Trauma Pathways from Victimization to Violence in Children and Adolescents Exposed to Structural Violence

Background and Purpose: Funded by the U.S. Department of Justice, the Cuyahoga County Defending Childhood Initiative (CCDCI) launched one of the nation’s most comprehensive responses to youth violence exposure by developing a cross-system model that included screening tools for violence and trauma exposure, referral for full assessments, and delivery of trauma-informed treatment, primarily TF-CBT. Among those screened, 94% reported past-year victimization and 85% experienced multiple forms, including assault, psychological abuse, and witnessing harm (Kretschmar et al., 2016). While it is known that ongoing exposure to violence can prompt children to mirror such behaviors, the trauma pathways linking exposure to violent behavior remain less understood. To address this gap, this study draws on full-assessment CCDCI data to model trauma symptom pathways connecting violence exposure to violent behavior among high-risk, multi-system-involved youth in Northeast Ohio.

Methods: Participants were 529 children aged 8 and older (M = 12.76, SD = 2.82), aligning with the developmental validity of the Trauma Symptom Checklist for Children (TSCC). Violence exposure was assessed using the 16-item reduced Juvenile Victimization Questionnaire (JVQ; M = 5.08, SD = 2.96), and violent behavior using the 5-item Violent Behavior Questionnaire (VBQ; M = 3.15, SD = 2.48), both with established psychometrics. Trauma symptoms were measured using the TSCC; composite factors were computed for internalizing (anxiety, depression, PTSD, dissociation), externalizing (anger), and sexual concern symptoms using age- and gender-specific T-scores from TSCC.

Hayes’ (2022) PROCESS macro in SPSS was used for parallel and moderated mediation analyses (Models 6, 58, 59) to examine whether trauma symptoms mediated the exposure-behavior link, and whether sex, race (Black vs. White), and age moderated these pathways.

Results: Parallel mediation revealed that violence exposure significantly predicted violent behavior (b = 0.17, p < .001) and was associated with elevated internalizing, externalizing, and sexual concern symptoms. Indirect effects were significant through externalizing (b = 0.08, 95% CI [0.05, 0.13]) and internalizing symptoms (b = –0.07, 95% CI [–0.11, –0.03]), but not sexual concerns. Internalizing symptoms had a mild suppressing effect, while externalizing symptoms amplified violent behavior.

Conditional indirect effects showed no significant moderation by sex or race, though the externalizing path was stronger for males and Black youth. Age moderated the internalizing path: internalizing symptoms linked exposure to violent behavior only among younger participants (b = 0.042, 95% CI [0.008, 0.080]), with this effect gradually weakening and disappearing as children got older.

Conclusions and Implications: Among high-risk, multi-system-involved youth, violence exposure contributes to violent behavior through distinct trauma symptom pathways. Externalizing symptoms consistently amplified risk, while internalizing symptoms predicted aggression only among younger children. These findings inform how the CCDCI assessment model can assist future cross-system strategies to identify high-risk youth early and target trauma symptoms that drive behavioral escalation. They also underscore the need for early, developmentally attuned trauma screening and intervention. The absence of race or sex moderation points to shared structural vulnerability rooted in systemic inequities. Public health and social work systems must collaborate to implement trauma-informed strategies that align science, policy, and frontline practice.