Vol.5, No.2, 298-305 (2013) Health
http://dx.doi.org/10.4236/health.2013.52040
Exposures to violence and trauma among children
and adolescents
Clarissa Agee Shavers
The Safer Tomorrows: Injury Prevention and Violence Reduction Project©, Primary Care Office, Detroit, USA;
Received 18 December 2012; revised 17 January 2013; accepted 24 January 2013
ABSTRACT
Children and adolescents (youth) may be ex-
posed to various forms of violence and trauma
in a number of ways. Research and clinical stud-
ies have revealed that youth may be signifi-
cantly impacted by isolated, single or repetitive
exposures to violence and trauma. Further, these
exposures may ultimately impact the overall
psycho-social-emotional, and mental health, as
well as, the ment al health care of this population
of youth who self-report, who are at-risk and
who may or may not be at risk for exposure to
violence and trauma in their lives. Thus, con-
sequently, health care providers (HCP’s) w ho do
not view or understand that exposures to vio-
lence and trauma among youth, as well as, ex-
posures to adverse environments or situations
may pose as a serious or potential psycho-
social-emotional and mental health care con-
sequence for this population of youth may in-
advertently impede or delay timely access to
appropriate health care for this population.
Hence, as a consequence of this delay in timely
access to appropriate psycho-social-emotional
and mental health care services for this popula-
tion of youth, may significantly compromise
their overall psycho-social-emotional and men-
tal health care status. This article reviews the
impact of exposures to violence and trauma
among youth, with a focus on current empirical
findings noted in the literature regarding vic-
timized and traumatized children and adoles-
cents, and the implications of these findings in
promoting the healing and restoration for this
population of youth for HCP’s. In addition, a
brief discussion of an empirical evidence-based
psycho-social-emotional intervention/project re-
ferred to as The Safer Tomorrows: Injury Pre-
vention and Violence Reduction Project© which
has been designed for children and adolescents
who may or may not be at-risk for exposures to
violence and trauma is presented. The impor-
tance of early identification, screening, assess-
ment and treatment among victimized and trau-
matized children and adolescents are also ad-
dressed.
Keywords: Violence; Trauma; Children;
Adolescents; Prevention
1. INTRODUCTION
Sorrowfully today, millions of children and adoles-
cents (youth) in the world reside in neighborhoods or
communities where violence or acts related to various
forms of violence and trauma occur daily and millions
more have been deemed to be at-risk [1-6]. Also, youth
exposed to violence and trauma may exhibit adverse
psycho-social-emotional, mental, and physical health
care problems [5-9]. Research has shown that youth who
have experienced directly, indirectly or even witnessing
including being a stand-byer of violent or traumatic
events may be at-risk for psycho-social-emotional and
mental health issues of varying degrees and intensities
[9-12]. Similarly, children and adolescents exposed to
violence and trauma may b e at-risk for exposure to sexu-
ally transmitted infections including chlamydia, gonor-
rhea, human immunodeficiency viruses (HIV)/acquired
immunodeficiency syndrome (AIDS) and numerous other
adverse conditions or situations including rape and sex-
ual abuse [3,13-15].
For these reasons, HCP’s engaged or employed in di-
verse ethnic-cultural, geographic, and socioeconomic
communities are in a key position to confront and at-
tempt to effectively assist children and adolescents who
have self-reported actual, previous or past, and who are
at-risk and who may or may not be at-risk for exposure
to trauma and violence [1,3,8,9]. Likewise, the literature
has shown that proactive attitudes of HCP’s and others
can also significantly influence access to psycho-social-
emotional and mental health services for children and

C. A. Shavers / Health 5 (201 3) 298-305 299
adolescents residing in adverse or volatile environments,
conditions, or situations [16,17]. Moreover, effective out-
of-school or after-school evidence-based violence and
trauma prevention interventions utilized by HCP’s and
others have been found to be beneficial in promoting the
psycho-social-e motional and mental health well-being of
children and adolescents who may have been actual or
potential victims, survivors, bystanders, perpetrators or
rescuers in relations to exposures of violence and trauma
[18-21].
Thus, the purpose of this paper is three-fold: 1) Pro-
vide a succinct overview of the background and scope of
the problem pertaining to exposures of violence and
trauma among children and adolescents (youth). 2) To
highlight some of the challenges and issues that may be
encountered or associated with providing psycho-social-
emotional and mental health care including clinical ser-
vices by HCP’s for children and adolescents who self-
report or identify a need for assistance as a result of ac-
tual, past or previous, and potential exposures to violence
and trauma. 3) Briefly discuss the development of an
evidence-based intervention/project referred to as The
Safer Tomorrows Project: Injury Prevention and Vio-
lence Reduction Project© designed by multidisciplinary
HCP’s and interdisciplinary professionals for children
and adolescents (youth) who self-report, who are at-risk
and who may or may not be at-risk for exposures to vio-
lence and trauma.
2. BACKGROUND AND SCOPE OF
PROBLEM
An alarming increase in the prevalence of violence
and trauma in the world has led to a serious pressing
global health care concern for the safety and overall
well-being of children and adolescents who self-report
exposures to violence and trauma [4,5,22,23]. Even more
disconcerting, emerging evidence suggest that isolated,
acute, repetitive or chronic exposure including poly-vic-
timization to violence and trauma may have a profound
impact on children and adolescents physical, psycho-
social-emotional, and mental health well-being [24-27].
Similarly, sexual violence or assault agains t children and
adolescents is a sober health care concern as well due to
the risk of adverse responses including the risk of suicide
[28]. However, not all children and adolescents may ex-
perience serious or adverse effects as a result of expo-
sures to violence and trauma for a number of reasons
including protective factors such as strong family support
and resilience [2,22,29-36]. Yet, in still, the literature
continues to acknowledge that globally many recognized
or unrecognized victimized and traumatized youth are
psycho-socially-emotionally and mentally adversely im-
pacted from exposures to violent and traumatic events
and reflect a need for preventive and early mental health
intervention or treatment [22,29-34,37].
Additionally, research has revealed that thousands of
children and adolescents are openly discussing the nega-
tive impact of these adverse exposures of violence and
trauma on their daily lives including bullying [2,37-41].
In fact, several studies involving youth self-reports of
exposures to various forms of violence and trauma have
identified that these youth experience a variety of stress-
ors including at home and school, various types of bul-
lying, a lack of effective coping strategies, and meaning-
ful adult support for dealing with the issues surrounding
exposures to violence and trauma in their young lives
[2,37-41]. Equally HCP’s and others are encouraged by
society and today’s youth to be more keenly aware of the
existence, nature, and real life dynamics of relationships
among youth that include acts of bullying and cyberbul-
lying, dating violence, witnessing DV or IPV and family
violence as reported or non-by the youth under their care
or guidance [5,15,38,40]. So therefore, HCP’s and others
are being advised to early identify, screen, treat, and in-
corporate evidence-based prevention and health promo-
tion interventions to assist in decreasing or eliminating
the actual or potential adv erse impact of youth exposures
to various forms of violence and traumatic events [5,17,
21,22,39,40].
3. PROVISION OF SERVICES:
CHALLENGES AND ISSUES FOR
HCP’s
As previously cited, it is important to note that chil-
dren and adolescents may experience feelings of anger,
anxiety, depression, social isolation and helplessness as a
result of being exposed to violence and trauma [7,25,
30,31]. Also, youth victims and survivors of violence and
trauma may develop severe mental health problems in-
cluding depression and suicide ideation [2,37-41]. Fur-
thermore, while not all youth exposed to violence and
trauma may need mental health services to effectively
deal with the psycho-social-emotional and mental after-
math of victimization, there are still many children and
adolescents who may need specialized mental health care
services to help them heal from these violent or traumatic
events [34,42]. Hence, it is imperative that HCP’s recog-
nize signs and/or symptoms of psycho-social-emotional,
physical and mental trauma in a concerted effort to make
appropriate and timely referrals to psycho-social-emo-
tional and mental health providers or health service sys-
tems for victimized and traumatized youth [34,43,44].
However, access to community based psycho-social-
emotional and mental health services or resources con-
tinues to be an issue for many victims and survivors of
violence and trauma especially those who are residing in

C. A. Shavers / Health 5 (201 3) 298-305
300
volatile or traumatic environments, the under or unin-
sured, poor and minorities or people of color, children
and adolescents [8,15,37,45-47]. As a result, this may
significantly impact the efforts of HCP’s seeking to id en-
tify, as well as, to make appropriate and timely referrals
to community-based psycho -social-emotional and mental
health providers or health care systems on behalf of this
population of children and adolescents. Moreover, sub-
stantial populations of victimized and traumatized chil-
dren and adolescents may still not be reached. For re-
search has shown that many community-based organiza-
tions or facilities which p rovide psycho-social-emotional
and mental health services may either 1) not have a suf-
ficient range of multid isciplinary services includ ing wrap-
around services or 2) funds to meet the diverse needs of
youth victims of violence and trauma [22,30,31]. Thus, it
is imperative that HCP’s must continue to address and
confront these issues in order to promote the healing and
restoration of this population of children an d adolescents
[47].
Furthermore, HCP’s must keep in mind that less se-
vere psycho-social-emotional or mental health care pro-
blems including mental illness must be understood in a
developmental, ethnic, linguistic, social and cultural con-
text in order to meet the health care needs of diverse po-
pulations (i.e. victimized and traumatized children or
adolescents) [1,48-52]. Also, mental health services must
be designed and delivered in a manner by HCP’s that is
sensitive to the persp ectives an d needs of racial or p eople
of color, and other vulnerable populations including vic-
timized or traumatized youth [1,48,49,52]. Nevertheless,
there are numerous reported evidence-based interven-
tions (i.e. individual-level and group-level risk reduction
interventions) that have been proven to be effective and
efficacious in the clinical, school, and community-based
settings including the systems approach to intervention
which may involve working with social services agencies,
phase-based skills-to-exposure treatment, case manage-
ment, individual and group cognitive-behavioral therapy
(CBT), and a combination of optimal medication man-
agement regimens with psychosocial interventions [53-
60]. What’s more promisingly, research has shown that
evidence-based interventions and treatment models in
and out-of-school, as well as, community-based settings
including adolescent clinics may prove to be effective in
improving the qu ality of services provided for v ictimized
and traumatized youth as well [29,61-64].
4. THE SAFER TOMORROWS: INJURY
PREVENTION AND VIOLENCE
REDUCTION PROJECT©
Thus, in response to the call to assist, build on prior
research, and meet the needs of this vulnerable popula-
tion of children and adolescents, The Safer Tomorrows:
Injury Prevention and Violence Reduction Project©, an
evidence-based randomized controlled psycho-social-
emotional intervention/project was formally created in
2002 [1,3,16,4 7] . Prese ntly, The Sa fer Tomorrows: I njur y
Prevention and Violence Reduction Project© (also re-
ferred to as The Safer Tomorrows Project©) in collabora-
tion with the Primary Care Office, New Center Commu-
nity Mental Health Services, the Michigan Department
of Community Health, as well as with other Partners,
Volunteers, Collaborating Agencies and Organizations, is
presently identifying children and adolescents at-risk for
exposure to violence and trauma. This multi-phase and
multi-level evidence-based randomized controlled psy-
cho-social-emotional intervention/project presently in-
volves children, adolescents, parents, teachers, multidis-
ciplinary health care providers, interdisciplinary commu-
nity-based professionals or providers, and volunteers in
the United States of America (USA), Canada, West In-
dies Caribbean Trinidad and Tobago.
Similarly, the proposed evidence-based 10 week out-
of-school and community-based structured curriculum
(designed for future implementation during Phase II of
The Safer Tomorrows Project©) includes an educational
model which focuses on the themes of violence and
trauma, injury prevention, and global healthy peaceful
conflict resolutions or strategies. In addition, presently,
the evidence-based structured curriculum is primarily de-
signed for children (pre-teen) aged 8-to-12, or in grades
four, five, and six, who have previously or in the past self
reported actual or potential exposures to 1) community
violence, interpersonal violence, intimate partner vio-
lence; 2) trauma; 3) intentional injuries as a result of
violence or acts related to violence (e.g. bullying, physi-
cal fighting); and 4) unintentional or non-fatal mild
traumatic brain injuries (TBI) such as those sustained
from sports or aggressive physical contacts, falls from
bicycles or skateboarding, pellet guns or firearms. Also,
this evidence-based curriculum focuses on a variety of
topics (i.e. anger management, bullying) and includes
strong connections to the existing educational research
based on injury prevention, violence reduction or pre-
vention, and global healthy peaceful conflict resolution
interventions or strategies for elementary school-aged
children.
Hence, The Safer Tomorrows Project© has been de-
signed to address intervention at various levels for indi-
viduals (children and adolescents or youth), families
(parents/guardians/primary caregivers), and communities
(including teachers and multidisciplinary health care pro-
viders) and can be used to individualize the unique needs
of each child, adolescent, family, and community. Like-
wise, we plan to proactively promote the healing and
restoration of this population of children an d adolescents
with the use of The Safer Tomorrows Project Case Man-

C. A. Shavers / Health 5 (201 3) 298-305 301
agement Research Practice Model© [65]. In brief, this
evidence-based model consists of a structured format
which addresses the issues of 1) safety nets for children
and adolescents, 2) access to services, resources, and
programs, 3) coordination of services with local multi-
disciplinary and interdisciplinary providers or profes-
sionals and volunteers, and 4) global health education
around the themes of evidence-based injury prevention,
violence reduction, and healthy peaceful conflict resolu-
tions or strategies [65]. Furthermore, we plan to em-
power children and adolescents to effectively address the
issues of violence and trauma with the use of The Child-
hood Violence Trauma Reduction Model© (see Figure 1)
[2,37].
The theoretical constructs for The Childh ood Violence
Trauma Reduction Model©, an empirical model (see
Figure 1) were derived from an extensive literature re-
view, as well as, empirical evidence obtained from se-
veral research studies conducted by Shavers and/or in
collaboration with other investigators over several years
time span which included children, adolescents, par-
ent/guardians/caregivers, teachers, multidisciplinary and
interdisciplinary professionals or providers, and volun-
teers as human participants [2,37,15,16]. In quintessence,
the majority of the significant findings from Shavers
and/or other colleagues empirical studies revealed that
self-reports of various exposures to violence and trauma
by the children and ado lescent particip ants assisted in the
further development of the evidence-based derived theo-
retical constructs and the hypothesized conceptual map-
ping noted in Figure 1 [2,15,16,37]. Likewise, many of
the significant findings or data collected from the self-
report instruments utilized by Shavers and/or other col-
leagues identified youth participant self-reports of none
to mild-moderate-severe psycho-social-emotional and
mental health symptomatology as a result of self-reports
of exposures to various forms or related acts of violence
and trauma among the hu man research particip ants [2 ,15,
16,37,66,67]. Also, in the studies conducted by Shavers
and/or in collaboration with colleagues revealed that the
children participants who self-reported exposures to in-
timate partner violence (IPV) or domestic violence (DV),
often self-reported feelings of anger or mad, and fear
[15,37]. In addition, notably, many of the children par-
ticipants who self-reported exposures to DV or IPV also
revealed feelings of sadness [15,37]. Further, preliminary
findings from The Safer Tomorrows Project© pilot of the
Focus Group process co nducted in 200 4 revealed th at the
adolescent participants reported a higher rate of expo-
sures to various acts of violence and trauma versus the
children participants [66,67].
Congruently, the hypothesized theoretical and con-
ceptual mapping of The Childhood Violence Trauma
Reduction Model© presently utilized by The Safer To-
*ECV
*IPV
Trauma
Antecedent
Childhood
Traumatic
Str e sso r(s)
Including
physical
injuries
PTSD
None
Mild
Moderate
Severe
Emotional
Respon se s
Behavioral
Patterns
*CommunityLevel
Vari ab l es
Environment‐
Home/Community
Fami ly Support
Teachers
Community
Support/Resources
*IndividualLevel
Var i a bles
ChildHealth
Language
Dev elo p men t a l
OrLearning
Disabilities
(ADHD)
Moderato r
Vari a bl e s
Ethnicity/Culture
Gender
Age
Incom eLevel
Peer Relation ships
inschool
Academic
Performance
Perf orma nce
T HE CHILDHOOD VIO LE NCE TRAUMA REDUCT ION MODEL©
Figure 1. Interrelationship of the concepts, mediator, con-
founding, and moderator variables: A Hypothesized Conceptual
Map© Shavers, C.A. (2000). The interrelationships of expo-
sure to community violence and trauma to the behavioral pat-
terns and academic performance among urban elementary
school-aged children. Dissertation Abstracts International: Vol.
61(4-B), 1876. *Exposure to Community Violence, Interper-
sonal Violence, Intimate Partner Violence (Domestic Abuse and
Bullying); *Posttra umatic Stress Disorder (PTSD); *Community
or County level variable (mediator variable); *Individual level
variables (confounding variables).
morrows Project Research Team© seen in Figure 1, in-
corporates depicting the interrelations among the theo-
retical concepts (constructs): 1) childhood exposure to
community violence, interpersonal violence and IPV or
DV including bullying, 2) trauma including physical in-
juries, 3) the antecedent childhood traumatic stressor(s),
4) psychological responses, 5) emotional responses, 6)
behavioral patterns, and 7) academic performance and
peer relationships. Nonetheless, the investigators for The
Safer Tomorrows Project© recognize the fact that no sin-
gle risk or protective factor or combination of factors can
predict the psychological, emotional, physiological, be-
havioral or peer relationships in school, and academic
performance with neither absolute accuracy nor linearity.
So therefore, due to the nature of the intervention/proj ect,
The Safer Tomorrows Project Research Team© decided
to use a model/theory building approach with the inter-
vention/project. Thus in essence, we have incorporated
the utilization of The Childhood Violence Trauma Re-
duction Model© in the designing of the intervention/
project in an effort to rigorously evaluate the effective-
ness and efficacy of this evidence-based randomized
controlled psycho-social-emotional intervention/project
over a 10-year period on a local, national and interna-
tional level.
5. SUMMARY
In summary, childhood and adolescent adverse expo-
sures to violence and trauma have been identified as a
distressing health care problem for our society [4,8,
10,14]. The literature has noted that evidence-based

C. A. Shavers / Health 5 (201 3) 298-305
302
health promotion and prevention of violence and trauma-
related interventions have been found to be effective in
assisting youth who have been impacted from being ex-
posed to various forms of violence and trauma [5,6,68].
HCP’s and others play a significant role in meeting the
needs of children and adolescents who self-report expo-
sures to violence and trauma [10,17,29,30]. Finally, in
collaboration with other Partners, Volunteers, Collabo-
rating Agencies and Organizati ons, The Safer Tomo rr ow s:
Injury Prevention and Violence Reduction Project© is
presently identifying children and adolescents who are
at-risk and who may or may not be at-risk for exposure
to violence and trauma in their lives to assist in the
global efforts to address this persuasive health care pro-
blem in our society [3].
6. CONCLUSION
Consequently, as a result of adverse exposures to vio-
lence and trauma among children and adolescents, this
may result in an unhealthy and vulnerable population of
victimized and traumatized youth. However, there is a
promisingly dearth of information that exists to assist
adults, HCP’s and others in integrating, implementing
and evaluating the utilization of appropriate physical,
psycho-social-emotional, and mental health services for
identified victimized and traumatized yo uth. Addition ally,
it is imperative that HCP’s and others engaged or em-
ployed in health care, schools or community-based set-
tings be actively involved in all endeavors including
health policy to promote the overall psycho-social-
emotional and mental h ealth of all youth who self-report,
who are at-risk and who may or may not be at-risk for
exposures to violence and trauma in their young lives.
Thus, hopefully these proactive endeavors on behalf of
society’s youth will co ntribute to safer and health ier phy-
sical, psycho-social-emotional, and mental health care
trajectories for today, tomorrow, and the future genera-
tion of children and adolescents.
7. ACKNOWLEDGEMENTS
This article was supported by the Text and Academic Authors Asso-
ciation Inc. (TAA) URL:
http://www.taaonline.net/membersonly/publication_grants/index.html
academic publication grant. Also, the author would like to especially
acknowledge the following members of The Safer Tomorrows Project
Research Team©: C. A. Archer-Gift, Ph.D., L. M. Green, M.A., L.L.P. C.,
L.B.S.W., J. E. Onyskiw, Ph. D., and M. Price, Ph.D. and all the mem-
bers of The Safer To morrows Project© for their support and dedication
to our mission and vision.
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