T he first time she witnessed a student’s major tantrum — a 2-year-old hurling a toy stovefilled with plastic pots and pans — Shanikia Johnson had just started as a teacher at LittleFlowers Child Development Center in West Baltimore. ¶ She knew toddlers acted out.But the rage-filled reaction, triggeredwhen Johnsonwouldn’t allow the boy to playwith atoy, stunned the 22-year-old teacher. Then, time and time again, she saw other childrenthrowing classroom furniture. Bookcases, chairs, tables— allwere flung around the room.

Teachers and caregivers struggleto head off the damage to children’s health fromthe traumatic stress of Baltimore’s brutal crime

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SPENDING BILL: The U.S. Senate, meetingin an unusual Saturday session, gives finalapproval to the $1 trillion spending bill thatpermits the federal government to keepoperating, despite opposition by Sen. TedCruz and other conservatives. NEWS PG 15

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SUN INVESTIGATES

Some students bit classmates, leaving teethmarks on hands and cheeks; a few threatenedtohurt staffmembers.Otherchildren,dubbed“runners,” darted out of the building anddownbarren city blocks,with frantic teacherson their heels. The encounters exhaustedJohnsonandother teachers,whobegan to seethe children as troublemakers.

But the day care center’s owner, CrystalHardy-Flowers, urged the staff to be patientwith the children, who often were like anyother preschoolers — dancing to music,playing teapartyandclimbingontoa teacher’slap. The former social worker understoodsomething that her teachers did not. The kidswere growing up in Upton/Druid Heights,

where police chases are common and sirenswake up kids like unwelcome alarm clocks atnight. Almost every day, in someway, the kidswere exposed to violence.

“It’s not just bad behavior. It is not justdefiance,” Hardy-Flowers said. “No, it isdeeper than that. People just don’t pick upchairs and throw them at you. Children don’tjust run out of the building.”

Science increasingly shows that Hardy-Flowers is right. Even as shootings, stabbingsand murder trials grab the spotlight, violencein Baltimore is exacting another insidious,often invisible, toll — warping the health anddevelopment of the city’s youngest residents.

City’s violence cantake hidden toll

Article by Andrea K. McDaniels, Photos by Lloyd Fox | The Baltimore Sun

Children at the Little Flowers Child Development Center romp on the playground. Their teachers like to get them out-side in the sunshine to exercise, which helps them to focus later in the classroom.

First of three parts

MoreonlineSee a videofrom the LittleFlowers ChildDevelopmentCenter, morephotos and aninteractivegraphic atbaltimoresun.com

See VIOLENCE, page 20

SUN INVESTIGATES

When the Chesapeake Bay Founda-tion, the Johns Hopkins University andother Maryland nonprofits want tomaximize the money they can spend inpursuit of their missions, they do whatmany wealthy individuals and busi-nesses do.

They open investment accounts over-seas.

Many of Maryland’s wealthiest non-profits — including the University ofMaryland Foundation, the BaltimoreMuseum of Art, The Associated: JewishCommunityFederationofBaltimoreandtwoorganizations that support theNavalAcademy — maintain accounts in suchtax havens as Bermuda, the BritishVirgin Islands, the Cayman Islands andIreland.

Also on the list are several Baltimore-area private schools, including Gilman,McDonogh and the Calvert School,according to Internal Revenue Servicefilings.

The accounts allow such organiza-tions to shelter a type of investmentincome that would normally be subjectto taxes — even for nonprofits thatgenerally do not pay such levies. Byinvesting in hedge funds based in thosecountries, they can keep most earningsbeyond the reach of the IRS.

While the arrangement — which can

MarylandnonprofitsinvestingoffshoreLittle-known practice islegal but has risk, leavesgroups open to criticism

By Doug DonovanThe Baltimore Sun

See NONPROFITS, page 16

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20 THE BALTIMORE SUN | NEWS | SUNDAY, DECEMBER 14, 2014 FROM PAGE ONE

For every child who is shot, provokingpublic outrage, hundreds of others heargunshots or see fights and stabbings inneighborhoods across the city. After theambulances drive off and the crimescenes are cleared, many of thesechildren are left with deep psychologi-cal wounds that can trigger physicalailments.

Studies have piled up showing that inthe tangle of tough, intractable issueslike poverty and drug addiction, expo-sure to violence is a major factordamaging children’s health. The stressthat fills their little bodies breedsanxiety and depression, making it hardfor them to concentrate in school. Infact, research has found that suchexperiences hurt the development ofcrucial areas of their brains — thoseinvolving attention,memory andbehav-ior control. In the worst cases, childrenwalk around with symptoms of post-traumatic stress disorder no differentfrom those plaguing soldiers who havefought on the front lines.

According to one researcherwho haslong studied these children, nearly athird of children exposed to violencewill develop PTSD. As the children age,researchers believe, the impact of vio-lence can translate into serious healthproblems, including hypertension anddiabetes. Some early research showsthat stressmay even alter theirDNA.

“You hear about the shootings, butyou don’t hear about the aftermath,”said Annette March-Grier, president ofRoberta’s House, a grief support centerthat borders on the Broadway East andOliver neighborhoods. “It’s like you’rekilling10otherpeoplewhenyoukillone.It’s just slowly.”

The stakes are high forBaltimore andMaryland—andtheir taxpayers. If thesechildren are not helped, they are morelikely to turn to violence themselves orneed government-fundedmental healthservices. Research shows that they’realso more likely to struggle to maintainjobs and be productive members ofsociety. Since a U.S. attorney general’sreport in 2012 described children’sexposure to violence as a national crisis,some fields, including social work,police and health care, have begunspecial training for workers. There arealso efforts to help schools become safeplaces where these children can getsupport.

“The science has caught up. Youcannot raise a kid with high levels oftrauma and violence and expect theycan just bounce back,” said MarthaDavis, senior program officer at theRobert Wood Johnson Foundation,which has funded projects in high-crime areas to address the problem.“Now the hardwork is: Howdowe takethis information and make systems thatwork?”

Upton/Druid Heights, near down-town, between North Avenue andMar-tin Luther King Boulevard, is on thefrontier of this daunting effort. Therearenearly3,000children18andunder inthe neighborhood, and statistics show itto be one of the sickest and mostdangerous in Baltimore, a place wherelife expectancy is nearly10 years shorterthan the citywide average. And it is here— a historic African-American neigh-borhood that was once a major part ofthe local civil rights movement — that acadre of social workers, teachers, pas-tors and others have been testing outways to help these kids.

Through a federal grant programcalled Promise Heights, the Universityof Maryland School of Social Work iscollaborating with schools, churchesand community groups. The goal of themultiyear initiative is to combat thecycle of poverty by wrapping childrenand families in supportive services from

cradle to college.Dealingwith trauma isamajor focus of thatwork.

TheUniversity ofMaryland teamhasembedded social workers in neigh-borhood schools. They make homevisits and coach adults on parenting.Teachers learn that instead of asking amisbehaving child, “What’s wrong withyou?” theyneed toask, “Whathappenedlast night?”

Said Bronwyn Mayden, the project’sexecutive director and an assistant deanat the University of Maryland School ofSocial Work: “The way we look at it inPromise Heights, everyone is trauma-tized.”

Deathof a sisterLike many other children in Upton/

Druid Heights, 10-year-old ShamiraWedlock has already been touched byviolence. The fifth-grader at SamuelColeridge-Taylor Elementary Schoolgets nervous when she hears gunshotsin the neighborhood — or when she’soutside and a nearby car slows down.She’s worried someone might startshooting.

This summer, she saw two menbeating someone up at the playgroundin her apartment complex.

“They punched him and kicked him,and he screamed, and there was bloodeverywhere,” she recalled. Amid theassault, one of the attackers stared rightat her, unnerving her. She ran and gothelp, but remains haunted by theincident.

The biggest blow came in March,when her 21-year-old sister was mur-dered. The sister was one of threepeople shot and killed in an apartmentacross from an elementary school in anearbyWest Baltimore neighborhood, acase that remains unsolved.

At the funeral, Shamirawas tornwithemotion — grief for her sister, and fearthat the shooter might come back thatday to threatenher andher family. Sincethen, those fears have ebbed, throughthe strong support of her step-grand-mother, Joann Brewer, who has taughther to be cautious, but not paralyzed byfear.

NowShamira talks easily about thoseincidents — and about how much sheloves her neighborhood. But she stilldoes find herself, when she’s homealone, taking out her sister’s obituary

and reading it, over and over.Another neighborhood girl has har-

bored some of the same fears. But in hercase, police and relatives requested thatshe not be identified — because shewitnessed a murder that has yet to besolved.

The 11-year-old was playing outsideher McCulloh Homes apartment on anApril evening a few years ago whengunshots rang out.

A man her family knew, 23-year-oldBrandon Simms, had been eating crabsin the courtyard about 8 p.m., whenanother man walked up to him, pulledout a gun and shot him in the leg. As thegirl and other neighbors watched fromyards away, Simms tried to crawl away.The shooter fired again — this time intoSimms’ head.

The girl’s mother, awakened from anap by the firecracker-like sounds, ranoutside.She foundherdaughter in tears,crouching in the doorway and holdingtightly to a younger neighbor. A teenagedaughter, whowas also outside, ran to anearby playground and hid in a playtunnel. Terrified, she didn’t move untilsheheardhermother’s voice callingher.

Bullet holes remain in the sidewalktoday — and the impact on the familylingered aswell.

The youngest of the four children, an8-year-old boy, slept on the floor of hisbedroomthenightof themurder, fearfulsomeone would shoot through thewindow. “When you were little,” heasked his mothermonths later, “did youused to go outside, and peoplewould belaying on the ground?”

After the murder, the 11-year-oldbegan to struggle in class. For months,she felt crippled by fear, and at nightdreamed aboutwhat she had seen.

She didn’t get a look at the killer’sface, so she still worries that he could beanywhere — walking next to her on thestreet, or in thepark—and shewouldn’teven know it.

“I never really prayedbefore. But thatday I was praying. I didn’t want him todie,” the girl said recently, reading fromthe letter she wrote a week after theshooting to sort through her compli-cated feelings. Now 14, she keeps theletterona shelf inher closet. “Iwas thenscared to go outside in my neigh-borhood. I thought that whoever wasshooting might have saw me and mightwant to come aftermenext.”

Reminders of the murder are hard toavoid. The whole family sidesteps thespot where Simms’ body once lay. Andthrough their living roomwindow, theycan still see a memorial dedicated tohim, made of sneakers, pictures andother items hanging in a tree.

The mother, who works full-time atFurman L. Templeton PreparatoryAcademy, worries about the dangersoutside school. Since the murder, she’sdesperatelywanted tomove.

“I know no one is promised today ortomorrow,” she said. “But in someplaces, that is even more true. I wouldjust like to feel safe.”

Neighborhood indistressThe neighborhood has a storied past.

For decades, it was home to a thrivingAfrican-American middle class and toprominentandpolitically active familiessuch as theMitchells and theMurphys,owners of the Afro-American news-paper. Many of the city’s importantchurches started here, and in the 1920s,the vibrant entertainment scene alongPennsylvania Avenue drew compari-sonswith theHarlemRenaissance.

Today, the neighborhood is home tomany committed, long-term residentsand strong community organizations.Bit by bit, with lots of hard work, someblocks once lined with boarded-uphomes have been transformed withrows of new townhouses. There areparks and a community garden.

Yet it’s still a neighborhood in dis-tress, one that reflects the reality formillions of children in high-crime citieslike Boston, Detroit, and Newark, N.J.Upton/Druid Heights has one of thehighest concentrations of poverty inBaltimore. According to themost recentcomprehensivedata fromthecityhealthdepartment, homicides and non-fatalshootings were about twice the cityaverage in 2011, and the life expectancyofresidentswas63yearscomparedto72years citywide. So far this year, as thenumber of homicides citywide haspassed the 200 mark, there have beenseven shootings and five homicides,among a total of 665 crimes in theneighborhood, which covers about 170blocks.

Many preschoolers at Little Flowersalso experience violence firsthand. Atleast four times a week, just outside the

Michelle Fleming teaches at Little Flowers Child Development Center, using cards with facial expressions to help children understand the different feelings they experience.

Stress inmind, stress in bodyVIOLENCE, From page 1

Joann Brewer walks with her step-granddaughter. Shamira Wedlock, center, to Samuel Coleridge-Taylor Elementary School. Brew-er’s great-granddaughter, Kendall Jones, 5, joins them.

coming withdrawn, said Dr. HarolynM.E. Belcher, director of research in theFamily Center at the Kennedy KriegerInstitute. She has been studying theeffects of and treatment for violence,parental substance abuse and childmaltreatment formore than10 years.

The unwritten rules of the neigh-borhoodmay tell children it’s not OK toshow sadness or fear, Belcher said.Crying is seen as a weakness. Instead,children will exhibit other feelings orbehaviors — for example, they’ll actangry, because that’s considered accept-able. “Sodepressionsometimes inurbanneighborhoods may not look like you’resadorblueordespondent,”Belchersaid.“It looks likeanger, overeating, irritabili-ty or problem sleeping.”

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

Craig K. Ewart began looking at theemotional state of children in Baltimoreneighborhoods during the 1980s and’90s as a professor at the JohnsHopkinsBloomberg School of PublicHealth. Hisresearch team interviewed more than700 children at Baltimore PolytechnicInstitute and Western, Patterson andWalbrook high schools, all in neigh-borhoodswith violence and other socialstressors that he foundput somekids onconstant alert and caused their bloodpressure to rise.

The flight-or-fight response that ele-vated stress hormones also elevatedheart rates in these children, saidEwart,who found the same symptoms instudents in Syracuse. Being constantlyvigilant to possible dangers for longperiods can cause wear and tear on theheart and the blood vessels, Ewart said.He compared it to a badly tuned carengine that runs too fast, burns toomuch gas, overheats, and requires con-stant braking. Everything wears outearly. In adolescents, the wear and tearof constant stress can lead to hyperten-sion and early heart disease later.

Ewart, a psychology professor atSyracuse University, recently re-inter-viewed some students, who are now intheir 20s and 30s, and found that manyhave the same problems with elevatedblood pressure they did as kids.

It’s hard for doctors to predict howthe impact of violence will play out inthe life of a particular child. Childrenexposed toviolenceexhibit awiderangeof reactions and outcomes, researcherssay, depending on a web of factors,including their personal characteristics,life experiences andcircumstances suchas poverty and family support. Ac-cording to theNationalChildTraumaticStress Network, a group of front-lineproviders, researchers and others whotreat these children, the more exposuretotraumaticexperiences, thegreater therisk for neurobiological disturbancessuch as impairments in memory andregulation of emotions and behavior.

One of the newest areas of medicalresearch looks at genetics. Scientists areexamining whether prolonged stressfrom trauma can alter DNA. Severalstudies of people in stressful communi-tieshave shownshorter telomeres at theends of chromosomes. Telomeres,which act like the protective plastic tipson the ends of shoelaces, prevent DNAin chromosomes from unraveling andcells from dying. Scientists at Duke andTulane universities, who have done thework, believe this may mean fasteraging.

Other researchers say more workneeds to be done.

Carol W. Greider, a Johns HopkinsUniversity professor who shared aNobel Prize for her work on telomeres,for example, noted that the degree ofshorteningwas insignificant andhasnotbeenshowntohaveanybiologicaleffect.

But IdanShalev, assistantprofessor inthe department of biobehavioral healthat Pennsylvania State University, whoworked on one of the studies whileemployed at Duke, said that researcherswill push ahead. The hope, he said, isthat findings in this area could lead tobetterways to treat victims of trauma.

Intervening tohelpIt’s sobering to realize that the

experience of the sisters whowitnessedthe murder at McCulloh Homes is apatternplayingout forhundredsof kids.There are somany gunshot victims thatmilitary medical personnel come to theMarylandShockTraumaCenter to trainbefore going towar.

A study from Hopkins’ BloombergSchool last week found that nearly halfof all children in the United States areexposed to at least one social or familyexperience that can lead to traumaticstress and endanger their healthy devel-opment — such as seeing their parentsdivorce, seeing a parent die, witnessingor being a victim of neighborhoodviolence, or living with someone whoabuses alcohol or drugs.

But there is hope, because if the kidsget help, experts believe they have achance to recover. Scientists understandthat thebrain ismore resilient thanoncethought, so as the kids get older, andtheir brains develop and mature, theymay adapt.

The key is to intervene early. Whilemedications can be prescribed to helptamp down symptoms such as difficultysleeping, anxiety and nightmares, thereis no medication that can definitivelytreat a child’s traumatic stress, ac-cording to theNationalChildTraumaticStress Network. But one treatmentproven to help is cognitive behavioraltherapy, including stress managementand relaxation skills. Therapists alsowork to correct untrue or distortedideas about a traumatic incident, aschildren sometimes think something

21SUNDAY, DECEMBER 14, 2014 | NEWS | THE BALTIMORE SUNFROM PAGE ONE

physical problems, according to re-search from Harvard University, theStanford University School of Medicineand other institutions.

Dr. Victor G. Carrion, a Stanfordprofessor who has studied traumaticstress in children in California, said theeffect can be seen on a brain scan.

Carrion has compared theMRI brainscans of highly stressed children, in-cluding thosewho live amid violence, tothose of healthy youngsters. Theyshowed overall decreased brain volumein childrenwithhigh cortisol levels.Keyareas responsible for complex learningalsowere smaller. Thework, among thenewest findings in the field, is still in itsearly stages and needs more devel-opment, but some scientists consider itsignificant.

Researchers like Carrion believe that— in a child who can’t sit still in school,or is so agitated that he or she throws achair — the brain is so busy fending offstress that other key areas don’t developproperly. Carrion’s scans of stressedchildren found a smaller prefrontal

door of her center, Hardy-Flowers said,she sees some kind of crime. One day,the staff couldn’t leave because policewere crouched behind the center’s bus,conducting surveillance.

Three years ago, when PromiseHeights socialworkersbegantheirworkatFurmanL.Templetonand theSamuelColeridge-Taylor, they found classicsymptoms of children stressed by vio-lence.

Students were hypervigilant and suf-fering from anxiety and depression.Small conflicts blewup into huge fights,and many children had a hard timeconcentrating. Mundane acts triggeredbad memories in kids and sparkedtantrums — for example, a child wouldflinch at a teacher’s gesturing with herhands because it looked like hitting.

These kids hear constant rumblingsabout violence, even if they don’twitness it. Carefully maintained memo-rials of flowers and balloons in trees, onlight poles or even in front of anelementary school can subliminallytraumatize kids by reminding them of apast shooting. According to a survey atFurman Templeton, some children skipschool because they’re afraid to walkthrough the neighborhood.

“I tell people ‘the boogeyman’ is notan invisible thing,” said Henriette Tay-lor, a community school coordinatorwith PromiseHeights.

At the pediatrician’s office on Divi-sion Street, Dr. Jacqueline Fulton, whohas worked in the neighborhood formore than30years, used to treatkids forinfectious diseases. Now, she says, it’smostly health problems related to soci-etal issues.

The stressed children haveworsenedasthma. Some need stitches from beingbeaten up on the way to school. Manyhave Vitamin D deficiencies becausethey don’t get enough sunlight — thereare few playgrounds, and children areeither afraid to be outside, or theirparents think it’s safer for them to stayindoors.

Some children are so angry andemotionally numb, Fulton noted, thatthey never feel afraid. And it’s notsurprising, experts say, that in school,many of the children can’t focus formore than10minutes.

Some efforts to improve educationaloutcomes for these kids may haveoverlooked this crucial factor, noted theUniversity of Maryland’s Mayden. Foryears, public schools have tried manystrategies—newcurricula,moreprofes-sional development for teachers, orchanging a principal —without seeing abig improvement in achievement, shesaid. “What we have to do, particularlyin high-poverty areas, is really begin tolook at and work with children andfamilies.”

Reaction in thebodyThe neighborhood pediatrician, Ful-

ton, and others around the country aregrappling with the reality that not onlyare large numbers of children in poorneighborhoods exposed to violence, butin many cases, according to research,their very biological makeup is beingaltered through long-lasting changes inbrain anatomy andphysiology.

The human body is designed to adaptto stressful situations. In dangerousmoments, energy levels rise, the heartpumps faster, and thehormonesadrena-line and cortisol kick in. Those changesallow people to run faster and defendthemselves. When the situation calmsdown, 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, becausethings never really calmdown.Adistantgunshot. A fight in the courtyard. Amemorial of flowers and balloons for ahomicide victim. Kids stay in a continu-ous state of alertness, always preparedfor something dangerous to happen —even if they don’t realize it.

Elevated levels of stress hormonescan reach toxic levels that have alifetimeeffectonhealth,derailingdevel-opment of the brain and leading to

cortex, the part of the brain responsibleforexecutive functionssuchasattentionspan, planning and organizing, goal-setting and behavior control. Carrionalso gave the stressed children attentionand memory tests — and the prefrontalcortexwas not as active.

Other brain scan studies showedstunted growth of the hippocampus,which may inhibit a child’s ability toform new memories, learn or controlemotions. The symptoms were worsefor kids who experienced trauma moredirectly, Carrion said.

“Themore interpersonal it is in termsof family or someone close to you, themore it affects you,” Carrion said. “It’slike being close to the epicenter of theearthquake [rather than]miles away.”

Other research has found that Balti-more schoolchildren exposed to vio-lence had a hard time sleeping andregressed to bed-wetting and otherbehaviors they had outgrown. Somechildren may become moody and haveangry outbursts; othersmay react in theopposite way, shutting down and be-

Living in violent neighborhoods raises the stress hormones in children’s bodies,hurting development of the brain.

Violence, stress andachild’s brain

SOURCE: Illustration by Betsy Hayes. In Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development:Working Paper No. 9, National Scientific Council on the Developing Child (2010).Retrieved from www.developingchild.harvard.edu.

BALTIMORE SUN GRAPHIC

PREFRONTAL CORTEXCenter of executive functions;regulates thought, emotions, andactions. Especially vulnerable toelevation of brain chemicalscaused by stress.

AMYGDALATriggers emotional responses;detects whether a stimulus isthreatening. Elevated cortisollevels caused by stress canaffect activity.

HIPPOCAMPUSCenter of short-term memory; connectsemotion of fear to the context in whichthe threatening event occurs. Elevatedcortisol levels caused by stress canaffect growth and performance.

See VIOLENCE, page 22

At Little Flowers, a volunteer bends near to better understand one of her young charges, Tyler Carter.

ROLANDPARK

DRUIDHEIGHTS

MIDTOWN

DOWNTOWN

PENN NORTH

SANDTOWN-WINCHESTER

SOUTHWEST

6383

72

LIFE EXPECTANCY

NON FATAL SHOOTINGS*

0

109

46

HOMICIDE INCIDENCE RATE*

4

38

21

HEART DISEASE DEATH RATE*

48

14

28

DIABETIES DEATH RATE*

8

31

SOURCE: Baltimore City HealthDepartment 2011 NeighborhoodHealth Profiles.

* per 10,000 residents

ADAM MARTON / BALTIMORE SUN GRAPHIC

Onmany key measures of health and crime, the residents in Upton/DruidHeights have some of the worst outcomes in the city. The numbers areespecially stark when compared to a neighborhood such as Roland Park,which is considered one of the healthiest neighborhoods in Baltimore.

Upton/Druid Heights among “least-healthy”neighborhoods in Baltimore

UPTON/DRUID HEIGHTS ROLAND PARK CITY AVERAGE

UPTON/

DIABETES

About the seriesComing Thursday: Parents facea decades-long struggle —emotionally and financially — tocare for victims of violence.Coming Sunday: Violent deathsleave relatives grieving for years,especially around the holidays.

The team: For more than a year,Baltimore Sun reporter Andrea K.McDaniels and photographerLloyd Fox have examined theunseen impact of violence — onchildren, caregivers and victims’relatives — in the Baltimore area.McDaniels wrote the articleswhile participating in TheCalifornia Endowment HealthJournalism Fellowships, aprogram of the University ofSouthern California’s AnnenbergSchool of Journalism.

Do you feel safe?Do you live in a neighborhoodwhere you don’t always feelsafe? What does it mean for youand your children? We want tohear your story. Text or call TheBaltimore Sun at (443)563-1224 or email usat baltimore.sun.neighborhoods@gmail.com. Leave your nameand phone number. We won’t useany of your identifyinginformation without contactingyou and getting your permission.

they did or didn’t domay have causedthe violence.

What scientists don’t yet know iswhether improvements in the behav-ior they see in kids getting treatmentare matched by improvements intheir brains, such as more activity inthe prefrontal cortex, said Carrion,the Stanford medical school profes-sor.He plans to study this issue next.

In situations like the one theBaltimore family went through, mostchildren here and in other cities don’tget help.Toooften, children are left todeal with the problem on their own,or there may not be resources forcounseling.

But shortly after the McCullohHomes shooting, the mother got thechildren counseling at their school,FurmanL.Templeton.Counselorssaykids will open up at their own pace;they just need an outlet. ClaireMeringolo, a clinical social workerand early childhood mental healthconsultant, who until recentlyworked with Promise Heights, letschildren guide her to what they wantto share. She uses play therapy, suchasdrawingpictures, to letkidsexpressthemselves. One child told her in asession that he saw a dead bodywhilewalking home; another talked about amanwhowas shot in the leg.

For children who internalize acrisis, therapists saygradually reintro-ducing them to the trauma andteaching them to cope with it hasbeen proved a successful treatment.Therapists gently guide the childrento tell their stories and help releasestored emotions. This helps restore asense of confidence and reducestrauma-relatedsymptoms, saidBridg-et Bauersfeld with the KennedyKrieger Family Center, which coun-sels families who have experiencedtrauma.

In Upton/Druid Heights, the Uni-versity of Maryland social workers —along with school staff members andothers in the community — aredeveloping new routines for thechildren. In the Little Flowers daycare, for example, teachers are dim-ming the lights at different times tohelp calm the kids, or conductingsome activities outside, where sun-shine and fresh air may help themfocus.

ThePromiseHeights teamhas alsoheld more than 24 sessions to teachadults how to deal with traumatizedchildren. More than three dozenteachers who work for Hardy-Flow-ers have had the training. Othersinclude foster parents, child welfareworkers, and Head Start adminis-trators.

Atarecentsession,12 teachers fromLittle Flowers sat around tables in thebasementofachurchonPennsylvaniaAvenue. Kyla Liggett-Creel, a clinicalsocial worker with the University ofMaryland School of Social Work,challengedtheclass to talkabout theirstudents’ behaviors and how it makesthem feel.

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

“Talking back by yelling,” saidanother. “Disrespected.”

“Kicking off their shoes,” said athird. “Makesmewant to throw theirshoes in the trash.”

Liggett-Creel told the teachers it’sOK to feel frustrated. But theyneededto consider that something in thechildren’s livesmightbecausing themto act out.

“If you’re having those thoughts,then the child is never going to ... getbetter,” she said. “Stop and say, ‘Thischildmaybe traumatized.My job is tostay calm andhelp him learn.’ ”

After the weeklong session, theteachers saw the children from a newperspective. “I just thought the kidswere bad,” said Johnson, one of theteachers. “Now, I take a step back andthink about whether something hap-pened that maybe the student isn’ttellingme.”

On a day after the training, somechildren were sculpting Play-Doh,while one tot sprawled in the middleof the floor, her socks and shoesdiscarded beside her. “She’s justhaving one of those days,” explainedJohnson,whonowhasmorepatience.Instead of scolding the 3-year-old, asshe might have done before, shetalked to her andhuggedher.

The elementary schools have alsoinstituted new rituals. At the begin-ning of the day, for example, whenstudents stream into Furman L. Tem-pleton’s cafeteria, Principal DebraSantos and a social worker are onlookout duty. They scan the faces forsigns that someone is upset. Whenthey notice a child who seems off-kilter or overwhelmed, they take himor her aside to seewhat’s going on.

One morning when the Universityof Maryland’s Mayden was at SamuelColeridge-Taylor for a meeting, staffmembers brought in a boy who wassobbing. “My heart hurts,” he cried.Mayden immediatelyworried about aserious health problem, but a social

worker who knew the boy took himaside to talk. It turned out the boy’sfather had been arrested the previousnight, and he was afraid he wouldnever see his father again.

Once the children get to theirclassrooms, some teachers gatherthem in a circle for what they call the“daily rap.” The schools, with theleadership of the Promise Heightsteam, started the custom three yearsago as a way to let students unleashfeelings and express themselves. Thehope is that if something is on theirminds, they will talk about it, ratherthan hold it in. Then they’ll be betterprepared to concentrate and learn.

This fall, during the daily rap inteacher Ladaisha Ballard’s fifth-gradeclass at Furman L. Templeton, stu-dents discussed the Ebola virus.Ballard thought this might spur talkabout drug addiction. She discussedwhether the disease might spreadeasily if it ever hit Baltimore, becausethere are so many drug users and thevirus is passed through bodily fluids.Soon the kids opened up about familymemberswhouse drugs.

Other protocols have been put inplace. When children are agitated,they can go to the social worker’soffice, where there is a “calm down”cornerwithacomfychair andcartonsfilled with stuffed animals and otheritems. The students can pull out abook or toy that they know makesthem feel better. Some kids stroke thepiece of velvet tacked to the wall. Ifthey’re angry, they can pop bubblewrap. One year, the kindergarten andpre-kindergarten classes used bal-loons and sand tomake stress balls, sothey each could have their own.

The goal is to help them get rid ofanxiety and to focus—andultimately,to regulate emotions themselves.

The social workers have alsoworked with police to make crime-fighting less traumatizing for thechildren, particularly after a SWATteam showed up one afternoon toexecute arrest warrants at the nearbyMcCulloh Homes. Mayden said theresulting situation at Samuel Cole-ridge-Taylor was upsetting, withteachers struggling to pull studentsback inside and parents who werethere for pick-up trying to reach theirkids.

Now thepolice give the school staffa heads-up on any raids,Mayden said.She’s also asked officers to removetheir sunglasses when talking withthe children, to appear less intimi-dating. Such incremental changes canhelp reduce trauma in a neigh-borhood where seeing raids, arrestsand even lifeless bodies on the streethas become routine for children.

WhatworksIn other parts of Baltimore, there

are scattered efforts to limit theimpact of violence on children.Mary-land’s chapterof theNationalAllianceon Mental Illness is working to stepup the role that primary care physi-cians play in helping people exposedto trauma in violent neighborhoods.

Behavioral Health System Baltimorehas funded programs to put counsel-ors in somepublic schools.

Nationally, trauma-focused treat-ments and initiatives are being dis-seminated to the systems most likelyto encounter these children: childwelfare, pediatric and emergencyrooms, courts, schools and law en-forcement, in part through the Na-tional Childhood Traumatic StressNetwork.TheYaleChildhoodViolentTrauma Center is collaborating withthe International Association ofChiefsofPolice todeveloptraining forpolice officers responding to trauma-tized children during calls for service.

“While there is enormouspotentialfor traumatized children and familiesto get help to recover through evi-dence-based treatments and programstrategies, the funding to supporttheir proliferation needs to be fargreater than it currently is, given thepublic health crisis we face,” said Dr.Steven Marans, the director of Yale’scenter and the Harris Professor ofChild Psychiatry.

Butmany programs in the PromiseHeights initiative have ripple effects.As adults are supported in variousways, they can support the kids. Andresearch has shown that having abond with an adult is a powerful wayfor children to overcome the conse-quences of violence, poverty andother social ills. Even an adult who isnot a relative can offer stability.

“Attachment is critical for the childto develop self-regulation of theiremotions,” said Belcher, of KennedyKrieger. “So when you get a littlefrustrated, you’re resilient, you comeback.”

For Shamira, the Samuel Cole-ridge-Taylor fifth-graderwhose sisterwas killed in March, the strong bondwith an adult has helped balance outmuch of the violence around her.Brewer, the step-grandmother, hasbeen the steadying force in her life foryears. So despite what she has to dealwith, Shamira is a good student wholoves math. She plays teacher to herstuffedanimalsandchatswith friendsat lunch and recess. She loves herneighborhood, and somedaywants tobe a teacher, ormaybe join theArmy.

Brewer, in turn, feels she was ableto support Shamira because someonewas there for her: an aunt. Brewerrecalls fighting and stabbings whenshe was growing up in Sandtown, butshe stayed involved in church andfound passion in sewing clothes —and her aunt always took her aside totalkwith her.

Brewer, 63, has experienced herown losses. Her son, Torrey, died atage23—hewas foundhanging fromatree in a park. Police ruled it a suicide,but Brewer believes he was killedbecause he associated with an unsa-vory crowd. She also now helps carefor the 2-year-old son of Shamira’smurdered sister.

“Most kids [here] know somebodyin the family who was shot or killed,”Brewer said. She has a strategy forkeeping her own pain in check: “Ihaveabox in thebackofmybrain, and

I just put everything in and close itdown.”

Meanwhile, she works to keepherself — and the kids — strong. Andshe helps them see the good in life.She mentors younger parents in asupport program, and she’s the presi-dent of the parent teacher associationat Samuel Coleridge-Taylor, whereshe’s known for her big smile andhugs. She’s like a grandmother to all.

“You can’t be scared. You can’t shutyourself in,” saidBrewer,whoencour-ages socializing and friendshipsamong the families. She pushes par-ents to get their children outside tothe newplayground, or to enjoy snowcones from the machine she bringsout on the sidewalk.

And in ways big and small, thePromise Heights team, along withteachers, day care staff and manyothers, have seenhard-won triumphs.

One program that teaches parentshow to bond and interact with theirkids — Parent University — has awaiting list. In one of the elementaryschools, scores on a test of schoolreadiness roseby30points.And in thelast fewyears, absenteeismatFurmanL. Templeton has dropped from 26percent to10.7 percent.

Perhaps most telling, the socialworkers in schools who used to haveto chase the “runners” are starting tosavor a new dynamic. Amanda Ma-lone-Diel, a University of Marylandgraduate student in social work whocounseled students at Samuel Cole-ridge-Taylor, remembers following akindergartner who ran all over theschool — to the first floor, secondfloor, gym, bathroom and cafeteria.Then one day, the social workerstopped chasing her and simplywaited in one spot.

Gradually, the girl started to runback to her counselor. And some-times, shewouldn’t run at all. Instead,they’d sit together, one hand on chest,one hand on tummy, and breathe.There, amid all the neighborhoodtroubles, Malone-Diel created anoasis of quiet, a chance to take thestudent to a more peaceful place, ifonly for a fewminutes.

“One, two, three, breathe,”Malone-Diel said slowly. “One, two, three,breathe.”amcdaniels@baltsun.com

22 THE BALTIMORE SUN | NEWS | SUNDAY, DECEMBER 14, 2014 FROM PAGE ONE

Gillian Gregory, a social worker at the University of Maryland School of Social Work, listens to students during the daily rapsession in a fifth-grade class at Furman Templeton Preparatory Academy.

Shanikia Johnson, a teacher at Little Flowers, likes to be with the children out-side for sunlight and exercise, which seems to help them focus.

Effortsto softenimpact ofviolenceVIOLENCE, From page 21

Alan Gross, an international aid workerfrom Maryland, speaks to the press inWashington after spending more than fiveyears in a Cuban prison.

ALGERINA PERNA/BALTIMORE SUN

WASHINGTON — President BarackObama announced plans Wednesday tore-establish diplomatic relations withCuba, openanembassy inHavanaandrelaxtrade and travel restrictions — reversingmore than half a century of policy aimed atisolating the Communist nation 90 milesfromFlorida.

“Neither theAmericannorCubanpeopleare well served by a rigid policy that’srooted in events that tookplacebeforemostof us were born,” Obama said at the WhiteHouse. “I do not believe that we can keepdoing the same thing for over five decadesand expect a different result.”

Obama said the moves became possible

onceCuba releasedAlanGross, the interna-tional aid worker fromMaryland who washeld for more than five years in a Cubanprison for trying to connect the island’ssmall Jewish community to the Internet.

Gross, a subcontractor to theU.S. Agency

for International Development, was freedinHavana earlyWednesday and flownbackto Maryland aboard one of the planes usedasAir ForceOne.

He was accompanied by Judy Gross, hiswife of more than 44 years and most vocaladvocate; Rep. Chris Van Hollen, who washis congressman before he was detained;and othermembers of Congress. The planelanded at Joint Base Andrews in PrinceGeorge’s County about11a.m.

Gross expressed gratitude to all whoworked for his release. Frail but in goodspirits, he spoke during a brief appearanceat his lawyer’s office inWashington.

“Chag Sameach,” he began, using theHebrew for “Happy Holidays,” on thesecondday ofHanukkah.

“What a blessing to be a citizen of this

U.S., Cuba to restore tiesByMatthewHay Brown,John Fritze and Ian DuncanThe Baltimore Sun

More insideHomecoming A grateful Alan Grosscelebrates “the best Hanukkah” PG 14

What it means The U.S. will open anembassy in Havana, ease trade andtravel restrictions, and reverse decadesof policy meant to isolate Cuba PG 15

Orioles In a twist, better relationsexpected to be good for baseball PG 15

See CUBA, page 14

DIPLOMACY: White House announces plans to re-establish diplomatic relations with HavanaGROSS FREED: Potomac man finally has ‘freedom to resume a positive and constructive life’

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His mother remembers the way heused to be: a daredevil with an athleticbuildwho drove a red Pontiac Firebird,listened to hard rock bands like Metal-lica and did handstands onhis thumbs.

But when a neighbor waving a gunshot Charles “Chuck” Ropka in thehead, the Parkville 18-year-old was leftparalyzed on his left side. The shootingderailed the high school graduate’splans to study to become a dieselmechanic. Instead of seeing him moveout on his own, his mother, ShirleyRopka, suddenly had tomake a place tocare for him in the family’s basement.And that’s where he still lives — 35years later.

“He getsmadwhen I say it, but it feltlike I had a large baby,” said ShirleyRopka, who became his medical aidewhile caring for threeother children. “Iwas41,andtheyalwayssay lifebeginsat40.Mywhole lifechanged. I thinkmoreor less I focused on him most of thetime.”

She and her husband found them-selves on a decades-long odyssey — anemotional, physical and financial strug-gle that illustrates the unseen toll ofviolence in theBaltimore region.

Even in Baltimore, which has thefifth-highest murder rate amongmajorU.S. cities, far more people survive

Area families strain to provideadequate care for the victims of violence

Somewoundedwind up at home

Shirley Ropka gets her son, Chuck, rear, ready for bed at her house in Parkville. Chuck has lived in the basement of the familyhouse since he was shot and partially paralyzed 35 years ago.

SUN INVESTIGATES

See VIOLENCE, page 12

Article by Andrea K. McDanielsPhotos by Lloyd FoxThe Baltimore Sun

Nationwide protests after the deaths oftwo unarmed black men by police inMissouri and New York might causeofficers to hesitate to use deadly force forfear of becoming the “nextDarrenWilson,”Baltimore’smayor saidWednesday.

Meanwhile, police unions say depart-ments across the country are battlinganxiety that could compromise officers’safety. They called uponmore police chiefsand elected leaders to vocally back officers,who have felt their public support erodeeven as they continue to do dangerous jobsprotecting communities.

In the latest flash point in Baltimore, acity officer drew a Taser on a manconcealing a gun who shot him Sundaynight. The investigation into the shootingcontinues.

During a weekly news briefing Wednes-day, Mayor Stephanie Rawlings-Blake said

Mayor says someofficers worryabout being ‘nextDarren Wilson’By Justin GeorgeThe Baltimore Sun

See POLICE, page 21

12 THE BALTIMORE SUN | NEWS | THURSDAY, DECEMBER 18, 2014

violent attacks than die from them. Here,for example, in 2014 there have been 204homicides and 356 nonfatal shootings.Many of these survivors spend weeks ormonths in rehabilitation units learning towalk, speak and eat again. Others, likeChuck Ropka, are left with permanentdisabilities.

For victimswho survive a serious brushwith violence, a string of relatives oftenmust pick up the pieces. They’re lovingmoms, dads, siblings, aunts and grand-mothers who are thankful their relativessurvived, butwho are unexpectedly thrustinto the role of caretaker for someonesaddled with severe physical or mentalhealthproblems.Longafter theadrenalineand terror of the emergency room mo-ments, these families shoulder a heavyburden as newcaregivers.

“It can have a tremendous, traumaticimpact on people’s lives that affects thewhole family,” saidDr.MichaelA.Scharf, aUniversity of Rochester psychiatry profes-sorwhohas studied the impact of violenceon families.

No one knows exactly how manysurvivorsofviolencewindupdisabled,butsome statistics give a glimpse of thenumbers: Violence is the third leadingcauseof spinal cord injuries in thecountry,affecting about 40,000 people a year. Inaddition, about 275,000 people suffertraumatic brain injuries caused by vio-lence every year.

Similarly, no one knows exactly howmany survivors of violence end up dis-abled, living with their families or innursing facilities.

Strainon the familyIn Chuck Ropka’s case, the paralysis,

which requires him to use a wheelchair,was accompanied by a head injury.Though caring for him was never aquestion for the Ropkas, who live in amodest, three-story rowhouse, the experi-ence has at times strained the family.

Experts say there is a lackof researchonfamilies like theRopkas, but compare theirexperience to that of families of injuredsoldiers back from war. Caregivers whotend to injured soldiers suffer fromdepression, isolation and financial bur-dens. They have a higher burden of stress,compared to more typical caregivers, forexample, someone who cares for anelderly person, according to a study by theNational Alliance for Caregiving. That’sbecause they tend to be in the caregivingrole for longer periods of time, andperform more daily tasks such as bathingand feeding a loved one.

“The cost goes into the millions veryquickly,” said Wanda Page, founder ofDisabled Crime Victims Assistance Inc., aTexas nonprofit that works with familieslike the Ropkas. “The treatment still goeson. It’s not like they are paralyzed and thatis it.”

The Ropkas’ younger daughters re-member the early years,whenparamedicswere summoned in themiddleof thenightbecause of their brother’s seizures. Thefamilywasn’table togoonmanyoutingsorvacations. His mother recalls the time shelefthimtopickupherhusbandfromwork,and her son tried to go to the bathroomonhisown.Hewounduptangled in the toilet,humiliated, and the Fire Department hadto be called to help. For years, his motherrarely left him alone again.

His mother tries to block out thoughtsabout the crime — in which the neighborwas charged but acquitted — and itsaftermath.Yet at age76, shehashadplentyof moments when shewonderedwhy thishappened to her family. Going to church,Calvary Lutheran, helped.

“I just take each day as it comes alongand just dealwith it,” she said.

Chuck Ropka, 53, is close with hisparents and appreciates how they havecared for him over the years. He, too, haslearned not to dwell on his past.

“I have to livemy life,” said Ropka, whocommunicates well, but sometimes con-fusesmemoriesbecauseofhisbrain injury.

Today, the Ropkas must keep up withnew health problems that constantly cropup.Twoyearsago,ChuckRopkahadallhisteeth pulled because seizure medicine ateaway theenamel.Theparalyzed sideofhisbody is stiff because he didn’t always go tophysical therapy. He lost two toes, fragile

from a skin infection, when he bangedthem on the side of the bed. And becausehis limbs are so stiff, he once had to ridewith his feet hanging out the window ofhismother’s stationwagon.

The family had to reconfigure hisbasement bedroom with a hospital bedand other changes to fit his new life in awheelchair. Medicaid, the federal-statehealth insuranceprogramfor thepoor anddisabled, has coveredmany of his medicalbills. The family has turned to grants andnonprofits formore help.

But Shirley Ropka, who baby-sat chil-drenfora living,andherhusband,aretiredbutcher, had to pay for a lot on their own.They took a nearly $15,000 loan — morethantheoriginal costof theirhouseonRedOak Road — to widen doors and install awheelchair lift, alongwith a device to helplift him. Later, Chuck Ropka’s stepfathercashed in a $5,500 life insurance policy topay for an elevator to carry him from thebasement to the driveway.

In Maryland, the state program thatcompensatescrimevictimspaidoutnearlytwo-thirds of its dollar awards in fiscalyear 2014 for assaults such as gunshots,stabbings and beatings. (Most of theremainingmoneywas related to homicidecases.) Much of the money for the assaultvictimswent for health care—$2.7millionformedical and dental claims and $75,000formental health claims. About 41percentof claimswerepaid toBaltimore residents.But officials with the Criminal InjuriesCompensation Board note that the fund isthe last resort for victims, who must firsttap out private insurance and Medicaid,meaning the overall cost of caring forvictims is likelymuchmore. Ropkadid notgetmoney from the fund.

All these families must adjust to a newreality. Neurological damage can alter aperson’s personality, something families

may struggle with, said Melanie Brown,director of Brain Injury Rehabilitation atthe LifeBridge Health Brain & SpineInstitute, which treats victims of violencewho suffer brain injuries.

“It’s like thepersonyouknewisn’t thereanymore,” Brown said. “They say thingsdifferently. They act differently.”

The victims, in turn, also struggle. Asmall percentage never fully accept theirnew fate, turn todrugs or alcohol andevenend up homeless, advocates say. Youngerdisabledvictims sometimeswindup livingin nursing homes, next to people theirgrandparents’ age.

BroughtbackhomeOne Baltimore-area family watched

their son deteriorate in a nursing home, sothey decided to care for him at home.Shannon Dudley was 22 and attendingschool to become a barber when he wasbeaten and stabbed in the heart during a2008 robbery at a bus stop at Charles andBaltimore streets. He emerged from acoma severely disabled and made someprogress at a rehabilitation facility. Butonce he was sent to a nursing home, heseemed towithdraw.

Fourteen months after the injury, thefamily brought him back to the rowhomewhere he had been livingwith hismother.He couldn’t walk and needed help beingfed and bathed. Dudley’s maternal grand-mother, 72 and retired from work as acrossing guard, decided to care for him.

“It was my grandson,” said NellieRansome, a petite and determinedwomanwith the strength and energy of someonemuch younger. “I had to do it.”

Physicians say it’s hard to know whichpatientswill recover, andwhichwill sufferlifelong disabilities. With brain damage,the most improvement occurs within thefirst few months. With physical disabili-ties, itmaytakeyearsofphysical therapytomake gradual improvements. One factor isthedeterminationof thepatient.Dudleyattimes seems to have given up, but hisfamily still believes hewillwalk again.

His grandmother arrives each morningat 6 a.m. to get him dressed. She tenderlybatheshim,brusheshis teethandslideshisstiff body into clothes. His 5-foot-8-inchframe towers aboveher 5 feet 3 inches, butshemanages to lift his body andmove himinto an old office chair with wheels. Sherolls that chair to the top of the steps andslides his body onto a glider chair, whichtakes himdownstairs.

On a recentmorning, Ransome held hishead and whispered to him, praying withhim. She then fed him spoonfuls of eggs,grits and applesauce.

Lately, Dudley now 29, has been feelingpain in his legs. He cries and points to histhin limbs, but can’t saywhat iswrong.Hismother and grandmother have spent longnights in the emergency room in hopesthat doctors could provide some relief.Andhis grandmothernowtries to exercisehis legs each day, wrapping her armsaround his chest and lifting him in the air.She then moves each leg back and forthand sways his body from side to side, as iftomimicwalking,usingherownversionofphysical therapy.

Two men were convicted in Dudley’sassault. His mother, Tilithea Ransome,who commutes to Washington for herwork as a pension financial manager forthe city, gets angry when she thinks aboutthat day. She believes others were in-volved. But she tries to focus on giving herson as normal a life as possible.

Mostdays,Dudleyandhis grandmotherwatch television. She steers clear ofanything violent, and instead, they enjoyreruns of “Martin” and other comedies.Dudley’s face lights up and he waves hishands, as his body shakes with laughter atcomedianMartin Lawrence’s antics.

His mother tries to keep his life asnormal as possible and has even managedto take him on trips, including a recentcruise toMexico.

Despite the obstacles, Tilithea Ran-some, 53, is glad her son survived,when somanydon’t. It is thisnotion that givesherapositive outlook.

“My son lived. That was for a reason,”

she said. “We knowhewill walk one day. Iwill never give uphope onhim.”

Anunclear futureThe Ropkas have also leaned on their

faith. Stepfather Carl Ropka said theirchurch has helped them cope. They arealso fortunate, he said, that services for thedisabled — particularly transportation —have improved since his stepsonwas hurt.An aide comes in several hours a week totake him to themovies and on outings.

Hismother has gone out of her comfortzone to do things for him — even takinghim to a strip club once. She rolled hiswheelchair to the front entrance, pushedhim through the door and then ran off soshe didn’t have to go in.

Chuck Ropka, too, has adapted to life ina wheelchair. He goes out on his ownseveral days a week, even wheelinghimself to vote on Election Day. He has a“maingirl” atTheLeagueForPeopleWithDisabilities, an adult day care center inNortheast Baltimore that offers rehabilita-tion services and recreational activities forpeople with severe physical or neurologi-cal disabilities. But he still gets down andfrustrated at times.

“ThenI just sayI’mthankful tobealive,”he said. “My life is good tome.”

His parents, meanwhile, are gettingolder. Shirley Ropka needs knee surgerybut postpones it because she needs to takecare of her son. She goes up and down thestairs using the chair lift built for him.

And the future is unclear. The Ropkasplan to leave the house to their son, butthey don’t know who would care for him.Shirley Ropka tries not to think about itthat much. She relies on a personalphilosophy to get her through each day.

“There’s always somebody worse offthan you are,” she said.

Each night, for all these years, ShirleyRopka goes downstairs and helps her songet ready for bed. In a kind of quiet duet,they work together — he changes his ownshirt, and she helpswith the pants.

He drags his body onto the bed, and —just as she didwhen hewas growing up—she pulls up the blanket and says goodnight.amcdaniels@baltsun.com

When the wounded child comes homeVIOLENCE , From page 1

Shannon L. Dudley, left, disabled since he was stabbed in the heart several years ago, iscared for by his grandmother, Nellie Ransome. At left, young Shannon with CouncilmanKen Harris.

DANA COLEMAN /BALTIMORE AFRO-AMERICAN

Below, Shirley Ropka helps her son,Chuck, take off his sweat shirt in thebasement of their home in Parkville. Atright, the Ropkas in 1979, after Chuckwas shot.

About the seriesLast Sunday: Violence in Baltimore isexacting an often invisible toll —warping the health of the city’syoungest residents. Read this articleat baltimoresun.com.Coming Sunday: Violent deathsleave relatives grieving for years,especially around the holidays.The team: For more than a year,Baltimore Sun reporter Andrea K.McDaniels and photographer LloydFox have examined the unseenimpact of violence — on children,caregivers and victims’ relatives — inthe Baltimore area. McDaniels wrotethe articles while participating in TheCalifornia Endowment HealthJournalism Fellowships, a program ofthe University of Southern California’sAnnenberg School of Journalism.

Do you feel safe?Do you live in a neighborhood whereyou don’t always feel safe? Whatdoes it mean for you and yourchildren? We want to hear your story.Text or call The Baltimore Sunat (443) 563-1224 or email usat baltimore.sun.neighborhoods@gmail.com. Leave your name andphone number. We won’t use any ofyour identifying information withoutcontacting you and getting yourpermission.

OnlineGo to baltimoresun.com to viewvideos and photos featuring subjectsof Sunday’s and today’s articles.

FROM PAGE ONE

Determined to replace his mother’sancient tube television for Christmasthis year, Ben Hebert bought a 40-inchflat-screenTVonline inaCyberMondaydeal and had it shipped to her Fallstonhome.

Butwhen theTVwasdelivered toherdoorstep, itwas obviouswhatwas insidethe box, said theUniversity of Baltimoregraduate now living in Austin, Texas.“Holy guacamole,” his mother textedhim.

“They shipped it in a giant box that’sbasically the TV,” said Hebert, 25. “Thesurprise was ruined way before Christ-mas.”

Online shopping is bigger than everthis year, setting records and eclipsingBlack Friday, but there’s a trade-off forthat convenience — it has upended thetradition and joy of surprise that comesfromhiding aholidaypresent. Insteadofstashing gifts in the closet or car trunk,shoppers must now intercept the deliv-eryman, hide email receipts in obscurefolders, scrub their Internet history andbuy with gift cards so a nosy spousedoesn’t spot the credit card charges.

Even Web-savvy shoppers have beenexposed when a loved one noticedtargeted advertising that uses a cus-tomer’s search history to suggest similarpurchases.

Canton resident Tyler Silvey said hewoke up to an email alert recently from

Shoppingonline canbe holidayspoilerInternet makes it harderto keep gifts a surpriseBy CarrieWellsand LorraineMirabellaThe Baltimore Sun

See SURPRISES, page 15

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W hen Alice Oaks’ older sonwasshot to death in Baltimore in2008, she said her goodbye at

the Maryland Shock Trauma Center. Helay there, a tube still in his mouth, and itseemed to her that his bodywas glowing.She felt numb. She bent over and kissedhim softly on the forehead and the cheek.

Then, last May, driving home from aseafood dinner, she got a phone call thather other child, also a son, had been shotdead. She screamed and beat her handson the steering wheel, so hysterical thatshe stopped the car in the middle of theroad.

“Not my only son,” she cried out over

and over. “Not again.”Her words could be a refrain for

Baltimore, which has the fifth-highesthomicide rate of major U.S. cities. Thebrutal killings leave behind thousands offamilies who must grapple with thedebilitating aftermath. Like the childrenexposed to violence, or the caregiverstending sons disabled by shootings, thegrieving relatives of the murdered arelittle noticed after the funerals and thecandlelight vigils. But their suffering ispart of the devastating domino effect ofviolence in the city.

For Oaks, 61, and other relatives, theholiday season is especially painful, and

Grief ripples outward among therelatives of homicide victims, the damage lingering for years

Article by Andrea K. McDaniels, Photos by Lloyd Fox | The Baltimore Sun

Alice Oaks, left, and Greta Willis weep during the Survivors Against Violence Everywhere holiday gathering.

Alice Oakes’ Christmasornament for the SAVEgathering. See GRIEF, page 20

SUN INVESTIGATES

Hiddensorrows

The shooting of a woman at an OwingsMillsapartmentcomplexwastheprecursorfor theambushkillingof twoNewYorkCitypolice officers later in the day, law enforce-ment officials said.

Police in New York and BaltimoreCounty said they believe Ismaaiyl AbdulahBrinsley shot and wounded his ex-girl-friend before 6 a.m. Saturday at an apart-ment near the Owings Mills Mall, thenposted anti-law enforcement messages on

socialmedia as he traveled toBrooklyn,N.Y.There, he approached a marked police

vehicle parked in the Bedford-Stuyvesantneighborhood around 2:45 p.m. He “took ashooting stance” and fired a handgunseveral times through the window, NewYork PoliceCommissionerWilliamBrattonsaid at a news conference.

Officers Wenjian Liu and Rafael Ramoswere struck in the head, and taken to ahospital, where they were pronounceddead. Police said Brinsley, 28, ran into asubway station, where he shot himself in

A shooting, an assassinationKiller of 2 New York police officers first shothis ex-girlfriend in Owings Mills, police sayBy Justin FentonThe Baltimore Sun

An ambulance carrying one of the two New York police officers whowere fatally shot passes a New York Fire Department honor guard.

CARLO ALLEGRI/REUTERS

See SHOOTINGS, page 22

Rafael Ramos

Wenjian Liu

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20 THE BALTIMORE SUN | NEWS | SUNDAY, DECEMBER 21, 2014

the fallout fromaviolent deathgoes farbeyond what most people imagine.Numerous studies show that the rela-tives of homicide victims suffer in adifferent and often more intense waythan those who have lost a loved onethrough natural causes, or long ill-nesses—partly because theymust dealwith the criminal justice system.

Every part of their lives is affected.Some can’t hold jobs, and familiesbreak apart. Grieving parents may notrealize their own children are alsosuffering. They often develop mentaland physical health problems, in-cluding eating disorders, insomnia,depressionandparanoia.Theygetpainin the arm or chest, where their lovedonewas shot. Inaphenomenonknownas “broken heart syndrome,” intensegrief can weaken the heart and lead toheart attacks. So can the anger, scien-tists say. In certain cases, some re-searchersbelieve, theburdenof grief—if not treated—can kill people.

Impact of homicideIn one of the largest studies ever

done on the bereaved relatives ofhomicide victims, the findings werestriking: 100 percent reported that themurder of a loved one had affectedtheir health, 25 percent stoppedwork-ing permanently, and 25 percent sud-denly gained responsibility for a child.All of them suffered significant fi-nancial burdens, according to the 2011government report from the UnitedKingdom, which involved interviewswithmore than 400 families.

“I don’t want to do anything. I justwant to withdraw into a cocoon,” saidOaks, who experiences heart pal-pitations, anxiety attacks and head-aches. She takes antidepressants butfinds herself sometimes crying uncon-trollably. Both sonshadbeen convictedofminordrugoffenses,butshefelt theywereworking to build better lives.

Researchers estimate that everyhomicide has a direct impact on 10other people, which means nearly24,000 Baltimoreans have been af-fected by homicides — just in the pastdecade. And that’s on top of otherdecades of loss.

“This has been going on for 30 or 40years ifnot longer.Thishasbeentwoorthree generations of death,” said PhilLeaf, a professor and director of theCenter for the Prevention of YouthViolence at the JohnsHopkins Bloom-berg School of PublicHealth.

At the state level, there is a growingawareness of the toll. The GeneralAssembly, noting that many areas ofMaryland lacked necessary counselingand follow-up services, passed a lawthis year to provide funding to bettersupport these relatives. So far, thefunding has paid for police sensitivitytraining, more support groups andhome visits from socialworkers.

“The old saying ‘Hurt people hurtpeople’ is so true,’” said AnnetteMarch-Grier, president of Roberta’sHouse, a grief center inEast Baltimore.“Weneed to address the rippling effectand the emotional scars that are leftbehind from violence— because it willonly replicate violence again. Angerturns to rage, and then it becomesself-destructive if that anger is notresolved in a healthyway.”

City health and public health offi-cials have long seen violence as almostan infectious disease, because of theway it can spread through the commu-nity. Two local violence preventioninitiatives, Operation Ceasefire andSafe Streets, have had varying degreesof success. Still, more than 200 peoplehave been killed inBaltimore this year.

Particularly hard hit is Baltimore’s

African-American community, whichaccounted for 90 percent of thehomicide victims this year.Most of the600 clients who use grief counselingand other services in a program at theBaltimore City state’s attorney’s officeare African-American mothers. Theproblem is so severe that a sociologyprofessor moved here in 2007 to workat theUniversityofMarylandSchoolofSocial Work so she could study howAfrican-Americans are affected by ho-micide andhow to help them.

“There isacultureofhomicide,” saidTanya L. Sharpe, the associate profes-sor whomoved here fromBoston. Thesurvivors’ grief is oftenmixedwith theshame, blame and stigma that maysurround crime, even if the loved onewas an innocent victim.

It is not uncommon for mothers inBaltimore, likeOaks, tohavemore thanone child who was murdered. Atrauma surgeon at Johns HopkinsHospital recalls walking out of theoperatingroomlastyear to tell relativesthat ayoungman, shot in theheart, haddied.

An elderly woman looked at thesurgeon,Dr.AdilHaider, in recognitionandsaid, “OhthankGod, it’syouagain.”

Thewoman, the grandmother of theshooting victim, explained that Haiderhad operated on two other grandsonswhohadbeenshotwithin thepastyear.One managed to pull through. Asecond, shot in the head, died. And bythe lookonHaider’s face the third time,she knew this grandsonwas also dead.

Some of Baltimore’s homicide vic-tims have been involved in criminalactivity. Many others are innocentvictims. Either way, their deaths havean impact, Haider says. “People don’trealize that behind every person whodies is a loving family, and the peoplewho saw this child grow up,” saidHaider, who operated on hundreds ofyoung male gunshot victims in his sixyears at Hopkins, and is now atBrigham and Women’s Hospital inBoston. “There are a lot of people wholove that person.”

Criminal justice systemHeartbroken families must make

their way through the criminal justicesystem,whichoften interfereswith theway they process their grief. Funeralsare delayed while autopsies are com-pleted. People’s homes are closed off ascrime scenes. When killers are un-known, familymembers are suspects.

Even when killers are caught, trialsmake families relive the ordeal. Many

cases are heard numerous times be-cause of hung juries and appeals,prolonging the sorrow.

“It’s like opening the wound andclosing it, opening the wound andclosing it,” said Kim Holmes, directorof the Family Bereavement Center atthe Baltimore state’s attorney’s office,which tries to help families navigatethe criminal justice system.

In the case of Oaks’ first son, IrvinLawson, 31, the killer was quicklyarrested and brought to trial, even-tually sentenced to life plus 20 years inprison. Knowing that the man whomurdered her son was brought tojustice eased someofOaks’ grief.

When her second son, Larry Hen-derson, 30, was killed, his body wastaken to the morgue before she evenlearned of his death. Oaks said shewasn’t allowed to see him for anothertwoweeks— just beforehewasburied.

His bodywas found in theWestportarea of South Baltimore. Six monthslater, no one has been charged.

Today, the two brothers are buriedside by side, and the combination oflosing a second son and not knowingthe killer has made Oaks’ sadnessalmost debilitating, she said. Eventhough she runs a support group forsurvivors like herself — called Survi-vors Against Violence Everywhere —she often feels isolated, as if no oneunderstands.EvenOaks’ husbandonceasked her why she hadn’t gotten overone of the sons’ deaths.

Relatives report feeling stigmatizedand judged because of the way theirloved ones died. People would insinu-ate that the victims were to blame,according to research published inJune from York College in Pennsylva-nia. That may cause survivors to lieabout the death and afterward feelguilty for not being true to the victim,accordingto theresearch.Onesurvivorsaid thatafter tellingaco-workerabouther son’s death: “I could tell she wasjudging me and judging my son, andthat hurt. I thought, ‘Why thehell did Iputmyself out there?’ ”

Other survivors find that closefriends become uncomfortable, andrather than say somethingwrong, theysaynothing.Onewoman told research-ers she wanted to put a big sign on herforehead that said, “Talk tomeplease.”

Toll on healthDealingwith the ups and downs can

take a toll on relatives’ emotional andphysical health.

It took Nichole Parrish months

before she finally faced thedeathofhermother, who worked in the bail bondsbusiness. The Baltimore woman, 42,was shot in the chest in the fall of 2011by a client who left her bleeding in aColumbia parking lot.

Parrish’s breaking point came dur-ing the trial, when she saw hermotherand namesake, Nichole BernadetteMcNair, limpandlifeless in theautopsypictures. She tried to walk out of thecourtroombutwas frozen in place andfoundherself sobbing uncontrollably.

The killer was convicted, but it wasthe beginning of a downward emo-tional spiral for Parrish. She sufferedpanic attacks and didn’t sleep for daysat a time. The University of Maryland,Baltimore County student stoppedgoing to a job she had just started,working with children with autism,and missed some days of class. Whenthe semester ended, she had no reasonto get out of bed at all.

Parrish’s condition got so bad thatshe was admitted to Johns HopkinsHospital for three months. She wasdiagnosed with post-traumatic stressdisorder, a trauma-induced disorderoften found in soldierswho come backfrom war, but now more commonlydiagnosed in people who experienceother tragic events.

Parrish,23,hassincegraduated fromUMBC, founda job incustomerserviceand lives with her father in EastBaltimore — but deals with hermother’s death every day. She findsherself crying at work sometimes. Shehas recurring nightmares of hermother getting shot in different placesaround town. And the panic attacksrecur.

“I get really scared,” said Parrish. “Ijust get panicked that something isgoing to happen. Then I wonder ifsomething happens, ‘Where will I go?Whatwill I do?’ ”

Research shows that Parrish’s expe-rience is common among the relativesof homicide victims.

In theYorkCollege study, JeannaM.Mastrocinque, an assistant professor ofcriminal justice, and her colleaguesconducted focus groupswith nearly 30relatives in Rochester and Albany, N.Y.,and parts of Indiana. They found thatanxiety and paranoia took over thelives of some relatives. They adoptedquirks tohelp themfeel safer, includingswitching to a sheer shower curtain tosee intruders, sleeping with the lightson or always keeping the blinds closed.For those notified of the death bysomeone who came to the house, orcalled, a knock on the door or ring ofthe phone triggered anxiety attacks.

Scientists at Johns Hopkins andother institutions have found that griefcan cause biological changes. Theimmediate grief after a death canweaken the heart and increase the riskof heart attacks. The lingering angerassociatedwiththisgriefcanalsocauseheart problems, a Harvard Universitystudy found. Other research connectsintense grief to high levels of stresshormones, a weakened immune sys-temand trouble sleeping.

Relatives interviewed in Mastrocin-que’s study attributed illnesses such ascancer, heart attacks and death to theirgrief. Many complained of feelingphysically sick, and some lost so muchweight that they dropped three or fourclothes sizes.Onedescribed it thisway:“I think this has changed me on amolecular level.”

Mastrocinque’s study recom-mended that primary care physicianspaymore attention to the health statusof the relatives of the murdered, givenall the problems they reported.

“Homicide is one of the leadingcauses of death for many age groups,”Mastrocinque said. “I don’t think

Kim Holmes, center, standing, leads a counseling session for relatives of homicide victims at Roberta’s House, a grief center in East Baltimore.LLOYD FOX/BALTIMORE SUN

Anxiety, paranoia, heart diseaseGRIEF, From page 1

Before leaving for college, Nichole Parrish posed for a photo with her mother, Ni-chole McNair, who was shot and killed in 2011.

FROM PAGE ONE

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Nichole Parrish helps her half-brother, Noah Parrish, 4, with his school uniform before heading to school. Isaac Parrish, 6, is anoth-er half brother. Nichole Parrish has struggled with post traumatic syndrome since her mother’s killing.

LLOYD FOX/BALTIMORE SUN

About the seriesRead previous series articles atbaltimoresun.com.Last Sunday: Violence inBaltimore is exacting an ofteninvisible toll — warping the healthof the city’s youngest residents.Last Thursday: Parents face adecades-long struggle —emotionally and financially — tocare for victims of violence.The team: For more than a year,Baltimore Sun reporter Andrea K.McDaniels and photographerLloyd Fox have examined theunseen impact of violence — onchildren, caregivers and victims’relatives — in the Baltimore area.McDaniels wrote the articles whileparticipating in The CaliforniaEndowment Health JournalismFellowships, a program of theUniversity of Southern California’sAnnenberg School of Journalism.

Do you feel safe?Do you live in a neighborhoodwhere you don’t always feel safe?What does it mean for you andyour children? We want to hearyour story. Text or call TheBaltimore Sun at (443)563-1224 or email usat baltimore.sun.neighborhoods@gmail.com. Leave your nameand phone number. We won’t useany of your identifyinginformation without contactingyou and getting your permission.

OnlineGo to baltimoresun.com to viewvideos and photos featuringsubjects of Sunday’s and today’sarticles.

FROM PAGE ONE

people thinkabouthowmuchhomicideripples through communities.”

Michelle Randolph considered her-self fairly healthy before her only child,Wesley Lewis, 19, was found murderedin August 2010. After his death, theBaltimore woman couldn’t control herblood pressure and suffered frompanicattacks and depression. “My chesttightens and my heart starts to work[hard]. It’s like it’s flooded,” she said.“They say it’s just stress.”

Many health problems can lastmonths after the initial grief, a study byresearchers at the University of Wis-consin-Milwaukee School of Nursingfound.

Grief killsWithin the circle of victims’ relatives

she knows, Oaks believes she has seengrief kill. She remembers amotherwhonever seemed to get over her child’sdeath, who suffered from depression,then a stroke and ended up in awheelchair. A fewyears ago, she died ina bathroomduring a birthday party.

In her work, Sharpe, of the Univer-sity of Maryland, has interviewed 300people in several cities, including morethan80 inBaltimore. She found that, onaverage,African-Americansnationwidehave experienced the homicide of aloved one at least 2.5 times in theirlifetimes — much more than other

groups. Yet African-Americans areoften neglected in research about thisissue, something Sharpe is trying toaddress in herwork.

She discovered that African-Ameri-can families often suppressed theirfeelings, either because of the stigma ofbeing associated with such a horrificcrime,or todealwitheveryday life, suchas working and putting food on thetable.

“Thewaywe deal with grief and lossas a people is to suck it up,move on anddeal with it, and pretend as if nothinghas happened. That has been ourculture—theAfrican-Americanculture— to not show emotions,” said March-Grier of Roberta’sHouse.

Gaining the trust and drawing outfeelings of her clients, many who areAfrican-American, can be difficult, sheadded.

Recently, Roberta’s House got fund-ing from the new state legislation toenhance its grief services, to help makerecovery less difficult for African-American survivors and figureoutwaysto help them. At an evening session lastweek, tears flowed as the relativesshared their stories. One motherblamed herself for not doing enough toprotect her son, while another talkedabout being angry at God for allowingthe killing. Others talked about the riseand fall of emotions thatmade it hard toget out of bed.

Other grassroots support groupshave formed to help survivors. ActivistMillie Brown started AMother’s Cry in2007 after seeing traumatized familiesat Johns Hopkins Hospital, where shecleaned operating rooms. She discov-ered that 50 fellow employees hadrelativeswhohad beenmurdered.Nowshe tries to tell survivors they need tolive, even if their kids didn’t.

“The pain never goes away,” Brownsaid. “I am there to give them some-thing better. The only thing I want is tosee them smile and to see them laugh.”

Theburdenof holidaysThis week, around the holiday sea-

son,much of the hurt intensifies.Oaks isn’t sure what she’ll do on

Christmas. Her brother is trying topersuade her she shouldn’t be alone.

Parrish, who lost her mother, alsoagonizes fromday todayaboutwhetherto spend the holidaywith family or not.

Randolph can’t stand to be aroundpeople who have their families whenshe no longer has hers. So she’ll spendthe day by herself and light a singlecandle for her son.

Some bereaved relatives find solacein an annual ceremony that helps themhonor their loved ones. Started severalyears ago by SurvivorsAgainstViolenceEverywhere, the ritual was held thismonth on a chilly, rainy evening at City

Hall. Even the band that was playing atthe event had been affected by homi-cide — three of the musicians had lostrelatives to violence.

As a member of the group read thenames of those who had died, familymembers came up, one by one, to hangan ornament on a tree. Most of themwere mothers, and many of the orna-ments were adorned with the namesand pictures of the victims. They criedand hugged each other. Oaks sat in thefront row, dabbing her eyes, rockingback and forthwith anothermother.

It didn’t bring back their loved ones.But for at least a night, it let themremember theyweren’t alone.amcdaniels@baltsun.com