Closing his eyes, an 11-year-old boy breathes in slowly through his nose, holds his breath for a count of three, and then gradually exhales. His hands are clasped tightly in front of him. He is serious at first, and then a smile begins to creep across his face with each deep breath he takes. His hands relax. Opening his eyes after several breaths, he is asked what he was thinking about. “Nothing,” he says—and then, grinning and exuberant, his hands fly to the top of his head in amazement, and he says, “That’s crazy!”
Just a few days earlier, this child witnessed his older brother being shot. Now, he can use this breathing exercise to fend off disturbing memories and anxiety he’s been experiencing since then. He learned the technique from a mental health clinician and a police officer who visited him at home as part of the Child Development-Community Policing (CD-CP) program—a partnership between the Yale Medicine Child Study Center’s Childhood Violent Trauma Clinic (CVTC) and the New Haven police department.
“Yeah, it is pretty crazy, isn’t it?” says the clinician helping him. “But it works!” The jittery and distracted feelings the boy had been experiencing are common ones following trauma, she tells him. Nothing anyone can say or do will take away what happened, but he can stop his racing thoughts and calm himself when he feels overwhelmed.
One huge need, two points of view
The CD-CP program, which recently celebrated its 25th anniversary, provides immediate help when children are exposed to traumatic experiences, especially violence. Police officers are trained to address the psychological needs of children and families when responding to calls for service. Officers have the option of getting help from mental health colleagues on-scene.
These interventions aim to calm children and their caregivers, assess immediate needs and establish an initial connection. Afterwards, two-person teams of police officers and clinicians conduct home-visits with children and their families. Children who develop traumatic stress symptoms are invited into the clinic with their caregivers for mental health treatment using an approach developed at the Yale Child Study Center, the Child and Family Traumatic Stress Intervention (CFTSI).
The CD-CP program has three goals: to help children and families stay safe; to restore a sense of security; and to provide support services to help them recover. By intervening early, the program can short-circuit the pattern of trouble that often follows traumatized children throughout their lives.
The program was established in 1991. For the police, the pivotal moment was a domestic dispute in which a mother was stabbed in front of her children. Could those children ever feel safe again? What help did they need? Who could provide it?
New Haven police officer Sam Cotto, now retired, recalls that prior to CD-CP, “On most of our raids we’d end up forcing the door open with a ram. That’s very loud. I can imagine how frightening that situation would be for a young kid,” Cotto says, adding that officers didn’t think much about the trauma suffered by family members in these situations.
Once CD-CP came along, New Haven police’s changed their approach to potentially traumatic situations, including domestic violence and drug interdictions. “Before a search, we’d have a briefing. We’d ask, ‘Will there be a child in the home?’ If the answer was yes, we did things differently,” says Cotto. “Having that information changes the whole dynamic of an entry.”
Meanwhile from the mental health perspective, “We knew we needed to look beyond the clinic only and go to the children, when and where they were most immediately impacted,” says Steven Marans, PhD, MSW, co-founder of CD-CP and CVTC director. “There are too many children who hear and see way too much, who are left to feel out of control and helpless in the face of events that any of us would find unbearable.”
New Haven Police Department Sgt. Renee Dominguez says the philosophy of the CD-CP program is now ingrained in the the organization’s culture. “It’s a part of what we do here and we pride ourselves in getting the training,” she says.
After trauma, hope
Childhood trauma is more common than many realize. A national study tracking adolescents ages 12 to 17, found that 8 percent had experienced sexual assault, 17 percent had been physically assaulted and 39 percent had witnessed violence.
Anxiety, sleeplessness and intrusive thoughts about a traumatic event aren’t just short-term problems. They could lead to a host of ills, ranging from failure at school to difficulty maintaining relationships. People who are traumatized as children are at high risk for anxiety, depression and substance abuse. And, what’s worse, they’re likely to continue a cycle of violence. “The same kids who don’t recover from violent trauma are the ones more likely to become involved in antisocial and violent behavior themselves,” Marans says.
But it’s not inevitable. Research from the Child Study Center pinpoints two factors as important predictors of recovery: whether or not the child’s traumatic experience is recognized, whether they receive social support and whether they can gain mastery over early post-traumatic symptoms.
What these traumatized children need most is support from their parents. For example, through the CFTSI program, parents and children learn about common symptoms that follow trauma and are urged to identify them to one another. So, when a child refuses to go to bed and begins acting out, his mother may realize that he is afraid of nightmares. The mom could then offer extra reassurance and remind him of available coping strategies, such as the breathing exercises.
Fighting crime with children in mind
A critical component of the program’s success is buy-in from the police officers, who are typically first on the scene when trauma occurs. Extensive training has reshaped the officers’ interactions with children. “They learn to be supportive to children and validate their experience of the event,” Marans says. “After working with the clinicians, the police go in with wider eyes and see things they might not have noticed before.”
The program teaches law enforcement and mental health professionals to work as a team. Together they undergo cross-training (in human behavior, trauma and basic policing procedures). They take part in weekly conferences to discuss new and ongoing cases and coordinate follow-up plans for home visits.
Clinicians find it beneficial to make an immediate connection with traumatized children. “It provides us with firsthand knowledge of their experiences and allows us to provide meaningful support at a time when it’s needed most,” says Kristen Hammel Kowats, clinical coordinator for the trauma section and the CD-CP program. “We’re able to be proactive. We are not just helping children in the moment, but are there to aid in their recovery and in interrupting the cycle of violence.”