg, M. T., & Walls, C. T. (2003). Examining the role of implementation quality in school-based prevention using the PATHS® curriculum. Prevention Science, 4, 55-63.

Coaching Boys into Men

Miller, E., Tancredi, D. J., McCauley, H. L., Decker, M. R., Virata, M. C., Anderson, H. A., Stetkevich, N., Brown, E. W., Moideen, F., & Silverman, J. G. (2012). "Coaching boys into men": a cluster-randomized controlled trial of a dating violence prevention program. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 51(5), 431–438. https://doi.org/10.1016/j.jadohealth.2012.01.018

Miller, E., Tancredi, D. J., McCauley, H. L., Decker, M. R., Virata, M., Anderson, H. A., O'Connor, B., & Silverman, J. G. (2013). One-year follow-up of a coach-delivered dating violence prevention program: a cluster randomized controlled trial. American journal of preventive medicine, 45(1), 108–112. https://doi.org/10.1016/j.amepre.2013.03.007

Miller, E., Jones, K. A., Ripper, L., Paglisotti, T., Mulbah, P., & Abebe, K. Z. (2020). An Athletic Coach-Delivered Middle School Gender Violence Prevention Program: A Cluster Randomized Clinical Trial. JAMA pediatrics, 174(3), 241–249. https://doi.org/10.1001/jamapediatrics.2019.5217

Dating Matters

DeGue, S., Niolon, P.H., Estefan, L.F., Tracy, A.J., Le, V.D., Vivolo-Kantor, A.M., Little, T.D., Latzman, N.E., Tharp, A., Lang, K.M., & Taylor, B. (2020). Effects of Dating Matters® on Sexual Violence and Sexual Harassment Outcomes Among Middle School Youth: A Cluster-Randomized Controlled Trial. Prevention Science, advance online publication.

Estefan, L. F., Vivolo-Kantor, A. M., Niolon, P. H., Tracy, A. J., Little, T. D., DeGue, S., Le, V. D., Latzman, N., Tharp, A. T., Lang, K. M., & McIntosh, W. L. (2020). Effects of the Dating Matters® Comprehensive Prevention Model on Delinquent Behaviors in Middle School Youth: A Cluster-Randomized Controlled Trial. Prevention Science, advance online publication.

Niolon, P.H., Vivolo-Kantor, A.M., Tracy, A., Latzman, N.E., Little, T.D., DeGue, S., Lang, K.M., Estefan, L.F., Ghazarian, S. R., McIntosh, W. L., Taylor, B., Johnson, L., Kuoh, H. Burton, T., Fortson, B., Mumford, E. A., Nelson, S., Joseph, H. Valle, L. A. & Tharp, A.T. (2019). An RCT of Dating Matters: Effects on Teen Dating Violence and Relationship Behaviors. American Journal of Preventive Medicine. 57(1) 13-23. 

Our Whole Lives

Charis R. Davidson, Gabrielle M. Turner-McGrievy, DeAnne K. Hilfinger Messias, Daniela B. Friedman, Alyssa G. Robillard. (2019) A Pilot Study Examining Religious Organization Affiliation, Sexual Health Information Sources, and Sexual Behaviors Among College Students. American Journal of Sexuality Education 14:1, 32-54.

Virginia Sexual and Domestic Violence Action Alliance (2011). Healthy sexuality for sexual violence prevention: A report on promising curriculum-based approaches. Virginia Healthy Sexuality Workgroup. 6-10.

Multi-Systemic Treatment

Butler, S., Baruch, G., Hickey, N., & Fonagy, P. (2011). A randomized controlled trial of multisystemic therapy and a statutory therapeutic intervention for young offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 50(12), 1220–35.e2. https://doi.org/10.1016/j.jaac.2011.09.017

Timmons-Mitchell, J., Bender, M. B., Kishna, M. A., & Mitchell, C. C. (2006). An independent effectiveness trial of multisystemic therapy with juvenile justice youth. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 35(2), 227–236. https://doi.org/10.1207/s15374424jccp3502_6

Zajac, K., Randall, J., & Swenson, C. C. (2015). Multisystemic Therapy for Externalizing Youth. Child and adolescent psychiatric clinics of North America, 24(3), 601–616. https://doi.org/10.1016/j.chc.2015.02.007

Healthy Divorce

Sbarra, D. A., Smith, H. L., and Matthias, R. M. (2012). When leaving your ex, love yourself: Observational ratings of self-compassion predict the course of emotional recovery following marital separation. Psychological Science, 23(3): 261-269.

Shaw, L.A. (2010). Divorce mediation outcome research: A meta-analysis. Conflict Resolution Quarterly, 27(4): 447-467

Kelly, J.B. (2012). Risk and Protective Factors Associated with Child and Adolescent Adjustment Following Separation and Divorce. In K. Kuehnle and L. Drozd (Eds.), Parenting Plan Evaluations: Applied Research for the Family Court (49-84). New York, Oxford University Press

Group Treatment for Trauma

Nisbet Wallis, D. A. (2002). Reduction of Trauma Symptoms Following Group Therapy. Australian & New Zealand Journal of Psychiatry, 36(1), 67–74. https://doi.org/10.1046/j.1440-1614.2002.00980.x

Saltzman, W. R., Pynoos, R. S., Layne, C. M., Steinberg, A. M., & Aisenberg, E. (2001). Trauma- and grief-focused intervention for adolescents exposed to community violence: Results of a school-based screening and group treatment protocol. Group Dynamics: Theory, Research, and Practice, 5(4), 291–303. https://doi.org/10.1037/1089-2699.5.4.291 

Sloan, D. M., Feinstein, B. A., Gallagher, M. W., Beck, J. G., & Keane, T. M. (2013). Efficacy of group treatment for posttraumatic stress disorder symptoms: A meta-analysis. Psychological Trauma: Theory, Research, Practice, and Policy, 5(2), 176–183. https://doi.org/10.1037/a0026291

Pennsylvania Coalition Against Domestic Violence

Lyon, E. (2002). Welfare and domestic violence against women: Lessons from research. Harrisburg, PA: National Resource Center on Domestic Violence.

O'Keefe, M., (2005) Teen dating violence: A review of risk factors and prevention efforts. VAWnet, a project of the National Resource Center on Domestic Violence, Harrisburg, PA.

Prolonged Exposure

Eftekhari, A., Ruzek, J. I., Crowley, J. J., Rosen, C. S., Greenbaum, M. A., & Karlin, B. E. (2013). Effectiveness of national implementation of prolonged exposure therapy in Veterans Affairs care. JAMA psychiatry, 70(9), 949–955. https://doi.org/10.1001/jamapsychiatry.2013.36

Goodson, J. T., Lefkowitz, C. M., Helstrom, A. W., & Gawrysiak, M. J. (2013). Outcomes of Prolonged Exposure therapy for veterans with posttraumatic stress disorder. Journal of traumatic stress, 26(4), 419–425. https://doi.org/10.1002/jts.21830

Powers MB, Halpern JM, Ferenschak MP, et al. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK79056/

Family Therapy

Liddle, H. A. (2010). Treating adolescent substance abuse using multidimensional family therapy. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (pp. 416–432). The Guilford Press.

Rowe, C.L. (2012), Family Therapy for Drug Abuse: Review and Updates 2003–2010. Journal of Marital and Family Therapy, 38: 59-81. https://doi.org/10.1111/j.1752-0606.2011.00280.x

Substance Abuse and Mental Health Services Administration (2013) Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction. Brochure

Ombudsman program

Estes, C. L., Lohrer, S. P., Goldberg, S., Grossman, B. R., Nelson, M., Koren, M. J., & Hollister, B. (2010). Factors Associated With Perceived Effectiveness of Local Long-Term Care Ombudsman Programs in New York and California. Journal of Aging and Health, 22(6), 772–803. https://doi.org/10.1177/0898264310366737

Hollister, B. A., & Estes, C. L. (2013). Local Long-Term Care Ombudsman Program Effectiveness and the Measurement of Program Resources. Journal of Applied Gerontology, 32(6), 708–728. https://doi.org/10.1177/0733464811434144

National Caregiver Support Program

Giunta, N. (2010). The National Family Caregiver Support Program: A Multivariate Examination of State-Level Implementation, Journal of Aging & Social Policy, 22:3, 249-266, DOI: 10.1080/08959420.2010.485523

Zebrak, K. A., & Campione, J. R. (2021). The Effect of National Family Caregiver Support Program Services on Caregiver Burden. Journal of applied gerontology : the official journal of the Southern Gerontological Society, 40(9), 963–971. https://doi.org/10.1177/0733464819901094

Depression in Older Adults

Frazer, C. J., Christensen, H., & Griffiths, K. M. (2005). Effectiveness of treatments for depression in older people. Medical Journal of Australia, 182(12):627–632.

Substance Abuse and Mental Health Services Administration (2011). The Treatment of Depression in Older Adults: Selecting Evidence-Based Practices For Treatment of Depression in Older Adults. HHS Pub. No. SMA-11-4631, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

Wilson, K. C., Mottram, P. G., & Vassilas,C. A. (2008). Psychotherapeutic treatments for older depressed people. Cochrane Database of Systematic Reviews (1), CD004853

Substance Use in Older Adults

Kuerbis, A., Sacco, P., Blazer, D. G., & Moore, A. A. (2014). Substance abuse among older adults. Clinics in Geriatric Medicine, 30(3), 629–654

Kuerbis A. (2020). Substance Use among Older Adults: An Update on Prevalence, Etiology, Assessment, and Intervention. Gerontology, 66(3), 249–258. https://doi.org/10.1159/000504363

Substance Abuse and Mental Health Services Administration (2020). Treating Substance Use Disorder in Older Adults. Treatment Improvement Protocol (TIP) Series No. 26, SAMHSA Publication No. PEP20-02-01-011. Rockville, MD: Substance Abuse and Mental Health Services Administration


TO FIND EFFECTIVE TREATMENT SERVICES click here


What Can We Do About It Resources


Example of Policies that Can Help


No Hit ZONES

https://www.apsac.org/nohitzone

Mental Health Student Services Act

https://www.paloaltoonline.com/news/2019/08/02/state-launches-50m-program-for-school-based-mental-health


https://www.samhsa.gov/about-us/who-we-are/laws-regulations

https://www.samhsa.gov/sites/default/files/samhsa-behavioral-health-integration.pdf

https://www.ncbi.nlm.nih.gov/books/NBK424848/

http://indianacouncil.org/sites/default/files/resources/LessonsLearned.pdf


Examples of Public Policies that Can Harm

https://www.npr.org/sections/thetwo-way/2017/02/22/514988040/key-moments-in-the-dakota-access-pipeline-fight


TO LEARN HOW YOU CAN HELP PREVENT VIOLENCE click here

This is funded with PA Tax dollars.  The opinions, findings and conclusions expressed within this publication are those of the author(s) and do not necessarily reflect the views of PCCD.