I will soon become the legal guardian of my niece and nephew, ages 8 and 11. They have lived in a dangerous and violent home where their mother had countless boyfriends and hangers-on. They were exposed to violence, drugs, alcohol, neighborhood shootings, and who knows what else. I’m concerned that by myself, I will not be able to deal with all the effects this has had on them. Where can I turn? 

You do not have to do this alone. The kids should be eligible for either private insurance or Medicaid. Both types of insurance providers can give you a list of covered therapists or psychiatrists—ask for ones who specialize in children. Office visits are usually longer with a therapist; psychiatrists are generally limited by insurance to medication prescriptions and medication management. School counselors can help you access special school programs for academic or behavioral problems. The appropriate mental health provider will:

• see the kids separately (due to the age/sex difference) as well as together when needed

• work with you on handling problems at home

• be comfortable with family therapy sessions

• be comfortable playing and talking alone with kids (some only see children with the caretaker(s) present, which can inhibit some kids)

• have a background in trauma treatment

If therapy and/or psychiatry are not enough, there are intensive in-home programs designed to prevent further placement. Contact the Children’s Division of the Missouri Department of Social Services (formerly Division of Family Services) or BJC Behavioral Health for information. Some children are amazingly resilient (due to temperament and/or environmental supports) after exposure to violence and chaos. Others begin to act out or exhibit emotional problems once they feel safe and secure enough to express their feelings. Your niece and nephew are fortunate to have someone to assist who is aware of the effect this type of situation can have on children. 

Cindy Fritz, LPC, LCSW
3550 McKelvey Road, #104
Bridgeton, MO 63044
314-298-0602

Children who have been exposed to trauma and chronic stressors often exhibit a variety of difficulties that can be challenging to manage. The violence and abuse they have witnessed may have influenced their self-image, their coping styles and their ability to trust others which impact how children think, feel and behave. They may have learned from their environment to be suspicious and to be constantly on guard in order to protect themselves. They likely will have trouble managing their strong emotions, which can range from sullen irritability to angry withdrawal and sadness. Your niece and nephew may be preoccupied with frightening memories of their experiences. Their histories may include adults that have abandoned, betrayed or hurt them. They may also struggle with thoughts of self-blame--- that somehow they were responsible for their own mistreatment. These distorted thought and feelings can make developing healthy family relationships challenging at first. However, children who have been exposed to trauma are remarkably resilient, especially when they have access to a caregiver who is loving, consistent and supportive. Seek professional help from an agency or therapist who specializes in providing trauma-informed interventions with children. A trauma-focused therapist can help educate you about what to expect from your niece and nephew, teach you strategies to manage their behaviors and work with the children individually to process their feelings about their experiences. 

Jerry H. Dunn, Ph.D.
Executive Director
Children’s Advocacy Services of Greater St. Louis
314-516-6798

Dedicated to reducing the impact of trauma on children and adolescents

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