Confronting The Isolation of Intimate Partner Violence and Child Abuse

As America on ‘Pause’ continues, we are all told to stay at home and/or work from home. For some families, that is a dangerous proposition. The places we call ‘home’, for many, are not always safe havens for the adults or the children who live there.

COVID-19 has caused major economic devastation, and has disconnected many from community resources and support systems. The widespread uncertainty of life today has many people confused and has brought forth panic, anxiety and intense stress. Some are angry, while others feel depressed. The range of emotions is wide and without positive outlets to identify and manage these emotions, home can become a dangerous and unhealthy place to be.

close up photo of boy with pacifier in his mouth

Some conditions may lead to violence in families where it never existed before and in homes where violence and maltreatment has been a problem. Violence in the home has an overall cost to society, leading to potentially negative  physical and mental health outcomes. These outcomes include substance use, depression, a higher risk of chronic disease and PTSD.  Victims of domestic violence and child abuse and neglect are at greater risk for injuries that result in fatal outcomes.

The CDC estimates that 1 in 4 women and almost 1 in 10 men have experienced intimate partner violence[IPV], sexual and physical violence and/or stalking by an intimate partner during their lifetime. More than 43 million women and 38 million men experienced psychological aggression by an intimate partner in their lifetime. Data from U.S. crime reports that 16%[1 in 6] of homicide victims are killed by an intimate partner.

Before this pandemic, a victim or survivor could leave a situation or file a protective order with the police. Right now, however, these options aren’t available to many. A stay-at-home order can force victims to remain in a dangerous environment.

CDC reports that at least 1 in 7 children have experienced child abuse and/or neglect in the past year and in 2018, almost 1,770 children died of abuse and neglect in the U.S. Rates of child abuse and neglect are five times higher for children in families with low socioeconomic status compared to children in families with higher socioeconomic status. Child abuse and neglect can have a tremendous impact on lifelong health and well-being if left untreated. Exposure to violence in childhood increases the risks of injury, future violence victimization and perpetration, substance abuse, delayed brain development, sexually transmitted infections, lower educational attainment and limited employment opportunities.

SADEYES

During COVID-19, children are especially vulnerable to abuse. Increased stress levels among parents is a major predictor of physical abuse and neglect of children. When parents are stressed, they are more likely to respond to their child’s anxious behaviors or demands in aggressive and abusive ways. The support systems we are used to, like extended family, schools and child care, religious groups and other community-based organizations, are not available for many due to social distancing and the stay at home orders.

pd surrouind school

Police and emergency services are interrupted and/or discouraged for many. In New York City, for example, a TV public service announcement openly states that residents should not call emergency services, 911, unless the emergency is ‘really serious’ or ‘grave’. While I understand the message’s purpose, the interpretation of the message for some, tells them that unless they are literally about to die, they should not call for help. The general public safety is now put through triage and prioritized to determine the how fast front line workers respond or whether they respond at all. That is a dangerous message, particularly for children, the most vulnerable.

Calling 911 is not always an option for a child, and the police or emergency medical services only respond after a parent frantically calls for help. At that point, the child in more urgent need of emergency services, is not breathing and/or has been severely injured. Child protective service agencies now have strained resources and working on limited staff, making workers unable to conduct home visits in many areas with stay at home orders. Children are not in school, making teachers and counselors unable to witness signs of abuse and promptly report to the proper authorities.

woman in yellow and orange sari dress

All of these facts and statistics, the data, inform us that we send strong wide-reaching messages to victims and survivors that make it clear that help is still available. We can work with law enforcement and other local and state personnel to help them understand that rigid stay at home or ‘sheltering in place’ orders need be more relaxed when the home is unsafe.

Virtual counseling  can be offered or telephone check-ins made available. Hotels/motels and hospitality industries have always provided help to house the homeless or healthcare practitioners. Remember Tina Turner’s autobiography? Escaping an abusive relationship, she was aided by hoteliers, who allowed her a room for safety.  The vulnerable populations affected by domestic violence can use these services.

We must ensure that healthcare practitioners are screening patients for intimate partner violence and child abuseLast and equally, if not more important, is that neighbors be neighborly, no matter where the location. Check in on one another, and if you see, hear or suspect a dangerous situation, make those 911 calls. It could be life-saving. Let your neighbors know that someone cares and will do what they can to be supportive. We need random acts of kindness, especially in this time of crisis, while still practicing social distancing.

 For a few of the resources to help families and communities address and prevent intimate partner violence[domestic violence] and child abuse and/or neglect, see below:

As always, do not hesitate to call 911! STAY SAFE.

How You Can Take Care of Your Behavioral Health During Infectious Disease Outbreaks

Everyone reacts differently to stressful situations such as an infectious disease outbreak that requires social distancing, quarantine or isolation.

People may feel anxiety, worry or fear related to:

  • your own health status
  • the health status of others whom you may have exposed to the disease
  • the resentment that your friends and family may feel if they needed to go into quarantine as a result of contact with you
  • the experience of monitoring yourself or being monitored by others for signs and symptoms
  • time taken off from work and the potential loss of income and job security
  • the challenge of securing things you need like groceries and personal care items
  • concern about being able to take care of children or others in your care
  • uncertainty or frustration about how long you’ll need to remain in this situation and uncertainty about the future
  • loneliness about being cut off from the rest of the world
  • anger if you think you’ve been exposed due to the negligence of others
  • boredom and frustration because you may not be able to work or engage in regular everyday activities
  • uncertainty or ambivalence about the situation
  • a desire to use alcohol or drugs to cope
  • symptoms of depression, such as feelings of hopelessness, changes in appetite or sleeping too much or too little
  • symptoms of Post-Traumatic Stress Disorder[PTSD], such as intrusive distressing memories, flashbacks, nightmares, changes in thoughts and mood, and being easily startled.

If you or a loved one experience any of these reactions for 2-4 weeks or more, contact your health care provider or other behavioral health provider and advocacy agencies.

In the event of an infectious disease outbreak, like the present day Coronavirus[COVID-19], our local, state or federal officials might require the public to take measures to limit and control the spread of the disease. In the case of COVID-19, it has been determined to be a pandemic. This means that the virus has become a global disease, whereby people all over the world are either becoming or can possibly become infected.

Some of the measures suggested or ordered to the public are social distancing, quarantine or isolation or a combination of these things. All of these are designed to stop the spread of the disease.

What Is Social Distancing?

Social distancing is a way to keep people from interacting closely or with enough frequency to spread the disease. Schools and other gathering places such as movie theaters may close, and sports events and even religious services may be cancelled.

What Is Quarantine?

Quarantine separates and restricts the movement of people who have been exposed to a contagious disease to see if they become sick. It lasts long enough to ensure a person has not contracted a contagious and/or infectious disease.

What is Isolation?

Isolation prevents the spread of an infectious disease by separating people who are sick from those who are not. It lasts as long as the disease is contagious.

man holding his face

Supporting yourself during social distancing, quarantine and isolation are best when you understand the risk. Media coverage may give the impression that everyone is in immediate danger when the risk may be very low.

Stay up to date on what is happening, while limiting your media exposure. Get your information from official sources, such as the CDC, NIH, WHO. Avoid listening or watching news 24/7. This tends to increase anxiety and worry. Remember that children are especially affected by what they see and hear on television.

Be your own advocate. Speaking out about your needs is really important if you are in quarantine, since you probably aren’t in a hospital or other facility where your needs are being met. Make sure that you have what you need to feel safe, secure and comfortable.

Work with official resources to find out how you can arrange for groceries and toiletries to be delivered to your home when needed. Inform health care providers of needed medications and ensure that you continue to receive them.

Educate yourself. Don’t be afraid to ask questions-clear communication may help relieve any stress or distress associated with social distancing, quarantine or isolation. Ask for information in writing when available or ask a family member or friend to pick up information for you if you are unable to on your own.

Work with your employer to reduce financial stress if you are unable to work during this time. Provide your employer with a clear statement/explanation of why you are away from work. Contact the U.S. Department of Labor toll-free at 1-866-487-2365 about the Family and Medical Leave Act[FMLA] which allows employees up to 12 weeks of unpaid leave for serious medical conditions, or to care for a family member with a serious condition.

Contact your utility providers, cable and internet provider, or other companies from whom you get monthly bills to explain your situation. Request alternative bill payment arrangements as needed. Also, ask that any delinquency not be recorded on your credit report during this time.

Connect with others. Reaching out to people you trust is one of the best ways to reduce anxiety, depression, loneliness and boredom during social distancing, quarantine and isolation. You can use your telephone, email, text messaging and social media. Talk ‘face to face’ with friends and loved ones using FaceTime, Skype or Google Duo. Ask for newspapers, movies and books from friends and families if medically approved.

Talk with your doctor if you are in a medical facility. If at home, and you’re worried about physical symptoms, call your doctor or other health care provider.Ask about possibly scheduling remote appointments via Skype or FaceTime for mental health, substance use or physical health needs. This called tele-health or tele-medicine.

Use practical ways to cope and relax. Relax your body often. Do things like deep breathing , stretching, meditation, praying or engaging in activities you like.Pace yourself, or do something fun after a hard task. Lat, talk about your feelings and experiences to friends and loved ones, if you find it helpful. Try to maintain a sense of hope and stay positive.

We are all in this together, and the spirit of hope and giving, and acts of kindness, not random but deliberate, will get us through the rough times. This too shall pass. Stay positive and healthy!

 

HELPFUL RESOURCES

SAMHSA: Disaster Distress Helpline                                                     toll-free: 1-800-985-5990[English and Spanish]                     SMS: Text TalkWithUs to 66746                                                 TTY: 1-800-846-8517                                                                     Website: http://www.disasterdistress.samhsa.gov

Treatment Locator                                                                       Behavioral Health Treatment Services Locator Website:         http://findtreatment.samhsa.gov/locator/home

If you are feeling overwhelmed with emotions such as sadness, depression, anxiety, or feel like you want to harm yourself or someone else, call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).      

 

For Opioid Overdose: ” Someone is unresponsive and not breathing.”

opiodOpioids include prescription medications used to treat pain such as morphine, codeine, methadone, oxycodone, hydrocodone, fentanyl, hydromorphone, and buprenorphine, as well as illicit drugs such as heroin.
Opioids work by binding to specific receptors in the brain, spinal cord, and gastrointestinal tract. In doing so, they diminish the body’s perception of pain. However, opioids can also have an impact on other systems of the body, such as altering mood, slowing breathing, and causing constipation. Opioid receptor binding causes the signs and symptoms of overdose as well as the euphoric effects or “high” with opioid use.
A variety of effects can occur after a person takes opioids, ranging from pleasure to nausea and vomiting, severe allergic reactions (anaphylaxis), and overdose, in which breathing and heartbeat slow or even stop.
Opioid overdose can be due to many factors. For example, overdose can occur when a patient deliberately misuses a prescription, uses an illicit opioid (such as heroin), or uses an opioid contaminated with other even more potent opioids (such as fentanyl).

Overdose can also occur when a patient takes an opioid as directed but the prescriber miscalculated the opioid dose, when an error was made by the dispensing pharmacist, or when the patient misunderstood the directions for use. It can also occur when opioids are taken with other medications—for example, prescribed medications such as benzodiazepines or other psychotropic medications that are used in the treatment of mental disorders—or with illicit drugs or alcohol that may have adverse interactions with opioids. At particular risk are individuals who use opioids and combine them with benzodiazepines, other sedative hypnotic agents, or alcohol, all of which cause respiratory depression.

An opioid overdose requires immediate attention. An essential first step is to get help from someone with medical expertise ASAP. Call 911 immediately if you or someone you know shows signs of an overdose. They are listed below.

Signs of overdose, a life-threatening emergency, include the following:

  • The face is extremely pale and/or clammy to the touch,
  • The body is limp,
  • Fingernails or lips have a purple or blue tone,
  • The person is vomiting or making gurgling sounds,
  • The person can’t be awakened from sleep or cannot speak,
  • Breathing is very slow or has stopped,
  • The heartbeat is very slow or stopped.

Signs of overmedication, which may progress to overdose, include:

  • Unusual sleepiness or drowsiness,
  • Mental confusion, slurred speech or intoxicated behavior,
  • Slow or shallow breathing,
  • Extremely small pinpoint pupils,
  • Slow heartbeat or low blood pressure,
  • Difficulty being awakened from sleep.

If any of these signs or symptoms are present, upon calling 911, all you have to say is,” Someone is unresponsive and not breathing.”

What is NALOXONE?

Naloxone is an antidote to opioid overdose. It is an opioid antagonist that is used to reverse the effects of opioids. Naloxone works by blocking opioid receptor sites. It is not effective in treating overdoses of benzodiazepines, barbiturates, clonidine, GHB, or ketamine. It is also not effective in treating overdoses of stimulants such as cocaine and amphetamines (including methamphetamine and MDMA). However, if opioids are taken in combination with other sedatives or stimulants, naloxone may be helpful.

Suspected fentanyl-involved overdoses should be treated with naloxone. However, because of the higher potency of fentanyl and fentanyl analogs compared to that of heroin, larger doses of naloxone may be required to reverse the opioid-induced respiratory depression from a fentanyl-involved overdose. Quicker oxygenation efforts and naloxone delivery may be warranted compared to heroin-only overdose.

Store naloxone in a safe and quickly accessible place at room temperature and protected from light. Keep all medicine in a safe place where children or pets cannot reach it.

HOW TO AVOID OPIOID OVERDOSE

1.Take medication only if it has been prescribed to you by your doctor. Make sure to tell your doctor about all medications you are taking.
2.Do not take more medication or take it more often than instructed.
3.Call your doctor if your pain gets worse.
4.Never mix pain medications with alcohol, sleeping pills, or any illicit substance.
5.Learn the signs of overdose and how to use naloxone[an antidote to overdose used to reverse the effects of opioids] to keep an overdose from becoming fatal.
6.Teach your family members and friends how to respond to an overdose.
7.Dispose of unused medication properly.

If you are concerned about your own use of opioids, don’t wait! Talk with the health care professionals who prescribed the medications for you. If you are concerned about family members or friends, urge them to talk to whoever prescribed their medications.

Effective treatment of an opioid use disorder can reduce the risk of overdose and help a person who is misusing or addicted to opioid medications attain a healthier life. Opioid use disorder is a chronic disease, much like heart disease. An evidence-based practice for treating opioid addiction is the use of Food and Drug Administration-approved medications, along with counseling and other supportive services.

These services are available at Substance Abuse and Mental Health Services Administration (SAMHSA)-certified and Drug Enforcement Administration-registered opioid treatment programs and from specialty substance use disorder treatment programs. In addition, physicians and other practitioners, including nurse practitioners and physician assistants who are trained to provide treatment for opioid addiction in office-based and other settings with medications such as buprenorphine/naloxone and naltrexone, may be available in your community.

If ” Someone is unresponsive and not breathing.”, call 911 immediately!

You may just save a life!

 

What To Tell Your Child About Opioids

opiod

As the professionals, practitioners and policymakers wrestle with the current OPIOID epidemic, parents, you will want to be proactive and prevent the disharmony from entering your home. Education, information and conversation are the first steps towards prevention. Children need to understand the myriad of components to substance misuse, and parents are perfect for information delivery.

Since the country is talking about opioids, parents can begin there. Initiate conversations about prescription drugs, for sooner or later, they will be confronted with a drug of some sort by the time they are adolescents. Other children will talk about it. It is best that parents, in an attempt to shelter their children from exposure to drugs, have honest discussions about drugs of all kinds.

We can’t shelter children from all possible dangers. Parents’ best effort to protect their children from harm is to educate them about these dangers. Age appropriate content, shared information, should guide you.

Use these tips to talk with your child:

  • Plan to have many short talks with your child through ‘bite-sized’ session concepts. One topic at a time to ensure your child fully processes the information. Allow time for questions. Invite them.
  • Choose informal times to have conversations, such as in the car or at dinnertime.
  • Continue talking as they get older. Stay age appropriate, and relevant. There should be no ‘taboo’ topics. The more hidden topics of concern remain, the more vulnerable children, families and communities become.
  • Clearly state what you expect regarding drug use.[be realistic] If your child is considering trying drugs or alcohol, you want them to feel safe enough to approach you to talk about it together.
  • Create family rules together, such as your expectations when hanging out with friends, and rules for having friends over, curfews, chores and
  • Let them know that you are always there for them.

photography of girl riding bike beside man

Encourage open discussions; don’t shy away from the discussions you may not be 100% comfortable having. If parents won’t begin the dialogue and encourage difficult discussions, children will always have the ‘streets’ to inform them. Better for parents to provide information and engage in real-life discussions than a child receiving ‘fake news’ from outside sources. Or allow the ‘blind’ to lead the ‘blind’.

Opioids are a group of drugs that includes prescription pain medications and illegal drugs like heroin. The most common prescription drugs are oxycodone, codeine, morphine and hydrocodone. After marijuana and alcohol , these are most commonly misused substances by Americans age 14 and older.

Misuse can be taking someone else’s medicine, taking medicine in a way other than prescribed, taking it to get ‘high’, or mixing medication with other drugs or substances. Children who take opioid pain medication, even just once, can suffer serious illness or death.

Between 2004 and 2005, approximately 71,000 children under age 18 went to emergency rooms because they took medications while their parent wasn’t looking.

Consequences of taking prescription pain medications include:

  • allergic reactions,
  • breathing problems,
  • coma,
  • permanent brain damage and/or
  • death.

Tell children that just because a medication was prescribed, it doesn’t mean that it can’t be harmful. It’s unsafe to take someone else’s medication, even if the child knows that person. Doctors prescribe different dosages based on a person’s size and age. Taking the wrong strength medication can be deadly. 53% of people age 12 or older obtained prescribed pain medication from a friend or relative.

Parents should talk to their child about how addiction is a disease and misusing medications can have devastating and life-threatening consequences. In 2017, it is estimated that 2.1 million people ages 12 and older had an opioid use disorder. Prescription opioids, when used long-term or improperly, can cause the brain to become reliant upon the drug and become highly addictive.open mouth

If offered prescription pain medication that aren’t theirs, talk to your children about having an ‘exit plan’.  Peer pressure can be powerful and having a way out to avoid taking pain meds, helps children say ‘no’. Ask your children what they would do if offered drugs, like maybe texting a code to a family member. Practice this plan with them to make it easier to follow through. Practice in a safe environment until it feels natural. Then, when your child is faced with a decision, they are better equipped to make smart choices. 

In some situations, your child’s doctor may prescribe an opioid before or after surgery or a broken bone. Talk to your doctor and your child about the risks associated with these drugs, taken as pain relievers. 

Research suggests that one of the most important factors when a child grows up is a strong and open relationship with a parent. Despite how children seem to resist, they really do hear you and listen to your words of concerns. Please discuss the risks of using pain medications with them. Sex isn’t the only conversation to have with your growing child. Add this one to your list of parental duties and responsibilities.