Remarks as prepared for delivery
I’d like to thank the American Academy of Pediatrics for inviting me to speak here this morning. While this particular organization’s mission is outside my professional area of expertise, my wife is an obstetrician – and I do have three kids -- so I suppose that’s why you’re willing to extend “professional courtesy” to me today.
I’m very pleased to be here, but more importantly, I’m very grateful that you’ve made time in your busy program to address this vital issue; namely, the subject of children and violence.
This issue has been both a personal and a professional concern of mine for a long time, going back to my days as a line prosecutor and as a superior court judge. And of course, as long as I’ve been a parent.
When I was the Deputy Attorney General at the Department of Justice a decade ago, we began working with researchers to take an in-depth look at the problem of children who are exposed to violence – as victims, yes, but also as witnesses. And we uncovered some interesting, and deeply troubling, things.
For instance, we learned that exposure to violence – whether as a victim or as someone in proximity to violence – was associated with long-term physical, psychological, and emotional harm. Children exposed to violence were more likely to go on to abuse drugs and alcohol. They were at greater risk of depression and anxiety and other post-traumatic disorders. They failed in school more often than other kids. They developed chronic diseases. They had trouble forming emotional attachments. And they were more likely to commit acts of violence themselves. In short, we learned that violence affects the brain as much as it affects the body and spirit.
But we still didn’t know how prevalent the problem really was. We didn’t have comprehensive data back then that could give us the full story about where violence touches the lives of children across age groups and across settings. And we didn’t have the research to tell us about the cumulative effect of exposure to violence.
We now have that critical information.
Less than two weeks ago, we released findings from the National Survey on Children Exposed to Violence, which was commissioned by our Office of Juvenile Justice and Delinquency Prevention and supported by the Centers for Disease Control and Prevention. The survey measured the incidence and extent of violence in children’s lives, and the results were published in the Academy’s Journal Pediatrics. The findings are a wake-up call.
The study found that more than 60 percent of children were exposed to violence in the past year, either directly or indirectly. Almost half of that number were assaulted at least once in that period. One in 10 had suffered some form of child maltreatment – abuse or neglect – and 1 in 16 was victimized sexually. And it was far from uncommon to hear of multiple victimizations. Almost 40 percent of all children experienced 2 or more direct victimizations in the previous year.
The study also found that one form of violence may make a child more vulnerable to other forms of violence. Nearly two in five children were exposed to more than one type of violence in the past year. Also, as children grow older, the incidences of victimization increase.
Finally, the survey shows the strong link between child victimization and domestic violence between adult partners. More than one in nine children were exposed to family violence in the past year, and more than a quarter of those surveyed had been exposed to family violence at some point in their lifetime. And about half of all kids who are exposed to domestic violence are also victims of maltreatment. I know the issue of co-occurrence is one that the American Academy of Pediatrics has really focused on. As the Academy noted 11 years ago, “The abuse of women is a pediatric issue.”
What should trouble us about these statistics – as professionals who work with and care about children – is the disproportionate impact that violence has upon children. Children in the United States are more likely to be exposed to violence and crime than are adults. Some see it, hear it, feel it in every part of their lives, including in their homes. They’re living with violence at rates that we, as adults, would never tolerate, and this exposure is having a profound and negative impact on their mental and emotional development.
The National Scientific Council on the Developing Child at Harvard identifies three categories of stress. There’s “positive stress,” which is provoked by normal challenges that children face every day – like dealing with frustration or going to a new school. There’s “tolerable stress,” which comes in response to frightening situations but can be dealt with in a healthy way. And then there’s “toxic stress,” which is the kind created by chronic subjection to traumatic situations like violence. This is the kind of stress that, absent the proper support, can alter the brain’s architecture. This is the experience of too many of America’s children.
It’s a serious situation, and one we can’t afford to ignore. It is one the I will not ignore.
But here’s the good news – it is possible to reverse the damage that exposure to violence causes. Research has shown that early intervention is effective in countering the effects of violence. Quality programs – including those that are pediatric-based – have shown clear results in enhancing resiliency and fostering healthy child development. And these benefits extend to children who have had frequent exposure to violence. It’s within our power to help these kids. But there are some steps we need to take.
First, we have to recognize that children’s exposure to violence is a public health issue that requires a public health approach. This means calling attention to the problem and raising awareness of the social costs of this disease called violence. It means attacking it at its source – addressing not simply the effects manifested in the child, but also the family and the environment in which that child lives. It means treating the cause, not just the symptoms.
Second, we have to address it holistically, not in fragments. We need to make sure that the systems our children come into contact with are talking to one another and working together. There are good examples of this interconnectedness. The Boston Medical Center brings pediatric providers together with mental health professionals and attorneys to make sure that all of a child’s interests are protected.
As I mentioned earlier, this is not a new interest for me. When I was Deputy Attorney General 10 years ago, we started the hard work of addressing the needs of these children. One of the programs that grew out of that work, Safe Start, supports efforts in hospitals and pediatric clinics to identify children suffering from trauma as a result of violence, including a “medical home” model like the one used at St. Barnabas Hospital in the Bronx.
Third, within each discipline, we need to make sure that professionals are sufficiently trained and knowledgeable to identify children exposed to violence and to assist with remediation. One of our goals is to work with health care providers, especially pediatricians, to recognize manifestations of exposure. These signs may be as obvious as a physical injury or as subtle as a mild cognitive impairment. Neither is a definitive sign of exposure to violence, of course, but a process for screening can be effective in determining what may be going on with that child and how best to address it. We have a publication specifically for pediatric care providers that highlights some of the promising approaches for dealing with children who may be victims or witnesses of violence. We also have a caregiver guide and a slide card with signs and symptoms that pediatricians and their staff can give to families. These are available online or in hard copy at our resource center at www.safestartcenter.org.
Fourth and finally, we need to meet this problem with all the resources that sound science can bring to bear. Research has told us a good deal about the incidence and impact of violence, but it hasn’t yet told us everything. We need more information about what works, so that policymakers and practitioners can make informed decisions about how to tackle this issue.
With the data we now have, we are surely within our rights to call this situation an epidemic. The fact is that millions of children in our country live with violence in their daily lives, either as witnesses or as victims. And whether they feel the fist on their own cheek or see it fall on another’s, it’s clear that they suffer.
But there is hope, and the hope lies with us – particularly with each of you here in this room. Somewhere along the way, each of you decided that a child’s physical health was important enough to merit your professional energies. I strongly commend you for that. Now I humbly ask that you expand that commitment just a little bit further to encompass those situations where children may not be physically harmed, but where they have been traumatized by the grave misfortune of experiencing violence in their young lives.
I am supremely confident that if people as committed, as dedicated, as talented, and as professional as all of you take that important step, we will be able to transform America for the better – one child at a time. This Administration, this Attorney General are committed to partner with you in this effort that is about nothing more than the future of our country and the fate of our most precious resource.
I look forward to working with you and I wish you all the best in your efforts for America’s children.