BEN SAUNDERS: Violence in the home and violence against children at the hands of caregivers is one of the most serious types of violence that kids can experience. MICHAEL DE ARELLANO: When children don’t receive services for trauma-related problems, we know that they are at greater risk for being re-victimized and for other types of problems, so it’s very important that we provide to kids that we serve the best possible treatment. YAMEIKA HEAD: Here at the Medical Center in Central Georgia, we see children that have been maltreated– so, physical abuse, neglect and sexual abuse kids. A pediatrician just has to realize that when they see things that they need to take note of things. You know, this doesn’t look right or that story doesn’t sound right. So, Christian, how did you get these? They have to be proactive. BEN SAUNDERS: There are many bad things that happen in the lives of children that are not necessarily traumatic. When we say traumatic, we mean that there is a threat either to the life, the health, physical integrity of a child in a way that it very likely raises fear and anxiety. YAMEIKA HEAD: These abused children usually have some emotional problems, so we need good mental health people to deal with the aftermath. The child has to be able to express themselves and be able to talk through their feelings. MICHAEL DE ARELLANO: There’s no one set profile for how kids respond to traumatic events. It’s important to keep in mind that not every child who experiences a traumatic event necessarily has long-standing problems. So the key is to do a real clear assessment. JIM HENRY: Moving into foster care. And when did that happen? MICHAEL DE ARELLANO: We know there’s a cumulative effect of trauma. The more traumatic events a child experiences, the harder it is to deal with subsequent events. BEN SAUNDERS: Children that have been exposed to violence oftentimes have difficulty processing emotion. They have difficulty processing things cognitively as well. This translates into difficult and sometimes dysfunctional behavior for them. YAMEIKA HEAD: We know from studies that children that have been physically abused are more aggressive, they have more school problems, they have poor social interactions. BEN SAUNDERS: We now have a variety of interventions that have a significant threshold of empirical research, demonstrating that they actually work with kids who have been victimized– kids from all ethnic backgrounds, kids from all sorts of families, all areas of the country. One of the hardest things that we have to deal with in the child victim world is: How do we put a child in contact with a trained therapist? MICHAEL DE ARELLANO: When law enforcement is coming into contact with these children, when guardians ad litem, when child protective services– all these different organizations that deal with children who have been violence exposed– they really need to be trained to provide appropriate referrals for evidence-based treatments. CINDY LEDERMAN: The harm that had been inflicted on this young boy was horrendous. From the moment a child comes into the child welfare system, into our courts, we focus like a laser on that child, what that child’s needs are. We try to use research and science to anticipate what some of the problems will be. For example, if this is a very young child, one to three, we know from the research that they have four to five times greater chance of having a developmental delay than children in the general population. We’ve set up a system of care once we identify the problem, to treat it and follow up to make sure that the child gets the treatment– developmentally, psychologically, emotionally and physically, as well. BEN SAUNDERS: We really use a variety of different evidence-based interventions with the kids we see. Probably the most common one we use is Trauma-Focused Cognitive Behavioral Therapy. MICHAEL DE ARELLANO: TF-CBT is really a very flexible type of treatment that can be adapted to different types of trauma problems, to different types of ethnic groups, you can integrate cultural constructs into it. CINDY LEDERMAN: Child-parent psychotherapy is one of the evidence-based practices that we have incorporated into our Miami Child Well-Being Court. It’s an amazing intervention. We have moms who come to us in our court who do not know that they should smile at their baby. They do not know that when their baby cries, they should pick their baby up. They think that is spoiling the baby. If there is a way to stop the intergenerational transmission of child maltreatment, this is it. BEN SAUNDERS: Virtually all effective interventions for children exposed to violence involve parents, caregivers, or other folks who are in charge of taking care of this child. YAMEIKA HEAD: When children don’t deal with their abuse issues, they have problems later on in life– a lot of physical things, emotional things. There’s a very important study that’s called the ACE Study about the adverse childhood experiences with abuse and violence. And it has shown that those people that have been exposed to that have high blood pressure, diabetes, heart problems, depression. So we know that we need to take care of those children that have been abused and maybe that can help with preventing those adulthood diseases that will affect them later on in life. BEN SAUNDERS: Coming up with new, creative ways of spreading evidence-based services so that every victimized child in every corner of the country has access to the effective interventions that they need is our biggest challenge in the field right now.