Among the many troubling questions raised by the coronavirus pandemic has been the impact of school closures and stay-at-home orders on vulnerable children and families. Child welfare experts suspect the emotional strain of job losses, health fears and home-schooling has left such children at greater risk of child abuse and neglect, but with fewer interactions with teachers and others who might report the cases. We spoke with Carole Swiecicki, head of the Dee Norton Child Advocacy Center in Charleston, for insight.
Q: Tell us about the Dee Norton Child Advocacy Center.
A: Our mission is to prevent abuse, protect children and heal families. Our primary service area is Charleston and Berkeley counties and we serve about 1,500 children per year with our direct services. We also work through Project Best, which is a Dee Norton project that's co-led by the Medical University of South Carolina, with support from The Duke Endowment.
Q: What is Project Best?
A: Its mission is to ensure that every abused child in South Carolina has access to evidence-based assessments and treatments for trauma. It includes training and technical assistance for therapists and for those we call brokers. These are professionals who are in a position to identify a child in need of treatment and can make that referral. The project includes training for providers in our service area, but also expands beyond to train providers throughout the state.
Q: How have your services been affected by the pandemic?
A: It's almost a question of how haven't they been affected at this point. With our direct services, we have provided in-person services throughout the pandemic. We scaled back considerably at the beginning and have gradually increased. We use masks and physical distancing. We've set up cameras in some of our larger conference rooms so that the child and interviewer can be at least six feet apart. We have also set up tele-forensic interviews where the family is in one location and the interviewer interviews from a different room.
Q: Sounds like you’ve had to rely a lot more on telehealth services.
A: We shifted all of our therapy services, including assessments and treatment, to tele-mental health. We set up a training with experts who worked at MUSC's Health Disparities Clinic, which has a tele-health outreach program. Because of Project Best, we now have a roster of about 450 therapists fully trained in the best telehealth practices concerning treatment for child trauma. We were able to offer that statewide and nationwide for therapists.
Q: What makes delivering these services through video more challenging?
A: I'm a licensed psychologist and a trainer in this treatment. When I'm doing in-person therapy and kids are talking about their experience, part of what you're paying attention to is their level of anxiety. You notice that they are starting to tap their toe, and so that subject matter is considered a ‘hot spot,’ one that's a bit more upsetting to them. It’s one that you’d want to come back to, to process their thoughts and their feelings on. If a camera only shows their shoulders and face, you can't see those things.
Q: There’s been a lot of discussion among child welfare experts about whether the stay-at-home quarantines have been affecting the safety of vulnerable children. Some suspect child maltreatment is being underreported. What are you seeing in your caseloads?
A: DSS reports are certainly down for the counties we work with, just as they are for the rest of the state, so we are definitely seeing that. We're planning in-depth trainings with Charleston County teachers to support them in the upcoming academic year because they already are having some video contact with students. We’re trying to support them in terms of filing mandated reports if they have a suspicion and what that suspicion might look like over Zoom. It is a tough situation for sure.
Q: In ramping up your telehealth services, did you have to buy new equipment or computers or pay for access to platforms like Zoom?
A: There were a fair amount of added costs just in terms of setting up Zoom accounts for all of our direct service providers. For families who don't have resources or consistent internet access, we've purchased data-enabled iPads that we've configured so that all they can do is the Zoom app.
Q: Are there other challenges or benefits of tele-delivery?
A: The only other thing I would add is the need for good supervision for the providers themselves. Trauma work is tough work, so we're trying to infuse support for the providers, too.
Q: How are you doing that?
A: We do Zoom supervision rather than by phone, so you are still seeing the person and there's a bit more of a connection. Our clinical teams also started doing group supervision via Zoom, so people are seeing each other in small groups.
Q: And you go over case notes and that kind of thing?
A: Yes. And we've continued offering consultation for therapists across the state, providing tele-health for them as well.
Q: Are there things you've learned as a manager during this year of upheaval that would provide broader lessons for other nonprofit leaders?
A: This is a really good time to make sure that you stay focused on your core values and mission, and make sure that they're serving you well. Our core values, as an agency, are compassion, collaboration and commitment to excellence. I have really tried to fall back on that with all of the changing that we're doing.
There’s so much going on in our world, and the pandemic is a stressful event and potentially traumatic for high-risk individuals. We’re thinking through the question of how do we make sure that we address that, but stay on our mission for how that's impacting children who've been abused. Similarly, with racial injustice, which is so prevalent and at the forefront of people's attention right now, we're looking at that as an agency, in terms of how that filters to our mission of preventing abuse, protecting children and healing families, and making sure that we're compassionate to all children and to our staff. It is essential that we collaborate with the right people to learn about the history and about how that impacts how families interact with the child welfare system and with law enforcement because those are our partners. And that can impact their trust, which is so important when someone has experienced child abuse.
Q: How should adults talk to children about all the uncertainty and fear people are feeling?
A: The first thing is for the adults to get to a point where they're comfortable talking about these things. The pandemic is uncomfortable and anxiety provoking; racial injustice is uncomfortable and sometimes fear and anger inducing. Adults need to be in a place where they can talk about it calmly. Once they are, the first thing is to ask children what they know and how they're feeling. From there, it gives them the opportunity to share accurate information. Sometimes children are very fearful – and with the pandemic, they might be having thoughts about the whole family dying.
Second, you can share the risks that are out there, but then focus on what the grownups are doing to keep kids safe. The same principles apply to racial injustice. Ask them what they know, ask them how they feel, make sure that they know you, as the adult, are comfortable talking about their feelings and can get them help and provide the safety that they need.
Q: What gives you cause for hope?
A: First, is my faith -- knowing that we are part of a broader plan that God has and he's in control. Secondly, I would say we have such a strong community here in Charleston and across the Carolinas. We can get through this together and rely upon one another to help one another out. I have a lot of hope in our fellow neighbors.