Hello and Happy July!
We are thrilled to share this month’s E-Press that contains information about ways to discuss culture with families, how to communicate with families about disabilities, and information about the opioid epidemic in Florida and the greater United States. Additionally, the first chapter titled, Overview of the Training Manual, of the new Child Sexual Abuse Referrals Training Manual is included at the end of the E-Press.
We hope you enjoy this month’s edition!
Clearinghouse on Supervised Visitation
The Institute for Family Violence Studies
Florida State University
NEWS
There will be an additional phone conference on
July 14th at 12ET/11CT on the Overview Chapter of the new Supervised Visitation Training Manual for Child Sexual Abuse Case Referrals. The chapter is included at the end of this E-Press.
QUESTIONS FROM DIRECTORS
Is there a prohibition on putting the photographs and full names of our staff members, interns, or volunteers on our webpage or on social media?
No, there is no such prohibition in the Standards or Best Practices. However, the Clearinghouse has received complaints by programs in which clients or former clients followed program staff outside of the parameters of the visit and the program, left inappropriate messages for staff/volunteers, and otherwise exhibited stalking behavior toward program staff. Because of these incidents, the Clearinghouse recommends that programs limit the amount of freely available information about staff/volunteers. It is also why many programs only use the first name of the staff on name badges and IDs.
We have interns from local colleges that supervise visits. Are they required to have the full 24 hour training even if we only use them occasionally to monitor parent-child contact?
Yes. Anyone who supervises parent-child contact is required to have the full training. This is for the protection of the children, the vulnerable parents, and the monitor him or herself. The frequency of monitoring is irrelevant – even One visit creates a mandate that the monitor is trained. Frequent shadowing, where a monitor observes multiple visits supervised by a trained monitor, is not a substitute for thorough training, even though it does provide the new monitor with additional information. Remember, the Standards have always required training, and this mandate cannot be superseded. The only exception to this rule is if there is ALSO a fully trained monitor in the room with the intern, and that fully trained monitor is responsible for the visit.
If one family brings a toy to a visit, and a child from another family breaks that toy, is the program responsible for replacing the toy?
The question has never gone before a judge, and my advice is always to warn parents not to bring breakable or valuable items to visits. Things can happen quickly in group visits: children can run over to a different family and break something by mistake or with intent. Cell phones can fall out of pockets and shatter. Jewelry can go missing. Programs need to be sure that parents understand that staff are not responsible for such events. In thinking about this case scenario, I also suggest that if you notice that parents are wearing expensive watches, or earrings, etc., you repeat your admonition that the program is not responsible for ensuring the property of the family.
Are we allowed to recommend parenting coordinators or therapists or evaluators to clients?
I would avoid such recommendations, and instead direct parents to the list that most Court Administrators have on file. The issue is the appearance of favoritism – even if you know that a certain professional in the community has a good reputation, stay neutral and let the parents make their own decisions. Recommendations by parenting professionals can become highly divisive for the parents, and I see no benefit to becoming part of the conflict by making suggestions to the parties.
Discussing Culture with Families
Every family is different and monitors have a responsibility to take the time to understand how the families they work with are unique. Monitors may not have the same cultural background as the families they work with; cultural competence will help those monitors provide visitation in a non-judgmental and accepting way. An important way for monitors to be culturally competent is to be aware of different family’s cultural backgrounds.
If programs do not learn how to acknowledge and appreciate cultural differences, families may feel overlooked or ignored. This E-Press will discuss the ways that visit monitors can ask questions to stay informed and learn about the cultural background of the families they work with. Through communication and acceptance, monitors can build a working knowledge about a family’s cultural background and foster a strong connection.
Starting the Conversation
It is important to provide parents with the opportunity to express their cultural background at various points of service delivery (intake, during a visit, at the end of a visit). Different pieces of a family’s cultural background may come to light at various points of visitation, and monitors can use conversation to learn more about what is important to a family.
During Intake
Intake is the first opportunity to ask questions about what cultural information parents want the program to know about themselves and their family. Programs can use the questions below to start the conversation with parents.
Questions to Ask
- Are there any important holidays that you celebrate that you want me to know while you are working with our program?
- Are there any important religious or cultural beliefs that you want me to know?
**If you are unfamiliar with something from a family’s cultural background, it will be beneficial to do personal research after the visit to educate yourself about it**
- Are the roles in your family specifically defined? If so, what are they?
- What pronouns do you use?
- Is there anything in your culture considered disrespectful that you want me to know? (ask the same question but use the word respectful instead)
- Is there anything in our program that makes your culture feel ignored or criticized?
- Tell me something that is important to you and your family that you want me to know as a visit monitor.
Monitors should never assume they know a family’s cultural background due to their race, gender, or ethnic background. Intake provides a great opportunity for monitors to ask questions before making any assumptions. The only expert on a family’s cultural background and practices is the family themselves.
During/After Visitation
During the visit, you should be making visual and audial observations by listening to the content the parent and child are discussing and noticing any reactions or mannerisms. Listening to the parent and child talk will provide you with details about what a family’s culture is. In some cases, monitors will not receive all of a family’s cultural background information during intake and will slowly begin to notice things as visits go on. Review the scenario below for an example.
The monitor is observing the third visit between Mr. Carter and his twelve-year-old son Demetri. During the first two visits, the monitor noticed that Demetri never looked his father in the eyes. The monitor assumed the child was afraid of his father, but hasn’t observed other reactions to indicate Demetri was fearful.
The monitor decided to speak with Demetri alone to ask him about it.
Monitor: Hi Demetri, how are you feeling about your visit with your dad today?
Demetri: Pretty good, I really like getting to see him and telling him about baseball and school.
Monitor: That’s good, I can tell by the big smile you have every time you’re here that you enjoy seeing him which is why I wanted to ask you a question. I’ve noticed that you don’t look at your dad in the eyes during your visits with him. Can you talk to me about why you don’t look at him?
Demetri: Oh, I guess I don’t really notice that I do that. I mean, a long time ago my parents told me to not look at the eyes of my elders because it’s disrespectful so maybe that’s why.
Monitor: Okay, I just wanted to make sure that you weren’t feeling scared or anxious when you were with him.
Demetri: No, I’m not. I definitely do look at my dad sometimes, but I guess I just don’t look at him a lot because of what they told me.
In the scenario above, the visit monitor was dangerously close to making a faulty assumption about why a child didn’t look at his parent. In some cultures, not looking elders in the eyes is a symbol of respect and the visit monitor above was able to learn that by communicating with the child. The monitor could even go a step further and confirm that cultural practice with the parent as well.
During some visitations, a visit monitor might observe how a cultural belief is impacting a visit negatively between a parent and child. This does not mean that the cultural belief is negative necessarily, but that the parties involved are at a disagreement about the belief at hand. Instead of trying to change the view of a parent or child, it is better for the monitor to help the parent or child find ways to communicate with the other about their differences. Review the example below.
Monitor: During the visit today I heard you tell Theresa that she needs to stop playing soccer because as a girl she shouldn’t be playing a sport that boys play. I know you mentioned to me during the intake that you want your daughter to be modest and not engage in sport activities, but I’m worried you might be pushing her away. After you told her to stop playing soccer she looked discouraged and wouldn’t talk to you the rest of the visit. I think it’s important that you talk to her about why you don’t want her to play soccer, and also give her the opportunity to explain to you why she does.
Mrs. Mitchell: I know she stopped talking to me and she’s upset with me, but I’m her mother and I know what is best for her.
Monitor: I understand Mrs. Mitchell, but I don’t want to see her withdraw from you because I know you have worked so hard to strengthen your relationship with her. This visit was very different from the other ones you two have had. I think talking more about this with her will be important for your relationship. We can take a few minutes to talk about how you can have that conversation with her if you’d like?
Mrs. Mitchell: Okay, we can talk about it but that doesn’t mean I’m going to change my mind.
Monitor: Okay. First, I want to ask you what makes Theresa not playing sports so important to you?
In the scenario above, the monitor mentioned an observation of how the mother’s cultural belief was impacting her child without passing judgement. The monitor showed respect and acknowledgement of the mother’s belief, but expressed concern in how the mother and daughter were functioning as a result.
Supervised visitation monitors should take the initiative to understand and engage with a family’s culture by paying attention to what is said during the visit. If the monitor learns something new about the family’s culture, he or she can follow up with the parent and child while the visit is wrapping up. Review the conversation below.
Monitor: “I heard you and Fahim discussing Ramadan. Is there anything you want me to know leading up to or during Ramadan?
Mr. Abdalla (Father): Yes, there is. During Ramadan we fast during the day and break the fast just after sunset for Iftar, and we eat again for Suhoor just before the sun rises. Since our visits are in the afternoon, Fahim might seem more tired than usual since he’ll be up late to eat and then early to eat as well. I wanted to make sure you knew about that.”
Monitor: “Fahim, during Ramadan you get more tired around the afternoon?
Fahim (Son): “I do feel a little more tired than normal in the late afternoon, but it’s really not a huge deal. I’ve done it before, and it’s summer time now so I have time to nap and rest.”
Monitor: “Okay, how long does Ramadan last for?”
Fahim(Son): About a month.
Monitor: I’ll make a note of that so I can remember. Thank you both for sharing that with me.
In the scenario above, the monitor made an effort to ensure relevant cultural background was not ignored or overlooked. When monitors engage with parents and show a willingness to learn and accept, families will feel more comfortable during visitation.
Conclusion
The scenarios above make it clear how important it is for supervised visitation monitors to communicate with families about their culture. While intake is a key time to ask families questions about their beliefs, practices, and background, it is not the only time that monitors will learn about a family’s culture. Monitors have a responsibility to engage, accept, and respect a family’s culture throughout the visitation process.
This E-Press has provided monitors with questions on how to start the conversation with families, and case examples that show how those conversations may look during visitation. Programs can show they care about families by asking questions and recognizing their culture.
References
Klein, A. (n.d.) How Ramadan Works. Retrieved from http://people.howstuffworks.com/culture-traditions/holidays-other/ramadan2.htm
Community Tool Box. (n.d.) Building Culturally Competent Organizations. Retrieved from http://ctb.ku.edu/en/table-of-contents/culture/cultural-competence/culturally-competent-organizations/main
Resources
The Clearinghouse has previously written E-Presses about different topics related to cultural competence before. You can find them here:
Cultural Awareness and Diversity for Supervised Visitation Workers- Page 9 http://familyvio.csw.fsu.edu/wp-content/uploads/2014/01/2014-01_EPress_web.pdf
Cultural Competence and Multiculturalism in Supervised Visitation- Page 19
http://familyvio.csw.fsu.edu/wp-content/uploads/2013/05/May13EPress_MB.pdf
Additionally, cultural competence is discussed in Chapter 7: Working with Culturally Diverse Families of the Supervised Visitation Training Manual.
Communicating with Families about Disabilities
Families from all backgrounds attend supervised visitation programs, and it is essential that monitors are equipped with the skills to work with each one. In some instances, programs may work with a parent or child who has a disability. When monitors are working with family members who have disabilities it is important to ensure that the program understands how they can accommodate that person’s needs. This E-Press will discuss how monitors and programs can create a safe and supportive environment for families with disabilities through respectful language and asking questions.
People First Language
For individuals who do not have disabilities, they may not know or be aware of language that is outdated, hurtful, and even discriminatory towards people with disabilities. Before learning what questions are important to ask families regarding disabilities, monitors must first know how to use respectful disability language. The table below reviews language that is outdated and how monitors can replace it with its respectful language counterpart.
| Outdated Language | Respectful Language |
| Crazy, insane, psycho, mental, maniac
Crippled, crippled, lame, physically challenged
Confined to a wheelchair, wheelchair bound
Autistic
Birth defect, deformity, congenital defect
Blind, visually impaired
Hidden disability, invisible disability: Learning disabled
Mentally retarded, retarded, imbecile, feeble minded
Midget, Dwarf
Normal |
A person with a mental illness
A person with a mood disorder A person with an anxiety disorder
A person with a disability A person who uses a walker A person with a physical disability
A person who uses a wheelchair
A person with Autism/Autism Spectrum Disorder
A person with a disability since birth
A person with vision loss A person who is blind
Non-visible disability A person with a learning disability
A person with an intellectual disability A person with a developmental disability
A person of short stature A person who has a form of dwarfism
A person without a disability A person who is not disabled |
Important Reminders
Program monitors should never ask a parent “what happened to you” or “what happened to your child”. Asking questions like those can make the parent or child feel alienated and uncomfortable.
Monitors must remember that a person is more than their disability, which is why using respectful language puts the person first before their disability. Person-first language can be empowering and positive when working with individuals who have disabilities.
Communicating with Families
A key component of providing effective services as a program is understanding how the program and monitors can accommodate the different needs of families. During the intake process with parents, supervised visitation monitors have the opportunity to ask parents if they or their child has a disability.
The questions below are examples of questions that monitors can use during intake.
Questions to Ask
- How can our program accommodate you or your child’s needs?
- Will you or your child need help getting to and using the restroom?
- Is there something you want us to know about you or your child’s learning abilities?
- Is there specific language you would like us to use during your visits?
- Is there anything you want us to keep in mind or know about you or child during visitation?
- Was there any difficulty getting to our program today?
**If parents disclose a disability that they or their child has, it is important that the program has an adequate understanding about that disability and how it might impact visitation**
Monitors can assure parents that they have made a note of any important information and concerns regarding their own or their child’s disability. It may also be helpful to inform parents that the program will do all that they can to accommodate their needs.
Conclusion
The most important thing to remember when working with parents or children that have disabilities, is that they are more than their disability. While it is often important and necessary information to know whether or not an individual has a disability, it is crucial that a monitor does not characterize them solely by their disability.
After reading this E-Press, monitors should have a better understanding of what kind of language to use to ensure that they are putting people first, and not disabilities. Additionally, monitors can use the example questions during intake as a starting point with families to learn if there is any information they or the program needs to know in order to adequately accommodate and address their family’s needs.
References
Kids as Self Advocates. (n.d.) Respectful Disability Langauge. Retrieved from http://www.fvkasa.org/resources/files/history-nyln-language.pdf
Ontario Education Services Corporation. (n.d.) Tips on Serving Customers with Disabilities. Retrieved from http://www.ddsb.ca/AboutUs/Accessibility/Documents/Accessibility%20Tips.pdf
Resources
The Clearinghouse has previously written E-Presses related to working with parents and children with disabilities. Some of these topics are below.
Working with Parents with Learning Disabilities- Page 8
http://familyvio.csw.fsu.edu/wp-content/uploads/2013/07/Aug13EPress_MB.pdf
Supervised Visitation and Special Needs Children- Page 4
http://familyvio.csw.fsu.edu/wp-content/uploads/2012/11/Nov2012_EPress_forWeb.pdf
The Opioid Epidemic
In the state of Florida, Governor Rick Scott has declared the opioid epidemic to be a public health emergency. The epidemic has plagued various parts of the country for several years, and Florida, particularly areas in South Florida, have witnessed the devastating effects of opioid addiction and overdoses for years.
This overview will provide a basic understanding of what opioids are, statistics about addiction and overdose rates, and risk factors for opioid addiction.
Florida’s Opioid Epidemic
The Center for Disease Control and Prevention reported that in 2015, close to 3,900 people died across the state due to opioid abuse. In 2016, an estimated 4,000 people died from opioid overdoses.
In Palm Beach County in 2016, 525 people died by opioid overdoses. Continuing, in Delray Beach last year more than 900 individuals died from opioid overdoses.
Additionally, during 2016 in Miami-Dade County 220 individuals died due to a fatal combination of heroin mixed with fentanyl (which is significantly stronger than morphine) or carfentanil. In Broward County that same year, 90% of fatal drug overdoses included a mix of opioids such as heroin or fentanyl.
Types of Opioids
- Natural Opioid and Semi-Synthetic Opioid Analgesics: for natural opioids there are morphine and codeine, and examples of semi-synthetic opioid include oxycodone, and hydrocodone. These are commonly referred to as prescription opioids and have been used to treat moderate to severe pain in some patients. These drugs are commonly available by prescription.
- Synthetic Opioid Analgesics: Besides methadone this includes drugs such as tramadol and fentanyl.
- Fentanyl is man-made and is 50 times more potent than heroin and 100 times more potent than morphine. The first type of fentanyl is pharmaceutical which is primarily prescribed to advanced cancer patients in order to manage pain. Fentanyl can be prescribed as transdermal patches or lozenges. The second type is illegally made and is non-pharmaceutical. This kind is often mixed with other drugs such as cocaine or heroin in order to enhance the drug’s effects.
- Heroin: An illegally made opioid created from morphine which can be a white or brown powder, or sticky black substance. This drug is highly addictive and is often used with other drugs and alcohol which increases the risk of overdose. Heroin can be injected, snorted, or smoked.
How Addiction Develops
Addiction to opioids can occur in a variety of ways. In some instances, an individual may be given prescription opioids to manage pain and then begin to develop a tolerance that can lead to physical dependence and then addiction. Some individuals may begin using heroin because it is cheaper and easier to obtain than the prescription opioids they are addicted to.
Research has also shown that some individuals are more susceptible to using and becoming addicted to opioids due to abnormalities in a person’s brain structure. These abnormalities can affect the decision-making areas of the brain, making it more likely for a person to engage in compulsive and addictive behaviors. These behaviors include trying new drugs and having low impulse control.
Additionally, addictions to other substances can create abnormalities in the brain which can increase the likelihood for individuals to try opioids and continue using them to experience feelings of euphoria.
Opioids affect various parts of the central nervous system including the brain stem, the limbic system, and the spinal cord. It is important to understand the ways in which opioids affect a person’s brain functioning, since those effects are primarily responsible for how dependence and addiction to opioids develop. Opioids can decrease breathing by changing the balance of different neurons and chemicals in the brain system, which is responsible for controlling vital body functions such as breathing and heart rate. Opioids affects the part of the brain responsible for controlling emotions, the limbic system, by increasing feelings of pleasure and changing how that part of the brain typically functions. Lastly, opioids can block the feelings of pain from being sent through the spinal cord from the body. All of these effects combined provide insight as to why opioids can be addictive for many individuals.
When an individual develops a tolerance to opioids, they will experience withdrawal symptoms if they discontinue use of the drug. These symptoms can be incredibly uncomfortable and dangerous if not monitored by a medical professional. When a person becomes addicted to opioids by developing a tolerance and physical dependence, their brains have grown accustomed to functioning under the effects of the drug. When the opioid is no longer present, the body performs abnormally due to that dependence and addiction factor. During the withdrawal process, an individual may experience anxiety, muscle cramps, diarrhea, and jitters. The more severe the addiction is, the more difficult the withdrawal process will be for an individual. In addition to the pain relief and euphoric effects, the discomfortable withdrawal experience is a reason many avoid discontinuing opioid use.
Effects of Opioids
The effects of opioids can vary depending on which type it is. The following list describes the potential effects of prescription opioids on an individual:
- Higher tolerance to the drug- the longer you use the opioid the more you will need to provide the same effect.
- Physical dependence which leads to withdrawal symptoms after discontinuing opioid use.
- Increased sensitivity to pain
- Constipation
- Nausea, vomiting, and dry mouth
- Sleepiness and dizziness
- Confusion
- Depression
- Itching and sweating
The following effects are specific to heroin use:
Short-Term Effects
- A high or “rush”
- Decreased breathing
- Slower and cloudy mental functioning
- Nausea and vomiting
- Pain is blocked
- Spontaneous abortion if pregnant
Long-Term Effects
- Addiction
- Infectious disease (e.g., HIV, hepatitis B and C) due to unclean needles that may be used to inject heroin
- Collapsed veins
- Bacterial infections
- Abscesses
- Infection of heart lining and valves
- Liver and kidney disease
Addiction and Overdose Statistics
The following statistics have been found from research related to information about opioid addiction and overdose from around the United States.
- As many as 1 in 4 Americans who were prescribed opioids long term to manage non-cancer related pain struggled with addiction.
- In 2014, over two million Americans abused or relied on prescription opioids.
- Every day, over 1,000 people are being treated for opioid abuse in Emergency rooms.
- The most common prescription opioids to cause overdose are methadone, oxycodone (OxyContin), and Hydrocodone (Vicodin).
Overdose Deaths
It is important to note that overdose does not always lead to death, but as an addict prolongs their abuse of heroin or prescription opioids, the amo unt they need to induce a “high” increases their risk of having a fatal overdose. A heroin overdose can cause very slow and shallow breathing which can result in coma or death. The startling statistics provide more information about the prevalence of overdose deaths due to opioid abuse.
- More than six out of ten drug overdose deaths in the United States involve an opioid.
- More than 500,000 people died from drug overdoses from 2000 to 2015.
- Every day, 91 Americans die from an opioid overdose.
Research conducted from 1999 to 2014 found that among those who died from prescription opioid overdoses:
- People aged 25 to 54 years old had the highest overdose rates.
- Overdose rates were higher among non-Hispanic whites and American Indian or Alaskan Natives, compared to non-Hispanic blacks and Hispanics
- Men were more likely than woman to die from overdose, but that gap is beginning to close.
Risk Factors for Addiction
Research has found risk factors that may lead to prescription opioid and heroin addictions. As part of recognizing these addictions as a public health emergency in Florida, Governor Rick Scott committed 54 million dollars in U.S. Department of Health and Human Services grant money aimed towards prevention and intervention including equipping all EMS personnel with naloxone (and overdose reversal drug).
Prescription Opioids
Research shows that some risk factors make people particularly vulnerable to prescription opioid abuse and overdose, including:
- Receiving overlapping prescriptions from different doctors and pharmacies.
- Consuming high daily quantities of prescription pain relievers.
- Having a mental illness or history of alcohol or other substance abuse
- Living in rural, isolated areas and having low income.
Medicaid Patients
- Inappropriate opioid prescribing rates are significantly higher among Medicaid patients than they are for patients who have private insurance.
- Based on 2010 data, 40% of Medicaid recipients with prescriptions for pain relievers had at least one of the following potential indicators of inappropriate use or prescribing:
- overlapping prescriptions for pain relievers, and possibly benzodiazepine prescriptions,
- long-acting or extended release prescription pain relievers for acute pain, and
- high daily doses.
Heroin Addiction
Research has found that the following risk factors may make an individual more susceptible to developing a heroin addiction:
- Addicted to prescription opioid pain relievers or cocaine
- Uninsured or enrolled in Medicaid
- Non-Hispanic whites
- Males
- Addicted to marijuana and alcohol
- Living in a large metropolitan area
- Being between the ages of 18 to 25 years old.
Additional Important Statistics:
- More than nine in 10 people who have used heroin also used at least one other drug.
- Among new heroin users, approximately three out of four reported abusing prescription opioids prior to using heroin.
Conclusion
Opioid addictions and overdoses are becoming more prevalent not only across the nation but in Florida as well. It is important to understand that as supervised visitation programs, you may work with parents who are struggling with a prescription opioid addiction or a heroin addiction. Many of those who have a heroin addiction were first prescribed an opioid to manage their pain which turned into abuse of the prescription drug then introduction to heroin.
This E-Press has provided supervised visitation programs with a basic foundation to understand the opioid epidemic and how it affects the individuals who have developed a dependence and addiction to the drug. It is important for all monitors to remember not to generalize or make assumptions regarding individuals with an opioid addiction. There are various ways that an individual may develop an opioid addiction, and each person has their own story.
References
Algren D, Monteilh C, Rubin C, et al. (2013). Fentanyl-associated fatalities among illicit drug users in Wayne County, Michigan (July 2005-May 2006). Journal Of Medical Toxicology: Official Journal of the American College Of Medical Toxicology. 9(1):106-115.
Ceballos, A. (2017). Florida Bolsters Response to Opioid-Addiction Crisis. Retrieved from https://www.usnews.com/news/best-states/florida/articles/2017-05-03/florida-bolsters-response-to-opioid-addiction-crisis
Centers for Disease Control and Prevention. Demographic and Substance Use Trends Among Heroin Users — United States, 2002–2013. MMWR 2015; 64(26):719-725.
Centers for Disease Control and Prevention, National Center for Health Statistics. (2015). Multiple Cause of Death 1999-2014 on CDC WONDER Online Database. Retrieved from http://wonder.cdc.gov/mcd-icd10.html.
Center for Disease Control and Prevention. (2016). Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics. Retrieved from http://wonder.cdc.gov.
Haden, P. (2017). The number of daily opioid overdoses in South Florida is overwhelming police. Retrieved from https://www.pri.org/stories/2017-04-20/number-daily-opioid-overdoses-south-florida-overwhelming-police
- R., & George, T. P. (2002). The Neurobiology of Opioid Dependence: Implications for Treatment. Science & Practice Perspectives, 1(1), 13–20.
Muhuri P.K., Gfroerer, J.C., and Davies, C. (2013). Associations of nonmedical pain reliever use and initiation of heroin use in the United States. CBHSQ Data Review.
National Institute on Drug Abuse. (n.d.) What are the medical complications of chronic heroin use? Retrieved from https://www.drugabuse.gov/publications/research-reports/heroin/what-are-medical-complications-chronic-heroin-use
Ossiander E.M. (2014). Using textual cause-of-death data to study drug poisoning. Am J Epidemiol. 179(7):884-94. doi: 10.1093/aje/kwt333.
Rudd, R.A., Seth, P., David F, Scholl, L. (2016). Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep. DOI: http://dx.doi.org/10.15585/mmwr.mm6550e1.
Siemaszko, C. (2017). Florida Gov. Declared State’s Opioid Epidemic Public Health Emergency. Retrieved from http://www.nbcnews.com/storyline/americas-heroin-epidemic/florida-gov-declares-state-s-opioid-epidemic-public-health-emergency-n755056
Substance Abuse and Mental Health Services Administration. (2013). Highlights of the 2011 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits. The DAWN Report. Rockville, MD. Retrieved from http://www.samhsa.gov/data/2k13/DAWN127/sr127-DAWN-highlights.htm
New Training Manual for Florida’s Supervised Visitation Programs
Referrals to Supervised Visitation in Child Sexual Abuse Cases
Overview of the Training Manual
The Keeping Children Safe Act requires supervisors of visits in sexual abuse cases to have specialized training in child sexual abuse dynamics. This manual provides such training, and can be supplemented by local training.
Child sexual abuse negatively affects the victimized child, the family of that child, and society as a whole. It is important for supervised visitation providers to become knowledgeable about the dynamics of child sexual abuse in order to effectively protect vulnerable children and non-offending parents. This involves rebutting the myths that surround child sexual abuse victimization, as well as understanding how sexual abuse can be part of polyvictimization – multiple forms of abusive family dynamics that may exist in the family.
The manual provides supervised visitation monitors with information about the ways that different systems respond to allegations of sexual abuse. The manual will include the requirements for reporting suspicions of child maltreatment, the process of making a report, as well as how the legal system and the Florida Department of Children and Families (DCF) respond to allegations of child sexual abuse.
In addition, staff will learn about new research that reveals the extent of juvenile sexual offending, the strategic process of how abusive adults victimize vulnerable children, and how visitation staff can protect children at every stage of the investigation.
Finally, staff will learn how to prepare to monitor cases that involve allegations or confirmed cases of sexual abuse, as well as to protect children during supervised visits.
Upon completion of this chapter, a visit monitor will be able to:
- Understand the Keeping Children Safe Act
- Understand other relevant cases that set precedence in family cases
- Apply this knowledge to better serve families in supervised visitation
| The Keeping Children Safe Act
Florida Statutes § 39.0139 |
Intent of the Keeping Children Safe Act
Section 39.0139, Florida Statutes, which is cited as the “Keeping Children Safe Act,” is a response by the Florida Legislature “to protect children and reduce the risk of further harm to children who have been sexually abused or exploited by a parent or other caregiver.” Fla. Stat. § 39.0139(2)(b) (2016).
When creating the Keeping Children Safe Act, the Legislature found that:
- For some children who are abused, abandoned, or neglected by a parent or other caregiver, abuse may include sexual abuse,
- These same children are at risk of suffering further harm during visitation or other contact with the child’s abuser, and
- Visitation or other contact may be used to influence the child’s testimony. Stat. § 39.0139(2)(a).
The Keeping Children Safe Act attempts to reduce the risk of such further harm by creating a special judicial process relating to approval of visitation or contact between a child victim and certain abusive parents or guardians to whom the Act applies. Fla. Stat. § 39.0139(2)(b).
What type of cases does the Keeping Children Safe Act apply to?
The Keeping Children Safe Act only applies in cases brought under Chapter 39of the Florida Statutes, which primarily involves dependency and termination of parental rights cases. The focus of the Keeping Children Safe Act is to protect children who are abused, abandoned, or neglected.
For example, the Keeping Children Safe Act will not apply in a Chapter 61 dissolution of marriage case where the custody of the children is being fought over.
Who is the Keeping Children Safe Act applicable to?
Subsection (3)(c) of the Act states that if a person meets certain criteria that create a “rebuttable presumption of detriment” to a child, they may not visit or have contact with a child victim without a hearing and order by the court. Fla. Stat. § 39.0139(3)(c).
Subsection (3)(a) gives the criteria for when a presumption of detriment is created, as follows:
- A court of competent jurisdiction has found probable cause exists that a parent or caregiver has sexually abused a child as defined in s. 39.01;
- A parent or caregiver has been found guilty of, regardless of adjudication, or has entered a plea of guilty or nolo contendere to, charges under the following statutes or substantially similar statutes of other jurisdictions:
- Section 787.04, relating to removing minors from the state or concealing minors contrary to court order;
- Section 794.011, relating to sexual battery;
- Section 798.02, relating to lewd and lascivious behavior;
- Chapter 800, relating to lewdness and indecent exposure;
- Section 826.04, relating to incest; or
- Chapter 827, relating to the abuse of children; or
- A court of competent jurisdiction has determined a parent or caregiver to be a sexual predator as defined in s. 775.21 or a parent or caregiver has received a substantially similar designation under laws of another jurisdiction.
As used in this subsection, “substantially similar” means “any offense that is substantially similar in elements and penalties to one of those listed in this subparagraph, and that is in violation of a law of any other jurisdiction.” Fla. Stat. § 39.806(1)(d)(2) (2016).
Rebuttable Presumption
If a parent or guardian meets one of the criteria set forth in subsection (3)(a), a “rebuttable presumption of detriment” to the child has been created. If such a person wishes to have contact or visitation with the child victim, they have the right to a hearing to determine whether contact is appropriate. Fla. Stat. § 39.0139(4)(a).
During such a hearing, the court will presume that visitation or contact would be detrimental to the child. It is up to the person to “rebut” this presumption – toshow that visitation or contact would not endanger the safety, well-being, and physical, mental, and emotional health of the child. Fla. Stat. § 39.0139(4)(c).
Hearing Details
Prior to a hearing under the Keeping Children Safe Act, if an attorney or guardian has not already been appointed to represent the child, the court shall appoint one that has had special training in the dynamics of child sexual abuse. Fla. Stat. § 39.0139(4)(a). Such an attorney or guardian is known as an “attorney ad litem” or a “guardian ad litem.”
Evidence rules for a hearing are relaxed compared to other types of court hearings. A court may rely upon “any relevant and material evidence submitted to the extent of its probative value, including written and oral reports or recommendations from the child protection team, the child’s therapist, the child’s guardian ad litem, or the child’s attorney ad litem, even if these reports, recommendations, and evidence may not be admissible under the rules of evidence.” Fla. Stat. § 39.0139(4)(b).
Possible Results of a Hearing
There are two possible results from a hearing under the Keeping Children Safe Act: the presumption of detriment is either (1) rebutted or it is (2) not rebutted:
- If, after the hearing, the court finds that the person has successfully rebuttedthe presumption of detriment, the court may allow visitation or other contact. This is done by proving “by clear and convincing evidence that the safety, well-being, and physical, mental, and emotional health of the child is not endangered by such visitation or contact.” Stat. § 39.0139(4)(c).
- In such a case, the court shall enter a written order setting forth findings of fact and specifying any conditions it still finds necessary to protect the child. Stat. § 39.0139(4)(c).
- Alternatively, if, after the hearing, the court finds that the person did not rebutthe presumption of detriment, the court shall enter a written order setting forth such findings of fact and prohibiting or restricting visitation or other contactwith the child. Stat. § 39.0139(4)(d).
- Any visitation or contact that is still allowed, despite not rebutting the presumption, must be limited by the conditions set forth in the Act in Section (5) – Conditions.
Conditions on Visits when Presumption Not Rebutted
Section (5) provides two alternative conditions that will be imposed on any visitation or contact that is ordered when a person does not rebut the presumption of detriment to a child under subsection (4)(d).
The visitation or contact will have one of the following requirements:
- Supervised by a person who has special training in the dynamics of child sexual abuse, or
- Conducted in a supervised, approved visitation program. Stat. § 39.0139(5)(a), (b).
If the contact is to be conducted in a supervised visitation program, subsection (5)(b) gives two requirements for the program:
(1) “an agreement with the court and a current affidavit of compliance on file with the chief judge of the circuit in which the program is located affirming that the program has agreed to comply with the minimum standards contained in the administrative order issued by the Chief Justice of the Supreme Court on November 17, 1999,” and
(2) “a written agreement with the court and with the department as described in Fla. Stat. § 753.05 containing policies and guidelines specifically related to referrals involving child sexual abuse.”
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Influencing Testimony –
Subsection (6)(a) provides the procedure for when a person is attempting to influence the testimony of a child involved in a Chapter 39 case.
The subsection applies in two situations:
- once a rebuttable presumption of detriment has already arisen under subsection (3), or
- if visitation has been ordered under subsection (4).
At that point, if a party or participant to the case informs the court that they have knowledge a person is trying to influence the testimony of the child, the court must hold a hearing within 7 business days. Such a hearing is held to determine whether it is in the best interests of the child to prohibit or restrict visitation or contact with the person alleged to have tried to influence the child’s testimony.
Impeding Child’s Therapeutic Progress –
Subsection (6)(b) applies when children are in therapy as a result of any finding or conviction included in subsection (3)(a). The (3)(a) findings and convictions include when:
- A court of competent jurisdiction has found probable cause exists that a parent or caregiver has sexually abused a child as defined in s. 39.01;
- A parent or caregiver has been found guilty of, regardless of adjudication, or has entered a plea of guilty or nolo contendere to, charges under the following statutes or substantially similar statutes of other jurisdictions:
- Section 787.04, relating to removing minors from the state or concealing minors contrary to court order;
- Section 794.011, relating to sexual battery;
- Section 798.02, relating to lewd and lascivious behavior;
- Chapter 800, relating to lewdness and indecent exposure;
- Section 826.04, relating to incest; or
- Chapter 827, relating to the abuse of children; or
- A court of competent jurisdiction has determined a parent or caregiver to be a sexual predator as defined in s. 775.21 or a parent or caregiver has received a substantially similar designation under laws of another jurisdiction.
If a child is in therapy as a result of any of the above findings or convictions and the child’s therapist reports that the visitation or contact is impeding the child’s therapeutic progress, the court shall hold a hearing within 7 business days. At the hearing, the court will review and possibly adjust the terms, conditions, or appropriateness of continues visitation or contact.
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Mahmood v. Mahmood, 14 So. 3d 1 (Fla. 4th DCA 2009).
Ultimate Impact:
- The Keeping Children Safe Act may only be invoked in cases brought under Chapter 39, which primarily relates to dependency and termination of parental rights.
- It may not be invoked in cases brought under other Chapters, such as Chapter 61 dissolution of marriage cases.
- Part of the Act was concerning to the court, as it created a rebuttable presumption of detriment merely from an anonymous tip to an abuse hotline regarding a parent or guardian.
- This part of the Act has since been deleted and replaced.
Background Facts:
Wahid Mahmood, husband, and Patricia Mahmoud, wife, had a pending dissolution of marriage case under chapter 61, Florida Statutes, when Patricia Mahmoud filed a motion to invoke the Keeping Children Safe Act, alleging sexual abuse by the father. Chapter 61 relates to dissolution of marriage and has its own guidelines to protect the interests of children when parents are getting divorced. Those guidelines specifically take into consideration evidence of abuse, neglect, abandonment, and sexual abuse of a child. Fla. Stat. § 61.13(3)(m) (2016).
Patricia Mahmoud filed multiple motions to suspend the husband’s visitation rights with their two children until a hearing under the Keeping Children Safe Act could be conducted, based on the claim that she had reported the husband to a child abuse hotline. At the time, one of the criteria of the Keeping Children Safe Act that would create a rebuttable presumption of detriment to a child was “a parent or caregiver has been the subject of a report to the child abuse hotline alleging sexual abuse of any child as defined in s. 39.01.” Fla. Stat. § 39.0139(3)(a)(1) (2008) (amended 2011).
What the Court Decided:
The Fourth District Court of Appeal found that the Keeping Children Safe Act did not apply in dissolution of marriage proceedings and therefore the mother’s report to the child abuse hotline did not require suspension of the father’s visitation pending a hearing under the Act. The court reasoned that the focus of the Act was to “provide an entry mechanism into the court system for children who need protection.” The court explained that when the Act referred to a “court” it was referring to a court assigned “to hear dependency and parental termination cases, not the circuit court in general or a family division of the circuit court primarily assigned to hear Chapter 61 dissolution of marriage cases.” Mahmood v. Mahmood, 14 So. 3d 1, 4 (Fla. 4th DCA 2009). Courts are already given broad powers to protect children who are mixed up in a chapter 61 dissolution of marriage proceeding. It was therefore not appropriate to invoke the Keeping Children Safe Act during a chapter 61 proceeding.
Additionally, the court expressed concern that, under the Act at that time, an anonymous tip to an abuse hotline automatically triggered the presumption of detriment and suspended visitation rights until a hearing could be held, under subsection (3)(a)(1). See also In re: Potts, No. 07–00742DPAWS (Fla. 6th Cir. Ct. 2007). This concern was legitimate, as this subsection was later amended by Chapter 2011-209, Florida Laws, which deleted the abuse hotline criteria and replaced it with the current subsection (3)(a)(1), which reads: “a court of competent jurisdiction has found probable cause exists that a parent or caregiver has sexually abused a child.” Fla. Stat. § 39.0139(3)(a)(1) (2016).
Leneve v. Leneve, 64 So.3d 196 (Fla. 4th DCA 2011).
Ultimate Impact:
- The court restated that the Keeping Children Safe Act only applies within Chapter 39 child dependency cases.
- Again, it could not be invoked in a Chapter 61 dissolution of marriage case.
- Again, the court was concerned that part of the act was unconstitutional. Specifically, the part that automatically created a rebuttable presumption of detriment merely when an anonymous tip was made to an abuse hotline regarding a parent or guardian.
- This part of the Act has since been deleted and replaced.
Background Facts:
Tamela Chappell, former wife of William Leneve, wanted to invoke the Keeping Children Safe Act to modify the final judgment of dissolution of marriage between the former spouses. The former husband had been granted shared parental responsibility and shared custody in the final judgment, but was nearing the completion of a three-year prison sentence for bankruptcy fraud and had been denied phone contact with the children for two years when the former wife raised the allegations of sexual abuse. The Department of Children and Families investigated the allegations and found them unfounded and “highly suspicious,” noting that it was “quite obvious” that the boys had been coached.
What the Court Decided:
The Fourth District Court of Appeal again found that the Keeping Children Safe Act could not and did not apply to chapter 61 dissolution of marriage proceedings. See also Mahmood v. Mahmood, 14 So. 3d 1 (Fla. 4th DCA 2009). The court stated that the Keeping Children Safe Act “does not apply outside the context of a Chapter 39 child dependency proceeding.” Leneve v. Leneve, 64 So.3d 196, 197 (Fla. 4th DCA 2011).
The court again noted their concern that the circuit court in In re: Potts found portions of the Act unconstitutional. The court agreed with the In re: Potts circuit court and again expressed their concern from Mahmoud that a mere anonymous tip would trigger the presumption of detriment under the Act. The court noted that, at the time, legislation was pending that would ultimately become chapter 2011-209, Florida Laws, which deleted the abuse hotline criteria and replaced it with the current subsection (3)(a)(1), which reads: “a court of competent jurisdiction has found probable cause exists that a parent or caregiver has sexually abused a child.” Fla. Stat. § 39.0139(3)(a)(1) (2016).
In re S.C., 83 So. 3d 883 (Fla. 2d DCA 2012)
Ultimate Impact:
- The Keeping Children Safe Act does not apply to children who have never been abused or exploited by a parent or guardian.
- The Act does not apply to a situation where a parent or guardian with a past child abuse offense wants to visit or contact a child who has never been abused or neglected.
- A court must treat the presumption of detriment as rebuttable. The Act specifically states that the presumption may be rebutted.
- Petitioners in the trial court to a Chapter 39 case qualify as “parties” under the Act, even though they are grandparents, and may therefore challenge a resulting order.
Background Facts:
Paternal grandfather, J.C., and paternal grandmother, C.C., were seeking review of the trial court’s Order under the Keeping Children Safe Act that prohibited contact between S.C., the grandson, and the grandfather, while the grandson was to remain in the care of the grandmother. Effectively, this prevented the grandfather from living with his wife.
The grandfather and grandmother had been caring for the grandson, who was two years old at the time of trial, since he was five months old, because the parents were abusing prescription drugs and the grandson was born dependent on methadone. When the grandson was approximately one-year-old, the parents executed power of attorney which gave the grandparents custody of the grandson. The father died of a drug overdose soon after. The grandfather had been living in a motel for two and a half months at the time of the trial.
The Keeping Children Safe Act was at issue because the grandfather was convicted of a misdemeanor involving molestation of his ten-year-old daughter in 1988. The hearing under the Keeping Children Safe Act made it clear that the 1988 incident was strongly related to the grandfather’s substance and alcohol abuse at the time. The grandmother reported the incident immediately and the grandfather completed probation, counseling, and two substance abuse programs, and had been clean and sober for over twenty years since.
The child protective investigator and the appointed guardian ad litem that testified at the Keeping Children Safe Act hearing recommended that the grandson would be safe living with the grandparents and that there were no indications of sexual abuse of the grandson. The grandfather had no objection to doing a substance abuse evaluation or a psychosexual evaluation.
However, after the hearing, the trial court entered a written order that prohibited the grandfather from any contact with the grandson and ordered that the grandson remain in the grandmother’s custody. The order did not contain any findings of fact or explanation of the court’s reasoning.
What the Court Decided:
The Second District Court of Appeal first noted that the grandparents were indeed “parties” to the order, contrary to the Department of Children and Family Services and Guardian Ad Litem Program’s (the Department) argument that they were merely participants that would require additional standing to challenge the order regarding placement. The court quoted the definition of “party” from section 39.01(51), Florida Statutes (2010), which included “the petitioner.” As such, the grandparents were parties and had standing to challenge the order, which affected the grandfather’s legal rights by preventing him from living with his wife.
Most importantly, the court ruled that the intent of the Keeping Children Safe Act was “to protect children and reduce the risk of further harm to children who have been sexually abused or exploited by a parent or other caregiver,” as stated within the Act at subsection (2)(b). Therefore, since there was no suggestion that the grandson had ever been sexually abused, the Act did not apply to the grandson and the trial court applied the incorrect law.
Additionally, the court stated that even if the Act was applicable to the grandson, the trial court erred by not applying the rebuttable presumption that the Act specifically created. The grandparents presented substantial uncontradicted evidence and testimony that there would be no issue for the grandfather to have contact with the grandson. The trial court, however, did not appear to treat the presumption of harm as rebuttable, as it made clear that it believed that no amount of evidence could rebut the presumption of harm to the child. Therefore, the trial court did not apply the law correctly, as section 39.0139(3) provided for a rebuttable presumption, and the Second District Court of Appeal quashed the trial court’s Order on the Keeping Children Safe Act.
Department of Children and Families v. P.F., 107 So. 3d 1123 (Fla. 5th DCA 2012).
Ultimate Impact:
- During a Keeping Children Safe Act hearing, it is not a court’s job to review whether there was enough probable cause that sexual abuse had previously occurred.
- If a judge previously issued an arrest warrant regarding sexual abuse of a child, then that is enough to trigger Subsection (3)(a)(1) and create the rebuttable presumption of detriment.
- This holds true even if the charges surrounding the arrest are later dropped due to lack of evidence.
- The hearing is meant to be an opportunity for the person to attempt to rebut the presumption, not a review of a previous court’s finding of probable cause.
Background Facts:
The Department of Children and Families (the DCF) and the father of K.A., the child, were seeking review of the trial court’s order on a Keeping Children Safe Act hearing. The hearing had granted the child’s maternal grandfather access to the child. The DCF and father claimed that the trial court did not follow the procedure provided for by the Keeping Children Safe Act.
After changing custody several times, the child had been put into the custody of the maternal grandfather’s long-term companion, D.K. The DCF objected to this placement for two reasons. First, there had not been an approved home study. Second, there was a verified finding of sexual abuse of the child by the maternal grandfather one year prior, although the charges were eventually dropped due to lack of reliable evidence. The court nonetheless placed the child with D.K. and ordered the grandfather to leave the residence until a Keeping Children Safe Act hearing could be held, but permitted the grandfather to have supervised visitation.
When the Keeping Children Safe Act hearing was held, the court looked at a wide range of evidence. The evidence included testimony by the child protective investigator who investigated the allegations of sexual abuse by the grandfather. The court also heard testimony by a member of the Child Protection Team that interviewed the child and gave her a medical exam after the previous allegations of sexual abuse. Both of these witnesses stated that the child, who was four years old, disclosed that the grandfather had sexually abused her. Testimony was also given by the detective that interviewed the grandfather regarding the sexual abuse and the detective stated that the grandfather displayed “obvious signs of deception through all the interviews.” The detective also testified that the mother revealed that she had heard that the grandfather had previously abused her sister and step-brother. Additionally, the maternal grandmother had informed him that she had previously witnessed the grandfather abusing their daughter, who was seven years old at the time.
Nonetheless, the court indicated that it would watch the recordings of the Child Protection Team interviews and then allow the grandfather to testify to rebut the presumption of detriment under the Keeping Children Safe Act. After watching the films, the court announced that it did not need to hear anything else, found no probable cause for abuse, and allowed the grandfather to return home. The court acknowledged that the grandfather had been arrested and charged with two counts of sexual battery on a child under the age of 12 and was in custody for a month, but stated the following:
“Upon personally reviewing the evidence of the child’s statements that lead to the necessity of a KCSA hearing, this Court finds no probable cause that Mr. Flanagan has sexually abused the child. The child’s statements were inconsistent and unreliable. There was no evidence that the child will be endangered by her grandfather.”
The DCF appealed the case on the grounds that the trial court did not follow the requirements of the Keeping Children Safe Act in two ways: “1) the trial court incorrectly interpreted the probable cause determination that triggers the rebuttable presumption of detriment to the child pursuant to section 39.0139(3)(a)(1), Florida Statutes; and 2) the grandfather did not meet his burden to rebut the presumption or to support the court’s findings and grant of custody.”
What the Court Decided:
The Fifth District Court of Appeal ruled that the trial court incorrectly interpreted what type of probable cause had to be present in order to trigger the rebuttable presumption of harm provided for in the Keeping Children Safe Act. The trial court appeared to look back at the evidence surrounding the arrest and decide that there was not enough evidence to prove probable cause in a trial, which was indeed why the charges were eventually dropped. However, this was an incorrect interpretation of the probable cause requirement of section 39.0139(3)(a)(1), Florida Statutes.
The trial court’s responsibility was to determine whether a court of competent jurisdiction had already found probable cause, and then allow the grandfather to attempt to rebut the presumption of harm that was triggered by that probable cause. In the case before the court, probable cause existed when the arrest warrant was granted to arrest the grandfather, because under the Florida Rules of Juvenile Procedure, in the context of a shelter hearing, “the issue of probable cause shall be determined in a nonadversarial manner, applying the standard of proof necessary for an arrest warrant. Fla. R. Juv. P. 8.305(b)(3).”
The court stated that the objective of the hearing was for the grandfather to prove clearly and convincingly that he was not a threat to the child, but this did not happen due to the trial court’s misinterpretation of the Act. The court then quashed the order given by the trial court and remanded the case for a new Keeping Children Safe Act hearing, whereby the grandfather would attempt to rebut the presumption of harm.
| Preparation for Training |
Before using the new manual, the Clearinghouse recommends that program directors take specific steps to prepare themselves and staff.
First, directors should read over all of the chapters of this manual. The Clearinghouse conducts monthly training and technical assistance calls during which these chapter will be discussed with program directors and lead staff.
Second, directors should prepare their staff for the emotional impact of this training. This is a crucial component of training because of the tragic nature of child sexual abuse. Non-offending adults often have very strong reactions to child abuse, including a full range of negative emotions. Program directors and trainers should be prepared to acknowledge and deal with these emotions during and after training. In addition, because of the prevalence of child sexual abuse, it is possible that individual staff members were themselves abused as children. It is important that these staff members are provided opportunities to deal with their own trauma histories before they are assigned to supervise families that have been affected by similar trauma.
Third, directors should make full use of the resources that the Clearinghouse has compiled from publically available platforms. Choose one of the online videos that we have provided links to. Offer multimedia training, so that participants can have the messages of the curriculum reinforced. Lauren’s Kids has excellent resources, as do a number of prominent websites. Call the Clearinghouse if you have questions.
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Child Sexual Abuse Online Resources |
- RAINN The Rape, Abuse & Incest National Network is one of the largest anti-sexual violence organizations in the country. They run an online hotline for sexual assault victims and their family and friends, and provide specific resources for children, members of the military, and for Spanish speakers. RAINN also carries out programs to prevent sexual violence, help victims, and ensure that perpetrators are brought to justice. https://www.rainn.org/
- Safe Horizon Safe Horizon provides support for victims of sexual abuse, domestic violence, human trafficking, and more. Safe Horizon also offers free legal information and advice, direct legal assistance to low-income victims, and connects victims with advocates who can help them report their assaults or find counseling. https://www.safehorizon.org/
- National Sexual Violence Resource Center NSVRC connects people with the information, resources, tools, and expertise needed to effectively address and prevent sexual violence in all communities. NSVRC offers e-learning courses related to the prevention and intervention of sexual violence like “Bringing hope: Responding to disclosures of child sexual abuse” and “From Approach to Practice: Improving outcomes for children after sexual abuse.” Their extensive online library is also a resource for researchers. http://www.nsvrc.org/
- Men Can Stop Rape Man Can Stop Rape promotes nonviolent expressions of masculinity by mentoring male youth and teaching them about consent. It also lists many resources for male sexual assault victims and male perpetrators of sexual violence. http://www.mencanstoprape.org/
- 1in6 One in six men experienced unwanted sexual conduct before the age of 18—and 1in6 provides resources for those men and their families, such as an online hotline, a questionnaire focused on helping men sort out their experiences, and more. https://1in6.org/
- Darkness to Light Darkness to Light is a nonprofit committed to empowering adults to prevent child sexual abuse through public awareness and education campaigns. Darkness to Light also provides a hotline for information, referrals to local resources, and training and education programs for educators, the faith community, and physicians on recognizing and responding to signs of child sexual abuse. Darkness to Light offers an award winning Stewards of Children training that helps adults prevent, recognize, and react responsibly to child sexual abuse. http://www.d2l.org/about/success-stories/
- LAUREN’S KIDS Lauren’s Kids offers a parent toolkit designed to educate and encourage conversations between parents and children about making safer and smarter choices. There are sections for children to practice safe choices, videos to learn valuable lessons, and kid and parent tips. http://laurenskids.org/curriculum/safer-smarter-kids/
- STOP IT NOW! Stop It Now! prevents the sexual abuse of children by mobilizing adults, families, and communities to take actions that protect children before they are harmed. Stop it Now! provides programs such as help services, prevention advocacy, prevention education, and technical assistance and training in an effort to prevent child sexual abuse. http://www.stopitnow.org/
- Parenting Safe Children The Parenting Safe Children workshop is a lively 4-hour workshop aimed at keeping children safe from child sexual abuse. http://www.parentingsafechildren.com/
- Safesport The U.S. Center for SafeSport goal is to prevent and respond to emotional, physical and sexual abuse. Safesport delivers tools to help sport organizations across the country champion respect and diversity on and off the field. https://www.safesport.org/
More Videos on How to Recognize Child Sexual Abuse
Short film/documentary about child sexual exploitation. Discusses some of the signs of child sexual abuse. 20 min, 30 secs long.
Short video listing 14 signs of child sexual abuse. 2 min, 17 secs long
Comprehensive video covering the physical and behavioral warning signs of child sexual abuse and what to do if you suspect child sexual abuse. Video is geared towards child care providers/teachers. 10 min, 52 secs long.
Short video covering signs of sexual abuse. 2 min, 35 sec