Preventing Child Abuse During a Pandemic – PediaCast 461
- Child abuse and neglect occur even as families stay home. And yet reports of abuse are down because teachers, medical providers and community partners have less contact with the families they serve. Dr Kristin Crichton and Becca Fredin explore the problem and provide tips for supporting families and preventing child abuse during these difficult days. We hope you can join us!
- Child Abuse and Neglect
- COVID-19 Pandemic
Resources for Providers in Central Ohio
- To report a concern for child abuse or neglect, contact ODJFS: 1-855-OH-CHILD
- Child Assessment Team is available 24/7 through Physician Direct Connect (PCTC): 614-355-0221
- The Center for Family Safety and Healing: 614-722-8200
- Childhelp National Child Abuse Hotline: 1-800-4-A-CHILD
- Please note any concern for child abuse MUST be reported to LOCAL child protective services.
- National Sexual Assault Hotline: 1-800-656-HOPE
- Online Chat Service: www.rainn.org
- National Parent Helpline: 1-855-4A-PARENT
- for emotional support from a trained Advocate to empower and strengthen parents.
Announcer 1: This is PediaCast.
Announcer 1: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone. And welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from Nationwide Children's Hospital.
It's Episode 461 for May 7th, 2020. We're calling this one "Preventing Child Abuse During A Pandemic". I want to welcome all of you to the program.
Child abuse is a really serious topic and something that we're always concerned about. We want to make sure that kids are safe and healthy. And home safety, and safety in their neighborhoods and schools, and wherever they are is going to be really important to us. And so, the issue of child abuse and neglect and non-accidental trauma, although they're serious, they're also important things to talk about.
And during a pandemic, when stress is high and folks are together inside the home, there's not really as much interaction with adults who would be considered mandated reporters outside of the home like teachers, and medical providers, coaches, people who are seeing what's going on with kids and then able to intervene when trouble is suspected.
So it really has kind of a perfect storm right now with kids being sort of cooped up with their family and also a lack of accountability in terms of what would normally get reported. And so, we would expect there to be sort of more incidence of abuse and neglect during a pandemic where everyone is staying at home and yet less of an opportunity to report those events.
So, we're going to talk about it, but really, not just abuse itself, but how do you prevent this? What can we do within our homes, within maybe with our own kids because no one wakes up in the morning thinking I'm going to abuse a child today. It happens. And there are some things that you can do to prevent it from happening. So we'll talk about that in your own homes.
And then, if you are someone who knows a family with children at home, maybe you are social distancing from them but you still are in contact, or maybe you are a teacher or a medical provider, or someone who is having contact with kids, how can you still sort of intervene when you think that abuse and neglect may be going on? So important thing to talk about, not the most fun thing, but it's still very important to think about these things and to prevent child abuse and neglect wherever we can.
Also, it is the time of the year, it is May, and at least here in Ohio in the Midwest, this is when grass and tree pollen season start. And you know the symptoms especially if you suffer from this every spring. It comes around this time of the year, you get the congestion, the runny nose, the watery itchy eyes, itchiness in the nose itself, headache, scratchy throat, a little bit of a cough, not sleeping really well, and then sort of grumpy and having difficulty concentrating the next day, all goes along with allergies.
And of course, with COVID out there and the symptoms of allergies, some of them sort of overlap, having a little congestion, a little cough. However, with viral and bacterial infections, often we see fever. Whereas with allergies, springtime allergies you would not expect fever to be a part of those symptoms.
So, if your child does have a fever, 100.4 degrees Fahrenheit or higher, so definition of the fever, make sure you light your child's medical provider know about that.
The other thing that differentiates spring allergies from a viral infections like COVID, if you do have nasal congestion with a virus, it tends to get a little thicker, a little bit darker in color. Whether it's yellows or greens, doesn't really matter so much. But with allergies, it tends to be more of a thin and clear drainage, that's something to think about as well.
Treatment of spring allergies, just a reminder. First, just try to avoid allergens whenever you can, so the grass and tree pollens. Pay attention if you do suffer from these, make sure you pay attention to the pollens counts in your area.
And stay indoors when you can when the pollens counts are high. Although, it's also good to get outside since we have been in our homes for so long. We still want to distance from one another, but it is good to get outside and to exercise and play and get some fresh air, get a little sunshine.
All important things and so we may have a bit more tolerance this spring to being exposed to those allergens and pollens because you do want to get outside.
However, when you come back in, especially you've been out for a while. Good idea would be to take a quick shower. Just rinse the pollens and other allergens off of your skin and change your clothes so that we can still try to avoid exposure to these allergens once we come back inside.
And then, first line treatments are going to be those nasal steroids, things like fluticasone or Flonase is a brand name and there are others. That's really going to help with the inflammation in the upper airway, all that congestion, helps to clear that. It does take a few days to really get going and working. This does not provide immediate relief.
And then, the non-drowsy antihistamine things like cetirizine or Zyrtec is a brand name and there are many others. And the generics of all of these are going to be fine. That in particular helps the itchiness and the itchy watery eyes. It might help the congestion a little bit, but mostly, the itchy sensation is what it's going to help you with the most.
And then, if those first line treatments are not helping, allergen avoidance, the nasal steroid, the antihistamines, and obviously during all of these, check in with your child's doctor. Let them know what symptoms they're having, what you're doing for them, get their advice, always important. And then, when the first-line stuffs not working, might be time to see an allergist that has medical practices open back up. They can do testing to see what it is exactly that you're allergic to, what to avoid.
And those allergists, boy, they're tricky. They have more medicines up their sleeves that they can use that are a little bit more complex and tailored to specific individuals. So be sure if things aren't going well for you, you don't have to suffer from allergy symptoms. Get in to see the allergists, so they can take good care of you.
All right, we have been covering lots of information about the current global pandemic. And you can find all of our past episodes wherever you listen to podcasts. Please do subscribe so you have ready access to all of those. But we've talked about mental fitness during a pandemic, physical fitness during a pandemic, and academic fitness during COVID.
So, we want to really take care of ourselves, mentally, physically. And then for kids, also academically, as school is still important even as we stay at home. And today, we are going to expand on all of these topics and talk about child abuse during a pandemic and how to prevent that.
Again, not an easy topic to talk about, it's really important to consider this, though. And I have a couple of really terrific guests as we sort through preventing child abuse. Dr. Kristin Crichton is a pediatrician and child abuse expert with the Center for Family Safety and Healing here at Nationwide Children's Hospital. And Becca Fredin is a licensed clinical social worker and program coordinator of the Child Protection Program at Nationwide Children's.
Before we get to them, I do want to remind you, you can find PediaCast wherever podcasts are found. We are in the Apple and Google Podcasts apps, iHeart Radio, Spotify, SoundCloud and most podcast apps for iOS and Android. If you like what you hear, please remember to subscribe to our show so you don't miss an episode.
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Also, I want to remind you, the information presented in each one of our episodes is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to consult his or her pediatrician or other healthcare provider.
So, let's take a quick break. We'll get our experts connected to the studio and then we will be back to talk about the prevention of child abuse during a pandemic. That's coming up right after this.
Dr. Mike Patrick: Dr. Kristin Crichton is a pediatrician and child abuse expert with Nationwide Children's Hospital and the Center for Family Safety and Healing. She's also an assistant professor of Pediatrics at the Ohio State University College of Medicine. Becca Fredin is a licensed clinical social worker and program coordinator for our institution's Child Protection Program.
They're here to talk about preventing child abuse during a pandemic. So, let's give a warm PediaCast welcome to our guests. Thanks so much for being here today.
Becca Fredin: Thanks for having us.
Dr. Kristin Crichton: Thank you.
Dr. Mike Patrick: Really appreciate you taking time to stop by. Kristin, let's start with you. Kind of define for us what we mean by child abuse. We also hear about child neglect. In the medical field, we talk about non-accidental trauma. What do these terms mean?
Dr. Kristin Crichton: Absolutely. So there's various definitions for physical child abuse existing depending on the source. The Federal Child Abuse Prevention and Treatment Act, also known as CAPTA, really can give us some minimum standard to the state, every state, for defining child maltreatment. And then, each state defines child physical abuse within its own laws.
CAPTA states that, I'm going to quote this directly, "Child abuse is any recent act or failure to act on the part of the parent or caretaker which results in deaths, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm."
And then, state laws are defining physical abuse very widely and often include vague terms like risk of harm, substantial harm, or reasonable discipline that are really not very well defined.
Locally, in Ohio, the Ohio Revised Code, which is what we go by, defines an abuse child as any child who, I'm going to quote again "exhibit evidence of any physical or mental injury or death inflicted other than by accidental means, or an injury or death which is at variance with the history given of it."
The Ohio Revised Code also states that that any child who because of acts of his parents, guardian or custodian suffers physical or mental injury that harms or threaten to harm the child health or welfare. So the definition definitely leaves some room for interpretation by medical providers, Child Protective Services, law enforcement and all other agencies and persons involved.
But in general, we think child abuse is a crime when a child has an injury that occurred through a non-accidental mechanism, which is why in medical terms, we often use to phrase non-accidental trauma.
One other thing we always want to think about is corporal punishment or spanking, which is legal in the US and certainly is not a reportable event. But we would not expect physical discipliners to need a persistent mark like a bruise on a child.
And then, with regard to neglect, the Ohio Revised Code defines a neglected child as any child who's abandoned by her caregiver or who lacks adequate parental care because of the faults or habits of the caregiver or whose caregiver neglects the child or refuses to provide proper or necessary food, education, medical care or other care necessary for the child.
So there are lots of different forms of neglect. And it is important to note that neglect is by far the most commonly reported form of child maltreatment to Children's Services, at about 70% of the reports.
Dr. Mike Patrick: When child neglect and abuse and non-accidental trauma occur, it's usually hidden. It's not usually out in public for people to actually see the event. Becca, kind of walk us through how this sort of concerns come to light. How are they typically identified, reported, and then investigated?
Becca Fredin: Absolutely. So a lot of times, it's an adult in the child's life who notices something first. So it might be an aunt or an uncle, maybe it's a friend's parent, a teacher, a boy scout leader. And because they know the child well, they might say "Hey, this kid isn't engaging the way they usually do." Or, "They're acting out in some way."
And they start to realize something's going on. Maybe they see that there's unexplained marks on the child. And so, eventually, someone will identify and then report that concern.
There are also certain professionals, teachers, counselors, medical providers, so those folks are mandated reporters. Meaning that by law, they need to report any concern like this to Children Services as part of their licensure. That said, anybody can make that call. So if anyone is concerned, they should be making a call at Children Services.
Dr. Mike Patrick: And when you make that call, you're not guaranteeing that the child was neglected or abused. You're just saying, "Hey, someone needs to look into this because there's a concern."
Becca Fredin: And it's not that you're trying to get a family in trouble. It's that you're worried about a child's safety and you just want to make sure that they're okay. So when Children Services gets that call, they go through an algorithm to decide what to do with that report. So sometimes, they may say "This is concerning but it's not enough that we're going to actually open a case." So they retain that in their records, but they don't take any kind of action.
Whereas other times, there's sort of two tracks that they can take. And one would be an alternative response where they will make contact with the family in the next several days. And that could be a phone call or that could be a visit to the house to kind of understand what's going on.
Alternatively, or otherwise, they might take what's called a traditional track and start a formal investigation. And that would mean making contact with the family within 24 hours, needing to actually see that child, see physically that they're okay and kind of take it from there.
Dr. Mike Patrick: Once they do their investigation, what are some of the possible outcomes that can follow?
Becca Fredin: Sure. So there's a couple of different outcomes. And just in the course of investigation, to give a little context, they don't just talk to the family, or not just the parents. They'll talk to other people who know the child. If medical providers are involved, they'll talk to those folks. To teachers, to try to get that full context.
So when they have all that information, they can come up with a couple of different results. And one of them could be that they go through this process and there are no findings. They say, "You know, these concerns are not merited, we're going to close the case."
Another possibility is that they identify concerns, they identify that the child may not be fully safe in this situation, but that the family is willing to team up with Children Services to come up with what's called the Safety Plan. And so, that's a voluntary contract that family engages with CPS, with Children Services. And they sign a document saying I'm going to do A, B, and C to help keep my child safe, to help get us back on track.
And that could mean that someone, a trusted family member is coming into the home and living with them to really help keep an eye on things. Or that the child may be going to stay with someone, often a relative for a while, while parents continue to have contact with them and work on kind of getting back on track.
And the thing with the Safety Plan is that the parents retain guardianship of their child. They are still the person who consents for medical treatment, things like that. But the final possibility here is, sometimes, the family just isn't able to do that safety planning at the moment. And those are the cases when Children Services may believe that foster care is needed for a while.
And I say for a while because Children's Services, their goal is always to reunify a family whenever it's safe or possible to do so. So when they place a child in foster care, it's with the goal of reunifying them by working with the family that whole time to try to help them get where they need to be. So if they believe foster care is necessary, they're going to bring this concern before a judge who would decide whether the county should take custody. Meaning, that when a child is in foster care, the county has custody in it. It's the county who's consenting to various things like medical decisions.
Dr. Mike Patrick: And when we take that information in the context of what Kristin was saying that like 70% of cases are neglect. In the case of neglect, oftentimes, there are services that just aren't being met or needs that aren't being met. So I mean, it may be that there's food scarcity or maybe a parent has to work and be out of the home. There's lack of supervision. I mean, it's not always that parent is willfully neglecting their child.
And oftentimes, what child protective agencies can do is help to link that family up with resources that they may not have even known was available that could help them care for their child in a better way. And often, those families, at first, you have that defense like "Oh, I got reported to Children Services and this is a terrible thing." But then when kind of walk the path, I'm sure that some of those families are grateful for the assistance that they find out was available they didn't know existed. Is that an accurate statement, you think?
Becca Fredin: Yeah, yeah. I think we know anytime a report is made, it is a traumatic event to the family, and we recognize that it is. But absolutely, there are times that they're just needing to get that extra help and they're getting linked to things like food or rent assistance, things like that.
So I think the Children Services does try to take that holistic look at what's going on with the family's life. Like you said, if those basic needs are not being met, it's so hard to cope with all the stresses that go on top of that.
Dr. Mike Patrick: Yeah, and for families and friends who may be thinking about reporting someone, again, you really have the family's best interest in mind in terms of trying to ensure the safety and that the needs of children are met and to help that family. But then that, of course, can create stress and maybe conflict between you and that family.
But does your involvement in that remain anonymous when you make the report or is the family going to find out who did it?
Becca Fredin: That's a great question. From Child Services perspective, the person who makes the report does remain anonymous. That said, if we're making a report at Nationwide Children's, we always let the family know that we're doing it. It's so important on our end as a caregiver and as a medical provider that we really team with the family and be transparent.
It's fair to them that they understand what our concerns are so that we can truly work with them through all of this. And it's also, I mean, beyond just being in their best interest, it's also in ours. We know that the child is going to return to their parents if they're for some reason removed from care.
And we want to look at the long term and see what we can do to help this family throughout everything that they're dealing with. And I think as part of that, if we're telling them about the report and telling them that we made it, it's also an opportunity to really answer their questions and help them understand what to anticipate. Because I think one of the scariest things is just not understanding what's going to happen next or how the system works. So it's really this opportunity to help talk to them about what this process could look like.
Dr. Mike Patrick: Yeah, absolutely. And as mandated reporters, of course, we want to be transparent and let people know what we're doing it and why we're doing it. But the family and friends, it's not as easy for them when they're not mandated reporters and you have this relationship that's going to persist long past this event, and you want to maintain those relationships. That can be tricky because you also want to be transparent in your relationship. That's a difficult line to walk, for sure.
Dr. Crichton, what would we expect the trends of neglect and abuse to be during a pandemic?
Dr. Kristin Crichton: Yeah, so the pandemic that we're all currently experiencing and the necessary isolation that we're all kind of committing to in efforts to social distance and kind of flatten the curve, as we're being encouraged by our public health officials to do, are really unfortunately a perfect storm for both child abuse and neglect.
We know from past experience, but most recently, with the financial crisis of 2008 and the recession that child physical abuse really increases during times of financial stress. And we know that so many people are experiencing financial stress due to job losses because so many businesses are closed.
Add to that, the schools and daycares are closed. So now, much of the job of children's education are kind of placed on these stressed caregivers. And those parents that have jobs may be trying to work from home while also juggling the educational needs of their children. Or with young children, trying to provide fulltime care for others that are running around, which can be very very challenging.
So families are stressed and with parents juggling their own work, school and regular efforts at parenting that they have a baseline, we have to all recognize that the burden for families is very very high right now. So the risk of physical abuse goes up as caregivers are really trying to balance so much.
They don't have their usual physical support in place like other family members, friends or neighbors come over. You don't have playdates so you can kind of send your kids away, go play with some else for a while, because we're trying to socially distance. And we know also from the data that schools and teachers are one of the highest sources of reports for concern of child maltreatment. Seventy to 80% of reports come from schools to Children Services.
So children are really isolated from these mandated reporters that Becca was telling us about. So no one's around to recognize concerning signs and symptoms that these children may be experiencing which can delay children kind of getting to safer place.
So stressed out families and isolated children is just not a great combo and we may be seeing more abuse. Right now, reports are actually down across the country, reports for child abuse. And I think that's because kids are isolated from these mandated reporters, not because children are not experiencing abuse.
Dr. Mike Patrick: Yeah, that's a really important point to make, that just because reports are down does not mean that the events are down and in fact, they are likely increased.
Dr. Kristin Crichton: Exactly. And then, in terms of neglect, with parents having to juggle so much, their ability to supervise gets kids really compromised because they're doing so many different tasks all at once. So children are suffering more accidental injuries.
Incidentally, we really note the rise in accidental burns here at the hospital, from spilled hot liquids and food. Kind of everyone's cooking at home a lot more and kids are probably trying to cook for themselves. And parents are doing a lot so they may not be there to kind of teach the kids taking the ramen noodles out of the microwave. And so we're seeing more accidental burns.
Dr. Mike Patrick: And dog bites, too. And with dog bites, as the weather gets warmer and we go outside and take walks, there's more opportunity for kids to be approached by stranger dogs that don't necessarily know them and that can be an issue. Again, that's not necessarily abuse or neglect other than if you know that there's a dangerous dog on your walking path, maybe choose a different one, right?
Dr. Kristin Crichton: Right, right.
Dr. Mike Patrick: And I think dogs are stressed out too in the home. They're not getting their alone time.
Dr. Kristin Crichton: Yes, I definitely have a dog that wishes we would go to work more.
Dr. Mike Patrick: Yeah, yeah.
Dr. Mike Patrick: So what are action can parents, and of course, there's a lot of grandparents who take, I mean they're the primary caregivers for children. So I want to definitely include them and also any family member who has primary responsibility for taking care of children in the home. What can caregivers do to prevent neglect or abuse from occurring in their home?
At the end of the day, people don't wake in the morning and say "Hey, I'm going to abuse and neglect my child today." But it happens and how can we prevent that in our homes?
Dr. Kristin Crichton: So I think that caregivers can use some strategies to kind of cope with the adjustment and strain of being at home all day every day. And some approaches are really keeping a consistent daily schedule with meals, physical activity, bedtime really occurring around the same time every day.
I know every day feels kind of the same way and it feels we’re in Groundhogs Day. But that kind of routine really helps kids, especially young children know what to expect and that really support good behavior from them, and good behavior helps prevent child abuse.
So being really routine with what time we wake up, or what time we eat, going outside as much as the weather allows us to getting some good activity to wear kids out at about the same time every day.
And then I think engaging kids in structured activities that can be reasonably accomplished. So I think it's really important to have a reasonable expectation of ourselves and our children. I know that teachers are doing an amazing job, teacher appreciation day, so we appreciate tremendously, of getting schoolwork out to families and kids.
But I also think that it's important for parents to know their limitations and get done what we can get done, get done what can be reasonably accomplished and gives us a sense of fulfillment. Remember also that both parents and children really need to take regular short breaks from assigned task. Kids cannot sit for hours at a time in front of the computer.
And adults can, but probably shouldn't. It's good to get up and walk around and stretch and get some of that physical activity we talked about. The other thing that's important to remember is the changes that kids have experienced are just as stressful to them as they are to all of us as adults. Kids are going to experience big feelings and they may not know how to really express themselves very well, which can lead to them acting out. And acting out can lead to kind of unfortunate outcomes in terms of physical abuse.
So trying to give parents, trying to encourage parents to give kids attention and really ask them, "How are you feeling? You're separate from your friend, you're not getting to play with neighbors next door that you usually get to play with. How do play about that?" And try to talk about that.
And I would also encourage families to try and catch their kids being good to really reinforce positive behaviors and kind of minimize the more challenging ones and be positive when it's possible.
And parents need to remember also to engage in their own self-care. It's important to acknowledge this is hard and take some time and some breaks away. A grandparent or friends or neighbors can support that by doing some kind of virtual babysitting, reading books to kids through FaceTime, playing games online with kids, trying to engage the kids so the parents that are at home with them can have a break.
While we're on the topic of screen time, one of the other issues that I just want to hit on briefly is talking about safe online activities for kids. With so many kids going online for school and other activities, the risk of meeting a potential perpetrator goes up. And a lot of kids haven't been online very much until now, their whole school is online.
And I'd like to remind parents and caregivers to discuss online safety just the same way you would talk to kids about in-person safety. If the child is experiencing something that feels uncomfortable or doesn't feel right, you need to tell an adult. And all online activities including schools need to be done in an observable space where parent can kind of walk through checking on, be interruptible to ensure that children especially those for whom internet activities are really new, make safe they're in safe places online and interacting with safe people.
So it's just something to kind of talk about that may be new for some kids.
Dr. Mike Patrick: Yeah, really, really important, and great points all around. We have shared in the last three episodes lots of resources for parents who are looking for ideas on building schedules and doing activities both physically, mentally with academics. So we did one episode on mental fitness during a pandemic, another physical fitness during a pandemic. And then, academic fitness during a pandemic. And we had tons of resources, and I would encourage folks to check out the show notes of those episodes.
I'm going to add some more to this one. And in particular, and even if you don't live in Central Ohio, the Columbus Metropolitan Library site has a ton of fantastic resources and ideas for families. And I'm sure wherever you live, your local library probably has similar kinds of resources but hey, it's online.
So you can tap into the Columbus Metropolitan Library. They have links to trusted resources, e-books, audiobooks, digital magazine. You can stream music, movies, documentaries, explore history, research your family tree. They have online classes, hobby, ideas, do it yourself projects, just lots of stuff if you're looking for great ideas online.
And then, there's another resource I want to put in, the Coronavirus Tip and Resources page from Prevent Child Abuse America. And then another one is a parent and caregiver guide to helping families cope with coronavirus disease and that's from the National Child Traumatic Stress Network, all really great items.
And then, finally, I mentioned, there are a lot of grandparents living within homes and multigenerational families. And there is a group called Generation United and they have a fact sheet on COVID-19 for grandfamilies and multigenerational families. So if that describes your household, you'll probably find some great information from that group that would be helpful.
In addition to families within the same household, Becca, we're all trying to stay connected with our families who aren't in our household but maybe down the street or across town or across the country. What can distancing family and friends do to help prevent neglect and abuse in an individual household that they may not be living in right now?
Becca Fredin: That's a great question. So we know right now that this is just a universally tough situation. There's just a kind of pervasive sense of isolation for all of us. And for some people, that also comes with kind of loss of hope. And so we know that when we lose hope, we can also lose our capacity to deal with all the stress that we're facing.
So one big thing that distancing family and friends want to do is try to help these families, help these parents prevent the loss of that hope and prevent their inability to manage stress. So what that might look like would be concretely trying to do things to take items off their plate. So rather than saying, you know, if we're talking to someone, a parent or a loved one that may be taking care of kids, rather than saying, "Oh, let me know if there's anything I can do," it would be probably a better idea to take more of an active role and say, "Tell me the things that's the hardest for you to manage right now. Is it one thing that we can try to sort out together?"
And then as you say that, the key thing is to really mean it. So maybe they'll say, "I'm just having so much trouble navigating the unemployment website." And you could say, "Well, why don't you take five minutes and get online right now. And tell me about these questions, and we'll get through this together."
Or it they say, "I got my three kids, I can't figure out how to safely get groceries with everything going on." Maybe say, "Why don't you give me your grocery list and I'll be that person who goes to the grocery store with my mask on right now, to try to get you those things." Sometimes the act of concretely taking actual items off someone's to-do list, that can do a lot more that we might realize.
Another thing is really being a good active listener and letting parents know that you can be that person in their life that they can call anytime if they're really struggling with the situation. And then, again, you want to be that consistent person that does pick up the phone if they call you at 3AM because their baby won't stop crying. Being that person who listens and kind of helps them think through, what are these next steps that you're going to take if it's a hard day.
I know Kristin also mentioned some other things that friends and distancing families can do, whether that's reading to someone via Skype or FaceTime, things like that can give parents a little bit of a break. So I think there's several different options but the big thing to me is offering to help in some way, and then following up with that second part of sort of actually taking an action to help.
Dr. Mike Patrick: Yeah, yeah, great ideas. Franklin County Children Services here in Central Ohio also has tips for distancing families and friends on their website, on a page called Preventing Child Abuse and Neglect During COVID-19. I'll put a link to that also in the show notes for this episode, 461, over at pediacast.org.
In addition to family members and friends who are distancing but still staying social with families, teachers and medical providers still are maintaining contact remotely. How, and obviously these are mandated reporters, and as you guys have both mentioned, teachers are one of the largest number quantity-wise of mandated reporters because they just have so much engagement and interaction with children and families. So how can they, and medical providers too, maintain awareness of these concerns during a pandemic and kind of be on the lookout for potential neglect and abuse?
Becca Fredin: Sure. Well, for starters, I think the biggest thing we want teachers and medical providers to do is try however they can to help prevent abuse from happening. We know that there are ways to identify abuse that I'll be talking about, but we hope rather than sort of picking up the pieces afterwards that we can take actions to help families during that tough time.
So similarly, to distancing friends and families, we'd hope that teachers and medical providers when talking to parents can say things like, "Is there one thing that you're really struggling with right now that I can help figure out a plan for or talk you through?" So to me, that would be maybe the first thing.
But like you said, teachers, providers are mandated reporters. So they do want to be aware of how to identify concerns. So as far as teachers, I would recommend that teachers look for changes of behavior in children in online classes. You know, you get to know students so well, so there might be a change if they appear more withdrawn or if they're just really acting out in a different way.
Another thing would be providing kids with basic education about safety, about their bodies, about what is and isn't okay, and routinely identifying yourself as a safe adult that they come to if there's ever an issue.
Another thing for teachers is to be really aware of what to do if you do have a concern. Familiarize yourself with who is your county's Children Services agency and how do you go about reaching them? I will say, as a side note, those are almost all of us county members are online. So a teacher, if they had a concern, can Google their county and should be able to find that phone number.
With providers, if they're thinking about identifying abuse, a big thing that they would want to do is engage with the whole family during a telehealth visit. So not just sort of looking the child over but also really talking to the child and getting to know them and having that sense if their behavior has changed in some way. Again, as a mandated reported, they would need to contact Children Services usually in conjunction with social work helping if there was concern that came up.
One more thing with providers is there are also things that they can do to prevent abuse. And a big one would be I think giving parents some basic education about what are normal child development stages and what things might be very normal to expect. Sort of giving education about yes, babies cry a lot and here are some things to do on this tough situation. Sort of normalizing the stress that's going to come with all of this and helping them get resources, linking them to things like social work and psychology, or other folks that can do also do telehealth visits during tough times.
Dr. Mike Patrick: And those providers who see injuries, obviously, you want to really think about the injury occur, how could it have been prevented, is there a need in the house for more supervision and how I can help facilitate that if you see injuries?
Becca Fredin: Absolutely.
Dr. Mike Patrick: What about distancing family and friends? So we want to maintain, we want to maintain connection. We want to help prevent abuse and neglect from happening. But how do you maintain awareness that could be possible? What sort of warning signs would arise for family and friends who are connecting distantly from households?
Becca Fredin: So to me, one important thing to do is just really maintain regular contact with parents and children. So talking to them on a regular basis so you can notice if there are changes in behavior or if the child is acting differently or if a parent is really behaving significantly differently.
So I think this is a place where video chatting is really important and useful, having one more way to kind of understand what's going on. So I think making a point to really spend time on video chat connecting with kids in the household and not just parents.
Asking them about their day, what did they have for dinner? Are they getting regular meals? What are they doing with their time? Just getting to know the kids and understanding what their day-to-day life is like. Also, along with that, really having that connection with children, older children to say "Hey, you know, if things are really stressful at home, if something comes up, I am someone you can reach out to."
That again is that hugely important connection that will lead to more awareness if something is going on. With older children, we know most children have cellphones. And you can let them know you're someone that they can text at any time. You're a connection point to them. So that's another important thing right now. That they know they can reach out to you anytime. And that you're being that reliable adult who follows up with them if they do reach out.
Dr. Mike Patrick: And if there's changes in behaviors. So if someone who you text with sort of regularly and suddenly they're not texting anymore or the tone of their text changes. I mean then it may be time to ask some questions or "What's going on?" and, "Hey, I'm here for you."
Becca Fredin: Exactly. Exactly.
Dr. Mike Patrick: Now, let's say that your distancing family or friend and you do suspect that there is neglect or abuse happening. We mentioned that anyone can make a report to Children Services but is that always the first thing that you ought to do, Kristin? Or are there some things that you can do to kind of head things off with the past before it got to that point?
Dr. Kristin Crichton: I think if you're at the point where you're truly suspecting abuse or neglect, the best approach is for all to think of ourselves as mandated reporters right now, while kids are separated from the people that most typically make these reports. I think it takes a village to help a family mode of thinking. Just go ahead and think of yourself as a mandated reporter.
We talked a lot about prevention and efforts to kind of head things off and try to not to get this point. But if you truly suspect any form of abuse is happening or neglect, please please, I would encourage everyone to reach out to their county Children Services agency. In Ohio, we're by county, in other states, it would be different.
And there is actually one centralized number in Ohio that anyone can call, 1-855-OH-CHILD and that will get you to your local Children Services agency to report.
Just like we said earlier, please don't think of this as being punitive or punishment or getting someone in trouble or telling on someone, it's not. It is making sure that children are safe in getting them the help that they may need. And this may be help that they have never needed before.
I mean, one of the things I heard from the Mid-Ohio Food Banks, people that were donating to the Food Bank last month are in the line this month. People are experiencing truly new challenges. And they have never encountered these challenges and they don't know where to go for resources. And if we just need to get Children Services involved to help them, then that's the right thing to do.
Just like Becca said, all Children Services agencies have a goal of keeping families together, so a call to Children Services does not mean that children will be removed. It means the children will be helped. And that's the most important thing to think of.
So I would encourage everyone, if you suspect abuse, please please report it because that's going to be the best thing to help kids get help quickly.
Dr. Mike Patrick: Yeah, so important. Let's think about this on the community level. So let's say that I don't have kids in my house, and I don't have really close family that I'm in regular contact with children. What can we do in our community? We are all on this together. So how can we make a regional difference together?
Dr. Kristin Crichton: That's a great question. One of the biggest things, I think, would be taking more of a collective viewpoint towards coping with this really tough isolating situation. So making it more of a cultural norm to reach out to each other and offer assistance, to talk to each other about the stress that we're experiencing, being a little vulnerable about our own experiences in this pandemic. That can go a long way towards making regional difference.
So it might mean if you don't have contact with families with children on a regular basis, really being more on social media, making it the norm to say "Hey, if you need help, I'm a person you can talk to." Or letting your friends know that, even if they don't have kids, I think sort of shifting the viewpoint from "We each need to take care of ourselves here. We each need to figure out how to survive this," to looking more as a community as how are we as collective going to get through this together.
I think that would be one of the big first steps. Taking more of that trauma and form of response towards this would be important to understanding that we as a society are going through a collective trauma and knowing that situations like this that can cause that hopelessness. But if we're kind of all in this together, we have that potential to survive this. And in the course of surviving it, it actually builds some resilience. We'll come through this feeling a little bit stronger about our ability to get through tough situations.
The big thing that I'm hoping for is that, as a community, we can make sure that we aren't just sort of coming in afterwards and picking up the pieces, being punitive towards people who are struggling in some way. Rather, that we're really looking at how do we prevent whether it's child abuse or hunger or loss of housing, places to live, really looking at right now what can we do what can we do to reach to one another and build these connections.
So I think that as we start to slowly reopen, as community organizations may be coming back together a little bit more, places like community rec centers or churches, they can do things like think about setting up some kind of committee or a group to routinely reach to community members that they know are a bit more isolated. Really being intentional about reaching out to people around us, and again offering to do some sort of concrete thing for one another. I think just having that attitude can be really sort of a growth experience for all of us and can get us through together.
Dr. Mike Patrick: Yeah, absolutely. There are so many needs that families have, as you've mentioned, from housing, utilities, food, school supplies, even Internet connection because now that's our lifeline to connecting socially with families and friends. So having that, and then of course, childcare, especially if you're a single parent now and you have to work, it can be so difficult to figure out what to do and where to turn.
And so, if you are thinking about this from a community standpoint, there's so many different resources that you could support. And in supporting those, you are supporting families and children. And if you want some ideas on what sort of resources out there need your support, Franklin County Children Services here in Central Ohio has a page that is really dedicated to resources in the Central Ohio community.
And there is just like, you just scroll, there's just so many resources, which is fantastic. But those people who are giving out resources also need your energy and your money and your items and those sorts of things. So it may just sort of get the creative juices flowing as you read through what resources there are. And maybe one will really make itself big in front of you that this is one I could be passionate about, so one that I could donate my time and efforts and energy and passions into.
So I'll put a link to that in the show notes, 461, for this episode as well. As we close, we talked about the fact that both of you are with Nationwide Children's Hospital and the Center for Family Safety and Healing. Dr. Crichton, what exactly is that?
Dr. Kristin Crichton: The Center for Family Safety and Healing here at Nationwide Children's Hospital is a center that really fully addresses all aspects of family violence including child abuse and neglect, teen dating abuse, domestic violence, and verbal abuse. We offer one-stop kind of coordinated response to family violence, for individuals and families, through partnerships with our law enforcement agencies, Child Protective Services, prosecution, and a wide range of community resources.
We have home visitation services which they have been amazing and have adapted substantially during this time of physical distancing to support via lots of cell phone apps. They've been great. We have domestic violence advocates support, legal support, and behavioral health services for victims of child abuse.
The other thing we have here is our Child Advocacy Center which is where we see children primarily for concerns of suspected sexual abuse. One thing I would like to note, one trend that has been noted with the pandemic and with isolation, the calls for minors into our National Sexual Assault Crisis line in March were higher than they have ever been, with more than half of the calls coming in being for minors, which has never been that high.
So there's absolutely concern that children are at high risk right now for multiple forms of violence including sexual violence. They may be isolated with perpetrators. So I think that's something that's hard to think about, but we all want to be mindful of and give resources to those kids.
Obviously, in Ohio, in Central Ohio, we have the Center for Family Safety and Health. From nationally, there are resources, the Childhelp National Abuse Hotline. And Darkness to Light is another agency. And I can share their contact information for you to put up.
Dr. Mike Patrick: The Center for Family Safety and Healing has a terrific website with lots of resources for families. And again, so much of it really is not specific to Central Ohio necessarily, but folks anywhere in the country. It can at least be a launching point to finding resources in your own area, if you need to.
And I know you have some great information on preventing child abuse and neglect during COVID-19 actually on the website. And I'll put links directly to that page into the Center for Family Safety and Healing, in general. I'll put links to all of that and all the things that we've talked about.
And then, don't forget those past three episodes with just tons of resources to get ideas going on not only resources but activities and things to do in the house, as you think about your own and your family's mental health, physical health, academic health. And in all of this, we want to prevent neglect and abuse of children.
So Dr. Kristin Crichton, pediatrician and child abuse expert with the Center for Family Safety and Healing at Nationwide Children's Hospital, and Becca Fredin, licensed clinical social worker and program coordinator of our Child Protection Program, thanks so much to both of you for being with us today.
Dr. Kristin Crichton: Thank you.
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.
Also, thanks once again to our guests, Dr. Kristin Crichton and Becca Fredin, both with the Center for Family Safety and Healing at Nationwide Children's Hospital.
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Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.
Announcer 1: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.