Child Abuse Prevention: A Conversation with Kathleen Strader 01:03:48

Covering the Kowalski case this season and reading so much of the adjacent media coverage has honestly left me feeling a bit bleak. This idea of, quote, medical kidnapping, basically that an innocent parent could bring their child to the hospital for treatment only to have them snatched away because the doctors and child welfare workers have conspired against the parents. This concept's been around for a while, but in the past couple of years, we've really seen it go mainstream.

Some of the pushback around this issue questions the validity of medical child abuse as a diagnosis specifically. And that was the case in the coverage of both my sister's case and the Kowalski case. But many of these other cases in the news have to do with abusive head trauma and other non-accidental injuries, which are far more straightforward to diagnose than medical child abuse or Munchausen by proxy.

Look, I understand that child abuse isn't something that people want to think about. But denying its existence only protects abusers. And it protects them at the expense of vulnerable children.

Sadly, child abuse isn't just real, it's relatively common. According to a national survey on children's exposure to violence that was published in JAMA, that is the Journal of the American Medical Association, 18% of adolescents between 14 and 17 reported being abused by a parent.

And according to the Department of Health and Human Services, 46% of all child deaths were a result of physical abuse. The truth about child abuse is a hard one, but it's the truth. This is the truth we see when we look at the real data, not just a litany of anecdotal stories from parents who say they didn't do it.

And if we want to protect kids, we can't look away from this. So what can we do about it? This podcast is sponsored by Talkspace. You know when you're really stressed or not feeling so great about your life or about yourself? Talking to someone who understands can really help. But who is that person? How do you find them? Where do you even start? Talkspace. Talkspace makes it easy to get the support you need.

With Talkspace, you can go online, answer a few questions about your preferences, and be matched with a therapist. And because you'll meet your therapist online, you don't have to take time off work or arrange childcare. You'll meet on your schedule, wherever you feel most at ease. If you're depressed, stressed, struggling with a relationship, or if you want some counseling for you and your partner, or just need a little extra one-on-one support, Talkspace is here for you.

Plus, Talkspace works with most major insurers, and most insured members have a $0 copay. No insurance? No problem. Now get $80 off of your first month with promo code SPACE80 when you go to Talkspace.com. Match with a licensed therapist today at Talkspace.com. Save $80 with code SPACE80 at Talkspace.com.

Did you know that I have a new book coming out? True Story. And unlike my previous books, this one actually is a true story. The Mother Next Door, Medicine, Deception, and Munchausen by Proxy, which I co-authored with friend of the show, Detective Mike Weber, chronicles three of his most harrowing and impactful cases—

Longtime listeners of the show will have some familiarity with these cases, but I promise you will learn so much more about them, and you'll also just learn so much more about Detective Mike's journey in this arena and also mine. Dr. Mark Feldman, another friend of the show and an esteemed expert in all things Munchausen by proxy, read an early copy, and this is what he had to say about it.

A truly vital, groundbreaking, and riveting contribution to the true crime literature on child abuse. Over the past four decades, I have read just about everything dealing with medical deception, including Munchausen by proxy abuse, and can easily affirm that this immensely readable book is the most important literary work since Professor Rory Meadow coined the Munchausen by proxy term 50 years ago.

And if you don't think that that endorsement from that particular man made me cry, you would be wrong. So the book comes out on February 4th of next year. And now I know what you're thinking. Andrea, why are you talking to me about this right now? February is approximately 100 years from now. We have to do a whole election and whatever else before then.

And I hear you, but I'm telling you this now because, as you may know if you have any other authors in your life, pre-orders are vital to a book's success and will really affect how our publisher positions and supports the book's launch. So if you think you are going to buy this book, doing so now will really help us out. It's available for pre-order in all formats wherever books are sold, and you can find it at a link in the show notes. I hope you will love it, and I appreciate your support.

One of the criticisms I heard from folks this season is that my own biases and background with Munchausen by proxy were keeping me from understanding or sympathizing with the Kowalskis and, in a broader sense, with parents who are, quote, targeted by the system, as though I'm somehow rooting for these families to be separated.

And while I believe in accountability for parents who harm their children, and I feel very strongly that children deserve to be safe in their homes, I don't think our current child welfare system is working well to achieve those outcomes, as I discussed at length with our guest, Dr. Jessica Price.

But we can't stop at identifying what's not working, even if that's a good first step. We need to look at what we can do instead. And so today, I brought in an expert to help us unpack what that might look like.

My name is Kathleen Strader and I work at a national organization called Prevent Child Abuse America as the National Director for Healthy Families America, which is our signature home visiting program supporting families throughout the country.

This was such a fascinating and hopeful conversation, and I really encourage you to check out Prevent Child Abuse America if you want to support what they're doing or if you or someone you know needs some help. So I will include all of that information in the show notes, and we will be back next week with our mailbag episode answering all of your questions about the Kowalski case. So now, without further ado, here is my conversation with Kathleen.

Thank you so much, Kathleen. I am so excited to have you here with us and give us some hope, quite frankly, about this very challenging topic that my entire show is dedicated to. Obviously, we are in sort of a niche piece of it, but we have been talking a lot about how various forms of child abuse are being treated in the media right now and how this whole landscape with child welfare systems and all of these complicated systems is

looks and just looking forward to talking to you about the work that you do. So to start off with, how did you get into this line of work? My background is in social work. I started off my career as a medical social worker.

and specifically in a large hospital in the metropolitan Detroit area. And in the work I was doing, I also functioned as the coordinator for our hospital's child protection team because I was focused on supporting families whose children were in our pediatric intensive care unit and being seen in our pediatric clinic.

In the time that I did that work, I had some really life-changing experiences happen that really set me on a different career path. Specifically, it was children who had been admitted to the hospital and later died as a result of injuries that they had experienced from a parent or caregiver.

And the very first experience I had, and this was like right out of grad school, was a very young girl. Her name was Sarah. She was 22 months old. It was Memorial Day at a family event that probably was intended to be entirely joyful and positive. There ended up being a circumstance where she had a toileting accident and

and was thrown against a wall in anger and frustration by a parent, and then died within 24 hours of coming into the hospital. And that really was the first...

first time that I had an experience of knowing that parents who want to do the best for their children can find themselves in situations where really terrible things happen. And that was unfortunately not the last time that I had a situation with a child death as a result of abuse or neglect.

But it moved me in a way that I knew we needed to start doing something different at the hospital to support families. So this is back in the late 80s and early 90s. There was a lot of evidence-based home visiting in the way that it is now available in our country. And so we got a small amount of grant funds and we were able to start doing very short term, like three months of support to families that

once they had delivered a baby at the hospital. And I coordinated that program for a period of time. And it only took about three months for us to realize that there was no way we could ever really fully support families in various challenges and stresses that they were experiencing in the space of three months. And so we started looking for

an opportunity to extend the way in which we were available to families for a longer period of time.

And it was one of those things where, you know, sometimes the stars just come into alignment and Prevent Child Abuse America had at that time. So this is now like 1991, been working with a program in Hawaii called Hawaii Healthy Start that had some really good outcomes being demonstrated related to child abuse and neglect reduction and improved health outcomes and various things like that.

And they were interested in partnering with the national organization who could help bring that program to national scale and prevent child abuse. America felt that that was a perfect opportunity for the organization whose mission was all about how to support and prevent situations that impact the health and well-being of families and children.

So they took that on. And as a result, I was able to start up a Healthy Families program in my hometown area back in 1992 when Healthy Families America first launched.

And so I ran that program for about 10 years and then joined the national office, having had so many experiences in over 10 years of just hearing from parents how invaluable it was for them to have an individual who was there.

Every family I ever talked to then, as well as now in my current work, will almost universally say she was there for me, my worker was there for me, in a way that they oftentimes have not had an individual who has been able to be in a role of supporting not only their parenting, but supporting them.

their needs as an individual. It's been a life-changing experience for me. And so I've now been connected to this work for a little over 30 years. I've been at the national office for about 20 and in my current position as national director for a little over six years.

Wow. That's really an incredible introduction to your origin story of how you got into this work, because as someone who has been drawn to this work for my own reasons, I am always curious to know how other people that have decided to really dedicate their careers to this got here.

So much of what you said really resonates with me, in particular, sort of this idea, which I know is very much sort of tentpole of what you do with the time around pregnancy and birth being so important. And I know you have three children. I have two kids of my own. My kids are little. They're two and five.

And so that experience of pregnancy and new motherhood is very immediate for me. And I am extremely lucky. I have a very supportive spouse. Both of us are close with our families. We had a lot of support. And even so, I think you go through that experience and they send you home with a baby. And then they're like, we're going to check on the baby a bunch. But you, we're going to check on you once at six weeks to tell you you can have sex with your husband again. And then that's it. So goodbye, good luck.

You know, and I was lucky. I had good doctors and everything, but that is the standard. And if nothing else sort of goes wrong during that time physically, then you don't necessarily see anybody or get any support. You know, it just became so clear to me in such a visceral way how there just is no institutional support built in for parents in this country. And it was a hard time for me being in the most privileged position possible. And you really start to think, oh my God, if I didn't have all of these people

supports that I'm just lucky enough to have, this could push someone to the edge so easily. I mean, it's such a stressful time. You're sleep deprived. You're worried about finances. It just could not be more stressful of a time. And so you can absolutely see how that time is really crucial. Can you tell me a little bit more about the home visiting program and what that looks like and how that operates?

So there are a number of evidence-based home visiting programs now operating in the country. We are very fortunate that starting a little over a decade ago, there was significant increase in federal funding to support home visiting for families with infants and young children.

And that has continued to grow, and both through an existing funding source, which is the Federal Maternal Infant Early Childhood Home Visiting Program, which was able to successfully pass Congress when reauthorized to double the funding to go from $400 million to $800 million a year supporting evidence-based home visiting. There's also other

federal sources through Family First Prevention Services that allows for families to be in receipt of a number of parenting support programs, including in-home parenting support like Healthy Families America. Healthy Families America is one of the largest

evidence-based home visiting programs in the country. We currently have about 600 sites throughout the country in 38 states, Washington, D.C., and then all five U.S. territories, as well as in Israel, and supporting about 70,000 families each year.

So in terms of like how the program gets implemented in local communities, once a community has identified that there are some existing gaps in the community in terms of supports that are available for families and they're able to identify a funding source that will allow them to draw down some resources to implement home visiting programs,

then generally they will look at the different models that are available and select what they think is the right or best fit for them. Models differ a little bit. We also have a lot of similarity, but we differ a little bit in underlying philosophy. Some are very focused on health, others on education. HFA has, from the very beginning, taken a relational health grounded in the way that

relationships between parents and children are really the underpinnings of successful and healthy growth and development for children and positive relationships in families.

our work is really focused on supporting families in relationship building in a holistic way so that it is certainly a priority as it relates to between primary caregivers and their infants and young children, but also who are the others in the family and whether that's other children or other adults.

that are also involved in the life of this child. And so how do we support a family in a way that meets the variety of needs that they might have? Just as there's no one home visiting program that will work for every family, there's no family that is exactly like another in terms of what they bring or are wanting to access some support around.

And so we have what we call the staff who work directly with families, our family support specialists, and they engage with the family at the family's choosing. So families are not mandated to participate.

beginning prenatally or in the newborn period most often, though sometimes families might not begin until their child is like up to 24 months, specifically when they're being connected to HFA from child welfare directly.

Oftentimes, child welfare and child protective services aren't connecting families in the prenatal period, especially if it's a first birth, or sometimes even in the newborn period is too early for things to have gotten to a level where then they're wanting to make a referral to the type of services that HFA can provide. But it's then providing support services in the home over a three to five-year period

And having a family support specialist who works really closely with the family, seeing them on a weekly basis initially, focusing on the kinds of things that the family identifies they are wanting to work on or to be connected to in terms of other supports in their community.

There just might be a variety of different concerns or worries or challenges that they've experienced in the near term, as well as sometimes going back to their own childhood and having parents with their own early childhood experience that has made it a little bit more difficult for them to come into this new parenting role. Oftentimes, a parent will say they want to do different than what they experienced growing up.

but are unsure how to make that sort of thing happen. And so it's really through a relationship with a family support specialist that those kinds of things are able to be focused on and really building relationships

on the strengths of families. So often, like you were saying earlier, feeling really fortunate about the supports that you had. I feel the same way about my own parenting experience and being surrounded by a lot of support, but is so much not the case for many families.

I'm wondering when a family comes to you, and this is very interesting because this is a very different model than the sort of child welfare system where I think people are thinking of, and as you sort of alluded to there, where there's not an intervention until there's been an incident. That incident gets reported.

One of the things that seems problematic about getting support at that point is then you're in sort of an adversarial relationship just by the nature of it. If a family's been reported and they're not choosing to get that support, even if the social workers really have the best intentions possible, it seems very likely that that family is going to feel like they're being sort of watched and surveilled as opposed to supported. So for moms or dads that get in touch with your program,

It sounds like they're identifying kind of their own risk factors, not to say that that is even a personal failing, right? Because I consider the failing the fact that we just don't do a better job of supporting families institutionally in general. I don't think that necessarily needs to be painted as an individual failing. If someone is just feeling isolated when they're a new parent, that's very normal. What kind of things do they generally want help with? What

what situations and circumstances are families identifying when they come to you? What happens is families sometimes are unsure exactly. They've just had a baby. That alone feels stressful. And there might be other things going on related to housing or employment or challenges accessing other things like health care or education or

Sometimes it might even just be how to get more diapers and formula, just the most basic of needs. And it isn't until we have a conversation. So part of the way that we begin a relationship with a family is having a conversation through a process of

that we call Family Resilience and Opportunities for Growth. And it's talking with families about a number of different things that can impact families. And it's not to say that all families are struggling in all the ways, but sometimes families need to be given permission to say, here's the variety of things that can be impacting families. Some of these may relate to your experience. Some of them may not.

Some of them, maybe you'll experience later on in your parenting of your child. And we want to bring this up in the beginning so that you know that these are the kinds of things it's okay to talk with us about. And so by opening up

a conversation that way with a family that works to build trust with the family and allows them maybe not initially to share all the things. It's kind of hard when you're first meeting a brand new person, especially given the nature of our child welfare system historically, which has many families feeling reluctant

and unsure whether this is really something that is different, that is not going to result in a child being taken away. That relationship building with a parent is really the most critical part. And I think that for us,

we feel like the other thing that so often is either absent or in short supply for families who are feeling stressed is experiences that bring them joy. And so we're very intentional on making sure that

our relationship and what we are bringing to the family will be something that allows them to experience joy. And in doing so, it also helps for that family to want to have a family support specialist come back out. And then by way of having heard what the family is experiencing, we are then able to focus specifically on those things.

And it might be that those are the things right now. And as we continue the relationship and a year later, it might be some other things that have surfaced for the family. And so we're very comprehensive in the way in which we will be there for a family to help them work through various situations that they might experience.

Something that has really stuck with me last season, we had a wonderful author and expert on called Dr. Jessica Price, who is also a former social worker and now is very much in the same mindset that your organization is of sort of these other people.

other support systems for families and just saw kind of how damaging the child welfare system can be and that there's a very strong narrative within that system. And I think within the way that we talk about child abuse and neglect of sort of personal responsibility, one of the things that stuck with me in reading the statistics that you have on your website and reading Dr. Price's book is what a huge percentage of child removals happen because of neglect, right? And I think neglect is one of those things that's

very much a direct result of access, of economic status, of all of these things that have absolutely nothing to do with personal responsibility, whether someone is a, quote, good parent or bad parent. So can you talk us through how you and your organization work?

sort of look at that differently. And as much as you're looking at people and their individual situations and problems, like there obviously are some really vast systemic issues that are contributing to who gets their children taken away or who is able to be the parent that they want to be.

Yeah. And the way in which we want to create a system that is more supportive of families and without some of the biases that exist, some of the family policing that has been experienced.

I mentioned earlier that Healthy Families America has been in existence since 1992. Our organization, Prevent Child Abuse America, has been in existence since 1972 and has been a leading organization in terms of the way in which we want to ensure that there are systems and the conditions that

allow families and children to thrive. And the way that we think about that from an equitable perspective is that all families should be able to receive what they need, when they need it, in the communities that they live in before a crisis occurs. And in order to have all of those pieces working in that way means that we have to work in partnership across

states and communities and identify what are the ways in which we can address things like poverty and homelessness and food insecurity and the challenges associated with families who cannot because of the way that our system has set up for so many families not to be able to flourish. How do we do something different? It

HFA is just one of what is many things that are needed in terms of a system that can be supportive of all families and all children. Our mission is, while HFA, again, is very focused in the kind of early childhood space,

Really, our overall organization's mission is focused on all families and all children and how it is that we ensure that we're working in a way that allows for systems to be developed that work to ensure family well-being. And

It may happen through some of our public policy work, through research. We also have a system of state chapters who are working in almost all states in terms of advocacy around some of the systems that will create the conditions for children to thrive.

I think what's so heartbreaking to me about the idea of families ending up in the child welfare system and getting their children removed over issues of neglect, if you're a parent that doesn't have enough diapers and formula for your child, I mean, that's not a problem with your parenting. That's a problem of the community failing you.

We shouldn't have children whose parents are struggling to have those things in this country. I think that just seems obscene to me, and especially the fact that that accounts for the vast majority of families that end up in child removal situations, I think 76 percent. And then I think what's hopeful to me about the work that you're doing, it seems like not

obviously easily solved because these systems are incredibly complex. Right now, I think that there's a strong punitive element to some of these systems, but it does seem in some ways like low-hanging fruit, right? You're like, just give those families money. They're problem-solving. Just give those families money to buy food for their children. Give them better housing. Allocate those resources there instead of paying people to sort of take them through this onerous system that's more about these punitive measures. There you go. The whole problem's solved.

I think it's more complex when you're looking at a situation where you're looking at physical abuse, abusive head trauma, that kind of thing, where obviously there is an element where if a parent has done that to their child, then there does, in my opinion, need to be accountability and that protecting the child should always be the paramount thing.

And obviously you've seen some incredibly heartbreaking situations where a child has died or, you know, really suffered in those situations. And I think it can be very hard for people from the outside to feel any empathy for parents that do things like that. But I think that there is a way in which sometimes we as parents

parents that have not had those same stressors can sort of separate ourselves and hold that at arm's length and say, well, I would never do that to my child. And I think sometimes if you actually sort of see how things escalate over time in these physical abuse situations, you sort of start to think, well, there but for the grace of God, go I, because, you know, I was never in that situation where I was

worried about how I was going to feed my child and I wasn't trying to work three jobs while I was trying to take care of an infant and et cetera, et cetera, right? So I think that these are very human problems. And can you talk to me specifically about

some of the evidence-based methods that you have when it comes to preventing physical abuse. It's very easy to look at a parent that does that and say, that's a violent person who was violent with their child and I just can't relate to it at all. And so how could you ever prevent a violent person from being violent? But in fact...

There are strategies that have a lot of evidence behind us. Can you talk about sort of the prevalence of physical child abuse and what are some preventative strategies to keep those kids from ever ending up in the hospital?

And some of it is just what you know and what you experienced. And it's hard to see a different way when you've only experienced one way. And so I think about parents whose upbringing might have included spanking and other forms of physical discipline. So a lot of

our connection with the family is to help them kind of see the world through the eyes of their infant. And when it's important to speak on behalf of the infant of what they're experiencing, we use what we call reflective strategies to help heighten awareness for parents of their thoughts, their feelings, their behaviors, and their impact on their child. And while we are

are generally pretty clear about non-physical forms of discipline. Because when you ask parents what they want for their child, oftentimes the pathway to the values that they have and

the aspirations that they have for their children is through a loving, nurturing, stable, secure approach rather than one that might create fear, uncertainty for the child. And so

Sometimes it's just that paradigm shift for a family that they hadn't even really seen the world quite in that way. And oftentimes for individuals whose upbringing was incredibly stressful and traumatic, that it is getting to a place of then becoming a parent, then

themselves and feeling not necessarily like they have control over their circumstances. And so in addition to helping a parent kind of see how their behaviors and feelings impact their child, it's also really being there for the parent to help them increase their own awareness of not only the traumatic experiences that they had and the impact,

but also the way in which they can move forward in a healing sort of way and really begin to have some control over their circumstances. It's actually one of the reasons that we're really clear that when participating in a program like HFA,

It will always be the parent's choice. There needs to be that element of control right from the beginning. And we really strive to continue that throughout the time that we have relationship with the family. Well, it sounds like that trust is just so important that you would need to have people sort of opting into it. And despite many of the gruesome things I've reported on and that you've seen in real life, it sounds like we share the belief that most parents

want to be good parents, and most parents do love their children and want to be good parents to their children. If, like me, you think, hey, I'm still young, I'm cool, I'm with it, but at the same time you find yourself needing to ask your Gen Z co-worker to explain what brat means or give you the etymology of the word feminine-omenon, it might be a sign that you, my friend, are in perimenopause. So thank goodness for the Hormone Harmony supplement from Happy Mammoth.

Now, this is a company dedicated to making women's lives easier. That means only proven science-backed ingredients. And hey, we love science on this show. Women's hormones are really a whole journey, as I can tell you after having my second baby at 40. Now, I love being in my 40s, but I do not love the mood fluctuations, the bloating, and the sleep disturbances that come along with it.

I've only been taking Hormone Harmony for two weeks, and already I've noticed a change in my mood and my sleep, which were two of my biggest issues. And seriously, go peruse the tens of thousands of rave reviews for this product. Women report this helping them with hot flashes, dry skin, better sleep, fewer sugar cravings, mood...

and just feeling more like themselves again. So for a limited time, you can get 15% off your entire first order at HappyMammoth.com. Just use the code NOBODY at checkout. That's HappyMammoth.com and use the code NOBODY for 15% off today. And remember that supporting our advertisers is a great way to support the show.

Judy was boring. Hello. Then, Judy discovered JumbaCasino.com. It's my little escape. Now, Judy's the life of the party. Oh, baby. Mama's bringing home the bacon. Whoa. Take it easy, Judy.

The Chumba life is for everybody. So go to chumbacasino.com and play over 100 casino-style games. Join today and play for free for your chance to redeem some serious prizes. chumbacasino.com No purchase necessary. Voidware prohibited by law. 18 plus terms and conditions apply. See website for details.

Did you know that I have a new book coming out? True Story. And unlike my previous books, this one actually is a true story. The Mother Next Door, Medicine, Deception, and Munchausen by Proxy, which I co-authored with friend of the show, Detective Mike Weber, chronicles three of his most harrowing and impactful cases—

Longtime listeners of the show will have some familiarity with these cases, but I promise you will learn so much more about them, and you'll also just learn so much more about Detective Mike's journey in this arena and also mine. Dr. Mark Feldman, another friend of the show and an esteemed expert in all things Munchausen by proxy, read an early copy, and this is what he had to say about it.

A truly vital, groundbreaking, and riveting contribution to the true crime literature on child abuse. Over the past four decades, I have read just about everything dealing with medical deception, including Munchausen by proxy abuse, and can easily affirm that this immensely readable book is the most important literary work since Professor Rory Meadow coined the Munchausen by proxy term 50 years ago.

And if you don't think that that endorsement from that particular man made me cry, you would be wrong. So the book comes out on February 4th of next year. And now I know what you're thinking. Andrea, why are you talking to me about this right now? February is approximately 100 years from now. We have to do a whole election and whatever else before then.

And I hear you, but I'm telling you this now because as you may know, if you have any other authors in your life, pre-orders are vital to a book's success and will really affect how our publisher positions and supports the book's launch. So if you think you are going to buy this book, doing so now will really help us out. It's available for pre-order in all formats wherever books are sold, and you can find it at a link in the show notes. I hope you will love it, and I appreciate your support.

I think something that is fascinating for me sort of looking back through the literature about child abuse and hearing that Prevent Child Abuse started in 1972, that's very early days of child abuse being recognized as a problem. That's what like maybe a decade or less after the battered child syndrome paper that was really the introduction to like, maybe people shouldn't be disciplining their children so hard that they end up in the hospital. Many people, especially my age and younger,

really have no idea how recent this idea that people should not abuse their children is and that it used to be just the norm that people would physically discipline their children and not just like a light spanking, but really physically discipline their children. And so this is sort of a new project in many ways that sort of

speaks to that in terms of how common it still may be when you're talking about what people inherited from their parents and what was the norm generationally when they were growing up and how they might be passing that along. And I think we all are so affected by our childhoods, and that is the project of being a parent is trying to do a better job and that lots of parents could use help with that. Taking these issues one by one and how complicated they are to combat,

Physical abuse, again, that's obviously very tied in with things like addiction and poverty and stressors and anger and mental health of the parent. And there's obviously a lot of complex things there. I think an even more complex one is child sex abuse. How do you handle something like that?

From a preventative standpoint, what factors, especially considering the statistic that was on your website was 90% of children are abused by someone who's a family member or is within their sort of very intimate circle. How do you go about preventing that?

So a couple of different things I can talk about from an HFA perspective, but then also through our Prevent Child Abuse chapters and states, a lot are working on a number of different sexual abuse prevention strategies.

HFA, because of our getting involved with the family and kind of at the earliest juncture when their babies are so tiny and sometimes not even yet born, is really also kind of setting in motion kind of this thinking around how you identify others who are in the lives of your children, who are around your children, and the necessity of

reliable, responsible caregivers and being able to think not so much about the relationship that an adult to an adult might have, but how another person might be in the life of a young child.

And that includes childcare, how to think about appropriate quality childcare, both in what might be formal childcare setting as well as an in-home setting. And oftentimes it is because of one, childcare is just so expensive.

And because of the limited income status of so many families, you mentioned economic mobility earlier, and it really is huge in terms of the potential impacts if we put more focus on the kinds of policies and ways that we could ensure families have greater economic mobility. But when it comes to child care, so often it might result in children being left with unreliable caretakers. And so how do we just

start right from the beginning, talking and thinking about that in a way that as much as possible, the best decisions will be made in terms of who children are being cared by.

Child sex abuse is very analogous in many ways to medical child abuse. It often is a parent, statistically much more likely to be a male family member. So you're sort of talking about the strategy of how can you protect your child from people who might be unreliable caregivers, who might be prone to abuse them.

And I wonder if there's any evidence-based work on sort of preventing the abuser from abusing in the first place in cases of child sex abuse, because there's another layer of disgust and horror and just thinking a person who would do that is irredeemable. They're a pedophile. There obviously is pedophilic disorders in the DSM. That person is just going to do it no matter what.

But is that true? Is it just a matter of that's a bad man, keep him away, Uncle Johnny's a creep, get him out of here? Or are there some things that you can...

possibly identify and ameliorate that from ever happening because in the case where it's the dad or the grandfather or someone who's very close to the family, especially in the case of a father that has legal rights to that child, that's not so easily dealt with. So what about the concept of helping possible would-be perpetrators to not ever go down that road? Is there anything that can be done?

Well, you were right. It is not an easy question and no easy answers. And I think also points to what is another lacking element within our systems in terms of the mental health support that is accessible to families. And while it's outside the scope of

of what a program like HFA would be involved with. One of the things that HFA is really well suited for and has good evidence around is the ability to know what exactly

exists in the community and all of the different facets of needs that a family might have so that a connection can be made. And if in a particular community support or service or treatment of some sort has been made available for families, it would certainly be to connect them in that way. But I would venture, and I don't have any data on this,

that in most communities, the availability of anything like that is really limited and leaves families in a tough spot and children incredibly vulnerable. For me, it's a real balance with these conversations of

I want to give people productive ways to think about it if possible. And thank you for helping me do that today. And, you know, I want to give people some hope and different ways to think about how these systems can work better for families, for parents and children. But I also don't want to pull back from how serious and how prevalent this problem is because I think that's the wrong move.

Right now, a huge trend that I've been noticing in the media and that I've been reporting on, and specifically it's been huge around some of these medical child abuse cases like the Maya Kowalski case in Florida, where there was that huge verdict on behalf of the family that's now kind of working its way through or will be in the next couple of years working its way through the Court of Appeals.

But obviously, there's a lot of conversations about child abuse in general and sort of this concept of lots of families being falsely accused of child abuse. And while this is especially hot over the idea of Munchausen by proxy and medical child abuse accusations, I'm noticing that there are many other forms of child abuse. And I've looked into a bunch of these cases that have been reported as false accusations. And that is certainly not my impression of what happened in those cases.

And these are cases of abusive head trauma, cases of where children came to the hospital with numerous broken bones and were evaluated by child abuse pediatricians. Obviously, those professionals have a tremendous amount of training to be able to identify what injuries are a result of abuse and treat.

There seems to be a very coordinated pushback on the idea basically that child abuse exists at all. And that sounds extreme, but that is my takeaway after looking at the cases that are being presented as false accusations. And the way this is often couched in the media is, oh, doctors disagreed.

And when I pull back which doctors disagreed about what, they found, for instance, in several of these cases, there was a defense expert who is in the 5% of the medical community that does not believe that abusive head trauma exists. It's very, to me, bad faith reporting, and it's very, very scary. What I want to ask you about this is...

I feel like as much as it is necessary to push back on the involvement with police in some of these communities and the involvement of CPS and the failings of the child welfare system, which very different than what you describe as sort of the child well-being system where you're working with families and working with partnerships. And I believe so strongly that these reforms are needed.

This is not the reforms that people who are saying child abuse doesn't exist want. My overall takeaway from having read many, many, many of these pieces is that they want to take us back to the early 1960s. They want to do away with mandatory reporting. I mean, there's a real push for that. And to me, that is terrifying and not the answer. And I just am wondering, being in your position now,

Having seen some of these horrific cases when you were a social worker and having seen what the result is,

and can be from a complete lack of intervention. If the point of the sort of parents' rights movement around medical decision-making and the sort of pushback on child abuse pediatricians, I disagree with it in its nature. But if the point of that, we're like, we need these systems instead. We need to be helping families. We need to be allocating resources to families that are in poverty. But it's never that. And most of the parents, quite frankly, who are featured in the media, they

They do not line up with statistically who we know is getting involved with the system most often, right, which is families of color. Most of these parents are white. A lot of them are middle class, upper middle class, the kind of families that can hire expensive defense attorneys to come and do that kind of testimony about abusive head trauma.

So I wonder from your perspective, what is going on here with this conversation and how can we sort of correct for it and have a more productive conversation about child abuse?

So there's a couple of things that come to mind. And first, it's part of a responsibility that every HFA staff person has is as a mandated reporter. And so while we are always there in a way to support families, that when we

observe or hear of situations that place a child at risk of abuse and neglect, those are things we are going to get other supports like child welfare involved with to

come around the family and provide more support. It was one of the things that I knew many years ago in my previous work is that child welfare oftentimes, while yes, there's a lot of talk of the system being broken and things needing to happen differently in the way that children are identified and children are helped to not be in a situation where their safety is at risk.

despite all of the systemic flaws that exist, we still have a system that doesn't

generally has more resources that they can bring to bear for the family when a dire situation happens. And our perspective in reporting is most of the time we will work in partnership with a family, oftentimes even calling child welfare together to be able to talk about

what was happening, what is needed, and that way too, ensuring that the partnership we have with a family is going ideally to be sustained through this. It's not always possible, as you can imagine, that a family will want to stay connected to a program like Healthy Families if a report has been made to protective services. But when engaging in a partnership sort of way,

It allows a family to know that our primary interest is in the health and well-being of the family and especially their young children. So that is a way in which we work with families. We are very glad that research has shown that families who participate in HFA have reduced incidents of abuse and neglect.

For families who were referred from child welfare or had previous substantiated abuse and neglect in their family and then get linked to HFA, the incidence of being connected again to child welfare is reduced substantially. And so it's important that these types of services and supports are available to families.

That said, when it comes to how do we balance what feels like, and so often it seems just symbolic of the way we are moving in lots of fronts, which is in kind of a divisive sort of way. It's not that we're with a system where families are being entirely falsely accused and we're also not in a system where child welfare is entirely in the wrong, but like come to the middle ground often

which I believe has to be centered around children. And I think all individuals really should and generally do want the best and care for children in our communities. And if we can stay focused on the children and less on some of the other political kinds of things that have people kind of taking very strong positions on one side or another, which

doesn't serve the child at all is, I think, probably one of the only clear pathways to recovery.

what we are all wanting in terms of our goal for healthy health and well-being for our children. I really agree with you. And I agree that obviously it's very hard to sort of lower the valence on everyone's political feelings, especially right now. We have a little election coming up in a few months. So people are, you know, a little bit stirred up about things. One of the most hopeful things that's come out for me of making this show is

has been actually the wide political net of support. The subject of our upcoming season is a person who is trans and a prison abolitionist. And in season two, we had a Republican sheriff and his family were the center of, and we're all in agreement about the way to deal with this. And we're all very aligned on what we think should be done. And so I think

We can find those places of agreement. I feel like if you kind of sweep away some of the more inflammatory rhetoric, and I just encourage people to sort of be open-minded and also maybe critical of headlines that are screaming at you to be worried about one thing when that's probably not the thing that you should be worried about, i.e. doctors snatching children from innocent parents who bring them to the hospital, which I think is a very, very terrifying conspiracy theory that there's no evidence of.

We're talking about mandatory reporting, and I understand where there are complexities with that and nuances with that. However, we already know what things were like before mandatory reporting existed because it hasn't, again, been with us for all that long.

Right now, I don't think people realize how imperiled mandatory reporting is by the Kowalski verdict in Florida because we had a follow-up interview with Ethan Shapiro, who's the lead attorney for Johns Hopkins All Children's. You really cannot have a situation where people are

federally mandated to report on child abuse and also personally liable in court if they do. That's an untenable situation. So to me, the ultimate inevitable outcome, if that verdict stands, especially considering the size of the verdict and the number of sort of copycat lawsuits that are popping up, the inevitable outcome will be that mandatory reporting will be overturned.

And I don't think people understand that those are the stakes right now. I think this is sort of going under the radar. In your opinion, what happens if mandatory reporting goes away? I think it's a really difficult situation we would find ourselves in, in terms of that, yes, while there are a number of professionals who have found themselves over the year in a category of being a mandated reporter, and I think would

continue to exercise responsibility associated with their interactions with children and do the right thing on behalf of a child to make sure that they're getting the kind of support and care that is needed to ensure their health and well-being.

to overturn entirely. And we've already experienced some of our sites who express concern about, well, what if we're not required in our state to be a mandated reporter? And

And what we say as a program is that if you're implementing healthy families and you're implementing the model to fidelity, then you're going to exercise that responsibility even if your state does not require it of you. And I think it will take a lot of

similar sorts of things for other aspects of our system to ensure that individuals who come into contact with children and families are doing the right thing on their behalf.

As I've seen these play out, some of these situations, that protection element, though, of people who report is so important because up until the Kowalski case and the APSAC committee that I'm part of, we say, like, report, that's the right thing to do, that's the right thing by the child. You can say that on the one hand. I believe that. Obviously, I believe the safety of children should be paramount of anybody that works with children, anybody who's a parent, anybody who's coming in contact with children ever. Just as a society, that seems like that should not be up for debate, that that is number one.

And yet, I've seen what's happened to some of these people individually. You know, Dr. Sally Smith has been harassed. She's gotten death threats. She's gotten stalked. She was made the villain of a Netflix film for a report that, in my opinion, saved that child's life. The same thing happened in my own family, where the doctor who did the report about my niece—and I believe that intervention saved my niece's life also—and she—

She was dragged through the mud in the media. She ended up leaving her job. She got harassment, death threats, etc.,

It seems to me like how can you ask people to voluntarily put themselves in that position, do the right thing by the child, do your duty, but it might ruin your life, sorry. I mean, that just seems absolutely absurd and untenable and really morally wrong. There are a lot of people that are responsible for that, including the media, but I don't know what the right thing to tell people is under those circumstances, particularly in medical child abuse cases that are so complex and it's so complex for children

The police and CPS to investigate those reports is such a lift. It's leagues more complex than physical child abuse cases or even child sex abuse cases because it's just so misunderstood. We're at a tough spot. So I love to have something else to sort of point people towards like your organization or you can say we can support organizations like this.

You can advocate for legislation that is providing more support to low-income families for the mother and infant programs. I don't think people necessarily always connect supporting those things with

preventing child abuse or things like universal pre-K or things like that. But in fact, those are prevention strategies. People can get in these very politically motivated debates. But, you know, I think there's all kinds of things that sort of come up where they just think like, oh, people are getting handouts or people have very strong feelings about social welfare programs.

listen, you can think whatever you want about whether that parent should be working harder or whatever. Obviously, I don't frame things that way. But do you want the kids to suffer because of it? No. I think most people would ultimately answer no. They don't want children to suffer. Even if you feel like it's a personal responsibility issue and that parent's made a bunch of bad choices, okay, fine. Even so, do you want their children to suffer? Do those people's children deserve to suffer? And so I think people need to also look at those things as like,

This is not government handouts. This is a prevention strategy. This is a way to save money on how many CPS workers need to be assigned to that person down the line when something bad does happen. So I like that reframing. I think that that's very productive. So I wonder, and again, this is a difficult question, and I know for a fact we're not going to have data to work with on this one. So we'll just be kind of speculating from our experience. But I wonder if

When you look at medical child abuse and munchausen by proxy abuse, which I'm sure, especially having been a social worker at a hospital, you've seen cases and are familiar with it, even though that's not part of what you're doing at Healthy Families. Do you envision a scenario where there could be prevention strategies around medical child abuse? I would like to think so, absolutely.

It is really complicated. Obviously, you know, and have spent a lot of time focused on this particular issue. And it's difficult, I think, in part because in the work that I do, the voluntary nature of it that is set up in a way that is for families who want support. And if a family doesn't want support, that makes it challenging to intervene.

at various stages along the way. I would like to think that by getting involved with families as early as possible, ideally in pregnancy,

And being able to, one, begin a relationship that is structured around providing support to parents related to their own coping, their own preparation for a new baby, working in ways that support a healthy birth outcome will...

maybe tip the scale a little bit in terms of individuals who may have maybe traveled a path that might have led to medical child abuse, but have found a way to get their needs met in the

other ways through other relationships. And again, because as you led in with the question, there isn't data to support that, but I'd like to think there might be an opportunity that that could be useful for some families.

You know, when I look back at my own family having that as a test case where I saw the sort of evolution of the behavior over time before the pregnancies and during and after, this is where there is a lot of parallels with child sex abuse where you just sort of think, okay, is this just an inevitability that this person was going to do this? And

there was really nothing that you could do other than keep them away from children. And I think in some cases with physical abuse and all forms of abuse, there are going to be that percentage of parents where the answer is this person is never going to be capable of healthy parenting. And the solution is they should not be around children.

And I think that's fair and we need to keep that as an option. But we do see these behaviors on a spectrum. We see everything from parents that kill their children or put their children's lives at great physical risk and are really, really interfering with their children's lives to these sort of

You know, you see some compulsive behaviors that are mostly manifesting online. As you said, it's a maladaptive coping mechanism so that where I do think there are some interventions in some of those cases that could possibly help those parents find healthier outlets and that if we could identify the behavior much earlier on, I tend to think having looked at a lot of cases that

The further it gets and the further that parent has gone down that road, the less likely they ever are to be accountable for their behavior. Whereas if they're doing something that's sort of more on the shameful or embarrassing end, then the I've really hurt my child and that an intervention might be more possible. So again, I think the awareness is hopefully part of the solution.

I agree. It's really hard to know, but it feels like if we don't put as much potential support out there in front of families and available for families early, we will not have accomplished even maybe the little bit of support in a way that could offset a situation from beginning in the first place.

What's so frustrating to me about the conversation that's happening right now is there's sort of a very vague reference towards these systems need to be reformed. And I think I'm like, yes, a lot of us are in agreement with you about the flaws in the system, but the solution is not to deny that child abuse exists or that child abuse is relatively common. I guess it sort of astounds me that people could go through their whole lives into adulthood and think that child abuse is so vanishingly rare today.

that a parent who's been accused is more likely to have been falsely accused of it than not, that doesn't vibe with any of my human experience. I mean, even just talking to your fellow adult peers and how many people do you know that experienced child abuse? Like, it's not so vanishingly rare that everyone was just going along in their happy childhood. You know, it is a very real prevalent problem. And I think that like acknowledging that is step one to dealing with it.

So is there anything that I should have asked you or that you would like to say about this and also the work that you do there at Prevent Child Abuse and with Healthy Families America that I did not get to? Well, I really appreciate this opportunity for you and I to have had some conversation today. And I feel like we covered kind of broad array of different things associated with the experience that some children and families may have that

that is not what we would want for any child and what are the many ways in which we can create and bolster families to avoid those kinds of circumstances. One of which is the work that I am just so grateful to have been a part of for the last 30 years in terms of healthy families. And I also have an opportunity to work on a national level with other home visiting and family support programs

And you were speaking earlier about some of the bipartisan support that is around children's issues. And we really are, despite the political circumstances that we find ourselves in at times, that through all of that, I have seen that sort of bipartisan support as well. When we were able to get the reauthorization of the Maternal Infant Early Childhood Home Visiting Funding, it was nearly unanimous.

in terms of how that passed.

On both sides, Democrats and Republicans are making it clear that they're committed to supporting the needs of children and families. And I take that as the hopefulness that we will continue to do the things that while are probably never going to completely erase abuse or neglect of children in our society are going to help ensure that it happens less and less frequently over time.

That's very, very encouraging to hear about the support for that legislation. And I think we all need to remember that that's possible because I have my own strong political beliefs, but we all have to be open to the fact that we have more in common than we remember sometimes about our shared values in this country and that that's something we need to cling to in these trying times. So if people are listening to this and they

I want to support the work that you're doing over there, both from maybe even a local legislative standpoint. Is there stuff we can look at legislatively to support? And also, what can we do to support just the work that you're doing over there if people want to donate and or volunteer and that kind of thing?

Oh, there are so many different ways that people can get involved depending on their interest. I would first suggest just going to our websites. The website for Prevent Child Abuse America is preventchildabuse.org and for Healthy Families America is healthyfamiliesamerica.org. And we have lots of information in both places about ways to connect.

Through PCA, as I said earlier, we've got a really strong state chapter network and folks could engage with their state chapter on different issues, whether from an advocacy perspective, folks who might just want to donate to help ensure that there's more resources to support families.

On the healthy family side, same thing. There's certainly ways to donate. There's also ways to learn more about how to be connected in the community to help be part of the infrastructure that supports families, whether it's through community service volunteers, through faith-based organizations.

Truly, we say so often that prevention happens in partnership and it takes all of us. And so love that there are folks who really want to figure out ways that they can be of support. And we have lots of suggestions we can tap them into. And our contact information is also on our website and would really just look forward to people who even just have questions they'd like to learn more about. We are accessible in that way, too.

Fantastic. We will leave all that information in the show notes as well so people can find it easily. Thank you so much, Kathleen, for being with us. This has been a fantastic conversation. I really wanted to leave people on a...

somewhat hopeful and productive note after all of this talk about how scary everything is. So this has been really wonderful and I really appreciate you and all the work that you're doing. And thank you so much for your time. Thank you.

Welcome to another round of Boardroom or Miro Board. Today we talk retrospectives with Agile coach Maria. Let's go. First question. You've spent two hours in a team retro, but the only input you've heard is Dave's. Boardroom or Miro Board? Boardroom. In Miro, Dave can't hog the space because everyone can add thoughts anonymously online at the same time. Correct. Next. You need the team to act on feedback fast. So you turn all those retro notes into Jira tasks. Miro all the way.

And I can assign those tasks to teammates. You're nailing this. Now, you see hundreds of sticky notes from the retro. A real mess. But you organize them into five themes in just seconds. Miro, I basically get back an entire hour when I use its AI tools for clustering.

And she's done it. For a limited time, visit miro.com slash retro now for a free business plan trial to unlock advanced retro tools like private mode, voting, and two-way jira syncing. That's miro.com slash retro now.