Caring for Infants and Toddlers in Violent Environments: Hurt, Healing and Hope
Osofsky, Joy and Fenichel, Emily (eds.) (1994).
Arlington, VA: Zero to Three/National Center for Clinical Infant Programs; 48 pages. $NPL. ISBN 0-943657-30-X.
It is tempting to believe that infants are less affected than older children by violence in their surroundings. This report from Zero to Three makes it impossible to indulge in this fantasy. Violence, it is clear, has profound effects on the development and well-being of the very young, and even infants can show symptoms of post traumatic stress disorder. “Today's infants are in double jeopardy,” says Dr. Joy Osofsky, one of the editors of the report, “On the one hand, they are in danger of becoming the victims of violence. On the other hand, they can become accustomed to violence, losing the ability to empathize with its victims and taking on the role of the aggressor.”
Zero to Three, a non-profit organization, is dedicated to promoting the healthy development of infants and toddlers, and to communicating to the public the importance of the first three years of life. Caring for Infants and Toddlers is the product of Zero to Three's Violence Study Group, which began in 1991 to examine the impact of violence on young children and their caregivers. The editors describe the report as a contribution to the development of caretaking strategies for young victims of violence. They look at what it means to be a parent in a violent environment; they attempt to address the concerns of those who deal with very young children in the larger community; and they discuss the assessment and treatment of infants and toddlers who have been exposed to violence.
The publication is dense and informative, combining overviews of the various topics with case studies and guidelines for response. But there is only so much that can be covered in 48 short pages. It is hard not to wish for a more comprehensive treatment of the subject from this knowledgeable group of contributors. The booklet appears to be geared towards those who care for very young children, be they parents, daycare workers, or therapists. But it is far too brief and superficial to serve as a real guide for anyone of these constituencies. Given the brevity of the treatment, it would have been helpful if the authors had included recommendations for further reading. Better still, though, we can hope that this is intended as an initial report, and that much more will follow.
Editor Joy Osofsky introduces the report with the kind of statistics that never lose their power to shock. Homicide, she tells us, is the second most common cause of death among all 15-24 year olds in the United States. Thirty percent of 6th, 7th, and 8th graders in this country report witnessing at least one crime daily. Many inner city children report that they don't expect to live to adulthood. The leading cause of death for children less than a year old is physical abuse.
Violence in the home, rather than in the community, is the most serious problem for very young children. But being the victim of abuse is not the only danger. Children who witness domestic violence are also at risk; they are subject to severe psychological trauma and there can be dire consequences for infant development. Osofsky reminds us that while very young children are not sheltered from violence by virtue of their age, they have fewer ways of expressing their feelings or organizing their experience than older children do; they can neither ask the questions nor understand the answers that might bring some relief.
Although domestic violence is a primary concern for those dealing with this age group, violence in the community cannot be overlooked, and it presents a challenge for many parents. Beverley Roberson Jackson, one of the contributors, describes some of the strategies that she has been forced to resort to as a parent in a violent neighborhood. Her sons are forbidden to look out of windows that face over a major thoroughfare, and family activities are planned in other parts of the house. When they drive through the neighborhood, they play the “hiding game;” the three year old unbuckles his seat belt and slides onto the floor, and the baby in his car seat keeps his head down as he watches his brother. When Jackson sees police officers posted outside of the park where her children play, she takes the boys home, knowing that police presence implies that violent suspects are in the area. Some parents in strifetorn neighborhoods put their children to bed in the bathtub to protect them from stray bullets, or require them to lie flat on the floor when they watch television. Raising confident and secure children in a violent environment draws on all the strength a parent can muster, but as James Garbarino and Dolores Norton point out in their contributions to this section, parental steadfastness and reassurance can do much to bring stability and meaning to a child's life, even in the face of severe stress.
The second section of the book deals primarily with the role of child care providers and police officers in maintaining the fabric of community life. The authors describe several model programs which provide safe havens for children and support the often overwhelmed adults in their lives. One of the programs presented here by Steven Marans is an impressive collaboration between the Yale Child Study Center and the New Haven police. Police officers take seminars in child development and are trained to respond appropriately to children who have been victims of or witnesses to violence. Police who report to the scene of a violent event at which children were present set up immediate contact with clinicians at the Yale Center's 24 hour service, and continue to coordinate their efforts with those of mental health care professionals at weekly case meetings.
Children in New Haven are fortunate with regard to the accessibility of services. Charles Zeanah, in his contribution on the assessment and treatment of young children exposed to violence, paints a bleak picture of the situation in the country at large. Infants and young children exposed to violence, he says, display a range of symptoms from numb withdrawal to extremes of anger. Their mechanisms for coping may interfere seriously with their primary developmental task of learning, and their social relationships may become damaged and distorted. Zeanah discusses the scarcity of adequate mental health resources for infants and toddlers, and the poor level of understanding of the complex needs of the very young. There is the fact, too, that few young children who experience violence, and even fewer who witness it, are ever referred for assessment or treatment. When children do see mental health professionals, it is most frequently in an attempt to verify allegations for legal purposes. In the event of a child having access to good therapeutic help, another concern remains: no successful treatment can occur while further trauma continues to be a factor. Unfortunately it is often unrealistic to expect that families can change their circumstances. The effects of violence remain most profound for those without the resources to take control of their lives or to escape from their violent surroundings.
The recommendations of the Violence Study Group are depressingly, but perhaps inevitably, macrostructural. They stress that there are no simple solutions to the complexity of the issues surrounding violence. Violence in the home, in the community, and in society at large cannot be untangled from one another or addressed separately. To reduce violence effectively in any one domain will involve concerted efforts to change attitudes across the whole social spectrum. Zero to Three calls on legislators, law enforcement agents, and the media to join clinicians and practitioners in advocating a realignment of values and comprehensive public policy strategies for reducing violence.
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