Family Audio Messages Help Johns Hopkins ICU Team Connect with COVID Patients

Family Audio Messages Help Johns Hopkins ICU Team Connect with COVID Patients

Getting to know the critically ill patients they’re taking care of is hard enough for ICU doctors under normal circumstances. But it’s even worse during COVID-19.

Not only are there no visiting family members to give you information, “but the patients are all similar in terms of their medical issues, they’re all on a breathing machine, and many are lying on their bellies,” explained Brian Garibaldi, MD, associate professor of medicine and anesthesiology at Johns Hopkins Medicine and director of the isolation unit at Johns Hopkins Hospital in Baltimore, in a phone interview. “You might go for days without examining the front side of their body, so we’re not seeing their face. That makes establishing connections with patients a little more difficult.”

An Idea From the Chaplain

One day Garibaldi was talking to Elizabeth Tracey, a chaplain at the hospital who also is director of audio production at Johns Hopkins Medicine — someone very familiar with audio recordings. She had an idea: how about if she interviewed patients’ family members and made a recording of what they say? “I could edit it down to a few things families really want their doctors to know about their loved one,” she said. Garibaldi was immediately on board.

In a separate interview, Tracey — who also edits and appears on MedPage Today‘s TTHealthWatch podcast, said she had heard from a chaplain colleague who told her that a physician had said after an extubation of a terminal COVID-19 patient that “I realized I didn’t know anything about this person; I didn’t know if he had children, if he was married. I didn’t know anything.” So why not give the physicians and the rest of the healthcare team personal details — “Do they have a dog? Do they like to play poker? It’s all the things that make them human,” said Tracey.

Tracey said Garibaldi emphasized one thing: “The only way this is going to work is if it’s in the voice of the family member.” So Tracey began calling family members and saying, “Hey, I’m part of the team helping take care of your loved one … Under normal circumstances you’d be here in the ICU telling us your loved one’s story. The team would like to know your loved one better as a person; would you like to spend 15 to 20 minutes talking about them?”

So far, only one person has turned her down since Tracey began doing this in April, and that was because they didn’t like the sound of their recorded voice, Tracey said.

After getting the family member’s permission, she records the phone call and edits the comments down to 2 or 3 minutes; she estimated that she has completed 30 to 40 recordings so far. Currently, the recording is distributed to the medical staff by an administrator at the hospital, although she hopes to eventually get it added as a link in the patient’s electronic health record.

A Message to the Healthcare Team

Tracey also added a second component: the opportunity for the family member to send a recorded message directly to the patient. “I said, ‘if you were talking to your family member, what would you say? Talk to them directly.'”

“They say these things that are just unbelievable,” said Tracey. One mother recorded a message for her adult daughter, whose autistic child the mother was the custodian of. “She says, ‘I want you to know that everything is forgiven,'” said Tracey. “How can you have a more powerful example of love?” Those conversations also are edited down to 2 minutes and played for the patient.

The recordings for the medical staff are very helpful, said Garibaldi. “Just learning the simple things — What would they prefer to be called by if I met them in the grocery story? What hobbies do they like? What favorite music can we program on an iPad to keep them awake and stimulated during the day? Also, learning things like what that person has accomplished in their personal and professional life; it really puts things in perspective, to put their current illness in the context of where they’ve been, where they are, and where they might want to be going.”

Dale Needham, MD, professor of pulmonary and critical care medicine at Johns Hopkins, agreed. He noted that although the medical staff speaks with patients’ family members every day, “those conversations have to be efficient and focused, whereas Elizabeth has the luxury of spending more time, and distilling it into an audio file that we can listen to and understand and easily share.”

For example, Needham said, “we found out that one patient previously had worked at a Smithsonian museum, and we found out that one of our patients likes to tango. And we found out that one of our patients that we wouldn’t have expected — was a DJ” on the weekend, while he had a white-collar job at a law firm during the week.

“This can help us understand who the patient is, and as the sedation is lightened, it helps us interact with them in a more humanized way.” It’s also mutually beneficial because the families are aware that the staff knows a little about their loved one, he added.

“What a Gift She Gave Us”

Barbara Johnson, whose late sister was a COVID-19 patient at the hospital, agreed. “I thought it was an incredible opportunity, given that none of us could see my sister,” said Johnson, of Silver Spring, Maryland, who did a recording for her sister and one for the medical staff. (You can listen to the recordings in the player above; her recording for her sister Beverly is first, followed by the one for the healthcare team at 3:25.)

When she spoke with Tracey for the recording, Johnson said she was thinking about her sister, “What would I have said if I got to talk to her” the day she was intubated? “What a gift Elizabeth gave us.”

Regarding the recording for the medical staff, “I think that when you take away the family from a hospital room, it might be hard for doctors and nurses to relate to the individuals, and the fact that they wanted to was really quite powerful for me,” Johnson said. “I really wanted them to know what made her happy, and if she was there talking to them, what would she have told them? … I also wanted them to know — in case she woke up — that she was the kind of patient that would tell them what they wanted to hear. If she was not feeling well and wanted them to feel good about their job, she would say, ‘I’m doing great.’ So I wanted them to know, just read between the lines.”

Tracey has recruited several dozen additional volunteers — including chaplains and medical residents — to make the phone calls and edit the recordings. She also has expanded the service — which she calls “This Is My Story,” or TIMS — to include other patients in the hospital, since they also aren’t getting visitors during the pandemic. She said she hoped that other hospitals would adopt the practice.

Within the hospital, “there’s definitely a lot of enthusiasm from the medical units and also an enthusiastic response from pediatrics,” she said. “What parent wouldn’t want to record ‘Green Eggs and Ham’ for their kid?”

The Strain Home Hospice Care Exerts on Families

The Strain Home Hospice Care Exerts on Families

“I’m not anti- hospice at all,” said Joy Johnston, who relocated to New Mexico years ago at age 40 to care for her dying mother.

“But I think people aren’t prepared for all the effort that it takes to give someone a good death at home.”

Surveys show dying at home is what most Americans say they want. But it’s “not all it’s cracked up to be,” said Johnston, a caregiver advocate and writer from Atlanta.

She wrote an essay about her frustrations with the way hospice care often works in the United States. Johnston, like many family caregivers, was surprised that her mother’s hospice provider left most of the physical work to her. She said that during the final weeks of her mother’s life, she felt more like a tired nurse than a devoted daughter.

Hospice allows a patient deemed to have fewer than six months to live to change the focus of their medical care — from the goal of curing disease to a new goal of using treatments and medicines to maintain comfort and quality of life. It is a form of palliative care, which also focuses on pain management, but can be provided while a patient continues to seek a cure or receive treatments to prolong life.

According to a recent Kaiser Family Foundation poll, 7 in 10 Americans say they would prefer to die at home. And that’s the direction the health care system is moving, as part of an effort to avoid unnecessary and expensive treatment at the end of life. (Kaiser Health News is an editorially independent program of the foundation.)

The home hospice movement has been great for patients and many patients are thrilled with the care they get, said Dr. Parul Goyal, a palliative care physician with Vanderbilt Health.

“I do think that when they are at home, they are in a peaceful environment,” Goyal said. “It is comfortable for them. But,” she noted, “it may not be comfortable for family members watching them taking their last breath.”

“While it was difficult for me to witness, I knew what to do”

When it comes to where we die, the U.S. has reached a tipping point. Home is now the most common place of death, according to new research, and a majority of Medicare patients are turning to hospice services to help make that possible. Fewer Americans these days are dying in a hospital, under the close supervision of doctors and nurses.

Hospice care is usually offered in the home, or sometimes in a nursing home. Since the mid-1990s, Medicare has allowed the hospice benefit to cover more types of diagnoses, and therefore more people. As acceptance grows among physicians and patients, the numbers continue to balloon — from 1.27 million patients in 2012 to 1.49 million in 2017.

According to the National Hospice and Palliative Care Association, hospice is now a $19 billion industry, almost entirely funded by taxpayers. But as the business has grown, so has the burden on families, who are often the ones providing most of the care. For example, one intimate task in particular — trying to get her mom’s bowels moving — changed Joy Johnston’s view of what hospice really means. Constipation plagues many dying patients.

“It’s ironically called the ‘comfort care kit’ that you get with home hospice. They include suppositories, and so I had to do that,” she said. “That was the lowest point. And I’m sure it was the lowest point for my mother as well. And it didn’t work.”

Hospice agencies primarily serve in an advisory role and from a distance, even in the final, intense days when family caregivers, or home nurses they’ve hired, must continually adjust morphine doses or deal with typical end-of-life symptoms, such as bleeding or breathing trouble. Those decisive moments can be scary for the family, said Dr. Joan Teno, a physician and leading hospice researcher at Oregon Health and Science University.

“Imagine if you’re the caregiver, and that you’re in the house,” Teno said. “It’s in the middle of the night, 2 o’clock in the morning, and all of a sudden, your family member has a grand mal seizure.”

That’s exactly what happened with Teno’s mother.

“While it was difficult for me to witness, I knew what to do,” she said.

In contrast, Teno said, in her father’s final hours, he was admitted to a hospice residence.

Such residences often resemble a nursing home, with private rooms where family and friends can come and go and with round-the-clock medical attention just down the hall.

Teno called the residence experience of hospice a “godsend.” But an inpatient facility is rarely an option, she said. Patients have to be in bad shape for Medicare to pay the higher inpatient rate that hospice residences charge. And by the time such patients reach their final days, it’s often too much trouble for them and the family to move.

Hospice care is a lucrative business. It is now the most profitable type of health care service that Medicare pays for. According to Medicare data, for-profit hospice agencies now outnumber the nonprofits that pioneered the service in the 1970s. But agencies that need to generate profits for investors aren’t building dedicated hospice units or residences, in general — mostly because such facilities aren’t profitable enough.

Joe Shega is chief medical officer at the for-profit VITAS Healthcare, the largest hospice company in the U.S. He insists it is the patients’ wishes, not a corporate desire to make more money, that drives his firm’s business model.

“Our focus is on what patients want, and 85 to 90% want to be at home,” Shega said. “So, our focus is building programs that help them be there.”

For many families, making hospice work at home means hiring extra help.

“I Guess I’ve Just Accepted What’s Available

On the day I visit her home outside Nashville, hospice patient Jean McCasland is at the kitchen table refusing to eat a spoonful of peach yogurt. Each morning, nurse’s aide Karrie Velez pulverizes McCasland’s medications in a pill crusher and mixes them into her breakfast yogurt.

“If you don’t, she will just spit them out,” Velez said.

Like a growing share of hospice patients, McCasland has dementia. She needs a service that hospice rarely provides — a one-on-one health attendant for several hours, so the regular family caregiver can get a break each day. When Velez is not around, John McCasland — Jean’s husband of nearly 50 years — is the person in charge at home.

“I have said from the beginning that was my intention, that she would be at home through the duration, as long as I was able,” John said.

But what hospice provided wasn’t enough help. So he has had to drain the couple’s retirement accounts to hire Velez, a private caregiver, out-of-pocket.

Hospice agencies usually bring in a hospital bed, an oxygen machine or a wheelchair — whatever equipment is needed. Prescriptions show up at the house for pain and anxiety. But hands-on help is scarce. According to Medicare, hospice benefits can include home health aides and homemaker services. But in practice, that in-person help is often limited to a couple of baths a week. Medicare data reveals that, on average, a nurse or aide is only in the patient’s home 30 minutes, or so, per day.

Jean McCasland’s husband hasn’t complained. “I guess I’ve just accepted what’s available and not really thought beyond what could be,” he said. “Because this is what they say they do.”

Families often don’t consider whether they’re getting their money’s worth because they’re not paying for hospice services directly: Medicare gets the bills. John keeps his monthly statements from Medicare organized in a three-ring binder, but he had never noticed that his agency charges nearly $200 a day, whether there is a health provider in the home that day or not.

That daily reimbursement covers equipment rentals and a 24-hour hotline that lets patients or family members consult a nurse as needed; John said it gives him peace of mind that help is a phone call away. “There’s a sense of comfort in knowing that they are keeping an eye on her,” he said.

The rate that hospice charges Medicare drops a bit after the patient’s first two months on the benefit. After reviewing his paperwork, John realized Medicare paid the hospice agency $60,000 in the first 12 months Jean was on hospice.

Was the care his wife got worth that?

“When you consider the amount of money that’s involved, perhaps they would provide somebody around the clock,” he said.

Sue Riggle is the administrator for the McCaslands’ hospice agency and said she understands how much help patients with dementia need. Her company is a small for-profit business called Adoration; she said the agency can’t provide more services than what Medicare pays for.

“I think everybody wishes we could provide the sitter-service part of it,” said Riggle. “But it’s not something that is covered by hospices.”

I checked in with John and Velez (Jean’s longtime private caregiver) this winter. The two were by Jean’s side — and had been there for several days straight — when she died in October. The hospice nurse showed up only afterward, to officially document the death.

This experience of family caregivers is typical but often unexpected.

It’s A Burden I Lovingly Did

“It does take a toll” on families, said Katherine Ornstein, an associate professor of geriatrics and palliative medicine at Mount Sinai Hospital in New York, who studies what typically happens in the last years of patients’ lives. The increasing burden on loved ones — especially spouses — is reaching a breaking point for many people, her research shows. This particular type of stress has even been given a name: caregiver syndrome.

“Our long-term-care system in this country is really using families — unpaid family members,” she said. “That’s our situation.”

A few high-profile advocates have even started questioning whether hospice is right for everybody. For some who have gone through home hospice with a loved one, the difficult experience has led them to want something else for themselves.

Social worker Coneigh Sea has a portrait of her husband that sits in the entryway of her home in Murfreesboro, Tennessee. He died of prostate cancer in their bedroom in 1993. Enough time has passed since then that the mental fog she experienced while managing his medication and bodily fluids — mostly by herself — has cleared, she said.

But it was a burden.

“For me to say that — there’s that guilt,” she said. “But I know better. It was a burden that I lovingly did.”

She doesn’t regret the experience but said it is not one she wishes for her own grown children. She recently sat them down, she said, to make sure they handle her death differently.

“I told my family, if there is such a thing, I will come back and I will haunt you,” she said with a laugh. “Don’t you do that.”

Sea’s family may have limited options. Sidestepping home hospice typically means paying for a pricey nursing home or dying with the cost and potential chaos of a hospital — which is precisely what hospice care was set up to avoid. As researchers in the field look to the future, they are calling for more palliative care, not less — and, at the same time, they are advocating for more support for the spouses, family members and friends tasked with caring for the patient.

“We really have to expand — in general — our approach to supporting caregivers,” Ornstein said, noting that some countries outside the U.S. pay for a wider range and longer duration of home health services.

“I think what we really need to do is be broadening the support that individuals and families can have as they’re caring for individuals throughout the course of serious illness,” Ornstein said.

“And I think that probably speaks to the expansion of palliative care, in general.”

This story is part of a partnership that includes Nashville Public Radio, NPR and Kaiser Health News.

Republished courtesy of Kaiser Health News, a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

The 10 Best Tips You Need To Help Pay For College

The 10 Best Tips You Need To Help Pay For College

The 10 Best Tips You Need To Help Pay For College
Especially when you never thought you would have to apply for financial aid.

1. Do not self-determine that you are ineligible for any kind of federal, state, or institutional financial aid. Submit all financial aid applications. Check with your college financial aid office for specific application forms and required steps.

2. The FAFSA application can be completed at, and it is a free application.

3. The FAFSA will ask for tax information from two years ago, even though you are no longer employed. Go ahead and list your income from the two prior tax years, as required, but later you will file an appeal letter documenting your current financial reality. There is no place to write an appeal on the FAFSA form so you will have to write a separate letter, with documentation to the college financial aid office.

4. If your student was offered a merit scholarship by the school, ask for additional merit scholarship funds due to the loss of income, especially if the student will be attending a public out-of-state institution.

5. Are you separated from your spouse? If so, for FAFSA filing, only include the income of the parent that the dependent child lives with more than half time. You do not have to be legally separated or divorced.

6. You should always shop and compare all federal, state, college, and private loan opportunities. For federal and state loan programs, you will still need to complete a FAFSA.

7. If there are other relatives in the household besides a spouse and children that are dependent on the family and reside in the household such as grandparents, make sure to include them in the total number of dependents in living in the household.

8. If there any health costs not covered by insurance, make sure to list them when you submit your letter of appeal, with documentation.

9. If a parent decides to go back to college, at least half-time, tell the financial aid office. They might consider counting the parent as an additional family member in college possibly resulting in additional financial aid.

10. Run, don’t walk, virtually to the college financial aid office for immediate guidance. Follow-up and follow-through.

Dealing with Financial Aid During a Time of National and Personal Crisis

Dealing with Financial Aid During a Time of National and Personal Crisis

1. I just became unemployed and when I submitted my FAFSA back in October, I was told that we didn’t qualify for any need aid assistance. What do I do now?

a. Step One: Go immediately to your college’s financial aid website to see if there are any updates on how to appeal. If there are no updates check to see if any instructions are listed on how to appeal. Some colleges have step-by-step instructions, and some simply do not. Or, call or email the college for advice.

b. Step Two: How to Appeal: Gather all necessary paper documentation that supports your appeal letter. Any type of loss of family income is appealable, as long as you can prove your situation. Even loss of savings can be appealed in addition to unemployment. Make sure to keep a copy of all appeal information and then by certified mail to your college’s financial aid office.

c. Step Three: When to Appeal: Appeal immediately because hundreds, if not thousands of your classmates will be appealing as well. Warning: Do not self-decide if you should appeal. You can’t win if you choose not to appeal, even if you or your family’s income used to be high.

2. How often do appeals get granted?

a. Usually about 30% of the time, but that percentage will be increasing due to the Coronavirus and all its impact.

3. Could I possibly qualify for any other aid, such as state aid?

a. Yes! Check with your state Higher Education Agency and ask how you can appeal for additional need-based funding. Also ask your financial aid office for guidance.

4. I am a grad nursing student and I received some need-based grant funds. Do I follow the same steps you have just described to appeal for additional assistance?

a. Yes, however, you need to appeal directly to the graduate school of nursing financial aid office, not the undergraduate financial aid office.

5. Will appealing for more financial aid reduce my chances of being admitted to my college of choice?

a. No. Every college is trying their best to address students’ needs. The issue will be the amount of additional funding available. Some colleges have large endowments, and some do not. That’s why it is urgent to appeal now!

6. Since it will take time to have my appeal reviewed, is there any other kind of immediate funds assistance? I don’t want to deal with a lot of red tape.

a. The good news is yes! Colleges and universities have historically had emergency funds available for students, but they are not always well-known, nor well-advertised.

b. Today, several schools have made funds available to give to students in the form of one-time grants as the ongoing pandemic has forced thousands of students to leave their campus and cope with financial hardship.b. Today, several schools have made funds available to give to students in the form of one-time grants as the ongoing pandemic has forced thousands of students to leave their campus and cope with financial hardship.

c. Ask your school if it has an emergency loan or grant fund you can apply for, and how you apply. Best to ask the financial aid office for assistance.

7. Even if I have been awarded my maximum amount of financial aid, I can still apply for emergency funds?

a. Yes. An emergency is an emergency. You need funds now.  Just remember that emergency funds are limited, so make that call ASAP. Make sure to specify how much you need and how the Coronavirus adversely impacted you.

8. Since I was told by the college that I had to leave campus due to COVID-19, how do I appeal to get my money back for my room and board that I already paid?

a. Great question. It all depends. Every college is handling this issue differently. Some colleges will give students who paid their bill for the spring semester a prorated credit for room and board to be applied for the fall semester. Other schools will allow students to receive a partial refund for the difference in their prorated housing and dining plans. You have to ask the office of on-campus housing how you can get a refund.

9. What can I say to alert I my college that I am financially in trouble?

a. Appeal for additional fund consideration by saying “I will have to drop out!” The reality is, it costs more to recruit a student than it does to retain a student. And schools are all about saving money and helping students.

10. Can I appeal for additional merit scholarship assistance, not based on financial need (my income) or my family’s income?

a. Yes, you can and should. As we wrote in our book, take ownership of the college funding process, either need-based or merit-based.

b. Best way to appeal for additional merit scholarship funds due the pandemic is to appeal directly to the office that awarded you the merit scholarship. For example, most colleges will award merit scholarships from the admissions office if you are a first time undergrad, as in a freshman. The other office to contact would be the office of your major: English, History, Engineering, etc. Review your merit award letter and determine which office or offices gave you your merit award and appeal directly to the awarding authority.

See more tips and best practices from – Pay for Your Graduate Nursing Education Without Going Broke: Tips from the Pros

By: Carl Buck MS, CCPS & Rick Darvis CPA, CCPS

Nurses and Doctors Self-Isolate to Protect Their Families from COVID-19

Nurses and Doctors Self-Isolate to Protect Their Families from COVID-19

A growing number of nurses and other first responders are living in self- isolation, cut off from the support and affection of their loved ones during the pandemic. To protect their families from the virus, many healthcare providers have been sleeping in basements, campers, hotel rooms, backyard tents, and even in their cars after their shifts instead of returning to the comforts of home. Others, who have no choice but to go home, go through meticulous self-decontamination procedures, stripping off their work clothes in the garage and taking long showers before allowing themselves to have any contact with family—and even those staying at home often use a designated bathroom and sleep in separate bedrooms.

One NP in Missouri, who has an asthmatic child and immunocompromised husband, “moved out of her home completely and into her co-worker’s apartment, leaving behind her husband, their two children and her mother-in-law,” according to NBC News. And in mid-March, anesthesiologist Michelle Au, who has been sleeping in the basement of her family home, told the Guardian, “There is a sizable portion of people who have already started self-isolating. They have started sleeping in separate bedrooms, separate bathrooms.” Asked when she had last seen her parents, one ED nurse told the Chicago Tribune, “I don’t know, oh my, God, I can’t even remember.”

By isolating themselves from family and friends, healthcare providers on the front lines of COVID-19 find themselves working without one of the key sources of emotional support that normally helps protect them from burnout. As psychiatrist Judith Gold writes in Stat News, “It is no wonder that the preliminary research on coronavirus in China showcases high rates of mental health issues, including depression, anxiety, insomnia, and distress, which are much higher in nurses, women, and those on the front line.”

What can be done to help nurses and other healthcare providers who are struggling with anxiety, depression, and isolation from the people they love? While the pandemic lasts, experts are seeking ways to maintain the resilience of clinicians on the front lines as they carry on amid the health risks and the physical and emotional wear and tear. The World Health Organization (WHO), in their statement on mental health during the COVID-19 pandemic, has issued particular recommendations to hospital managers at this time:

  • Ensure that good quality communication and accurate information updates are provided to all staff.
  • Rotate workers from higher-stress to lower-stress functions. Partner inexperienced workers with their more experienced colleagues. The buddy system helps to provide support, monitor stress and reinforce safety procedures.
  • Ensure that outreach personnel enter the community in pairs.Initiate, encourage and monitor work breaks.
  • Implement flexible schedules for workers who are directly impacted or have a family member affected by a stressful event.
  • Ensure that you build in time for colleagues to provide social support to each other.
COVID-19 Isolation Can Increase Risk of Child Abuse

COVID-19 Isolation Can Increase Risk of Child Abuse

COVID-19 social isolation measures are designed to make the population safer, but the stresses of isolation can exacerbate the risk of child abuse. How can this pandemic period affect at-risk children, and what can we do about it? DailyNurse asked Dr. Normajean Colby, RN, PhD, CNE, CPN, Coordinator of Pediatric Nursing at Widener University’s School of Nursing, about the concerns of child abuse experts in what she describes as a time of “unprecedented changes… with tens of millions of our nation’s children at home instead of in schools or daycares.”

Normajean Colby
Dr. Normajean Colby

Why children at risk of abuse are in particular jeopardy now

Dr. Colby: The number of factors that contribute to the risk for child maltreatment may have potentially increased for families in our nation. Even where those factors themselves haven’t changed, what has changed is that parents and children are now isolated together 24/7 and for an undetermined length of time.

Another vital reason that this unprecedented time in our history makes this period a particularly dangerous time for children at risk of abuse is that the eyes that are generally on these children as a safety valve are not present. What I mean by this, is that teachers, daycare workers, Sunday School teachers, coaches, etc., are not seeing these children on a regular basis. When business is as usual, these are individuals in a child’s daily life that can recognize if abuse may be occurring. In fact, during this time, it is expected that the number of child abuse reports will decrease temporarily, but that in no way means that the actual incidence has decreased.

How can we reduce the dangers of child abuse at this time?

Dr. Colby: We need to truly “come together” as has been the mantra in our nation lately. It is our responsibility to help each other to successfully get through this period of time. What we can certainly do is to check on our neighbors and friends, give a phone call, drop off a note, and connect with others, while maintaining physical distance.

As pediatric healthcare providers, pediatrician offices, daycares, early intervention programs, etc. we can reach out to the caregivers, particularly those who may have more of the risk factors that can contribute to the risk for abuse. Reach out and check in, see how they are doing, how the kids are doing, and offer an empathetic ear and ideas for the kids. These folks know the families and have a relationship often with the families, so reach out!

Also, nurses and healthcare providers are mandated reporters, therefore it is federal law that they report suspected child abuse. The reporter does not have to “prove” such abuse; that task is up to the Child Welfare Agency. But any suspicion of child abuse must be reported. [To make such a report, contact your state child abuse protection agency or call the Childhelp National Child Abuse Hotline at 1-800-422-4453 ]

Dr. Colby: tips for all parents and caregivers to reduce family stresses

  • Give yourself a break! Keep expectations of yourself as a caregiver and of your child/ren realistic and in check. [many times abusive caregivers have higher expectations for a child, that may even be above their capacity developmentally, and when the child does not live up to that expectation, the caregiver becomes frustrated and that is when physical abuse may be more likely to occur]. It’s OK if there are dishes in the sink, or laundry in the basket. There are really worse scenarios.
  • When you feel yourself getting frustrated, take a slow deep breath, hold a few seconds, and slowly exhale, then slowly count from ten to one backwards, before you respond or react.
  • Look for silver linings. Maybe even make it a family activity, before bed or during a meal, ask “What is a good thing about today?” Even if it is a small or silly good thing.
  • Never ever shake a baby! If the baby is clean, and fed, and seems all right, place the baby in its crib and step away, put on the TV or put headphones on and listen to music, being sure to check on the baby periodically, but never ever shake a baby!
  • Practice self-care. Get enough sleep, eat healthy if possible, get exercise or incorporate movement into every day, go outside, yoga, meditation, prayer, relaxation techniques, stay connected to others whether email, text, phone, skype/zoom. Turn off the news – you don’t need to be exposed all day long to the news.
  • Know that you are not alone – Frustration with stress is normal. Childrearing is rewarding, but also can be tiring. If you can connect in some way with other parents/caregivers to share ideas and empathize, across back yards, via phone or technology. Talk to someone you know. Reach out to a healthcare provider or clergy member.
  • Always remember: children pick up on the anxiety of those adults around them!

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