Dr. Regan Williams was up all night Sunday treating a toddler with a gunshot wound.
“Isn’t that crazy?” said Williams, medical director of Trauma Services at Le Bonheur Children’s Hospital. “Every week, it seems, some adults are having a fight in a house where children are playing and then a kid gets shot.”
More than 100 kids 14 and younger have been shot in Memphis this year — more than any year on record. At least 10 have been shot every month since the pandemic began. Ten have died.
“We used to get a handful of child gunshot victims every year,” said Williams, who has worked at Le Bonheur for nearly a decade. “Now it’s every week. It’s a horrible thing. Unfortunately, it’s become a regular thing with lifetime consequences.”
Like the toddler Williams treated Sunday, most children survive gunshot wounds, but they take the trauma home with them.
That trauma — clinically known as Acute Stress Disorder (ASD) — can be even more debilitating to the child and the larger community in the months and years ahead.
Without proper treatment and social support, acute trauma can lead to developmental trauma (a form of PTSD in children). That can lead to a wide range of long-term mental, physical and emotional problems that impact the entire community.
Starting in January, all children treated at Le Bonheur’s Level 1 Pediatric Trauma Center will be eligible for free mental health counseling services.
The new program is a joint initiative between Le Bonheur’s Trauma Center and the opens in a new windowBRAIN CENTER at the University of Memphis, led by Dr. Eraina Schauss.
Schauss and her advanced graduate-level students in the university’s Clinical Mental Health Counseling program will provide the counseling. Funding is provided by a grant from the Urban Child Institute.
“Trauma comes in so many shapes and sizes,” Schauss said. “We see every day how trauma can trigger the onset of mental health symptoms in children. They need to start getting treatment for their mental wounds as well as their physical wounds.”
Le Bonheur’s opens in a new windowTrauma Center began screening children for Acute Stress Disorder in March 2019. Last year, about 30 percent of the children treated at the center had developed ASD. This year, the figure is closer to 40 percent.
“COVID just made everything worse, economically, socially, emotionally,” Williams said. “The pandemic is making everyone irritable, depressed, lonely. We’re having more domestic violence, more community violence. Most schools are closed, so most kids are home more, which means they’re even more vulnerable than normal to all the conflict and violence around them.”
Through November this year, Le Bonheur’s Trauma Center treated 115 children with gunshot wounds. That compares to 89 in 2019 and 67 in 2018.
The reasons children get shot generally fall into one of two categories, Williams said.
They live in violent homes or neighborhoods. Or they live in homes where firearms aren’t stored safely, if at all.
“Some teenagers who get shot are doing the wrong thing, but most of these kids are just living in violent neighborhoods or violent homes,” Williams said. “Or they live in homes where they have easy access to guns. They are victims.”
Studies show that victims of violent crimes are more likely to be victimized again.
“We know that if you’ve been injured once, you’re more likely to come back with another injury, and usually those injuries are worse each time you come back,” Williams said.
Those victims are more likely to become perpetrators of crimes.
“It’s a cycle that happens over and over, and the cycle is starting earlier and earlier,” Williams said. “We need interventions that break the cycle.”
The COVID Crash
COVID-19 isn’t just filling up regular hospitals.
“We are treating an unprecedented number of suicide attempts and overdose events,” said Dr. Lucas Trautman, chief medical officer at the 80-bed opens in a new windowCrestwyn Behavioral Health Hospital in East Memphis.
Trautman said the increasing levels of psychological and emotional distress are a direct result of the pandemic’s economic devastation and social isolation.
“The pandemic has taken away their jobs and income, their peer relations, their ability to go to therapy in person,” Trautman said. “We’re seeing people who have a lot of resources, people we hadn’t seen coming before. It’s dire.”
Psychiatrists are calling it the COVID crash.
The overall rate of psychiatric illness among COVID-19 patients is nearly 20 percent.
Rates of new psychiatric illnesses in COVID-19 survivors are double those found in survivors of other diseases.
“COVID-19, while clearly a physical health crisis, is also a mental health crisis,” Dr. Grant Hilary Brenner wrote last month in opens in a new windowPsychology Today. “Long after the initial medical and socioeconomic needs are addressed, the mental health consequences and impact of trauma and moral distress may linger. While resilience is the norm for many, for a large percentage, based on prior experience, the long-term impact will snowball if resources are not allocated early.”
The COVID crash is hitting children even harder, Trautman and other specialists say.
They are experiencing the same anxiety and anger, sadness and grief as adults, but in very different ways.
“Children and adolescents see and hear many of the same things adults do, but their understanding of what these things mean may differ,” said Kiersten Hawes, a licensed professional counselor. “Because children and teens understand death differently from adults, their reactions may seem alarming. Under stress, children may behave as they did at a younger age.”
Hawes has been working with the local opens in a new windowACE Awareness Foundation to help parents, caregivers and their children recognize and manage the COVID crash.
Since mid-October, more than 1,000 people have participated in 20 different virtual sessions of Parenting in the Pandemic: Tools for Surviving and Thriving.
The project includes the production of half a dozen video public service announcements called Mindfulness Moments. The Shelby County Commission used CARES funding to help pay for the project.
Hawes is leading a session Wednesday on “Coping with Grief and Loss.” The goal is to help parents understand the grief recovery process and how children react to grief and loss.
“For example, children who have recently mastered potty training may start to have accidents,” Hawes said. “Children who have been acting with greater independence may become clingy or have difficulty with separation. Children and adolescents could also become demanding, act out in rage, refuse to share, or pick fights with siblings or other family members.”
Children of Trauma
The closing of so many schools during the pandemic has intensified the trauma.
Kids who go to school risk exposing themselves and others (teachers, fellow students, their families) to the coronavirus.
But many kids who stay home risk being exposed to more “adverse childhood experiences,” or ACEs, chronic stress and trauma, which are further aggravated by the coronavirus.
Since the pandemic began, several hundred families enrolled in Le Bonheur’s opens in a new windowFamily Resilience Initiative are self-reporting a 250 percent increase in depression and other mental illnesses, and a 350% increase in violence in their homes and neighborhoods.
“We still need more data points to rise to the level of clinical significance, but we are definitely still seeing the trend of increased reports of community violence,” said Dr. Jason Yaun, director of the initiative.
Acute and chronic stress and trauma can be especially hard on a young, developing brain.
Prolonged stress and trauma can strengthen neural connections to the brain’s “fight or flight” center and weaken those to the brain’s “self-control” center.
And it can shrink areas of the brain associated with the regulation of emotions, metabolism, memory, and learning.
Children of chronic stress and trauma become more prone to violence, aggression, depression, substance addiction, suicide, illness and disease, not to mention academic failure.
“Trauma reorganizes the brain,” Schauss said. “These therapies we can offer can help the brain regain its balance, teach the brain to self-regulate and become more resilient to trauma.”
Acute Stress Disorder isn’t limited to children who have been physically wounded by illness, abuse or accident.
Children who witnessed or were confronted with an event that involved actual or threatened death or serious injury can be just as vulnerable.
Such traumas can include everything from COVID-19 to car accidents, from severe burns to drug overdoses.
“Not long ago, we treated a child whose parents both died in a car accident,” Schauss said. “The child had no ACEs before the accident, but suddenly was experiencing severe and debilitating mental health symptoms.”
Le Bonheur’s pediatric residents and the BRAIN CENTER’s graduate students will “triage” every child that comes into the trauma center.
Children who are experiencing Acute Stress Disorder, or other forms of Adverse Childhood Experiences (ACEs), will be eligible for free counseling services.
The program will provide two forms of therapy that have proven effective in clinical settings with ACEs patients: Interpersonal and Social Rhythm Therapy (IPSRT), and Mindfulness Based Stress Reduction (MBSR).
Parents also will be eligible for an Active Parenting Program.
“Children are incredibly resilient,” said Schauss, “but this year has put an unusual strain on them. They need adults to help them get through this.”
The ACE Awareness Foundation, opens in a new windowUniversal Parenting Places, and Shelby County Schools are teaming up to present Parenting in the Pandemic.
The six remaining virtual sessions are
- Coping for Elementary School Kids in Challenging Times, opens in a new windowSaturday, Dec. 12, 10 a.m.
- Social-Emotional Learning Strategies to Combat Digital Fatigue (for teachers), Tuesday, Dec. 15, 4 p.m.
- Coping for Teens in Challenging Times, opens in a new windowSaturday, Dec. 19, 10 a.m.
- Family Fun Time Christmas Decorating, Thursday, Dec. 17, and Monday, Dec. 21, 5 p.m.
- Mindfulness Painting, Tuesday, Dec. 29, 5:30 p.m.
For more information, visit opens in a new windoweventbrite.com and search for ACE Awareness Foundation.
David Waters’ reporting on issues affecting Memphis children is funded, in part, by a grant from the Urban Child Institute. UCI has no prior knowledge of topics Waters chooses nor is it involved in any aspect of the editorial process.
This story first appeared at dailymemphian.com under an exclusive use agreement with The Institute. Photos reprinted with permission of The Daily Memphian.