A new approach to community violence

More than 25 percent of children and adolescents in the United States are exposed to a traumatic event by the age of 16. Such incidents become a recurring event for many Boston youth — and many also become victims of violent bullying — as they grow up, often triggering depression, post-traumatic stress disorder, anxiety and behavior problems, even school avoidance, says psychologist Joanna C.M. Cole, PhD.

“Often, children are jumped on their way to school, and then they are afraid it may happen again,” says Cole, director of child psychology training program at Boston Medical Center.

Now, with help from a $10,000 American Psychological Foundation Drs. Raymond A. and Rosalee G. Weiss Research and Program Innovation Fund Grant, Cole and her co-investigator, Boston Medical Center pediatrician Renée Boynton-Jarrett, MD, ScD, are developing a program to prevent lingering trauma symptoms among adolescents living in Boston’s most crime-ridden neighborhoods. Using components from trauma-focused cognitive behavioral therapy, Cole created a 10-week group therapy curriculum for at-risk youth ages 12 to 15. While researchers have shown that the technique is effective for individual therapy, this intervention is using a group therapy setting and targeting youth exposed to community violence with subclinical trauma symptoms.

At after-school sessions once a week in her Boston Medical Center office, Cole teaches groups of boys coping skills and relaxation strategies, and offers practical guidance on how to seek help from the police and avoid dangerous sections of their neighborhoods. In some sessions, she explains how physiological and psychological symptoms, such as headaches and anxiety, can linger long after a violent incident. She also encourages students to share their experiences through role-playing and journal writing.

“Some don’t have language for what they are feeling, so we also allow for cartooning and graffiti,” she says. “Some are able to reflect on what they are thinking about better through art.”

Last year, Cole and colleagues at Boston Medical Center piloted the curriculum with two groups of boys, four in the first group and six in the second, each of whom was living in a high-crime neighborhood and had been a victim or witness of violence close to home. Her preliminary data are positive: The boys’ school attendance and performance improved both during and after the program and their post- traumatic stress symptoms diminished. In addition, the boys who participated came almost every week, developed stronger social networks, including friendships with their peers in the group and more effective communication and coping strategies to discuss and manage feelings surrounding community violence exposure.

“That’s the power of group work,” she says. “In the end, they had this nice collective support network with boys from other neighborhoods who were experiencing the same type of violence exposure.”

This spring, Cole will use the funding to run two more groups — with girls this time — and is adding a four-session curriculum for parents that a fellow psychologist will facilitate. “We noticed that parents waiting for their children were getting to know each other and saw a great opportunity to have them learn the same skills their children are,” says Cole.

She hopes that, as she continues the groups and gathers more data, she can expand her model throughout the city. The goal is to continue to tailor the curriculum to meet the needs of the youth exposed to community violence and ultimately run many more groups and share this tool with schools and community-based health centers.

APF’s Drs. Raymond A. and Rosalee G. Weiss Research and Program Innovation Fund Grant Program awards grants from $5,000 to $20,000 to projects and programs that use psychology to solve social problems.