Nandini Ray: Hello everyone! Welcome to our show Between Friends: Conversation with Maitri. In today's episode, I'm your host, Nandini Ray, and we will be discussing the importance of child abuse prevention, and we are hoping to engage our listeners in raising awareness about this issue. As a nation, we must do everything within our power to stop child abuse and neglect before they occur. To discuss this very important issue we have invited Dr. Suzanne Frank and Steve Baron. Both Suzanne and Steve have extensive experience and knowledge in Child Abuse Prevention fields, and I'm glad that they are here today to share their experience, knowledge, resources, and strategies to prevent child abuse and neglect. Friends, let me give you a small introduction about Suzanne and Steve. Both of them are experts in their own fields. Dr. Suzanne Frank is a Supervising Pediatrician at School Health Clinics of Santa Clara County. She retired last year after working at Kaiser San Jose for almost 30 years. She was the Child Abuse Services and Prevention Champion and ADHD co-Champion. Suzanne received her medical degree from the Northwestern University. She has worked at the Santa Clara County Children's Shelter and Juvenile Hall. Subsequently, she continued to work as a Pediatric SART Examiner in Santa Clara County for 20 years. Suzanne received the Santa Clara County Child Protector of the Year award in 2018 from the Child Abuse Prevention Council, a board of supervisors commission. Steve Baron is a retired Director of Family Code Services in Santa Clara County, Former Adjunct Faculty for the National Council of Juvenile and Family Court Judges on the subject of juvenile dependency mediation, and for Santa Clara University where he taught in the Graduate department of Counseling Psychology and Education on subjects including child abuse and neglect domestic violence, drug abuse, substance abuse, and trauma. Steve's also retired from 25 years of private practice as a therapist. He continues to serve as an occasional trainer for the court system, as well as various community agencies on the impact of trauma on child development, and victims of domestic violence and trauma informed systems. He has been the recipient of several awards for services to children and families from legal advocates for children and youth, The Judge Lynn awards champion of peace awards, Award from the Santa Clara County, or Domestic Violence Council, and for the training of mental health professionals from the Santa Clara County Psychological Association. He currently serves on the Board of the Domestic Violence Intervention Collaborative, the Santa Clara County's Child Abuse Prevention Council, the greater Bay Area Child Abuse Prevention Council coalition, the Santa Clara County domestic violence debt review team, and occasionally on the Santa Clara County child death review team. Wow, I'm so excited to have you both in this show, thank you so so much for coming.

Steve Baron: Your welcome.

NR: So listeners, you may know that is Child Abuse Prevention Month, and this is a great opportunity for us to talk about this issue. Let's start our discussion on what does Child Abuse Prevention Month mean. I would like if both of you can describe the importance of Child Abuse Prevention Month.

SB: Child Abuse Prevention Month is typically the month of April across the country, where all of our local agencies tried to shine a light on the issue of child abuse and neglect to keep it in the view of the community. Because child abuse and neglect traditionally is not something people want to think about because it makes you feel uncomfortable and it makes people feel helpless and anxious. And so they would rather not think about it, and it tends to happen anyway behind closed doors and in secrecy. So you have to keep the light shining on it and what we try to do is educate the community on things that they can do that might help prevent child abuse and neglect and support one another and that community and their neighbors and their family members in positive ways. We also typically every year do a Child Abuse Prevention Symposium for about 400 people and professionals and various agencies in the community, and community members on a theme. This time we had to cancel it this year for the first time, because of the shelter in place. And it was going to be on the impact of gun violence on children, but we will plan to do that sometime in the future. There are various activities that happened, including proclamations and declarations from Board of Supervisors. But, the basic point of it is to shine a light on that and keep that in front of everybody so they pay attention to it, and encourage people when they get concerned about children to report their suspected abuse and concerns to the appropriate child abuse protective agencies and/or law enforcement.

NR: Thank you. Suzanne, do you want to add anything?

SF: Yes, at Kaiser what we have done in the past, to educate our patients and families about Child Abuse Prevention Month. We use the color blue which is the color on the blue ribbons for Child Abuse Prevention, we make fabric wreaths out of blue and white, have pinwheels, and decorate. We usually have a theme each year. One year it was Father Friendly Kaiser, and we put up large posters of fathers and children engaged in different activities. We emphasized to our staff to include fathers in the medical care of children, because we found in our medical charts at Kaiser, most of the time we didn't have the Father's name, his birthday, what activities he does, as compared to the mother there so we've tried to educate our staff. This year, with COVID-19, that became the thing. And we're educating our doctors and nurse practitioners, our providers, to be aware of stress. We have our pediatric social workers, available to help families were stressed during COVID-19. We set that child abuse service and prevention committees at all the kaisers have sent out to all the doctors doing telehealth two questions to always ask about assessing for safety.

NR: Since both Steve and Suzanne, both of you, were talking about COVID and the lockdown situation. And I was reading an article that says, with schools closed and teachers, unable to report suspected cases of abuse and neglect, states are reporting fewer calls to child abuse hotlines. For example, calls to Washington State child abuse hotline are down about 50%. Calls have gone down but that doesn't mean that abusers stop. Right? So it's possible that you know, children suffering in silence, and it is underreported. So how is the current COVID-19 lock down situation, affecting the incidence and reporting of child abuse?

SB: Child abuse tends to thrive in environments that are isolated from outside sources of support and outside resources who can identify it and report it. So, while the reports are down, including locally Santa Clara County about 50%. All the indications are that the actual incidence of child abuse is rising. And it's rising because of isolation. Also conjoined with the kind of increased stresses that families are feeling, including parents and caretakers, who are more vulnerable to perpetrating child abuse and neglect, making life harder for them and where people are confined with one another. And so just anecdotal reports from the Bay Area resources suggests that the reports that are coming to the attention, to the system, appear to be somewhat more serious and more severe than they normally are, where cases may be identified at a lower level, which is a good thing, and earlier can have a less severe level. Now it might be taking more for it to come to the attention of someone, and it's very it's much more difficult to identify because kids who are normally seen not just by schools, but by medical staff and physicians and nurses and child serving agencies and extracurricular activities, are not. And so they're, and sometimes from extended family. So, sometimes, if we're fortunate we get to see them on, on the media, and through video, and through phone calls and that becomes an avenue, where we're going to have to pay more attention to this during this period of time, to determine if there is someone is not sounding safe, looking safe, or the environment doesn't look safe to report it. Because reports are definitely down, and all the indicators are that incidence is going up.

SF: And here in San Jose, they had a 50% increase with the San Jose police department, going out for family violence calls. And in March, at our, for CPS reports, they went down from 2019 where we had 120 calls in Santa Clara County down to 50 this March. And again, without the school reports because that's the majority of the substantiated reports. But, we have to remind people all our operations, protecting children, continue, that child protective services or virtual with telephone calls, home visits continue. Child Protective Services are using the same procedures as law enforcement to protect themselves from COVID-19. And that issues that are being called in to CPS have taken a little bit of a different pattern. There's a lot of problems with custody. Parents are concerned with especially with joint custody, that the child is going to a house of another parent that there's concerns that they have people living there with COVID-19. We have a lot of people call with COVID fears. Substance abuse, there's a lot since everybody's at home and this week here reported increased sales for drugs and alcohol, so we're getting reports of that. Also, we're getting calls from parents calling in with concerns of danger and get them back they're able to get conferenced into domestic violence support. Again, we said the factors that are increasing the risk of child abuse, most abusers are within the family so now they have complete access. Online predators have more access to children online nationally. The increased cybercrime tip line reports they've increased, and more poly victimization, where a child is the victim of more than one type of child abuse. And one thing we're trying to teach the instructors because the teachers are teaching virtually now, is that in the background if a parent yells more than two times, that is a clue that there is stress, and that's an opportunity for us to address stress and give the parent resources to reduce their level of stress. We see that as increased risk for child abuse. Also, grooming: we want another adult to be on all messages from the teacher, and we want to require the teachers to record the virtual sessions, and also remind the teachers that conducting the session in an appropriate location, not the instructor’s bedroom. Another issue that comes up is education. They get a lot of homework. Yeah, I was just talking with Carmen Castille, our Pediatrics, past Social Worker over at Kaiser Santa Clara, just in their family, she could see the kids get a lot of work more the expectations have increased because the teachers don't have the familiarity with doing this kind of teaching. So that you know when the parents sees a child being stressed by too much work they need to respectfully talk to the teacher about this level, and also the parents, we don't want them to have unrealistic expectations of education we want to remind them that learning happens all the time.

NR: I'm glad that you shared the work that has been done. Our people are working to make our children's safe and that's wonderful of you to share those statistics. So, since we are talking about child abuse and neglect. So I am thinking that when a child is abused or neglected the trauma can be a lifelong trauma and the short term and long term effects can be devastating. So, can you please discuss how does child abuse affect children over the lifespan, from a medical perspective?

SF: Right, so we call that ACEs, adverse childhood experiences, and studies were done in Kaiser San Diego back in the late 90s. Based on that work, we continue to expand research, both clinically and medically. The adverse childhood experiences are traditionally divided into 10 types of names and experiences, although now we're going to be calling COVID epidemic, a new ACE. And so these adverse childhood experiences are traditionally abuse like sexual abuse, physical abuse, psychological abuse or neglect, physical or psychological, and also household dysfunction. So in the house, someone grew up in was their domestic violence, mental health problems, incarceration, separation or divorce. So we can look at these exposures that people have during their childhood, and we know most people have over two thirds of people have at least one adverse childhood experience and over 25% have more than four. These adverse childhood experiences, stress the body, stress the brain, and the brain affects the rest of the body affects the immune system affects the endocrine system, so we know that these experiencing this toxic stress, it affects the immune system so in this time of COVID-19. We know people are not going to fight the infection or the security or the negative effects of the virus, if they're under stress. We'll talk later about stress reducing activities, but the other is adverse experiences affects the body, and both physically and mentally. If you have more than six adverse childhood experiences that decreases your life expectancy by 19 years, but also all these adverse childhood experiences the stress takes a toll on the body with increased rates of diabetes, increased rates of heart disease, increased rates, you know, difficult to control, and asthma. Almost every medical problem is affected by stress. Now the good news is that we can recover we can build resilience in the body, so your past is not your destiny. That is why we want to prevent the toxic effects of the ACES epidemic on the body. It's sort of like what we call the second wave of illness and death and violence and mental health problems. It's not just the COVID-19, actually the germ causing infections, but it's all the environment that we are experiencing because of the increased anxiety which is going to be leading to depression, and we try to tell people we're looking at people, we want to think of, not saying what's wrong with that person but what happened to that person, and we know it's multi-generational- how we were raised is affecting us, and that affects how we parent our children.SF: Right, so we call that ACEs, adverse childhood experiences, and studies were done in Kaiser San Diego back in the late 90s. Based on that work, we continue to expand research, both clinically and medically. The adverse childhood experiences are traditionally divided into 10 types of names and experiences, although now we're going to be calling COVID epidemic, a new ACE. And so these adverse childhood experiences are traditionally abuse like sexual abuse, physical abuse, psychological abuse or neglect, physical or psychological, and also household dysfunction. So in the house, someone grew up in was their domestic violence, mental health problems, incarceration, separation or divorce. So we can look at these exposures that people have during their childhood, and we know most people have over two thirds of people have at least one adverse childhood experience and over 25% have more than four. These adverse childhood experiences, stress the body, stress the brain, and the brain affects the rest of the body affects the immune system affects the endocrine system, so we know that these experiencing this toxic stress, it affects the immune system so in this time of COVID-19. We know people are not going to fight the infection or the security or the negative effects of the virus, if they're under stress. We'll talk later about stress reducing activities, but the other is adverse experiences affects the body, and both physically and mentally. If you have more than six adverse childhood experiences that decreases your life expectancy by 19 years, but also all these adverse childhood experiences the stress takes a toll on the body with increased rates of diabetes, increased rates of heart disease, increased rates, you know, difficult to control, and asthma. Almost every medical problem is affected by stress. Now the good news is that we can recover we can build resilience in the body, so your past is not your destiny. That is why we want to prevent the toxic effects of the ACES epidemic on the body. It's sort of like what we call the second wave of illness and death and violence and mental health problems. It's not just the COVID-19, actually the germ causing infections, but it's all the environment that we are experiencing because of the increased anxiety which is going to be leading to depression, and we try to tell people we're looking at people, we want to think of, not saying what's wrong with that person but what happened to that person, and we know it's multi-generational- how we were raised is affecting us, and that affects how we parent our children.

NR: So what I'm sharing that it is possible that one child who is seeing violence and abuse on a daily basis at their own home, they can learn, they may think that it is normal. Right?

SB: That is absolutely correct. So this highlights a couple of really important things. If a child is the victim of abuse or neglect or other forms of serious trauma, it's extremely important to identify that issue as early as possible in that child's development so that cycle can be interrupted. And interventions can be provided to make it safer for that child and get that child to help their child and that family needs in order to reduce the negative effects and handle the underlying problems that are contributing to the abuse and neglect. So you need early identification and early effective intervention in services, because if you don't, that's right. If I'm a child who is abused and neglected and that's the only behavior that I am exposed to, then that is how I'm going to learn how to treat other people and take care of myself. Now it's also important to understand that, as Suzanne mentioned, child abuse or neglect usually doesn't happen in isolation. It happens in conjunction with other forms of trauma and adverse childhood experiences like substance abuse, like exposure to domestic violence, like mental illness, depression or severe anxiety in the home or like people who are having problems with the law. So, multiple traumas are happening with regard to that and they're exposed to these various kinds of behaviors. So one of the most important things is to do whatever we can do to make sure there's at least one healthy supportive relationship that child has access to, that has, who can provide him another form in a healthier form of role modeling for how to treat other people and how to take good care of yourself. They can learn the various skills that they're going to need in order to mitigate the effects of the abuse and neglect that they've experienced. So yeah, so you can take two children who have the same degree of abuse and neglect in their life- why does someone grow up to have a significant areas of emotional problems, behavior problems, social problems, work related problems, and medical problems? Suzanne might want to talk a little bit more about those medical problems. And another child has far fewer of those problems, and does better. Often in sometimes is pre-genetic disposition, but often it's because that other person had other resilience characteristics in their environment, including the most important thing being healthy supportive relationships that to which they have regular access, who could provide them the emotional support and the attention and the understanding and the teaching of appropriate ways to behave. Then, and how to take care of themselves so they can mitigate the impact of the abuse and neglect.

NR: Well thank you so much, Steve, for sharing your insight. Thanks for those who have joined us late, we have two experts from the Child Abuse Prevention field, Dr. Suzanne Frank and Steve Baron, and so far we have discussed the CGS lifelong trauma children suffer from abuse, and the impact of COVID lockdown on child abuse reporting. This is the time for us to take a short break. Don't go anywhere we will be back soon.

[You can call us Monday to Friday 9pm to 3pm or 1-888-624-874. For after hours, leave us a voicemail in your language. You can also email us at maitri@maitri.org]

NR: Friends, I'm your host Nandini Ray, and you are listening to the Maitri show Between Friends Conversation with Maitri. I'm so glad that we have Steve Baron and Dr. Suzanne Frank with us to discuss a very important issue and that is prevention of child abuse. Steve and Suzanne, I want to share something with you- when we talk to our clients and survivors of domestic violence, most of the time we see that the children are also, you know, depressed they're suffering. But, many times, ordinary people in our community, they think that children are not noticing if we have any unhealthy abusive relationship to them, not noticing children don't know what is going on. From medical perspective, is there any correlation between domestic violence and child abuse? Can domestic violence lead to child abuse or does it have any negative impact on a child's life? anything you want to share.

SF: Yes, as I said before, domestic violence is considered an ACE and adverse childhood experience, and by studies we know that leads to increased problems of physical and mental health. Especially now with COVID-19, we're seeing increased domestic violence and increased child abuse. We should not look at those in parallel, because most of the time if there's domestic violence over half the time there's also child abuse. So when someone reports to us that they have domestic violence in their home, we are obligated to talk about child abuse, and look into that also. And as far as statistics, 54% of children who are sexually abused also have domestic violence in the home and that's even higher if the mother was physically abused as a child. And, witnessing parental violence can be physically dangerous the children can get physically hurt, but it's also psychological abuse, and this causes significant emotional harm and risk. Again, we always look for signs of sexual abuse, physical abuse, and neglect if we see domestic violence in the home, and only there is the risk of being physically hurt by the children, but also the emotional abuse by the parent. And if the parent is experiencing verbal abuse threats and controlling behavior, then the parent is being emotionally abused, that affects the children. Even when we don't think the children hear and see, they do hear and see. The symptoms we are going to see from the children, are the common symptoms of trauma, which we call FRAYED. FRAYED is a mnemonic F for fits, frets, fear, and anxiety, R for regulation disorders like ADHD. When we see problems in regulation of attention and ADHD, we always need to look at, see if other Adverse Childhood Experiences going on with domestic violence or abuse in the house. A for attachment disorders, where there's problems between the relationship between the parent and children. Y is for yelling and yawning that would be like tantrums, and sleep problems, E is for educational delays, and D is for defeated. So, when we see domestic violence when we hear of domestic violence, we need to assess the children for the symptoms, called FRAYED and see if this is a sign that there is a risk for long term physical and mental health effects.

NR: Hmm. Steve, do you want to add anything or did Suzanne cover everything?

SB: Yeah, one major point for everybody to understand is, a lot of times parents will tell one another so they don't feel as bad about it, that the kids didn't know about. But what the research says is that they almost always know about it. The children might be in their bedroom with their hands over their ears or humming to themselves, or turning on the music louder, so they don't hear, but it still affects them, and it still traumatizes them. Another thing for people to understand is that exposure of children to domestic violence is always emotionally abusive and some kids may be more resilient than others, but there's no good thing that comes out of it with regard to that. So, it's important for them to understand it and the impact of that. And the third thing is, say, well, the kids were very young, they really aren't going to remember it, and it's not going to affect them. It's exactly the opposite. The younger the children are when they're exposed to domestic violence, the more it can impact their brain development. This is because the trauma and the toxic stress that goes along with domestic violence can interfere with healthy brain development. I'm going to suggest to your listeners, if they want to see something on YouTube. That will give them a really good explanation of how and why exposure to domestic violence impacts kids, and is emotionally abusive to them, and it can lead to long term impact is to watch a YouTube video called First impressions: Exposure to Violence, and the Child's Developing Brain. It is about 14 minutes long. It's a great one. And Suzanne is citing research which is important to understand when there is significant domestic violence, at least half of the time there's also, child abuse, beyond the normal emotional abuse that occurs by exposure to domestic violence. When you find serious child abuse, at least half the time, there's also domestic violence that's occurring in that family. So, for the child, they're accumulating various forms and numerous forms of trauma and again with regard you may have a parent experiencing Post Traumatic Stress Disorder because of their victimization by the domestic violence, depression, anxiety, and often substance abuses in the home. So when you get one serious problem in one area, usually it's not limited to that one. There are multiple problems. And, as Suzanne described with the ACES, it's the number of those things and accumulation of trauma that puts a child at risk of increased potential for experiencing very very long term problems, unless somebody intervenes. The child is made to be safer, and the child in the family gets the resources they need to deal with those problems. So the child can begin to recover. It's also important to understand this is true for not only children, but for everybody. You cannot recover from child abuse or neglect or domestic violence, or any type of serious trauma, until you're safe. You have to be physically safe, emotionally safe, and sexually safe, in order to begin to recover. A metaphor for that one is there's a boxer in a boxing ring, who is injured and is not going to heal that injury or that cut that they experience while the fight is still going on the bell has to ring the fight has to stop and the trainer needs to come in and the medical people come in and start treating that wound. And then the person can begin to heal and may have to go to some kind of rehabilitation, get some help, get some rest and recover, but you got to be safe before you can recover from that.

NR: Great analogies, Steve. I'm hoping that many people out there listening to our show are learning that domestic violence has a huge negative impact on all children if they're witnessing domestic violence. You know statistics wise, I was reading one article that says that statistics say in the United States more than four children die from child abuse and neglect on a daily basis, and over 70% of these children are below the age of three, and most of the times, perpetrators are parents or family members that that means they're there under domestic violence. So if you have so far discussed that you know how to look for a medical practitioner or a law enforcement officer, they can see that trauma and the child is suffering from abuse. But, for example, if I am a neighbor or a family friend, how do I know that a child is being sexually physically or psychologically abused or neglected? Are there any kind of signs that indicate your child is facing some kind of abuse?

SF: Okay, the physical signs, you know, if you see bruising, if you see the children are losing weight if you see sadness, the other thing is a change in behavior of the child. And you know, talking with them about how schools going. Are their grades are dropping? Also we get concerned if you see a family having a violent arguments or somebody's out of control. If the caregiver and/or parent talking about the child in negative terms. Those kind of things would make you think what's up and how can I talk with them and offer support, but also always assessing safety.

SB: Some other kinds of general signs that people can look for, but harder now to become aware of because we're not with children as much. But the typical kinds of signs include a child who appears to be frightened of a caretaker, a child who has obvious injuries or bruises, and there's not an appropriate explanation that's believable or consistent with regard to explain it, either from the child or from the parent or caretaker. Children, and you're not gonna be able to see this as well, but children who attach very quickly to strangers or new adults in their environment. For sexual abuse, children who demonstrate unusual sexual knowledge or behavior for their age, that doesn't automatically mean they've been sexually abused, but it's a red flag that should be checked out. Difficulty walking or sitting. I will tell you this for parents who are worried right now that their child may have been sexually abused by somebody physically, they can contact the Center for Child Protection at the Valley Medical Center. They will answer your call, I believe 24 hours a day, and then make an appointment for you to bring them into that center for a physical examination by people who are professionals and the best at their trade. It's called the Center for Child Protection at Valley Medical Center. If anybody comes aware of witnesses and adult inappropriately touching a child, obviously, or watching pornography with a child, or saying sexual things to a child is an indicator. Any child who shows extremes in behavior, such as overly aggressive or overly passive and compliant or withdrawn. If a child appears emotionally unattached to a parent or caretaker, is a warning sign. If you see a parent who is constantly blaming or belittling or berating a child, refusing to help a child when needed, if there are indications that a child is better for stealing food has severely poor hygiene or states that nobody at home is caring for him or her. If a child is using drugs or alcohol that is a major problem, or if you know that the family is undergoing an extreme amount of stress, and there is substance abuse in the role, and anytime there are a lot of guns or weapons available to a child. Those are just some of the indicators, but what the child abuse professionals are telling us now in the time of Coronavirus is trust your gut, trust your intuition. If something does not look safe, sound safe or feel safe then report it. And if you suspect child abuse, if you think there's an emergency and something is happening right now, report, call 911 and call your local law enforcement agency. If you just think it's not something that's happening as we speak, but something that's occurring in the home even reported 24 hours a day to the 24-hour reporting hotline and that phone number is a 1(833) SCC-KIDS.

NR: I think every community member and concerned citizen should know this number. And they should be aware that help is available if they have any concern that a child is being abused or at risk of being abused so that they can reach out to someone for help. And thank you Steve for sharing this information. I would like to say one more time that the Santa Clara County Child Abuse and Neglect Hotline is 24 hours on 1(833) SCC-KIDS. Please call them if you suspect that anyone is any child is in any danger. So the Suzanne and Steve if you want to share any local resources that help victims and survivors and families to heal. Please feel free to share that with our community members and with our listeners.

NR: Thank you, Suzanne and Steve for providing so much information, good information, that anybody can be benefited from. I actually don't want to end this show. It's a such a good show for me. I am enjoying listening to both of you. But the time is an issue too. So I would like to request both of you. Do you want to share any advice or tips for our community members and families? What can families and the community do to prevent child abuse? Anything you want to share? Any advice?

SB: Yeah, I'll start. One principle is, we want to surround kids as much as possible with healthy relationships. Now on the Child Abuse Prevention Council website, there's a healthy relationships link there that has a PSA, one-minute video, a public service announcement on healthy relationships in English, Spanish, and Vietnamese where the child says, What's a healthy relationship? A healthy relationship is always physically and emotionally safe, respectful, caring, and never ever abusive or violent. And surrounding kids with those relationships, helps them to grow up to be healthy, happy, strong, kind, and productive. If there's one thing we can do, we can try to do that as much as possible because not only does that help prevent child abuse, but when it happens, it helps identify it early, and then give the child the help they need. Being involved with children in those kinds of relationships builds children's brains in neurological systems in a way that makes them more resilient. So that if they do encounter trauma in their life, they're more likely to have a really good prognosis for recovering, bouncing back, and transforming that into something positive and constructive in their life with regard to that. Other things that were mentioned is that we want to incorporate into our educational system from kindergarten through high school, as much social emotional training for children, including things like not only healthy relationships, but how to regulate their emotions with breathing exercises and meditation skills and arts and creativity. Learning about the components of healthy relationships, how to practice them, how to prevent bullying, how to ask for help, about how to have safe dating relationships and identify relationships that aren't safe. Teaching them no later in high school, about things about what's a healthy attachment between a very young child and a parent and a caretaker. How do parents and caretakers build healthy brains? We need to teach people and prepare them before they have children about early childhood development and healthy attachment, about how important it is to provide them with good nutrition, prevent them from exposure to environmental toxins, protect them from trauma, and provide early good child education. That is long term Child Abuse Prevention. Also, taking excellent care of pregnant women from the time children are still in utero because the child's brain is developing especially in the third trimester and whatever negatively traumatizes a mom can impact child development. Those are some of the things we can do, while also educating people on the importance of supporting policies, such as political policies, governmental policies that support families and children, providing them with medical care, and trying to get rid of poverty and address all the problems that go along with poverty, to reduce the level of stresses in families. So parents can be the best potential parents they can be. Those are some of the things.

NR: Yeah, so that is the one thing you know, I like hearing. The bottom line is, if we want to prevent child abuse, we have to take care of children before they're even born. It's so good. So then you want to ask some tips.

NR: Wonderful, Steve. Wonderful, Suzanne. This is a really good show. I hope people are listening. I'm sure they will learn many things from this show. Listeners, every child deserves the security of a stable, loving, and nurturing home. We must work together each day in defense of the most vulnerable among us- Our children. We must make every effort to ensure that they are treated with dignity, love, respect, and have the opportunity to pursue their dreams in secure and healthy environments. So with this note, I'm concluding this episode hoping that we will be able to end child abuse from our society. Keep listening to our show: Between Friends- Conversation with Maitri. Find us on Apple podcasts, Spotify, Google, YouTube and SoundCloud. Stay safe, stay healthy. Thank you.