Sources of Trauma in

International Childhoods:
Providing Individualized Support to Increase
Positive Outcomes for Higher Risk Families

Prepared for TCK Training by

Tanya Crossman, Lauren Wells, Elizabeth Vahey Smith, and Lauren McCall
October 2023
Contents

2 ... Introduction
3 ... Previous Research
7 ... The Triaging Method
10 ... Preventive Care: A Hopeful Approach

11 ... Part I: Triaging by Time and Relationships

11 ... Risk by Years Abroad
17 ... Cross-Cultural Families
23 ... Peer Relationships
30 ... Household Adults
38 ... Non-Residential Caregivers

48 ... Part II: Triaging by Events

48 ... Medical Events
55 ... Violent Events
63 ... Large-Scale Events
70 ... Witnessed Events
82 ... When No Potential Trauma Was Reported

88 ... A Vision for Well Supported Families

90 ... Reference List

2
Introduction

Previous Research
In 2021, TCK Training ran a survey on Adverse Childhood Experiences (ACE
scores) in Adult Third Culture Kids who experienced global mobility as
children. 1 Out of over 2,300 survey responses, we accepted 1,904 into our
data set. More information on how the survey was conducted is available in
2
our methodology report. When planning this survey, our goal was to
combine two existing fields of research: prevention science, and research on
the TCK experience.

Our White Papers

In June 2022, we released our first white paper exploring the data from this
survey – Caution and Hope: The Prevalence of Adverse Childhood
3
Experiences in Globally Mobile Third Culture Kids. We began this paper with
an exploration of existing research on Third Culture Kids, and a foundation on
existing research into Adverse Childhood Experiences. The body of the paper
explored the different demographics in our data set – reason for mobility,
education type, and age – and compared the rate of high-risk ACE scores for
each sub-group.

One of the key findings was a connection between high mobility and high-
risk ACE scores. We found differences in the ACE scores of TCKs from
missionary and non-missionary backgrounds (non-missionary including
diplomat, military, business, education and humanitarian sectors). We also
saw a difference by generation, significantly between those born before
1980 (Boomers/Gen X) and after 1980 (Millennials/Gen Z).

In December 2022, we released a second white paper titled TCKs at Risk:

Risk Factors and Risk Mitigation for Globally Mobile Families.4 This paper
explored the ten risk factors in the ACE questionnaire, along with two
additional factors we considered important to add. We saw differences
according to the same factors outlined in Caution and Hope. 3 The 12 risk
factors were divided into two categories, as follows:

3
Child Maltreatment
Physical Abuse
Emotional Abuse
Sexual Abuse
Child-to-Child Sexual Abuse
Grooming
Physical Neglect
Emotional Neglect

Household Dysfunction
Household Adult Mental Illness
Parental Violence
Parental Separation/Divorce
Incarceration
Household Adult Substance Abuse

The statistics shared in this white paper demonstrated that while the
stereotype of global mobility is that of privilege, children in these families are
at higher risk of emotional abuse and neglect – regardless of demographic
factors. Household dysfunction was generally low, suggesting that expatriate
parents were providing good homes yet not meeting their children’s
emotional needs effectively. We also presented existing research into
Positive Childhood Experiences (PCEs) as a proven method of combating the
negative impact of high-risk ACE scores, along with recommendations for
child safety measures that any family, sector, and school could implement.

In our previous white papers, we compar-

ed our results primarily to the CDC-Kaiser While the stereotype of global
study of 17,000 Americans, using it as our mobility is that of privilege,
control measure for rates of ACEs in a pop- children in these families are
3
ulation due to its large sample size. In at higher risk of emotional
TCKs at Risk, we compared our results abuse and neglect – regardless
not only to the CDC-Kaiser study done in of demographic factors.
the USA, but also to studies done in
6,7,8,9,10
Australia, England, Ethiopia, Nigeria, the Philippines, and Wales. These
studies all used the same question wording and had published results
organized in a way that made comparison possible. The TCKs we surveyed

4
reported significantly higher levels of emotional abuse, emotional neglect,
and household adult mental illness than those surveyed in these global
studies.

Throughout this paper, we will not be comparing our results to outside

surveys, but instead comparing the results within our group of Adult TCKs. It
therefore bears repeating here, at the beginning, that the rates of emotional
abuse and neglect seen in TCKs overall, as well as the rate of mental illness in
the adults they lived with during childhood, are not normal when compared
to populations in countries across the world. When we talk about certain risk
factors which increase risk within the TCK population, remember this relative
risk increase is occurring in a population that is already high-risk, thus further
amplifying the risk.

Additional Traumas
When creating our 2021 survey, we reviewed the ACE questionnaire and
noted that many traumas were omitted. This includes not just different types
of child maltreatment or household dysfunction, but also commonly heard
experiences of TCKs living abroad. During debriefing sessions, we regularly
heard TCKs of all ages unstack and process these types of traumas –
sometimes to the surprise of their parents. So in addition to questions
pertinent to the ACE questionnaire, we also included a range of questions
reflecting our anecdotal experiences of supporting TCKs through trauma
sustained through ‘normal life’ where they grew up.

The life factors and traumatic events recounted in this paper acknowledge
elements of life for many international families that are not represented in
the ACE framework. When we asked these questions, we did so with
curiosity rather than with a clear hypothesis. We knew that these elements
impacted many families, and we had expectations based on research outside
the TCK world that they would impact TCKs as well. What that impact might
be, we would discover through months of data analysis.

Throughout this paper, we share core insights from this data analysis in two
ways. First, we offer a chart showing the impact of each factor on high-risk
ACE scores. That is to say, what percentage of TCKs impacted by this factor

5
had an ACE score of 4 or higher, including sub-groups – those born before or
after 1980, those from missionary or non-missionary sectors, etc. Second, we
look at 11 risk factors identified in TCKs at Risk (incarceration is not included
as it was so low among all TCK sub-groups surveyed). Main sub-groups (age
by decade, sector, education type) have at least 100 respondents each;
further breakdown groups have at least 50 respondents each unless marked
with an *, denoting a small group (and therefore potentially less reliable
results).
TCKs who had spent fewer than
Some Highlights four years outside their passport
Our analysis of the data left us country were the most likely to have
with several notable highlights a high-risk ACE score, suggesting that
that we’ve amassed here for you. all families should receive both pre-
For one, we discovered that TCKs departure and post-return support –
who had spent fewer than four no matter how long (or short) their
years outside their passport coun- international assignment lasts.
tries were the most likely to have
a high-risk ACE score, suggesting that all families should receive both pre-
departure and post-return support – no matter how long (or short) their
international assignment is scheduled to last. Another discovery was – as
predicted – one in three TCKs who lacked an appropriate peer group had a
high-risk ACE score, however this risk was lower among homeschooled TCKs.

We also discovered an interesting pattern: traumas more likely to be

perceived as ‘small’ were more likely to be associated with a higher rate of
high-risk ACE scores. For example, higher ACE scores were associated with
the death of a caregiver who did not live in the TCK’s home and was not a
family member or family friend, than with a death in the family. Another
example: trauma occurring in the community (experiencing or witnessing
violence) was associated with higher ACE scores than large-scale disaster
(war, natural disaster, evacuation).

The takeaway, before we even begin digging into this new data, is that just
because something happens frequently within a community does not mean it
is not a source of trauma. Events that happen often can easily be normalized,
which means it is important to know what is affecting international families in

6
negative ways so we can call Just because something happens
them out as stressors that need frequently within a community does
to be acknowledged and pro- not mean it is not a source of
cessed. trauma. Events that happen often
can easily be normalized, which
The Triaging Method means it is important to call them
out as stressors that need to be
An approach we find useful when
acknowledged and processed.
working with families abroad, and
especially when training carers for
their sending organizations, is the triaging approach. 11 ‘Triaging’ means
learning what to look for when deciding on the level of care necessary and
how urgently that care needs to be applied – very similar to the triage
process medical personnel go through when required to see a lot of patients
simultaneously.

Triaging in the globally mobile context acknowledges that not every family
living abroad needs, or should receive, the same level of care. This is
particularly important when the majority of sending entities are limited in the
staff-to-personnel ratio they can offer. Instead, risk factors should be
considered and inform the level and type of care that a family receives.

All families considered ‘high risk’ should re-

Triaging in the
ceive some or all of the care measures out-
globally mobile context
lined below. As we explore specific potential
acknowledges that not
risk factors throughout this paper, we will
every family living abroad
highlight care measures that are particularly
needs, or should receive,
impactful for families with that risk factor.
the same level of care.
Regular Check-ins
We have found that a routine in which a trained person checks in with
families on a regular basis can be an effective tool in caring for the wellbeing
of the family. These check-ins should occur quarterly at minimum, monthly
being ideal. In these check-ins, the caregiver should seek to discern how the
parents are doing, how each child is doing, and how the family unit as a
whole is doing. The role of the caregiver is to:

7
 1) Understand if and how the children’s needs are being met based on an
educated understanding of what all TCKs need to thrive and build
resiliency.
2) Understand how the parents are doing and provide insight into how they
can thrive in the midst of a stressful season or situation.
3) Notice challenges before they manifest into large issues and collaborate
with the family to create and manage tailored care plans.
4) Recommend resources

Pre-Departure Education

Pre-departure education for families should include research-based

preventive care measures such Positive Childhood Experiences as discussed
3
in TCKs at Risk. It should also include a discussion of available resources that
the family can access while abroad, particularly if they encounter difficulties.
Likewise, there should be education on:
The types of challenges the family might encounter
What the indicators are that they need additional support
How to find the related services needed

We have found that many families do not seek support when they
desperately need it because they are unsure if their situation is ‘bad enough’
to warrant reaching out for support or because they do not know the process
for finding appropriate support. Dispelling the shame that can come with
reaching out for support and giving a clear process for seeking support needs
to be a part of pre-departure training.

A family is more likely to increase

longevity on the field if they reach Many families do not seek support
out for support when they first recog- when they desperately need it
nize the need for it rather than when because they are unsure if their
challenges have manifested so signif- situation is ‘bad enough’ to warrant
icantly that the intensive support is reaching out for support or because
required. The difference between they do not know the process for
those who reach out early and those finding appropriate support.
who wait often depends on what was
communicated to them during their pre-departure training.

8
 We often work with families who Resources for Difficult Times
disclose a crisis that happened
years prior for which they never Families living abroad need to be
received care. While a crisis debrief regularly informed about the
would not have taken away the resources available to them and
trauma, it may have helped them to when to seek them out. While
cope, process, and move forward many of the risks outlined in this
from the event in healthier ways. paper such as medical crises,
witnessing traumatic events, and
experiencing violence can often not be prevented, the way that the family is
supported through and after an event impacts how it affects them.

For example, we often work with families who disclose a crisis that happened
years prior for which they never received care and which is still deeply
impacting them. While a crisis debrief would not have taken away the
trauma, it may have helped them to cope, process, and move forward from
the event in healthier ways.

Examples of resources that parents need to be aware of are:

Standard debrief: Regularly scheduled debrief to be provided for families
every 3-4 years. This debrief will review their entire family history with a
focus on emotional processing.
Annual debrief: A debrief which covers the previous 12 months. Provides
help processing between standard debriefs.
Crisis debrief: A debrief soon after a potentially traumatic event that
focuses on coping and regulation. Processing the event is not the primary
objective of a crisis debrief.
Counseling services
Educational support
Parent consultations
Continuing education on raising TCKs

Throughout this paper, we will explore how each of these care measures can
be specifically tailored to address the risk factors being discussed.

9
Preventive Care: A Hopeful Approach
We believe that international life, despite its inherent risks, is worth it! Hard
things are not necessarily bad things. When we are aware of potential risks,
we can put safety measures in place. We wear seatbelts as a reasonable
precaution in the unlikely event of an accident. We brush our teeth to
prevent cavities. We use the preventive care strategies in this white paper to
empower TCKs to have a healthy childhood abroad.

The aim of this white paper is to explore

International life, despite its
different areas of potential risk which we
inherent risks, is worth it! Hard
discovered through our research, and dis-
things are not necessarily bad
cuss safety measures that can be put in
place to protect children and families who things. When we are aware of
may experience these things. potential risks, we can put
safety measures in place.
How to use this paper to ‘triage’
Each of the following ten sections will discuss a risk factor we identified,
including several sub-categories of risk. We start with an explanation of why
this factor is important in the context of globally mobile families.

Next, we include data on how prevalent this risk was within the 1,904 TCKs
we surveyed and whether it impacted the overall rate of high-risk ACE scores
(associated with negative outcomes in adulthood) and specific types of child
maltreatment or household dysfunction. We also discuss any significant
differences between different sub-groups. Finally, each section has an
application guide, in which we discuss specific ways to apply effective
preventive and protective care for families who have experienced these
things.

This white paper can be used to understand how certain events can impact
12
children and families, and promote ‘safe space responses’. This paper can
also be used as a reference when creating a triage system – a series of
‘cautions’ to let you know a family may need additional support – and a guide
as to what supports may be helpful in their situation. Any family experiencing
something explored in this white paper should be flagged for additional
support.
10
Part I: Triaging by Time and Relationships

Risk by Years Abroad

The Impact of Childhood Years Overseas

We have been asked many times about a “safe” number of years for a family
to spend overseas. How long is too long? When do the difficulties of TCK life
begin? In short, parents and caregivers seek a magic number which will
protect children.

Previous research by various groups indicates that the act of moving itself
13
creates risk, and several papers have investigated why this might be. One
common theory is the loss of social networks and accompanying social
14
capital. Another is the stress that the disruption of moving places on a child,
15
both before and after the move. Studies in Europe established a connection
between mobility and negative impact on a child’s academic performance,
even when compensating for improvements in the family’s economic
16
situation due to their mobility. Research in the USA found a connection
between two moves with decreased academic performance after controlling
for background variables, and a particular risk for those who experienced
17
three or more moves.

A threshold of three moves (including domestic moves) during school years is

associated with “increased risk for emotional/behavioral and school
18
problems.” These families were also less likely to have a regular medical
provider for their children’s preventive health care needs, and more likely to
19
make use of emergency health services. A ‘short term’ international
assignment results in two moves during a child’s school years; it only takes
one more to hit the three-move threshold.
This research has led us to
Cumulatively, this research has led us to rec-
recommend pre-departure
ommend pre-departure training and support
training and support while
while abroad for even short-term international
abroad for even short-term
assignments. Yet we were interested to learn
international assignments.
11
what, if any, differences we might find between TCKs who had lived shorter
or longer amounts of time outside their passport countries.

Recognizing Potential Risks in the area of Time

Abroad
While every situation is different, we did seek to know if there was a
correlation between the number of years a family spent outside their
passport country and the difficulties they faced. The data we collected
contained results we were not expecting.

The 1,904 TCKs we surveyed had a fairly even distribution across the six
three-year time periods we created. We saw a general pattern develop: as
time abroad increased, risk decreased. While 28% of those who spent 0-3
years outside their passport countries had a high ACE score, only 15% of
those who spent 16-18 years outside their passport countries did.

0-3 Years
TCKs who spent 0-3 years outside Prevalence of High Risk ACE Scores in
their passport countries before age 18 TCKs who Lived Abroad 0-3 Years
had a one-third higher rate of 4+ ACE Overall 28%

scores than TCKs overall, with 28% Born before 1980 28%

recording a high-risk score (regardless Born after 1980 28%

of age). Missionary kids and non-mis- Missionary 21%

sionary TCKs had different scores (21% Non-missionary 31.5%
and 31.5% respectively), but at the same
increased rate. While there was only a small sample of TCKs from business
families who spent 0-3 years abroad, it is worth noting that 40% had high-risk
ACE scores.

The rates of household adult substance abuse and parental

divorce/separation in TCKs who lived 0-3 years abroad were each nearly
double that of TCKs overall, in both cases driven by the non-missionary
sectors.

12
Rates of emotional abuse (48%), emotional neglect (45%), and household
adult mental illness (41%) were all higher than among TCKs overall.
Respondents were not asked when/where these adverse events occurred,
but the fact that the overall TCK numbers were already much higher than
those seen in studies in various countries should give all TCK caregivers
pause.

4-6 Years
TCKs who spent 4-6 years outside their Prevalence of High Risk ACE Scores in
passport countries before age 18 had a TCKs who Lived Abroad 4-6 Years
slightly higher rate of 4+ ACE scores Overall 23%

than TCKs overall, at 23%. There was a Born before 1980 28%

significant difference by age, with 28% Born after 1980 17%

of those born before 1980 and 17% of Missionary 19%

those born after 1980 reporting high- Non-missionary 25%

risk ACEs. Physical neglect was low

(7%), driven by the non-missionary sector (3.5%). Substance abuse remained
higher than among TCKs overall, also driven by the non-missionary sector.

7-9 Years
TCKs who spent 7-9 years outside their Prevalence of High Risk ACE Scores in
TCKs who Lived Abroad 7-9 Years
passport countries before age 18 had a
similar rate of 4+ ACE scores to the 4-6 Overall 23%

year group, also at 23%, but without a Born before 1980 22%

distinction by age or sector. Nearly half Born after 1980 23%

experienced emotional abuse from a Missionary 22%

household member. The rate of house- Non-missionary 23.5%

hold adult mental illness was also higher

than among TCKs overall, at 44%.
Prevalence of High Risk ACE Scores in
TCKs who Lived Abroad 10-12 Years
10-12 Years
Overall 19%

TCKs who spent 10-12 years outside Born before 1980 22%

their passport countries before age 18 Born after 1980 17%

had a slightly lower rate of 4+ ACE Missionary 16%

scores than TCKs overall, at 19%. There Non-missionary 24%

13
was a small difference by age, with only 17% of those born after 1980
reporting 4+ ACEs, compared to 22% of older TCKs.

13-15 Years
Prevalence of High Risk ACE Scores in
TCKs who spent 13-15 years outside
TCKs who Lived Abroad 13-15 Years
their passport countries before age 18
Overall 19.5%
had a similar rate of 4+ ACE scores to
Born before 1980 17%
the 10-12 year group, at 19.5%. There
Born after 1980 21%
was a small difference by age, with
Missionary 17%
younger TCKs this time having the high-
Non-missionary 26%
er rate (21%) compared to 17% of those
born before 1980.

16-18 Years Prevalence of High Risk ACE Scores in

TCKs who Lived Abroad 16-18 Years
TCKs who spent 16-18 years outside Overall 15%
their passport countries before age 18 Born before 1980 15%
had the lowest rate of 4+ ACE scores, at Born after 1980 15%
15%, with no difference by age. There Missionary 7.5%
was a significant difference between the Non-missionary 24%
missionary and non-missionary sectors,
however, with 7.5% and 24% respectively recording a high-risk ACE score.
The higher rate among the non-missionary sectors was driven by TCKs from
business families, one-third of whom had high-risk ACE scores. Among other
non-missionary sectors the rate was 17%, a more similar rate reduction to
that seen in the missionary sector.

TCKs from business families reported higher rates of physical neglect (10%),
emotional neglect (52%), and household adult mental illness (44%) than other
non-mission sectors. Overall, household mental illness was lower among
families that spent 16-18 years outside the passport countries – 33% overall,
28% in mission families, and 34% in other (non-business) sectors.

Given the nature of this data, we applied a “years abroad” filter to all other
factors discussed in this paper. As some of these sub-divided groups get very
small, we combined several time abroad categories to create four time-
brackets: 0-3 years, 4-9 years, 10-15 years, and 16-18 years.

14
 7-9 years
TCKs overall
10-12 years
0-3 years
13-15 years
Abuse by Years Abroad 4-6 years
16-18 years
50%

40%

30%

20%

10%

0%
High Risk Physical Abuse Emotional Abuse Sexual Abuse Child-to-Child Grooming
ACE Score Sexual Abuse

Neglect and Household Dysfunction by Years Abroad

50%

40%

30%

20%

10%

0%
Physical Emotional Household Adult Parental Parental Household Adult
Neglect Neglect Mental Illness Violence Divorce Substance Abuse

Applying Effective Support in the area of Time

Abroad
As we look to apply this data to practical TCK care, it is There is no “safe”
important to remember that there is no “safe” number of number of years
years abroad. It may feel easy to believe that the longer abroad.
TCKs are on the field, the more hardships they will have
faced. However, we cannot confuse neat calculations with the real families
that we care for.

Most often, taking one’s family to live abroad is a major commitment in

alignment with the trajectory of the parents’ lives and work. It would follow
then that a cessation of this commitment was caused by orders – anticipated
or otherwise – from their sending agency or a number of hardships outside of

15
the family’s ability to manage. Whether these circumstances are traumas
themselves or whether they cause stress levels that lead to ACEs such as
household adult mental illness, emotional abuse, and emotional neglect, the
impact is felt by the TCKs, themselves.

Conversely, families that have been abroad for an extended period have
often found rhythms and communities of stability that provide children with
preventive and protective care, and provide parents with a support system
that decreases stress and increases their longevity abroad. While this support
can lower the risk of high ACE scores (and increase buffering PCEs), it can
also increase the grief of leaving the com-
munity when TCKs repatriate. TCKs can The needs of TCK families
go from a deep sense of belonging in this can differ based on their
long-term community to feeling outcast in a
duration abroad, but the
new setting with people who do not under-
care recommended remains
stand them. The needs of TCK families can
consistent regardless of
differ based on their duration abroad, but
their tenure.
the care recommended remains consistent
regardless of their tenure.

It is in the best interest of sending organizations to prepare families for long-

term success. The benefits of longevity is a greater return on investment, a
more stable company culture, and higher levels of productivity, in addition to
the reputation of the organization from both the employees and their
children’s perception. While suitability screening is recommended before
assigning a family abroad, it cannot often be predicted which families will
flourish abroad and which families will need to reassess their goals.
Therefore, we recommend providing robust preventive care for all TCK
families being assigned abroad. This begins with pre-departure training for
both parents and children focused on stress-management, emotional
wellbeing, and providing emotionally safe spaces.

Every family, regardless of the time they spent abroad, also needs a standard
debrief every 3-4 years. This debrief should be proactive in nature and should
not take the place of reactive debriefs (i.e. crisis debriefs). As the research has
shown that families who’ve been abroad for 0-3 years have the highest risk

16
of high ACEs, if a family decides to repatriate after three years, this does not
negate their need for a debrief. Families that live abroad for longer than three
years will need regular debriefing throughout their time abroad.

Cross-Cultural Families

How a Cross-Cultural Family Background can

Impact Children
You may wonder why we are talking about cross-cultural families in the
context of ‘potential risks.’ Firstly, we considered this factor because TCKs
from cross-cultural backgrounds form a significant segment of our
respondents – one-quarter of the 1,904 TCKs surveyed. As the environment
in which a child grows up necessarily impacts them, we wanted to know if an
additional cross-cultural element (on top of global mobility) would impact
ACE scores or other factors.

One of the two main categories of cross-cultural family that the TCKs in our
survey belonged to were where their parents came from different
cultural/linguistic backgrounds. Intercultural couples may carry more
20
personal and relational stress than other adults. Celia Falicov wrote a
chapter on Cross Cultural Marriages in the 1995 Clinical Book of Couples
Therapy which gives insights into this. While acknowledging the “enormous
complexity and variety of cross-cultural marriages” and that “it is extremely
difficult to make generalizations,” she offers the following analysis of the
extra work required of those partnered cross-culturally:

“Getting married can be defined as a crucial life transition. For

the cross-cultural marriage, another transition is superimposed
on the many changes involved in going from single to being
married. This is because, metaphorically speaking, a couple that
21
intermarries enters, of necessity, a form of cultural transition.”

17
A successful cross-cultural marriage includes all the aspects of life transition
present in any marriage, plus the additional transition of cultural adjustment,
the main work of which “is to arrive at an adaptive and flexible view of the
spouses' cultural similarities and differences.”21 A cross-cultural marriage
where this work has not been accomplished in all areas will carry stress for all
family members. Not only this, but these cross-cultural stressors often affect
the individuals for a long period of time, with the impact of chronic stress
20
being more significant to the relationship than acute stressors. The need for
extra work to make the
relationship work effect-
ively may contribute to a A successful cross-cultural marriage
higher divorce rate in inter- includes all the aspects of life transition
22
cultural marriages. Children present in any marriage, plus the additional
raised in these multicultural transition of cultural adjustment. Children
homes will also need to do raised in these multicultural homes will also
the acculturation work of need to do the acculturation work of
moving between extended moving between extended families with
families with significant significant cultural differences.
cultural differences.

The other cross-cultural background we found in our respondents was

immigration – a permanent relocation (taking citizenship in a new country) in
addition to the temporary international relocation of the Third Culture. In
some cases parental immigration occurred prior to the TCK’s birth, while
other TCKs themselves immigrated before later moving to another country
on their new passport. Immigrant-origin TCKs are likely to experience
23
acculturative stress.

TCKs who themselves experience immigration may face “stressors resulting

from (a) separation of families, (b) changes in familial roles, (c) social and
legislative pressure that targets immigrant families, and (d) school bullying
24
and harassment” while adapting to their new passport country. A 2015
study found no difference in levels of depressive symptoms for native-born
and foreign-born students of immigrant-origin families.25 Acculturative stress
and accompanying internalizing symptoms are present more often in foreign-
26
born young people, however.

18
Another potential stressor for children of immigrant families is that the
27
acculturative stress of parents impacts outcomes for their children. A 2018
study demonstrated a link between the mental health of parent and child
during acculturation: “Immigrant-related stress was found to predict parent
mental health, which in turn predicted child mental health...for children,
change in mental health symptoms depended on parent mental health
28
symptoms.” While immigrant families can
provide incredible support to one another, at Another potential stressor
times they “can also be too overwhelmed by for children of immigrant
their own immigration demands to provide families is that the
support or can generate additional stress for acculturative stress of
its members.”
29
parents impacts outcomes
for their children.
In TCKs at Risk we presented data showing
TCKs reported high rates of emotional abuse and neglect, high rates of
household adult mental illness, and low rates of any other household
4
dysfunction. We interpret this pattern to indicate loving parents providing a
good home in an international/intercultural context, but lacking the internal
resources to meet their children’s emotional needs. While we saw a higher
risk level in TCKs from cross-cultural families, we do not associate this risk
with ‘bad parenting’ but rather, additional stress that families are coping with.

Recognizing Potential Risks for Cross-Cultural

Families
One-quarter of the 1,904 TCKs surveyed came from a cross-cultural
background. 24% come from an immigrant background – their parents
immigrated before they were born (12%), and/or with them as a child (15%).
25% come from multicultural families, in which parents have different native
languages (13%), different cultural backgrounds (19%), different ethnic/racial
backgrounds (8%), and/or different citizenships (12%). Half of these
multicultural TCKs were missionary kids; half came from non-missionary
backgrounds.

When analyzing the data about these groups, we saw that the rate of high-
risk ACEs was about one-third higher among cross-cultural TCKs: 27% for

19
immigrant families, 28% for multicultural families. For this reason, we looked
at the responses of cross-cultural TCKs in all areas.

High Risk ACE Scores Among Cross-Cultural Families

Prevalence of High Risk ACE Scores among TCKs of Immigrant Families

Overall 27%
0-3 yrs abroad 37%
Born before 1980 32%
4-9 yrs abroad 31%
Born after 1980 26%
10-15 yrs abroad 26%
Missionary 22%
16-18 yrs abroad 21%
Non-missionary 32%

Prevalence of High Risk ACE Scores among TCKs of Multicultural Families

Overall 28%
0-3 yrs abroad 39%
Born before 1980 35%
4-9 yrs abroad 33%
Born after 1980 25%
10-15 yrs abroad 27%
Missionary 23%
16-18 yrs abroad 17%
Non-missionary 33%

More than half of cross-cultural TCKs were emotionally abused by a

household adult, reported by 51% of TCKs from immigrant families and 54%
of TCKs from multicultural families. Nearly half reported emotional neglect
(48% and 49% respectively). 25% of immigrant TCKs and 28% of
multicultural TCKs were physically abused by a household adult, a 30%-50%
greater risk than for TCKs overall. There was no rise in substance abuse
among immigrant families, though an increase among multicultural families –
15%, 1.5 times the rate seen in TCKs overall.

Cross-cultural families were more likely to have external family or domestic

staff live in their home, and TCKs had higher ACE scores when this was the
case. There were some increases with non-residential caregivers, as well.
(The specific risk to cross-cultural TCKs will be discussed in the
corresponding sections on Household Adults and Non-Residential
Caregivers.)

20
 TCKs overall
Immigrant TCKs
Abuse in Cross-Cultural Families Multicultural TCKs
60%

40%

20%

0%
High Risk Physical Abuse Emotional Abuse Sexual Abuse Child-to-Child Grooming
ACE Score Sexual Abuse

Neglect and Household Dysfunction in Cross-Cultural Families

50%

40%

30%

20%

10%

0%
Physical Emotional Household Adult Parental Parental Household Adult
Neglect Neglect Mental Illness Violence Divorce Substance Abuse

Applying Effective Support for Cross-Cultural

Families
As discussed earlier, TCKs tend to have lower rates of household dysfunction
(with the exception of household adult mental illness) and higher rates of
emotional abuse and neglect. This paints a picture of most globally mobile
parents providing relatively stable home environments, yet finding it difficult
to be emotionally available to their children due to the stresses of
international life. The addition of a cross-cultural layer in the family may add
to this stress because of the cultural complexities not just outside the home
but also within the home. Intrafamily cultural differences are also more likely
to go unnoticed by caregivers, who do not expect cultural conflict to happen
within a home.

Understanding best practices for global parenting and how to create a

21
healthy home environ- This data paints a picture of most globally
ment may be particularly mobile parents providing relatively stable
challenging if the parents home environments, yet finding it difficult
differ greatly in their cul- to be emotionally available to their children
tural backgrounds and due to the stresses of international life.
thus approach parenting The addition of a cross-cultural layer in the
very differently. The fric- family may add to this stress because of
tion these differences can
the cultural complexities not just outside
cause between the parents
the home but also within the home.
could certainly affect the
morale of the home.

This research indicates that organizations sending families abroad need to be

aware of the cross-cultural families in their care so that effective support can
be applied. When an international assignment is considered, any cross-
cultural influences in the family should be noted. This may include a system
to inform the sending entity if immigration or a cross-cultural marriage
occurs. If we are acknowledging that cross-cultural families are at higher risk,
then knowing who these families are is an important part of caring for them
well.

Pre-departure education that focuses on what TCKs need to thrive and build
resilience is important for all parents of TCKs, but especially for those whose
native cultures differ greatly in their parenting approaches. Education on
‘what all TCKs need’ gives a neutral approach that allows parents to all aim
toward a common goal instead of focusing on one parent’s cultural parenting
preference.
We also recommend that pre-
departure training includes
Pre-departure education that focuses on opportunities to explore the
what TCKs need to thrive and build cross-cultural dynamics of the
resilience is important for all parents of family and how those chal-
TCKs. Education on “what all TCKs lenges will be navigated
need” gives a neutral approach that abroad. Having these conver-
allows parents to all aim toward a sations preventively can mit-
common goal instead of focusing on one igate risk and set families up
parent’s cultural parenting preference. for success. Providing op-
portunities for on-going
22
parenting counseling with an outside therapist (so they know anything shared
in therapy cannot be accessed by their employer) is another useful tool.

Peer Relationships

Why Peer Relationships in Childhood Matters

Community and specifically peer relationships
Community and specifically
are not simply preferable, but are vital to the
peer relationships are not
long-term wellbeing of all humans. The study
simply preferable, but are
on Positive Childhood Experiences (PCEs) that
vital to the long-term
we discuss extensively in TCKs at Risk found
wellbeing of all humans.
that the presence of “supportive peers”
throughout the first 18 years of life drastically
impacted adulthood outcomes. For example, having friends throughout life
30
lowered adulthood depression by 18%.

Peer relationships in childhood are an important part of social development

that is necessary for childhood wellbeing and also for gaining important social
skills needed in adulthood. A study done by Jude Cassidy and Steve Asher in
1992 showed that “children's abilities to form close relationships and to
function successfully within the peer group are increasingly viewed as
important indicators of social competence and as reliable predictors of
31
adjustment in later life.” This same study found that 93% of the children
surveyed could understand and
can articulate the feeling of
Peer relationships in childhood are an
loneliness and lack of peers by
important part of social development age eight. This is significant be-
that is necessary for childhood cause we are often asked if
wellbeing and also for gaining younger TCKs really need
important social skills needed in peers other than siblings or if
adulthood. Children feel, recognize, that only becomes critical du-
and will be impacted by a lack of peer ring the adolescent years. The
relationships even earlier in childhood. reality is that children feel, re-
cognize, and will be impacted

23
by a lack of peer relationships even earlier in childhood.

One of the important components of having peers in childhood is learning

how to navigate peer relationships. When high levels of loneliness were
present in the Cassidy/Asher study, the children were viewed by peers and
adults as less prosocial, more aggressive, more shy, and more disruptive. This
perpetuated loneliness because potential peers became uninterested in trying
to engage them. A childhood of perpetual loneliness was shown to lead to
difficulty building and maintaining relationships in adulthood, evermore
increasing the tendency for loneliness and isolation.

Additional studies on loneliness express even more serious concerns for

those who do not have strong community support saying, “the influence of
social relationships on the risk of death are comparable with well-established
risk factors for mortality such as smoking and alcohol consumption and
exceed the influence of other risk factors such as physical inactivity and
obesity.”32 Loneliness is also connected with a significant increase in suicidal
ideation.33

In our survey we asked two questions related to peer relationships: who they
played with and what language they spoke.34 The question of language is
important as TCKs “really seem to need friendships with peers who speak
their mother tongue.” 35 Our goals were to determine if the age and language
familiarity of a TCK’s peers was correlated with higher or lower ACE scores
and to see the prevalence or absence of peer relationships in the TCK
population.

Recognizing Potential Risks in the area of Peer

Relationships
Peer Groups
More than half of the TCKs we surveyed had a peer group their own age.
One-quarter had a consistent peer group of varied ages. 11% had only their
siblings, and 10% had no appropriate peer group. This final category
combined three groups – those who only played with children older than
them (6%), younger than them (2%), or who had no peers (2%).
24
Missionary kids were slightly less likely to have a peer group their own age,
but the same percentage with no appropriate peers. Only 17% of
homeschooled TCKs had peers their own age, with 38% having only their
siblings as peers and 15% having no appropriate peers, including 6% with no
peers at all.

TCKs who reported having peers their own age had lower ACE scores than
TCKs overall. This was also true across different subgroups (age, sector,
education). Those with consistent peers, whether a group of varied ages or
their own siblings, had ACE scores roughly similar to the overall group. TCKs
without an appropriate peer group, however, reported higher rates of all ACE
factors, with more than 1 in 3 having a high risk ACE score of 4 or more.

High Risk ACE Scores in Peer Groups

High Risk ACE Scores among TCKs with Peers their Own Age
All 18%
Born before 1980 20%
0-3 yrs abroad 28%
Born after 1980 17%
4-9 yrs abroad 20%
Missionary 13%
10-15 yrs abroad 16%
Non-missionary 23.5%
16-18 yrs abroad 13%
Homeschooled TCKs 22%
Other Education 18%

High Risk ACE Scores among TCKs with Peers of Varied Ages
All 20%
Born before 1980 22%
0-3 yrs abroad 25%
Born after 1980 19%
4-9 yrs abroad 25%
Missionary 17%
10-15 yrs abroad 21%
Non-missionary 25%
16-18 yrs abroad 11%
Homeschooled TCKs 15%
Other Education 21%

While homeschooled TCKs were more likely to lack an appropriate peer

group, those TCKs did not have higher ACE scores. 22% of homeschooled
TCKs with no peers had high risk ACE scores, compared to 20% of
homeschooled TCKs overall. 37% of TCKs from other educational
backgrounds with no peers had high ACE scores, compared to 21% overall.
25
 High Risk ACE Scores among TCKs with Sibling Peers Only
All 22%
Born before 1980 25%
0-3 yrs abroad* 17%
Born after 1980 22%
4-9 yrs abroad 27%
Missionary 21%
10-15 yrs abroad 21%
Non-missionary 25%
16-18 yrs abroad* 13%
Homeschooled TCKs 22%
Other Education 24%

High Risk ACE Scores among TCKs with No Peers

All 22%
Born before 1980 25%
0-3 yrs abroad* 46%
Born after 1980 22%
4-9 yrs abroad 30%
Missionary 21%
10-15 yrs abroad 32%
Non-missionary 25%
16-18 yrs abroad* 36%
Homeschooled TCKs 22%
Other Education 24%

TCKs overall sibling peers

Abuse by Peer Group own-age peers no approproiate peers
varied age/consistent peers
60%

40%

20%

0%
High Risk Physical Abuse Emotional Abuse Sexual Abuse Child-to-Child Grooming
ACE Score Sexual Abuse

Neglect and Household Dysfunction by Peer Group

60%

40%

20%

0%
Physical Emotional Household Adult Parental Parental Household Adult
Neglect Neglect Mental Illness Violence Divorce Substance Abuse
26
Language Comfort
When it came to language comfort with peers, we asked respondents to
select if their peer interactions were mostly in a language they were fluent,
comfortable, or uncomfortable in. We then asked the same for their closest
friends. 79% were fluent with childhood peers in general, and 92% were
fluent with their closest friends. ACE scores rose as fluency with peers
dropped; the rate of high risk ACE scores rose from 19% of the group who
were fluent with peers, to 25% of the comfortable group, and 30% of those
who used a language they were uncomfortable in.

High risk ACE scores were also more common in TCKs whose close friends
spoke in a language that was comfortable rather than fluent for them (29%).
The sample size of TCKs whose close friends spoke a language that was
uncomfortable for them was too small to analyze.

High Risk ACE Scores among TCKs who were Linguistically Fluent with Peers
All 19%
0-3 yrs abroad 25%
Born before 1980 22%
4-9 yrs abroad 22%
Born after 1980 18%
10-15 yrs abroad 18%
Missionary 15%
16-18 yrs abroad 13%
Non-missionary 25%

High Risk ACE Scores among TCKs who were Linguistically Comfortable with Peers
All 25%
0-3 yrs abroad* 45%
Born before 1980 29%
4-9 yrs abroad 24%
Born after 1980 23%
10-15 yrs abroad 24%
Missionary 21%
16-18 yrs abroad 18%
Non-missionary 30%

High Risk ACE Scores among TCKs who were Another pattern worth discussing
Linguistically Uncomfortable with Peers is that the rate of TCKs who had
All 30% fluent peers/close friends dropped
Born before 1980* 22% with country mobility. That is, the
Born after 1980 34% more countries a TCK lived in
Missionary 29% before the age of 18, the less
Non-missionary 33% likely they were to have peers and

27
 close friends with whom they interacted in a language they spoke fluently.
This was particularly apparent in TCKs who lived in six or more countries
before age 18, where 85% were fluent with close friends and only 58% were
fluent with peers generally.
TCKs overall uncomfortable
Abuse by Language Comfort
fluent
with Peers comfortable
60%

40%

20%

0%
High Risk Physical Abuse Emotional Abuse Sexual Abuse Child-to-Child Grooming
ACE Score Sexual Abuse

Neglect and Household Dysfunction by Language Comfort with Peers

60%

40%

20%

0%
Physical Emotional Household Adult Parental Parental Household Adult
Neglect Neglect Mental Illness Violence Divorce Substance Abuse

Applying Effective Support in the area of Peer

Relationships
As outlined above, peer relationships are an important preventative measure
for Third Culture Kids. When TCKs have peers their age who speak the same
language, they are less likely to have a high risk ACE score. We also know
that having these peer groups is linked to a lower likelihood of negative
impacts on social development or long-term mental health impacts of

28
loneliness. The presence of peers is a protective measure, and the absence of
peers is a significant risk factor. Because peer relationships promote well
wellbeing, it is important for par-
ents to consider availability of
The presence of peers is a protective
friendships when deciding on
international placements. Sending measure, and the absence of peers is
entities need to communicate the a significant risk factor. Because peer
social setting of locations as they relationships promote wellbeing, it is
are suggesting and assigning loca- important for parents to consider
tions to families. The opportunity availability of friendships when
for children to build and maintain deciding on international placements.
peer relationships should be a
factor in considering field
suitability for a family.

During pre-departure training, education on the importance of peer

relationships is important. Parents should be made aware that appropriate
peer groups are necessary for development, resilience, and mitigation of ACE
scores. Peer support is linked to thriving, so it is important that parents
pursue ways to engage their TCKs in relationship building during/after
relocation.

At times, the repeated goodbyes associated with living in a transient

community can impact a child’s ability to connect with peers. This may
include periods when a child does not have an appropriate peer group living
nearby. Resources should be made available for parents to connect their
children to peers using alternative solutions. There are online TCK groups for
all ages where children can meet with the same TCKs and leaders on a
regular basis. This can be a great way to supplement peer relationships in
seasons that have been impacted by high mobility. Research by Dr. Gila
Cohen Zilka on the correlation between online friendships and social
development says, “Social networks provide a sense of belonging,
experiences of close friendships, and a sense of social acceptance, as
opposed to feelings of loneliness and alienation. These kinds of interactions
create in children a sense of self-worth, of being needed, of contributing
significantly to the environment.” 36

29
Companies can aid families with peer relationships by creating opportunities
for their employees’ TCKs to get together on a semi-regular basis. Many
entities will hold a yearly conference or retreat where all these families come
together. This can create great opportunities for TCKs to meet peers in-
person, with whom they stay connected virtually throughout the year. We
hear of many TCKs finding their closest friends at events such as these.

In addition, the importance of language fluency for TCK friendships means

that children should be provided with language-learning support to increase
their fluency in the language of their schooling and of peers in their
community. Both sending agencies and schools bear responsibility in this
area.

Household Adults

Additional adults living in the family home can be a source of support, a

source of stress, or a mix of both. Adults living in a child’s home have a big
impact on their ACE score, as nine of the ten ACE factors are dependent on
the actions of those household adults.
Therefore we wanted to know who had Additional adults living
lived in a TCK’s home if they reported in the family home can
experiencing emotional or physical abuse
be a source of support,
in the home.
a source of stress, or a
mix of both.
In our survey 24% of TCKs experienced
living with extended family, including 16%
with a grandparent. Previous research established a potential negative impact
on children in multigenerational households, as the “mother-grandmother
relationship conflict presents a risk to children's behavior directly and
37
indirectly”.

Living with non-biologically related adults was common among the TCKs we
surveyed: 26% had lived with domestic staff, 19% had lived with dormitory
staff, and 26% had lived with other non-family adults. Multiple studies have
found that living with a non-biologically related adult greatly increases a
38,39,40,41
child’s risk of experiencing physical abuse.
30
Recognizing Potential Risks in the area of
Household Adults

We asked the 1,904 TCKs we surveyed “Who were the adult members of
your household? (Adults who lived in the same home with you at some point
before your 18th birthday).” We analyzed the results to see if any patterns
would emerge.

Parents
All but three participants lived in a home with at least one parent (whether
biological, adoptive, or step-parent). 98% had both a mother and a father at
home. Some had more than two parents throughout childhood; for example,
half of those who lived with an adoptive parent also lived with their biological
mother. Five TCKs lived with two mothers; none lived with two fathers.
These two-mother situations may have involved a single mother adoption, or
represented queer families. 1.1% of families in the US are raised by a same-
sex couple, so this is a very small number (0.003% if counting all five).

Tanya Crossman notes the lack of “non-traditional” families in her book

Misunderstood: The Impact of Growing Up Overseas in the 21st Century,
writing that “Families in which the parents are not legally married are also
less likely to seek or accept overseas positions, as many countries will 42
not
issue dependent visas for an unmarried partner. Divorced parents may be
barred from international moves due to custody arrangements...These legal
hoops prevent some families from pursuing or accepting overseas
assignments.” 43

Extended Family
One-quarter of TCKs overall (24%) had extended family members living in
their childhood home, regardless of age or sector. 16% lived with a
grandparent; 7% lived with an aunt/uncle; 6% lived with an adult sibling; 2%
lived with an adult cousin. Those from cross-cultural families were more likely

31
to report extended family at home (30% of immigrant TCKs, 28% of
multicultural TCKs). TCKs who reported having no appropriate peers were
also more likely to report living with extended family (32%).

The rate of high-risk ACE scores was 1.5 times higher among TCKs who lived
with extended family members (30.5% compared to 21% overall), with all
ACE factors rising from overall TCK rates. This risk compounded with other
risk factors. More than half of TCKs living with extended family who also had
no appropriate peers (52%) had a high-risk ACE score. The risk was also
higher for immigrant TCKs living with extended family, with 42% having a
high-risk ACE score.

High Risk ACE Scores in TCKs with Extended Family living in the Home
All 30.5%
Born before 1980 29% 0-3 yrs abroad 43%
Born after 1980 31% 4-9 yrs abroad 30.5%
Missionary 25% 10-15 yrs abroad 31%
Non-missionary 39% 16-18 yrs abroad 20%
Immigrant 42%
Multicultural 39%

Domestic Staff
One-quarter of TCKs (26%) overall had domestic staff living in their
childhood home. 19% lived with a housekeeper; 9% lived with a nanny; 0.3%
lived with a nurse; 5% lived with other staff. Missionary families were slightly
less likely to have live-in domestic staff than other sectors (24% vs 28%).
Cross-cultural families were more likely to have residential domestic staff
(31% of both immigrant/multicultural TCKs).

There was an increased risk of about 30% for TCKs who had live-in domestic
staff, with 27% of the group overall reported 4+ ACEs. The compounded risk
was slightly lower for multicultural TCKs (32% with 4+ ACEs). The rate of

32
emotional abuse in TCKs overall with live-in domestic staff rose from 44% to
54%; in immigrant TCKs from 51% to 62%; and in multicultural TCKs from
54% to 63%.

High Risk ACE Scores in TCKs with Domestic Staff living in the Home
All 27%
Born before 1980 26% 0-3 yrs abroad* 41%
Born after 1980 28% 4-9 yrs abroad 27%
Missionary 22% 10-15 yrs abroad 22%
Non-missionary 33% 16-18 yrs abroad 18%
Immigrant 36%
Multicultural 32%

Dormitory Staff
One in 5 TCKs (19%) reported living with a dormitory parent; this differed
greatly by age, and 88% were missionary kids.3 Older TCKs reported living
with a dormitory parent (27%) than TCKs born after 1980 (14.5%).

High Risk ACE Scores in TCKs living with Dormitory Staff

All 21%
Born before 1980 23% 0-3 yrs abroad* 33%
Born after 1980 19% 4-9 yrs abroad 26%
Missionary 18% 10-15 yrs abroad 22%
*Non-missionary 37% 16-18 yrs abroad* 16%
Boarding TCKs 20%
Other Education 21.5%

The rate of high-risk ACEs among TCKs who lived with a dorm parent was
21%, equal to TCKs overall, but higher than boarding school students and
missionary kids overall (both 17%). While sexual abuse went down by age in
boarding school students overall, among those who reported living with a
dorm parent the rate of sexual abuse went up by age. That is, TCKs born
after 1980 who lived with a dorm parent were more likely to report sexual
abuse and child-to-child sexual abuse than older generations of TCKs who
lived with dorm parents. The rate of grooming was similar between the two
4
groups.
33
It is important to note at this point that our survey did not ask participants
where or when their abuse occurred. Boarding schools should take note,
however, to ensure their staff are properly vetted for safety to work with
children and provided regular training in trauma-informed care, as nearly one-
third of their students are likely to be survivors of sexual abuse.

Other Adults
We also asked about other adults living in the home; 18% of TCKs overall
reported that their childhood household included an adult friend of the family
(12%), boarders (4%), or another adult (6%). Younger TCKs were more likely
to live with these other adults than those born before 1980 (20% vs 14%).
Missionary kids were more than twice as likely to live with other adults than
TCKs from other sectors (24% vs 10%). Homeschooled TCKs were also twice
as likely to live with other adults than TCKs with other educational
experiences (30% vs 16%).

One-quarter of TCKs who lived with other adults (26%) had a high-risk ACE
score. The risk was higher among those in non-mission sectors (35% with 4+
ACEs), and those with no appropriate peers (44% with 4+ ACEs).

High Risk ACE Scores in TCKs with Other Adults living in the Home
All 26%
Born before 1980 32% 0-3 yrs abroad* 44%
Born after 1980 24% 4-9 yrs abroad 28%
Missionary 21% 10-15 yrs abroad 25%
Non-missionary 35% 16-18 yrs abroad* 23%

Immigrant 30%
Multicultural 37%

34
 TCKs overall Other Adult
Extended Family Dorm Parent(s)
Abuse by Household Adults Domestic Staff
60%

40%

20%

0%
High Risk Physical Abuse Emotional Abuse Sexual Abuse Child-to-Child Grooming
ACE Score Sexual Abuse

Neglect and Household Dysfunction by Household Adults

50%

40%

30%

20%

10%

0%
Physical Emotional Household Adult Parental Parental Household Adult
Neglect Neglect Mental Illness Violence Divorce Substance Abuse

Applying Effective Support in the area of

Household Adults
As we consider providing specialized care for families at higher risk, it is
important to consider which adults live in their household. An adult living
with a child should be screened and trained so that their presence does not
add physical or emotional risk to the child. This is true for family members,
friends, employees, and even those paying to stay in the home. Every one of
these adults should receive care, education, and screening.

Housekeepers and nannies were reported by a significant number of TCKs,

and many co-resident family members also provide child care. The
intentionality of an adult carer living in a child’s home is a particularly
important factor, as it addresses their motive in providing care, and often
leads to higher quality care that should lead to positive developmental
44
outcomes for the child.
35
We also recommend that a policy An adult living with a child should
be made regarding any disclosure of be screened and trained so that their
abuse or neglect from any house- presence does not add physical or
hold adult. There should be a policy emotional risk to the child. This is
for external caregivers to enact
true for family members, friends,
should a disclosure about abuse or
employees, and even those paying
neglect occuring within a home be
to stay in the home.
made, and a plan for parents to
enact should their children disclose
to them. When a disclosure about a household adult is made, the initial
priority is ensuring the child is believed, affirmed, and to remove the adult in
question in order to provide physical and emotional distance for the child’s
wellbeing.

When abuse or neglect is disclosed, counseling for both the child and parents
should be offered, along with a crisis debrief after they have been removed
from the threat.

Extended Family
When extended family lives in the home, those family members impact TCKs
whether or not they take on direct caregiving responsibilities. It is therefore
important to consider what support is offered to, or required for, all adult
members of the household. This begins with a clear protocol that requires
that families inform the organization of all adults living in the household.

It is also critical that anyone living with the TCK receive the same child safety
screening measures that would be in place for any adult working with the
organization, even if the adult is not
It is also critical that anyone living employed with the organization.
with the TCK receive the same Extended family members consider-
child safety screening measures ing living abroad with the TCK
that would be in place for any adult should also receive some education
working with the organization, on the unique challenges of the TCK
even if the adult is not employed life and TCK care, including protect-
ive and preventive factors.
with the organization.

36
Because our research showed that TCKs living with extended family in the
home were less likely to have appropriate peers, it is important that the
importance of peers and the definition of “appropriate peers” is
communicated to these families in particular.

Domestic Staff
Because the risk increases significantly for TCKs who lived with domestic
staff, it is critical that additional support, care, and communication is in place
for families who have live-in staff members.

While education and background checks are typically a first step toward
prevention, these are challenging to accomplish across culture, language, and
socioeconomic divides. Thus, it is our recommendation that the parents
receive additional support so that they know:

1. How to notice and prevent abuse and neglect

2. What all TCKs need to thrive
3. How to communicate to their staff expectations on meeting the
emotional needs of their TCKs
4. Practical ways to remain vigilant about safety with live-in domestic staff
5. How to establish – for both children and domestic staff – expectations of
appropriate relationships and behaviors. This is particularly important as
children depend on adults to set their expectations of normal and would
easily normalize inappropriate behavior without clear expectations set by
an adult.

We know that domestic staff can be a wonderful addition to the life of a TCK
and have heard many stories of wonderfully nurturing domestic staff
members, and it is important to recognize that this is not everyone’s story so
it is important to put risk prevention methods into place wherever possible.

Dormitory Staff
Professor Smallbone of the school of criminology and criminal justice at
Griffith University says that in the case of child sexual abuse in institutional
settings, “the most likely abuse circumstance is in fact the abuse occurring

37
 45
between children themselves.” From our anecdotal conversations with
TCKs who lived in dorm environments, we believe that the majority of abuse
experienced is less likely to be directly from or allowed by a dorm parent, but
more often it is a lack of awareness and attentiveness on the part of the
dorm parent.

Third Culture Kids who live with dormitory staff are at higher risk for
physical, emotional, and sexual abuse (particularly child-on-child sexual
abuse). Because of the higher risk associated with dorm living and the direct-
care relationships of dorm parents to TCKs, it is pertinent that all dorm staff
receive robust training and edu-
cation on TCK care including a Because of the higher risk
substantial unit on abuse and associated with dorm living and the
neglect prevention. Effective direct-care relationships of dorm
education for dorm parents parents to TCKs, it is pertinent that
equips them to be proactive in all dorm staff receive robust
their care and protection of TCKs. training and education on TCK care
including a substantial unit on
A reporting policy should also be
abuse and neglect prevention.
in place so that if an allegation is
made against a dorm parent or about an abuse or neglect situation in the
dorm, the family’s sending organization ensures proper measures are taken to
remove the TCK from the environment. Then, the sending organization
would contact the school to urge an investigation. Regardless of what the
school provides, the family’s sending organization should offer follow-up care
and support for the TCK and their parents, such as counseling services and
educational planning if a new schooling situation is needed.

Non-Residential Caregivers

The Impact of Non-Residential Carers in a Child’s

Life
Non-residential caregivers are part of the village that supports families –
parents and children alike – and as such can have a big impact on children as

38
they grow. When these addi-
Non-residential caregivers are part of
tional supports are positive
the village that supports families –
mentoring figures, they can
parents and children alike – and as such
provide one of the buffering
can have a big impact on children as
Positive Childhood Experiences
they grow. When these additional
(PCEs): “Connections between
youth and caring non-parent
supports are positive mentoring figures,
adults can develop into natural they can provide one of the buffering
mentoring relationships that Positive Childhood Experiences (PCEs)
foster positive youth develop-
ment and buffer against the risks associated with the tumultuous years of
adolescence.” 46 Non-residential caregivers may provide many different types
of support in a child’s life, resulting in guidance during decision making, or
emotional support during loss and other difficulties. 47

Formal mentoring programs are beneficial as well as more informal

relationships. “Participating in mentoring services was related to higher family
functioning across a number of domains including child behavior, parenting
stress, perceived parent social support, and perceived parent-child
48
relationship quality.”

At-risk adolescents and youth seek to form relationships with adults (whether
parents, youth leaders, or others) who will see and reflect their developing
identities back to them – and they look for this even when they appear to be
very peer-oriented.49 This means the adults in their lives can have a very
strong impact on them. “Caring adults can play a vital role in the educational,
behavioral, and emotional development of children and adolescents.” 46

When non-residential carers are not well screened, however, unsafe adults
can gain access to children. This lack of safety might take the form of
discouraging words that sap a child’s self-esteem. In extreme cases, unsafe
adults may abuse children, physically, emotionally, or sexually.

39
Recognizing Potential Risks in the area of Non-
Residential Caregivers
We asked the 1,904 TCKs we surveyed “Which adults NOT LIVING WITH
YOU had a caretaker role in your life? (An adult who did not live with you,
but spent time with you in a caretaking capacity (part of your regular routine)
at some point before your 18th birthday.) 1

Three-quarters of TCKs had at least one non-residential caregiver during

childhood: 73% overall, and 77% of those born after 1980. 6% had a non-
residential parent, 21% had other non-residential family carers, 23% had a
friend-of-family carer, 37% had a domestic staff carer, 30% cited a teacher in
a caretaking role, 15% cited dormitory staff, and 26% had another adult carer.

Non-Resident Parent
The non-residential parents cited by 6% of TCKs included: biological mother
(5%), biological father (5%), stepmother (0.5%), stepfather (0.3%), adoptive
mother (0.3%), adoptive father (0.5%). The rate of high-risk ACE scores (and
most individual ACE factors) was 1.5 times higher in this group than among
TCKs overall, regardless of sector.

As would be expected, the rate of parental divorce among TCKs who

reported a non-resident parent was twice the rate among TCKs overall.
These TCKs also reported higher rates of parental violence and substance
abuse. On the other hand, this group was 15% less likely to report household
adult mental illness.

High Risk ACE Scores in TCKs with Non-Residential Parent Caregiver

Overall 32%
0-3 yrs abroad* 57%
Born before 1980 27%
4-9 yrs abroad* 23%
Born after 1980 36%
10-15 yrs abroad* 36%
Missionary 25%
16-18 yrs abroad* 33%
Non-missionary 40%

40
Extended Family
Of the 21% of TCKs who reported a non-residential extended family carer,
15% listed a grandparent, 10% listed an aunt/uncle, 2% listed an adult sibling,
and 2% listed an adult cousin. One-quarter of TCKs with a non-residential
extended family carer had a high-risk ACE score, a higher rate than among
TCKs overall, but lower than TCKs who lived with extended family. 25% of
TCKs with a non-residential extended family carer were physically abused at
home; 52% were emotionally abused at home.

The compounded increase was higher for immigrant TCKs (39%, a 50%
increase), and lower for multicultural TCKs (30%, a 10% increase). 66% of
immigrant TCKs with a non-residential extended family carer were
emotionally abused at home; 59% were emotionally neglected. 58% of
multicultural TCKs with a non-residential extended family carer were
emotionally neglected.

High Risk ACE Scores in TCKs with Extended Family Caregiver

All 36%
Born before 1980 20% 33%
0-3 yrs abroad
Born after 1980 23% 4-9 yrs abroad 28%
Missionary 21% 10-15 yrs abroad 26%
Non-missionary 31% 16-18 yrs abroad* 20%
Immigrant 39%
Multicultural 30%

Friend-of-Family
There was a slight rise (10%) in the rate of high-risk ACEs for TCKs who had a
friend-of-family carer, with 23% reporting 4+ ACEs. The compounded risk
was slightly higher among missionary kids (a 20% rise, from 17% to 20%), and
slightly lower among immigrant TCKs (28%, a 5% rise).

Emotional neglect and sexual abuse were slightly higher among TCKs with
friend-of-family carers, reported by 45% and 30% of the group, respectively.
Emotional abuse at home and household adult substance abuse was slightly
lower (43% and 8.5% respectively).

41
 High Risk ACE Scores in TCKs with Friend of Family Caregiver
All 23%
Born before 1980 22% 0-3 yrs abroad* 42.5%
Born after 1980 24% 4-9 yrs abroad 26%
Missionary 20% 10-15 yrs abroad 21%
Non-missionary 29% 16-18 yrs abroad 14%
Immigrant 28%
Multicultural 32%

Domestic Staff
The 37% of TCKs who reported non-residential domestic staff as carers listed
a variety of household roles: housekeeper (26%), nanny (13%), driver (6%),
medical carer (0.5%), and other domestic staff (6%). The rates of high-risk
ACE scores, and most risk factors, were very similar for TCKs with non-
residential domestic staff as for TCKs overall, and lower than for TCKs with
live-in staff. There was a slight risk increase among missionary kids (from 17%
to 20%), and a slight decrease among multicultural TCKs (from 28% to 26%).

46% of TCKs with non-residential domestic staff reported emotional abuse at

home; 42% reported emotional neglect. 30% reported child-to-child sexual
abuse, a 20% higher rate than among TCKs overall.

High Risk ACE Scores in TCKs with Non-Residential Domestic Staff Caregiver
All 22%
Born before 1980 26%
0-3 yrs abroad* 35%
Born after 1980 20% 4-9 yrs abroad 26%
Missionary 20% 10-15 yrs abroad 19%
Non-missionary 27% 16-18 yrs abroad 18%
Immigrant 31%
Multicultural 26%

42
 TCKs overall Friend of Family
Abuse among TCKs with Non- Domestic Staff
Non-resident parent
Residential Caregivers (1/2) Extended family
60%

40%

20%

0%
High Risk Physical Abuse Emotional Abuse Sexual Abuse Child-to-Child Grooming
ACE Score Sexual Abuse

Neglect and Household Dysfunction among TCKs with Non-

Residential Caregivers
50%

40%

30%

20%

10%

0%
Physical Emotional Household Adult Parental Parental Household Adult
Neglect Neglect Mental Illness Violence Divorce Substance Abuse

Teacher
Of the 30% of TCKs who reported a teacher as a carer, 27% listed a
classroom teacher and 6% listed a homeschool teacher. The rates of high-risk
ACE scores, and most risk factors, were very similar for TCKs who counted a
teacher as a carer as for TCKs overall. There was a slight increase among
TCKs from non-missionary sectors (32%), and immigrant TCKs (32%).

48% of non-missionary TCKs and 52% of immigrant TCKs who counted a

teacher as a carer also reported household adult mental illness – slightly
higher than expected. This may indicate that their teachers provide safe
spaces for TCKs when parents are struggling.

43
 High Risk ACE Scores in TCKs with Teacher Caregiver
All 22%
Born before 1980 21%
0-3 yrs abroad* 21%
Born after 1980 22%
4-9 yrs abroad 25%
Missionary 19%
10-15 yrs abroad 21%
Non-missionary 32%
16-18 yrs abroad 18%
Immigrant 32%
Multicultural 30%

Dormitory Staff
The 15% of TCKs who reported dormitory staff as non-residential carers had
very similar rates of ACEs to TCKs overall, with 21% having 4+ ACEs.
Emotional neglect was slightly higher than among TCKs overall, at 42%.
Given that the majority of boarding students in our survey came from
missionary backgrounds this does represent a small risk increase.

The rates of sexual abuse and child sexual abuse were lower among TCKs
with non-residential dormitory carers (27% and 27%) than among those who
reported living with dormitory staff (29% and 31%). While these numbers can
say nothing about causation (only correlation), it is possible that some non-
residential staff in boarding schools provide additional supervision and/or act
as mentors, creating a protective factor against sexual abuse.

High Risk ACE Scores in TCKs with Dormitory Staff Caregiver

All 21%
0-3 yrs abroad* 31%
Born before 1980 23%
4-9 yrs abroad 25%
Born after 1980 19%
10-15 yrs abroad 23%
Mission 18%
16-18 yrs abroad* 22%
Non-Mission* 37%

Other Non-Residential Carer

The 26% of TCKs who reported a different non-residential carer fell into
three categories: pastor/rabbi/imam (16%), coach/tutor (14%), and other
(4%). TCKs with these carers were 25% more likely to have high-risk ACEs
(26% vs 21% of TCKs overall). TCKs from non-missionary sectors were more
likely to have high-risk ACE scores (36%, a 40% higher risk).

44
 High Risk ACE Scores in TCKs with Other Non-Residential Caregiver
All 26%
Born before 1980 32%
0-3 yrs abroad* 44%
Born after 1980 24% 4-9 yrs abroad 29%
Missionary 21% 10-15 yrs abroad 24%
Non-missionary 36% 16-18 yrs abroad 22%
Immigrant 30%
Multicultural 32%

No Non-Residential Carers
The 27% of TCKs with no non-residential carers had 10% lower rates of high-
risk ACE scores than TCKs who had at least one non-residential carer (19% vs
21%). For missionary kids, the rate of a high-risk ACE score rose 50% when
they reported at least one non-residential carer. Boarding school students,
however, had lower ACE scores when reporting at least one non-residential
carer (17% vs 20%).

Child-to-child sexual abuse and grooming were both lower in TCKs who had
no non-residential carers; child-to-child sexual abuse was 30% lower (21% vs
27%), and grooming was 15% lower (25% vs 29%). Emotional neglect was
also 20% lower in TCKs who had no non-residential carers (35% vs 41%).

High Risk ACE Scores in TCKs with No Non-Residential Caregiver

All 19%
Born before 1980 21% 23%
0-3 yrs abroad
Born after 1980 18% 4-9 yrs abroad 19%
Missionary 12% 10-15 yrs abroad 18%
Non-missionary 24.5% 16-18 yrs abroad 11%
Immigrant 25%
Multicultural 27%

45
 TCKs overall Other
Abuse among TCKs with Non- None
Teacher
Residential Caregivers (2/2) Dorm Staff
50%

40%

30%

20%

10%

0%
High Risk Physical Abuse Emotional Abuse Sexual Abuse Child-to-Child Grooming
ACE Score Sexual Abuse

Neglect and Household Dysfunction among TCKs with Non-

Residential Caregivers
50%

40%

30%

20%

10%

0%
Physical Emotional Household Adult Parental Parental Household Adult
Neglect Neglect Mental Illness Violence Divorce Substance Abuse

Applying Effective Support in the area of

Caregivers
This data does not mean that TCK parents
While considering these
should avoid seeking other caregivers to
statistics, it is important to
support their children. The presence of risk
remember this data does not
merely necessitates the implementation of
mean that TCK parents
risk mitigation strategies. Indeed,
should avoid seeking other
caregivers to support their
supportive non-parent adults provide a
children. The presence of Positive Childhood Experience which is
risk merely necessitates the recommended for children.
implementation of risk miti-
gation strategies. Indeed,

46
supportive non-parent adults provide a Positive Childhood Experience which
is recommended for children to have in their lives. Non-resident caregivers
often fill this role. Furthermore, care support often reduces stress on the
parents and may help with lowering rates of mental illness and substance
abuse in parents, along with emotional abuse and emotional neglect at the
hands of overwhelmed parents. However, given the risks found in this
research, it is valuable to ensure certain precautions are implemented.

Organizationally, screening and child

When children are safeguarding training should be regularly
empowered, they are implemented to create a company culture of
better able to self- how to treat children. Child safe-guarding
advocate regarding their training should not only include prevention of
mistreatment. sexual and physical abuse, but also emotion-
al abuse. Where unsafe caregivers can contri-
bute to ACE scores, emotionally safe caregivers help build resilience in
children. Parents should be encouraged to screen caregivers for themselves,
especially those outside of the organization. Parents and caregivers should
collaborate to determine how multiple children will be cared for in order to
lower the risk of child-to-child sexual abuse, knowing that quality supervision
is an important protective factor.

Children should also receive education on how adults are expected to treat
children and what to do in instances where that quality of care is not being
administered. When children are empowered, they are better able to self-
advocate regarding their mistreatment. It should be impressed upon parents
and caregivers to listen attentively to the concerns of children. Not only
might this help remove them from dangerous situations, but it will also help
fulfill a Positive Childhood Experience: feeling heard.

Parents can also ask targeted questions to children who have non-residential
caregivers, asking how they like their time with the caregiver, asking if there
is anything that makes them uncomfortable, and making sure the child knows
their parent is always ready to listen to them.

Should abuse or neglect from a non-residential caregiver be disclosed,

ensuring the child is believed, affirmed, and given physical and emotional

47
distance from the offender should be the initial priority. Counseling for both
the child and parents should also be offered, along with a crisis debrief when
the family is ready to begin processing the experience.

Part II: Triaging by Events

Medical Events

How Medical Events can Impact Families

Multiple studies have connected serious medical issues, including chronic
illness, with negative impacts on the patient’s family – as well as negative
50
impacts on the patient’s health based on their family situation. “Families
51
undergo great stress when one of their members has a severe illness.”

Medical care can be financially stressful due to the cost of medical care
and/or impact on ability to earn – whether a parent is unable to work
through injury/illness, or because they are needed as a child’s caregiver.
“Many families of seriously ill patients experience severe caregiving and
52
financial burdens.” If one parent is sick, it also detrimentally affects the
53
other’s stress levels and mental health. In the case of cancer, for example,
studies document a correlation between spousal and patient distress. “From
20% to 30% of partners suffer from psychological impairment and mood
disturbance as a result of the spouse’s cancer… interventions do not reduce
spousal distress.” 54

These are just a few examples of how the stresses of medical issues in a
family can impact the family’s long term emotional health. As both the
physical and emotional environment of the family and home impact ACE
scores, we were interested to see if there was a correlation with medical
events that occurred during a TCK’s childhood.

48
Recognizing Potential Risks in the area of Medical
Trauma
Household Medical Event
Prior to the 2021 survey, we had seen the impact of medical trauma in many
globally mobile families. Existing research already demonstrated that medical
trauma negatively affects families. What we didn’t know was whether the
presence of medical trauma would impact ACE scores among globally mobile
TCKs. We chose to ask about three categories of medical trauma:

1. Medical crisis
2. Prolonged illness
3. Death

We also asked whether the person affected was an adult or child, and in the
case of death, also added non-residential caregivers as an option. 59% of
TCKs reported a household medical event (medical crisis or prolonged illness
in an adult or child living in their home during their childhood). 12% reported
the death of a household member or caregiver during childhood. We will look
at each variable individually below.

There was a big difference in ACE scores between those who reported a
household death, and those who reported the death of a non-residential
caregiver. 24% of the 147 TCKs who reported a household death had a high-
risk ACE score. High-risk ACE scores were more common among 96 TCKs
who reported a non-residential caregiver death, with 31% having 4 or more
ACEs.
High Risk ACE Scores in TCKs reporting Household Medical Events

All 26%
0-3 yrs abroad 41%
Born before 1980 27%
4-9 yrs abroad 29%
Born after 1980 25%
10-15 yrs abroad 25%
Mission 21%
16-18 yrs abroad 17%
Non-Mission 34%

49
Medical Crisis (Household)
Household medical crises during childhood were reported by nearly half of
TCKs (48%); 41% reported an adult affected, 23% reported a child affected.
Those affected by a medical crisis had a one-third higher risk of a 4+ ACE
score. 35% of TCKs from non-missionary sectors and 38% of TCKs who lived
three or fewer years overseas reported a household medical crisis.

Nearly half of TCKs who reported a household medical crisis during

childhood also reported emotional abuse, emotional neglect, and household
adult mental illness. Physical neglect was also higher, at 16% of the total
group.

High Risk ACE Scores in TCKs reporting Household Medical Crisis

All 26%
0-3 yrs abroad 38%
Born before 1980 27%
4-9 yrs abroad 26%
Born after 1980 26%
10-15 yrs abroad 26%
Mission 22%
16-18 yrs abroad 18%
Non-Mission 35%

Prolonged Illness (Household)

Household prolonged illness during childhood was reported by 28% of TCKs;
22% reported an adult affected, 10% reported a child affected. 31% of TCKs
who reported prolonged illness in their household during childhood had a
high-risk ACE score; 35% of those born before 1980 had 4 or more ACEs.
This represents 1.5 times the risk seen in TCKs overall. Missionary kids had
lower rates of high-risk ACEs than those from non-missionary backgrounds
(27% vs 41%) but this represents an equal increase of the overall group rates
of 17% and 26% respectively.

Short stays were associated with higher risk in those who experienced
prolonged illness. Nearly half of TCKs reporting prolonged illness in their
household who spent no more than six years outside their passport country
(47%) had a high-risk ACE score. This is nearly twice the overall group rate of
25%.

50
When household prolonged illness was present, over half of TCKs reported
experiencing emotional abuse, emotional neglect, and household adult mental
illness. Over 30% reported sexual abuse, child-to-child sexual abuse, and
grooming. Of those who spent six or fewer years abroad, 62% reported
emotional abuse, 58% reported emotional neglect, and 61% reported
household adult mental illness.

High Risk ACE Scores in TCKs reporting Household Prolonged Illness

All 31%
0-3 yrs abroad 50%
Born before 1980 35%
4-9 yrs abroad 33%
Born after 1980 30%
10-15 yrs abroad 29%
Mission 27%
16-18 yrs abroad 16%
Non-Mission 41%

Household Death
Household death during childhood was reported by 8% of TCKs; 4% reported
an adult death, 6% reported a child death. Among missionary kids, household
death was associated with increased risk; high-risk ACE scores increased
from 17% to 21%. There was no increased risk in non-missionary sectors.
30% of TCKs who experienced a household death and also spent nine or
fewer years outside their passport countries had a high-risk ACE score.

More than half of TCKs who reported household death also reported
emotional abuse and emotional neglect. More than a third (38%) reported
sexual abuse, including 40% of those born after 1980.

High Risk ACE Scores in TCKs reporting Household Death

All 24%
0-3 yrs abroad* 38%
Born before 1980 21%
4-9 yrs abroad* 28%
Born after 1980 26%
10-15 yrs abroad 19%
Mission 20%
16-18 yrs abroad* 15%
Non-Mission 29%

51
Caregiver Death
Seven percent of TCKs reported that a caregiver who did not live in their
household died during their childhood. Caregiver death was associated with
much higher risk, with 36% of TCKs who reported caregiver death having
high-risk ACE scores, compared to 24% of those who reported household
death.

TCKs were not asked additional questions about proximal deaths during
childhood, as the survey had limited scope. That said, when the group who
reported caregiver death are sorted by what type of caregivers they reported
having, we see a pattern. Those who listed extended family and friends-of-
family as non-residential caregivers had lower ACE scores. The rate of high-
risk ACE scores among those with extended family caregivers who reported
caregiver death was 24%, the same as those who reported household death.
For those with friends-of-family caregivers, the rate of high-risk ACE scores
was 29%.
High Risk ACE Scores in TCKs
For those with other caregivers reporting Caregiver Death
(group too small to subdivide further)
(domestic staff, teachers, pastors,
All 36%
etc.) the rate of high-risk ACE scores
Born before 1980 41%
was 43%. That means nearly half of
Born after 1980 34%
TCKs who lost a non-family, non-
Mission 35%
residential caregiver during childhood
Non-Mission 39%
had a high-risk ACE score.

What we infer from these results is that while the death of non-residential
family caregivers, and friends who are ‘chosen family,’ impact families
similarly to household deaths even
The death of non-residential when these people do not live in
family caregivers, and friends who are the same household, the deaths of
‘chosen family,’ impact families non-family and non-residential
similarly to household deaths even caregiver deeply impact ACE
when these people do not live in the scores. Lower ACE risk does not
same household; the deaths of non- equal less grief. The death of a
family and non-residential caregiver family member is always devastat-
deeply impact ACE scores. ing. We suspect that the higher
ACE risk associated with caregiver
52
 deaths outside the family reflects a lack of support/understanding of the
child/family’s grief.

Rates of emotional abuse were very high among TCKs who reported the
death of a non-residential caregiver: 64% overall, and 74% of those from
non-missionary backgrounds. Emotional neglect was also very high: 54%
overall, and 58% of those from missionary backgrounds. Half reported
household adult mental illness. One-third reported sexual abuse (39% of non-
missionary TCKs), 43% reported child-to-child sexual abuse, and 40%
reported grooming.

TCKs overall HH Prolonged Illness

Abuse by Medical Events HH Medical Event HH Death
HH Medical Crisis Caregiver Death
75%

50%

25%

0%
High Risk Physical Abuse Emotional Abuse Sexual Abuse Child-to-Child Grooming
ACE Score Sexual Abuse

Neglect and Household Dysfunction by Medical Events

60%

40%

20%

0%
Physical Emotional Household Adult Parental Parental Household Adult
Neglect Neglect Mental Illness Violence Divorce Substance Abuse

53
Applying Effective Support in the area of
Medical Trauma
While not recorded as ACE scores, medical trauma can have particular impact
on families living outside their passport countries and away from their
extended families. Depending on location, their access to medical and social
support may be limited or certainly different to what they would have in a
country where they have the rights of a citizen. This is in addition to the
documented stress medical issues have on couples and families. The
increased ACE scores we see demonstrate that medical events impact
children long term, even if the medical crisis was resolved.

When we debrief families and

Medical events impact children long
past medical trauma comes up, we
term, even if the medical crisis was
often hear family members who
resolved. Medical trauma doesn’t
weren’t direct victims of a medical
impact just the individual but the
trauma hesitating to add it to their
list of grief-inducing experiences to family as a whole. The shifting of
process. The reality is that medical routines, caregivers, and family
trauma doesn’t impact just the norms impacts the entire family unit.
individual but the family as a whole.
The shifting of routines, caregivers, and family norms impacts the entire
family unit.

For many families, a medical crisis necessitates a separation of the family unit
in order to procure appropriate medical care. Perhaps one parent
accompanies the other to a different country for medical care, leaving their
children with a caregiver during that time. Perhaps one parent accompanies a
sibling to their passport country for medical care while the other parent stays
with the remaining children in their home abroad.

It is therefore important that organizations are aware of medical crises taking

place, how the crisis has disrupted or changed the family’s typical structure/
routines, and provide care for all family members. A medical crisis might
warrant a crisis debrief to help families stay connected and grow closer as
they return to normalcy. It would be important for a family who has had a

54
medical crisis to receive a full or annual debrief within 6-12 months of
returning to normalcy. This opportunity will allow everyone in the family the
space to process and debrief how the medical crisis impacted them, even if
they weren’t the one who directly experienced medical trauma.

In the event that a medical crisis leads to the death of a caregiver, additional
care measures should be put into place. This is true whether the caregiver is
family, lives in the child’s home, or is part of their wider community. Since a
non-residential caregiver's death is associated with much higher ACE scores,
it is important that we acknowledge the deep impact these relationships have
on children. After a tragedy of this nature, robust follow up care should be
provided in order to prevent the accumulation of ACE factors and/or to
reduce the impact that a high ACE score can have.

Pre-departure training should include organizations communicating to

families the importance of reporting these types of medical events so that
follow up care can be provided. In the event that a caregiver's death takes
place, a crisis debrief should take place immediately to help the children to
cope and grieve, and to provide additional support and education to the
parents. The family should then be encouraged to have a standard debrief
within 18 months of the event. This standard debrief will provide the
opportunity for the family to process and grieve the caregiver’s death after
enough time has passed that they are in a mental state in which it is healthy
and safe to do more thorough emotional processing.

Violent Events

How Violence Impacts Children

In our survey we asked about a range of ways that TCKs were impacted by
violence in the communities they lived in. These are important questions to
ask, because these sorts of events constitute trauma, and “early exposure to
stress and trauma causes physical effects on neurodevelopment which may
lead to changes in the individual’s long-term response to stress…Exposure to
trauma also affects children’s ability to regulate, identify, and express
emotions, and may have a negative effect on the individual’s core identity

55
 55
and ability to relate to others.”

A 2013 study asserted that while frequency of lifetime exposure to violence

(including witnessing violence) was not a factor in predicting negative
outcomes, if witnessed violence was combined with experienced violence
(such as physical assault, sexual abuse, or other maltreatment) the risk of
56
negative outcomes rose. Fear of violence in their regular spaces (home,
school, and community) causes “persisting fear states in children” with lasting
57
consequences.

We also included questions on indirect violence – when a violent event

occurred in a place the TCK often went to, even if they were not present at
the time of the event. We consider this worthy of inclusion as it has been
observed that these sorts of events correlate with negative health outcomes
for a community in general – including those not present at the time of the
58
violence.

Recognizing Potential Risks in the area of Violent

Events
Nearly half of all 1,904 TCKs surveyed (48%) were
Nearly half of all 1,904
impacted by violence before age 18. 29% of TCKs
TCKs surveyed (48%)
were impacted by home invasion. 28% reported
were impacted by
their home was broken into while they were not
violence before age 18.
present; 13% of TCKs were present in the home
at the time of a home invasion or break-in.

22% of TCKs were directly impacted by a violent event. 12% of TCKs

reported that during their childhood, a household member suffered violent
harm (10% said this happened to an adult, 9% to a child). 13% of TCKs said a
violent event (such as an armed robbery) occurred outside the context of
their home while they were present; 5% said this happened at school, 10%
said it happened elsewhere in their community. 23% of TCKs were indirectly
impacted by a violent event (a violent event happened at a place they
regularly went to, but at a time they were not present).

56
Home Invasion
Home invasion had a mild impact on ACE scores, associated with a 10% rise
in the risk of 4+ ACEs. 23% of TCKs who reported experiencing home
invasion had a high-risk ACE score. There was a 25% rise for TCKs who were
present during a home invasion, with 26% reporting 4+ ACEs. There was a
clear risk of higher ACEs associated with shorter stays abroad in TCKs who
experienced home invasion; 40% of those who spent three or fewer years
outside their passport countries had a high-risk ACE score, nearly double the
rate seen in TCKs overall.

Sexual abuse and household adult mental illness were more than 10% higher
among TCKs who reported home invasions. Regarding sexual abuse, one-
third reported child sexual abuse, one-third reported child-to-child sexual
abuse, and 35% reported grooming. For household adult mental illness, 44%
reported experiencing this in their childhood homes.

High Risk ACE Scores in TCKs reporting Home Invasion

All 23%
0-3 yrs abroad* 40%
Born before 1980 24%
4-9 yrs abroad 26%
Born after 1980 23%
10-15 yrs abroad 21%
Mission 20.5%
16-18 yrs abroad 16%
Non-Mission 32%

Directly Impacted by Violence

TCKs directly impacted by violence were significantly more likely to have a
high-risk ACE score. 38% had an ACE score of 4 or more, 80% more than
TCKs overall. The risk was 95% greater for missionary kids impacted by
violence than for missionary kids overall. The risk was even higher for those
who lived fewer than seven years outside their passport countries (2.2 times
the rate seen in TCKs overall).

More than half of TCKs directly impacted by violence (58%, including 67% of
those from non-missionary backgrounds) were emotionally abused by an
adult in their childhood home; 42% were sexually abused before age 18. 54%
of TCKs directly impacted by violence reported emotional neglect, and 58%
reported a mentally ill adult living in their childhood home.

57
 High Risk ACE Scores in TCKs reporting Direct Impact from Violent Events

All 38%
0-3 yrs abroad* 48%
Born before 1980 43%
4-9 yrs abroad 40%
Born after 1980 35.5%
10-15 yrs abroad 36%
Mission 33%
16-18 yrs abroad 29%
Non-Mission 46%

Violent Harm to Household Member

When the specific type of violence directly impacting a TCK was violent harm
to a household member, the risk was even greater. Nearly half of TCKs who
reported that a household member in their childhood home suffered violent
harm also reported 4+ ACEs (47%), more than twice the rate of TCKs overall.
The associated risk was higher for missionary kids, 40% of whom had 4+
ACEs, and for TCKs who lived fewer than seven years outside their passport
countries (56% had a high-risk ACE score).

Two-thirds of TCKs who reported violent harm to a household member and

three-quarters of those from non-missionary backgrounds (67% and 74%
respectively) were emotionally abused by an adult in their childhood home.
27% of TCKs who reported violent harm (35% of missionary kids) reported
physical neglect, and 59% reported emotional neglect. 48% were sexually
abused before age 18, and 44% reported experiencing grooming.

Parental violence is clearly connected with this group, and the risk factor it
represents. 21% of this group reported parental violence – three and a half
times the rate of 6% among TCKs overall. 87% of TCKs who reported
parental violence had a high-risk ACE score; 67% were physically abused at
home, and 85% were emotionally abused at home.4

For this reason, we also looked at the data for TCKs who reported violent
harm to a household member but did NOT report parental violence. 35% of
this group had a high-risk ACE score – lower than the overall violent harm
group, but still significantly higher than TCKs generally. 59% were
emotionally abused at home, and nearly half were sexually abused as children
(45%). Physical and emotional neglect were also high (24% and 52%).

58
 High Risk ACE Scores in TCKs reporting Violent Harm to Household Member

All 47%
0-3 yrs abroad* 56%
Born before 1980 51%
4-9 yrs abroad 51%
Born after 1980 45%
10-15 yrs abroad 42%
Mission 40%
16-18 yrs abroad* 43%
Non-Mission 55%

Violence While Present

Nearly a third of TCKs who reported being present during a violent event
(31%) had a high-risk ACE score, about 1.5 times the overall risk. The risk was
much higher for missionary kids, 32% of whom had an ACE score of 4 or
more, nearly twice the rate seen in missionary kids overall. There was a
moderate impact on risk by years abroad, with those who spent more than 12
years abroad having a lower rate of high-risk ACE scores (25%).

More than half of TCKs who were present during a violent event reported
emotional abuse (51%), emotional neglect (51%), and household adult mental
illness (57%). 39% were sexually abused before age 18, and 43% reported
experiencing grooming.

High Risk ACE Scores in TCKs reporting Violence when present

All 31%
0-3 yrs abroad* 38%
Born before 1980 39%
4-9 yrs abroad 34%
Born after 1980 28%
10-15 yrs abroad 31%
Mission 32%
16-18 yrs abroad* 21%
Non-Mission 30%

Indirectly Impacted by Violence

TCKs indirectly impacted by violence still saw a 30% increase in the rate of
high-risk ACE scores, with 27% reporting 4 or more ACEs. Again, the risk was
much higher among missionary kids, with 26% reporting 4+ ACEs,
representing a 50% risk increase. TCKs indirectly impacted by violence who
lived fewer than seven years outside their passport countries were 80% more
likely to report 4+ ACEs (38%, compared to 21% of TCKs overall).

59
 High Risk ACE Scores in TCKs Indirect Impacted by Violent Events

All 47%
0-3 yrs abroad* 45%
Born before 1980 51%
4-9 yrs abroad 28%
Born after 1980 45%
10-15 yrs abroad 27%
Mission 40%
16-18 yrs abroad* 11%
Non-Mission 55%

Other Intense Experience of Grief of Fear

When we asked our 1,904 Adult TCKs about their experiences of medical or
violent events, we also asked them if they had experienced any other intense
moments of grief or fear; 39% said they had. Of those, 31% had a high-risk
ACE score – about 1.5 times the rate seen in TCKs overall. The risk was
slightly higher among missionary kids, and significantly higher for those who
spent less time outside their passport countries. 42% of these TCKs who
spent fewer than seven years outside their passport countries had a high-risk
ACE score – twice the rate seen in TCKs overall.

One-quarter of these TCKs were physically abused (24%) and more than half
emotionally abused (55%) by an adult in their childhood home. These rates
were even higher for TCKs from non-missionary backgrounds (30% and 61%
respectively).

High Risk ACE Scores in TCKs reporting other Intense Moment of Grief or Fear

All 31%
0-3 yrs abroad 46%
Born before 1980 35%
4-9 yrs abroad 33%
Born after 1980 29%
10-15 yrs abroad 30%
Mission 28%
16-18 yrs abroad 24%
Non-Mission 37%

60
 Violence to HH Member
TCKs overall
Violence when present
Home Invasion
Abuse by Violent Events Indirect Impact
Direct Impact
Other Intense grief/fear
75%

50%

25%

0%
High Risk Physical Abuse Emotional Abuse Sexual Abuse Child-to-Child Grooming
ACE Score Sexual Abuse

Neglect and Household Dysfunction by Violent Events

60%

40%

20%

0%
Physical Emotional Household Adult Parental Parental Household Adult
Neglect Neglect Mental Illness Violence Divorce Substance Abuse

Applying Effective Support in the area of Violent

Events
One of the first ways organizations can work One of the first ways
to protect families is through strategic evalu- organizations can work to
ation of field suitability before family place- protect families is through
ment. Through survey work (including learn-
strategic evaluation of
ing from the experiences of expats already
field suitability before
allocated), organizations should know if a lo-
family placement.
cation has a high likelihood of violence. This
information should be provided to families, along with access to research on
the impact of violence on high ACEs, in order to evaluate the suitability of the
field location for each family. When assigning families to locations with
known risks, sending organizations should also provide easy access to crisis
61
 When assigning families to debriefing – before a traumatic
locations with known risks, sending event occurs – informing
organizations should also provide parents how and when to reach
easy access to crisis debriefing – out for those services for
before a traumatic event occurs – themselves and their children.
informing parents how and when to
reach out for those services for Prior to departure, sending
themselves and their children. organizations should provide
trauma-informed contingency
training for parents and children. The training should not frighten participants
but give them tools in communicating “what’s the plan, and what’s in place.”

If a TCK family is living in an area with violent events occurring – whether

this was known before or after their placement – organizations should
educate families on the ways in which being in the vicinity of violence can
impact their families. We see the increase in adverse childhood experiences
most notably in physical abuse, emotional abuse, emotional neglect, and
mental illness of parents in the home. All four of these ACEs are a direct
reflection of the parent’s emotional wellbeing. The impact of living in a
violent area can negatively affect children through the overflow of how it
affects their parents.

Parents need to be educated on how to manage their stress, how to identify

when the stress has reached a level where it’s negatively affecting their
families, and what to
do when that hap-
pens. For many org- The impact of living in a violent area can
anizations, this may negatively affect children through the overflow of
require a shift in how it affects their parents. Parents need to be
culture to prioritize educated on how to manage their stress, how to
the well-being of identify when stress has reached a level where
team members and it’s negatively affecting their families, and what to
families over do when that happens. For many organizations,
‘toughing it out’ to this may require a shift in culture to prioritize the
continue their work. well-being of team members and families over
Parents also need ‘toughing it out’ to continue their work.
to be educated on

62
the need for emotional processing and the research on the impact of
unprocessed trauma on families.

Alongside this, parents may need counseling and support to be capable of

responding to their children’s emotional needs. “Research indicates that the
most important resource protecting children from the negative effects of
exposure to violence is a strong relationship with a competent, caring,
positive adult, most often a parent. Yet, when parents are themselves
witnesses to or victims of violence, they may have difficulty fulfilling this
role.” 59 A well-trained TCK caregiver can be an invaluable resource to come
alongside the parent in this situation.

Crisis debriefs should be sought after each violent event. The debrief doesn’t
need to be elaborate, but an emotionally safe space needs to be provided for
those impacted by violence to process what they saw, how it impacted them,
and any worries or concerns they may have. If the frequency of crisis debriefs
is becoming tiresome, it may be time to reevaluate location suitability.

Additionally, sending organizations should organize debriefs on an annual

basis for all families living in a violent context. We recommend the full debrief
format every 3-4 years and an annual debrief during the other years. This will
give an opportunity for regular processing of any grief blocks and also equip
families with tools to support emotional health, interpersonal communication,
and family dynamics.

Large Scale Events

How the Wider Environment a Child Grows Up in

Impacts Them
Our survey also asked about larger-scale events that can impact childhood
circumstances, including political violence/corruption, war/unrest, natural
disaster, and experiencing evacuation (for these or other reasons).

63
As early as 1990, Andrew Dawes argued that “there is no simple relationship
between exposure to [political] violence and psychological disturbance or
endorsement of violent conduct by children,” as the support they received
from family and community could mitigate these risks.60 This still
demonstrates that a risk exists unless properly mitigated.

Children exposed to war, including those born during war, “experience

61
negative impacts due to conflict.” The long-term consequences of
exposure to war in utero and during childhood include the risk of chronic
health conditions “such as stroke, hypertension, diabetes, and cardiovascular
62
disorder in adulthood.”

In a similar fashion, those affected by natural disasters while in utero or as

63
young children suffered long-term consequences. In both cases, the
populations studied were citizens of the region where war/disaster struck, so
there can be no direct correlation for TCKs – especially those evacuated –
but these studies serve to demonstrate that these events can impact even
the youngest of children. Carolyn Kousky unpacks multiple ways that natural
disasters can impact children; while she imagines children living in their native
land, much of what she describes could (and would) be experienced by the
TCK in a disaster setting:

“Children may be injured or killed...disasters can cut off medical

care, even for non-disaster-related illnesses. Not only are
disasters themselves stressful and frightening, but children can
suffer psychological harm from the damage to their homes and
possessions; from migrations; from the grief of losing loved
ones; from seeing parents or caregivers undergo stress; from
neglect and abuse; and from breakdowns in social networks,
neighborhoods, and local economies...disasters can interrupt
children's educations by displacing families, destroying
64
schools…”

Evacuation usually takes place when a location is deemed unsafe for a family
– whether the whole family, or certain family members. This is usually
prompted by a large-scale crisis event, such as political/civic unrest, a
coup/revolution or the outbreak of war, or in the aftermath of a natural

64
disaster. A final type of ‘evacuation’ is medical evacuation, when a person
becomes so ill the recommendation is that they be transferred elsewhere for
treatment.

Evacuation may be the decision of the family, the sending organization, or the
government of their passport country. The family are often evacuated to
their passport country, though sometimes they are moved out of danger to a
nearby place. Evacuation as a form of ‘forced’ repatriation is associated with
65
much higher likelihood of difficulty in adjustment.

Recognizing Potential Risks in the area of Large

Scale Events
We included a multiple-choice question about larger-scale events that might
impact children growing up globally. We asked whether they were ‘exposed
to or directly impacted by’ the following before age 18:
1. Political violence or corruption
2. War or unrest
3. An environmental disaster (earthquake, tsunami, etc.)
4. Evacuation/seeking refuge due to any of these, or similar, reasons

Political Violence
Nearly half (47%) of the TCKs we surveyed reported being exposed to or
impacted by political violence or corruption. We received comments from
TCKs who considered the government corruption they encountered
(sometimes in the form of common, casual bribes) to be minor, and hardly
worth mentioning. That said, while the rate of physical abuse was slightly
lower for this group, rates for every other type of child maltreatment were
higher.

Overall, exposure to political violence and/or corruption was associated with

a small increase in high-risk ACE scores. The pattern of higher ACE scores
among those who spent less time abroad was striking here. 30% of those
who spent 6 or fewer years abroad had high risk ACEs, compared to 22% of
those who spent 10-15 years abroad, and only 8% of those who spent 16-18
years abroad.
65
 High Risk ACE Scores in TCKs exposed to Political Violence/Corruption

All 23%
0-3 yrs abroad 30%
Born before 1980 24.5%
4-9 yrs abroad 28%
Born after 1980 23%
10-15 yrs abroad 23%
Mission 22%
16-18 yrs abroad 7.5%
Non-Mission 25.5%

War
One-third (32%) of TCKs reported being exposed to or impacted by war or
unrest. This was associated with a small but consistent increase in rates of all
types of child maltreatment, as well as mental illness in and substance abuse
by household adults. In most cases, ACE factor rates were higher in those
impacted by war/unrest than for those impacted by political
violence/corruption.

Overall, 24% of TCKs impacted by war/unrest had a high-risk ACE score. The
impact of time abroad was less marked here, but still present; 29% of those
who spent 0-6 years abroad had a high-risk ACE score, compared to 19% of
those who spent 13-18 years abroad.

High Risk ACE Scores in TCKs exposed to War/Unrest

All 38%
0-3 yrs abroad* 26%
Born before 1980 43%
4-9 yrs abroad 27%
Born after 1980 35.5%
10-15 yrs abroad 25%
Mission 33%
16-18 yrs abroad 10%
Non-Mission 46%

Environmental Disaster
One-quarter (25%) of TCKs reported being exposed to or impacted by an
environmental disaster, such as an earthquake or tsunami. Child
maltreatment rates were higher again for this group than for the preceding
disaster groups. Over half (51%) of TCKs who experienced an environmental
disaster were emotionally abused, and 45% were emotionally neglected. 17%
were physically neglected; this rose to 20% of missionary kids. 31% were
sexually abused by an adult before age 18.

66
25% of TCKs impacted by environmental disasters had high-risk ACE scores.
This includes 23% of missionary kids and 30% of TCKs from other sectors.
Again, those who spent less time abroad were more likely to have high-risk
ACE scores: 31% of those who spent 0-6 years abroad, compared to 22% of
those who spent 13-18 years abroad.

High Risk ACE Scores in TCKs exposed to Environtmental Disaster

All 25%
0-3 yrs abroad 37%
Born before 1980 25%
4-9 yrs abroad 27%
Born after 1980 25.5%
10-15 yrs abroad 28%
Mission 22.5%
16-18 yrs abroad 13%
Non-Mission 30%

Evacuation
15% of TCKs were evacuated from their overseas home due to political
violence, war, environmental disasters, or other reasons during childhood.
The ACE scores and risk factors for this group were not greatly different from
those of TCKs overall with few exceptions, the most significant being the rate
of physical neglect. 18% of evacuated TCKs reported physical neglect,
compared to 10% of TCKs overall.

In addition, 45% of evacuated TCKs reported a mentally ill adult living in their
home, compared to 39% of TCKs overall. The rates of sexual abuse and
grooming were also higher, from 27% and 28% among TCKs generally, to
34% for both categories among those who experienced evacuation.

High Risk ACE Scores in TCKs who experienced Evacuation

All 22%
0-3 yrs abroad* 47%
Born before 1980 26%
4-9 yrs abroad 25%
Born after 1980 20%
10-15 yrs abroad 22%
Mission 20%
16-18 yrs abroad* 9%
Non-Mission 27%

67
 TCKs overall
Abuse among TCKs impacted by Political Violence
Environmental Disaster
Evacuation
Large Scale Events War
60%

40%

20%

0%
High Risk Physical Abuse Emotional Abuse Sexual Abuse Child-to-Child Grooming
ACE Score Sexual Abuse

Neglect and Household Dysfunction among TCKs impacted by Large

Scale Events
50%

40%

30%

20%

10%

0%
Physical Emotional Household Adult Parental Parental Household Adult
Neglect Neglect Mental Illness Violence Divorce Substance Abuse

Applying Effective Support in the area of Large

Scale Events
While outbreaks of political While outbreaks of political instability
instability and natural disasters and natural disasters are generally
are generally unavoidable, it is unavoidable, it is important to consider
important to consider them as we them as we triage families who need
triage families who need more more intentional support and care. In
intentional support and care. In general, large-scale events had less
general, large-scale events had impact on ACEs in TCKs than expe-
less impact on ACEs in TCKs than riencing or witnessing violence did.
experiencing or witnessing
violence did (witnessed violence will be discussed in the next section). This
was particularly true for missionary kids.
68
One theory as to why large scale events had less impact is that they were
more likely to be one-off events rather than a pattern of life in a particular
environment. They could absolutely be traumatic for the TCK but didn’t
contribute to additional ACE scores because the long-term political climate or
environment did not contribute to more abuse, neglect, or household
dysfunction.

Another theory is that these events are more commonly recognized as

trauma, so organizations are already triaging these situations and applying
care and support. This care and support would, in theory, prevent an increase
in ACE scores over time despite the traumatic nature of the event itself.

In order to apply effective support, organizations should flag locations known

to be at risk of difficult political climates or natural disasters. These locations
should be presented to families considering relocation as ‘higher risk’ along
with information on preventive
factors such as Positive Child- The Positive Childhood Experience
hood Experiences. The Positive related to a child’s need to feel safe
Childhood Experience related to a and protected should be highlighted,
child’s need to feel safe and pro- along with strategies for how to
tected should be highlighted, achieve this when living with
along with strategies for how to potential threat from the
achieve this when living with po-
environment – natural and/or
tential threat from the environ-
political – in which the family lives.
ment – natural and/or political –
in which the family lives.

In the event that a natural disaster does occur or the family is directly
impacted by the political climate, a debrief should take place. If any family
member is experiencing a trauma response due to the event, a crisis debrief
should be conducted. If there are no obvious trauma symptoms present, a
standard debrief should take place. Psychological First Aid Training is
66
recommended to learn to recognize symptoms of trauma.

69
Witnessed Events

The Impact of Witnessing Traumatic Events

In addition to asking TCKs what they had experienced, we also asked what
they had witnessed. Witnessed trauma has come up frequently in our
debriefs and other support work with TCKs (both children and adult TCKs) as
a source of stress and distress that required unpacking and processing.

Most of the events asked about in our survey involved some type of violence.
Existing research demonstrates that “witnessing violence can have an adverse
effect on children and adults.” In the67case of children, witnessing violence
changes their worldview and ability to trust their own safety; they may
68
“develop ‘pervasive pessimism’ or a ‘sense of foreshortened future’.”

“Chronic exposure to community violence can compromise children and

adolescents' health, cognitive functioning, and development.” 69 For this
reason, we asked survey participants both if they had ever witnessed each
type of traumatic event, and also if they had witnessed this type of traumatic
event regularly.

Recognizing Potential Risks in the area of

Witnessed Events
Our survey asked about exposure Of 1,904 Adult TCKs surveyed, 64%
to various types of violence, as well had witnessed extreme poverty, 37%
as extreme poverty and serious had witnessed a serious traffic
traffic accidents. The last aspect of accident, and 52% had witnessed
our Witnessed Trauma section was armed conflict, traumatic death, or
looking at when these events/ex- violence; three quarters of TCKs
periences occurred regularly, as (78%) witnessed at least one of these.
opposed to at all.

Of the 1,904 Adult TCKs surveyed, 64% had witnessed extreme poverty,
37% had witnessed a serious traffic accident, and 52% had witnessed armed
conflict, traumatic death, or violence; three-quarters of TCKs (78%)
witnessed at least one of these.
70
Witnessing extreme poverty did not have a significant impact on ACE scores,
while high-risk ACE scores were about one-third higher in TCKs who
witnessed serious traffic accidents. The risk was much greater for TCKs who
witnessed violent events, however.

Extreme Poverty
When asking about witnessing extreme poverty, we asked if they had been
exposed ever or if they had been regularly exposed to extreme poverty. Most
TCKs had witnessed extreme poverty (64% ever, and 47% regularly) but the
breakdown was very different by sector. Missionary kids were the most likely
to have witnessed extreme poverty (77% ever/61% regularly), followed by
Edu-NGO kids (69%/47%) and Diplomat kids (62%/50%). Even less exposed
to extreme poverty are business kids and military kids. Half of business kids
had witnessed extreme poverty during childhood (51%), but barely a quarter
of military kids had (27%); even fewer TCKs from these sectors regularly
witnessed extreme poverty (29% and 12%, respectively).

High Risk ACE Scores in TCKs who witnessed Extreme Poverty

All 20%
0-3 yrs abroad 30%
Born before 1980 23%
4-9 yrs abroad 23%
Born after 1980 19%
10-15 yrs abroad 20%
Mission 18%
16-18 yrs abroad 13%
Non-Mission 24%

High Risk ACE Scores in TCKs who regularly witnessed Extreme Poverty

All 21%
0-3 yrs abroad* 28%
Born before 1980 24%
4-9 yrs abroad 25%
Born after 1980 20%
10-15 yrs abroad 21%
Mission 20%
16-18 yrs abroad 13%
Non-Mission 24%

Witnessing extreme poverty was not associated with higher ACE scores in
TCKs overall. There was a slight increase in missionary kids, and a slight
decrease in those from non-missionary sectors. Most risk factors were similar

71
to those of TCKs overall, with slightly higher rates of all grooming and
household adult mental illness, and slightly higher rates of all types of sexual
abuse in those who reported regular exposure to extreme poverty.

Serious Traffic Accident

More than one-third of TCKs surveyed (37%) had witnessed a “serious traffic
accident,” and 8% said they regularly witnessed serious traffic accidents. The
risk of high ACE scores went up modestly for this group (around 25%-30%).

All types of sexual abuse (adult-to-child, child-to-child, and grooming) were

significant higher in TCKs who reported regularly witnessing serious traffic
accidents – regardless of their age or sector. Overall, 48% of TCKs who
regularly witnessed serious traffic accidents reported sexual abuse, 37%
reported child-to-child sexual abuse, and 48% reported grooming.

High Risk ACE Scores in TCKs who witnessed a Serious Traffic Accident

All 27%
0-3 yrs abroad 40%
Born before 1980 33%
4-9 yrs abroad 36%
Born after 1980 23%
10-15 yrs abroad 22%
Mission 21%
16-18 yrs abroad 19%
Non-Mission 35%

High Risk ACE Scores in TCKs who regularly witnessed Serious Traffic Accidents

All 26%
0-3 yrs abroad* 54%
Born before 1980 31%
4-9 yrs abroad* 41%
Born after 1980 24%
10-15 yrs abroad* 17%
Mission 23%
16-18 yrs abroad* 21%
Non-Mission 31%

War/Death/Violence
More than half of TCKs surveyed (52%) had witnessed armed conflict (two
groups fighting with weapons), traumatic death of a human or animal, or
physical violence (e.g. beating a person). 20% (one in five) said they regularly
witnessed such events.
72
 More than half of
29% of TCKs who had witnessed one of non-missionary TCKs who
these events, and 39% who witnessed regularly witnessed witnessed
armed conflict, traumatic death, or armed conflict, traumatic
physical violence regularly, had high-risk death, or physical violence
ACE scores – increases of 40% and 85% had a high-risk ACE score.
over the whole group of TCKs. The risk
increase was higher for non-missionary sectors, at 50% and 105%
respectively; more than half of non-missionary TCKs who regularly witnessed
armed conflict, traumatic death, or physical violence had a high-risk ACE
score.

Rates of emotional abuse were very high among TCKs who witnessed
violence: 53% overall, and 62% of those who regularly witnessed violence,
were emotionally abused in the home. Nearly three-quarters of non-
missionary TCKs who regularly witnessed violence (72%) were emotionally
abused in the home.

High Risk ACE Scores in TCKs who witnessed War/Death/Violence

All 29%
0-3 yrs abroad 44%
Born before 1980 33.5%
4-9 yrs abroad 35%
Born after 1980 26%
10-15 yrs abroad 25%
Mission 23%
16-18 yrs abroad 22%
Non-Mission 39%

High Risk ACE Scores in TCKs who regularly witnessed War/Death/Violence

All 23%
0-3 yrs abroad* 60%
Born before 1980 24.5%
4-9 yrs abroad 48%
Born after 1980 23%
10-15 yrs abroad 33%
Mission 22%
16-18 yrs abroad 34%
Non-Mission 25.5%

73
 Serious traffic accident, ever
TCKs overall
Abuse by Witnessed Events Extreme Poverty, ever Serious traffic accident, regularly
War/death/violence, ever
(1/3) Extreme Poverty, regularly
War/death/violence, regularly
75%

50%

25%

0%
High Risk Physical Abuse Emotional Abuse Sexual Abuse Child-to-Child Grooming
ACE Score Sexual Abuse

Neglect and Household Dysfunction by Witnessed Events (1/3)

60%

40%

20%

0%
Physical Emotional Household Adult Parental Parental Household Adult
Neglect Neglect Mental Illness Violence Divorce Substance Abuse

Physical Violence
One in three TCKs surveyed (31%) had witnessed physical violence (such as a
person being beaten), and 11% said they regularly witnessed physical
violence. The question wording did not specify where this violence was
witnessed, so family violence was included. In future surveys, we anticipate
separating the influence of family violence and violence witnessed outside
the home/family. In this case, however, there is an overlap with the ACE of
parental violence, with 12% of TCKs who witnessed physical violence (and
15% of those who witnessed it regularly) also reporting parental violence.
Notably, one-quarter of non-missionary TCKs who regularly witnessed
physical violence reported family violence (24%) and parental
separation/divorce (24%).

74
Adult TCKs who witnessed physical violence as children were much more
likely to have high-risk ACE scores, with 39% of the total group and 51% of
those who regularly witnessed physical violence reported 4+ ACEs. That is an
increased risk of 85% and 145%, respectively. The risk was greater for those
from non-missionary sectors, with 51% of this group, and 76% of those who
regularly witnessed physical violence, having high-risk ACE scores – risk rates
two and three times higher than non-missionary TCKs overall. Even with the
higher proportion of TCKs from this group reporting parental violence, these
numbers are high.

High Risk ACE Scores in TCKs who witnessed Physical Violence

All 39%
0-3 yrs abroad 51%
Born before 1980 46%
4-9 yrs abroad 47%
Born after 1980 35%
10-15 yrs abroad 36%
Mission 31%
16-18 yrs abroad 31%
Non-Mission 51%

High Risk ACE Scores in TCKs who regularly witnessed Physical Violence

All 51%
0-3 yrs abroad* 71%
Born before 1980 61%
4-9 yrs abroad 67%
Born after 1980 46%
10-15 yrs abroad 41%
Mission 39%
16-18 yrs abroad* 43%
Non-Mission 76%

From the entire group of TCKs who witnessed physical violence during
childhood, 35% were physically abused at home and 61% were emotionally
abused at home. 23% reported physical neglect – more than twice the rate
seen in TCKs overall. More than half reported emotional neglect and
household adult mental illness (54% and 53%, respectively).

Child maltreatment was the norm among TCKs who regularly witnessed
physical violence during childhood. Nearly half the group reported physical
abuse (48%) and sexual abuse (48%). Nearly two-thirds reported emotional
abuse (68%) and emotional neglect (63%). One-third reported physical
neglect (35%). Among non-missionary TCKs, household adult substance
abuse was quite high, with 35% of those surveyed reporting it.

75
Armed Conflict
Nearly one in five TCKs surveyed (17%) had witnessed armed conflict (two
groups fighting with weapons), and 5% said they regularly witnessed armed
conflict. There was an increase in high-risk ACE scores: 28% of TCKs who
witnessed armed conflict reported 4+ ACEs, with almost no difference by age
or sector. This means that missionary kids carried a much greater increased
risk – 65% vs 10% in non-missionary sectors. 34% of the smaller group of
TCKs who regularly witnessed armed conflict had a high-risk ACE score, an
increased risk of 60%.

High Risk ACE Scores in TCKs who witnessed Armed Conflict

Regularly witnessed Armed Conflict 34%
(group too small to subdivide further)

Any human death 28%

0-3 yrs abroad* 38%
Born before 1980 29%
4-9 yrs abroad 32%
Born after 1980 28%
10-15 yrs abroad 27%
Mission 28%
16-18 yrs abroad 17%
Non-Mission 29%

Certain risk factors increased at a higher rate that was to be expected, given
the overall increase in high-risk ACE scores was only about 10%. More than a
quarter of TCKs who witnessed armed conflict during childhood also
reported being physically abused at home, an increase of 40% from the
overall TCK population. There was a distinct difference here by age, with
physical abuse experienced by 37% of those born before 1980, and 20% of
those born after 1980.

Sexual abuse was also quite high in this group. 41% of TCKs who witnessed
armed conflict reported sexual abuse, 35% reported child-to-child sexual
abuse, and 40% reported grooming – an increased risk of 30%-50%. This
group also reported physical neglect at nearly twice the rate of TCKs overall
(19% vs 10%).

One-third of TCKs who regularly witnessed armed conflict (33%) experienced

physical abuse in the home – a 75% increase in risk. More than a quarter
(27%) reported physical neglect, an increased risk of 170% when compared
to TCKs overall.
76
 TCKs overall
Abuse by Witnessed Physical Violence, ever
Armed Conflict, ever

Events (2/3) Physical Violence, regularly

Armed Conflict, regularly

75%

50%

25%

0%
High Risk Physical Abuse Emotional Abuse Sexual Abuse Child-to-Child Grooming
ACE Score Sexual Abuse

Neglect and Household Dysfunction by Witnessed Events (2/3)

75%

50%

25%

0%
Physical Emotional Household Adult Parental Parental Household Adult
Neglect Neglect Mental Illness Violence Divorce Substance Abuse

Traumatic Death (Human)

One in five TCKs surveyed (19%) had witnessed traumatic human death
(including 3% who specified having witnessed a murder), and 3% said they
regularly witnessed traumatic human death. (‘Human’ death is specified, as
we also asked about witnessing the death of animals, which will be discussed
next.)

We also collected data for those who reported they regularly witnessed any
(human) death, that they did not necessarily categorize as traumatic. There
were several reasons for the decision to add this extra category. First, we
wanted to leave space for death that, while sad, is well processed and not
experienced as traumatic. Second, we wanted to leave space for individuals
for whom witnessing death during childhood was normalized to the point of
not recognizing it as a trauma they had experienced.

77
TCKs who reported witnessing a traumatic death had higher ACE scores than
TCKs overall, with 30% recording 4+ ACEs – a 45% risk increase. For
missionary kids, the risk increased 65%. TCKs who regularly witnessed death
(whether or not they considered this traumatic) had higher risk, with 32%
recording 4+ ACEs – a 50% risk increase. Again, the risk increased more for
missionary kids (90% increase). The 3% of TCKs who reported regularly
witnessing traumatic death had the higher level of risk, with 37% recording
4+ ACEs – a 75% risk increase.

High Risk ACE Scores in TCKs who witnessed Traumatic Human Death

All 30%
0-3 yrs abroad* 38%
Born before 1980 32%
4-9 yrs abroad 34%
Born after 1980 28%
10-15 yrs abroad 28%
Mission 28%
16-18 yrs abroad* 21%
Non-Mission 33%

High Risk ACE Scores in TCKs who regularly witnessed Human Death
Traumatic human death 37%
(group too small to subdivide further)

Any human death 32%

0-3 yrs abroad* 53%
Born before 1980 36%
4-9 yrs abroad* 29%
Born after 1980 29%
10-15 yrs abroad* 36%
Mission 33%
16-18 yrs abroad* 25%
Non-Mission* 35%

In TCKs who reported witnessing a traumatic death, the risk increase for
most factors was similar to the overall 30% increase seen in ACE scores. The
exception was sexual abuse and grooming, which were reported at 35% and
42% respectively. More than half of TCKs who had witnessed a traumatic
death (52%) were emotionally abused at home, and half (50%) reported
emotional neglect.

TCKs who regularly witnessed any kind of human death also had higher risk
for all forms for child maltreatment, including higher rates of sexual abuse
than would be expected. Nearly half (45%) reported sexual abuse, and 49%
reported grooming, an increased risk of about 70%. More than half (59%)
were emotionally abused at home – more than was seen even in TCKs who

78
regularly witnessed traumatic death.

Nearly half of TCKs who regularly witnessed traumatic death (48%) were
physically abused at home, and 35% reported physical neglect – both at a
higher risk increase than overall ACE scores. More than half were emotionally
abused at home (56%), experienced emotional neglect (60%) and reported
household adult mental illness (58%). More than half were sexually abused
(56%), with child-to-child sexual abuse at (56%) and grooming at (58%).

Traumatic Animal Death

We added a question about animal death to the survey as we found in our
work with TCKs that, when they experience animal death, it was often
unprocessed trauma that required debriefing. We specified “traumatic”
animal death, as some animal death is not experienced as traumatic, for
example, when growing up in an area where animals are typically slaughtered
for meat. More than one-quarter of TCKs surveyed (28%) reported
witnessing traumatic animal death, and 8% said this happened regularly.

High Risk ACE Scores in TCKs who witnessed Traumatic Animal Death

All 30%
0-3 yrs abroad* 39%
Born before 1980 33%
4-9 yrs abroad 38%
Born after 1980 29%
10-15 yrs abroad 29%
Mission 24%
16-18 yrs abroad 24%
Non-Mission 42%

High Risk ACE Scores in TCKs who regularly witnessed Traumatic Animal Death

All 36%
0-3 yrs abroad* 50%
Born before 1980 41%
4-9 yrs abroad 43%
Born after 1980 33%
10-15 yrs abroad* 32%
Mission 33%
16-18 yrs abroad* 35%
Non-Mission* 45%

The increased risk associated with witnessing traumatic animal death was
similar to that of witnessing traumatic human death. In both cases, 30% of
TCKs who ever witnessed traumatic death (human or animal) had a high-risk

79
 ACE score. Over a third of TCKs who regularly witnessed traumatic animal
death (36%) had a high-risk ACE score, very similar to those who regularly
witnessed traumatic human death (37%). For missionary kids, regularly
witnessing traumatic animal death was associated with a doubled risk of 4+
ACEs (from 17% to 33%).
TCKs overall Traumatic human death, regularly
Abuse by Witnessed Traumatic human death, ever Traumatic Animal death, ever
Events (3/3) Any human death, regularly Traumatic Animal death, regularly

60%

40%

20%

0%
High Risk Physical Abuse Emotional Abuse Sexual Abuse Child-to-Child Grooming
ACE Score Sexual Abuse

Neglect and Household Dysfunction by Witnessed Events (3/3)

75%

50%

25%

0%
Physical Emotional Household Adult Parental Parental Household Adult
Neglect Neglect Mental Illness Violence Divorce Substance Abuse

Applying Effective Support in the area of

Witnessed Events
When it comes to witnessing trauma, we see again – as we did with other
categories – the toll that living in these contexts takes on the whole family.
Children have high ACEs because the adults living with them have not
adequately met their physical/emotional needs. In the context of the Adult

80
TCKs we surveyed, high rates of Household Adult Mental Illness combined
with low rates of other types of household dysfunction suggest that most of
these parents are providing good homes but struggle to manage the stressful
context in which they live.

The category of witnessed trauma is noteworthy as there is a common

assumption that a person can only be traumatized by events that occur to
them directly. In actuality we see a huge impact in people who have
witnessed trauma.

The types of incidents itemized in this section can form a useful list of red
flags to help evaluate the stress impact of an environment while determining
or evaluating field suitability. Where these
events are being witnessed by children, The stress of bearing witness
they are probably also being witnessed by to trauma is easily brought
their parents. The stress of bearing witness into the home, impacting
to trauma is easily brought into the home, family dynamics and parent-
impacting family dynamics and parent-child child connectedness.
connectedness.

When families are living in such contexts it is vital to provide them with
regular debriefing. This should include crisis debriefing after witnessing
traumatic events, annual debriefs, and full debriefs every 3-4 years.

Questions that may help caregivers get to the heart of witnessed trauma
include:
Have you ever seen someone get really hurt?
Have you ever seen someone hurting someone else?
Have you ever been afraid someone would get hurt?
Have you ever seen a person or an animal die?
Has anyone made you feel uncomfortable?

These questions – direct and stative without graphic details – can give
children an opportunity to recall and share any such incidents during annual
debriefs. In addition, parents should be empowered to communicate to their
children that if they see anything scary or frightening, they should tell their
parents right away. Parents should also be trained on how to respond to such

81
disclosures using safe space responses (acknowledging, affirming, and
comforting) and reaching out for crisis debriefing.

When No Potential Trauma was Reported

The Other Side of the Data

Throughout part two of this paper, we have presented data and the potential
risks gathered by asking TCKs about traumas they experienced and
witnessed. What about the TCKs who said they did not go through the
traumas we have discussed? We conclude this presentation of our research
with an entire section devoted to the ACE scores of the ‘other’ TCKs – those
who did not experience these traumas.

No Medical or Violent Events

Only 26% of TCKs reported no medical events, no violent events, and no
other intense moments of grief or fear. The results among this group of 396
individuals, however, were astounding to us. Only 10% had a high-risk ACE
score. That is less than half the rate seen in TCKs overall, 20% less than seen
in the CDC-Kaiser study of Americans, and on par with non-TCK studies
around the world. The impact was even greater on missionary kids, with only
4% having a high-risk ACE score – about one-quarter of the rate of
missionary kids overall.

High mobility was correlated with higher ACE scores in this group, though
more strongly correlated with house moves than location moves, especially in
comparison to TCKs overall. Among TCKs who reported no medical/violent
events, 15% of those with 10+ house moves had high ACEs and 29% of those
with 15+ house moves had high ACEs. This compares to 26% of TCKs overall
with 10+ house moves who had high ACEs and 33% of those with 15+ house
moves who had high ACEs. Since we see
high ACEs present in this low-risk group this demon- Mobility is in
strates that mobility is in itself a risk factor for high itself a risk
ACEs in TCKs. factor for high
ACEs in TCKs.
82
TCKs who reported no medical/violent events were also much less likely to
report physical neglect, at only 3% regardless of sector (this represents an
80% decrease in the missionary sector). Rates of emotional abuse and
emotional neglect did not drop as much as ACEs overall. One-quarter of this
group reported emotional neglect, and 31% were emotionally abused by an
adult at home – 2.5 and 3 times the rate seen in the CDC study, respectively.

High Risk ACE Scores in TCKs who experienced No Medical/Violent Events

All 10%
0-3 yrs abroad 10%
Born before 1980 11%
4-9 yrs abroad 13%
Born after 1980 9%
10-15 yrs abroad 8%
Mission 4%
16-18 yrs abroad 7%
Non-Mission 13%

Not Impacted by Disaster

When no large-scale/disaster events occurred during a TCK’s childhood,
which was true for 36% of the TCKs surveyed, their risk factors were lower.
This effect was most prominent among missionary kids. 18% of TCKs who
did not experience disaster had high-risk ACE scores, compared to 21% of all
TCKs. While 17% of missionary kids overall had high-risk ACE scores, among
those who did not experience disaster only 8% had a high-risk ACE score.
That is on par with (or lower than) the rate of high-risk ACE scores seen in
non-TCK studies.

All types of child sexual abuse were lower, at 22% across the board rather
than 26%-28% overall. Emotional neglect was 35% instead of 39%.
Household adult mental illness dropped from 39% overall to 32% among
TCKs with no experience of disaster events.

High Risk ACE Scores in TCKs who were Not Impacted by Disaster

All 18%
0-3 yrs abroad 24%
Born before 1980 20%
4-9 yrs abroad 19%
Born after 1980 16%
10-15 yrs abroad 12.5%
Mission 8%
16-18 yrs abroad 24%
Non-Mission 26%

83
Did Not Regularly Witness Traumatic Events
Nearly half of the TCKs we surveyed (47%) did not regularly witness
traumatic events during childhood. Of this group, 17% had high-risk ACE
scores – a risk reduction of 20%. The risk reduction changed by sector,
however. Only 9% of missionary TCKs who did not regularly witness
traumatic events had a high-risk ACE score, halving their risk rate and
bringing it in line with various worldwide studies. For TCKs from other
sectors, the risk fell about 15%, with 22% of this group recording 4+ ACEs.

Physical neglect dropped to only 6% among TCKs who did not regularly
witness traumatic events, lower than rates seen in the US. Sexual abuse was
reported by 22% of TCKs, and 15% were physically abused. All factors were
under 40% of the group, including the three most commonly reported:
emotional abuse (39%), emotional neglect (36%), and household adult mental
illness (34%).

High Risk ACE Scores in TCKs who did Not Regularly Witness Traumatic Events

All 17%
0-3 yrs abroad 23%
Born before 1980 17%
4-9 yrs abroad 18%
Born after 1980 17%
10-15 yrs abroad 15%
Mission 9%
16-18 yrs abroad 10%
Non-Mission 22%

Did Not Witness Any Traumatic Events

About 1 in 5 of the TCKs we surveyed (22%) did not witness any traumatic
events during childhood, and only 12% of this group had high-risk ACE
scores. For missionary kids the rate was even lower, with only 6% recording
4+ ACEs – a 65% risk reduction; among TCKs from other sectors, the risk
decreased by 55%.

Physical neglect was only reported by 3% of this group. Emotional neglect

and household adult mental illness were both under 30%. Emotional abuse
decreased to 34%, and physical abuse to 13%.

84
 High Risk ACE Scores in TCKs who did Not Witness Traumatic Events

All 12%
0-3 yrs abroad 14.5%
Born before 1980 10%
4-9 yrs abroad 15%
Born after 1980 14%
10-15 yrs abroad 11%
Mission 6%
16-18 yrs abroad 0%
Non-Mission 12%

No Traumatic Events
All the sources of the traumatic events we asked about corresponded with
higher ACE scores. 6% of respondents reported none of these: no medical
events, no violent events, no disaster/large scale events, and no witnessed
trauma. Only 7% of this group had a high risk ACE score.

Only 8% of TCKs with no exposure to High Risk ACE Scores in TCKs

these traumatic events experienced reporting No Traumatic Events
(group too small to subdivide further)
physical abuse in the home, 25% experi-
All 7%
enced emotional abuse in the home, and
Born before 1980 6%
23% reported emotional neglect – a de-
Born after 1980 8%
creased risk of 40% compared to TCKs
Mission* 0%
overall. Only 3% reported physical ne-
Non-Mission 10%
glect. 13%-15% reported child sexual
abuse and grooming, and only 17% reported household adult mental illness –
half the rate of TCKs overall, and lower than reported by Americans (19%).

Even we were shocked by the huge

differences seen in TCKs who were not
exposed to these types of traumas. These
numbers demonstrate how great the impact
of violence is on international families.
Regardless of whether this violence was
experienced firsthand, witnessed, or it
happened in the community, the impact of
violence cannot be understated.

85
 Did not regularly witness
TCKs overall
Abuse When Potential traumatic events
No Medical/Violent Events Witnessed no traumatic
Trauma was Not Reported Not Impacted by Disaster events
No trauma events
50%

40%

30%

20%

10%

0%
High Risk Physical Abuse Sexual Abuse Child-to-Child
Emotional Abuse Grooming
ACE Score Sexual Abuse

Neglect and Household Dysfunction When Potential Trauma was

Reported
40%

30%

20%

10%

0%
Physical Emotional Household Adult Parental Parental Household Adult
Neglect Neglect Mental Illness Violence Divorce Substance Abuse

Applying Effective Support in the area of

Traumatic Events
While we hypothesized that there would be a connection between exposure
to traumatic events and high-risk ACE scores, even we were shocked by the
huge differences seen in TCKs who were not exposed to these types of
traumas. These numbers demonstrate how great the impact of violence is on
international families. Regardless of whether this violence was experienced
firsthand, witnessed, or it happened in the community, the impact of violence
cannot be understated.

Placing families based on field suitability is an invaluable prevention tool to

keep TCK families in contexts that will allow them to thrive in their work. The

86
 The drastic risk decrease in TCKs
stress of violent contexts is
who did not live in violent contexts
counter-productive to field
illustrates how the expatriate lifestyle is
longevity, workplace perfor-
mance, overall return-on- not in contradiction with a healthy
investment, and – most im- family life. TCK families can lead healthy
portantly – holistic family lives and have fruitful work in locations
health. The drastic risk with a lower risk of witnessing or
decrease in TCKs who did not experiencing violence or trauma.
live in violent contexts illu-
strates how the expatriate
lifestyle is not in contradiction with a healthy family life. TCK families can
lead healthy lives and have fruitful work in locations with a lower risk of
witnessing or experiencing violence or trauma.

It is however noteworthy that while ACEs overall experienced a sharp

decline, the decline in emotional abuse and neglect was less dramatic. This
reveals that emotional abuse and neglect may be culturally normalized within
international communities, and intentional education is required to help
families identify these harmful behaviors and choose to parent in different
ways that better support their children’s emotional needs.

We also need to remember the impact of high mobility on TCK families

regardless of whether they’ve experienced the traumas listed in this paper.
High house and location moves are associated with increased risk of high
ACEs in both TCKs who reported traumas and those who did not.

Families who move frequently and have experienced trauma are in more
urgent need of access to crisis debriefs and regularly scheduled debriefs.
Families who have not experienced these traumas and who do not move
frequently still need regular debriefing in order to have an opportunity to
process their TCK experience in a structured way. When working in contexts
with limited resources it is recommended that families who have experienced
trauma and/or high mobility receive first priority annual debriefing. Every
family should be debriefed no less frequently than every 3-4 years.

87
 A Vision for Well Supported Families

The data we discussed in this paper can feel heavy and even discouraging at
times. Realizing how many TCKs have experienced and witnessed such a
wide range of traumas, and seeing the correlation between these experiences
and the child maltreatment they also experienced, is sobering. Yet there is
hope! Our desire is that this data
will lead to more robust care for
Our desire is that this data will lead
international families, so that un-
to more robust care for international
necessary trauma can be avoided,
families, so that unnecessary trauma
unexpected traumas are dealt with
appropriately, and difficult experi-
can be avoided, unexpected traumas
ences do not necessarily lead to are dealt with appropriately, and
high ACEs. difficult experiences do not
necessarily lead to high ACEs.
Given the strong link between en-
vironmental traumas, especially community violence, and high ACE scores, it
is important that the risk factor of these events be considered when
assessing a location’s suitability. TCKs who were not impacted by these
traumas demonstrate that a healthy TCK experience can and does happen!

We may assume an increased level of stressful events is to be expected while

living in an international context, but this does not mean that they should be
considered normal – nor
should they be normalized.
We may assume an increased level of Instead, we need to
stressful events is to be expected while recognize these stressful
living in an international context, but this events as threats to the
does not mean that should be considered mental health and stability
normal – nor should it be normalized. of international families.
Instead, we need to recognize these When we recognize them
stressful events as threats to the mental as such, we can mobilize
health and stability of international families. to acknowledge and
debrief these events.

88
Parents under stress need support to care for their children’s emotional
needs. When the environment the family lives in adds additional stressors,
and especially if those stressors include traumatic events, that support must
be robust and easily accessed – preferably as part of a built-in support
structure provided for them by the sending organization that placed them in
their location.

Effective support for international families should include an awareness of

their risk factors and any potentially traumatic experiences so a care plan can
be adapted to their specific needs. A ‘one-size-fits-all’ approach does not
work, especially when trauma is involved.

We believe that when proactive and We believe that when

effective pre-departure education, proactive and effective
preventive care, and on-going sup- pre-departure education,
port are deployed by sending agen-
preventive care, and on-going
cies, we will see healthy international
support are deployed by sending
families long term.
agencies, we will see healthy
international families long term.

89
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