Covenant Childrens Blog: Child Welfare and Safety during the COVID-19 Pandemic

After identifying a need for more public information on maternity and child-focused issues during the COVID-19 era, Providence and Covenant Children’s in Lubbock, Texas, recently collaborated on a series of Facebook live events. One of the heartbreaking realities that has come to light during this time is the statistics that show an increase in reports of child abuse. In this broadcast, Covenant Children’s CEO Dr. Amy Thompson sat down remotely with Larel Jacobs, who is the Clinical Program Manager of the Childhelp National Child Abuse Hotline. Following is the video, and transcript of their conversation.

Dr. Amy Thompson

Good morning. I'm so glad to be back with all of you today on Facebook Live, talking specifically about children, women and COVID. We have another installment of that today. I'm Dr. Amy Thompson. I'm the Chief Executive Officer at the Covenant Children's Hospital. We're in Lubbock, Texas. I'm also a pediatric specialist by training and still actively see patients in the hospital as well. I want to do a couple of disclaimers. As a reminder, the information provided during this event is only for informational purposes. If you have any questions around the COVID-19 pandemic, please visit our website at providence.org for medical updates. This event does not create a doctor-patient relationship. And any questions or medical advice that is discussed is not considered guidance on what you should do. For any medical questions, please reach out to your primary care or healthcare professional.

So with that, we're so glad to have you here today. This is Larel Jacobs, and I had the privilege of meeting her earlier. She is the clinical program manager of the Child Health National Child Abuse hotline. I just want to start by saying thank you guys for the work that you do. And this is such important work, and things that are close to my heart as both a pediatrician and now someone who runs a hospital. So thank you so much for the work that you guys do. The first question is super simple. I would love for you to tell us kind of more about your job, what is it that you do and what are the the things that happen in your sphere of influence in the realm of child abuse?

Larel Jacobs

Sure. Thank you, Dr. Thompson for having me today. I’ll start off by explaining what our hotline does. The child health hotline is a national hotline. We're anywhere, including Canada, and we are here to provide emotional support and access to resources. We use professional counselors on our hotline. So everyone has degrees in specialties in this field. And we are designed to really fill in the gap between anyone that's struggling with some kind of concern related to child abuse and the official reporting agencies. Sometimes there's confusion. Every state across the country has its own laws and policies related to abuse. And so reports have to be made to the state. Some states have one hotline, some states have separate one. So we have all that information and we want to help someone process if what they're seeing appears to not be right. How do they handle it? Who do they report to? We can get them that information right away. But then we also have the extra steps, right? Sometimes the system is failing a bit, what are other resources people can go to? We work with a lot of adult survivors. We work with parents who are trying to be preventative or have just found out what's happening to their, to their kids. And now we have added text and chat to our hotline, designed specifically to reach us directly because some people don't want to call a hotline, that's how they prefer to reach out. And so we have a lot of us reaching out to us and wanting to seek help. So my role as a clinical program manager is mostly to support the counselors that we have these wonderful sponsors that work on, I make sure they have the information and the resources they need at their fingertips to be the best source of support. But then I'm especially involved in that tech jet component launched just over a year ago. And I analyze and assess and we're trying to figure out best practices for how to truly connect and support reaching out to our hotline, communication like written text chat, so it's really exciting work.

Dr. Amy Thompson

Well, again, thank you so much for the work that you guys do. I think it's so great that you have resources that are not just for providers and parents and you know, those involved. I echo your sentiment about the phone, and you know, tech things. I have a senior that just graduated this year. And sometimes the only way that I can talk to him is actually through text. Interestingly, he's interested in text and he wants to, I don't know, communicate through all these other media apps. So that's great that you guys are stepping into that. Thanks. So let's talk specifically about COVID. We've had a lot of things that have happened with COVID, not the least of which was when we had the shelter in place orders. I live in Texas, and you're right now in Arizona, and we have some other folks from Providence that are on other parts of the West Coast. And I think all of us are in various stages of the shelter in place orders, but what changes have you seen? Is there something that you can talk with us about that you've seen, with your hotline and the things that have happened related to COVID-19?

Larel Jacobs

Absolutely. So COVID and the unprecedented conditions added this extra layer of stress, instability and complications to families. Some of that was families that were already struggling, maybe with things that were going on it it exacerbated that. But I think it also added stress to families that didn't know how to handle it. A lot of our stories; an example that comes to mind is healthcare workers. On the front lines, she has an essential job. She had young kids and there's no daycare, there's no schools, there's very limited options, but she has to work. So she leaves her kids in the care of a boyfriend, who maybe doesn't make the best choices and ended up physically harming her kids. It's those increased stressors, whether it's increased substance abuse in the home, you've got close living quarters, and you have people that don't have access to any of the normal healthy outlets or resources that they normally have. So they're fighting about school issues, and food and water scarcity and fears. There are the tensions in the home, maybe they are taking it to the next level. So they're starting to go into that physical level. It just adds this extra layer of intensity to things that are already abnormal, and cutting off any support systems.

Dr. Amy Thompson

Yeah, we've seen the same thing. I'm sad to say that the county that I live in, in Texas, we are a state leader in non-accidental trauma, and some of these incidents are for kids. So we've seen very similar things. I'm with the patients coming into the hospital. But to your point, I think we've also seen some situations that weren't happening before the stressors of COVID. And it really is an unprecedented time with all of the stress. And I would say all of us, irrespective of what field we work in, are feeling an uneasiness about what the future is going to look like. Are the kids going to have school? How is this going to change things? When you put on top of that job loss, it adds to all of these things. So do you think that kids, during this pandemic, are at higher risk for abuse?

Larel Jacobs

We do know that with higher stress, that tends to be one of the biggest risk factors of abuse. Abuse cuts across sex and ethnicity, all those kinds of things. Stressors add to that. So the other component we think is the most important is that lack of access to the support systems that most of them had. We hear a lot that many state hotline calls aren't getting through. And that makes it seem like abuse isn't happening. But we believe that it's because the mandated reporters, the safe adults who speak out for children, aren't laying eyes on the kids, right? They're not seeing the bruises and the signs. And so they are apparently unseen and possibly intensifying, right? Because there's that lack of protection. So yes, we think that there's a higher risk for kids.

Dr. Amy Thompson

It scares me too, because I feel like we've seen some really severe kids that have come in for us as well. I also worry that kids just in general are not getting health care, because of these things. Even in my own situation, I'm a working mom and my mother has always been the person who has helped me with my children. But then my mom is now in this age range, that we're trying to be extremely careful around my mother. So even in my own life, I can attest to the fact that real stressors happen when you upset this system of support that's been there. So what statistically do you see? Are you seeing this bear out in statistics for child abuse and or other indicators of child abuse?

Larel Jacobs

So there's kind of conflicting numbers. The state's reporting is down, but our hotline experienced an increase in contact. When you know, a lot of years relatively stay the same, maybe fluctuate throughout the year, but year to year, they're very similar. So for March, April, and May, our numbers went up anywhere between 17 and 43% of people reaching out. And there's just so many populations that are impacted. You know, you kind of talked about you look at we saw stories from college kids that had been displaced from their, their, you know, their living conditions are back in maybe not so comfortable households, and they're not necessarily children, but they're all built and where do they go? They might be witnessing things happening with siblings and not sure what to do. There are so many complications, right? Like, how to keep kids safe while not being able to see the kids, and not being able to have access to resources. With the shutdown, many CPS or even emergency services are shut down a little bit too. So that gray area that's almost harder - the emotional abuse, the witnessing violence - those are the things that are scary because we aren’t able to see the effects yet on the kids until they get out and get back into safe populations.

Dr. Amy Thompson

Yeah, I agree. And that's always one of the things that we talk about around here is, kind of this long term effect that you can have and not just in child abuse terms, but in terms of childhood trauma. And that kind of gets to the thing that you were discussing, a kid can have trauma and be having other forms of trauma that are not just broken bones and the things that we historically think about whenever you see kids come in, with this stuff. So talk to me a little bit about that. So talk to me more about kind of long-term effects - and I'm gonna put it in that bigger box of - childhood trauma.

Larel Jacobs

Right. So for me, ACE’s research is the best at really establishing what those long term effects are. It does a great job of breaking down all those little intricate situations, whether it's abuse, physical, emotional, sexual, neglect, physical or emotional, and then your household challenges, right, the things I talked about; domestic violence, substance abuse, absent parent loss or incarceration or divorce, those kinds of things and they have effects. The kids are forced into situations where you're dealing with stress levels that become toxic, and it literally changes brain development. It impacts depression rates of depression and anxiety, suicidal ideation, the instances of substance abuse. But it also impacts physical health, higher rates of cancer, higher rates of diabetes, cardiovascular issues. I mean, the fingers are just so long reaching, especially on those things that you can't quite see. Most people know the bruise or you know, the heartbreak of the broken bone. But all the layers of those other things are so vital. And we hear that so often on our hotline, and this makes it even more intense.

Dr. Amy Thompson

Yeah, I agree. And I think the interesting thing, and I think this will probably be interesting to most of our viewers, is when you go over the things about disease. I'm a pediatric specialist and you know, mainly we end up taking care of kids medically, here in the hospital. And it was amazing to me when I began as a young physician to understand the statistics that you're talking about. We probably understand that there's going to be some psychological effects on kids. But I think it's always surprising to people when they figure out even medically, kids who have suffered childhood trauma will have more issues with their overall health. Some of the things that you were talking about, sure stress me out because, these are all the things that I'm hearing that are on the rise. We have heard about more substance abuse, and clearly, obviously, because of economic situations, there are places that now food is harder to come by. And so when you look at that list of stressors, I think that's where the real thing is, it's like COVID itself is stressful. But all of these things that have happened because of this really raise that level of stress. And that brain development piece, that is always the piece that has stuck with me the most is because we are literally reorganizing it. That brain development occurs from childhood trauma. And I always feel like, I wish that people could really understand those aspects of it that this is not just, if we can get them through the situation in the hospital that somehow this is just going to be okay. There's a lot of work that has to be done on the other side of that, as well. So I want to turn a little bit and talk about - I hope that we have some parents listening today. And if you're a parent who's listening today, we are so grateful that you're here. Especially if you're someone who is having some of these stressors, you are not alone. I think we're all experiencing this, but for the parent who's listening today, for themselves or for others, can you tell us about some things that they can do both specifically with an organization like yours or other suggestions that you would have for them?

Larel Jacobs

Sure. First, up, that help is out there, right. Help is available to you. That's number one. Parenting is already hard. And then you're talking about these extra stressors. So that's why we want to stick in that space between official agencies, because we want to be that first step of a safe, supportive environment. If someone is struggling with it, it's okay. We often use the metaphor of the oxygen mask. When you can, put your oxygen mask on first, then help others. So it's not selfish, you are doing what's best for you. Our counselors are there to help you through. We brainstorm with you to let you vent, but we can also help search for resources within the system. So actually connecting to the programs, whether it's prevention or parenting things, or maybe even Child Protective Services. You know, they [CPS] get a bad rap sometimes; if they take the kids, you know, “they're stealing kids,” but then if they leave the kids, then “they're leaving them in harm's way.” Right? But there's so much middle area for CPS, and the best situation, their goal is family safety. Family support. So when you're working collaboratively with them and it's not adversarial, it's so much more productive. So that's number one. Second, though, sometimes there's outliers. We hear from grandparents or family members that abuse is happening to other family members or people. So how do you support that? Again, we'd be happy to talk through that, finding you resources to come alongside someone, right? If you have that relationship, if it's not that way, who do you report to? And there's also a piece that, to me, is so vital, almost the same as the ACEs. The research on adverse childhood experiences is clear. But so is the research showing what the resiliency things are and they're positive experiences. One stable healthy, loving adult in a child's life can become a buffer to all those things that they're experiencing. So people can do that. They can be a consistent, encourager to the kids. And it may feel like not much, but research shows, one personal story can make a difference. So I want that to be, you know, hugely encouraging to people. I know it doesn't feel like much, but that is doing something encouraging, being involved, finding activities that let a child have an outlet. Those are their building blocks to supporting a child that has gone through these tough times. So that's one main piece.

Dr. Amy Thompson

Yeah, that's great. And I would like to point out, we're seeing this live as you and I are talking and if you are watching us, you can see that there's actually the one 800 number for these services. And I would say if you're having any questions at all, and I'll repeat this again at the end, we really encourage you to reach out to these services. If you're watching, that means you qualify to reach out to this number to get help because we certainly want to get you some help. So, you know, one of the things that I get asked a lot is, you know, you have a mom and she's very nervous about the situation that they're in. And these questions about shelters and different things like that. And I get a lot of questions about “Am I safe if I go to a shelter?” But I also think sometimes it's confusing to know when to do that. So I would love for you to interact a little bit with the question of shelters, and the steps that you think someone should take if they're really in a dangerous situation.

Larel Jacobs

It's kind of back to always reaching out for help. And yet I'm aware that there is research that kind of shows that one of the most dangerous times for someone to leave an abusive situation is when they leave. That's obviously a very scary situation. But really talking to a professional to try to get a safety plan, really helps with processing the things that they have to think of. We do have that database that we refer them to, local resources for them. But I also want to say that one of our partner hotlines, one of the hotlines that we work alongside is the domestic violence hotline. And they specialize in intimate partner violence and shelter finding as well. So don't feel like you can't call us, but I want to throw them out there because they do specialize in that. Whereas our focus is child abuse. Theirs can be for shelter, so people can call us, and we can refer them as well. But that's just a good thing to mention. Those shelters are out there, there are a lot of safety measures that they put around those shelters so that they're unlisted. You can only find them through a hotline. And, there are steps that can be taken. You know, we have a lot of legal resources in our database as well. So really trying to help families to connect to other kinds of supports if they have to. Just that brainstorming process, it can be overwhelming and scary to think about, like that. We want to help them along.

Dr. Amy Thompson

I think that's great because, really what we can talk about with a number like this is, there is a place that they can call. If you're out there, and you just don't know what to do, this is great to call because it sounds like you guys can help get them to the right resources and places. So, you know, talking a little bit about something else, let’s turn to community involvement. I know certainly, living in Lubbock, Texas, I'm proud to say, we have held a big conference every year where we bring all the folks in the community together, here at the Children's Hospital to talk about strategies for child abuse, because it has to be more than just medical providers. I always point out to people, by the time I see the kid, typically something bad has happened to them. And there's a lot of stuff that leads up to the point at which they actually come to me for medical care. And so, really, we have tried to emphasize the importance of folks in the community. Teachers, and folks who work at a daycare, lawyers, you know, people who understand the system, police enforcement. I mean, there have been many at our conference. We feel like we have gotten so many leaders together. So what are strategies? If you're a community person, and you're watching this and you're thinking, is there a role for me and how is it that I can come alongside this? What would you say to those community leaders?

Larel Jacobs

Sure. I think one of the key pieces is helping with the prevention component, right? Educating kids on signs of abuse, how to protect themselves, you know, sort of the inappropriate touch boundaries, it's okay to tell, all of that plus education, puts up that extra fence of protection that people have to come through in order to pick up kids. Sometimes it's being aware of stranger behaviors in a setting, right, like having those protocols in place, whether it be always knowing who to tell, right, like whatever procedures that allow for situations so that kids know what to do, know who they can go to, that you're helping set up scenarios that set a precedent and culture of safety. Other people are just looking to really get hands on experience. There are lots of volunteer opportunities when it comes to this. Whether doing these prevention programs or advocacy centers which are kind of sprinkled across the country, and they're really state of the art when it comes to approaching with the child's best interest. Pulling together all the investigative components so that you aren't bringing a young child into a police station. That could be very scary, right? So you're doing this in settings. And so a lot of those organizations rely on volunteers to help with some of the programs they have. So that's another great way to really be on the front lines. Just behind the investigation.

Dr. Amy Thompson

Yeah, that's great. You know, one of the things that we always want to encourage people to do is, if you're a teacher, for instance, we want you to learn the way to recognize, what I always call pre abuse. So are there things that are leading up to that? What are warning factors? What are things that you should be looking for? And I'm certain that you guys would have those types of resources as well, to help people understand what are the signs and symptoms. We've done a lot of that in our conference that we did together to try to bring people in and say, “Hey, those of you guys who have the first touch with these kids outside of their house, what are ways that you can help be a partner with that and be vigilant to help us get kids educated?” And then we have a bunch of providers in the community, everything from our United Way here in Lubbock, to the school systems to I mean, just so many partners that are willing to step into this space. So I'm going to turn us to one of the questions that I have for you. And I will call it the wrap up question. Is there anything else that you feel would be pertinent to share, specifically about child abuse and COVID as we close?

Larel Jacobs

Sure, I would love to mention that some of the information that you've talked about is on our website. You can go there, and there are these lovely PDFs that you can print out. And then child help does have a curriculum as well, that could help if you ever wanted to look at that. So just to throw that out there. Um, gosh, really, I always want to stress reducing the stigma of asking for help. Over and over again. There is help out there and it can be scary and hard to ask. But let us be the first step. If we can't help, let us be that safe, confidential environment to set it up. Let us be that first step to get you ready to reach out to the amazing programs and people that are out there that want to help.

Dr. Amy Thompson

That's great. And actually I love knowing that. I did not know that about some of the training materials and stuff that are available. So that's fantastic. I always say you don't want to create something that somebody has already done a good job of doing. I'm going to turn to a question. And this is actually specifically for Covenant Children's. And it says, How does Covenant Children's Hospital deal with a situation when they see a child that may be being abused? And then the second question is, what are the signs that you look for? So again, the first question to deal with is when we see a child that we think may be being abused, most of the time those kids actually will come to us through our ED. And so in our emergency department, we will have kids that come in for various things. I would say that sometimes it's very obvious. There are some injuries and some things that a kid comes in with. It's very clear that this is probably a child abuse situation. Sadly, we also have some others where we see a kid with something that just doesn't quite make sense in the story. So, oftentimes one of the things that will kind of pique our interest is when the story doesn't really add up to the particular injury that we're seeing. I would also say, like different accounts of the story, and so sometimes it's really soft kind of signs, to these things. And it's difficult because I have boys - the only children that I have, and man, they break bones, and they jump off of things! So I get asked a lot of questions like, “How are you?” You know? How do you distinguish between a kid who's just, you know, a boy, and is doing these things and breaking bones? And I would say that there are some signs, but sometimes those are hard, and it's hard to know. And I do think sometimes people also fear, “What if I make this accusation and then it wasn't true?” And the way that I always talk to my patients is, I tell them my concerns. I just come out with it in terms of Look, it's my responsibility as the pediatrician that seeing this kid is to ensure that this child is safe. And so if you feel like I'm asking you more questions with this, please, it's because I want to support you. And it's because if there's something going on, we want to get you help, but certainly my job is to protect the child. And actually I've had really good success with just kind of leading with that honesty with people when you're asking questions. And certainly I'm so proud to say at our children's hospital, we have access to a child abuse specialist. She can be exceptionally helpful to come in and look at records and you know, kind of piece things together for us to see if we think that this is a picture that's concerning for abuse.

It's a difficult situation. So right now, this is the only question that I'm seeing. Larel, as I told you, I think that is a beautiful name. So, thank you so much for joining us today. And just so, so grateful for the work that you guys are doing and stepping into the space of child abuse and, also the services that you guys are providing. And I'll just make one last plea and then I'll ask if Larel has anything else to add. And that's again, if you are watching this and you either know a child that you think is being abused, or if you are a parent or a caregiver of a child and you are experiencing stress and you feel like you need help, please reach out to this hotline AND OR to another in your region. And we want to ask you to get help. So Larel, I'll ask if you have any parting words?

Larel Jacobs

Thank you for having me on, and for speaking on this topic we obviously believe it's so important. So we appreciate your partnership.

Dr. Amy Thompson

Fantastic. Thank you so much and y'all keep up the good work, keep standing in that space.

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Child Welfare During COVID

Watch Covenant Children’s CEO Dr. Amy Thompson sat down remotely with Larel Jacobs, who is the Clinical Program Manager of the Childhelp National Child Abuse Hotline talk about child welfare during COVID