N THE LAST DECADE, THERE HAS BEEN heightened awareness of the extent to which children personally witness or experience violence. [1][2][3] Public health officials have responded by identifying violence as one of the most significant US public health issues. [4][5][6] Large numbers of US children experience such violence, and an even greater number may experience symptoms of distress after personally witnessing violence directed at others. 2,7-9 For many children, personally experiencing or directly witnessing multiple incidents of violence is the norm. 3,10,11 Violence affects all racial, ethnic, and socioeconomic groups, but its burden falls disproportionately on urban, 5,12 poor, and minority populations. 13,14 Several studies have found that the majority of children exposed to violence, defined as personally witnessing or directly experiencing a violent event, display symptoms of posttraumatic stress disorder (PTSD), 15,16 and a substantial minority develop clinically significant PTSD. [17][18][19] However, the harmful effects of violence extend beyond symptoms of PTSD. Exposure to violence is associated with depression 20 and behav-Author Affilations are listed at the end of this article.

National Center for Child Traumatic Stress Children and adolescents who are exposed to traumatic events are helped by numerous child-serving agencies, including health, mental health, education, child welfare, first responder, and criminal justice systems to assist them in their recovery. Service providers need to incorporate a trauma-informed perspective in their practices to enhance the quality of care for these children. This includes making sure that children and adolescents are screened for trauma exposure; that service providers use evidenceinformed practices; that resources on trauma are available to providers, survivors, and their families; and that there is a continuity of care across service systems. This article reviews how traumatic stress impacts children and adolescents' daily functioning and how various service systems approach trauma services differently. It also provides recommendations for how to make each of these service systems more trauma informed and an appendix detailing resources in the National Child Traumatic Stress Network that have been produced to meet this objective.

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