child abuse

A pregnant woman with a mask sits in her room.

Disrupting the cycle of addiction, one mother at a time

October 26, 2020 by Liora Engel-Smith

Disrupting the cycle of addiction, one mother at a time - North Carolina Health News

A Robeson County program for pregnant and postpartum women and their infants helps mothers grow their recovery skills while growing a life.

By Liora Engel-Smith

Baby Tyler uttered his first word the other day, and much to Kerry T.’s surprise, that word was “dada.”

“I’m the one taking care of you, not your daddy,” Kerry, 21, who did not want her full name used to protect her privacy, chided the six-month-old.

Tyler grinned at his mom, flapping his arms this way and that. Kerry, from Maxton, a town of roughly 2,500 less than 20 miles from the South Carolina border, knows that she is lucky. She could have just as easily lost her child to foster care. The drugs she used could have killed him too, she knows.

Kerry got hooked on opioid pills in her late teens. She was almost halfway into her pregnancy, with Tyler, still addicted, when she found out. Learning she was pregnant was a turning point for her, she said, helping her realize that she needed to be sober for her child.

But she had a terrifying thought when she considered getting help.

“Nobody will take my baby away from me,” she said. “I would die. He’s literally the only thing I have.”

A woman and her baby are playing together — Kerry T., 21, and her 6-month-old son, Tyler, at Our House. The Maxton resident has been in the program for roughly 5 months. Photo credit: Liora Engel-Smith.

It’s a reality that many addicted moms contend with when they consider getting help. Substance misuse was cited as a reason for separating children from their parents in 40 percent of North Carolina foster care cases in fiscal year 2017-18, up from 25 percent a decade ago, data from the state shows.

As of August, almost half of children and teens in the North Carolina foster care system — roughly 4,600 — were there because of parental substance use, including alcohol and drugs, according to data from the state. Of these, more than a thousand were babies, the data shows.

The number of families affected is likely much higher, as the state’s data does not account for informal custody arrangements between family members, said Renee Rader, assistant director for policy and programs at the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services, which is part of the state Department of Health and Human Services.

Kerry had another choice, though. She got a bed at Our House, a Pembroke-based rehabilitation program that allows mothers and their babies to stay together. With a more than 30-year history, Our House is the longest-running program for mothers and children in the state. It is one of only 13 rehabilitation facilities for mothers and their children in the state. Between them, the facilities have 264 beds, most of them in urban centers such as Chapel Hill and Charlotte.

Demand for beds fluctuates, so it’s hard to know if the state’s bed supply for new and expecting moms is enough, but an Oct. 6 snapshot showed that roughly 15 of these beds were open. Approximately 20 mothers and pregnant women in North Carolina were placed on a waiting list for specific facilities across the state, data shows.

Tucked on a side street on the outskirts of downtown Pembroke, a town of roughly 3,000 and the seat of the Lumbee tribe of North Carolina, the nondescript structure that holds Our House can accommodate up to 10 moms and their babies. While the women are the clients and most of the services are geared toward them, the babies also receive medical care there.

Babies born to women who use drugs can develop a dependence on the drugs they were exposed to. Unlike addiction, which has an emotional component, the condition babies experience is purely physical. The condition, termed neonatal abstinence syndrome, is linked to tremors, seizures, sleep problems, poor weight gain and a host of other symptoms. Tyler, for example, spent nine days in the hospital weaning off of opioids, Kerry said, after medical providers noticed he was jerking his legs and sleeping poorly.

A sign with a native American drawing and the words — Pembroke is the tribal seat of the Lumbee tribe of North Carolina, a state recognized native American tribe. Photo credit: Liora Engel-Smith

Under the soft lights at Our House — which often have a calming effect — babies get screened for developmental delays and receive basic medical care. There’s no day care onsite, so the children attend support groups and counseling with their mothers. To aid their recovery, women whose substance of choice is opioids also receive suboxone or other medications to reduce cravings and prevent an overdose.

“We treat the mind, body and soul,” said program director Shirley Williams.

The women there have two big jobs: learning to care for their children and navigating the rough waters of recovery. As many new mothers know, babies don’t always sleep through the night. The turmoil of addiction, a disease so powerful that it upends people’s lives, coupled with a lack of coping skills could easily push even the most motivated of new moms to the brink.

Throughout their stay, which can last months or more than a year, women develop the confidence to care for themselves and their children, even when things don’t go as planned. That’s how Kerry discovered a powerful motivator to get her through the rough patches with Tyler.

“I [don’t] want him to grow up and look at me and be like ‘you picked drugs over me,’” she said. “You don’t love me, you love drugs, and that would be devastating.’”

A critical window

Pregnancy can be a powerful motivator for recovery, Williams said, but it can also be a deterrent. Mothers who use drugs experience the additional stigma of potentially harming their babies. Pregnant women who use drugs can also find themselves criminally charged for child neglect or even murder.

A masked woman is talking to the camera. — Shirley Williams, program director at the Our House, a program for pregnant, new moms and their infants. Photo credit: Liora Engel-Smith

In June, the General Assembly passed a bill that would have defined drug use during pregnancy, regardless of the impact on the infant, as child abuse. The bill failed after Gov. Roy Cooper vetoed it. The state senate attempted to pass a similar bill in 2015, but it died in committee.

Such bills, on top of stigma, advocates worry, can deter women from seeking help. Kerry, for her part, said the thought of losing her child to foster care did cross her mind, but she worried more about inadvertently killing her baby. It was fear for his welfare that prompted her to seek help.

At the same time, North Carolina covers opioid treatment for expecting mothers under a Medicaid rule that offers temporary coverage during pregnancy and up to 60 days after delivery, removing some cost barriers on low-income women seeking recovery.

The existence of this rule goes beyond helping individual women. Medicaid only covers medical treatment — not room and board — but that revenue stream has allowed programs such as Our House to have a stable source of income, said Rader, of the state health department. Programs can also cover room and board through flow-through state and federal funds.

The best outcome of all, Rader said, is finding a way to keep mothers and children together, with comprehensive interventions, such as parenting assistance and medical care, as early in the process as possible.

“We know that children entering the foster care system experience trauma,” she said. “That separation from the family members has a lasting impact on children.”

But addiction doesn’t always resolve after one episode in rehab. An estimated 40 to 60 percent of people with substance use disorders relapse after treatment, data from the Federal National Institute on Drug Abuse shows.

As China D., another resident at Our House knows first hand, recovery is rarely linear or predictable.

Putting the pieces together

In her softly lit bedroom at Our House, China D. inspects the fragments of her life. A grainy photo of her mom, who died this summer, is on the vanity. On the floor near the window is a preschool graduation photo of her now 7-year-old son, who is growing up with his father.

She didn’t get help that first time, she said, and she used drugs for a good portion of her pregnancy. But when China found out she was pregnant, she weaned herself off of drugs on her own.

She didn’t get help for her addiction until a couple of years later when she and her son attended Grace Court, a sister rehabilitation program in Lumberton that also accommodates mothers and children through the recovery process. China said she was sober for roughly a year before the death of her mom started a journey that ended in relapse.

The 27-year-old, who asked that her full name not be used to protect her family’s privacy, tears up when she looks at the framed photo of her smiling child. She touches her swelling belly. China wants this time to be different.

A woman with a mask points to artwork on the wall. — Eva Locklear, counselor at Our House, works with the women on setting and defining goals for recovery. Photo credit: Liora Engel-Smith

Like many people who use substances, China did not discover her pregnancy right away. She did not go to prenatal appointments or get ultrasounds, blood tests or any of the other medical monitoring that are the standard of care for pregnant women. Her other medical needs went unaddressed too. What she did have was the haze of drugs — cocaine and opiates, a habit that she picked up from loved ones.

Finding out she was pregnant again had rekindled her desire to do better for her children. That’s how the Pembroke resident landed at Our House, where she’s been for the past month or so. Balancing recovery and motherhood, she said.

“It’s very hard,” she said. “I struggle daily. I do my work here and I pray and that’s my strength. I struggle with it every day. It’s very hard to deal with addiction. And being away from my family, it’s very hard.”

China, who had a heart attack the doctors attributed to IV drug use in 2015, recently discovered that she has a leaky heart valve that would require surgery after her child is born. Getting the medical and emotional support she needs, she said, makes a difference.

Near the photo of her son, a pumpkin China painted displays the goal she’s working toward: “2020,” it says in angled, neon lettering. “A different chance at life!”

Coronavirus Today – July 14: “Plan B” for K-12 schools; district choices; simmering COVID-19 trends and metrics

July 14, 2020 by Anne Blythe

Coronavirus Today – July 14: “Plan B” for K-12 schools; district choices; simmering COVID-19 trends and metrics - North Carolina Health News

NC governor recommends in-person combined with remote teaching for the coming K-12 school year. Each district would have discretion over the exact mix.

By Anne Blythe

Once school resumes next month, North Carolina’s 1.5 million public school children will have the opportunity for some in-class instruction across the state while some kids might continue with remote learning only.

Gov. Roy Cooper announced on Tuesday that he had selected his “Plan B,” a hybrid model for instructing children in kindergarten through high school as a new school year begins amid the COVID-19 pandemic that has obliterated traditions and routines since early March.

“In the spring, when this pandemic first broke out, we made the difficult but necessary decision to close in-person learning at K through 12 schools and move to remote learning,” Cooper said during an afternoon press conference. “March feels like a long time ago given everything that we’ve been through. And that was just the beginning of a series of tough decisions to slow the spread of COVID-19 that have helped our state cope and prevented our hospitals from being overwhelmed.”

Simmering, not boiling

North Carolina has not seen the tsunami of cases that recently have forced some states to reverse reopening plans because hospital beds have filled with COVID-19 patients.

Nonetheless, there has been a sharp rise in the number of lab-confirmed cases in recent weeks throughout North Carolina that cannot be explained simply by more testing. The percentage of tests coming back positive hovers at 9 to 11 percent, double what health care experts would like to see before opening society up further. These high numbers of positive tests indicate community spread of the virus continues.

Even as North Carolina has seen record hospitalizations there continues to be capacity for more patients as hospitals adjust their routines, adopt plans to add beds and learn better how to care for patients with COVID-19.

But recently, concerns about testing supply shortages have grown. Shortages of equipment and chemicals have created long waits for lab results across the country, putting contact tracers further behind in trying to contain the spread of the virus.

“We continue to simmer,” Mandy Cohen, secretary of the state Department of Health and Human Services, said Tuesday. “We’ve avoided boiling over as many states are doing now.

“If we see indications that we’re changing quickly or there’s new scientific data that emerges, we will not hesitate to act.”

Cohen said planning for the coming school year has been full of difficult decisions.

She and her public health team helped Cooper come to the decision he announced on Tuesday after examining research showing that elementary school-aged children and preschoolers seem to be at lower risk for COVID-19 infection and less likely to transmit it to others.

They weighed that research and medical data against evidence that school is critical to a child’s education, health, emotional and social well-being, as well as advice from pediatricians that missing school is harmful to children.

“With any decision like this it is necessary to weigh the risks and the benefits and there are no easy answers,” Cohen said.

Tailoring plans district by district

Though individual school districts across the state may tailor attendance plans that work best for the areas their students come from, face masks, temperature checks and screenings at the door will be required for any in-person instruction.

For instance, Wake, Durham and Forsyth counties have already developed plans with a priority to bring elementary school children back to in-classroom instruction first. The Chapel Hill-Carrboro district is postponing the return of high school students until mid-September, weeks after the start of the school year.

There’s no one-size-fits-all plan.

The few hard and fast requirements that public health leaders have pushed throughout the pandemic have been the wearing of face masks, social distancing and hand-washing.

Students and teachers will each be issued five cloth face masks, one for each day of the school week, that can be washed and reused. The state also has distributed personal protective equipment and other supplies to school nurses.

Cooper called the state’s baseline plan “a measured, balanced approach,” but acknowledged that some teachers, school staff and families might not be as enthusiastic about being inside school buildings.

“As a part of this plan, we want local districts to provide for remote options for any child that chooses it,” Cooper said.

Eric Davis, chairman of the state Board of Education, said districts are surveying teachers and staff to gauge how many will be willing to teach and work inside school buildings even as COVID-19 continues to spread, and which staffers feel like they need to stay away.

“We certainly anticipate that some teachers and staff members will not be able to return to school for a variety of reasons, where others, as the governor mentioned, are energetically awaiting the day that they can get back with their students and move forward,” Davis said. “We’re confident in the work that our districts have underway to care for the needs of our staff and teachers and we will continue to send them the support and the assistance that they need, including revised policies or other things needed to continue to meet the needs of our teachers.”

Working parents, more home schooling and child care

If a district chooses, Cooper added, it can opt out of any in-classroom instruction and solely provide remote teaching that will require parents or others to help with home schooling children.

That option, as well as plans calling for children to have in-classroom instruction for one week and then two weeks of remote learning, have working parents struggling to figure out what they’ll do about child care in the weeks and months ahead.

Volunteers help children read their books in the Read and Feed van. — In many instances, parents don’t have the ability to suspend their work day to instruct their children. Photo credit: Hyun Namkoong

Not everybody can work from home, and as parents who have that ability will attest, it can be difficult to help with school lessons while also attempting to work.

Not just a place for teaching and learning

Over the decades, schools have become far more than places where children from kindergarten through high school go to learn.

They have become places where children from low-income families have access to food. They provide safety and security for children from abusive homes. They provide a set number of hours of child management for working parents.

Lisa Gennetian, an economist at Duke University, noted these realities in a panel discussion Tuesday morning before Cooper made his announcement.

“When we think about school openings and closings, we should really think hard about the function of schools in these communities,” said Gennetian. “They’re not just environments for learning.”

One in five children, according to Gennetian, are poor in America, a number that is likely to grow during the pandemic.

In many households, one or both parents may have lost jobs or suffered income losses that force them to choose between putting food on the table, paying monthly bills and keeping up economically.

Economists and others are predicting a tsunami of evictions that will make providing shelter even more difficult for some families barely making ends meet.

“The U.S labor market is not designed well to absorb formal care,” Gennetian said, adding that it could be child care for preschool children or for the older ones who still need the supervision of an adult. “This intersects super closely with the question of school closings.

“The U.S. lacks a strong safety net for reaching vulnerable people, and again, schools have played an important role in filling that gap.”

For that reason and others, Gennetian and two pediatricians from Duke agreed that opening schools in a safe way would be beneficial to the children.

Developing COVID-19 research on children

The three offered their thoughts during a panel discussion on Tuesday before Cooper announced his decision.

“There’s a really strong case for trying to reopen schools because there are so many benefits both for children, not only their academic benefits, but also their health and well-being and social, emotional health … and also for families, many of whom are trying to get back to work and reopen the economy,” said Charlene Wong, a Duke pediatrician who specializes in care for adolescents and teens.

“We really need to proceed with caution and care and avoid broad, sweeping mandates about requiring schools to open,” she added. “We are certainly very early in learning about the experience of children and their experiences, particularly in schools and other congregant settings.”

Image by Editor B, flickr creative commons — The classroom experience could be very different this year, with children staying with one cohort and teacher for their entire school day, eating at their desks, wearing masks and social distancing. Image by Editor B, Flickr Creative Commons

Wong suggested that scientists and medical researchers should start including children in broader studies about the impact of COVID-19 that could help guide school decisions and others ahead.

“While we’ve seen an explosion of COVID-19 research and we’re learning something new every day, a relatively small proportion of that research has been on children,” Wong said.

The data show that high school students and elementary school children should be considered in a different light for several reasons.

There is evidence of teens becoming infected and transmitting the virus, as well as acknowledgement that high school students are better suited for remote learning than younger children.

“We are seeing a difference in the way in which the infection presents itself,” said Ibukun Christine Akinboyo, a Duke pediatrician and infectious disease specialist. “It seems to be milder in younger kids.”

Develop a quarantine plan

Nonetheless, that does not mean they are immune, Akinboyo said.

“Particularly in our area, we have had child care settings that have been open … until recently we have not seen rapid clusters around spread in those settings,” she said. “As the community prevalence has gone up, we have seen some clusters of spread among staffers, among children. And that is not unexpected.

“I’m in full support of making decisions based on local data,” Akinboyo added. “That may be on the state level, that may be on the county level. We have to ensure resources are available across the board, so counties that historically have not had adequate access to resources have them.”

Whether a district chooses in-person instruction or remote learning, Wong suggested that families develop quarantine plans that anticipate lab-confirmed cases in a school and the disruption that would come at home and work.

“In many ways these unpredictable two-week quarantines for individual children or classrooms … can sometimes cause more chaos for families than what we saw with the blanket closures in the spring when all of us who were working parents were mostly in the same boat as we tried to juggle our personal and professional obligations,” Wong said.

She said people need to prepare for the inevitable disruptions.

“Preparation now will help ensure that families will be able to follow these quarantine guidelines so that we can slow the spread of the virus and so schools can remain open for learning,” Wong said.

What happens if students, teachers or staff test positive?

If a student or teacher contracts a lab-confirmed case of COVID-19, Cohen said contact tracers will work to find close contacts and encourage those people to get testing and isolate themselves while awaiting results.

Schools or classrooms wouldn’t necessarily be closed down, even if a student were to test positive for the virus.

“We would do what we would do now related to somebody being positive,” Cohen aid. “If it was in elementary school it is likely that they would have been cohorted and with the same number of students and one teacher throughout the day and would only have come into contact with the students.”

In such a case, contact tracers would alert people who were within six feet of that person for longer than 10 minutes, telling them to get tested. Public health officials also would work with schools on cleaning protocols outlined in their guidelines and recommendations.

“It doesn’t mean immediately that a school needs to close,” Cohen added. “They may want to go beyond our protocols and do that. Again, it depends on the situation, what was the age of the kid, how those contacts were arrived at.”

“We don’t want to have a one-size-fits-all,” Cohen added. “We really do need to tailor to what the situation is, what kind of student, how long were they in school, what were their contacts. That’s why we really need local health departments involved in each one of those situations.”

First five days of school year

The protocols for the coming school year are included in an updated StrongSchoolsNC public toolkit created by DHHS.

“In-person education is important for children, and it happens in the context of a community,” said Theresa Flynn, a Wake County pediatrician who serves on the board of directors of the North Carolina Pediatric Society. “This plan strikes the right balance between health and safety, and the benefits of having children learn in the classroom. We must all continue with proven measures to reduce COVID-19 transmission like wearing a face covering, keeping distance between people, and frequent hand and surface cleanings so we can move closer to safely re-opening public schools.”

Cooper, an advocate for higher salaries for teachers who has pushed for more state spending for public schools by the Republican-led General Assembly, said he would be asking for more to be allocated from both the state and federal government to address increased school needs.

Phil Berger, the Republican from Eden at the head of the state Senate, and Cooper were in a budget stand-off for much of last year in large part over the school budget.

During the session that just ended, Berger added an additional twist to how schools would open next month when he failed to put forward a requested lifting of a law that requires North Carolina school children to spend the first five days of a school year in classrooms.

During the Duke panel discussion, the pediatricians and economist said such a mandate could cause health and safety problems.

“Certainly that could cause a spike in spread,” said Wong, whose practice focuses on adolescents and young adults. “It’s my opinion there shouldn’t be such a broad sweeping mandate to say that every child must attend in person at any point during the semester and certainly not during the first week when everyone’s going to be trying to work out the kinks of the new systems that have been put together over the summer time. … There should always be a remote learning option.”

Cooper said Tuesday that Josh Stein, a fellow Democrat and the state attorney general, had provided the Cooper administration with a letter saying that his office thought it was OK to proceed with a hybrid model.

“We’re in a state where we’re rethinking everything. We’re rethinking how we eat, how we buy groceries, how we go to the restaurants, gyms, how we take public transit,” said Akinboyo.

“Now more than ever, we need to rethink how we go to school and how kids go to school. So I’m not sure that mandating in-person appearance for every kid allows each administrator, each group, each parent and staff — they’re trying to figure out the best thing for a child — to be flexible in those options.”

Coronavirus by the numbers

According to NCDHHS data, as of Tuesday afternoon:

1,552 people total in North Carolina have died of coronavirus.
89,484 have been diagnosed with the disease. Of those, 1,109 are in the hospital. The hospitalization figure is a snapshot of people hospitalized with COVID-19 infections on a given day and does not represent all of the North Carolinians who may have been in the hospital throughout the course of the epidemic.
67,124 people who had COVID-19 are presumed to have recovered. This weekly estimate does not denote how many of the diagnosed cases in the state are still infectious.
To date, 1,254,846 tests have been completed. As of July 7, all labs in the state are required to report both their positive and negative test results to the lab, so that figure includes all of the COVID-19 tests performed in the state.
Most of the cases (45 percent) were in people ages 25-49. While 12 percent of the positive diagnoses were in people ages 65 and older, seniors make up 79 percent of coronavirus deaths in the state.
264 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
There are 3,374 ventilators in hospitals across the state and 921 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.

Fayetteville hospital system gets COVID-19 diagnostic equipment

Cape Fear Valley Health, the state’s eighth largest health system, is now using lab equipment that can diagnose inpatients for the coronavirus in an hour.

The health system, which is based in Fayetteville, bought the $140,000 equipment through a donation from its foundation. The equipment allows Cape Fear Valley to test inpatients suspected of having COVID-19 by performing a Respiratory Pathogen Panel test. The tests can simultaneously check for dozens of potential targets, including bacteria, parasites, yeast, antimicrobial resistance genes and viruses such as COVID-19.

Cape Fear Valley no longer will have to send inpatients’ test kits out of state for testing. Patients admitted during weekends who are suspected of having COVID-19 previously waited up to three days for results, hospital officials said in a news release.

“We get the results in real time now,” said Chris Tart, Cape Fear Valley’ vice president of professional services. “That helps us place COVID-19 patients on the appropriate unit.”

BioFire Diagnostics, the equipment manufacturer, says its system can run up to 264 samples a day. Faster diagnosis means faster treatment for the correct condition, according to the news release. — Greg Barnes

shows a tile wall, each tile has the handprint of a child and some text on it as a proxy for child abuse

Unsafe conditions for children in wake of COVID-19

April 28, 2020 by Sarah Ovaska

Unsafe conditions for children in wake of COVID-19 - North Carolina Health News

Child abuse and neglect are expected to rise in the wake of the COVID-19 pandemic, with children unable to escape to the safety of schools and struggling families experience unprecedented levels of stress.

By Sarah Ovaska

The spread of the novel coronavirus has meant an unprecedented retreat from our everyday lives – schools unexpectedly shut down, restaurants closed, and many jobs suddenly disappeared.

Children as a whole seem to be avoiding the more serious health effects of COVID-19. But that doesn’t mean they are all safe. The closure of public schools and some child care facilities means some vulnerable children could be staying in homes that may not have been stable or safe before the pandemic.

“You think about families who are isolated and how a small situation can set things off” in normal times, said Erin Drew, the executive director of The Family Place, a community support center in Transylvania County.

Add social isolation and mounting economic pressures from the COVID-19 pandemic to existing substance abuse or mental health struggles and “it’s almost a trifecta of issues that can blow up,” Drew said.

That unsettling truth has those working in and around the child welfare system trying to figure out how to best protect children and support families from afar in this unexpected new normal.

Switch to virtual support in WNC

In Transylvania County, where community groups built their ambitious community-level Get Set program to improve the lives of young children, COVID-19 has presented an enormous challenge, said Jaime Laughter, the manager of the western North Carolina county.

“We’re all having to socially isolate, but at the same time, that really compounds all those different issues” that struggling families face, Laughter said.

A patchwork of government and community groups are trying to do what they can – county library employees are manning hotlines for community members seeking food assistance or other help, while community centers throughout the mountainous county are offering free Wi-Fi to anyone parked in the center’s lots.

Staff of The Family Place, a family support organization, are dropping off disinfected activity packs of crafts for those with young children and hosting virtual meet-ups for parents to talk about life during a pandemic with young children.

Meanwhile, Family Place caseworkers are also dropping by a local shelter for homeless families to have socially distant walks with parents in need of a break from the pressures of living in close proximity with other families with no other outlets.

In addition, county child protective services workers are volunteering at food distribution sites for children as a way of just being able to observe and pick up on any problems.

“That way we can at least lay eyes on the kids and see how they are,” said Darrell Renfroe, Transylvania County’s Department of Social Services director, who oversees child welfare investigations.

School closures, financial pressures weigh on families

In Transylvania County and across the state, concerns mount about the effects of keeping public schools closed, as well as the economic fallout from business closures that have prompted more than 705,000 North Carolinians to file for unemployment in a five-week span.

In the best of times, there are struggles with the government system designed to keep children safe and families supported. Even before the pandemic, the state was already dealing with record numbers of children entering North Carolina’s foster care system, in part from the fallout from the ongoing opioid addiction crisis.

“It’s absolutely something for us to all be concerned about,” said Sharon Hirsch, the executive director of Prevent Child Abuse NC, a non-profit organization, about the risk of child maltreatment. “The biggest risk factors for child abuse and neglect are economic stressors and social isolation – we’ve got both of those things happening right now.”

April is also Child Abuse Prevention Month, when community groups typically set out blue pinwheels in public spaces to raise awareness and talk about ways communities can work together to notice and fight against such problems. This year, groups are trying to figure out how — from afar — they can carry out such a mission.

The stakes are high for the short and long term. Trauma experienced in childhood — whether it’s the stress of living with a mentally ill parent, a stint of homelessness, or witnessing domestic abuse — have lasting effects on children that undermine their own health years down the road, studies show.

A continuously growing body of scientific research over the past 20 years has linked these adverse childhood experiences, referred to as ACEs, to psychological as well as physical health challenges later in life. Essentially, the more toxic stress a child experiences, the more likely he or she may face future issues in their lives: difficulties in school and work settings, their own battles with substance abuse, or susceptibility to chronic health problems that shorten lives.

It’s why child abuse prevention work has moved in recent years to connect family units to broader communities, in the hope that giving families and children support to weather the challenges of life will limit those adverse conditions.

But so much of this support happens in public and community settings, from parenting support groups to nurse-visiting programs for newborns to simple community gatherings to get to know neighbors, Hirsch said.

And COVID-19 has put a hold on much of that, for now.

Having parents and children under the same roof with no breaks for anyone is trying for most families, said Karen McLeod, the executive director of Benchmarks, an alliance of provider groups, including those that work around the child welfare system.

Those that are dealing with the fears that go along with not having the money for rent or struggles with addiction or mental health may need even more help.

“For families that are struggling, school is a source of respite,” McLeod said. “For that parent to have eight hours where they know their child is being fed and is safe and is being nurtured is really important. It’s eight hours of that respite time every day.”

Incidents expected to rise, behind closed doors.

Domestic violence shelters are also bracing for an influx of need during the course of the shutdown, with some victims now in nearly continual contact with their abusers. Children, of course, live in many of those homes and may witness abusive conditions or be subjected themselves to physical or sexual abuse.

While police in some locales such as Charlotte are seeing reports of domestic violence rise, that is less likely to happen in cases of child maltreatment. The reasons for that are multiple, including the hidden nature of the abuse and the difficulty that children and youth face reaching out for help.

A large portion of reports of suspected or known child maltreatment come in from school employees, about 20 percent nationally. North Carolina, like many other states, requires all adults, from teachers to parents to neighbors, to report allegations or suspicions of childhood abuse or neglect to county social services departments.

But the schools are closed.

“It’s all going on behind closed doors,” McLeod said. “The only time we’re going to know [about abuse] is if someone is making a call, and people aren’t seeing kids as much.”

Some things have remained constant in the course of the pandemic, however.

Child welfare workers based out of North Carolina’s county social services departments are considered critical employees and are following up still on suspected cases of abuse and neglect. Foster parents are still taking in children in need of a safe home, though visits with biological parents may now be happening virtually through FaceTime calls instead of in person, Renfroe said.

Renfroe and his counterparts around the state aren’t mistaking the drop in reports as a sign that things are all well.

“Our fear is that once all this is over, many, many things will come up and our numbers will greatly increase,” Renfroe said.

A bunch of men with suits sit around tables in the General Assembley in Raleigh, where last week they changed the definition of sexual assault, closing a loophole in the law.

NC sexual assault reforms pass unanimously

November 7, 2019 by Carolina Public Press

NC sexual assault reforms pass unanimously - North Carolina Health News

Loopholes on revoked consent and incapacitated sexual assault closed without opposition by NC House and Senate.

Kate Martin

Carolina Public Press

UPDATE: Gov. Cooper signed the bill into law this week.

A wide-ranging legislative package reforming sexual assault laws passed both chambers of the NC General Assembly unanimously last week, with two elements closing decades-old legal loopholes on the definition of rape that set North Carolina apart.

The Senate passed SB 199 49-0 Thursday morning. The House voted 108-0 Thursday afternoon.

The package was hammered out in conference committee in recent weeks and had wide bipartisan support, despite related measures failing in committee in previous sessions of the legislature.

Two of the key measures, revocation of consent and sex with someone who was incapacitated due to alcohol or drugs, closed loopholes in North Carolina due to old court precedents, which were strongly featured in the Seeking Conviction, a series examining the prosecution of sexual assault crimes in the state that Carolina Public Press and a collaboration of 10 statewide media partners produced in March.

Before now, North Carolina was the only state in the nation where continuing sex with someone after that person revoked consent was not considered a crime.

After the bill passed both chambers, NC Attorney General Josh Stein said, “I’m very much aware of how prosecutors have been handcuffed on this issue.”

The changes to the consent laws, “are both changes for the good,” he said. “Our criminal justice system has to do better for victims of sexual assault.”

The bill “brings North Carolina to the 21^st century,” NC Rep. Dennis Riddell, R-Alamance, said on the floor of the House. “If you were a victim of child abuse, this is for you. If you are an adult victim, this bill is for you.”

Talking with CPP after the bill passed, Riddell said North Carolina’s sexual assault laws were “archaic.”

“Once a person consented there was no going back,” he said of the withdrawal of consent loophole. “We are defining what ‘no’ means. ‘No’ is not the new ‘yes.’ ”

This is not the first time legislators considered closing the withdrawal of consent loophole. State Sen. Jeff Jackson made his first attempt to change the law in 2015, and has tried several times since then. Many times his bills died without a hearing, including this year.

“Initially there was confusion about how controversial the bill was,” Jackson said. “Eventually they realized what was controversial was not passing it.”

The legislation passed Thursday also increases the statute of limitations for a child sexual assault victim to sue an assailant, expands the duty of anyone over 18 to report knowledge of a sex crime against a juvenile, requires school personnel training on child sex abuse and sex trafficking, bans online conduct by high-risk sex offenders that endangers children, and prohibits attempts to drug someone’s food or drink.

The measure would become law if signed by Gov. Roy Cooper. Cooper’s office had previously indicated he would study it carefully before deciding whether to sign it. Contacted after its unanimous passage by both chambers on Thursday, a spokesperson for the governor said that had not changed.

Leah McGuirk was at a bar in Charlotte last year when she felt unwell and collapsed to the floor; she suspects her drink had been drugged. Her friends were near and took her to safety, but it could have ended much worse. She reported the incident to police but they told her it was not a crime to drug someone’s drink if it was not accompanied by another crime. This legislation changes that.

“There is a part of me that’s sad because I know there’s so many victims who won’t be able to take the people who preyed upon them to court,” McGuirk said. “These laws are built on the backs of victims who won’t get their day in court.”

Stein’s office worked on sections of the bill that includes protections for children.

“As a result of this legislation, now our children will be better protected from sexual assault, and online from sex offenders,” he said.

Raleigh resident Katie Trout, who watched the legislative action from the visitors’ gallery, said she was preyed upon by a member of her church starting at age 15. She said her perpetrator has already been convicted, but being able to sue would be empowering.

“Until this passed, I had no control or power to hold him more accountable for what happened,” she said.

But Stein said age 28 is “by no means adequate” when it comes to a statute of limitations for child sex abuse lawsuits. He said he intends to try to increase the civil statute of limitations to 40 years old during the next legislative session.

Several of the measures in the bill had been strongly supported by North Carolina district attorneys, who said the loopholes created by precedents interfered with their ability to prosecute some cases.

“There’s just an enormous amount of benefit for all of these things,” said District Attorney Ashley Welch, whose district includes the six southwestern counties of North Carolina. “This would allow us to more aggressively go after someone who engages in non-consensual (activity).”

While some House members expressed some reticence to support some aspects of the legislation despite supporting others, Rep. Brian Turner, D-Buncombe, reassured the group and said they had done their research.

“At the end of the day, it’s going to make North Carolina a better state,” Turner said.

North Carolina Health News was one of the partners involved in the Seeking Conviction series.

Shows a woman hugging a little boy she's had in foster care. She is signing his adoption papers.

Foster care case numbers continue to climb in NC, as opioid crisis affects families

September 24, 2019 by Sarah Ovaska

Foster care case numbers continue to climb in NC, as opioid crisis affects families - North Carolina Health News

Record numbers of children, almost all of whom have trauma of their own, are entering the foster care system as a result of abuse and neglect.

By Sarah Ovaska-Few

North Carolina could use more people like Lisa Link, as the state grapples with record numbers of children entering and staying in the already stretched foster care system.

Link, an auto broker and owner of a small used-car lot in Charlotte, opted five years ago to become a foster parent after years of helping with family members’ children. She was single, in her early 40s, and wanted to help children coming out of difficult situations in need of a stable and loving home even if temporarily. More than 20 children have been under her care since, some for short stays of a few days or weeks and others for a year or more.

She cherishes being a dependable, caring presence for children who are often coming from chaotic or unpredictable households. She makes sure they get the childhood joys of playing at local parks or experiencing what might be new things such as eating out at a restaurant, a day at the nearby Carowinds amusement park, or going to museums.

“I’m going to take this a level up, where I can help children that needed help,” said Link, about her decision to become a foster parent. “That’s when I felt like this was my place and my calling.”

And something else happened she hadn’t expected or intended – she met her 6-year-old forever son, Latrell Ma’az Link, who has lived with Link since he was 3. Latrell ended up in the foster care system and Link’s home because of neglect. His adoption to Link was formalized last month.

“I’ve had him three years and wiped his little nose,” Link said. “I couldn’t see him going anywhere else.”

The foster care system in North Carolina continues to experience record levels of need, the increases believed to be yet another aspect of the devastation from the opioid abuse epidemic.

As of mid-summer, there were 11,700 children and teens younger than 20 in the foster care system. According to the N.C Department of Health and Human Services, that’s a 20 percent jump from just five years ago. Some of those children are in family foster homes such as Link’s. Other children stay with non-parental relatives as part of the state’s focus on kinship care to lessen the trauma experienced by children entering the system.

Those numbers also include more than 800 older teenagers. Those young people can opt to continue receiving support services such as health care through the age of 21 if they are working or in school, one of a series of reforms passed in 2017 by the state legislature.

Prescription drugs, heroin abuse behind surge

Opioid misuse and addictions are the likely culprits behind the recent growth, say those that work in and around the foster care systems. The effects of pervasive poverty, untreated mental illness and domestic violence also continue to be significant factors driving increases in foster care.

Parental substance abuse was the primary reason for the removal of a child for nearly 40 percent of the cases during the 2017-18 fiscal year, up from 30 percent five years ago and from 25 percent a decade ago, according to data provided by DHHS.

The state and most counties don’t track what specific substances – drugs or alcohol – were at the root of a family’s troubles, however. The actual number of affected children may be higher, as each county categorizes information differently. Some counties, for instance, report no substance abuse-related removals of children from homes, an unlikely scenario given the pervasiveness of addiction and the current opioid crisis.

At the state level, the focus on children removed from homes because of substance abuse is the same as any other scenario – a desire to get them in a stable and safe situation. Ideally, these children would be reunified with their parents, said Erin Baluyot, the interim program manager for DHHS’ State Foster Care and Adoption Services. If reunification is not a safe option and parental rights are terminated, the goal is to find a child an adoptive home as soon as possible.

“We do business as usual; our goal is to achieve permanency for children no matter the reason for them coming into foster care,” Baluyot said.

Sadly, children can spend years in the foster care system before being reunified with family members, or being adopted, according to DHHS.

More kids, more time

Statistics kept by the DHHS show the median time a child spends in the system was 525 days in the 2018 fiscal year that ended in June. That’s up by nearly 20 percent from four years prior, when the median stay was 441 days. The state is intent on reducing the amount of time children dwell in foster care, whether they end up going back to family or being adopted. This is one of the measurable goals in the department’s ongoing early childhood action plan.

Several high-profile deaths of children in recent years, including the 2016 drowning death of 3-year-old Rylan Ott, led to the state legislature passing changes in 2017 restructuring how child abuse investigations are handled across the state. The law was named for 3-year-old Rylan Ott, who wandered away from his Carthage home and drowned in a nearby pond. He had been returned to his mother’s home shortly before his death by the Moore County Department of Social Services, despite the mother’s erratic behavior and over a court-appointed guardian’s objections.

100 counties, one system

Though the state oversees North Carolina’s child welfare system, each of the state’s 100 counties is responsible for handling abuse and neglect claims in their respective areas, as well as the placements and well-being of children in foster care. That’s led to great disparities in how children fare in the foster care system, as the non-profit journalism outlet Carolina Public Press has highlighted in reports about Cherokee County. There, multiple children were improperly removed from their homes by county-level workers who also falsified records related to the children’s care. In addition, some children in the Western North Carolina county were put up for adoption without a judge’s knowledge or permission – major violations of the laws dictating how children are treated in the child welfare system.

Baluyot acknowledged those failings but also pointed out that there’s more to the system than tragic headlines.

“We always hear about the negative and bad things that happen, but a lot of good things happen too,” she said, pointing out that 1,300 to 1,400 children are adopted out of foster care each year. “It’s certainly a good thing. That’s 1,400 children we don’t have lingering in foster care.”

How to address the current influx of children in the foster care system is not a settled question.

A bill introduced last month in the state legislature is seeking to change how the state does business as usual. House Bill 918 would speed up the time to terminate parental rights to as little as nine months for children born with illicit drugs in their systems. The bill would also give a foster family nearly equal standing as biological family when deciding permanent placement for a child and also broadening the reasons why a child can be taken from a home.

The bill drew heated debate when it was heard in committee and has not progressed since late August.

Rising need across country

This trend of rising numbers of children in the child welfare system isn’t isolated to North Carolina. The U.S. has seen foster care cases steadily rise since 2012, following decades in which the numbers dropped, according to research published in July in JAMA – Pediatrics.

Parental drug abuse was a root cause of a child’s entry into foster care in 36 percent of cases in 2017. Young children – those under 5 – were most likely to be affected by removals because of substance abuse, according to the research. Young age is a particular concern given that those years are also when children form bonds with caretakers.

“[W]hen children enter foster care because of parental drug use, episode duration is longer and less likely to result in reunification with the parent,” wrote journal authors Angelica Meinhofer, a Cornell University researcher, and Yohanis Anglero-Diaz, a psychiatrist with Boston Children’s Hospital and Harvard Medical School.

Those trends are reflected in North Carolina, where more children 0 to 8 years old entered the foster care system last year than in previous years, according to DHHS data.

That creates a unique challenge for social workers, foster parents, teachers and other caregivers, given that those are critical ages in a child’s development.

Taking trauma into consideration

Entry into foster care, in addition to the circumstances that bring a child to the attention of child welfare workers, are considered traumatic events that carry long-term psychological and health effects. Public health researchers found in landmark research conducted two decades ago that adverse childhood experiences (ACES), events such as living in a household with domestic violence or substance abuse, can lead to a lifetime of both mental health and even physical health challenges.

Public health experts have in turn emphasized having more trauma-informed care in many settings, in hopes of lessening the impact of childhood trauma.

In the past, the number of foster care cases has decreased when the economy is doing well. That reduction is a sign that parents are able to find work and have fewer financial stressors to trigger abusive or neglectful behavior, said Ken Maxwell, head of Seven Homes, a privately run High Point nonprofit foster care placement and adoption agency that he co-founded in the mid-1990s.

Shows an African American woman and a little African American boy smiling, they're both dressed up. The little boy is in the foster care of the woman. — LIsa Link and son Latrell Link, 6, who she adopted after he spend three years in foster care in her home.

That’s not what’s happening now, Maxwell said. North Carolina’s foster care system has continuing to swell to record numbers despite the overall strength of the economy and historically low unemployment rates.

“We’re not seeing the numbers decline, we’re seeing the numbers increase,” he said. “The numbers are staying high because of substance abuse or opioid abuse.”

He also said that many of the birth families haven’t had interaction with the foster care system before, a departure from what he’s seen in other illicit drug crises. To him, it’s an indication of how quickly opioid addiction can overtake a person’s ability to maintain the regular rhythms and responsibilities of their lives.

“This sneaks up on families and they don’t realize it until they’re at risk of losing their kids,” Maxwell said. He has seen higher reunification rates, though, with children eventually being able to go back to their parents or with other family members.

Many of the children coming to Seven Homes needing temporary placements are young infants, and Maxwell has had difficulty finding enough foster families with the ability to take in newborns in need of around-the-clock care.

Though the rising numbers are not what anyone wants to see, Baluyot maintains the state currently has enough foster homes, though there’s always a need to recruit more.

Children with complex needs due to disabilities, mental health or behavioral issues as a result of sustained trauma or sibling groups may, however, end up facing longer waits for suitable homes, she said.

“We do have a lot of foster homes, it’s not like we’re in a crisis where we desperately need more,” she said.

How children fare at epicenter of opioid crisis

One county keeping track of the precise reasons why children enter foster care is New Hanover, home to Wilmington and among the most affected in the state and country by opioid misuse.

In 2013-14, 10 percent of the 189 children who entered the foster care system did so because of their caretakers’ heroin or opioid addictions. Substance use was a factor in 36 percent of cases overall, according to statistics provided by the New Hanover Department of Social Services.

Just four years later, nearly half of the 205 children entering the system came from homes where substance use was a factor, with opioids or heroin involved in 23 percent of the cases, according to 2017-18 data collected by New Hanover DSS.

Child welfare reforms

A 2017 state law enacted major changes in how the state’s child welfare and foster care agencies work. Here are some of the major pieces of Rylan’s Law, with changes currently being phased in at the state and local levels:

Requires social services observation before a child removed from custody is reunified with parents or other caretakers.
Funds to help foster care youth obtain driver’s licenses and insurance.
Shortens the amount of time to 65 days (from 180 days) for a parent to appeal court-ordered termination of parental rights.
Third-party assessment of North Carolina’s child welfare system and creation of working group looking at how to improve state oversight.
Requirement that counties agree to performance requirements set by the state, with a data dashboard later available to the public.
Allows counties to join regional departments of social services, to share resources and improve performances.
Creates goals to cut down on time children are in the foster care system and move to reunify families or start the adoption process.

Rylan’s Law followed a number of other laws that made it easier for foster youth to participate in school sports, to obtain driver’s licenses and insurance, and participate in other after school activities such as clubs and the prom.

Source: UNC School of Government, N.C. DHHS

The county also experienced an unexpected surge of need in 2016, when 280 children entered the foster care system. Their current living situations were deemed unsafe or babies born exposed to substances were unable to safely leave the hospitals with their mothers, said Mary Beth Rubright, the assistant director of social work for New Hanover Department of Social Services.

Children aren’t automatically or permanently taken away if there’s someone using drugs in the home, Rubright said. Instead, child protective services workers evaluate whether the home is safe and whether a family member can step in and provide stability if the current situation isn’t tenable.

Social workers are also steering parents toward resources for treating addiction, if applicable, and the courts often include it as a condition of being reunified with children.

“If they’re in recovery and in a program, it makes our job a whole lot easier,” she said.

Hospitals take a bigger role

There have been more babies born in the Wilmington area with opiates or other substances in their system than in the past, with social services getting involved with families in the first days, or even hours, of a child’s life, Rubright said.

In 2016, New Hanover DSS workers were notified of 54 babies born drug-positive, a term that includes both drugs being abused and those prescribed as a part of opiate recovery treatments. That went up by a startling 89 percent within two years, with 102 babies born drug-positive in 2018, Rubright said.

A big part of the increase is due to the county child welfare workers reaching out to local hospitals and making sure hospital staff were properly flagging them about children born drug-positive, a requirement under federal regulations. Reasons for notification include exposure to illicit drugs as well as to drugs such as buprenorphine or methadone that may be prescribed as part of an addiction treatment plan.

Hospital staff wasn’t consistently contacting DSS in those situations in the past, Rubright said.

To help those families, the county launched an intensive support program for mothers who give birth to children with drugs in their system. The goal: having the baby back in their mother’s care within 60 to 90 days, provided the household is assessed as safe by social workers.

The social worker running this program only has three cases at a time, down from the former average caseload of 15. This allows for more visits with the family to offer parenting support, to check in on the mother’s progress with substance abuse recovery programs and to help locate housing or other assistance, if needed.

It’s an expensive program for DSS to administer, at a cost of about $100,000 to pay for the single social worker assigned to the program and the related therapies and programs for affected parents. But the goal is to try and ensure the household is safe for a baby while setting up both mother and baby for longer-term success.

“It’s critical that you give [mothers] opportunities to bond with her children,” Rubright said. “The truth is that in the end, it’s a lot less expensive to pour those resources in on the front end.”

Rousing a community to the effects of child abuse in Cumberland County

April 25, 2019 by Sarah Ovaska

Rousing a community to the effects of child abuse in Cumberland County - North Carolina Health News

A multi-pronged effort is underway to build resilience in the community, where a rash of child deaths spurred outrage and a desire to address the root problems.

By Sarah Ovaska-Few

Cumberland County is rethinking how it responds to child abuse.

Instead of framing abuse as a problem shouldered by individual families, an ambitious effort by a collection of two dozen nonproft partners, government groups and concerned residents are instead naming it a community problem deserving of a community-wide solution.

Pupppets and toys used to interact with children who visit Cumberland County’s Partnership for Children (Photo by Sarah Ovaska-Few)

The S.O.A.R.(Strengths in Overcoming Adversity thru Resiliency) program aims to use evidence-based strategies to make families stronger and more resilient to the ups and downs of life that can lead to parents lashing out or exposing children to harmful environments.

“We all need to take ownership of this,” said Eileen Cedzo, a family resource center counseling manager at the nonproft Partnership for Children of Cumberland County, one of the groups involved in S.O.A.R.

S.O.A.R. started working on a community-wide approach in 2016 and formalized its plan to combat child abuse two years ago. The group was galvanized by a 2017 Fayetteville Observer series that took sharp aim at the dangerous conditions that led to the deaths of children under the watch of local child welfare officials. S.O.A.R. members range from those at groups like the Partnership for Children and the Child Advocacy Center that work day in and out with families as well as Fort Bragg’s Army Community Service, school system officials, law enforcement, faith leaders and interested citizens.

The goals of the program are lofty – shifting an entire community to address and reduce abusive situations by boosting what are known as five protective factors: parental resilience, social connections, knowledge of parenting and child development, concrete support in times of need, and the social and emotional competence of children.

Much of the work in Cumberland County is happening through community-wide education and is intentionally geared toward families of all backgrounds, incomes, races and make-up.

“Parenting is really, really hard,” said Sharon Hirsch, the executive director of Prevent Child Abuse NC. Most, if not all, people who have had young children know how easy it is to give way to anger, she said.

The work includes hosting frequent parent cafes, where parents meet to discuss their challenges and struggles; screenings of the movie “Resilience: the Biology of Stress and the Science of Hope” about the adverse effects of childhood trauma; and training early education workers on how to recognize trauma effects in young children and respond in ways that help the child.

If you live in Cumberland County and are interested in attending a viewing of “Resilience,” contact Eileen Cedzo at 910-867-9700.

The county is also mimicking what’s been successful in other places, including participating in an evidence-based parenting education program called Triple P Positive Parenting Program.

It’s also in the planning stages of bringing Family Connects to the county. The program allows for an experienced and trained nurse to visit new babies and parents at their homes soon after birth. A similar program led to a steep decrease in emergency room visits in Durham. S.O.A.R. members hope it will be in place in Cumberland County by 2021.

Abuse in early life leads to life challenges

Abuse, both physical and sexual, is often a hidden problem, suffered behind closed doors and with young victims unable or afraid to call out for help. At times, they may be unable to recognize they need and deserve help.

Groups like Prevent Child Abuse NC and others use April, National Child Abuse Prevention Month, to highlight the long-lasting damage abuse can cause, and highlight ways communities can better recognize dangerous situations and prevent abusive situations from taking root.

Abuse and neglect can affect a person’s health and well-being for decades to come, as was revealed 20 years ago when catalyzing research into adverse childhood experiences, was published. Adverse childhood events, frequently referred to as ACES, are situations such as when children are exposed to family violence, experience housing or food insecurity, or have someone in their life suffering from addiction or incarceration. Having these experiences, it’s been found, can lead to a lifetime of health challenges, from disrupted neurodevelopment and heart disease to increased risk of the adult child’s own substance abuse, even early death.

Much of the child welfare system has been focused on dealing with families after allegations of abuse and neglect have occurred. And while that work will continue in Cumberland County, the S.O.A.R. program is seeking to pay more attention to the ways abuse can be prevented in the first place.

Part of that is trying to work with families ahead of time to offer understand how difficult it is to be a parent, especially given that many people are living in places without family close by or have financial or other pressures bearing down on them, Cedzo said.

The work in Cumberland County isn’t happening in a vacuum, however. The N.C. Department of Health and Human Services is looking closely at protective factors as part of its Early Childhood Action Plan and hopes a focus on social determinants of health in the upcoming switch to Medicaid managed care will bring more efforts like S.O.A.R. to other areas of the state.

“There are no plans really at the local level for child welfare,” Hirsch said. “Prevention happens locally.”

By working on the community level to build up those securities – referred to as protective factors – families will hopefully be better able to handle the crises that may occur and not resort to violence or neglect by activating support networks around them.

Change is often most effective and attainable at the local level, with community members better able to identify where the gaps are in their strategies and how best to support families in need, Hirsch said.

That’s why Cumberland County’s foray into building a community-wide response to abuse is so important, she said. It has the potential to push past the limitations that often come with federal or state-government funded programs and dig deep into areas where the need is apparent.

shows a garden with an array of pinwheels in the sunlight. — Pinwheels in Charlotte to mark April being Child Abuse Prevention Month. Photo credit: Yen Duong

Prevent Child Abuse NC is now working on similar countywide resiliency plans in Wake, Transylvania, Onslow and Clay counties, in addition to supporting the ongoing community-wide efforts in Cumberland County.

Steep challenges in Cumberland County

Cumberland County has a unique set of challenges when it comes to improving conditions for children, with endemic rates of poverty and people connected to the military constantly cycling in and out of the community.

The county’s health outcomes ranked 73rd, worst of any urban counties, in an annual assessment of the state’s 100 counties, a ranking that uses infant mortality rates, hospitalization rates, child poverty numbers and other data to create its list. The city and county are also scarred by poverty, with a quarter of its children living in households earning less than $25,000 for a family of four.

The Army, an integral part of the Fayetteville’s identity and economy, brings an element of transience to the county, with a large portion of the community spending just a few years in the area at a time when they’re starting families, far away from where extended family support structures may be. Deployments only increase the types of stress that can lead to abuse.

The S.O.A.R. group has gotten ideas and support from the military, where the Army Community Services already offers home visits to new parents and has long been working to help families handle the well-known stressors of military life, said the Partnership for Children’s Cedzo.

Funding has also been a challenge, and the S.O.A.R. effort has so far been happening without any specialized funds, said Sharon Moyer, a community engagement administrator with the Partnership for Children. The group has offered meeting space and staff time to develop the idea and joining with Army Community Services (ACS) to pay for the “Resilience” DVDs shown at facilitated showings. ACS has picked up the tab for training the 28 facilitators who run the Parent Cafés.

Resistance to talking about abuse

Funding isn’t the only hurdle the S.O.A.R. group faces in trying to have more honest conversations about abuse and its detrimental effects.

Faith Boehmer, the volunteer prevention coordinator for the area’s Child Advocacy Center, relayed how the nonproft organization that works to address abuse struggled to find community interest in a “Body Safety” class it offers to teach children about their own bodies and how to talk with trusted adults if they’re uncomfortable with someone’s interactions. They routinely teach a similar class at the preschool level every November, reaching as many as 900 to 1,500 children each fall.

But there was little interest when Boehmer offered the class, which involved an intern reading books and conducting a related exercise, at no charge to 15 to 20 summer camps in the Fayetteville area.

Only one program – the Find-A-Friend mentorship program run by Fayetteville Urban Ministry – ended up taking the training last year, she said. Staffing shortages, with no intern available, has meant it won’t be offered this upcoming summer.

Part of the reason Boehmer suspects so many summer camp and youth program operators passed is the discomfort adults feels around the topic of sexual abuse. Concerned parents, even with advance notice and an effort to collect permission ahead of time, may object, Boehmer said.

“We still just don’t want to address that it’s an issue,” she said, adding that sometimes the resistance could be unconscious and a result of victimization a person themselves has experienced.

Having a community-wide effort like S.O.A.R., she said, is heartening because it leads to more conversations about the realities of abuse and ways to prevent it

“When you work in your silos, you don’t see” all the solutions,” Boehmer said.

Her hope, and that of other S.O.A.R. members, is that those solutions will come when an entire community works together.

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