Whaley, 34, didn’t make it.
Shawn is now 8 years old. He lives with his grandmother and five siblings in one of Hartford’s rundown neighborhoods. “They got a lot of anger,” said Ishmeal Turner, Shawn’s grandfather. “It’s been rough. Rough.”
Turner, a cab driver, lives a few streets down and comes by to help. Shawn’s mother had moved out before Whaley’s death, and his grandmother is on chemotherapy for colon cancer. Turner said he pulled Shawn out of public school for aggression. He still worries over the child’s outbursts of anger, and nightmares involving gunshots and blood.
Like Shawn, thousands of children suffer from trauma, or what experts call traumatic dysregulation. When children are overwhelmed by a traumatic event, their ability to think in a linear fashion is compromised, and their coping mechanism goes haywire. The National Child Traumatic Stress Network estimates that 26 percent of children will experience a traumatic event by age 4.
But they are getting little or no help. “Imagine if you feel small or frightened all the time, imagine if you can’t get rid of intrusive thoughts about the original traumatic experience,” said Steven Marans, PhD, director of the Childhood Violent Trauma Center at the Yale Child Study Center, and professor of psychiatry at the Yale School of Medicine. “These are burdens that the developing child is not able to adequately negotiate and master.”
When left untreated, children are at a higher risk of post-traumatic stress disorder (PTSD), anti-social behavior, academic failure, difficulty forming relationships, and anxiety disorders. They are also more likely to abuse drugs and alcohol. There are physical disruptions too because “our bodies are central to our feelings,” Marans said. Symptoms can include increases in the heart rate, changes in the respiratory rate, headaches, and gastro-intestinal disorders.
Melanie Stengel Photo.
Hilary Hahn, Project Director, Yale Childhood Violent Trauma Center and New Haven Police Department’s Lt. Manmeet Colon during a meeting at the Yale Child Study Center.
The long-term repercussions can be devastating. Doctors say they are frustrated by the cyclical nature of how adults exposed to trauma in their childhood end up in the ER repeatedly. Nothing has changed, they say, in the last 15 years. “They are showing up because they are using substances, for erratic behavior in the community, or are a threat to themselves,” said Dr. Gregory Shangold, an ER physician and vice president of the Connecticut State Medical Society.
Most, Shangold said, are from inner cities and the ER is their last resort. When they go back to their communities, they lack access to therapy and are at a higher risk of returning to the ER.
The late 1980s were particularly violent across the United States. The average penetrating wound per individual with a gunshot wound was 3.5 bullets per person, Dr. Jonathan Gates, chief of surgery at Hartford Hospital, pointed out. The volume of aggravated assaults appears to be on the rise again, Gates despaired. “Young victims pour into the trauma centers night after night, some with life-threatening wounds. Those who are saved are faced with long term post-traumatic stress from the event,” he said. Hartford Hospital admits over 2,000 trauma patients per year of which 10-15% are victims of penetrating wounds.
The need, then, is to intervene swiftly in the aftermath of a traumatic event. “The police can be the first adults for the children to provide an immediate sense of safety,” Marans said.
Under Marans’ guidance, the New Haven Police Department will become among the first in the country to train all of its officers in trauma-informed responses to children exposed to violence. The initiative builds upon an already existing partnership with the Yale Child Study Center through which mental health professionals respond to police calls involving child victims or witnesses of violence. The professionals offer an immediate buffer and assess initial symptoms—anxiety, discomfort, irritability, difficulty sleeping, easy startling, and more— identifying a child in need of treatment. The children are then referred for trauma-focused counseling at Yale.
Marans says the model is working and police departments have replicated it nationwide. “This is a great example of intervening early to help children and their families turn down the volume on symptoms,” he said.
Yale has several other treatment methods. In a June 2019 paper published in the journal Child Abuse & Neglect, Marans and his co-authors found that 640 caregivers nationally saw a 62 percent improvement in post-traumatic stress under the child and family traumatic stress intervention (CFTSI) model. Adult well-being has a cascading effect on how traumatized children recover.
But the need is so vast that nonprofits are filling the gap. Ellen Tracy, executive director of Big Brothers Big Sisters of Southwestern Connecticut, said a child once had a man drive up to her at her bus stop and he tried to get her into his car. The girl ran away but was afraid to take the bus again. “They see all levels of street violence—drugs, gang violence, domestic violence. They are very used to it and it becomes part of their life,” she said.
It shouldn’t.
A May 2019 study in Health Affairs found that children exposed to neighborhood violence, and whose parents also felt they were unsafe in their neighborhood, experienced nearly three times the rate of chronic physical ailments and five times the rate of mental health conditions compared to children who had not been exposed to neighborhood violence and whose parents perceived them to be safe in their neighborhood.
The findings highlight the link between children’s health and neighborhood safety, and the need for public-private investments in underserved communities.
Data from the Child Health and Development Institute of Connecticut, Inc. show that in the next five years across Connecticut, 13,000 additional children will receive an evidence-based trauma treatment. Of these, 2,000 will be under the age of 7. More than 700 early childhood providers will be trained in trauma through the Early Childhood Trauma Collaborative.
For now, though, kids like Shawn need immediate help. Though he has a counselor, Shawn’s grandfather is uncertain if he is receiving trauma-focused intervention, which is what he needs, Marans said.
Shawn remembers playing basketball with his dad. He misses his dad’s grilled chicken. How does he cope? The child shrugged, looking at the floor. “Dunno,” he whispered.
Families across Connecticut can search for providers offering selected evidence-based trauma treatments by visiting www.
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Sixty-four percent of Connecticut’s youth who use Emergency Mobile Psychiatric Services (EMPS), the state’s mobile crisis intervention team, have experienced one or more traumatic incidents, such as domestic violence, cyber-bullying, physical assaults, or gang warfare, experts report.
Research shows childhood exposure to violence, physical or sexual abuse, and other traumatic events can cause chronic health and behavioral health problems, and such exposure is associated with increased involvement with the child welfare and criminal justice systems.
“The number of children who have been exposed to trauma is a significant concern. It’s a common occurrence among young people,” said Jeffrey Vanderploeg, vice president for mental health initiatives for the Child Health and Development Institute of Connecticut (CHDI). He is director of the EMPS Performance Improvement Center, which is housed at CHDI.
Expanded Role For Crisis Intervention
EMPS is a crisis intervention program with a statewide network of about 150 mobile mental health professionals who assist children up to age 18 with behavioral or mental health emergencies. When a call is placed to 2-1-1 from any Connecticut town, clinicians respond within 45 minutes, either by telephone or at a face-to-face crisis assessment and intervention at home, at school or in the community. They can remain involved for up to 45 days, creating care plans, coordinating services and following up.
Last fiscal year, EMPS provided 12,376 instances of care – up 11.4 percent from the previous fiscal year – and some worry that demand will soon exceed the program’s capacity.
State lawmakers are currently considering future funding for EMPS and other mental health initiatives. In October, Gov. Dannel Malloy issued an “action plan” for children’s behavioral health that called for using $160,000 to post a full-time EMPS crisis-intervention worker in the emergency department of Connecticut Children’s Medical Center and a part-time worker in another hospital. The plan also said the governor was “considering” enhancing the EMPS network by increasing the hours of service from 11 hours a day to 18 hours a day, at an expected cost of $3 million. Current EMPS costs are about $10.5 million this year.
EMPS was created to assist children in their homes and communities, reduce emergency department visits, and divert youth from more restrictive and costly interventions, such as hospitalizations, residential care settings or arrest. Funded by the state Department of Children and Families in partnership with United Way of Connecticut, the program serves all youth regardless of health insurance status.
Heightened awareness about behavioral health issues and the EMPS program accounts for some of the increased demand for services, experts said. But clinicians also report an increase in the severity of cases, compounded by the shortage of outpatient and residential treatment placements and the inability of many families to afford the behavioral health care their children need.
“We’re seeing kids who require an intense level of services that might not be available right away. We’re being called in to provide treatment in the interim so their situation does not escalate. Some children need a high level of care. But others can step down from the crisis,” said Jessica Welt, director of crisis services at the Child Guidance Center of Southern Connecticut. The center is one of six agencies that provide crisis intervention services from 15 satellite sites statewide.
“EMPS clinicians are doing a tremendous job of responding to crisis, but their ability to follow up with clients is being stretched,” Vanderploeg said.
More Youth At Risk
Twenty percent of Connecticut youth – that’s 156,000 children under age 18 – could benefit from behavioral health treatment, but many can’t access services, according to the Connecticut Children’s Behavioral Health Plan. The plan was developed after the Sandy Hook Elementary School shooting that killed 20 students and six adults in 2012.
But more Connecticut children and young people with mental health problems are being hospitalized. Mental disorders surpassed respiratory problems and all other ailments as the leading cause of hospitalization in Connecticut in 2012 for children ages 5 to 14, teenagers and younger adults, according to a new state Department of Public Health report. Common conditions among children include mood disorders, depression, attention deficit disorder and disruptive behaviors.
Youths 13 to 15 years old (37.6 percent) and 9 to 12 years old (24.5 percent) accounted for most EMPS clients. Harm or risk of harm to self or others (36 percent) is the most common reason parents, school staff and police call EMPS, followed by disruptive behavior (22 percent), depression (15 percent), family conflict (6 percent) and anxiety (6 percent).
Elizabeth Peralta, a social worker and manager of crisis intervention at Danbury Hospital, assists children and adolescents who come to the emergency department. Volume has remained steady, she said, “but the cases are very much more involved and intense.” She steers youth who do not require hospitalization to EMPS to connect with community behavioral health services.
“There is a huge need for mental health services for children and adolescents,” said Peralta. “They and their families are struggling. It’s heartbreaking.”
Stressors On Multiple Fronts
“We’re seeing more kids who are traumatized by problems at home and at school. Their actions and behaviors are more understandable when you view them in the context of what is happening in their environment,” said Amy Evison, senior program director for Community Health Resources in Middletown, which handled more than 1,200 crisis calls last year.
Social media is a major source of angst. “We see lots of kids who are struggling with how to manage social media,” said Evison. “They have contact with people in the community and the world that they don’t even know, yet they’re immediately impacted by what they say. Kids are saying very violent and threatening things over social media.”
Christine Mullin, one of five social workers serving 2,600 students at New Britain High School, contacts EMPS clinicians at the Wheeler Clinic in Plainville about four times a month and sometimes twice in a week.
“The number of kids who need help keeps increasing each year,” said Mullin. “It’s hard to keep up with demand.”
Mullin sees students who are experiencing trauma, anxiety, panic attacks and depression, with some teens threatening to harm themselves and others. Students face multiple stressors, ranging from academic pressure to succeed to concerns about unemployment and hunger at home.
“What is wonderful about EMPS is that they come out to the school for all forms of crisis, not just when a student is suicidal,” said Mullin. “They can help students who are in a state of serious duress that could worsen without early intervention. It’s a preventative measure.”
With assistance from EMPS, Mullin has been able to keep students from inappropriately using the emergency department. EMPS clinicians also “bridge the gap” by following clients for up to 45 days until children and families are connected to home- and community-based services.
“I know our families and kids are in good hands when EMPS is involved,” she said.
Latin America children traumatized by their journey to the United States and their experiences back home represent a growing portion of youth accessing crisis services, said Welt, of the Child Guidance Center. The agency – which saw a 33 percent increase in crisis calls last fiscal year – serves Stamford, New Canaan, Greenwich and Darien.
“Fairfield County has a large immigrant population. We’re seeing an increasing number of children and young adolescents who have been exposed to horrific traumas en route to the United States or in their country of origin,” she said. These include youths who have experienced or witnessed physical or sexual abuse, assault, homicides, separation from loved ones, gang violence and more.
For some youths, the trauma of witnessing the arrest of a parent or caregiver can have long-lasting implications, said Lt. Sean Grant of the Manchester Police Department. Grant is the liaison for REACT (Responding to Children of Arrested Caregivers Together), which brings police and EMPS clinicians together to support traumatized children.
“We understand kids are seeing a lot of traumatic events in the world and in our community,” said Grant. “As much as we are called up at times to be social workers, we don’t have expertise in this area. It’s nice to be able to call EMPS professionals when we don’t have all the answers.”
Limited Access And Affordability
Experts don’t expect demand for crisis services to lessen anytime soon, given the shift from congregate to community-based treatment settings, a shortage of child psychiatrists, and the lack of sufficient inpatient and outpatient treatment placements.
Families with health insurance plans that have high co-payments and deductibles are struggling to find affordable behavioral health services. Some child psychiatrists don’t accept commercial insurance at all.
“We see many families who may have insurance, but they still can’t afford the services their children need, such as medication, partial hospital programs or an intensive in-home program,” said Evison. “Health care is out of reach for many working poor families.”
Disparities in access to care among children with private insurance and those enrolled in HUSKY, the state’s health insurance program for the poor, exacerbate the situation.
“People in the child welfare and court systems have access to a more robust range of evidenced-based mental health services at home and in the community than what is available to people with commercial insurance,” said Vanderploeg. “Access to services even differs for children (covered by the state) depending on whether they entered through the child welfare or court system. These are all issues that were struggling with and need to change.”
For now, advocates are calling for increased funding from private and public insurers to support mental health services for children, including the EMPS program. “There are many kids out there facing mental health problems that need to be addressed,” said Welt.
For a partial list of mental health services offered in Connecticut click here.
On May 7, C-HIT will host a community forum on teen mental health at The Lyceum, 227 Lawrence St., in Hartford. The event, which features an expert panel, is being held in collaboration with ConnectiCare and Hartford Hospital’s Institute of Living. For information and to purchase a ticket, go here.
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