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IPV is when a person hurts or threatens their significant other. (You might already understand this form of trauma as "domestic violence".) This can be physical violence, harsh words, controlling, or isolating the partner. The problem stems from the home, but it spreads much further, and it is much more common than generally thought. When kids see or experience IPV, they feel fear, deal with nightmares, or they completely disassociate and lose focus on reality. Often, the problem persists into adulthood and becomes aggressiveness, anxiety, or misdirection. It is important to address this problem by providing kids affected by this trauma with loving and caring adults that can help them heal.

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This article explores the types, signs, causes, and impact of intimate partner violence, also known as domestic violence.

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Definition:
Child sexual abuse is any interaction between a child and an adult (or another child) in which the child is used for the sexual stimulation of the perpetrator or an observer. Sexual abuse can include both touching and non-touching behaviors.

Difference between sexual abuse and sextual Assault:

Abusers often do not use physical force, but may use play, deception, threats, or other forms of coercion to engage children and maintain their silence.

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Sex trafficking is the recruitment, transportation, transfer, harboring or receipt of persons who under threat, force, coercion, fraud, deception or abuse of power are sexually exploited for the financial gain of another.

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Physical abuse is defined by the NPSCC as anytime "someone hurts a child or young person on purpose." Physical abuse can take many forms, and has an incredibly negative impact on childhood cognitive development.

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Complex trauma describes both children’s exposure to multiple traumatic events—often of an invasive, interpersonal nature—and the wide-ranging, long-term effects of this exposure. These events are severe and pervasive, such as abuse or profound neglect

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The National Child Traumatic Stress Network

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Complex trauma describes both children's exposure to multiple traumatic events-often of an invasive, interpersonal nature-and the wide-ranging, long-term effects of this exposure. These events are severe and pervasive, such as abuse or profound neglect. They usually occur early in life and can disrupt many aspects of the child's development and the formation of a sense of self. Since these events often occur with a caregiver, they interfere with the child's ability to form a secure attachment. Many aspects of a child's healthy physical and mental development rely on this primary source of safety and stability.

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Complex trauma describes both children's exposure to multiple traumatic events-often of an invasive, interpersonal nature-and the wide-ranging, long-term effects of this exposure. These events are severe and pervasive, such as abuse or profound neglect.

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Complex PTSD  can occur after prolonged and repeated trauma, particularly due to child abuse or domestic violence. Trauma can cause problems with memory and disrupt the development of a person's identity and their ability to control emotions and form relationships with others.

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Six Core Components of Complex Trauma Intervention
1. Safety:
The installation and enhancement of internal and environmental safety.
2. Self-regulation:
Enhancement of the capacity to modulate arousal and restore equilibrium
following dysregulation across domains of affect, behavior, physiology,
cognition (including redirection of dissociative states of consciousness),
interpersonal relatedness and self-attribution.
3. Self-reflective information processing:
Development of the ability to effectively engage attentional processes
and executive functioning in the service of construction of self-narratives,
refl ection on past and present experience, anticipation and planning, and
decision making.
4. Traumatic experiences integration:
The transformation, incorporation, or resolution of traumatic memories,
reminders and associated psychiatric sequelae into a nondebilitating,
productive, and fulfi lling existence through such therapeutic strategies
as meaning-making, traumatic memory containment or processing,
remembrance and mourning of the traumatic loss, symptom management
and development of coping skills, and cultivation of present-oriented thinking
and behavior.
5. Relational engagement:
The repair, restoration or creation of effective working models of attachment,
and the application of these models to current interpersonal relationships,
including the therapeutic alliance, with emphasis on development of such
critical interpersonal skills as assertiveness, cooperation, perspective-taking,
boundaries and limit-setting, reciprocity, social empathy, and the capacity for
physical and emotional intimacy.
6. Positive affect enhancement:
The enhancement of self-worth, esteem and positive self-appraisal through
the cultivation of personal creativity, imagination, future orientation,
achievement, competence, mastery-seeking, community-building and the
capacity to experience pleasure.

Resource:
[https://bpb-us-e1.wpmucdn.com/sites.northwestern.edu/dist/f/1961/files/2022/08/Complex-trauma-in-children.pdf]

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Overview

Losing a loved one is one of the most distressing and, unfortunately, common experiences people face. Most people experiencing normal grief and bereavement have a period of sorrow, numbness, and even guilt and anger. Gradually these feelings ease, and it's possible to accept loss and move forward.

For some people, feelings of loss are debilitating and don't improve even after time passes. This is known as complicated grief, sometimes called persistent complex bereavement disorder. In complicated grief, painful emotions are so long lasting and severe that you have trouble recovering from the loss and resuming your own life.

Different people follow different paths through the grieving experience. The order and timing of these phases may vary from person to person:

Accepting the reality of your loss

Allowing yourself to experience the pain of your loss

Adjusting to a new reality in which the deceased is no longer present

Having other relationships

These differences are normal. But if you're unable to move through these stages more than a year after the death of a loved one, you may have complicated grief. If so, seek treatment. It can help you come to terms with your loss and reclaim a sense of acceptance and peace.

Products & Services

Symptoms

During the first few months after a loss, many signs and symptoms of normal grief are the same as those of complicated grief. However, while normal grief symptoms gradually start to fade over time, those of complicated grief linger or get worse. Complicated grief is like being in an ongoing, heightened state of mourning that keeps you from healing.

Signs and symptoms of complicated grief may include:

Intense sorrow, pain and rumination over the loss of your loved one

Focus on little else but your loved one's death

Extreme focus on reminders of the loved one or excessive avoidance of reminders

Intense and persistent longing or pining for the deceased

Problems accepting the death

Numbness or detachment

Bitterness about your loss

Feeling that life holds no meaning or purpose

Lack of trust in others

Inability to enjoy life or think back on positive experiences with your loved one

Complicated grief also may be indicated if you continue to:

Have trouble carrying out normal routines

Isolate from others and withdraw from social activities

Experience depression, deep sadness, guilt or self-blame

Believe that you did something wrong or could have prevented the death

Feel life isn't worth living without your loved one

Wish you had died along with your loved one

When to see a doctor

Contact your doctor or a mental health professional if you have intense grief and problems functioning that don't improve at least one year after the passing of your loved one.

If you have thoughts of suicide

At times, people with complicated grief may consider suicide. If you're thinking about suicide, talk to someone you trust. If you think you may act on suicidal feelings, call 911 or your local emergency services number right away. Or contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

Causes

It's not known what causes complicated grief. As with many mental health disorders, it may involve your environment, your personality, inherited traits and your body's natural chemical makeup.

Risk factors

Complicated grief occurs more often in females and with older age. Factors that may increase the risk of developing complicated grief include:

An unexpected or violent death, such as death from a car accident, or the murder or suicide of a loved one

Death of a child

Close or dependent relationship to the deceased person

Social isolation or loss of a support system or friendships

Past history of depression, separation anxiety or post-traumatic stress disorder (PTSD)

Traumatic childhood experiences, such as abuse or neglect

Other major life stressors, such as major financial hardships

Complications

Complicated grief can affect you physically, mentally and socially. Without appropriate treatment, complications may include:

Depression

Suicidal thoughts or behaviors

Anxiety, including PTSD

Significant sleep disturbances

Increased risk of physical illness, such as heart disease, cancer or high blood pressure

Long-term difficulty with daily living, relationships or work activities

Alcohol, nicotine use or substance misuse

Prevention

It's not clear how to prevent complicated grief. Getting counseling soon after a loss may help, especially for people at increased risk of developing complicated grief. In addition, caregivers providing end-of-life care for a loved one may benefit from counseling and support to help prepare for death and its emotional aftermath.

Talking. Talking about your grief and allowing yourself to cry also can help prevent you from getting stuck in your sadness. As painful as it is, trust that in most cases, your pain will start to lift if you allow yourself to feel it.

Support. Family members, friends, social support groups and your faith community are all good options to help you work through your grief. You may be able to find a support group focused on a particular type of loss, such as the death of a spouse or a child. Ask your doctor to recommend local resources.

Bereavement counseling. Through early counseling after a loss, you can explore emotions surrounding your loss and learn healthy coping skills. This may help prevent negative thoughts and beliefs from gaining such a strong hold that they're difficult to overcome.

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Losing a loved one is one of the most distressing and, unfortunately, common experiences people face. Most people experiencing normal grief and bereavement have a period of sorrow, numbness, and even guilt and anger. Gradually these feelings ease, and it's possible to accept loss and move forward.

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In addition to the powerful emotional effects, there are also a number of serious physical symptoms of grief. Many people mistakenly believe that grief is a single emotion, but normal grief is actually a powerful, multifaceted, and often uncontrollable response that human beings experience following a personally painful or traumatic event, such as the death of a loved one.

Grief can affect us not only emotionally but also physically, mentally, and even spiritually. When you are experiencing grief, you may feel it both mentally and physically. During this time, you may experience a variety of physical symptoms that are part of the normal grief response.

This article discusses some of the physical symptoms of grief and describes some of the strategies that you can use to cope.

Digestive Problems and Weight Changes

Digestive problems and weight changes are common physical symptoms of grief. Often connected with the disruption to normal eating habits or routines, bereavement can cause temporary digestive problems such as constipation, diarrhea, stomach pain, a "hollow feeling" in the stomach, queasiness, or feeling nauseated.

Changes in weight are also common. In the days, weeks, and months following a death, many people often gain a few pounds. Lack of exercise, lack of personal care, overeating, eating out more often, and eating more junk food can play a role in weight changes. Isolation from loved ones who might otherwise encourage healthier or more consistent eating habits can also be a contributing factor.

It's also true that when grieving, many people "under eat," fail to eat regular meals, or simply eat nothing at all. Particularly during the first several days or first weeks following the death, mourners tasked might find the myriad of necessary details and decisions-as well as the influx of relatives and friends-distracting and simply forget to eat, or to eat on a regular schedule.

Recap

Pain, Discomfort, or Illness

The experience of grieving a death can induce other physical symptoms of grief including genuine feelings of pain or discomfort, such as headaches or migraines, chest pain, heaviness in the limbs, aches in the neck, back, or skeletal joints, or overall muscular pain.

One study found that people already at high cardiovascular risk might experience an increased risk of a heart attack in the days following the death of a significant person.

The stress of losing a loved one and the subsequent grief can reduce or suppress the immune system, making you more susceptible to viruses and infections. In addition, people with an existing chronic health condition might experience a worsening of their symptoms.

Research has also shown that grief is linked to increased levels of inflammation in the body. Inflammation is a predictor of cardiovascular issues, other illnesses, and increased mortality.

Sleep Problems

Sleeping issues are also common physical symptoms of grief. Insomnia can deprive a grieving individual of the necessary recuperative benefits of a good night's sleep. This lack of sleep can affect appearance, such as creating puffiness in the face and eyes. A lack of adequate sleep due to grief often affects physical coordination, cognitive function, and blood pressure.

While sleep is an essential daily human function, sleeping for too many hours at a time, or throughout the day, can actually sap your energy and leave you feeling lethargic.

Sleeping offers a refuge that often helps mourners temporarily escape the pain of grief. Regardless of whether a grieving person naturally sleeps too long or chooses to take extra naps, they may feel less than refreshed after too many hours of slumber.

Recap

Difficulty With Daily Activities

Physical symptoms of grief can make it difficult to cope with daily activities. For example, you may experience symptoms of fatigue or nervousness that make it challenging to manage normal tasks.

Feeling nervous or anxious often manifests itself in physical ways, such as tapping your fingers, pacing back and forth, fidgeting, an inability to sit and relax in one place for long, sweaty or clammy hands or feet, or feelings of tingling or numbness in those extremities.

Some mourners have also reported experiencing dry mouth, noise sensitivity, trembling or feeling shaky, tightness in the throat or chest, shortness of breath, and increased allergy symptoms.

What Is Complicated Grief?

Coping With Physical Symptoms of Grief

Unfortunately, there is no method to eliminate or avoid the physical symptoms of grief that you might experience after a loss. While difficult and often painful, grief is a normal and necessary response to the death of a loved one, and most people will see a reduction of grief-induced physical effects with the passage of time.

For some symptoms, such as stomach upset, over-the-counter medications may be helpful. Always take these medications as directed.

If any of the physical effects you're experiencing do not subside in time or feel unbearable, consult your physician or healthcare provider. This is particularly the case for pain or physical discomfort, digestive problems, illness or flu, or if an existing chronic health issue worsens.

The most important way you can help yourself while grieving is to take care of yourself and your needs. Many of the physical effects of grief arise from the failure to listen to our bodies and practice the healthy habits we otherwise might. Here are several important ways grievers can care for themselves.

Stay Hydrated

Drink plenty of water throughout the day and avoid excessive alcohol consumption. Alcohol acts as a diuretic and can actually dehydrate your body.

If you regularly exercised before the death of your loved one, try to continue that routine as much as possible. And if you led a sedentary lifestyle, consider finding some time to exercise each day, such as taking your dog for a walk, riding your bike, or asking a friend to stroll with you in the local park or shopping mall.

Even moderate daily exercise can help you sleep better, help work out some muscle stiffness or discomfort, and lift your spirits and improve your outlook.

Eat Nutritious, Nourishing Foods

Grievers often find it difficult to have a meal even if they feel like eating. At times like this, consider eating several smaller meals during the day if your schedule interferes with your usual breakfast, lunch, and dinner routine.

In addition, the foods you consume should consist of healthy, nourishing items. If you lack the time or energy to shop for groceries, consider asking a loved one to visit the market for you.

While grief typically disrupts our normal sleep patterns, getting proper rest is important. To whatever extent possible, try to develop a regular bedtime routine and schedule; minimize distractions, such as a television, iPad or tablet, or cell phone; and keep your bedroom dark. In addition, try to avoid caffeinated drinks for at least three hours before bedtime.

Making plans for the future and staying busy can also help with the physical pain of grief. Having things to do in the future can give you something to look forward to. Staying busy at the moment can help take your mind off of your discomfort and grief.

Recap

A Word From Verywell

People don't just experience grief on an emotional level; they also feel it on a physical one as well. These symptoms can be concerning at times, but it is important to recognize that the physical pain you feel is a normal part of the grieving process.

Many of these symptoms gradually resolve on their own with time. However, if they are causing serious impairment or lasting longer than you think they should, don't be afraid to talk to your healthcare provider.

Frequently Asked Questions

How long do the physical symptoms of grief last?

Many of the most intense physical symptoms of grief occur in the first few days and weeks after a loss. Others may last longer, but often gradually improve on their own as you begin to heal. Many people start to feel better within six to eight weeks and most grief symptoms largely resolve within one to two years.

What does grief do to your body?

The body goes through a variety of changes in response to grief. Loss triggers a flood of stress hormones that impact how the body's cardiovascular and immune systems function.

Grief can cause a variety of effects on the body including increased inflammation, joint pain, headaches, and digestive problems. It can also lower your immunity, making you more susceptible to illness. Grief also can contribute to cardiovascular problems, difficulty sleeping, and unhealthy coping mechanisms.

What are physical symptoms of grief in children?

Kids may display their symptoms somewhat differently than adults. Some of the physical symptoms a child may experience include headaches, stomachaches, problems sleeping, nightmares, and changes in appetite. Children may have a harder time describing what they are feeling or understanding the source of these symptoms.

Where do we hold grief in our body?

Grief affects the entire body, including the organs, skin, brain, and tissues. It can create issues with muscle tenion, sleeping difficulties, and affect how the brain and body process information and emotions. Grief can lead to physical pain and affect your body's ability to fight off illness.

What happens when you grieve too much?

Prolonged grief is a symptom of complicated grief, a mental health condition that can contribute to long-term challenges with health, well-being, and daily living. It can also lead to sleep problems, and an increased risk for medical problems including heart disease and cancer, anxiety, and post-traumatic stress disorder.

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How Grief Can Affect Different Parts of Your Body

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The physical symptoms of grief can take a serious toll on your body, literally making you sick. Learn about what grieving does to your body and how you can cope.

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Traumatic Grief: What it Is, Symptoms, and How to Cope

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Traumatic grief can happen after a sudden or unexpected loss. Learn about ways to cope here.

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Traumatic Grief: 10 Things to Know About World-Shattering Loss

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Traumatic Grief: 10 Things to Know About World-Shattering Loss

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Traumatic Grief: 10 Things to Know About World-Shattering Loss " Urns | Online

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What is traumatic grief, and how is it different from other kinds of grief? Learn more here about how trauma affects the grieving process.

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What Is Traumatic Grief Therapy?

Traumatic grief therapy is a type of treatment used to help people who have experienced the sudden death of a loved one. When a loved one passes away suddenly, the people left behind often experience traumatic grief. In order to deal with this intense kind of grief, therapy can be a helpful and healthy way to process painful emotions.

Jennifer R. Levin, PhD, a therapist who is an expert in thanatology (the study of death, dying, and bereavement), defines traumatic grief therapy as "therapy that simultaneously addresses the trauma response and grief associated with a traumatic death."

The goals of this form of therapy include emotional regulation, reduction of trauma symptoms, learning skills to cope and manage trauma, and processing losses associated with grief.

Types of Grief

Traumatic grief specifically takes place after a loved one passes away in a traumatic manner, and, as Levin says, "usually, but not always, in a sudden, unexpected manner."

Examples of death that might lead to traumatic grief include:

"Traumatic grief can also occur when an individual, who is a survivor, is involved in the incident that took a loved one's life, witnessed what happened, or found a deceased loved one," Levin says. Additionally, if someone needs to make difficult medical decisions regarding a loved one's care such as resuscitation or terminating life support, a trauma response can follow.

Techniques

Traumatic grief therapy is often tailored to address an individual's specific needs and symptoms. It may draw on various techniques, including:

Although everyone's traumatic grief therapy journey differs, Levin outlines some general techniques and steps you can expect throughout therapy.

Stabilization of Trauma

Stabilization is the step in which you and your therapist will develop a rapport and feeling of safety, with a focus on routine and structure so you can rebuild an environment in which your body will begin to trust again.

Jennifer R. Levin, PhD

We focus on how to regulate emotions, calm the nervous system, develop skills to self-regulate, and build a support system.

Process the Trauma

After you've built a solid foundation, you'll begin to process the trauma and grief using the skills learned in the first step. If you feel overwhelmed or experience trauma responses, Levin says that you'll stop and go back to earlier skills to "decrease symptoms" and "increase coping skills."

Later Grief Work

This step focuses on the continual processing of feelings associated with loss, living with the uncertainty of the trauma, grieving what has been lost, addressing what has been left undone, rewriting narratives, meaning-making, developing continual bonds, and facilitating post-traumatic growth. In this stage, participants can seek further treatment through individual therapy, group therapy, or both.

Press Play for Advice On Healing From Trauma

Hosted by Editor-in-Chief and therapist Amy Morin, LCSW, this episode of The Verywell Mind Podcast, featuring Kati Morton, LMFT, shares how to heal from trauma. Click below to listen now.

What Traumatic Grief Therapy Can Help With

Traumatic grief therapy is specifically designed to help people cope with the trauma of a sudden loss. There are two key signs that you may be specifically dealing with traumatic grief:

The trauma response that interacts with the grief

The shattering of your assumptive expectations that guide you in the world

Levin explains the details of these signs. First of all, she says, "The trauma response is what makes traumatic grief different from other forms of grief."

In some cases, a person may respond normally to an abnormal event. While everyone has different reactions to trauma, traumatic grief therapy can help people cope with different aspects of the response to trauma including:

Psychological/emotional responses

Cognitive responses

Physical responses

Behavioral responses

Trauma also upends some of the assumptions that keep you safe in the world, such as:

You and your loved ones are safe in the world (school, work, crossing the street, etc.)

You expect the world to be predictable and not random

You expect things to happen for a reason

You expect to be rewarded for your work

When these ideals are challenged with a sudden and painful loss, traumatic grief can challenge the very core of your belief system. Traumatic grief therapy can help restore normalcy and help you better process and understand the trauma and its effects.

There are several benefits associated with traumatic grief therapy. According to Levin, they include:

A decrease in symptoms

Increased coping mechanisms

An increased likelihood for post-traumatic growth

Continuing bonds with deceased

Ability to envision future possibilities

Continue living a meaningful life

"So many of my clients cannot envision continuing on without their loved one, especially when a spouse dies," Levin says.

While many clients are not suicidal after the sudden death of a loved one, they often show a lack of motivation or desire to engage with the world.

In her work, Levin has seen many people benefit from traumatic grief therapy. With time, patience, and the belief that life can improve, many go on to lead meaningful lives.

Effectiveness

Research suggests that therapy can be an effective tool for helping people manage the symptoms and experience of traumatic grief.

One 2015 study published in the European Journal of Psychotraumatology found that intervention with brief eclectic psychotherapy was effective for help people to cope with the symptoms of traumatic grief. Strategies used in this intervention included reviewing the traumatic event, finding meaning, writing assignments, and farewell rituals.

Another study found that a day treatment program designed to help people experiencing traumatic grief could also be effective. Such programs could potentially be helpful for people who have experienced natural disasters or war-related trauma.

Things to Consider

If you bottle your grief or pretend it doesn't exist, you may resist seeking out traumatic grief therapy, which can have a number of negative effects on your well-being.

Levin says that people may experience a "continuation or an increase of trauma symptoms, including rumination about details of the incident, flashbacks, nightmares, hypervigilance anxiety, and depression."

"You may be able to repress symptoms for the short term, but it will come back and cause bigger issues, or you will have multiple issues to address," Levin warns.

How to Get Started

If the trauma symptoms you're experiencing and/or the pain of grief are making it difficult for you to function in areas such as work, taking care of others, getting out of bed, or getting through the day-it's likely time to seek out traumatic grief therapy.

Talk to your doctor about the symptoms you have been experiencing and ask them to refer you to a mental health professional in your area who can provide this type of therapy. Some research also suggests that web-based options may be helpful for relieving symptoms associated with grief and bereavement, so you might also consider online therapy as an option.

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Traumatic grief therapy is a type of treatment used to help people who have experienced the sudden death of a loved one. When a loved one passes away suddenly, the people left behind often experience traumatic grief. In order to deal with this intense kind of grief, therapy can be a helpful and healthy way to process painful emotions.

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Factors that lead to child sextual abuse

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Factors that lead to child sextual abuse

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1.     Family neglect or lack of supervision:
It often occurs in some unhealthy families and disharmonious families. Due to parents' lack of care for their children, observation of abnormal behavior, and daily communication will create an environment where children are more likely to be abused.

2.     Social Isolation:
This tends to occur in more withdrawn, socially inept children who experience social isolation or lack of support around them. These children may be more vulnerable to abusers who give them attention, love and a sense of belonging Impact.

3.       Abilities or power imbalance: Perpetrators of child sexual abuse often seek to exploit their position of power and authority over children. This power imbalance can exist within families, communities, institutions, or other settings where adults have authority over children.

4.       Lack of Awareness:
Children may not fully understand the concept of sexual abuse or may lack awareness of inappropriate behavior. Abusers take advantage of this lack of awareness to manipulate and exploit children.

5.       Grooming:
An abuser may resort to deception in order to gain a child's trust and create an emotional bond. Grooming involves creating short-term or even long-term relationships with children and their families, creating opportunities for abuse while minimizing suspicion

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The strategies to ease traumatic stress from Sextual Abuse

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The strategies to ease traumatic stress from Sextual Abuse

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From classroom implementation, creating social and emotional safety environment in your classroom:

The common traits resulting from trauma caused by sexual abuse include a lack of security and issues with trust. Establishing a strong basis of social and emotional safety in the classroom becomes imperative to promote positive results and guarantee both physical and emotional well-being. Utilize strategies such as introducing classroom contracts, integrating curricula focused on anti-bullying or community building, promptly addressing conflicts and hurtful interactions, and actively instructing and displaying empathy and active listening skills. These actions collectively foster an environment conducive to learning and personal development.

From teachers’ perspective, increase teachers’ self-awareness and trauma competency:

Elevate teachers’ understanding of trauma from sextual abuse including symptoms and effects. To establish connections with students and their families to access relevant resources. Embrace strategies like pursuing professional development focused on interacting with specific identity groups, sharing supportive resources with fellow educators, establishing ties with community organizations, and consistently engaging in self-assessment and practice trauma-responsive approach.

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Different factors cause traumatic stress in children who have been sexually abused.

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Different factors cause traumatic stress in children who have been sexually abused.

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1. Negative Thoughts About Self, Others & The World
A negative change in the way someone sees or thinks about things. This may include thoughts of self-blame, guilt, or shame. Thoughts like "the world is not safe" are also common. This can lead to hopelessness about the future.

2. Feeling Detached from Family & Friends

Feeling isolated. They may avoid family or friends or feel a sense of disconnection. This can increase the general feelings of disconnection and loneliness that can occur after a traumatic event.

3.Mood Changes

Changes in mood may include a lack of interest in activities that were once enjoyable or ongoing feelings of sadness or hopelessness. It can also include difficulty experiencing positive emotions or feeling emotionally numb.

4.Irritable & Aggressive Behavior

A changeable mood involves irritable or angry than usual. One may find that everything is irritating them, or they may experience anger or even aggression.

5. Severe Anxiety

Experiencing heightened anxiety symptoms such as rapid heart rate, sweaty palms, or a feeling of panic.

6.Personality disorder,

Involve personality disorders, such as borderline personality disorder, characterized by patterns of instability and impulsivity.

7. Self-harm or suicidal behaviors:

Feelings of self-disgust, boredom with life, disinterest in people and surroundings, and a sense of disappointment can contribute to self-cutting behaviors and thoughts of suicide. These distressing feelings may arise in the aftermath of traumatic experiences.

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TRAUMA-FOCUSED THERAPY FOR CHILDHOOD SEXUAL ABUSE

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TRAUMA-FOCUSED THERAPY FOR CHILDHOOD SEXUAL ABUSE

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The Promise of Trauma-Focused Therapy for Childhood Sexual Abuse

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What it is:

It is a deliberate and unsolicited action with the intent of inflicting social, emotional, physical or psychological harm, often to those perceived as being less powerful. It is a form of aggression and harassment that prevents individuals from enjoying a safe environment.

How:

Bullying can be done through physical (hitting), verbal (name calling) and social (embarrassment, spreading rumors). Further bullying can be through the use of online or cyberbullying methods such as posting harmful images or messages to others.

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Effects:

Being bullied can affect individual’s self-image, social interactions or school performance which in turn can lead to mental health problems such as depression, anxiety and suicidal thoughts. Studies also suggest that bullying can lead to post traumatic stress disorder for those affected.

Symptoms:

Some symptoms that children might be affected by bullying include but not limited to;

Stress, anxiety, poor academic performance, self-injury, eating disorders, loneliness changes in sleep and school avoidance

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Complex Trauma (CPTSD) is a version of post-traumatic stress disorder that occurs due to prolonged abuse or multiple traumas. It involves stress responses, such as:

Anxiety.

Having flashbacks or nightmares.

Avoiding situations, places and other things related to the traumatic event.

Heightened emotional responses, such as impulsivity or aggressiveness.

Persistent difficulties in sustaining relationships.

Examples of chronic trauma include:

Long-term child physical or sexual abuse.

Long-term domestic violence.

Being a victim of human or sex trafficking.

War.

Frequent community violence.

While CPTSD is often associated with chronic trauma in childhood, adults who experience chronic trauma can also develop the condition.

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Exposure to intentional acts of interpersonal violence committed in public areas by individuals who are not intimately related to the victim. Acts of community violence include but are not limited to riots, sniper attacks, gang wars, drive-by shootings, bullying, workplace assaults, terrorist attacks, torture, bombings, war, ethnic cleansing, and widespread sexual, physical, and emotional abuse.

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Childhood Trauma: The Lives of the Neglected Children

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Children traumatized by community violence may experience a wide range of negative, long-term outcomes:

Psychological problems, including depression, anxiety, post-traumatic stress disorder, fear, guilt, isolation, shame, low self esteem or difficulties forming and maintaining relationships as an adult.

Physical problems, including eating disorders, sleep problems, poorer physical health, illnesses and self-injury.

Academic problems, including declines in academic performance and are more apt to dropout of high school.

Behavioral problems, including substance and alcohol abuse, bullying, physical fighting, teen pregnancy, aggression and violent behaviors.

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What is Medical Trauma and how does it cause to stress in learners?

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What is Medical Trauma and how does it cause to stress in learners?

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Medical trauma encompasses the psychological and emotional responses of children, which are more influenced by their subjective experience of an event rather than its objective severity. Reactions can vary in intensity and may either be adaptive or disruptive to their functioning. In general, the majority of pediatric patients and their families demonstrate resilience and effectively cope with medical trauma.

However, it is important to acknowledge that a significant percentage, up to 80%, of children and their families who have faced life-threatening illnesses, injuries, or painful medical procedures may experience traumatic stress reactions. Persistent traumatic stress symptoms can be experienced by approximately 20-30% of parents and 15-25% of children and siblings, negatively impacting their daily functioning, adherence to treatment, and overall recovery.

If these traumatic stress reactions persist, they can impair day-to-day functioning, affect adherence to medical treatment, and impede optimal recovery.

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How do Disasters Cause Traumatic Stress in Learners?

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How do Disasters Cause Traumatic Stress in Learners?

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Disasters can affect students even when they weren't directly affected. Children may experience feelings of fear and uncertainty due to the impact of disasters on their community, friends, or family. Disasters create uncertainty about the future and this can be distressing for students. In addition, natural disasters have an impact on daily routines which include school attendance amongst other things. This disruption in routines contributes to a sense of instability and anxiety for children who thrive on consistency. Some children may be experiencing feelings of loss or grief as they might have to deal with the passing of loved ones, homes or experience separation from families during disasters. These natural occurrences cast a heavy cloud over students, even if they weren't directly affected. Kids grapple with unsettling feelings of fear, not knowing what tomorrow might bring. The disruption in their daily routines adds to their anxiety, especially for those students who find comfort in consistency. As educators, our role is to recognize and address these emotional scars, offering a safe and caring space along with providing access to proper support systems.

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Acts of mass violence or community trauma, such as shootings or bombings, can deeply affect families and children. The degree of impact can vary based on the nature of the event and individuals' experiences during and after the incident. Some might be physically injured, requiring medical care and prolonged rehabilitation. Others may grapple with concerns about the safety of loved ones or grief over a loss. The reactions of children and teenagers can differ based on their age and past experiences. Recovery time can also vary significantly, depending on each individual's experiences. While some may gradually return to their usual routines, others may find it more challenging. Understanding and supporting the different responses that might emerge is crucial.

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Terrorism against children in schools (1970 - 2014)

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Terrorism against children in schools (1970 - 2014)

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Early childhood trauma refers to any distressing or harmful experiences that occur during the early years of a child's life(0-6), typically before the age of six. These traumatic events can include physical or sexual abuse, neglect, witnessing violence, experiencing natural disasters, or losing a loved one.

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Early childhood trauma refers to any distressing or harmful experiences that occur during the early years of a child's life(0-6), typically before the age of six. These traumatic events can include physical or sexual abuse, neglect, witnessing violence, experiencing natural disasters, or losing a loved one.

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The effects of early childhood trauma can be long-lasting and pervasive. They can impact a child's physical, emotional, cognitive, and social development. Some common effects of early childhood trauma include:

Emotional and psychological difficulties: Traumatized children may struggle with mental health disorders(PTSD) and regulating emotions, leading to mood swings or outbursts.

Cognitive impairments: Trauma can affect a child's cognitive abilities, such as attention, memory, and problem-solving skills. This can result in difficulties with learning and academic performance.

Traumatized children often struggle with social and relational challenges, such as trust issues, difficulty forming and maintaining healthy relationships, aggressive or withdrawn behavior, and emotional problems.

Childhood trauma can cause physical health problems like chronic illnesses, weakened immunity, and a higher risk of substance abuse or self-destructive behaviors.

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Getting shot or assaulted can change a young person’s life forever. But just living with chronic community violence can be enough to rob children of their sense of safety, putting them into “survival mode,” making them ready to gear up for fight or flight. Exposure to community violence can affect children’s outlook on the future and their sense of control.

Here are ways that youth have described the impact of community violence in their lives:

I don’t know who to trust anymore.

I’m on edge all the time, like something’s going to happen to me, and I can’t be caught off guard.

I’ll do anything to stay safe. That’s why I carry a gun or knife, like my friends do.

I don’t expect to graduate from school. I’ll probably die young anyway.

I worry most about my little brother and sister getting shot.

My friends say I’m different since the shooting.

Sometimes thoughts pop up in my head, and I’m right back to the night my world changed.

I’m more tempted to get drunk or high to numb it all.

I feel angry even when nobody is messing with me.

I get jumpy or nervous at the smallest things or little sounds.

I just can’t stop thinking about all the violence, how it’s never going to end.

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The National Child Traumatic Stress Network

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Getting shot or assaulted can change a young person's life forever. But just living with chronic community violence can be enough to rob children of their sense of safety, putting them into "survival mode," making them ready to gear up for fight or flight. Exposure to community violence can affect children's outlook on the future and their sense of control.

Here are ways that youth have described the impact of community violence in their lives:

I don't know who to trust anymore.

I'm on edge all the time, like something's going to happen to me, and I can't be caught off guard.

I'll do anything to stay safe. That's why I carry a gun or knife, like my friends do.

I don't expect to graduate from school. I'll probably die young anyway.

I worry most about my little brother and sister getting shot.

My friends say I'm different since the shooting.

Sometimes thoughts pop up in my head, and I'm right back to the night my world changed.

I'm more tempted to get drunk or high to numb it all.

I feel angry even when nobody is messing with me.

I get jumpy or nervous at the smallest things or little sounds.

I just can't stop thinking about all the violence, how it's never going to end.

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Getting shot or assaulted can change a young person's life forever. But just living with chronic community violence can be enough to rob children of their sense of safety, putting them into "survival mode," making them ready to gear up for fight or flight.

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1. Allow children the chance to share their experiences or their opinions with you. Encourage them to express their worries and make inquiries.

2. Allow children to be with you or another trustworthy adult who can make them feel secure, at ease, connected, and hopeful.

3. Limit their exposure to news coverage of the disaster and its aftermath. If they see or hear reminders of the accident, children who were directly affected by it may get sad once more.

4. Encourage students to take appropriate action in response to the disaster. They may be able to manage their emotions and regain control as a result. Children can for instance, volunteer to assist community people or family members in a secure setting following a disaster. Children shouldn't help with disaster cleanup efforts, especially very young ones.

Your Child is at Risk for Mental Health Issues After a Disaster

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Trauma-Informed Approach to Child Care and Early Education

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Interventions for Early Childhood Trauma 

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Interventions for Early Childhood Trauma 

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Interventions for early childhood trauma aim to mitigate the adverse effects and promote healing and resilience. Some effective interventions include:

TF-CBT(Trauma-Focused Cognitive Behavioral Therapy) helps children cope with trauma using cognitive restructuring, relaxation exercises, and trauma narrative work.

Play therapy is a safe and effective way to help children process their emotions and traumatic experiences. It uses play and creative activities to teach coping skills and improve emotional regulation. It's an excellent tool for children facing psychological challenges.

PCIT(Parent-child interaction therapy) focuses on improving the parent-child relationship and enhancing parenting skills. It helps parents provide a secure and nurturing environment for their child, promoting healthy attachment and reducing the impact of trauma.

Creating safe and stable environments in schools and communities can mitigate the impact of trauma. Consistent routines, positive role models, and supportive services contribute to a sense of security for those affected.

Early interventions for childhood trauma, such as home visiting, education programs, and community support, are most effective when implemented early on.

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Response strategies:

Educate:

-Help children understand what is bullying and what forms it takes.

-Send clear messages that school bullying is unacceptable and use consequences to teach bullies to build empathy

For those being bullied:

-Walk away and find help. If you leave the area this can defuse the situation

-If you are a bystander show that you do not appreciate the bullying behavior, or help to get the bullied person away without resorting to violence.

Teacher strategies:

-Listen to bullied children and provide advice or role-plays to help the student in knowing how to react in future situations

-work with other teachers, students or parents to resolve bullying disputes

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The amount of attacks has been increasing rapidly over the years.

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When you experience a traumatic event, it activates the limbic system in the brain. This “fire alarm” shuts down all nonessential systems (rest, digestion, sleep) and floods your body with stress hormones, like cortisol, so you can prepare for fight, flight, or freeze.

Once the danger passes, your parasympathetic nervous system provides inner calm, otherwise known as your “rest and digest” mode.

At this point, normal cognitive function returns, and you can go back to your day with relatively few side effects, perhaps only feeling a little jittery for a while, or a bit on edge.

But for people who live with complex trauma, this balance doesn’t quite return all the way.

The limbic system stays engaged most of the time. It’s a coping mechanism to try and stay safe in the face of ongoing adversity. It’s an experience of constantly being in survival mode, or on edge.

Over time, it becomes a “new normal” for the brain and body.

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Disaster Preparedness: The Key to An Effective Emergency Plan

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An interesting video on understanding trauma affects

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An interesting video on understanding trauma affects

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Understanding Trauma | Phoenix Australia

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Physical:
-Bruises
-Burn Marks
-Bite Marks
-Broken Bones
-Poisoning Effects
-Swelling
-Seizures

Non-Physical:
-Anxiety and Fear
-Behavioral Changes
-Avoidant Behavior
-Suicidal Thoughts

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How to implement trauma-informed care to build resilience to childhood trauma

https://www.childtrends.org/publications/how-to-implement-trauma-informed-care-to-build-resilience-to-childhood-trauma

Trauma in Children… and What we can do to help

https://www.seekfreaks.com/index.php/2017/11/27/trauma-in-children-and-what-we-can-do-to-help-2

Considerations for Trauma-Informed Child Care and Early Education Systems

https://www.acf.hhs.gov/opre/report/considerations-trauma-informed-child-care-and-early-education-systems

Trauma-Informed Strategies to Use in Your Classroom

https://resilienteducator.com/classroom-resources/trauma-informed-strategies

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Main types of traumatic stress reactions

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Main types of traumatic stress reactions

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There are three primary types of traumatic stress reactions that children may experience:

1. Re-experiencing: Re-experiencing involves persistent and intrusive thoughts about the trauma, even when the students consciously tries to avoid them. While some level of re-experiencing is considered normal and aids in the recovery process, excessive re-experiencing can be highly distressing. Students may have nightmares or "flashbacks" that make them feel as if they are reliving the traumatic event. They may also experience intense emotional distress or physical symptoms when triggered by reminders such as sights, sounds, or smells associated with the trauma.

2. Avoidance: Avoidance symptoms manifest as an attempt to evade thoughts about or discussions regarding the trauma or anything related to it. Students may actively avoid people, places, or activities that serve as reminders of the traumatic event. Consequently, they may develop new fears or worries. While it is reasonable for children to exercise caution after an injury, extreme avoidance or excessive fears can become problematic. Avoidance can interfere with daily life and prevent a student from engaging in activities they typically enjoy.

3. Hyper-arousal: Hyper-arousal stems from the body's natural "fight or flight" response to danger. Even after the immediate danger has passed, this response may persist in students. The student may constantly feel a sense of impending danger, as if something bad could happen at any moment. They may become easily startled or jumpy, particularly in response to loud noises. The physical sensations associated with hyper-arousal, such as a racing heart, can themselves be frightening.

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Coping with community violence has become more complicated since the onset of COVID-19. There has been a steady increase in mass violence in our country, with data from the CDC showing a 35% increase in gun homicides between 2019 and 2022 alone. This increase in mass violence can take a toll on our collective mental health, which is only compounded by the ever-present effects of COVID-19 and the associated loss of loved ones. Many may fear for their safety, especially as the warmth of the summer months draws us out of our homes and schools into public, community spaces. This is especially true for minority communities. Mass gun violence has a disproportionate effect on low-income, minority communities; Black, Hispanic, and American Indian/Alaska Native Americans are more likely to be victims of gun homicide than white Americans. Black individuals experience 20.3 gun deaths per every 100,000 people in the population, while Hispanic and American Indian/Alaska Native groups experience 4 gun deaths per 100,000 people. Compared to white individuals, who have 1.8-gun deaths per 100,000 people in the population, these differences are startling. Unfortunately, these minority groups have also seen the most severe effects of COVID-19. National Minority Mental Health Awareness Month serves as a reminder to ask ourselves: In midst of these many issues that disproportionately affect minority groups, what can be done to care for our mental health, support our loved ones, and keep each other safe?

Supporting the youth in our communities: There has been an 88 percent increase in gun violence on school grounds in the past 10 years. When children are exposed to this kind of violence at a young age, they are at an increased risk of experiencing post-traumatic stress disorder and substance use behaviors over the course of their lifetime. Community-based programs can provide useful resources and programs for children and youth to keep them safe and manage the stress of their environments. SAMHSA supports such programs, like Project ReCAST and the National Child Traumatic Stress Initiative, which assists youth and families in the wake of violence, civil unrest, and other traumatic stress issues by connecting them to trauma-informed behavioral health services.

Additionally, through the National Network to Eliminate Disparities in Behavioral Health (NNED), SAMHSA supportsPreventing Long-term Anger and Aggression in Youth (PLAAY), Familia Adelante, and Project Venture - three programs aimed to support youth experiencing behavioral health challenges by training community organizations in methods related to violence prevention and youth mental health.

Find healthy coping mechanisms: In hard times, it is important to engage in healthy coping mechanisms. It may feel easier to lean on certain substances to deal with the grief or anger that comes with violence and loss. However, substance use is a coping mechanism that increases the risk of negative health behaviors and outcomes in the future. Healthy coping methods may include becoming more involved with your communities and learning about ways to connect with local resources and services. Strong social support networks not only foster collective healing but can also increase healthy behaviors in the long term, especially for minority youth and adults. Communities are particularly important for minority individuals because their shared cultural experiences can offer great strength. Leaning on those with shared experiences, culture, or faith during these tough times can be critical for navigating the compounding stresses of the last few years. Furthermore, limiting certain forms of digital social media consumption and processing feelings with loved ones are other good ways to work through overwhelming feelings of loss. To access more culturally specific resources for minority individuals and communities of color visit the National Alliance on Mental Illness Identity and Cultural Dimensions resources.

Take advantage of behavioral health services: For the feelings we can't talk through with our loved ones, it is beneficial to seek out additional resources to protect our mental health. SAMHSA has a searchable database of behavioral health services that can be used to locate support throughout the country. Additional assistance can often be found through Employee Assistance Programs (EAP). Check to see if your employer offers EAP services and, if so, consider accessing those services when possible. For more urgent mental health struggles, the Disaster Distress Helpline and the 988 Suicide & Crisis Lifeline are both 24/7 resources. Engaging with mental health services can seem daunting at times, but it can provide us with the tools necessary to navigate the struggles we face individually and as a community. We recognize minority youth and adults often face unique barriers when using behavioral health services, including stigma and bias. When seeking care, it may be helpful to gauge a provider's sense of cultural competence and awareness to ensure you receive the best support possible. Behavioral health providers anticipate that they will receive questions from potential clients and are prepared to answer them. Questions you may ask include: Have you treated others with my racial or ethnic background? Have you received training on culturally competent care? Do you use a different approach for clients from various cultural backgrounds? These questions may help you identify whether a particular behavioral health service or provider is the right fit for you.

Disaster Distress Helpline: Call or text 1-800-985-5990 (for Spanish, press "2")

988 Suicide & Crisis Lifeline: Call or text 988 or chat 988lifeline.org

While dealing with violence can be challenging, we can find resilience in our communities and work together to keep each other safe. Please see the following resources for additional guidance.
Resources
1 https://www.cdc.gov/injury/about/timeline.html
2 https://www.ptsd.va.gov/professional/treat/type/violence_trauma_effects.asp
3 Psychological Impact of Mass Violence. (2017). The National Child Traumatic Stress Network. Retrieved 2022, from https://www.nctsn.org/resources/psychological-impact-mass-violence.
4 Kwon, R., Cabrera, J.F. Income inequality and mass shootings in the United States. BMC Public Health 19, 1147 (2019). https://doi.org/10.1186/s12889-019-7490-x
5 https://giffords.org/lawcenter/gun-violence-statistics/
6 https://everytownresearch.org/maps/gunfire-on-school-grounds/
7 Finkelhor, D., Turner, H.A., Ormrod, R.K., Hamby, S., & Kracke, K. (2009). Children's Exposure to Violence: A Comprehensive National Survey.
8 Stahl, S.T., & Schulz, R. (2014). Changes in routine health behaviors following late-life bereavement: a systematic review. Journal of Behavioral Medicine, 37(4), 736-755.
9 https://www.countyhealthrankings.org/explore-health-rankings/measures-data-sources/county-health-rankings-model/health-factors/social-and-economic-factors/family-social-support/social-associations
10 Hull, P., Kilbourne, B., Reece, M., Husaini, B. (2008). Community involvement and adolescent mental health: Moderating effects of race/ethnicity and neighborhood disadvantage. Journal of Community Psychology (36)4.
11 Berger Cardoso, J., Thompson S. (2018). Common themes of resilience among Latino immigrant families: A systematic review of the literature. Families in Society: The Journal of Contemporary Social Services
12 https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Black-African-American

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Coping with community violence has become more complicated since the onset of COVID-19. There has been a steady increase in mass violence in our country, with data from the CDC showing a 35% increase in gun homicides between 2019 and 2022 alone.1 This increase in mass violence can take a toll on our collective mental health2, 3, which is only compounded by the ever-present effects of COVID-19 and the associated loss of loved ones.

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Attacks can happen in every level of a school.

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In many cultures, violence has been used as a punishment towards women in the household. This is more often than not abused (not that it is excusable to be done at all in my personal opinion) and becomes a nasty habit for the man's aggression.

Socially, it can be hard to speak up about being the victim of IPV. People don't want to get involved in other people's business, and a cry for help often leads to repercussions and more violence in the household.

Household abuse is usually ignored by the law because it is considered private business. It usually isn't handled until it has become out of hand.

Stress and money are major factors, as they increase frustration and aggression in the household.

Addiction and other vices such as substance abuse play a major factor in IPV, as they are signs of instability of the mind.

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Physical Abuse of Children | EM:Prep LLSA Review

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What Symptoms will Students Experience in the Learning Environment as a Result of Disasters?

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What Symptoms will Students Experience in the Learning Environment as a Result of Disasters?

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Increased Anxiety: Children might become more fearful or easily startled. This can manifest as restlessness, fidgeting, or the inability to concentrate on lessons.

Emotional Distress: Disasters can trigger emotional distress, leading to mood swings, irritability, or tearfulness. Students might withdraw from classroom activities or experience emotional outbursts as a response to certain triggers.

Regressive Behavior: These types of behavior can involve clinging to caregivers, thumb-sucking, or bedwetting. In the classroom, regression may manifest as seeking excessive reassurance from teachers or displaying behaviors of typical younger children.

Academic Challenges: Living through disasters can impact a child's academic performance. Children might experience a decline in school performance, difficulty concentrating, forgetfulness, or a loss of interest in learning.

https://www.samhsa.gov/sites/default/files/srb-childrenyouth-8-22-18.pdf

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How the United Nations is preventing children from being recruited or exposed to terrorism

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How the United Nations is preventing children from being recruited or exposed to terrorism

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Complex trauma can arise in any situation where you feel an ongoing sense of fear, horror, helplessness, or powerlessness over an extended period of time, with the perceived or actual inability to escape.

It usually stems from trauma you experienced in childhood, though it can develop from trauma in adulthood as well.

Some possible causes of complex trauma include:

sexual abuse or incest

ongoing physical or emotional abuse

chronic neglect or abandonment

medical abuse or medical trauma

torture or being held captive

enmeshment or engulfment trauma

parentification (children taking on adult rules)

human trafficking

genocide campaigns

living in a war zone or area of civil unrest

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https://www.unodc.org/unodc/en/terrorism/expertise/children-associated-with-terrorism.html

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All Adults Should:

1. Model calm and control. Children take their emotional cues from the significant adults in their lives. Avoid appearing anxious or frightened.

2. Reassure children they are safe and (if true) so are the important adults and other loved ones in their lives. Depending on the situation, point out factors that help ensure their immediate safety and that of their community.

3. Remind them trustworthy people are in charge. Explain that emergency workers, police, firefighters, doctors, and the government are helping people who are hurt and are working to ensure that no further tragedies like this occur.

4. Let children know it is okay to feel upset. Explain all feelings are okay when a tragedy like this occurs. Let children talk about their feelings and help put them into perspective. Even anger is okay, but children may need help and patience from adults to assist them in expressing these feelings appropriately.

5. Tell children the truth. Don't try to pretend the event has not occurred or that it is not serious. Children are smart. They will be more worried if they think you are too afraid to tell them what is happening. At the same time it will be important to tell children that while the threat of terrorism is real, the chances they will be personally affected is low

6. Stick to the facts. Don't embellish or speculate about what has happened, or where another attack might occur. Don't dwell on the scale or scope of the tragedy, particularly with young children.

7. Be careful not to stereotype people or countries that might be associated with the violence. Children can easily generalize negative statements and develop prejudice. Talk about tolerance and justice versus vengeance. Stop any bullying or teasing immediately.

8. Keep your explanations developmentally appropriate. Early elementary school children need brief, simple information that should be balanced with reassurances that the daily structures of their lives will not change. Upper elementary and early middle school children will be more vocal in asking questions about whether they truly are safe. They may need assistance separating reality from fantasy. Upper middle school and high school students will have strong and varying opinions about the causes of violence and threats to safety in schools and society. They will share concrete suggestions about how to make school safer and how to prevent tragedies in society. They will be more committed to doing something to help the victims and affected community. For all children, encourage them to verbalize their thoughts and feelings. Be a good listener!

9. Maintain a "normal" routine. To the extent possible stick to normal classroom or family routines but don't be inflexible. Children may have a hard time concentrating on schoolwork or falling asleep at night.

10. Monitor or restrict exposure to scenes of the event as well as the aftermath. In particular, monitor exposure to social media. For older children, caution against accessing news coverage from only one source.

11. Observe children's emotional state. Depending on their age, children may not express their concerns verbally. Changes in behavior, appetite, and sleep patterns can also indicate a child's level of grief, anxiety or discomfort. Children will express their emotions differently. There is no right or wrong way to feel or express fear or grief.

12. Be aware of children at greater risk. Children who have a connection to this particular event, have had a past traumatic experience or personal loss, suffer from depression or other mental illness, or with special needs may be at greater risk for severe reactions than others. Be particularly observant for those who may be at risk of suicide. Seek the help of a mental health professional if you are at all concerned.

13. Provide an outlet for students' desire to help. Consider making get well cards or sending letters to the families and survivors of the tragedy, or writing thank you letters to doctors, nurses, and other health care professionals as well as emergency rescue workers, firefighters and police.

14. Keep lines of communication open between home and school. Schools are a good place for children to experience a sense of normalcy. Being with their friends and teachers is helpful. Schools should inform families about available resources, such as talking points or counseling, and plans for information sharing and discussions with students. Parents should let their child's teacher or school mental health professional know if they have concerns or feel their child may need extra support.

15. Monitor your own stress level. Don't ignore your own feelings of anxiety, grief, and anger. Talking to friends, family members, religious leaders, and mental health counselors can help. It is okay to let your children know you are sad, but that you believe things will get better. You will be better able to support your children if you can express your own emotions in a productive manner. Get appropriate sleep, nutrition, and exercise.

© 2015, National Association of School Psychologists, 4340 East West Highway, Suite 402, Bethesda, MD 20814, (301) 657-0270, Fax (301) 657-0275, www.nasponline.org

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Helping Victims of Mass Violence and Terrorism: Recovery

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Natural Disasters and Critical Thinking in the Classroom

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Natural Disasters and Critical Thinking in the Classroom

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Natural Disaster and Critical Thinking in the Classroom - Kim Lochner | The OC for Social Studies

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https://www.youtube.com/watch?v=64LNwrd0fHg

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Centers for Disease Control and Prevention (CDC)

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1. Talk to the student
Approaching the student with concern over what you have noticed is important in getting to the root of the issue. The student may or may not immediately open up, but establishing yourself as an advocate for the student will help them open up to you.

2. Raise the Alarm
Noticing physical abuse is something that you cannot keep to yourself. This information needs to be reported to the administration of your school as well Child Protective Services.

3. Follow Up
Following up with the student will help support them as the situation develops. Following up with your admin keeps them in the look and vice versa if there is any action being taken.
Following up with the student can depend on the behaviors they exhibit, and therefore, it is important to examine some response strategies to support students dealing with physical abuse.

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Managing the Impact of Trauma and Building Resilience for Families and Teachers:
Resilience, in the context of medical trauma, refers to the ability to recover from traumatic events. Here are some key points to consider:

1. Resilient students perceive themselves as safe, capable, and lovable.

2. Resilience is strengthened when students have at least one strong supportive relationship with a caring adult who recognizes and nurtures their abilities and strengths.

3. Students benefit from feeling a sense of control over their own lives and experiencing a sense of belonging within a larger community.

4. Engaging in activities that serve a cause can be healing for students who have experienced trauma.

5. Teachers can collaborate with families to establish routines as much as possible.

6. Parents should communicate openly and honestly with both the teacher and their child, providing step-by-step explanations of what to expect, addressing any concerns or worries about potential dangers.

7. Providing attention and ensuring a sense of safety for the child or student after trauma is crucial. Being available to listen and discuss their experiences and questions when they are ready to share is important.

8. Acting as a "reality check" for your child can help them confront reminders of the trauma, even when they may initially resist. Gradually facing their fears, they learn to recognize their own strength and resilience, resulting in decreased fear responses. Eventually, the trauma may no longer elicit a significant reaction.

By actively managing the impact of trauma and fostering resilience, both families and teachers play instrumental roles in supporting the healing process for students.

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UCSF Dept. of Psychiatry and Behavioral Sciences

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Initial distress among children and families in medical settings is common, expected, and understandable. Many families cope well, with support and with time. However, some may develop persistent traumatic stress reactions, which can impede health and psychosocial functioning.

What is Pediatric Medical Traumatic Stress?

Pediatric medical traumatic stress is "a set of psychological and physiological responses of children and their families to pain, injury, medical procedures, and invasive or frightening treatment experiences" - National Child Traumatic Stress Network, 2003

Traumatic stress reactions can include psychological and physiological symptoms of re-experiencing, avoidance, and hyper-arousal, as well as changes in thinking and mood. These reactions may include:

having unwanted and intrusive thoughts about what happened,

strongly avoiding things that are reminders of the event,

feeling numb or detached, blaming oneself or others, and

having trouble sleeping, eating, or concentrating.

When a constellation of these symptoms persists and causes distress, the individual may have Post-traumatic Stress Disorder (PTSD).

Children may have other kinds of reactions to illness and injury as well, including behavioral changes or symptoms of depression or anxiety.

Traumatic stress reactions are common in the aftermath of an injury, a scary new diagnosis, or a difficult medical event. When they persist, these reactions may get in the way of a child's or parent's everyday functioning and may warrant further attention.

Over the past several decades, a growing body of research has helped healthcare providers understand the development of traumatic stress reactions after a wide range of pediatric illness, injury, and medical experiences.

In the aftermath of a potentially traumatic event such as illness or injury, traumatic stress can be caused by a loss of a sense of personal safety, and by feelings of fear and helplessness. Children are especially vulnerable to the loss of safety that a medical experience may bring. Age and developmental stage impact how children understand illness, injury, and treatment, as well as their range of coping strategies.

What is traumatic about medical experiences?

Traumatic medical experiences are rarely a single event. All along the continuum of care, children and families in medical settings can experience multiple traumatic experiences (and things that will trigger feelings or remind them of those experiences).

A specific scary or shocking event (injury / initial diagnosis)

Pain / painful procedures

Treatment setbacks

Ongoing uncertainty about prognosis

The medical environment (hospital sights / sounds, etc.)

Sense of life threat (regardless of objective prognosis)

Separation from parents

Exposure to distress, pain, or death of others (e.g., other patients)

Reminders of past traumatic medical experiences

Physical limitations or impairment / visible changes in appearance

Research has shown that when a child is ill or injured, all family members can be affected - the ill or injured child, siblings, and parents. Research has also shown that children and parents may find different aspects of the experience traumatic.

Take-home message from the research data:

What counts in risk for traumatic stress is NOT the objective severity of the child's illness or injury, but the SUBJECTIVE experience of the child or parent.(Are they feeling scared or helpless? Do they think they might die?)
Read more about risk factors
How does traumatic stress affect child health outcomes?

Traumatic stress symptoms (including post-traumatic stress disorder - PTSD) are associated with worse health outcomes in children preschool through adolescence.

Unaddressed, these reactions can have serious implications for medical treatment and can represent a "hidden cost" to the health care system. Traumatic stress symptoms have been associated with:

poorer adherence with needed treatment and medication

adverse health outcomes

worse functional outcomes

Important Finding:

In a study of injured adolescents followed for 2 years post-injury, teens with more severe PTSD symptoms had lower health-related quality of life at each assessment point across the 2 years.

Research has suggested several possible mechanisms, including:

Biological effects: PTSD symptoms might lead to poorer medical outcome in ill or injured children because of physiological changes (i.e., increased heart rate, changes in stress response) associated with PTSD.

Impact of avoidance symptoms on adherence and follow-up care: PTSD symptoms might indirectly lead to poor medical outcome due to avoidance (for example, a child not taking prescribed medications because taking the meds has become a traumatic reminder).

Common underlying risk factors: PTSD symptoms may also be linked with poorer medical outcomes because of important associated features (i.e., prior trauma exposure, experiences of systemic racism) that hamper optimal recovery.

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Pediatric Medical Traumatic Stress - The Basics | Patient Centered Care and Trauma Informed Care for Pediatric Patients - HEALTHCARE TOOLBOX

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Initial distress among children and families in medical settings is common, expected, and understandable. Many families cope well, with support and with time. However, some may develop persistent traumatic stress reactions, which can impede health and psychosocial functioning.

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https://blog.cdphp.com/healthy-living/stop-bullying-strategies-preventing-responding-bullying/

https://www.adl.org/sites/default/files/10-Ways-to-Respond-to-Bullying.pdf

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According to government research, approximately 20 to 30 percent of school-aged children and young adults experience bullying. So how can you effectively address the issue and be an advocate for those affected? Moreover, what is the appropriate response if you are a bullying target or witness?

Strategies to Prevent Bullying

Bullying is a complex issue requiring multi-pronged prevention efforts and clear, consistent action and communication. For starters, the entire school community should be involved in creating and modeling a culture of respect and responsibility. Beyond that, it's important to be an active listener, encouraging kids to talk about their experiences and any concerns they may have.
Parents and teachers can also help by talking to kids directly about bullying and exploring the issue through role-playing. You might ask them: What does bullying mean to you? Do you know any bullies? What do you think motivates them? Have you ever experienced or seen bullying? What happened and how did you respond? Whom could you go to for help?

The goals of such a dialogue are to:

Help children understand what is bullying and what forms it may take.

Send a clear message that bullying is unacceptable and that no one deserves to be bullied.

Discuss ways children can get help if they are involved in a bullying incident, either as a target or a witness.

Encouraging children to pursue hobbies and participate in group activities they enjoy, such as performing arts, sports, or school-sponsored clubs, can also deter bullying. These activities help kids discover their strengths, develop self-confidence, and cultivate friendships with those who have similar interests.

Take a Stand, Lend a Hand

Bullying is a chronic, intentionally harmful behavior that should never be dismissed as just "kids being kids." Whether you are the target of bullying or a witness, you can take certain actions to cope with the situation.

Advice for Children

If You're Bullied

Look at the bully and in a clear, confident voice, tell him or her to stop the offending behavior. Or, try to defuse the situation using humor.

If speaking out feels unsafe or too difficult, walk away. Find an adult you trust and ask for help.

To avoid bullying in the future, try to stay away from places where the bullying occurs and seek the company of trusted adults and friends whenever possible.

Don't be afraid or ashamed to ask an adult for help, and be persistent until you find someone who will listen. Don't hold your feelings inside - speaking out can help you feel less alone and powerless, and a caring adult can help you make a plan for stopping the bullying.

If You See Bullying

Don't give bullying an audience. A bully's goal is to appear powerful by making someone else feel vulnerable and isolated. That only works if other people play along or do nothing to improve the situation. Instead of laughing or being a silent bystander, let the bully know his or her behavior is neither funny nor entertaining.

If it feels safe to do so, help the person being bullied get away, but never use violence. Try creating a distraction that takes attention away from the bully, or offer an exit strategy by saying something like, "Mrs. Hall sent me to get you - follow me," or "Come on, we need you for our ballgame."

If these tactics don't work, seek help from a trusted adult as soon as possible, either in person or by writing them a note.

In the long term, if you want to help kids who are being bullied, be their friend. Encourage them to tell a caring adult about the bullying incident. Let them know you're on their side. Talk to them, invite them to sit with you, or include them in an activity.

Advice for Parents, Teachers, and Other Adults

Adults who become aware that a child is being bullied should:

Intervene immediately, physically separating the bullying kid and the target. Enlist support from other adults if necessary.

Make sure everyone is safe and address any pressing medical needs.

Stay calm and reassure everyone involved, including bystanders. Label the behavior as bullying and tell all involved it will not be tolerated. Express empathy for the bullied child.

Hold bystanders accountable. If they stood up for the bullied child, praise them. If they gave the bully an audience or encouragement, make sure they understand it was wrong to do so.

Inform those involved that you will sort out the situation, and then proceed to get the facts, interviewing the bullying child, the target, and all witnesses separately.

Inform the parents of the children involved.

Determine logical consequences for the bullying child and monitor his or her behavior to prevent any recurrence or retaliation.

Don't make the children involved apologize on the spot or "work it out," and don't turn to peer mediation for solutions. Bullying involves a power imbalance, so such strategies are ineffective and may further traumatize the bullied child. Likewise, suspension or expulsion from school has been shown to be an ineffective deterrent.

Get appropriate professional help for those involved. Some children who are bullied need a structured support system so they can express their fears and feelings without risk of retribution. Strengthening the bullied child's self-esteem and coping mechanisms often requires the support of a parent, teacher, nurse, social worker, or psychologist. Parents can also consult their child's pediatrician for advice in dealing with bullying.

Children who initiate the bullying often need support as well, particularly with channeling aggression in more positive ways. Like the child who is being bullied, these children often benefit from professional counseling. Indeed, addressing the underlying cause of the aggressive behavior may be more effective than punishments or attempts to teach the child empathy.

Additional resources:
U.S. Department of Health & Human Services
National Education Association

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Stop Bullying! Strategies for Preventing and Responding to Bullying

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Use these tips for talking to kids about bullying and know what to do when bullying occurs.

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Childhood Medical Trauma and Medical Trauma and its Effect on Emerging Adult Mental Health Outcomes

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Childhood Medical Trauma and Medical Trauma and its Effect on Emerging Adult Mental Health Outcomes

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flashbacks

lapses in memory

difficulty regulating emotions

hyperarousal, or being “on alert”

dissociation or lapses in memory

depersonalization or derealization

sleep disturbances or nightmares

struggling in interpersonal relationships

low self-esteem or negative self-perception

avoiding people, places, or scenarios that upset you

Somatic (bodily) symptoms, like unexplained headaches or an upset stomach, are also common with complex trauma. Since the body is under chronic stress, it can lower your immune system and lead to a range of chronic health conditions.

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Complex Trauma and its Effects on Child Development

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Here are some effective therapies for complex trauma:

Cognitive behavioral therapy (CBT). In this form of therapy, you explore the relationship between your thoughts, feelings, and behaviors. Once you become aware of the connections, you may be able to change your actions.

Eye Movement Desensitization and Reprocessing (EMDR). With this treatment, you’re guided with gentle tapping (or tones) to reprocess traumatic events and form new beliefs around them.

Internal family systems (IFS). With this approach, you learn how to integrate the different parts of your personality into one whole “Self” to reprocess traumatic events in a way that can no longer harm you.

Somatic (body) therapies. Since trauma lives in the limbic area of the brain and not the frontal cortex (the part of the brain that talks in therapy), somatic therapies or body-centered therapies can teach your body that it does not have to be prepared for trauma all the time.

Dialectical behavioral therapy (DBT). This approach can be effective for people who live with borderline personality disorder (BPD), which has many overlapping symptoms with complex trauma. In this treatment approach, you learn mindfulness, radical self-acceptance, and distress tolerance.

Tips for coping

Recovery from complex trauma can be a gradual process. But having a range of tools and self-care strategies can make the process a whole lot easier.

It’s a good idea to keep a few deep breathing exercises up your sleeve for those tough moments. This is a direct way to let your body know that you’re safe. Try these:

4-7-8 breathing: Inhale for 4 seconds, hold for 7 seconds, exhale for 8 seconds.

Box breathing: Inhale for 4 seconds, hold for 4 seconds, exhale for 4 seconds, hold for 4 seconds.

Alternate nostril breathing: Place your right thumb over your right nostril. Inhale and exhale eight times through your left nostril. Repeat on the other side.

A consistent mindfulness practice can help too. A 2018 study involving veterans with PTSD found that a regular meditation practice can reduce symptoms of trauma. Yoga has shown similar results
Trusted Source, showing that both can be an effective complement to talk therapy.

It might help to access trauma-informed yoga sessions, where the yoga instructor is aware that trauma can be stored in the body, and that some body movements can trigger emotional reactions. They can help you navigate these reactions in a healing way.

Here are some lifestyle adjustments that can make complex trauma more manageable:

do tai chi or dance

journal your feelings

spend time in nature

eat a nutritious, balanced diet

sleep around 8 hours a night

“shake off” tough emotions by literally shaking your arms or your body to release tension

talk through your triggers with loved ones

practice progressive relaxation techniques

exercise five times a week, even if only a few minutes a day

try using the flashback halting protocol to manage flashbacks

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https://www.ncja.org/_files/ugd/cda224_c5b96183fb614e9692f99513646abd0d.pdf?index=true

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How do I take care of myself if I have Complex Trauma?

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How do I take care of myself if I have Complex Trauma?

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Aside from seeking treatment for acute stress disorder, things you can do to help yourself include:

Engaging in mild exercise to help reduce stress and boost your mood.

Setting realistic goals for yourself.

Spending time with people you trust and educating them about your experience and things that may trigger symptoms.

Identifying and seeking out comforting situations and places.

Attending a support group for people who have experienced trauma.

Being patient and kind to yourself. You should expect your symptoms to improve gradually, not immediately.

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More to read:What is complex PTSD: Symptoms, treatment, and resources to help you cope

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More to read:What is complex PTSD: Symptoms, treatment, and resources to help you cope

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Complex PTSD (CPTSD): Causes, symptoms, behaviors, recovery

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Complex post-traumatic stress disorder can develop when a person has experienced prolonged or repeated trauma. Learn about causes, symptoms, and treatments.

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More to read:C-PTSD: Symptoms, Causes, Treatment, and Coping

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More to read:C-PTSD: Symptoms, Causes, Treatment, and Coping

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Complex post-traumatic stress disorder (C-PTSD) is a response to a long-lasting, repeated trauma. While this type of trauma may occur as an adult, it is most often seen in childhood and adolescence. Symptoms are similar to post-traumatic stress disorder (PTSD) with an additional cluster of symptoms.

C-PTSD treatment is similar to treatment for PTSD, involving different evidence-based psychotherapy (talk therapy) approaches, eye movement desensitization and reprocessing (EMDR), and medications. A strong support system, journaling, and mindfulness are helpful coping mechanisms when a person is healing from C-PTSD.

PTSD vs Complex PTSD

Feeling stressed after a traumatic situation is common. You might feel anxious, have an increased heart rate, experience bad dreams, or get shaky. This may be post-traumatic stress (PTS). Acute stress disorder is the emergence of PTSD symptoms within the first month after a trauma. The symptoms can be very intense. However, you will only be diagnosed with PTSD if the symptoms don't go away within a month.

Post-traumatic stress disorder (PTSD) is a clinically-diagnosed condition caused by traumatic events such as combat, natural disasters, violence, abuse, and more.

The Many Names of PTSD

Complex PTSD (C-PTSD) is a response to a long-lasting, repeated trauma that lasts for months or years. C-PTSD is most often seen in those who experienced trauma earlier in life and is especially complex when someone was hurt by a caregiver or is still in contact with the abuser.

Symptoms of PTSD

Symptoms of PTSD are intense and persistent. They last long after the trauma has ended and include:

Intrusion symptoms: This includes reliving trauma through unwelcome memories, nightmares, or vivid flashbacks.

Avoiding triggering situations: PTSD can cause a person to avoid places, people, or activities that remind them of the trauma.

Changes in beliefs and feelings: A person may develop a negative view of the world, find it difficult to experience positive emotions, or do something enjoyable.

Hyperarousal: Hyperarousal is when someone is constantly "on edge," feels unsafe, and is easily startled. It can lead to reckless or self-destructive behaviors.

Somatic symptoms: Although not part of the formal diagnosis, those with PTSD may develop unexplained physical symptoms such as pain, fatigue, high heart rate, dizziness, tinnitus (ringing in the ear), blurred vision, and more.

PTSD Statistics

Symptoms of C-PTSD

C-PTSD involves the symptoms of PTSD along with the following:

Emotional dysregulation: This may be experienced as heightened emotional reactions to minor stress, reckless or self-destructive behaviors, or violent outbursts.

Changes in consciousness:A person may have periods of amnesia (forgetting) or dissociation, making them feel detached from themselves or their surroundings.

Negative self-perception: C-PTSD can cause a person to experience a negative self-image, shame, guilt, or self-loathing. They often express feeling inadequate or different from others.

Difficulty with relationships: Some people may struggle with isolation and distrust. They might also develop an unhealthy relationship or stay in an abusive relationship for too long.

Distorted perception of an abuser: This may result in an unhealthy preoccupation with the abuser. It may also include a preoccupation with revenge.

Loss of systems of meaning: Losing core values, religion, beliefs, or faith can cause a sense of hopelessness and despair.

Behavior Associated With C-PTSD

Substance abuse:Research suggests a strong correlation between substance use disorder and trauma. One of the most common theories is that drugs and alcohol are used to manage numb emotional pain.

Self-harm: Self-harm may also be called self-injury or self-mutilation and means hurting yourself on purpose due to emotional distress.

Avoidance:Emotional avoidance means creating distance with unpleasant emotions. Behavioral avoidance is staying away from people, situations, and senses that are reminders of the traumatic event. While this is natural in the short term, extreme avoidance can make it difficult to cope with other areas of life.

Inability to accept criticism:For those with C-PTSD, criticism can cause severe stress because they are already self-critical or feel shame. They may have also had an abuser who manipulated them with criticism to get an emotional reaction.

Diagnosing Complex Trauma

C-PTSD is not yet a diagnosis in Diagnostic and Statistical Manual of Mental Disorders ( DSM-5) or recognized by the American Psychiatric Association (APA). However, the World Health Organization (WHO) describes C-PTSD in the ICD-11.

While there is not a formal test to distinguish between the two, C-PTSD includes three additional clusters of symptoms as mentioned above, including:

Emotional dysregulation

Negative self-concept

Interpersonal difficulties

Causes of C-PTSD

Those with C-PTSD suffer long-term and repetitive trauma and are often hurt by a caregiver. Most survivors were unable to leave the situation and felt trapped or controlled.

C-PTSD risk factors involve chronic exposure to trauma, especially during childhood and adolescence when brain development is most vulnerable.

Some examples of trauma include:

Emotional, physical, or sexual abuse

Sex trafficking and exploitation

Neglect

Abandonment

Being a child soldier

Slavery

Torture

Genocide

Prisoner of war (POW)

Complex Trauma Treatment

C-PTSD is treated similarly to PTSD. However, treatment is usually longer. It may include one or a combination of the following:

Psychotherapy: Psychotherapy, or talk therapy, should be conducted by a trained therapist. It's best to find one with experience in treating trauma. Evidence-based psychotherapies for PTSD such as cognitive processing therapy (CPT) and prolonged exposure (PE) have been shown to benefit individuals with C-PTSD. Skills-based psychotherapies such as dialectical behavioral therapy (DBT) may also be of benefit. The goal is to facilitate the processing of the trauma and to identify and modify the trauma's harmful emotional impact on your life.

Eye movement desensitization and reprocessing (EMDR): EMDR combines psychotherapy with the use of eye movements. Treatment begins with the therapist building trust and teaching eye movement techniques. EMDR helps the trauma survivor process the traumatic memories until they are no longer distressing.

Medication: Healthcare providers often prescribe medications to treat PTSD and C-PTSD. These may include antidepressants such as Zoloft (sertraline), Paxil (paroxetine), Prozac (fluoxetine), and Effexor (venlafaxine), as well as other agents.

Food and Drug Administration (FDA) Off-Label Medications

Coping With C-PTSD

Recovery from C-PTSD is a long process. It's important to be easy on yourself or your loved one with C-PTSD. The following are coping mechanisms that are helpful when used along with treatment:

Find support: C-PTSD may cause you to shy away from being social. However, it is important to have a strong support system so you can reach out to those you trust. This might include friends, family, support groups, church, or other groups.

Practice mindfulness: Mindfulness means being self-aware and intentionally shifting attention to the present. Mindfulness techniques don't have to be elaborate. One can incorporate them into walking, eating, breathing, meditation, music, and hobbies.

Journaling: The brain can have a hard time processing difficult events. Journaling provides a place to write down private feelings and reflections. Putting thoughts on paper helps you express and begin to get a distance from painful emotions.

Complex PTSD, also referred to as C-PTSD, can result from chronic trauma that usually happens during childhood and adolescence. While it is similar to post-traumatic stress disorder (PTSD), it comes with an additional cluster of symptoms. C-PTSD treatment includes psychotherapy (talk therapy), eye movement desensitization and reprocessing (EMDR), medications, and the development of new coping mechanisms.

A Word From Verywell

Difficult emotions and thoughts stemming from complex trauma can lead to isolation and loneliness. Daily life and relationships can become strenuous because you use all of your energy for coping. It's good to seek immediate treatment with a qualified therapist to help you work through your feelings, form better relationships, and enjoy a fulfilling life.

Frequently Asked Questions

What is the best psychotherapy for complex trauma?

Certain types of cognitive behavioral therapy (CBT) have been shown to be effective for PTSD. Eye movement desensitization and reprocessing (EMDR) is also helpful in processing trauma-related emotions.

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Complex Trauma (C-PTSD) Treatment: What to Expect

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Complex trauma treatment deals with C-PTSD symptoms via several modalities including cognitive behavioral therapy, talk therapy, and exposure therapy.

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<Sexual Assault PTSD: Definition, Signs, & Treatment> by: Michelle Risser, LISW-S

<Adverse Childhood Experiences Study>: Data and Statistics. Atlanta, GA; Centers for Disease Control and Prevention (2005).

<Understanding PTSD After Sexual Assault> By Matthew Tull, PhD

<The Psychological Consequences of Sexual Trauma> by

Nicole P. Yuan; Mary P. Koss; Mirto Stone

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Victims can come from all backgrounds and become trapped in different locations and situations.

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Victims can come from all backgrounds and become trapped in different locations and situations.

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Many victims are women and girls, though men and boys are also impacted

Victims include all races, ethnicities, sexual orientations, gender identities, citizens, non-citizens, and income levels

Victims are trapped and controlled through assault, threats, false promises, perceived sense of protection, isolation, shaming, and debt

Victims do not have to be physically transported between locations to be victimized

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This type of violence exploits women, men, and children worldwide. Trafficking victimization and perpetration share risks and consequences associated with child abuse and neglect, intimate partner violence, sexual violence, and youth violence.
Perpetrators of human trafficking often target people who are poor, vulnerable, living in unsafe situations, or searching for a better life. Victims can come from all backgrounds and become trapped in different locations and situations.

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Sex trafficking is preventable. Efforts have focused on increasing community awareness of human trafficking and addressing exploitation after it occurs.  To learn more about how to recognize the signs of human trafficking, visit the National Human Trafficking Hotline’s, Recognizing the Signs website.

States and communities can implement and evaluate efforts that:

encourage healthy behaviors in relationships

foster safe homes and neighborhoods

identify and address vulnerabilities during health care visits

reduce demand for commercial sex

end business profits from trafficking-related transactions

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Surviving Sex Trafficking [Full Documentary] - BBC News

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Physical Violence involves the use of physical force to injure or control a partner. It includes hitting, punching, slapping, grabbing, choking, and many more horrid things along the same lines.

Emotional Abuse includes behaviors which aim to break a partner's self-esteem and emotional well-being. These involve manipulation, humiliation, threats, intimidation, or constant criticism.

Sexual Violence consists of non-consensual acts within an intimate relationship, such as rape, sexual assault, or forcing a partner into unwanted sexual scenarios.

Financial Abuse involves controlling or exploiting a partner's financial resources.

Stalking involves unwanted and obsessive attention, harassment, or monitoring of partner's activities. Not providing any personal space at all.

Digital or Cyber Abuse is a form of abuse that involves using technology to try and harass or control a partner. This can be done through cyber bullying or sharing intimate photos without consent (revenge porn).

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According to Kentucky law (KRS 403.720):

Domestic violence and abuse means physical injury, serious physical injury, stalking, sexual abuse, assault, or the infliction of fear of imminent physical injury, serious physical injury, sexual abuse, or assault between family members or members of an unmarried couple.

Family member means a spouse, including a former spouse, a grandparent, a parent, a child, a stepchild, or any other person living in the same household as the child if the child is the alleged victim.

Member of an unmarried couple means each member of an unmarried couple which allegedly has a child in common, any children of that couple, or a member of an unmarried couple who are living together or have formerly lived together.

The Centers for Disease Control and Prevention (CDC) identifies four types of intimate partner violence- physical violence, sexual violence, stalking, and psychological aggression. Information about the important revisions in definition can be found in the CDC's Intimate Partner Violence Surveillance: Uniform Definitions and Recommended Data Elements, Version 2.0, which was published in 2015. The CDC strongly advocates for coherent and uniform definitions to improve the collection and analysis of data and help to identify trends and make comparisons (CDC, 2015).

Physical Violence

Physical violence is the intentional use of physical force with the potential for causing death, disability, injury, or harm. Physical violence includes, but is not limited to:

Scratching, pushing, or shoving

Throwing, grabbing, or biting

Choking, shaking, aggressive hair pulling, slapping, punching, hitting or burning

Use of a weapon

Use of restraints or one's body, size, or strength against another person

Physical violence also includes coercing other people to commit any of the above acts. (CDC, 2016)

Research has shown that physical violence is often accompanied by psychological abuse and, in one-third to one-half of cases, by sexual abuse (Heise & Garcia-Moreno, 2002). The violence is usually not limited to one instance. The National Violence Against Women Survey (NVAWS) found that women who were physically assaulted by an intimate partner averaged 6.9 physical assaults by the same partner, while men who were assaulted averaged 4.4 assaults.

Women experience more chronic and injurious physical assaults at the hands of intimate partners than do men. The NVAWS found that more than 40% of women who were physically assaulted by an intimate partner were injured during their most recent assault, compared with about 20% of the men. Most injuries, such as scratches, bruises, and welts, were minor. More severe physical injuries may occur depending on severity and frequency of abuse. Physical violence can lead to death (Tjaden & Thoennes, 2000).

Sexual Violence

Sexual violence is divided into five categories, any of which constitute sexual violence, whether attempted or completed. Additionally, all of these acts occur without the victim's consent, including cases in which the victim is unable to consent due to being too intoxicated (eg, incapacitation, lack of consciousness, or lack of awareness) through their voluntary or involuntary use of alcohol or drugs (CDC, 2016).

Rape or penetration of victim. This includes completed or attempted, forced or alcohol/drug-facilitated unwanted vaginal, oral, or anal insertion. Forced penetration occurs through the perpetrator's use of physical force against the victim or threats to physically harm the victim.

Victim was made to penetrate someone else. This includes completed or attempted, forced or alcohol/drug-facilitated incidents when the victim was made to sexually penetrate a perpetrator or someone else without the victim's consent.

Non-physically pressured unwanted penetration. This includes incidents in which the victim was pressured verbally or through intimidation or misuse of authority to consent or acquiesce to being penetrated.

Unwanted sexual contact. This includes intentional touching of the victim or making the victim touch the perpetrator, either directly or through the clothing, on the genitalia, anus, groin, breast, inner thigh, or buttocks without the victim's consent

Non-contact unwanted sexual experiences. This includes unwanted sexual events that are not of a physical nature that occur without the victim's consent. Examples include unwanted exposure to sexual situations (eg, pornography); verbal or behavioral sexual harassment; threats of sexual violence to accomplish some other end; and /or unwanted filming, taking or disseminating photographs of a sexual nature of another person (CDC, 2016).

Sexual and physical abuse is often accompanied by controlling behaviors. In a World Health Organization survey of more than 24,000 women in ten countries, the percentage of those who had experienced one or more of the following controlling behaviors ranged from 20% in Japan to 90% in urban United Republic of Tanzania:

Keeping her from seeing friends

Restricting contact with her family of birth

Insisting on knowing where she is at all times

Ignoring or treating her indifferently

Getting angry if she speaks with other men

Often accusing her of being unfaithful

Controlling her access to healthcare (WHO, 2005)

Stalking and Cyberstalking

Stalking is a pattern of repeated, unwanted, attention and contact that causes fear or concern for one's own safety or the safety of someone else (eg, family member or friend). Some examples include repeated, unwanted phone calls, emails, or texts; leaving cards, letters, flowers, or other items when the victim does not want them; watching or following from a distance; spying; approaching or showing up in places when the victim does not want to see them; sneaking into the victim's home or car; damaging the victim's personal property; harming or threatening the victim's pet; and making threats to physically harm the victim (CDC, 2016).

In the United States 7.5 million people are stalked in one year, with 85% of the victims being stalked by someone they know. Sixty-one percent of female victims and 44% of male victims are stalked by an intimate partner. Among women who have been murdered, 76% were stalked by their intimate partner and 67% had been abused by them. Stalking victims may become fearful and anxious, and their physical and mental health can suffer as a result (National Center for Victims of Crimes, 2012).

Today, stalkers have at their fingertips a wide array of computers and equipment including the Internet, global positioning systems, cell phones, and tiny digital cameras. In many states, general stalking statues have not kept up with these new technologies. However, changes in the law in 2009 made cyberstalking a crime in Kentucky (KRS 508.130-150). Additional information for identifying and dealing with cyberstalking is available from the Kentucky Attorney General's office and at this link.

Psychological Aggression

Psychological aggression is the use of verbal and nonverbal communication with the intent to harm another person mentally or emotionally, and/or to exert control over another person. Psychological aggression can include:

Expressive aggression (eg, name-calling, humiliating)

Coercive control (eg, limiting access to transportation, money, friends, and family; excessive monitoring of whereabouts)

Threats of physical or sexual violence; control of reproductive or sexual health (eg, refusal to use birth control; coerced pregnancy termination)

Exploitation of victim's vulnerability (eg, immigration status, disability)

Exploitation of perpetrator's vulnerability

Presenting false information to the victim with the intent of making them doubt their own memory or perception (eg, mind games) (CDC, 2016).

Coercive control and intimidation by the abusive partner is considered an underlying component of all of these types of violence. The abusive partner's ability to control relies on the abused person's belief that if she or he does not comply with the abusive partner's demands, the victim, the victim's children, or other persons or things the victim cares about will be harmed. Often, threats are alternated with acts of kindness from the perpetrator, making it difficult for the victim to break free of the cycle of violence.

The ten-country World Health Organization survey and other research has consistently shown that emotional abuse can have a more profound and negative effect than physical violence. Between 20% and 75% of women across all the countries surveyed reported being the recipient of emotional abuse within the previous 12 months (WHO, 2005).

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According to Kentucky law (KRS 403.720): Domestic violence and abuse means physical injury, serious physical injury, stalking, sexual abuse, assault, or the infliction of fear of imminent physical injury, serious physical injury, sexual abuse, or assault between family members or members of an unmarried couple.

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Detailed Information on Types of IPV (Domestic Violence)

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Detailed Information on Types of IPV (Domestic Violence)

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Learn about the types of abuse and review topics such as: Control, Physical Abuse, Sexual Abuse, Emotional Abuse & Intimidation, Isolation, Verbal Abuse: Coercion, Threats, & Blame, Using Male Privilege, Economic Abuse,

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How does IPV in the household affect children?

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How does IPV in the household affect children?

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Children will face emotional and psychological effects such as fear, anxiety, and depression. These emotions can be overwhelming and distracting which makes it hard to focus on education.

Children exposed to IPV may be considered "naughty" in school because they are reacting to their environment at home. They could be angry at their situation, or simply desire the attention they don't get at home. In class, they might be aggressive, withdrawn, or defiant.

The emotional distress can directly interfere with a student's grades. Also, emotional development is usually stunted, which has dire consequences later in life.

Students living in households with IPV might isolate themselves or have difficulty forming and maintaining friendships due to embarrassment or a lack of self-respect.

Students exposed to IPV usually develop unhealthy coping mechanisms, such as abuse or self-harm. These behaviors can negatively affect their learning.

The scars forms from children witnessing IPV more often than not are carried into adulthood and become generational habits which are passed to their children.

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How to respond if you think a student has been exposed to IPV?

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How to respond if you think a student has been exposed to IPV?

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1. Establish a Safe, Trusting, and Supportive Environment where children feel safe, valued, and respected.

2. Listen Actively, with no Judgment in order to encourage the student to communicate openly. Allow them to share their feelings and experiences at their own pace. No pressure!

3. Keep it Confidential so that trust is maintained, but let the child know that you must tell someone if there are concerns about their immediate safety. There could be legal obligations to report any signs of child abuse or neglect.

4. Provide Emotional Support and validation so that you can remind the child that their feelings are normal and that they can heal. Also, make sure they know that they are not responsible for the IPV at home.

5. Refer to a Counselor which can connect with the child and their family so that they can provide the necessary therapeutic support.

6. Teach Lessons about Healthy Relationships which cover conflict resolution, positive communication skills, and how to build self-esteem.

7. Involve Parents or Caregivers so that the concerns are discussed and understood, which is the first step that must be taken to improve them. Support resources such as hotlines or counselors must also be shared.

8. Academic Progress must be Monitored in order to make up for the increased stress at home.

9. Provide Coping Skills which encourage the child to develop healthy coping mechanisms such as mindfulness exercises, journaling, or therapy rather than destructive vices.

10. Safety Planning is a necessary step which involves professionals and includes outlining a plan-of-action in the case of another IPV episode.

11. Advocate for the Child, ensuring that all of their needs are met inside and outside of the school (within bounds of your contract and capabilities).

12. Stay Informed with the current information and resources regarding IPV so that you can stay ready to assist students facing this very serious problem.

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The School of Education, University of Hertfordshire, Hatfield, United Kingdom

This article examines how domestic violence impacts the lives and education of young children, children, and young people and how they can be supported within the education system. Schools are often the service in closest and longest contact with a child living with domestic violence; teachers can play a vital role in helping families access welfare services. In the wake of high profile cases of child abuse and neglect, concerns have been raised about the effectiveness of multi-agency responses to children living with abuse. In the United Kingdom, the case of 4-year-old Daniel Pelka who died in 2012 following abuse and starvation by his mother, who experienced domestic violence, and her partner, led to a serious case review. It found recording systems in Daniel's school were not used consistently, and details held by different agencies were not collated to enable the formation of a coherent assessment. The lack of integrated working cited in the report echoes findings from previous serious case reviews. A strong correlation exists between domestic abuse and child abuse, with approximately half of all domestic violence situations involving direct child abuse. Children can also be affected indirectly by violence occurring in their home by seeing or hearing it taking place. This article examines the impact of domestic violence on the mental health of children, and the impact on their education. Violence in children's lives often causes disruption to their schooling and harms the quality of their educational experiences and outcomes. The abuse children experience can result in emotional trauma, physical and psychological barriers to learning, and disruptive behavior in school, while the underlying causes of these problems remain hidden. Knowing when and how to seek advice from multi-agency professionals is an essential part of effective practice among school staff. Despite their vital role in identifying signs of abuse and signposting referral pathways, research indicates teachers often lack confidence and knowledge for such work. The article examines how the professional learning and professional confidence of teachers can be developed, and how recent policy and practice developments in the United Kingdom have the potential to influence work in this area.

Introduction

Every school is likely to have children affected by domestic violence. The aim of this article is to examine how domestic violence impacts the lives of young children, children, and young people, and the potential role that schools can play in helping to address their needs. Wellbeing and healthy relationships are the foundations of learning. The immediate and long-term costs of domestic violence can thus be high, affecting children's education as well as having long-term developmental consequences.

While the term domestic violence is used in this article, a number of terms are present in literature such as intimate partner violence and inter-parental violence, and sometimes terms are used interchangeably. Since there is a governmental definition of domestic violence, and also for consistency, I will adopt the term domestic violence predominantly here. The terms intimate partner violence and inter-parental violence will be used when referring to studies that specifically adopt these terms.

Domestic violence and child protection is a complex, multifaceted area. It is common for domestic violence and, as specified in this case, intimate partner violence (IPV) to co-occur with other problems: 'children's experiences of and responses to IPV exposure cannot be viewed in isolation from other adversities and inequalities' ( Etherington and Baker, 2018, p. 70). The co-occurrence of stressful problems in early life is often referred to as adverse childhood experiences (ACEs). ACEs is a construct emerging from a long line of studies into traumatic events occurring in childhood such as domestic violence, sexual, physical and emotional abuse, household dysfunction, and neglect ( Felitti et al., 1998; Dube et al., 2001). Research studies find that having these ACEs has long-lasting effects into adulthood. ACEs can be a source of long-term psychological distress as well as having longitudinal effects on physical health, substance misuse, interpersonal violence and self-harm ( Hughes et al., 2017). The 'toxic trio' of domestic violence, substance misuse, and parental mental health problems can render children at risk of harm and complex trauma. Poverty all too frequently intersects with ACEs. Although poverty is viewed as a social marker regarding the distribution of domestic violence risk, the association is not causal ( Ray, 2011). Domestic violence cuts across all socio-economic groups and all backgrounds. Victims of all backgrounds, predominantly women, face common difficulties when leaving an abusive partner. Research demonstrates that it is at the point of leaving, or after she has left, that a woman is in most danger ( Calder and Regan, 2008). It is not uncommon for victims of domestic violence to remain living with perpetrators, even risking their own safety, rather than risking themselves, and their children, becoming homeless.

Teachers are well placed to play a pivotal role in identifying and responding to domestic violence since they have contact with children more than any other service. As emphasized by Sterne and Poole (2010, p. 17), 'although staff in schools may not be able to stop the violence at home, they are in a position to make a considerable difference to children's lives.' Statistics from the Department for Education [DFE] (2017a) show that of the 646,120 children referred to children's social care in England 2016-2017, the highest number of referrals, 27.5%, came from the police. The second highest percentage of referrals came from schools at 17.7% followed by health services at 14.4%. School referrals combined with education services referrals of 2.6% means that education accounted for 20.3% of referrals overall. Once referred and assessed, statistics show the percentage of children in need according to identified factors. In 2016-2017 ( Department for Education [DFE], 2017a) the most common factor was domestic violence which applied to 49.9% of children in need; this incorporated violence directed at children or adults in the household. The second most common factor was mental health at 39.7% which likewise encompassed mental health of the child or adults in the household. The prevalence of domestic violence is not only high among children in need but also among the wider population with as many as one in six young people in the United Kingdom reporting experiencing it during their childhood ( Radford et al., 2011).

Exposure to domestic violence generates a multitude of responses and needs and it is important for children and young people not to be regarded as a homogeneous group or lacking the capacity for posttraumatic growth and recovery: 'it is wrong to stereotype all children as inevitably and permanently damaged by living with domestic violence' ( Mullender et al., 2002, p. 121). Although some children experiencing domestic violence will exhibit difficulties in their schoolwork, the education of others will not be adversely affected: 'some children living with domestic abuse achieve highly in school; throwing themselves into school life and work can provide an escape' ( Sterne and Poole, 2010, p. 23). Similarly, while some students affected by domestic violence will experience educational settings as a source of continuity and security, others will experience them as challenging. It is therefore essential to take into account the range of responses to domestic violence among children. This article firstly looks at how domestic violence is conceptualized with regard to children, and how it affects them across different ages. This is followed by an examination of multi-agency working between schools and other organizations. The importance of recognizing individual and family contexts is considered before analyzing prevention education in schools. Finally, recent developments in policy and practice in the United Kingdom are examined in terms of both the challenges and opportunities they pose.

Conceptualizing Domestic Violence in Relation to Children

Domestic violence is manifested in various ways and has been conceptualized by some as taking direct and indirect forms. Indirect abuse can result from inter-parental violence where children are not the subject of direct abuse. However, children witnessing inter-parental violence, and hearing it without necessarily seeing it, can still feel its effects: 'While often characterized as witnesses to inter-parental violence, which implies a passive role, children actively interpret, attempt to predict and assess their roles in causing the violence' ( Baker and Cunningham, 2009, p. 199, emphasis in original). Indeed, the terms direct and indirect abuse have been interpreted as potentially misleading and perhaps simplistic. Callaghan et al. (2018, p. 1566) argue it is too restrictive to view domestic violence as abuse between partners in an intimate dyad whereby children are perceived as 'affected by' the abuse: 'Far from passive witnesses, they are not "exposed" to violence and abuse; rather they live with it and experience it directly, just as adults do.' Regarding children as 'affected by' domestic violence diminishes its impact on them. Instead, Callaghan et al. (2018) call for children to be recognized as direct victims of violence and abuse which in turn could improve professional responses to their needs.

Impact of Domestic Violence on Young Children, Children, and Young People

Domestic violence occurs at all ages. Sterne and Poole (2010) point out that the duration of children's encounters with domestic abuse has a greater bearing on their stress levels than the severity of the abuse. Harm caused by domestic violence can be physical, emotional, behavioral, cognitive, and social, and effects are usually overlapping and interrelated. Although harm can be present across all age phases, I will differentiate by three age groups, namely young children aged 1-4, children aged 5-10, and young people aged 11-16 since challenges and issues arising from domestic violence are different across these ages. It should be noted, however, these age groups are approximate and children's experiences and responses will be influenced by individual needs and context.

Impact on Young Children

Impact on Children

Impact on Young People

Research With School Teachers

Domestic Violence, Schools and Multi-Agency Working

Recognizing the Child and Family Context

Parental non-disclosure of domestic violence coupled with wariness toward social services have a deep-rooted history, due in part to feelings of guilt, shame and fear of children being taken into care. Young people themselves have expressed fears of being removed from home ( Ellis et al., 2015). Research shows that making a disclosure to professionals or other adults can be traumatic for children, with instances of family members becoming angry and upset and holding the child responsible for consequences ( Children's Commissioner, 2018). Cultural taboos can render disclosure of domestic violence, including 'honor-based' violence, even more difficult for members of certain communities. Interventions by social workers are sometimes perceived, if not directly experienced, as punitive rather than supportive. In order to facilitate identification and disclosure of domestic violence victims must be treated in a non-judgmental way and their complex needs recognized. Professionals, including teachers who are the Designated Safeguarding Lead in their school, require knowledge, training and strategies for inquiring about abuse, and how to manage both disclosures and non-disclosures.

The range of needs among those living with domestic violence requires a professional response informed by victim context. Welfare services need to adopt an intersectional approach to domestic violence and its attendant issues ( Ramon, 2015) whereby disability, race and ethnicity, gender, age, socio-economic status, immigration status, and sexual orientation of children and parents alike are taken into account. Immigration status, for instance, can be a factor in non-disclosure. In recognition of the importance of intersectionality Etherington and Baker (2018) advocate service providers engage in reflexivity by examining whether their provision ignores or attends to children's multiple social locations. The needs and access to resources of a middle-class child, for example, will differ to those of a child living in persistent or recurring poverty. An intersectional, child-centered approach is promoted by Etherington and Baker (2018), one which takes into account the specificity of children's individual experiences, and is sensitive to the characteristics shaping their experiences. Where interconnected factors such as domestic violence and mental health problems affect a family's context, they need to be understood and documented in conjunction with each other rather than in isolation ( Lloyd et al., 2017).

School Engagement With Domestic Violence Prevention and Education Work

In addition to making referrals to social care 'Schools also have an essential role in educating children about domestic abuse' ( Ofsted et al., 2017, p. 28). Yet research has revealed a lack of work in school on domestic violence. A survey commissioned by the domestic violence charity Refuge (2008) involving 513 young women aged 18-21 revealed that just 13% had learned about domestic violence while at school and nearly 70% responded they would have welcomed such lessons.

Prevention programs in school are more effective when promoted through whole-school policies and practices than through single-component programs or individual teachers ( Harne and Radford, 2008). Program evaluations also show that while one-off education initiatives have some value in raising awareness of domestic violence, attitudinal change is better sustained when learning is revisited and reinforced in subsequent years ( Harne and Radford, 2008). Adopting a gendered approach is another preferred format for changing attitudes as it underlines that domestic violence is rooted in unequal power relations between men and women; although men can be victims too, the majority are women and they are subject to domestic violence in more severe and repeated forms ( Women's Aid, 2009). Furthermore, where prevention programs in schools include a male facilitator, there is a higher likelihood of boys changing their attitudes ( Ellis et al., 2006).

For prevention and support work in school to be effective, teachers themselves evidently need to feel supported by school processes and management ( Sterne and Poole, 2010). When addressing the needs of children living with domestic violence school staff should be prepared with information about services, signposting to external agencies, ensuring student safety, and knowing what to do next following disclosure. Without this information, students could be put in a worse situation than before ( Howarth et al., 2016). Just as teachers need to have a clear understanding of their role in safeguarding children, so too they need to know the boundaries of their role. Research warns of the dangers of teachers acting beyond their professional scope such as asking a child to talk about their experiences without being suitably qualified which can have a traumatic effect on the child ( Swanston et al., 2014). A sensitive approach is needed to help both students and their parents already living with domestic violence. Yet teachers' responses to research reveal they often lack the professional confidence and expertise to provide domestic violence prevention education and intervention support, highlighting the need for effective staff training at both initial and continuing professional teacher education, and to include school nurses ( Refuge, 2008).

The content, manner and personnel delivering domestic violence education in schools clearly require careful consideration to enhance student engagement and handle student vulnerability ( Fox et al., 2014). Different models of educational program delivery have been employed in school. Some entail teachers delivering school-based initiatives themselves, others favor delivery from external specialists, while some opt for collaborative implementation. Although external facilitators have specialist knowledge, expertise and experience of discussing sensitive topics with young people, teachers have more in-depth knowledge of students and their individual circumstances ( Fox et al., 2014). Working in partnership with external facilitators provides a way for teachers to develop their professional learning and confidence. The respective strengths of external specialists and teachers can be complemented through collaboration:

...preventive interventions when co-delivered with specialist organizations might offer the possibility for school staff to increase their skills in dealing with disclosures and subsequently help improve the health and well-being of children and young people. ( Ellis et al., 2015, p. 60)

The need for effective professional learning and training of school staff applies to the issue of interpersonal violence too. Cross-national European research in secondary (high) schools found that teachers frequently had limited confidence and knowledge to address the problem of interpersonal violence and abuse ( Barter et al., 2015). Findings from the study echoed domestic violence program evaluations in that rather than interpersonal violence and abuse being left to the efforts of an individual teacher championing the cause, the issue should be addressed at institutional level as a whole-school concern. Schools have an essential role to play, then, in tackling domestic violence and the following section examines how recent policy and practice have the potential to influence work in this area.

Developments in Policy and Practice

Following long-running campaign calls for the introduction of mandatory relationships and sex education (RSE) in schools, the United Kingdom government announced in March 2017 it will introduce compulsory lessons in all schools in England (in Wales, Scotland and Northern Ireland RSE is expected but not compulsory). Current guidance on sex education in England was introduced in 2000 but content has not kept pace with social change, especially in respect to social media, online pornography and 'sexting.' While parents will still have the right to withdraw their child from sex education, draft government proposals have suggested parental withdrawal should only be possible until three terms before the child is aged 16, after which the child should be able to decide to attend ( Department for Education [DFE], 2018). Subsequent to a consultation period schools will be required to teach the new RSE content from September 2020 ( Department of Health, and Social Care and Department for Education, 2018). Statutory curriculum content in schools promoting healthy relationships, and raising awareness of unhealthy relationships and the unacceptability of violence in relationships, is a positive step toward equipping young people for modern-day life.

Another move in the right direction is the United Kingdom government's consultation document which proposes the implementation of a designated senior lead for mental health in every school and college ( Department of Health, and Department for Education [DOH and DFE], 2017). Educational settings present a valuable opportunity to promote mental wellbeing and prevent mental ill-health since half of all mental health conditions start by the age of 14 ( World Health Organization, 2013). Although 61% of schools currently offer counseling ( Department of Health, and Department for Education [DOH and DFE], 2017), concerns have been raised about schools' ability to resource such support coupled with the length of time students sometimes need to wait. There have also been long-standing concerns around high referral thresholds for external support services such as Child and Adolescent Mental Health Services (CAMHS) which some children affected by domestic violence have not been accepted for due to referral criteria ( Swanston et al., 2014). Long waiting times to access such services have been a further source of distress; the average waiting time is 12 weeks but the longest is up to 100 weeks ( Department of Health, and Department for Education [DOH and DFE], 2017) during which time problems can escalate requiring more intensive and more costly support. The government's consultation document proposes a 4-week waiting time for National Health Service mental health services for children and young people, and recommends content on mental wellbeing be part of the Personal, Social, Health and Economic education syllabus in schools. The government's aim to implement training for the designated senior lead for mental health to all areas by 2025 has been criticized for being too slow. Concerns have been raised about the added pressure these proposals would place on an already overstretched teaching workforce facing recruitment and retention difficulties, and about the level of funding needed to ensure teachers have well-developed training for the vital role of designated senior mental health lead ( Education and Health and Social Care Committees, 2018). While training programs can improve teachers' confidence and skills to deal with children's emotional needs ( Place2Be, 2015), budgetary and workload pressures mean training opportunities are unlikely to be available in all schools, discussed further below. With the number of young people with a diagnosable mental health condition standing at one in ten ( Department of Health, and Department for Education [DOH and DFE], 2017), strategies aimed at addressing the causes and symptoms of mental health problems must be adequately resourced if they are to be effective.

Another area for consideration when tackling domestic violence in children's lives is the role of school nursing. The number of school nurses has been reduced in recent years. They are not always represented at child in need meetings, nor is relevant information always shared with them ( Ofsted et al., 2017). Furthermore, term time working arrangements for school nurses mean they are not available during school holidays. Their restricted availability was referred to in the SCR of Daniel Pelka. School nurses attending relevant meetings and being employed during school holidays could facilitate greater consistency of care, better informed assessments, and improved multi-agency working.

Paramount to effectively supporting students is the adoption of a holistic, child-centered approach. If teachers are aware of issues in students' home lives, they will be better informed to provide tailored support to meet the individual needs of students regarding their learning, and social and emotional development. School staff need to be able to confidently ask students if anything is wrong at home and take appropriate action ( Mullender et al., 2002). Research with young people affected by domestic violence found they valued teachers, tutors, learning mentors and school counselors in helping to identify abuse and access support ( Howarth et al., 2016). In terms of educational attainment, additional learning support, perhaps in a one-to-one or small group context, could help improve the educational outcomes of students. This would require a sensitive approach, however, particularly as students get older and may not wish to be singled out from peers.

Early intervention strategies to help children and young people experiencing domestic violence can be strengthened through organizations engaging in joined-up thinking and working. An illustrative example is Operation Encompass, an early intervention initiative being piloted in selected areas of the United Kingdom which entails police notifying a school by 9 am if a child has witnessed or experienced a domestic abuse incident the previous evening. A key adult at school (the Designated Safeguarding Lead or Deputy) is informed of the case and cascades information to teaching staff to allow immediate and ongoing support to be given to the child. As a trauma-informed charity Operation Encompass takes into account the child's past trauma, where applicable, and the child's responses and coping strategies. Operation Encompass can explain to the school why a child is absent or has been dropped off at school by someone else. The initiative is enabling police and schools to work in partnership to mitigate the impact of abuse and has the potential to be an exemplar of collaboration.

The Freedom Programme is another initiative being run, including in schools, to teach and empower victims of domestic violence to recognize signs of abuse and make positive changes in their lives. Organizations interested in the program need to make a commitment in terms of ensuring their staff are trained in the program and have time for implementing it. The Freedom Programme can also work with children due to start school and has proved effective in bringing about positive change in women's and children's lives.

Schools play a role in providing help when dealing with the fallout of domestic violence in others ways too, such as setting up practical arrangements to minimize the risk of child abduction by the offending parent following parental separation ( National Children's Home, 1994). Volunteering at their children's school, where appropriate, can serve as a way of non-abusive parents spending more time with their children and helping to protect them ( Hamby, 2014).

Perhaps unsurprisingly, some teachers feel overwhelmed dealing with issues facing both children and their parents. Pressure on teachers to address problems among children and parents, such as increasing mental health issues, have left some feeling they are becoming like social workers. Mullender et al. (2002, p. 219) emphasize the importance of teachers listening to children vulnerable to domestic violence and offering emotional support:

This is not the same as becoming social workers, which teachers understandably fear in an already over-stretched working life and without the necessary training. Rather, it means being an effective channel for children to gain access to welfare services outside of school, by opening up an early opportunity for them to confide that something is wrong.

The Paradox of Greater School Autonomy and Working Together

Difficulties documented in research and governmental reports concerning inter-organizational working may be exacerbated by government policy devolving greater power to individual schools. Previously, state schools were funded by government and run by the local authority. Academy schools, initiated under the Labor government, and free schools under the Coalition government and subsequent Conservative government, are still state-funded but are not overseen by the local authority; they receive funding directly from central government affording them increased budgets. With budgetary independence and increased autonomy for their own governance these schools are able to set the pay and conditions for staff rather than abiding by national teacher pay and conditions required of local authority-run schools. Academies and free schools are attended by over two-thirds of secondary school students and a quarter of primary school students ( Department for Education [DFE], 2017b). Despite academy and free schools still being expected to liaise closely with local authorities on matters such as child protection and safeguarding, they have greater self-determination in shaping the relationship they have with local authorities ( Baginsky et al., 2015).

Greater school autonomy has additional implications for Local Safeguarding Children Boards (LSCBs) whose role is to coordinate local work to safeguard children. As a multi-agency body LSCBs are attended by representatives from the local authority and relevant organizations such as health services and the police. However, research by Baginsky and Holmes (2015) indicates that increasing fragmentation of educational services has seen academy schools (including free schools), and private fee-paying (non-state) schools being represented on less than half of LSCBs. While over 80 percent of boards were represented at senior level by local authority schools, the same was true of only 20 percent of boards attended by academy schools ( Baginsky and Holmes, 2015).

Domestic Violence and Student Wellbeing Within an Attainment-Driven Education System

Given the spectrum of behavioral responses to domestic violence teachers need to be attuned to changes in children, some becoming withdrawn, others disruptive. Confrontational responses can, however, be difficult to account for: 'If underlying contributory factors are not obvious or understood, those children are likely to be labeled as problematic' ( Ofsted et al., 2017, p. 14). This can lead to school staff misinterpreting students' behavior and disciplinary action might ensue. Indeed, data show a growing number of students excluded from school have mental health needs ( Education and Health and Social Care Committees, 2018), and children impacted by domestic violence ( Ofsted et al., 2017) and/or living in poverty ( House of Commons Education Committee, 2018) are more likely to be excluded from school in comparison to their peers. This is worrying in the context of schools focusing on examination results and league tables. Teachers and educationalists lament the marketization of education whereby examination results have become a key measure by which schools define themselves and are defined by others, and schools are set in competition with each other in the form of league tables ( Berry, 2016; Berry, 2017; Scott and Scott, 2018). Research with teachers shows such changes are negatively impacting teacher-student relationships and student wellbeing, with teachers reporting having less time to attend to the needs of individual students, and reporting that their own stress levels sometimes adversely affect their interaction with students ( Hutchings, 2015). Baginsky et al. (2015, p. 358) discern tension between the prioritization of examination results and children's wellbeing:

Potentially there may be an inherent conflict between, on the one hand, pressure on institutions to demonstrate high levels of academic attainment and discipline by pupils in a competitive educational "market" and, on the other, the role of schools in recognizing and meeting the pastoral needs of children who are vulnerable or disadvantaged.

Where teacher performativity and student outcome measures in the form of examination results are at variance with the more holistic nurturing of students, efforts to support those impacted by domestic violence could be hampered and diminished. Concerns about schools becoming 'exam factories' have led to calls for a rebalancing of the education system whereby schools do not give precedence to academic outcomes at the expense of student wellbeing and personal development.

Conclusion

What happens in childhood and adolescence has profound implications for wellbeing in adult life. The prevalence of domestic violence as the most common factor cited in cases of children in need in England in 2016-2017 ( Department for Education [DFE], 2017a) emphasizes the need for addressing this enduring problem through prevention, early intervention and education. So too is wider attitudinal and social change needed whereby domestic violence is no longer trivialized as 'just another domestic' or portrayed as the fault of, predominantly women, victims, as evidenced in our earlier research into media representations ( Lloyd and Ramon, 2017). Domestic violence must be addressed as a public health concern and not only as a privatized, individualized problem. The ways in which gender violence is based on and reinforced through women's wider structural inequality and lack of power in relation to men needs to be recognized if violence within the domestic sphere is to be tackled effectively.

Encouragingly there is some evidence of domestic violence research in the context of education, though it remains relatively under-investigated. The continuing fragmentation of the United Kingdom school system and plurality of school types highlight the need for increased research to evaluate schools' engagement in multi-agency working and to gain insight into effective practice. Some teachers and school support staff are themselves victims of domestically violent relationships and workplace support would be beneficial both for individuals and the school setting as a whole. Future research could usefully ask teachers and support staff their views on their professional learning and training needs in this important area of work.

Too frequently blame, shame and guilt cast a shadow over lives affected by domestic violence. Multi-agency working and in-school education and support can help prevent abuse and optimize outcomes for children, young people and their families living with the consequences of domestic violence.

Author Contributions

The author confirms being the sole contributor of this work and has approved it for publication.

Conflict of Interest Statement

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Footnotes

1. http://www.operationencompass.org/

2. http://www.freedomprogramme.co.uk/

References

Calder, M. C., and Regan, L. (2008). "Working with mothers in situations of sexual and domestic abuse: reframing resistance as restricted choices," in The Carrot or the Stick? Towards Effective Practice with Involuntary Clients in Safeguarding Children Work, ed. M. C. Calder (Lyme Regis: Russell House Publishing), 249-276.

Children's Commissioner (2018). " Are they Shouting Because of me?" Voices of Children Living in Households with Domestic Abuse, Parental Substance Misuse and Mental Health Issues. London: Children's Commissioner for England.

HM Government (2015). Information Sharing, Advice for Practitioners Providing Safeguarding Services to Children, Young People, Parents and Carers. London: HM Government.

HM Government (2018). Changes to Statutory Guidance: Working Together to Safeguard Children; and New Regulations, Government Consultation Response. London: HM Government.

House of Commons Education Committee (2018). Forgotten Children: Alternative Provision and the Scandal of Ever Increasing Exclusions. London: House of Commons.

National Association of Schoolmasters Union of Women Teachers [NASUWT] (2018). Special Educational Needs (SEN), Additional Learning Needs (ALN) and Additional Support Needs (ASN) Survey Report. London: NASUWT.

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Frontiers | Domestic Violence and Education: Examining the Impact of Domestic Violence on Young Children, Children, and Young People and the Potential Role of Schools

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This article examines how domestic violence impacts the lives and education of young children, children, and young people and how they can be supported withi...

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Philadelphia Department of Public Health