Competencies Needed By Health Professionals For Addressing Exposure To Violence And Abuse In Patient Care Consequences of Lifetime (Interactive)
Competencies with hyperlinks to recommended learning resources.
This visual (pdf) image, created by David McCollum, MD, of AVA can be used to illustrate the extensive negative impact that violence and abuse experiences can have on health and well-being.
The Academy on Violence & Abuse joins health professionals around the world in condemning racism. As recent events remind us, racism fuels hatred, violence and death. Racism also has a profound impact on the health of those suffering under the weight of bigotry. It is not enough, though, to express our outrage or to join in mourning those who have died. We must also proactively respond to systemic racism and biases of any kind. We are committed to exploring this topic at our annual Global Health Summit and to advancing concrete steps to stem the tide of racism and to join our members and our colleagues around the world in this effort. We believe that black lives matter. We also believe that we must support this sentiment with action.
AVA's Statement on Immigrant Children
Immigrant children face a number of stressful experiences including: loss of previous home, possibly fleeing from dangerous situations, unsafe travel, and potential separation from their parents. These situations pose concerns for children worldwide. Areas of recent concern include children and families fleeing the war in Syria, and children from Central America arriving at the southern US border.
A number of organizations have written statements, policies, and articles about the effect on children – particularly centered on the US border problems. The AVA joins in the concerns expressed by these organizations.
The American Academy of Pediatrics (Linton et al., 2017) has pointed out the potential effects on the developing brain for children separated from their parents. While children are often justifiably separated from abusive parents (both as immigrants, and every day for child abuse situations in US courts), in many instances at the US border children are separated because of the legal status of their parents, not abuse. As Zucker and Greene (2018) point out, a number of behavioral problems may occur – some of them serious. The policy of family separation creates at least 4 adverse childhood experiences (ACEs): emotional neglect, parental separation, possibly witnessing violence, and parental incarceration. This number of adverse childhood experiences can have life-long serious consequences on the health of the individual. Brain structure may also be affected along with genetic changes – which may not necessarily be undone. The young age of the child can magnify such damages.
In addition, such forced and unwarranted separations have effects on the parents and caregivers, and vicariously on the general public.
The AVA calls for:
1. Legislation to ensure that children are not unwarrantedly separated from their parents.
2. Legislation to ensure that children are not incarcerated with their parents, but that such families are treated with dignity and respect – both physically, environmentally, and emotionally.
3. The legislation should ensure that legislators have full access to facilities housing children and families so that transparency and accountability is assured.
4. That mental health services be available to children and their families given the probable negative circumstances of the situation, and especially to any children and adults who have been separated by government policy.
5. Public policy pronouncements for the general public that assure that such situations will not occur in the future.
6. Legislation to remedy issues about paths for citizenship and deportation.
While these steps are most specific for the US border situation, they also apply for immigrant children worldwide. Therefore we also recommend that:
1. The United Nations address the health effects of separation of children and parents and make specific recommendations.
2. Further research should be conducted on the long term effects on children and families.
Linton JM, Griffin M, Shapiro AJ, AAP COUNCIL ON COMMUNITY PEDIATRICS. Detention of Immigrant Children. Pediatrics. 2017;139(5):e20170483. http://pediatrics.aappublications.org/content/early/2017/03/09/peds.2017-0483
Zucker H, Greene D. Potential child health consequences of the federal policy separating immigrant children from their parents. JAMA. 2018. E1-E2.
American Psychological Association Immigration Fact Sheet http://www.apa.org/advocacy/immigration/fact-sheet.pdf
American Bar Association. https://www.americanbar.org/news/abanews/aba-news-archives/2018/05/statement_of_hilarie.html
American Professional Society on the Abuse of Children. http://centerforchildpolicy.org/blog.html#!/blog/posts/APSAC-and-Center-for-Child-Policys-Joint-Position-Statement-on-Separating-Children-and-Families-at-the-US-Border/24
American Psychological Association. http://www.apa.org/advocacy/immigration/fact-sheet.pdf
AVA's Statement on Gun Violence
Once again our nation has suffered the trauma of another mass shooting. Previous experiences show that this type of violence is a recurring due to inadequate prevention approaches. In the aftermath of such tragedies, there is an instinctual urge to search for answers. The larger hope is to prevent these tragedies from ever happening again. Gun violence is a symptom of larger underlying issues. It creates a ripple effect of trauma not only for the immediate victims and survivors, but also for children, first responders, the community and the rest of us. Such violence is not inevitable – these climates of fear are rarely seen in some parts of the world.
All humans develop optimally in safe, stable, stimulating, and nurturing relationships. Children’s brains and bodies develop, in part, to experiences, and violence can leave its mark on the body, brain and even the DNA. Stress impacts health at all ages and has a major effect on when and if adults experience disease and death. More than half of all adults have experienced adverse childhood experiences, potentially reducing their health, well-being and overall success in life. Unless the root causes of violence are effectively addressed, the symptoms will surface in one form or another when, in many cases, they could have been prevented. Gun violence is often associated with people who have experienced toxic stressors in childhood, which can disrupt the normal developmental trajectory of children, compounded by our society’s easy access to guns giving the impaired individual the ability to inflict significant chaos and carnage.
The Academy on Violence and Abuse notes that gun violence situations may vary but common elements are typically present. Two issues are particularly prominent – bad childhoods and, for shooting incidents, the specific symptom of gun safety as well.
Adverse Childhood Experiences
People who commit these horrendous gun violence events, were not born killers, nor was there a single event that led them to this pathway. Predictably, they were made. Some people survive difficult childhoods, but many do not. Oftentimes, the toxic environments that children are exposed to can cause permanent changes in the brain and body leading them down a path to poor brain and body health, not only in childhood but also into their adulthood. They are much more likely to drink and use drugs; commit suicide and domestic violence; have worse job performance; have mental health problems, heart disease, cancer, and other diseases; and die young. They are also more likely to shoot people.
The key is to reduce or prevent these adverse childhood experiences and toxic stressors so that children can reach their full potential. Systems and communities need to be trauma -and to focus on trauma prevention.
1. There should be extensive research and prevention efforts to target adverse childhood experiences in proportion to the pandemic itself. Initially, a federal effort should be made to commit $1 billion annually, with a committed plan to increase to $10 billion annually within 5 years.
2. There needs to be change at the system level as well as at the program level with ongoing evaluation driving improvement.
Integrating the knowledge about adverse childhood experiences trauma during adulthood in all patient encounters can improve patients’ health throughout their lifespan. Early integration of these concepts, indeed even starting at the undergraduate level, will help to transform our entire healthcare system. Incentives such as tying healthcare funding to prevention efforts could drive this change Contrast these proposed dollars with the CDC estimate that child abuse alone costs over $500 billion each year. The need is now.
Availability of high-capacity assault weapons
Gun violence is not the only health consequence of abuse and neglect. However, it is one that is more obvious to others outside the immediate family. Safe gun usage is a goal that should not imperil the public.
1. Ban high-capacity assault weapons. This was previously done from 1994 to 2004 without any negative effect on responsible gun ownership.
2. Repeal the Dickey amendment and actively encourage gun research by the CDC and other federal agencies. This should begin with a $50 million annual appropriation devoted to better understanding of the circumstances of how this form of violence is chosen and strategies that might address this.
3. Further approaches can be informed by this research.
While there may be other suggestions on how to protect children and adults from gun violence, the AVA encourages fundamental and extensive approaches to solve the underlying problems.
The mission of the Academy on Violence and Abuse (AVA) is to advance health education and research on the recognition, treatment, and prevention of the health effects of violence and abuse across the lifespan.
The vision of the AVA is that the recognition, treatment, and prevention of the health effects of violence and abuse are fully integrated into healthcare and society so that people of all ages are safe and healthy.
AVA, IVAT, Child USA and Zero Abuse Project Statement on QAnon
As organizations dedicated to ending violence, the Academy on Violence & Abuse (AVA), the Institute on Violence, Abuse & Trauma (IVAT), Child USA  and Zero Abuse Project, are deeply concerned about QAnon, a conspiracy theory which is gaining adherents at a concerning rate. 
As is often the case with conspiracy theories, QAnon is “constantly changing” but, at its core, "QAnon supporters believe that ‘Q’ is an anonymous government official sharing information about a secret battle" with "the deep state." [6 Adherents to this conspiracy theory contend that “Q” is likely an “intelligence or military insider with proof that corrupt world leaders are secretly torturing children all over the world.” QAnon is a quasi-religious phenomenon that distorts Christian teachings to advance what has been dubbed an “alternative religion.”
Throughout history, conspiracy theories have damaged reputations and, in some instances, incited violence. In keeping with this painful tradition, QAnon has recklessly asserted baseless claims that risk a violent response. In 2017, a religious father of two children drove 360 miles to a pizza parlor in our nation’s capital and fired several rounds at a locked door in the hope of freeing children he believed to be victims of a satanic sex ring. Given its potential to incite violence such as this, the FBI has deemed QAnon a “domestic terror threat.”
In addition to its potential to incite violence, QAnon is harmful to child abuse victims by focusing attention on child maltreatment in a fictitious world instead of addressing the abuse of children in the real world. The abuse of children, including human trafficking, is an egregious crime calling for a robust response by each of us. Our nation has numerous experts on child abuse who can assist every community and every interested individual in taking concrete actions to prevent abuse and, where it cannot be prevented to respond with excellence. We believe this a better approach than promoting a conspiracy theory.
AVA, IVAT, Child USA and Zero Abuse Project urges everyone to recognize the potential harm of QAnon to our families and communities and join us in taking concrete actions to address actual cases of child abuse in our homes, schools, neighborhoods, faith communities, and society.
 The mission of the Academy on Violence & Abuse (AVA) is to advance health education and research on the recognition, treatment, and prevention of the health effects of violence and abuse throughout the lifespan.
 The Institute on Violence, Abuse and Trauma (IVAT) is a 501c(3) organization that condemns violence and oppression in all its forms.
 Child USA is a 501(c)(3) nonprofit think tank that conducts evidence-based legal, medical, and social science research to identify laws and policies affecting child protection.
 Zero Abuse Project is a 501(c)(3) organization that is committed to the elimination of child abuse in all its form.
 Veronica Stracquarlusi, “The congressional candidates who have embraced the baseless QAnon conspiracy theory,” August 12, 2020, available online
 Aaron Franco and Morgan Radford, “QAnon candidates: Fringe Conspiracy Theory Moves Closer to the political mainstream,” NBC News, November 11, 2019, available online (last visited August 27, 2020).
 Adrienne LaFrance, “The Prophecies of Q,” The Atlantic, June 2020 issue, available online (last accessed August 27, 2020).
 Katelyn Beaty, “The alternative religion that’s coming to your church,” Religion News Service, August 17, 2020.
 Merrit Kennedy, “‘Pizzagate’ Gunman Sentenced to 4 Years in Prison,’” National Public Radio, June 22, 2017, available online (last visited August 27, 2020).
 Victoria Vanderzielfultz, “Conspiracy Theory Trends: QAnon,” HSDL Blog, August 4, 2020, available online (last visited August 27, 2020).
 See generally, Kevin Roose, Qanon Followers Are Hijacking the #SaveTheChildren Moveent, New York Times, August 12, 2020; Kaleigh Rogers, Trump ‘Fights’ Pedophilia. But the Group Has Made it Harder to Protect Kids, FiveThirtyEight, October 15, 2020, available online (last visited October 19, 2020).