A small child witnesses the tragic death of a family member. An adolescent is involved in a terrible accident. A teen has been the victim of repeated sexual abuse.

An estimated one in every four children will experience a traumatic event before age 16. Although trauma is immune to race, ethnicity, sex, age, and zip code, children living in urban areas are particularly at high risk for exposure to traumatic events. Moreover, youth of color living in urban areas are the most at-risk for experiencing multiple traumatic events over time. Chronic trauma exposure is a public health concern, associated with long-term mental and physical health issues, academic and employment challenges, and risk-taking behaviors such as unsafe sex and substance use.

In the aftermath of a traumatic event, caregivers often feel confused, frustrated, sad, and helpless.

It can even be difficult for caregivers to recognize if their child is experiencing traumatic stress symptoms. Traumatic stress can manifest in a variety of ways including nightmares and sleep difficulties, refusal to go to school, acting out, irritability, hyperactivity or difficulty paying attention, being on edge or easily startled, regression in skills (such as bed wetting), physical complaints (such as stomachaches), and avoiding certain people, places, and activities.

Not all children who experience a potentially traumatic event need therapy. It’s natural and appropriate for children to have a negative reaction immediately after a potentially traumatic event. When symptoms interfere with a child’s ability to participate in daily activities, then it may be time to seek therapy. The good news is that effective therapy can help prevent post-traumatic stress disorder (PTSD).

It’s important to ensure children in therapy are receiving evidence-based treatment, meaning that it has been tested multiple times and there is scientific evidence that symptoms improve in response to treatment. Here are questions that you can ask to ensure that your child is receiving the best possible care:

Are you trained in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)?

TF-CBT is the most effective evidence-based trauma treatment for children and adolescents. After a traumatic event, children often avoid thinking or talking about the trauma. A therapist trained in TF-CBT helps children face their fears in a gradual way. This may involve encouraging your child to share details about the traumatic event or helping your child engage in activities that they are avoiding while learning skills to tolerate their distress.

Will I be involved in treatment?

Treatment should include a high level of caregiver involvement so that caregivers know how to support children during treatment. Your child’s therapist should teach strategies for responding to your child’s behaviors.

Will you assign homework for my child to complete each week?

Treatment should also include weekly “homework assignments” so that your child has an opportunity to practice new skills in their daily life. These activities may involve having your child face a fear, like going to school, or practice relaxation strategy, like deep breathing.

Will you track my child’s progress?

It’s important to ensure that progress is being tracked as well. Your child’s therapist should ask you and your child to complete questionnaires throughout treatment to determine whether your child’s symptoms are improving with treatment.

City-wide initiatives are working to improve trauma screening and treatment in the area. For example, the Philadelphia Alliance for Child Trauma Services (PACTS) aims to improve trauma screening and treatment for young people ages 2 to 21 served by community mental health agencies throughout the city. PACTS represents a network of clinicians who are trained in TF-CBT and other evidence-based trauma treatments for children and their caregivers. If your child has Medicaid or is temporarily uninsured, you can visit the PACTS website to find a therapist in your neighborhood. If your child has private insurance, talk to your child’s pediatrician or school counselor and ask for referrals for local therapists who provide evidence-based trauma treatment for children.

Families can find hope in Philadelphia after experiencing trauma. Effective treatments are available in our city and children make great gains when families access these services.

Rinad Beidas, Ph.D., is an associate professor in the departments of psychiatry and medical ethics & health policy in the Perelman School of Medicine at the University of Pennsylvania. Colleen Harker, Ph.D., is a postdoctoral fellow with the Penn Center for Mental Health in the Perelman School of Medicine.