India Hart was dozing off in her high school sociology class last September when her teacher banged a drum near her ear. The loud noise sent her reeling.

“I was really angry,” she recalled. “Why would he do that? It sounded like a gunshot and took me right back to that moment.”

Just two days earlier, Hart had seen her dad get shot. Her family had gathered on the block where she grew up, in Chicago’s Englewood neighborhood, to mark the birthday of her late uncle, who was shot and killed in March of the previous year. Right after they released balloons into the air, nine shots rang out. One hit Hart’s dad in the leg and another flew right past her. More bullets hit a mother holding her 3-year-old daughter. Hart grabbed the toddler and ran to safety.

In the days and months that followed, Hart felt less and less like her usual self. She jumped at loud noises. “I couldn’t sleep. I wasn’t eating right. I wasn’t making eye contact,” Hart said. “And it started making me depressed because I was trying to put it in the back of my head and it wasn’t working.”

Hart’s father was one of nearly 3,000 people who were shot in Chicago in 2018, according to Chicago Police Department data. Young people like Hart are particularly vulnerable to the long-term mental health impacts of such violence.

“The vast majority of [Chicago Public School] students have been exposed to gun violence in their communities, if not within their own families and friends,” said Rebecca Levin, the executive director of Strengthening Chicago’s Youth, a collaborative of violence prevention organizations convened by Lurie Children’s Hospital. “So the toll that it takes on children in Chicago is pretty tremendous.”

But while the city has made great strides in recent years treating the physical trauma inflicted by gun violence, educators and doctors here are struggling to find the resources necessary to support young people who are experiencing the emotional trauma radiating from shootings. 

In Chicago, young people disproportionately live in communities impacted by gun violence: Sixty percent of those who are 5 and under live in neighborhoods where 91 percent of the city’s shootings occurred in 2018, according to an analysis released by Erickson Institute in July.

They also are disproportionately represented among victims and suspects. In 2016, the most recent year for which data is available, Chicagoans between the ages of 10 and 19 accounted for just 11 percent of the city’s population, but 19 percent of all homicide victims and 25 percent of all homicide suspects.

All of this violence exerts a psychological and emotional toll. A 2011 study by the Albert Einstein Medical Center and Thomas Jefferson University found that young people who frequently hear gunshots or have seen shootings or dead bodies are more likely to be anxious or depressed than their peers. They are also more likely to have a lower grade point average and miss more days of school than students who have not been exposed to such violence. The negative effects can last for years, making students fall behind their peers from safer neighborhoods.

But violence isn’t only detrimental to the people directly exposed to it. A 2018 study found that when Chicago students experience higher levels of neighborhood violence, their entire school reports “feeling less safe, having more disciplinary problems, and feeling less trust in their teachers.”

Schools are often the first line of defense for young people wrestling with mental health issues. They can provide support for students at school or make referrals for therapy and medical interventions. 

Chicago Public Schools (CPS) has made progress to bolster their support for trauma-informed initiatives. The district, which serves over 360,000 students, has established behavioral health teams in 180 schools. The teams bring teachers together with counselors and social workers to determine the best way to help students who are struggling. The district plans to eventually expand the program to all 517 schools.

“There’s a lot of activity nationwide around addressing trauma in schools, but the thing that’s different about Chicago is that they’ve been doing it longer and have quite a bit of expertise,” says Lisa Jaycox, a senior behavioral scientist at RAND Corporation who has worked with the National Child Traumatic Stress Network for more than 15 years. “They have national experts in Chicago, which a lot of cities don’t have.”

One of those experts is Colleen Cicchetti, who heads the Center for Childhood Resilience at Lurie Children’s Hospital of Chicago. Recently, the center has worked with CPS to train educators on trauma and has helped establish a team of student mental health ambassadors who can reach out to peers who are struggling with trauma but may not be comfortable talking about their feelings with school staff.

“It’s fair to say that CPS is one of the leaders in the country for addressing trauma,” said Cicchetti. “We’re doing a ton of work to make sure that all of the educators in Chicago that are working in schools are aware of the impact of trauma and they are also looking at how do they change their practices to do the best that they can do to support these kids.”

The district offers social-emotional learning programs to screen and assist students who may need help, and runs a special psychotherapy program called SPARCS for those who are experiencing chronic stress.

CPS has also welcomed groups that explicitly address trauma through mentoring and cognitive behavioral therapy (CBT), like Becoming a Man and Working on Womanhood, into their schools. WOW, which currently operates on the South and West Sides of Chicago, has been shown to dramatically decrease the number of students experiencing PTSD symptoms after just six months of participation in the program.

The school district is also planning to dramatically increase the number of social workers and nurses on staff, in part because of the toll of gun violence on students. After an 11-day strike by Chicago teachers in October, CPS agreed to put at least one full-time social worker and nurse in every school by 2023. Currently, social workers and nurses split their time between multiple schools.

Outside of CPS, efforts have been made to address the trauma of young people not in school, a group especially susceptible to gun violence. Nearly 17 percent of young people aged 16 to 19 were out of school and out of work in four West Side neighborhoods heavily impacted by gun violence in 2017, according to an analysis by the Great Cities Institute at the University of Illinois at Chicago.

To help both the young people hurt by gun violence and their families, the John H. Stroger, Jr. Hospital of Cook County and the University of Chicago Comer Children’s Hospital have introduced a hospital-based intervention program called Healing Hurt People, which provides therapy and mentoring to youth who have been shot. The program pairs emergency room doctors with psychiatrists and social workers to help injured young people heal both emotionally and physically.

But despite the headway the city has made on this issue, challenges remain.

“We have a ton of folks trained. We have a ton of effort being put into bringing the best practices available in the country to Chicago do trauma-informed work in schools,” said Cicchetti. “But often the way that we are providing these services is through grants.”

In Chicago, educators and doctors have had to rebuild their trauma care infrastructure for children at least four times in the last decade alone because of inconsistent funding through grants.

Federal funding under the Obama administration and then state funding under Illinois Governor Pat Quinn supported programs at schools and nonprofit organizations that were helping kids struggling with gun-related trauma. But both funding sources were temporary, and when the funding ended, so did many of the efforts in schools and communities.

More recently, the 793-day-long state budget impasse devastated programs with a long track record of success, including the state-run Safe from the Start, which funds therapy for young children impacted by gun violence.

In order to make mental health services for children sustainable, Levin said, the city needs to start using private health insurance and Medicaid to pay for these services.

“As a city and a nation, we’ve done a terrible job of adequately resourcing children’s mental health. We are creating a generation of children who have been traumatized by gun violence,” she said. “So while Chicago may be doing pretty well, it’s relative to a nation that isn’t adequately addressing the mental health of children.”

Pediatrician Karen Sheehan serves as the Gorter Family Professor of Healthy Communities at Northwestern University’s Feinberg School of Medicine. She says that while Chicago still has a ways to go in caring for its traumatized youth, she has seen a huge change in the conversation around trauma in the 30-year span of her career.

“I think everybody recognizes the need for trauma-informed care of adolescents,” Sheehan said. “It just takes a while to scale up [in] a city that has three million people in it.”

“In the ’90s, there was another peak firearm epidemic, and we talked at that time about the direct physical effects of violence,” she added. “But I don’t think anyone was really appreciating the psychological effects.”

What Sheehan saw in her patients, however, pushed her to do more. She joined a group of doctors and medical students to found the Chicago Youth Programs in Cabrini Green, a public housing project on the city’s near North Side that housed 15,000 people at its peak. The area was notoriously rough: 87 percent of the young people that CYP served between 1984 and 2011 had seen someone shot or stabbed.

Sheehan and the other CYP volunteers provided medical care, tutoring, and mentoring for people from birth through college or trade school. And despite the lack of therapy and counseling in the early days of the program, CYP has had impressive results. A study that compared the health and well-being of participants and non-participants found that participants were nearly twice as likely to be in good or excellent health today and 2.3 times more likely to hold a college degree.

“When we talk about what people need for mental health protection, there [are] some people that certainly need intensive therapy and psychiatrists and medicine and things like that,” said Sheehan. “But a lot of what we’re talking about isn’t super fancy. When we talk about being trauma informed, it’s just having those people in your lives you can rely on. That’s what children need. They need consistent adult figures.”

India Hart agrees.

She says she never received support from teachers and was never approached by a counselor or staff person after her uncle was shot. “When I was at Morgan Park [High School] and my uncle died, I would just go to school and go to the bathroom and cry. That was literally all I was doing at school,” she recalled. “None of the teachers noticed it. My friends were very supportive during that time. But none of my teachers noticed it.”

When Hart transferred to a charter school after her sophomore year, her classes were smaller and she built better relationships with her teachers. So when her father was shot and her friend was killed by gun violence just a few months after that, several of her teachers were looking out for her. “They saw that something was wrong with me and checked up on me first. They made me feel more secure and more comfortable with it.”

Hart eventually got therapy after speaking to her mother about her struggles with post-traumatic stress disorder. But she knows she is one of the lucky ones.

“I got help because I spoke up,” said Hart. “A lot of kids in Englewood and the South Side of Chicago are scared to speak up because they just don’t know who to go to.”

The solution, she says, is clear.

“Just a simple conversation,” Hart said. “I wish people would pay attention enough to know that something is wrong with somebody. Because nobody knows what somebody goes through at home and if somebody has a good support system like I do. So when they’re going through something they don’t have anybody to talk to and they keep everything bottled up and it makes your mental health even worse.”