Cities and counties in California and throughout the nation are intensifying their efforts to identify and counsel children exposed to violence at home or on the streets, in response to increasingly conclusive research on its link with emotional and developmental problems.
In San Francisco, the $3 million federally funded SafeStart Initiative aims to reverse the effects -- including post-traumatic stress, hyperactivity, attention deficit disorder, lower academic achievement, and increased rates of juvenile and adult offenses -- of exposing young children to violence in the home.
Advocates say the program is innovative, because it connects whole families with comprehensive support and services, from counseling and education to shelters and restraining orders.
SafeStart was launched by President Clinton as part of his "Children Exposed to Violence Initiative" in 1998, and it continues under Bush's Office of Juvenile Justice and Delinquency Prevention.
The program has funneled tens of millions of dollars to 11 sites chosen out of 300 applicants across the country to create pilot programs for the SafeStart Initiative.
Sitka, Alaska; Zuni, New Mexico; Chicago and Spokane are among the other SafeStart sites where programs have been individually tailored to meet the needs of the community.
In Spokane, for example, mental-health clinicians go with police to respond to domestic violence when children are present, or show up to the house within minutes of the call.
The program in San Francisco -- where an estimated 1,422 children under age six have witnessed domestic violence -- operates differently.
Because only about one-third of domestic violence victims in San Francisco go to police for help, SafeStart focuses on outreach, counseling and education to help children in neighborhoods where census and police records show there is a high incidence of violence.
SafeStart also trains health care workers, child-care providers, police, judges, domestic violence agencies, batterer intervention programs and other city and community agencies on how to identify and work collaboratively to help a child who has been exposed to violence.
"One of the challenges has been to get domestic violence community, children advocates and everyone else to talk to one another," said Claire Barnes, executive director of Kids' Turn, a nonprofit SafeStart partner in San Francisco that focuses on the needs of children whose parents are going through a divorce. "Batterer intervention services are off doing their thing. Domestic violence providers are doing their thing. Children's service providers have been working with the kids, but not the adults. So, you've got isolation."
Advocates say this comprehensive approach is a breakthrough.
According to the state Attorney General's office, one of every four children in California is directly exposed to violence as a victim or witness -- but for many years, the commonly held belief was that kids don't need special care because they were too young to be affected by violence.
"The general attitude was kids adapt to anything. It doesn't hurt them, we'll just put them in the other room," said Barnes.
"Domestic violence programs have traditionally focused exclusively on the primary victims, usually the wife/girlfriend," said Donna Hitchens, the presiding judge of the San Francisco Superior Court and chair of SafeStart's advisory council. "The whole point of SafeStart is to educate the community on the impact of domestic violence on the kids and facilitate system change."
Alan Fox, director of the San Francisco SafeStart program, is planning to launch a major publicity campaign this year to spread the message about the dangers of exposure to domestic violence. He is currently working with local marking firms on a slogan. One idea is short but to the point: "Watching hurts."
"If we can communicate to both offender and victim that exposing their child to violence is abuse, we believe that they would both be willing to take steps to help," he said. "If you can identify these children early enough and intervene early enough, you can reverse all of the effects -- the physiological impact and the emotional impact."
Fox, however, is quick to point out that San Francisco's program is trying to be very careful in not equating exposure to violence to physical abuse or severe neglect, which could result in the removal of a child from his home.
Many child experts say the measure if misapplied can further traumatize a troubled child.
"Everybody across disciplines agree that removing a child from a family should really be the act of last resort," said Dr. Alicia Lieberman of the UCSF Child Trauma Research Project, which is among the dozens of partners with SafeStart. "You need to do a very systematic assessment ... If the child can be kept safe within the family by providing services that reduce the danger, in the long run, this is more likely to help the child."
This approach -- of trying to keep families together and working to reform batterers -- is not without controversy.
The murder of Claire Joyce Tempongko in San Francisco raised difficult questions about the effectiveness of batterer intervention programs, which advocate counseling over incarceration.
Tempongko was stabbed to death in San Francisco by her abusive, ex-boyfriend who had been attending re-education classes for batterers just before the killing.
Indeed, studies done in Broward County, Fla. and Brooklyn, NY said batterer intervention programs had little or no effect in changing an abuser's behavior.
But other studies have shown that counseling programs for perpetrators can work.
Just this summer, the National Institute of Justice, an agency of the U.S. Department of Justice published a report suggesting that there may have been flaws in the studies in Broward County and Brooklyn.
The agency also concluded that some batterer intervention programs can work, especially as part of a "broader criminal justice and community response to domestic violence" that include among other things: arrest, restraining orders and intensive monitoring of batterers.
This collaborative, coordinated approach works for mental-health clinician Nellie Arrieta, one of 15 SafeStart staffmembers in San Francisco.
"I have been in the mental-health community since 1987 ... but what's different about this project is that as a clinician, I can help the family find a number of services, not just the shelter or restraining order, but nutrition classes for the father of a four-year-old son who doesn't know home to feed him properly, for example."
Arrieta, who visits about two families each week, is the first to acknowledge that it's not easy to change a batterer's behavior -- or to communicate to parents that it's not good for children to see them fighting.
She refers to the "stripping case" as a classic example of how parents believe that their fighting is not the cause of their children's emotional problems.
Her clients, she said, could not understand why their four-year-old girl was taking off all her clothes, right down to her diapers.
Then, Arrieta learned that the girl would strip about the time that her parents started fighting with one another.
Her parents never noticed the relationship until Arrieta pointed it out. With counseling, the girl's behavior eventually changed, she said.
Though funding for SafeStart is supposed to run out in 2005, Fox said he has already secured some grants and intends to apply more federal funding because he wants the project to expand to help more neighborhoods and eventually include children who have been exposed to turf wars over drugs, armed burglaries and other forms of community violence.
"Our definition of violence includes community violence, domestic violence ... if you use that definition you're talking about 100 percent of the children in this town. For now, we are talking about domestic violence. But at some point, we want to expand."