Helping kids cope with trauma and grief related to gun violence

Many communities across the nation are facing a harsh reality – including here in New Orleans. Far too many youth in our region are exposed to gun violence and death on a regular basis. Whether hearing about it on the news or experiencing it directly, the impact of violence is far-reaching and has the potential to change the trajectories of children’s lives.

In New Orleans, the number of deaths from gun violence among children continues to rise. Violent crime in our city continues to outpace the nation on a per capita basis. Homicide is the top cause of deaths for children ages 1 to 14 in New Orleans, according to the New Orleans Health Department. Furthermore, our state has the second highest rate of gun-related deaths according to the firearm mortality data published by the Centers for Disease Control and Prevention (CDC).

The impact of violence on our youth

In light of these issues, we launched the Trauma and Grief (TAG) Center at Children’s Hospital last fall, which is currently one of the only programs in the Gulf Coast region exclusively dedicated to meeting the mental health needs of children and adolescents exposed to trauma and loss.

The consequences of gun violence can be particularly traumatic for youth. The vast majority of children who are referred to our TAG Center are children who have either witnessed or learned of a homicide. Many have been exposed to violent deaths in their neighborhoods or have seen dead bodies in the street. When a child loses a loved one to violence, it can permanently change their world view, making them believe that the world is a scary and dangerous place. Common, preoccupying thoughts can include, “If this can happen to my mom, it can happen to anybody.” Or “Nobody can keep me safe.”

Many children we see at the TAG Center are scared to step outside their homes. Some are afraid to go to school for fear that something might happen to them on their way there. Some feel uncomfortable playing in the park because they are afraid of being shot. Many of the children and adolescents we treat have given up on their hopes and dreams for the future. We have heard teens say, “It doesn’t matter what I do because I am not going to live past 21.” Or “Why should I bother going to school? I’m not going to live long enough to go to college.” In addition to grappling with their trauma and grief, youth are often, and understandably, preoccupied with the social injustice of the deaths they have witnessed, especially when it appears that no one is being held accountable for acts of violence. In many cases of homicide, the perpetrator is never identified or caught, and among young survivors or witnesses, thoughts of revenge or retaliation are common.

TAG Center: Helping children cope with trauma and grief

When children come to the TAG Center, we use evidence-based assessments to determine which intervention will be the most helpful to them. We only use therapies that have proven to be effective at reducing posttraumatic stress, maladaptive grief, depression and/or suicide risk. Our clinicians work extensively with clients to develop emotion regulation skills and cognitive coping skills (i.e., changing maladaptive/unhelpful thinking patterns). In cases of trauma, our clinicians help youth to make sense of what happened to them through trauma processing (e.g., talking or writing about the traumatic event). As for the grief component, our goal is to reduce the more unhelpful grief reactions that youth often have (feeling “stuck” in their grief) while enhancing more adaptive or helpful grief reactions. This can include finding special ways of feeling connected to the deceased or ways they can honor a loved one’s memory. For instance, what can they do to live the kind of life that the deceased person would have wanted them to live? At the TAG Center, we help children to transform their tragedies into something meaningful, including how they can use their experiences to help others who may be going through similar adversities.

What can parents/caregivers do to help?

Parents and other caregivers play an important role in helping children navigate the trauma and grief process. While it can be uncomfortable talking to children about violence and death, the best thing we can do for our children is to validate their reality and be there for those difficult conversations. Here are several tips for caregivers to keep in mind when discussing difficult topics, like gun violence, with their kids.

• Acknowledge what is happening. It is hard to talk to children about violence – but the reality is – kids in New Orleans are seeing and hearing about violence all the time. Often parents shy away from talking about gun violence because they think it will upset their kids or make them worry more. But this silence can send the message that it’s not ok to talk about hard things and/or the child may not be able to handle it. Instead, it is helpful to let the child guide the conversation to ensure that their own questions or concerns are being addressed. Parents can ask, “I’m sure you heard about the shooting last night. What questions or worries do you have?” Parents can then provide simple, straightforward answers that are appropriate for the child’s developmental level.
• Minimize exposure to the media. The news media can be overwhelming for children, especially when the majority of stories are focused on gun violence and fatal shootings. Parents should consider reducing media exposure and maintain an open dialogue with their children so they can explain what they may be seeing or hearing on the news and answer any questions they might have.
• Provide a sense of safety and security. The most important thing caregivers can do for their children is to remind them that the adults in their lives are doing everything they can to keep them safe and protected. It can also be helpful to remind them about the difference between “kid worries” and “adult worries”. Kid worries can include, “How do I make sure I do well in school?” “When am I going to do my homework?” “Who should I invite to my birthday party?”. Too many children in New Orleans are being forced to take on adult worries related to safety and security, when it is the adults in their lives who should be bearing that burden.
• Be proactive and know the signs of trauma. Among pre-school aged children, signs to look out for include significant behavioral regressions such as language delays, difficulties sleeping, changes in eating patterns or excessive clinginess with caregivers. In older or school-age children, signs of trauma may include avoidance of activities they once enjoyed, irritability or aggressive behavior, new fears and anxieties or engaging in risk-taking behaviors. If caregivers notice any of these changes or new behaviors, it may help to seek out an evaluation from a trained trauma-informed therapist.

Empowering our community to make a difference

We know that it takes a village to address the mental health impact of gun violence on children. To that end, our TAG Center is partnering with school- and community-based clinicians throughout New Orleans by training them in evidence-based interventions to address trauma and grief in youth – some of the very same treatments we use within the TAG Center. We will also be partnering with Jefferson Parrish schools early next year to ensure all of their school-based clinicians are trained in a group-based intervention for students exposed to trauma and loss. In addition, we are also launching a new partnership with officials in the Juvenile Justice Intervention Center to provide evidence-based care to children and adolescents in the system to help reduce violent behaviors.

Although we continue to hear devastating stories of trauma and loss, our TAG Center also has the privilege of witnessing stories of strength, resilience, hope and healing. Together with our community, we can help to ensure that no child or adolescent exposed to adversity has to suffer in silence.

For more information about the TAG Center at Children’s Hospital New Orleans or to make an appointment with one of our therapists, please visit this website: https://behavioralhealth.chnola.org/programs-services/trauma-and-grief-center

Julie Kaplow, PhD, ABPP, is a licensed clinical psychologist, board certified in Clinical Child and Adolescent Psychology. Dr. Kaplow serves as Executive Director of the Trauma and Grief Centers at the Children’s Hospital New Orleans and The Hackett Center for Mental Health in Houston. She is also Professor of Psychiatry at Tulane University School of Medicine. In these roles, she oversees the development and evaluation of novel treatments for traumatized and bereaved youth and disseminates trauma- and bereavement-informed “best practices” to community providers nationwide. Following Hurricane Harvey, Dr. Kaplow and her team provided evidence-based risk screening and interventions to children and families adversely affected by Hurricane Harvey and its aftermath. She also helped to establish the Santa Fe Resiliency Center following the Santa Fe High School shooting in Texas, where her clinicians have provided evidence-based assessment and treatment to families impacted by the shooting. Prior to joining CHNOLA, Dr. Kaplow served as Chief of Psychology and Vice Chair for Behavioral Health in the Department of Pediatrics at Texas Children’s Hospital/Baylor College of Medicine. Dr. Kaplow received her BA in Psychology from the University of Michigan and her PhD in Clinical Psychology from Duke University. She completed her internship at Boston Children’s Hospital/Harvard Medical School followed by postdoctoral training at the Center for Medical and Refugee Trauma at Boston Medical Center.