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Advocates aim to save Baltimore children from impact of violence

Exposure to violence can affect the development of a child's brain and create life-long health problems.

The first time she witnessed a student's major tantrum — a 2-year-old hurling a toy stove filled with plastic pots and pans — Shanikia Johnson had just started as a teacher at Little Flowers Child Development Center in West Baltimore.

She knew toddlers acted out. But the rage-filled reaction, triggered when Johnson wouldn't allow the boy to play with a toy, stunned the 22-year-old teacher. Then, time and time again, she saw other children throwing classroom furniture. Bookcases, chairs, tables — all were flung around the room.

Some students bit classmates, leaving teeth marks on hands and cheeks; a few threatened to hurt staff members. Other children, dubbed “runners,” darted out of the building and down barren city blocks, with frantic teachers on their heels. The encounters exhausted Johnson and other teachers, who began to see the children as troublemakers.

But the day care center's owner, Crystal Hardy-Flowers, urged the staff to be patient with the children, who often were like any other preschoolers — dancing to music, playing tea party and clamoring for space on a teacher's lap. The former social worker understood something that her teachers did not. The kids were growing up in Upton/Druid Heights, where backyard police chases are common and sirens wake up kids like unwelcome alarm clocks at night. Almost every day, in some way, the kids were exposed to violence.

“It's not just bad behavior. It is not just defiance,” Hardy-Flowers said. “No, it is deeper than that. People just don't pick up chairs and throw them at you. Children don't just run out of the building.”

Science increasingly shows that Hardy-Flowers is right. Even as shootings, stabbings and murder trials grab the spotlight, violence in Baltimore is exacting another insidious, often invisible, toll — warping the health and development of the city's youngest residents. For every child who is shot, provoking public outrage, there are hundreds of others who hear gunshots or see fights and stabbings in neighborhoods across the city. After the ambulances drive off and the crime scenes are cleared, many of these children are left with deep psychological wounds that can trigger physical ailments.

Studies have piled up showing that in the tangle of tough, intractable issues like poverty and drug addiction, exposure to violence is a major factor damaging children's health. The stress that fills their little bodies breeds anxiety and depression, making it hard for them to concentrate in school. In fact, research has found that such experiences hurt the development of crucial areas of their brains — those involving attention, memory and behavior control. In the worst cases, children walk around with symptoms of post-traumatic stress disorder no different from those plaguing soldiers who have fought on the front lines.

According to one researcher who has long studied these children, nearly a third of children exposed to violence will develop PTSD. As the children age, researchers believe, the impact of violence can translate into serious health problems, including hypertension and diabetes. Some early research shows that stress may even alter their DNA.

"You hear about the shootings, but you don't hear about the aftermath,” said Annette March-Grier, president of Roberta's House, a grief support center that borders on the Broadway East and Oliver neighborhoods. “It's like you're killing 10 other people when you kill one. It's just slowly.”

The stakes are high for Baltimore and Maryland — and their taxpayers. If these children are not helped, they are more likely to turn to violence themselves or need government-funded mental health services. Research shows that they're also more likely to struggle to maintain jobs and be productive members of society. Since a U.S. attorney general's report in 2012 described children's exposure to violence as a national crisis, some fields, including social work, police and health care, have begun special training for workers. There are also efforts to help schools become safe places where these children can get support.

“The science has caught up. You cannot raise a kid with high levels of trauma and violence and expect they can just bounce back,” said Martha Davis, senior program officer at the Robert Wood Johnson Foundation, which has funded projects in high-crime areas to address the problem. “Now the hard work is: How do we take this information and make systems that work?”

Upton/Druid Heights, near downtown, between North Avenue and Martin Luther King Boulevard, is on the frontier of this daunting effort. There are nearly 3,000 children 18 and under in the neighborhood, and statistics show it to be one of the sickest and most dangerous in Baltimore, a place where life expectancy is nearly 10 years shorter than the citywide average. And it is here — a historic African-American neighborhood that was once a major part of the local civil rights movement — that a cadre of social workers, teachers, pastors and others have been testing out ways to help these kids.

Through a federal grant program called Promise Heights, the University of Maryland School of Social Work is collaborating with schools, churches and community groups. The goal of the multiyear initiative is to combat the cycle of poverty by wrapping children and families in supportive services from cradle to college. Dealing with trauma is a major focus of that work.

The University of Maryland team has embedded social workers in neighborhood schools. They make home visits and coach adults on parenting. Teachers learn that instead of asking a misbehaving child, “What's wrong with you?” they need to ask, “What happened last night?”

Said Bronwyn Mayden, the project's executive director and an assistant dean at the University of Maryland School of Social Work: “The way we look at it in Promise Heights, everyone is traumatized.”

Death of a sister

Like many other children in Upton/Druid Heights, 10-year-old Shamira Wedlock has already been touched by violence. The fifth-grader at Samuel Coleridge-Taylor Elementary School gets nervous when she hears gunshots in the neighborhood — or when she's outside and a nearby car slows down. She's worried someone might start shooting.

This summer, she saw two men beating someone up at the playground in her apartment complex along Pennsylvania Avenue.

“They punched him and kicked him, and he screamed, and there was blood everywhere,” she recalled. Amid the assault, one of the attackers stared right at her, unnerving her. She ran and got help, but remains haunted by the incident. 

The biggest blow came in March, when her 21-year-old sister was murdered. The sister was one of three people shot and killed in an apartment across from an elementary school in a nearby West Baltimore neighborhood, a case that remains unsolved.

At the funeral, Shamira was torn with emotion — grief for her sister, and fear that the shooter might come back that day to threaten her and her family. Since then, those fears have ebbed, through the strong support of her step-grandmother, Joann Brewer, who has taught her to be cautious, but not paralyzed by fear.

Now Shamira talks easily about those incidents — and about how much she loves her neighborhood. But she still does find herself, when she's home alone, taking out her sister's obituary and reading it, over and over.

Another neighborhood girl has harbored some of the same fears. But in her case, police and relatives requested that she not be identified — because she witnessed a murder that has yet to be solved.

The 11-year-old was playing outside her McCulloh Homes apartment on an April evening a few years ago when gunshots rang out.

A man her family knew, 23-year-old Brandon Simms, had been eating crabs in the courtyard about 8 p.m., when another man walked up to him, pulled out a gun and shot him in the leg. As the girl and other neighbors watched from yards away, Simms tried to crawl away. The shooter fired again — this time into Simms' head.

The girl's mother, awakened from a nap by the firecracker-like sounds, ran outside. She found her daughter in tears, crouching in the doorway and holding tightly to a younger neighbor. A teenage daughter, who was also outside, ran to a nearby playground and hid in a play tunnel. Terrified, she didn't move until she heard her mother's voice calling her.

Bullet holes remain in the sidewalk today — and the impact on the family lingered as well.

The youngest of the four children, an 8-year-old boy, slept on the floor of his bedroom the night of the murder, fearful someone would shoot through the window. “When you were little,” he asked his mother months later, “did you used to go outside, and people would be laying on the ground?”

After the murder, the 11-year-old began to struggle in class. For months, she felt crippled by fear, and at night dreamed about what she had seen.

She didn't get a look at the killer's face, so she still worries that he could be anywhere — walking next to her on the street, or in the park — and she wouldn't even know it.

“I never really prayed before. But that day I was praying. I didn't want him to die,” the girl said recently, reading from the letter she wrote a week after the shooting to sort through her complicated feelings. Now 14, she keeps the letter on a shelf in her closet. “I was then scared to go outside in my neighborhood. I thought that whoever was shooting might have saw me and might want to come after me next.”

Reminders of the murder are hard to avoid. The whole family sidesteps the spot where Simms' body once lay. And through their living room window, they can still see a memorial dedicated to him, made of sneakers, pictures and other items hanging in a tree.

The mother, who works full-time at Furman L. Templeton Preparatory Academy, constantly worries about the dangers outside school. And since the murder, she's desperately wanted to move her family out of the neighborhood. “I know no one is promised today or tomorrow,” she said. “But in some places, that is even more true. I would just like to feel safe.”

Neighborhood in distress

That's difficult in Upton/Druid Heights.

The neighborhood has a storied past. For decades, it was home to a thriving African-American middle class and to prominent and politically active families such as the Mitchells and the Murphys, owners of the Afro-American newspaper. Many of the city's important churches started here, and in the 1920s, the vibrant entertainment scene along Pennsylvania Avenue drew comparisons with the Harlem Renaissance.

Today, the neighborhood is home to many committed, long-term residents and strong community organizations. Bit by bit, with lots of hard work, some blocks that were once lined with boarded-up homes have been transformed with rows of new townhouses. There are parks and a community garden.

Yet it's still a neighborhood in distress, one that reflects the reality for millions of children in high-crime cities like Boston, Detroit, and Newark, N.J. Upton/Druid Heights has one of the highest concentrations of poverty in Baltimore. According to the most recent comprehensive data from the city health department, homicides and non-fatal shootings were about twice the city average in 2011, and the life expectancy of residents was 63 years compared to 72 years citywide. So far this year, as the number of homicides citywide has passed the 200 mark, there have been seven shootings and five homicides, among a total of 665 crimes in the neighborhood, which covers about 170 blocks.

Many preschoolers at Little Flowers also experience violence firsthand. At least four times a week, just outside the door of her center, Hardy-Flowers said, she sees some kind of crime. One day, the staff couldn't leave because police were crouched behind the center's bus, conducting surveillance.

Three years ago, when Promise Heights social workers began their work at Furman L. Templeton and the Samuel Coleridge-Taylor, they found classic symptoms of children stressed by violence.

Students were hypervigilant and suffering from anxiety and depression. Small conflicts blew up into huge fights, and many children had a hard time concentrating. Mundane acts triggered bad memories in kids and sparked tantrums — for example, a child would flinch at a teacher's gesturing with her hands because it looked like hitting.

These kids hear constant rumblings about violence, even if they don't witness it. Carefully maintained memorials of flowers and balloons in trees, on light poles or even in front of an elementary school can subliminally traumatize kids by reminding them of a past shooting. According to a survey at Furman Templeton, some children skip school because they're afraid to walk through the neighborhood.

“I tell people ‘the boogeyman' is not an invisible thing,” said Henriette Taylor, a community school coordinator with Promise Heights.

At the local pediatrician's office on Division Street, Dr. Jacqueline Fulton, who has worked in the neighborhood for more than 30 years, used to treat kids for infectious diseases. Now, she says, it's mostly health problems related to societal issues.

The stressed children have worsened asthma. Some need stitches from being beaten up on the way to school. Many have Vitamin D deficiencies because they don't get enough sunlight — there are few playgrounds, and children are either afraid to be outside, or their parents think it's safer for them to stay indoors.

Some children are so angry and emotionally numb, Fulton noted, that they never feel afraid. And it's not surprising, experts say, that in school, many of the children can't focus for more than 10 minutes.

Some efforts to improve educational outcomes for these kids may have overlooked this crucial factor, noted the University of Maryland's Mayden. For years, public schools have tried many strategies — new curricula, more professional development for teachers, or changing a principal — without seeing a big improvement in achievement, she said. “What we have to do, particularly in high-poverty areas, is really begin to look at and work with children and families.”

Reaction in the body

The neighborhood pediatrician, Fulton, and others around the country are grappling with the reality that not only are large numbers of children in poor neighborhoods exposed to violence, but in many cases, according to research, their very biological makeup is being altered through long-lasting changes in brain anatomy and physiology.

Biology may be working against them.

The human body is designed to adapt to stressful situations. In dangerous moments, energy levels rise, the heart pumps faster, and the hormones adrenaline and cortisol kick in. Those changes allow people to run faster and defend themselves. When the situation calms down, the body goes back to normal. Scientists call this the “fight or flight” response.

But for kids in Upton/Druid Heights, where crime and violence are common, this system gets overloaded, because things never really calm down. A distant gunshot. A fight in the courtyard. A memorial of flowers and balloons for a homicide victim. Kids who live in these communities stay in a continuous state of alertness, always prepared for something dangerous to happen — even if they don't realize it.

Elevated levels of stress hormones can reach toxic levels that have a lifetime effect on health, derailing development of the brain and leading to physical problems, according to research from Harvard University, the Stanford University School of Medicine and other institutions.

Dr. Victor G. Carrion, a Stanford professor who has extensively studied traumatic stress in children in California, said the effect can be seen on a brain scan.

Carrion has compared the MRI brain scans of highly stressed children, including those who live amid violence, to those of healthy youngsters. They showed overall decreased brain volume in children with high cortisol levels. Key areas responsible for complex learning also were smaller. The work, among the newest findings in the field, is still in its early stages and needs more development, but some scientists consider it significant.

Researchers like Carrion believe that — in a child who can't sit still in school, or is so agitated that he or she throws a chair — the brain is so busy fending off stress that other key areas don't develop properly. Carrion's scans of stressed children found a smaller prefrontal cortex, the part of the brain responsible for executive functions such as attention span, planning and organizing, goal-setting and behavior control. Carrion also gave the stressed children attention and memory tests — and the prefrontal cortex was not as active.

Other brain scan studies showed stunted growth of the hippocampus, which may inhibit a child's ability to form new memories, learn or control emotions. The symptoms were worse for kids who experienced trauma more directly, Carrion said.

“The more interpersonal it is in terms of family or someone close to you, the more it affects you,” Carrion said. “It's like being close to the epicenter of the earthquake [rather than] miles away.”

Other research has found that Baltimore schoolchildren exposed to violence had a hard time sleeping and regressed to bed-wetting and other behaviors they had outgrown. Some children may become moody and have angry outbursts; others may react in the opposite way, shutting down and becoming withdrawn, said Dr. Harolyn M.E. Belcher, director of research in the Family Center at the Kennedy Krieger Institute. She has been studying the effects of and treatment for violence, parental substance abuse and child maltreatment for more than 10 years.

The unwritten rules of the neighborhood may tell children it's not OK to show sadness or fear, Belcher said. Crying is seen as a weakness. Instead, children will exhibit other feelings or behaviors — for example, they'll act angry, because that's considered acceptable. “So depression sometimes in urban neighborhoods may not look like you're sad or blue or despondent,” Belcher said. “It looks like anger, overeating, irritability or problem sleeping.”

All of the built-up emotions can lead to physical health problems.

Craig K. Ewart began looking at the emotional state of children in Baltimore neighborhoods during the 1980s and '90s as a professor at the Johns Hopkins Bloomberg School of Public Health. His research team interviewed more than 700 children at Baltimore Polytechnic Institute and Western, Patterson and Walbrook high schools, all in neighborhoods with violence and other social stressors that he found put some kids on constant alert and caused their blood pressure to rise.

The flight-or-fight response that elevated stress hormones also elevated heart rates in these children, said Ewart, who found the same symptoms in students in Syracuse. Being constantly vigilant to possible dangers for long periods can cause wear and tear on the heart and the blood vessels, Ewart said. He compared it to a badly tuned car engine that runs too fast, burns too much gas, overheats, and requires constant braking. Everything wears out early. In adolescents, the wear and tear of constant stress can lead to hypertension and early heart disease when they are older.

Ewart, a psychology professor at Syracuse University, recently re-interviewed some students, who are now in their 20s and 30s, and found that many have the same problems with elevated blood pressure they did as kids, indicating that the health effects can be long lasting.

It's hard for doctors to predict how the impact of violence will play out in the life of a particular child. Children exposed to violence exhibit a wide range of reactions and outcomes, researchers say, depending on a web of factors, including their personal characteristics, life experiences and circumstances such as poverty and family support. According to the National Child Traumatic Stress Network, a group of front-line providers, researchers and others who treat these children, the more exposure to traumatic experiences, the greater the risk for neurobiological disturbances such as impairments in memory and regulation of emotions and behavior.

While much of this work is continuing, one of the newest areas of medical research looks at genetics of these children. Scientists are examining whether prolonged stress from trauma can alter a person's DNA. Several studies of people who live in stressful communities have shown shorter telomeres at the ends of chromosomes. Telomeres, which act like the protective plastic tips on the ends of shoelaces, prevent DNA in chromosomes from unraveling and cells from dying. Scientists at Duke and Tulane universities, who have done the work, believe this may mean faster aging.

Other researchers say more work needs to be done.

Carol W. Greider, a Johns Hopkins University professor who shared a Nobel Prize for her work on telomeres, for example, noted that the degree of shortening was insignificant and has not been shown to have any biological effect.

But Idan Shalev, assistant professor in the department of biobehavioral health at Pennsylvania State University, who worked on one of the studies while employed at Duke, said that researchers will push ahead. The hope, he said, is that findings in this area could lead to better ways to treat victims of trauma.

Intervening to help

It's sobering to realize that the experience of the sisters who witnessed the murder at McCulloh Homes is a pattern playing out for hundreds of kids in violent neighborhoods across Baltimore. The city has one of the highest homicide rates in the nation, and there are so many gunshot victims that military medical personnel come to the Maryland Shock Trauma Center to train before going to war.

In fact, a study from Hopkins' Bloomberg School last week found that nearly half of all children in the United States are exposed to at least one social or family experience that can lead to traumatic stress and endanger their healthy development — such as seeing their parents divorce, seeing a parent die, witnessing or being a victim of neighborhood violence, or living with someone who abuses alcohol or drugs.

But there is hope, because if the kids get help, experts believe they have a chance to recover. Scientists understand that the brain is more resilient than once thought, so as the kids get older, and their brains develop and mature, they may adapt.

The key is to intervene early. While medications can be prescribed to help tamp down symptoms such as difficulty sleeping, anxiety and nightmares, there is no medication that can definitively treat a child's traumatic stress, according to the National Child Traumatic Stress Network. But one treatment proven to help is cognitive behavioral therapy, including stress management and relaxation skills. Therapists also work to correct untrue or distorted ideas about a traumatic incident, as children sometimes think something they did or didn't do may have caused the violence.

What scientists don't yet know is whether improvements in the behavior they see in kids getting treatment are matched by improvements in their brains, such as more activity in the prefrontal cortex, said Carrion, the Stanford medical school professor. He plans to study this issue next.

In situations like the one the Baltimore family went through, most children here and in other cities don't get help. Too often, children are left to deal with the problem on their own, or there may not be resources for counseling.

But shortly after the McCulloh Homes shooting, the mother got the children counseling at their school, Furman L. Templeton. Counselors say kids will open up at their own pace; they just need an outlet. Claire Meringolo, a clinical social worker and early childhood mental health consultant, who until recently worked with Promise Heights, lets children guide her to what they want to share. She uses play therapy, such as drawing pictures, to let kids express themselves. One child told her in a session that he saw a dead body while walking home; another talked about a man who was shot in the leg.

For children who internalize a crisis, therapists say gradually reintroducing them to the trauma and teaching them to cope with it has been proved a successful treatment. Therapists gently guide the children to tell their stories and help release stored emotions. This helps restore a sense of confidence and reduces trauma-related symptoms, said Bridget Bauersfeld with the Kennedy Krieger Family Center, which counsels families who have experienced trauma.

In Upton/Druid Heights, the University of Maryland social workers — along with school staff members and others in the community — are developing new routines for the children. In the Little Flowers day care, for example, teachers are dimming the lights at different times to help calm the kids, or conducting some activities outside, where sunshine and fresh air may help them focus.

The Promise Heights team has also held more than 24 sessions to teach adults how to deal with traumatized children. More than three dozen teachers who work for Hardy-Flowers have got the training this summer and fall. Others include foster parents, child welfare workers, and Head Start administrators.

At a recent session, 12 teachers from Little Flowers sat around tables in the basement of a church on Pennsylvania Avenue, a busy thoroughfare in the heart of their neighborhood.

Kyla Liggett-Creel, a clinical social worker with the University of Maryland School of Social Work, challenged the class to talk about their students' behaviors and how it makes them feel.

“Sucking teeth,” said one teacher. “Angry.”

“Talking back by yelling,” said another. “Disrespected.”

“Kicking off their shoes,” said a third. “Makes me want to throw their shoes in the trash.”

Liggett-Creel told the teachers it's OK to feel frustrated. But they needed to consider that something in the children's lives might be causing them to act out.

“If you're having those thoughts, then the child is never going to ... get better,” she said. “Stop and say, ‘This child may be traumatized. My job is to stay calm and help him learn.'”

After the weeklong session, the teachers saw the children from a new perspective. “I just thought the kids were bad,” said Johnson, one of the teachers. “Now, I take a step back and think about whether something happened that maybe the student isn't telling me.”

On a day after the training, some children were sculpting Play-Doh, while one tot sprawled in the middle of the floor, her socks and shoes discarded beside her. “She's just having one of those days,” explained Johnson, who now has more patience. Instead of scolding the 3-year-old, as she might have done before, she talked to her and hugged her.

The elementary schools have also instituted new rituals. At the beginning of the day, for example, when students stream into Furman L. Templeton's cafeteria, Principal Debra Santos and a social worker are on lookout duty. They scan the faces for signs that someone is upset. When they notice a child who seems off-kilter or overwhelmed, they take him or her aside to see what's going on.

One morning when the University of Maryland's Mayden was at Samuel Coleridge-Taylor for a meeting, staff members brought in a boy who was sobbing. “My heart hurts,” he cried. Mayden immediately worried about a serious health problem, but a social worker who knew the boy took him aside to talk. It turned out the boy's father had been arrested the previous night, and he was afraid he would never see his father again.

Once the children get to their classrooms, some teachers gather them in a circle for what they call the “daily rap.” The schools, with the leadership of the Promise Heights team, started the custom three years ago as a way to let students unleash feelings and express themselves. The hope is that if something is on their minds, they will talk about it, rather than hold it in. Then they'll be better prepared to concentrate and learn.

This fall, during the daily rap in teacher Ladaisha Ballard's fifth-grade class at Furman L. Templeton, students discussed the Ebola virus. Ballard thought this might spur talk about drug addiction. She discussed whether the disease might spread easily if it ever hit Baltimore, because there are so many drug users and the virus is passed through bodily fluids. Soon the kids opened up about family members who use drugs.

Other protocols have been put in place. When children are agitated, they can go to the social worker's office, where there is a “calm down” corner with a comfy chair and cartons filled with stuffed animals and other items. The students can pull out a book or toy that they know makes them feel better. Some kids stroke the piece of velvet tacked to the wall. If they're angry, they can pop bubble wrap. One year, the kindergarten and pre-kindergarten classes used balloons and sand to make stress balls, so they each could have their own.

The goal is to help them get rid of anxiety and to focus — and ultimately, to regulate emotions themselves.

The social workers have also worked with police to make crime-fighting less traumatizing for the children, particularly after a SWAT team showed up one afternoon to execute arrest warrants at the nearby McCulloh Homes. Mayden said the resulting situation at Samuel Coleridge-Taylor was chaotic and upsetting, with teachers struggling to pull students back inside and parents who were there for pick-up trying to reach their kids.

Now the police give the school staff a heads-up on any raids, Mayden said. She's also asked officers to remove their sunglasses when talking with the children, to appear less intimidating. Such incremental changes can help reduce trauma in a neighborhood where seeing raids, arrests and even lifeless bodies on the street has become routine for children.

What works

In other parts of Baltimore, there are scattered efforts to limit the impact of violence on children. Maryland's chapter of the National Alliance on Mental Illness is working to step up the role that primary care physicians play in helping people exposed to trauma in violent neighborhoods. Behavioral Health System Baltimore has funded programs to put counselors in some public schools.

Nationally, trauma-focused treatments and initiatives are being disseminated to the systems most likely to encounter these children: child welfare, pediatric and emergency rooms, courts, schools and law enforcement, in part through the National Childhood Traumatic Stress Network. The Yale Childhood Violent Trauma Center is collaborating with the International Association of Chiefs of Police to develop training for police officers responding to traumatized children during calls for service.

“While there is enormous potential for traumatized children and families to get help to recover through evidence-based treatments and program strategies, the funding to support their proliferation needs to be far greater than it currently is, given the public health crisis we face,” said Dr. Steven Marans, the director of Yale's center and the Harris Professor of Child Psychiatry.

But many programs in the Promise Heights initiative have ripple effects. As adults are supported in various ways, they can support the kids. And research has shown that having a bond with an adult is a powerful way for children to overcome the consequences of violence, poverty and other social ills. Even an adult who is not a relative can offer stability.

“Attachment is critical for the child to develop self-regulation of their emotions,” said Belcher, of Kennedy Krieger. “So when you get a little frustrated, you're resilient, you come back.”

For Shamira, the Samuel Coleridge-Taylor fifth-grader whose sister was killed in March, the strong bond with an adult has helped balance out much of the violence around her. Brewer, the step-grandmother, has been the steadying force in her life for years. So despite what she has to deal with, Shamira is a good student who loves math. She plays teacher to her stuffed animals and chats with friends at lunch and recess. She loves her neighborhood, and someday wants to be a teacher, or maybe join the Army.

Brewer, in turn, feels she was able to support Shamira because someone was there for her: an aunt. Brewer recalls fighting and stabbings when she was growing up in Sandtown, but she stayed involved in church and found passion in sewing clothes — and her aunt always took her aside to talk with her.

Brewer, 63, has experienced her own losses. Her son, Torrey, died at age 23 — he was found hanging from a tree in a park. Police ruled it a suicide, but Brewer believes he was killed because he associated with an unsavory crowd. She also now helps care for the 2-year-old son of Shamira's murdered sister.

“Most kids [here] know somebody in the family who was shot or killed,” Brewer said. She has a strategy for keeping her own pain in check: “I have a box in the back of my brain, and I just put everything in and close it down.”

Meanwhile, she works to keep herself — and the kids — strong. And she helps them see the good in life. She mentors younger parents in a support program, and she's the president of the parent teacher association at Samuel Coleridge-Taylor, where she's known for her big smile and hugs. She's like a grandmother to all of the kids. 

"You can't be scared. You can't shut yourself in,” said Brewer, who encourages socializing and friendships among the families. She pushes parents to get their children outside to the new playground, or to enjoy snow cones from the machine she brings out on the sidewalk.

And in ways big and small, the Promise Heights team, along with teachers, day care staff and many others, have seen hard-won triumphs.

One program that teaches parents how to bond and interact with their kids — Parent University — has a waiting list. In one of the elementary schools, scores on a test of school readiness rose by 30 points. And in the last few years, absenteeism at Furman L. Templeton has dropped from 26 percent to 10.7 percent.

Perhaps most telling, the social workers in schools who used to have to chase the “runners” are starting to savor a new dynamic. Amanda Malone-Diel, a University of Maryland graduate student in social work who counseled students at Samuel Coleridge-Taylor, remembers following a kindergartner who ran all over the school — to the first floor, second floor, gym, bathroom and cafeteria. Then one day, the social worker stopped chasing her and simply waited in one spot.

Gradually, the girl started to run back to her counselor. And sometimes, she wouldn't run at all. Instead, they'd sit together, one hand on chest, one hand on tummy, and breathe. There, amid all the neighborhood troubles, Malone-Diel created an oasis of quiet, a chance to take the student to a more peaceful place, if only for a few minutes.

“One, two, three, breathe,” Malone-Diel said slowly. “One, two, three, breathe.


Part Two: Families struggle to care for victims of violence

Part Three: Relatives of Baltimore murder victims struggle with grief

Full coverage: Collateral Damage series and related stories

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For more than a year, Baltimore Sun reporter Andrea K. McDaniels and photographer Lloyd Fox have examined the unseen impact of violence — on children, caregivers and victims’ relatives — in the Baltimore area. McDaniels wrote the articles while participating in The California Endowment Health Journalism Fellowships, a program of the University of Southern California’s  Annenberg School of Journalism.