All right, um, welcome everybody. I am Wendy Ellmo, um, along with Paula Denslow, our program director, and.

Jennifer Rayman, who's working in the background. Today, as always, we welcome you here today.

We're happy you hear, as Jen just said, please go ahead and put your name, your title, your organization, and your email into the chat. That's how we.

Keep track of who is here. Um, and if you have anything at any point that you want to.

Put in the chat that relates to here, please feel free to do that.

Um, we love it when there's activity going on behind the scenes, too.

So, just a reminder of the agenda. I'll give a few housekeeping update kind of things, and then we'll get into our topic-specific talk about.

Child abuse and prevention. We've got 3 great speakers here today.

We'll then go to any questions you might have for them.

And then a discussion about, uh. The overlap in between child abuse and prevention and how that impacts with your.

System of support. If you're from that system, the Child Abuse system, um, please feel free to share with us, the rest of us.

What types of things you want us… um, doing, um, things that we can do to improve our systems.

To help you all out. And then we'll brainstorm, uh. Think about ways to make those systems changes.

And then sharing any news in your system of support, that'll be something that would relate to everybody, like a conference that might include everybody.

And then we'll close with a survey. Um, so the beef… the beef of it really is this purple part where we're hoping to have some discussion 

going on. You received the mental health resource pages? From Jennifer, they were sent on 7-15. If you haven't mailed them out, uh, sent them out to people, or.

Uh, she's included a little brief blurb in there that you can just put right into your newsletters.

Um, just please go ahead and do that. A lot of what we do is.

Kind of leverage the… the strength that we have here as a community to be pushing out these resources.

That are from all of our different systems, so please help us continue.

To do that. And there is a survey, I'm going to give you an opportunity to.

Do the survey here today at the end. But if not, uh, if you have to drop off early for any reason, please go back to that email from Jen.

And we can even send it again, just let us know, and take that quick survey.

This is different than the one that we usually do. Um, this one is kind of… we're wrapping up here. We have one more meeting after this.

We're sad to say, and this was just going to give us more information about how we've done, how you've used things.

We really want to know what kind of impact that this group has made.

You also got the child abuse… Brain Injury and Child Abuse Infographic.

In that email. Um, we think it's… actually, this one's coming up. This one will be coming up afterwards.

Um, this is now available. Um, we think it's adorable, and the only one that's not out now is the one on veterans, which is.

For our November meeting. Otherwise, the whole. Uh, the whole series is out there.

And you will be getting this one. Shortly after this meeting, a few days.

That'll come from Jen, with all of the resources. And I just wanted to remind you about this one. If you haven't sent this one out either. This is…

Kind of the culmination, also, of the work that we've been doing here for these last 3 years, and it… is an infographic on brain injury and all of the co-occurring conditions. So it has all of… you should find your area outside.

That, um, brain injury circle. And a little fact about how it relates to brain injury.

Then we go into, on the next page, brain injury by the numbers, and it's really about, um, 1 in 5 people.

Have, um, a brain injury in the population today in the United States.

Uh, we'd go through the connection to Anoxia. And how that relates here, and ACEs…

Um, how that relates as well. And then the next couple of pages just go in a little bit more into each of the areas, and their overlap with brain injury.

And then, if you see on the left-hand side, those three circles.

Those appear on every infographic, and that's really to be kind of bringing it home that.

With every system, what we need to be doing to be.

Integrating brain injury is the same. It's a very, very, very similar, so… Um, you can see it right there, and then some Tennessee.

Resources. Jen, was that you again? That wasn't you? Okay. That's fine.

Um, we've had stray squiggles before. Um, so…

Also, if you want to find all of the resources, you can go to the Tennessee Brighter Futures website.

Which is right there. Click on that little. Icon for a Tennessee Brighter Futures, where their yellow arrow is.

And you'll see the systems of support will come up. Click on the one that you want to learn more about. In this case, we're going to look at substance use.

And you'll see more, uh. You'll see the… that page will come up.

And on the right-hand side of that page, you'll see all of the downloadable things. So there are.

There's the recording, there's the PowerPoints, there are the resource pages, and there are the infographics there.

It's all there for you. There's a little thumbnail of the infographic, which is English… and Spanish. And…

The… we're really excited about the impact that we've all been making through this program.

We've… have, at this point, over 440,000. Uh, in some cases, it shares, in some cases, it's systems changes.

We know that it's over that, because sometimes we stumble on things.

Uh, so, um… we're sure there's some other things that we've stumbled… that we have not stumbled across that are out there, so thank you for all the sharing that you've been doing.

And all the… the… opportunities that you've taken to share, to…

Actually use some of the things that we're… we've been talking about.

And we hope that next time we meet in November, that will be over.

Half a million shares, and system changes. Um, so please, and share them, uh, in any way that you can think of, get these resources out.

Get these… if you're in the Child Abuse system, and you want those resource pages out, just.

Get them out to anybody who you would like to share them with afterwards.

And please let us know how many you've shared it with, but then even more, use the resources.

Tell us how you've used them. Did you begin screening in an area that you've never screened before?

Did you start incorporating somebody's handouts that you saw through this?

Did you add any information to trainings that are already existing? We've done all of these things.

Um, have you referred someone. To one of the TBF partners, because now you know who they are, and you could go directly to them.

And so let us know how you've done that. And thank you for doing that.

And we have, like I said, one more. Meeting. It's, uh, Veterans on November 6th.

That's our final one. We're also… please come, we're going to also do a bit of.

a summary of what has happened because of this program.

This collaborative. And just a quick, uh…

Kind of insight into, we're going to go right into the speakers from here. I just wanted to give you a little bit of information on how.

Brain injury relates here. So, 30 to 60% of perpetrators of domestic violence also abuse the children.

In the household, and that can happen through a number of different ways.

Um, punching, neglect, kicking, striking. Lots of different ways, and then abusive head trauma.

Is the leading cause of death from physical abuse under age 5.

And that accounts for one-third of all maltreatment deaths. And abusive head trauma includes shaken baby syndrome, where.

Um, it's… I'm not sure if anybody will talk about it today, but it's really a… Um, it's a… it's a terrible thing. The neurons…

The axons get stretched, and. There are shearing injuries, and the inside of the brain is not.

Smooth, so that the brain rubs against the inside of. The skull and creates a lot of damage, so it can really, really be.

Devastating. And with that, we will go to, um, our presenters.

So, this has been a great group to work with. Um, Chase Sanders, the Clinical Director, the Exchange Club for the Carl Perkins Center for the Prevention of Child Abuse.

Talor Thurneau? The Early Childhood Program Director of Tennessee Voices.

And David Imhof, the Assistant Commissioner of Regional Operations for the Department of Children's Services.

And we're real excited to have them today. Thank you for all that you have contributed to this, and without.

Further ado, I will stop sharing. And let Chase begin to share.

All right, um, as, uh, Wendy said, my name is Chase Sanders, and I'm the Clinical Director for the Carl Perkins Center for the Prevention of Child Abuse.

Uh, and we serve as the Child Advocacy Center for Rural West Tennessee, so that's every county between the Mississippi and Tennessee River.

With the exception of Shelby County. And we may talk a little bit about CACs, depending on time, as we move through our presentation today, but my responsibility is to just provide some general information about child abuse.

And so that's what we're going to try to do. Uh, so a couple of, kind of, housekeeping things as we work through this. You'll see some citations.

I do have a reference page in my PowerPoint that I think you have access to that.

Um, it may not be, uh, cited according to proper format, but it's enough to get you where you need to go. Outside of those specific citations, you're going to see NIH, which is the National Institute of Health, CDC, which is the Center for Disease Control.

And NCA, which is the National Children's Alliance, which is the accrediting body for child advocacy centers.

So, just wanted to let you know about that. Also, as we talk about statistics, obviously statistics are variable depending on what studies are, so if there's some.

Discrepancy from what you may have heard or seen elsewhere, just know that, you know, that's common with research, but also, especially with child abuse, there's some difficulties with studying child abuse.

Um, so we're gonna talk about abuse, uh, today, and, um, and a lot of what we'll talk about as far as some of the statistics and information is more on the sexual abuse side, um, largely because that tends to get studied more, but, uh, and is also.

Our perspective is what we see very, very frequently in our setting.

Um, but, uh, physical abuse, of course, and others are… we'll talk a little bit about those as well.

Uh, so the first thing we're gonna talk about, if I can… there we go. The first thing we're going to talk about is, uh, just defining child abuse. There are a million different ways that we could, uh, define child abuse.

I just chose to use the CDC definitions with a little bit of some, um, some editing to some things of how they.

Uh, they stated things. I think it is important for us to understand that child abuse, um.

You know, I think most of us would say, I know it when I see it, sort of that old saying, uh, it's hard to define.

Um, but it… it is something that… is, uh, really gotta be viewed through a… the legal lens of.

The jurisdiction where this behavior is occurring. Uh, as well as some cultural, uh, beliefs and things like that. So, what is considered to be child abuse today.

Um, in Tennessee, um, if you go back 100 years, most… there would probably be a very different definition of that.

Uh, we would consider things abusive that people might not have at that time. If you go to another part of the world, um, they may view something to be abusive that we don't, and vice versa. So we're going to be talking about this more from.

Um, you know, in a United States, current day, what are… we're… how are we defining these things? And there's still a lot of disagreement about that. Anytime you see child abuse discussed in the news, um, there's… I saw a story last week, and.

There was very divided opinions as a physical abuse case on social media about whether this was wrong or not wrong, and things like that. But… Uh, with that being said, uh, we're gonna use the definition of physical abuse as any, um.

Intentional use of physical force that can result in the injury of a child, so hitting, kicking, shaking, burning, choking.

Any number of things that would fall under that. One addition that I might add to this or change would be, um.

Physical abuse could be… the result of negligent behavior, um, rather than an intent, but usually we're going to focus more on an intentional act. Um, with sexual abuse, um.

We're going to define that as tempted or completed sexual acts or sexual exposure, other behavior.

With a child who does not or is unable to consent to that activity. So, generally, children are not going to be able to consent to sexual activity. Certainly, they're not going to be able to consent to sexual activity with adults.

Um, but that's the best way to look at that, um, because, um, you know, we could say forcible contact, but unfortunately.

Uh, due to grooming and other things, sometimes kids don't realize, um, that, you know, what is happening to them, the sexual abuse is wrong, and so that's where we really emphasize the ability to consent, as well as the.

You know, the legal ability for that. Um, emotional abuse, or sometimes we'll refer to that as psychological abuse, is any sort of behavior that harms a child's self-worth or their sense of well-being.

Um, and so that could be name-calling, shaming, rejecting, uh, one that we see a lot is threatening, uh, to.

Um, remove kids or threaten to send them away, and things of that nature. And then also, we have neglect, which is when a child's basic physical and emotional needs are not met by their caregiver.

That could be housing, food, clothing, education, medical care. Any number of things that might fall under that category. Whoops.

Are y'all still seeing the screen share? Okay. Okay, there. It just came back for me. Okay.

Yes.

So we're going to talk about some signs of these different types of abuse. I will say right off the bat, when you're… we're thinking about signs of abuse, um.

A lot of the time, abuse is not going to have any, um, glaring signs, um, that we may see. Now, with physical abuse and certain things, yes, there may be things that are very evident to the outside observer, uh, but that is not always gonna be the case, uh, especially with things like sexual abuse, or maybe the emotional abuse.

Um, and this is really unfortunate, because a lot of times, abuse victims do.

Believe that everybody can tell. Um, and so the child thinks that everyone knows what's happening to them, because they… they have this distortion that essentially there's a sign above their head that says, I need help.

Um, and that's not the case. So… We do need to, you know, not be, um…

So ignorant that we miss the glaring signs, but we also need to be aware of some of those… the more subtle things.

That we may pick up on, and especially if we start putting a number of things together. Uh, so with physical abuse, of course, as you might expect, we're looking for things like.

Frequent or unusual, unexplainable bruises, lacerations, fractures, burns, other physical injuries.

Um, and so. Kids get bruises and bumps and all sorts of things, so a kid having a bruise is not necessarily an immediate red flag, but if a child is getting bruises all the time.

It's, you know, they're not scrapes on their knee, they're… they're bruises and injuries that we don't see normally in kids.

Um, that's gonna be a concern for us. Another possible warning sign might be a child that is wearing clothing that is inappropriate for environmental conditions, so wearing a sweatshirts or.

During the middle of summer. Uh, and that may be an attempt to try to hide bruising or other injuries.

Um, social or emotional withdrawal, uh, sometimes we'll see the… the acting out of the things, the trauma and the abuse that's happening to them, so we may have a lot of.

Aggression. Um, we also may see kids that are just very easily startled, they have an exaggerated startle response. When people approach them, or if you, you know, as you're trying to help a child and you move toward them, and they jump back, or something like that, that could be a sign.

Um, and then also just inconsistent explanations for injuries or explanations that aren't consistent with the nature of the observed injury. So.

Uh, when I'm talking with teachers about this, I say, you know, if… If 3 different teachers ask a kid what happened, or where did this bruise come from, and the kid gives you 3 different answers, well, that's… that's probably a concern.

Um, or, you know, if they say they fell down the stairs, and yet you can very clearly see a handprint bruise, you know, somewhere on their body.

Obviously, we know that something else is going on there. As we move into sexual abuse, um, this is definitely one of the areas of abuse where we're not usually going to see any, um, readily observable external signs.

We're looking more for behavioral and emotional changes. Um, some of those might be sudden increase in interest about sex or sexual topics, kids displaying knowledge about sexual behavior that is, uh, is.

Abnormally advanced for the child's age or their developmental level, so it is normal for kids to have.

Some interest in sexual behaviors, to engage in some sexual behaviors, but there's kind of a charting of what is normal, what is to be expected at each age.

Um, and so when we see something that goes beyond that, that is a concern.

Uh, just to give an example of that, um, if we, you know, walked in and we saw a 6-year-old, and they had all the clothes off of their Barbie, and Barbie and Ken were.

Lying in bed. Um, that wouldn't inherently be concerning, because that's pretty typical behavior for that age. If we saw that kid using their Barbie and Ken to mimic.

Sexual acts, then that would be very concerning, and that gets to that point of play that imitates specific sexual acts.

Um, again, social-emotional withdrawal, uh, sudden onset of anxiety, depression, other sorts of mental health concerns.

Another thing to look for, and this gets into grooming that we'll talk about later, uh, kids having new possessions, uh, with no real explanation of how they received them. So that goes for.

You know, us as professionals, but also as parents. Um, phones, especially, are very valuable.

Tools in manipulating children into doing things, or keeping them quiet.

Uh, and then also sudden changes in hygiene, um, which could be over-cleaning, under-cleaning with sexual abuse.

With emotional abuse, uh, again, we're really looking for the behavioral and the, um.

Emotional signs, um, so lots of self-deprecating language, lots of shyness, bad, uh, poor self-esteem.

Inability to advocate for themselves, being very passive, these would all be things that.

That might be signs of emotional abuse. And then also, with neglect, um.

We might look for things like kids that are hungry all the time, kids that are, um, have poor hygiene, or they're, they're.

They have an unkept appearance. They're wearing the same clothes day after day. They have a lot of absences from school. They're sleeping all the time during school, they have food hoarding, or… seem to have food insecurity. Um, and then just overall delayed development. So their delayed development does not mean that a child, uh, has… is being neglected. There are many reasons that a child might have a developmental delay.

However, we know that neglect, uh, can contribute to, in an otherwise.

Healthy child, um, can inhibit development or even bring about developmental regression.

So, I wanted to share a few child abuse statistics, um, so the U.S. Government estimates that there were 550,000 unique instances of child abuse in 2022.

Uh, and child advocacy centers in the year 2024 served 300,000… 370,000.

Children. Um, 1 in 4 girls and 1 in 13 boys.

Will experience sexual abuse during their childhood, um, and the CDC said in 2021 there were 1,820 children who died from child abuse.

Uh, and that, uh, the annual mortality rate for child abuse, uh, runs around an average of 2 to 3 deaths per 100,000 children.

Well, that's not too bad, that's not too significant. Well, I think the average number of deaths in children per 100,000 each year is about.

25. So it is a pretty substantial number of. Those childhood deaths. Also know that child abuse victims.

Do often develop significant mental health concerns, and they are 4 times the rate… at 4 times the rate of the general population.

Also, we wanted to think about some of the impacts of child abuse. So obviously, child abuse impacts the child and the family.

Directly, but there are also some other impacts that reach all of us. There's an economic impact of child abuse. You see this study that estimated in 2018 that the overall cost of child abuse over the life of child abuse victims.

Per year is going to be about $592 million, or billion dollars, rather, in the United States.

Um, and then very pertinent to Tennessee, a couple of years ago.

Uh, UT Business School came out with. This study that found the economic impact of child abuse in Tennessee is around $3 billion every year, with a lifetime economic impact of $210,000 per substantiated child abuse victim.

There's lots of things that go into how do we calculate that cost, but that is a pretty staggering number. We also, of course, know most of you are familiar with the ACES study. We know that those.

Victims of child abuse are far more likely to develop substance use issues, chronic health concerns.

Poor mental health, their children are more likely to be abused, and even to experience an earlier death.

Than their peers. Uh, from the ACES study.

Um, I did want to talk a little bit about some myths that we might encounter when it comes to abuse and challenging some of those. One of them is with perpetrators.

So we spent a lot of time talking with our kids about stranger danger, but we know that 90% of child abuse victims are well known to.

Children and their families. Um, and so this is something that kids may not be told.

They're told about the strangers, but they may not be told about the dangers of people that they know. And that's unfortunate, because a lot of times, that is what the abuser is looking for the majority of the time. There's somebody that's known because they have greater access. Also, this is concerning because a lot of these are authority figures who, you know, whose motives are always assumed to be good, and.

Um, and so families may be more likely to doubt a disclosure of abuse by that person.

Also, I think it's important to note that about 40% of child sexual abuse is committed by minors, and that rate goes much higher the younger the child is, so under the age of 6, it is a substantial portion.

Um, and, um… And so we need to know that it's not just adults, it could be children as well.

Uh, and there's some information there about sibling sexual abuse that we won't get into specifically, but that is a significant concern.

So when we think about, um, sexual abuse specifically, uh, but could apply to any abuse, we talk about grooming, and grooming is kind of this buzzword, we… it's overused.

In our culture today, but it… the idea of grooming is very valid. And you can see the steps to grooming. This is the process by which a potential perpetrator is going to identify the victim, figure out how they can play a role in that victim's life to fill some needs, some inadequacy that they observe in that family.

Then they're gonna isolate the child, they're gonna create secrecy around that relationship, and then ultimately initiate sexual contact, and then maintain or control that relationship, either through threats or coercion, or gift-giving, bribing, things like that.

Uh, there are some factors that increase child abuse. Child abuse can happen to anybody, but any child, but there are.

Populations, they're at greater risk. Uh, girls, uh, are at twice the risk. Being in foster care increases risk by about 10%. Certain minority populations, uh, being low SES, uh, living in rural areas, having a disability, all of these are potential.

Um, they are factors that can potentially increase risk substantially. I think it's important for us to note that most child abuse victims will never disclose. A lot of them that do wait until their adulthood. We consider immediate disclosure to be within one month of the abuse happening.

Also know that many victims are going to tell multiple people before someone understands, believes them, or helps them.

And so, as a professional, if a child discloses to you, know that it is because there's something about you that that child sees that they can trust you.

Know that kids may not disclose. Or tell for a number of reasons. They may not realize what is happening is wrong. They may believe they're going to be in trouble, they may fear retaliation, um, they don't want to get their perpetrator in trouble, so there's a lot of dynamics there. A lot of times, that perpetrator, because of the grooming process, is…

The person that spends the most time with them and that they love, they truly love them, and so they don't want to get them in trouble.

They've told before, but they… they didn't get help. They fear the unknown about what's gonna happen if I do tell. How's our life gonna change? There's cultural beliefs that they may feel they can… will violate, and…

Um, and as I mentioned earlier, they… many of them believe that other people can already tell. Um, I do have some information in here about traumatic brain injuries and child abuse, so there is kind of a bi-directional relationship here off.

Um, obviously, um, child abuse can lead to traumatic brain injury. We talked about the shaken baby, um.

Syndrome, a little bit ago, but as far as perpetrators, we know that people who have experienced a traumatic brain injury may struggle with.

Uh, emotional regulation, they may have some more, uh, aggression. Um, and, um, and that may put them at a greater risk for perpetrating abuse. Most are not, but we… when you look at.

The people who do perpetrate and have aggressive criminal behaviors, TBI is a pretty common experience that they have.

And so that is a risk factor. And then also with child abuse victims themselves, obviously they can get… have those, uh, that abusive head trauma.

The very severe TBI that, you know, comes to the hospital, results in death, but also this study that I've referenced talks about.

Um, moderate, um, TBIs that may occur, um, and how they may present, and how they may be overlooked. So.

I'm out of time, but I'll encourage you to go back and read for that. One last thing I will say is that child advocacy centers are a great resource, and if you're in Tennessee, every, um, every judicial district.

Is served by Child Advocacy Center. We work with DCS law enforcement, district attorneys, all those people to try to coordinate a response to child abuse investigations, as well as the services that those families need.

Um, and, uh, you can find out more information about the CAC in your area and CACs across the state and the nation.

Uh, with the Children's Advocacy Centers of Tennessee, that's our state CAC organization, as well as the National Children's Alliance.

Uh, the National Children's Advocacy Center. So, appreciate the invitation to be here today, and look forward to hearing from everyone else.

Thank you, Chase. That was great. Um… And Taylor's getting ready.

To share…

Let me get this pulled up… And…

Alright, are you still able to see that, um, green slide as the first?

Looks good.

Yes. Looks good.

Perfect. Awesome. Um, well, thank you again for inviting me to be here today, um, and thank you to Chase for covering, um, such a.

Vivid description of exactly what we're looking at, and we're thinking about, um, and highlighting the serious nature and the long-term ramifications of child abuse, and, um.

I'm happy to share with you all the pyramid model, and considering the pyramid model as a framework for preventing, um, child abuse.

So, uh, the pyramid model offers practical and evidence-based tools, um, for preventing child abuse, and we're going to think about it through the lens of promoting social-emotional development, reducing caregiver stress.

And overall, creating supportive environments for children and families. And while we're going to talk, um, about preventing child abuse from a more, uh, broad and global perspective, I'd also love to highlight for you a few programs at Tennessee Voices.

That may be supportive for families or kiddos that you may be working with or encountering in your own practice.

So, um, why prevention matters? Child abuse is predominantly preventable, and the earlier that we are able to start, the more effective and better outcomes we can see.

And prevention isn't just about intervening once something has gone wrong, it's about being intentional and being proactive about creating environments and empowering caregivers.

Um, to… to build relationships and cultivate relationships that create abuse or situations where abuse is less likely to occur in the first place.

And the pyramid model, um, is a framework that offers us that practical guide to empower adults as they work.

Um, to build those responsive relationships, create high quality and supportive environments.

Um, that lay, ultimately, the foundation for social-emotional development of young children, which will then set the foundation for overall well-being.

Um, so I did have a little bit of information to share on brain development that really highlights the importance of those responsive relationships. So, when we're looking at the building blocks of what children need to thrive in their development, there's a lot of.

Foundational work of brain development that's happening in those earliest years of life. So 0 to 3 is a rapid time of growth and expansion.

Um, a child's life outcome is impacted far beyond, uh, just their genetic makeup and brain development happens through a series.

Of what scientists talk about, and we describe as serve-and-return interactions. It's a very interactive process that can be refined, it can be taught. We can support and empower caregivers to really understand the power and the beauty in relationships and identify when kiddos are expressing those serves, even if it's nonverbal communication.

Um, it could be nonverbal, it could be the slight look, um, at a preferred object.

Um, and we can support caregivers to understand, um, how to notice and respond effectively in ways that promote the healthy attachment of children to their caregivers.

Um, and support kiddos as they navigate the world and begin to feel confident in stepping outside that caregiving relationship.

To explore and then go back for a source of comfort. So, um, I do have just a brief video. It's about 2 minutes long. I will warn you, um, there are captions, but it does come through just a little bit quietly.

So I apologize for that in advance, but certainly a valuable example of the power of these responsive relationships, and really how simply we can capitalize on the serve and return interactions between.

Families, caregivers, and young children.

Children's brains are built from their earliest months. Back and forth interactions with parents, caregivers, and other important people in their lives.

Help them learn and grow. When a child talks or gurgles to an adult.

It's like they're serving in a game of tennis. When that adult talks, or gurgles in response.

They're returning that serve. By watching closely, we can pick up on what and when a child serves, and make a rally of these interactions.

And this repetition, back and forth, actively builds a child's brain.

Because every time a child uses their social, emotional, and language skills, they activate and strengthen.

Parts of the brain that underlie these skills. These form a sturdy foundation for future learning and growth, and healthy relationships with others.

Healthy development depends on the relationship a child has with important people in their life.

These and other trusting relationships are essential for a child to feel safe and begin to manage and regulate their emotions.

Serve and return interactions also help build other key skills, like turn-taking, as who's eating words and objects, and sharing attention.

These skills built from the age of 0 to 5 lay the foundations for more advanced skills in adolescence and non-adthood life.

Leading friendships, resolving conflict, and being motivated to learn. Serve and return is an active process. It's not the same thing as giving a child a book or letting them watch TV show, or…

Via mobile game on their own. Those caregivers and children must take part in this. Caregivers should be attention to the children's cues, like.

Pointing, looking and making noises, and… Actively respond to these clues.

Returning the serve with responsive words or gestures is positive feedback that means a child is more likely to reach out and serve to us again.

And this builds an even stronger foundation over time. Serve and return interaction.

Throughout a child's early years, helped build the foundation. Every child needs to thrive.

It's a hope that that video sound came through okay for you, um, and if not, I hope you were able to follow along with the captions, and.

I think it really highlights just the power of those responsive relationships, and helps us to understand and realize that responsive relationships build attachment and emotional safety, which can serve as a buffer against trauma.

Um, and potentially even buffer against child abuse, and children who feel seen and understood are significantly less likely to engage.

Um, in challenging behaviors, or behaviors that adults may find challenging. Um, and caregivers in these circumstances and situations, when they are engaged and responsive.

Um, relationships are less likely to escalate, um, during periods of stress.

And when we can support caregivers to experience this connection, even if it's nonverbal, with their kiddos, they're more likely to respond with empathy as opposed to frustration in those challenging moments that we all experience as.

Parents and caregivers supporting young children. I did want to, uh, provide a couple of, um, specific considerations for kiddos who may have experienced traumatic brain injury as we are engaging in serve and return interactions.

It's important for us to really slow down, um, and tune in, and remember that even a small glance or a sound can be a child's attempt to serve to us.

Um, and that's so important for us to return that serve so that we can build that pathway and continue to nurture and foster.

The developing relationship, um, as caregivers, parents, and families, it's important to be sure that they have a significant support system that allows them to maintain.

Um, a regulated sense of calm, uh, regulate their presence with calm, um, as they are working with, with young children.

Children's…

Alright, so now we'll actually dive into the pyramid model framework, and that's a tiered approach that promotes positive outcomes for young children by focusing on social-emotional development, family engagement.

Responsive environments, and you'll notice that, um, it's a tiered structure. So, much of that rests upon an effective workforce. So that means that families, professionals, and educators have access to the most updated information related to early childhood development.

Social-emotional development, um, and that they have access to a network of coaching that can help them to put those strategies and techniques into practical use.

Um, it also includes, um, universal supports, which you'll see identified in the blue section.

Which is comprised of nurturing and responsive relationships alongside high-quality and supportive environments.

The green tier focuses on the explicit and targeted teaching of social-emotional skills.

Um, and then up at the top of the pyramid is intense intervention. So, for the purposes of today's presentation and discussion.

We'll be focused primarily on those, um, first two tiers, the blue and the green sections.

But it is important to note that research tells us that when all other tiers of the pyramid model are working together and in conjunction.

Um, as it relates to kiddos, acquisition of social-emotional skills, only about 3-5% of children will need those more, um, intense interventions. So, we'll focus today on the general universal supports, and how we might make modifications.

Um, to provide targeted instruction and supports for populations and kiddos who may need just a little bit more.

Um, overall, the pyramid model is really widely used in early childhood settings to build children's social-emotional skills and mitigate those challenging behaviors.

And a lot of the strength lies in this multi-tiered approach that considers supporting all children while also providing individualized support and instruction.

To specific families or kiddos who may need that additional help.

And it's important for us to think of pyramid Model as a public health model.

Um, and at the base, we are continuing to offer, uh.

Access to universal supports, and as needs become more complex, we're able to be flexible, individualize, and customize as we work to meet, um.

Those targeted needs that may exist. So we'll dig into universal support. So we're looking specifically at that blue tier, which focuses on the foundations, and really those things that benefit every child and family.

These practices can work together to reduce risk across the board, and help us as professionals to support families as they work to build.

Um, protective and stable environments. As kiddos learn to express their emotions and needs safely.

And they are less likely to, um, experience or exhibit behavioral challenges that can increase caregiver frustration. So, um, as kiddos are also building these social-emotional skills, it can build trusting adult-child relationships, as we talked about before, um, the critical importance of serve and return and laying the foundation for those responsive relationships.

But overall, when children have access, um, to supports to help them as they are building their social-emotional skills and capacity.

And they're less likely to be misunderstood or potentially mistreated, and caregivers are also less stressed when kiddos are able to effectively communicate their needs.

And regulate their behaviors in ways that are developmentally appropriate and make sense. So when children understand what's making them feel, um, frustrated when.

Um, they don't necessarily need to use challenging behaviors to access the supports, and they need, uh, the supports in their needs in the environment. It helps to.

Reduce, um, caregiver stress. So we can think of social-emotional competence of young children as an element of protection against potential abuse.

Next, we're going to move into the targeted teaching of social-emotional skills. So.

Um, kiddos who have experienced brain injury may have impaired emotion regulation or difficulty with impulse control or social skills. So that's where the targeted teaching of social-emotional skills is critical and comes into play.

Um, a resource that I would love to point out, um, to you all, um, as you have kiddos that you may be working with that have experienced, um, have experienced brain injury, or may need some additional targeted support, is the National Center for Pyramid Model Innovations.

Um, that website is a wealth of information that has a variety of visuals.

Um, pre-made scripted stories that provide explicit instruction, um, on specific skills and social situations. So, um, there are actually scripted stories that teach kiddos.

How to calm down, what it looks like to regulate, what it looks like to problem solve.

Um, first, then, boards are also visuals that help children to really understand.

Um, and begin to get the concept of routines and consistency. So, um, visuals, modeling, and repetition are important when we are explicitly teaching social-emotional skills.

It's also important to think about the times when which we are teaching these skills. If a child is really upset or elevated, they may not be the time to teach, but the time to comfort and to co-regulate.

Um, it's important for us to think about calm settings, uh, when we are teaching new skills.

And it's also important to recognize that certain skills may take a little bit longer to develop.

Um, or during periods of stress, we may notice some regression, but going back to the consistency, the repetition.

Um, and having examples with models, um, and visuals can be extremely supportive as we are working to intentionally teach specific skills.

When caregivers are overwhelmed, their ability to parent can become compromised, and as we've discussed and identified, the pyramid model helps to build in supports that can reduce stress and strengthen relationships, which ultimately helps families.

To respond with care rather than conflict in those challenging moments.

And as professionals, it's important for us to keep in mind that referring families to programs and services that are designed to reduce stress and build capacity is absolutely critical in the overall reduction.

Um, and prevention of child abuse. So, when we think about it, um, the biggest piece on this slide that I'd love to point out for you is less stress equals more nurturing responses. So, um, we see that we can provide the support, we can provide community, we can connect and refer families to appropriate services and community providers.

That can give them that, uh, give them those skills to, um, manage their own feelings in moments of stress so that they can respond, um, with that care and continue to enhance the nurturing and responsive relationships, uh, with children.

So, a few key reminders, um, as we think about, uh, global opportunities to prevent child abuse, um.

Is really knowing that prevention can happen in every interaction, and that each of us have a role in preventing child abuse, whether we're working directly with kiddos, um, or if we are supporting their caregivers or families more broadly.

And I'll move quickly through this, um, for the sake of time, but I did want to highlight, um, a couple of prevention programs and resources that, um, are available and do offer capacity-building opportunities for.

Caregivers and professionals supporting young children that are grounded in the Pyramid model framework. So.

Um, I recognize that I was very excited to begin the presentation, and I don't know that I took a moment to really introduce myself, but my name is Taylor Thurneau, and I have the privilege of serving as the Ready, Set, Grow program director at Tennessee Voices.

Um, we are a mental health nonprofit providing an array of services from.

From birth, um, actually now prenatally through the entire lifespan, um, and I'm privileged to represent just a small section of that wonderful work that's being done at Tennessee Voices.

And again, in the Ready, Set, Grow program, our specific focus is to partner with the adults in a child's life.

To promote the development and well-being of young children ages 0 to 8, and we envision all of our youngest Tennesseans having access to an array of mental health consultation services.

That are anchored in that pyramid model framework that we described.

So as we think about, um, infant and early childhood mental health consultation, that can sound like word salad.

Um, but what's important to point out about this is that mental health consultation isn't about fixing kids, and it's not therapy. It's thinking about how we leverage.

Relationships, and how we can support and empower the adults that have significant influence on children.

Um, to build up their capacity to support young children as they are navigating, developing these really critical skills.

um, like, self-regulation, friendship skills, forming and maintaining positive attachment. We know that these are skills that are critical to not only future success in school.

Um, but lay the foundation for positive relationships all the way through, um, their lives.

To the next. Um, I won't go into detail on all of the services that are available.

Under our umbrella of, um, of programming at Ready, Set, Grow, but I will highlight a couple of supports.

Um, that are specific to individual children and families. So, we'll talk a little bit about our child-centered consultations, as well as our family support services.

Child-centered consultations are available across all 95 counties, um, in Tennessee.

Um, of important, uh, important to note is that our program is fully funded through a grant with the Tennessee Department of Mental Health and Substance Abuse Services.

Which means that all of our services are available at no charge, so we're able to support families, educators, and professionals.

Um, free of charge. Um, furthermore, there is no diagnostic requirement, so.

Um, while having a diagnosis of ADHD or autism, for example, um, is not required, it also would not negate kiddos from services. So we're able to support anyone.

Um, with our child-centered consultations, as long as they live in Tennessee, and they are between the ages of 0 and 8.

Um, child-centered consultations focus on the unique social-emotional needs of an individual kiddo within a school-based setting, so we can work in preschools, daycares, Head Starts, or.

Elementary settings, and work to develop, um, along with the educator and family, a comprehensive behavior support plan, um, that helps to mitigate any specific child… Any specific challenges exhibited by a certain child, um, and also supports in.

Identifying critical social-emotional skills that we can strengthen those pathways as well.

Uh, we really work in this process to individualize, customize, and support the acquisition of those social-emotional skills. So, while Children 0 to 8 are the direct beneficiary of services, we are working most closely, uh, with the educator in that class.

Classroom. Uh, the next piece that I'll highlight, um, focuses on our family training. So, um, we offer, uh, trainings that can support family from a trauma-informed lens, um, and help to give them anticipatory guidance on what to expect, uh, in children's development and challenging behavior. One of the series that I'll point out is our Positive Solutions for Families, and what's wonderful about this.

Um, is that not only are they learning practical skills and techniques for, um, supporting their children's development.

Um, but it's done in a cohort group. Um, so they have the ability and opportunity to build community and connection with other parents and caregivers, which can help to decrease overall stress.

And help to feel like they have a community behind them, um, as they're navigating some of the challenges and difficulties associated with parenting.

Um, finally, the last, uh, service that I'll highlight is our Family Support Services, uh, which is delivered by Certified Family Support Specialists who have lived experience in navigating child-serving systems.

And can really provide a wraparound service and support, um, to walk alongside families on their journey, um, as they work at home to promote those positive, uh, behaviors.

And teach kiddos the skills that they need for optimal development and school readiness.

A couple of, uh, quick data points, um, is 64% of caregivers who begin at.

Services with us report feeling stress almost always, um, compared to only 9% that report the same at the conclusion of services. So, we've been able to identify that family coaching significantly reduces caregiver stress, which can be associated with a protective.

Um, a protective component to prevent child abuse. We also noticed, um, that.

Self-regulation was the most significantly impacted skill through the provision of services, and more of our recent data coming out.

Um, has identified that kiddos who complete and participate in our programming have demonstrated an 83%, um.

Growth in a social-emotional domain. So, that is fantastic, um, to see.

That kiddos are able to, um, build that social-emotional capacity by having, um, and maintaining positive and nurturing relationships with adults that are getting support that they need to not feel alone.

Um, and to feel like they have somebody to bounce ideas off of and navigate situations that can feel puzzling or tricky.

Um, and I won't, uh, go too far into this, just for the sake of time, um, but you will have access, it sounds, to, um, the rest of the PowerPoint.

Um, and then finally, um, if you are interested in connecting or learning more about specific programming at Tennessee Voices or within the Ready, Set, Grow program.

I'd be happy to chat further, um, but really, as we think about, um, the pyramid model, it serves as a wonderful, um.

Pillar of protection, as we can support kiddos' social-emotional competence, and we can support to reduce caregiver stress overall.

So I will stop sharing and turn it back over to Wendy.

Taylor, thank you so much. That was great. Um, and we heard your… your audio.

On the video just fine. Something changed since practice time.

Um, so thank you so much. And David, if you're… ready, um, you want us to share for you, right?

Yeah, if you don't mind.

Okay, so I believe that's Paula. We lost Jen temporarily for a power outage in Knoxville.

I'm… Yes.

Just when you think you have it all… all ready to go, you don't, yeah.

But I think Paul's…

I can come while you get it up, Paula. I'm still here, y'all, but we're having some… strange power outages and internet outages, I don't want to…

Jinx, anything. Right.

I don't want to have something up the minute disappear.

Just bear with me one moment as I share my screen.

There you go.

Let's see if this goes along with us.

Maybe.

My screen is paused. Hmm.

Let's see if this'll work yet.

Um, sorry, hang on half a minute.

I don't… hey, Paula, I didn't see that you could do it from the top.

Options, but it looked like on your very bottom. Little icons, you could do presentation mode from there.

Mm-hmm.

If that helps.

Yes, that's where I… Thank you, it does, but that's where I… selected it, and it didn't wanna…

It wasn't agreeing with me.

Yeah. Yeah. No rush.

We were having issues earlier.

I had 3 steps when I did it. I did the share, and then I had to do the swap.

Thanks, everyone.

Yes, I'm in the middle of the swap. I'm not sure how far you're going with me, but…

Okay.

Bear with me, we're on tour.

There we go.

Yes. Yes. Excellent.

Nope. Is it correct, even?

There it is. Touch nothing.

Yeah, we're looking good. I appreciate the help. Thank you.

Yes. It looks great.

Good.

Wow. Man, thank you all. You just tell me when to go… oh, go ahead, go ahead, I'll hush.

All right, so real quick… I'll tell you. So, real quick, my name's David Emhoff, I'm Assistant Commissioner with the Department of Children's Services. I'm based out of Nashville.

Um… I've been here about 2 years. Prior to that, I was with the Metro Nashville Police Department for 30 years.

And I retired from there, and one of the roles that I played when I was with the Metro Nashville Police Department, I was a detective in the Youth Services Division, which investigated.

Child sexual abuse as well as child physical abuse. So, and then actually my first job out of college was a CPS caseworker in Indiana, so I've been around.

This work for quite some time. Uh, but I appreciate the opportunity to be here today to talk a little bit about the department and what happens when somebody calls in a referral to us, and how the hotline works.

And how we get, uh, resources out to the community. So, you can go to the next slide.

All right, so how do you… how do you report child abuse or neglect in Tennessee? Well, we have a Tennessee child abuse hotline.

And it takes in all the referrals for child abuse throughout the entire state.

It's Open365 days a year, 24 hours a day, 7 days a week.

You can see the phone number and the, uh, the website, so if you're… If you want to get on the website and just type in the referral to us, and it can be for anything. You can type in, uh, if you think it's an abuse case and a collect case, a sex abuse case.

People just need resources. We'll try to get you, uh, geared to the right place to get what you need, and to make sure… number one thing.

Is to make sure our kids are safe in the state.

Our mission at the department is act in the best interest.

Of Tennessee's youth and children, and our vision is just, uh, children first.

So, what this slide's telling us is. Who has to report child abuse?

And I can read this whole thing, but I'll just say, everybody.

Everybody is a mandated reporter. And they are mandated by state statute.

To call in or report any child being abused or neglected.

And it needs to be immediate, and it's either to the Department of Children's Services or any to local law enforcement. Now, one thing folks need to remember.

Is that you can be anonymous when you do this. You do not have to give your name, and even when you do the web referral.

You can put in anonymous and not put any of your information. And we protect that. All that information is confidential, so if someone calls us with a report of abuse or neglect.

We go out and investigate that. The local law enforcement will go out and investigate that.

But we are mandated by law that we can't tell the people that we're investigating who called us.

So I think it's important to understand that. You can go to the next slide.

So what happens if you don't report it? Well, like I said, this is mandated by Tennessee state statute.

And if you fail to report, it's a Class A misdemeanor. And what does that mean? That means you can go to jail for up to 3 months.

You can get a fine, or you can get both. Now, again, everybody's a mandated reporter. That includes me, that includes…

The governor. That includes the chief of police. No one is immune from having to report. And those that do report, as long as you do it in good faith.

You're immune from any civil or criminal charges that could result.

And like I said before, the reporter has the right to remain confidential and anonymous. What we want to do is we want to create a system.

That makes it very easy for folks to call us, because ultimately, we want to make sure kids are safe.

And the only way to make sure kids are safe is if people can report it easily.

So, either through phone, through the website. Uh, contact local law enforcement. As long as we get the word out there that we can look into these reports and make sure our kid's safe.

All right, next slide. So what happens when people call into the hotline or make a web-based referral?

Well, we have folks that work at the hotline, like we said.

365 days, every day of the… every day of the year, 24-7.

And they're trained in… screening these cases and finding out where we need to navigate these cases, or where we need to, uh.

Where we need to send the cases to. So… What happens when they use their screening tool.

One, they have to figure out what type of referral it's gonna be.

And for us, it's either an investigative case, an assessment case, and there's other type of referrals as well.

So, what does that mean, though? So. It can go to where I work. I work in regional operations. I'm over 30 counties, and within those 30 counties, I'm over all child abuse.

CPS, Child Abuse Services. Um, or Child Protective Services, as well as child programs, which is foster care.

And juvenile justice. And juvenile justice is all the kids that have been adjudicated of committing some type of criminal offense.

In the state, so that's what's in our regional operations. So, if we decide that it needs to go to regional operations.

Uh, for Child Protective Services, it can go there. We also have units within the department that are more centralized. We have drug teams.

We have the human trafficking team. And coming up at the end of this month.

We're gonna have a team that goes out and works nothing but any… all child deaths.

So, when you call in a referral, no matter what type of case it is.

Those people that are taking those calls and reading those referrals.

Are… have a screening tool in which they can figure out what unit does this need to go to, and what type of case does it need to be.

And lastly, what type of response do we need to have?

So, currently, with the department, we have 3 types of responses.

It's a priority one, a Priority 2, or a Priority 3 response.

A priority one response currently means we have to get out there within 24 hours, unless the referrant says.

I need immediate. Immediate… to come out immediately to this case.

Uh, that could be a hospital, that could be an emergency room, that could be the police department that we say we need an immediate response.

To this. Uh, a priority 2 means we have 2 business days, and a priority 3 means we have 3 business days to make that response.

An example of a Priority 3 would be a 17-year-old with educational neglects.

Um, so, what you're seeing on your screen is the type of referrals. Like we said, investigative cases, assessment cases, and other referrals.

Go to the next slide, we'll talk about what an investigative case is.

So, an investigative case, these are types of cases that are a little bit more severe.

Uh, we go out to determine if the child abuse, actually, and neglect actually occurred, and if the child's unsafe.

And these are cases that are… a high risk of severity, a high risk of, uh, just high-risk cases.

These are cases involving severe physical abuse. Uh, these are cases all sex abuse cases, and Chase did a really good job of defining all those different types of sex abuse. So any sex abuse case.

Is considered an investigative case, is considered severe abuse. Other types of severe abuse, broken bones, uh, lacerations.

Uh, anything that would be considered a severe case. And… With these cases, we have to investigate these cases and close these cases within 60 days, and we have to classify these cases within 30 days. And you might be asking yourself, what does it mean to classify a case?

Well, that means, do we substantiate the, uh… substantiate the allegation?

Do we substantiate the perpetrator? Do we unsubstantiate it? We also have the means to say we substantiate the abuse, but we don't know who the perpetrator is.

An example of that would be someone, let's say, a teenager says, hey, when I was 6 years old, and I was at the park.

I was sexually assaulted, but I don't know who it was.

In that case could end up being substantiated as to the abuse.

But because of the length of time and the lack of evidence in the case, we might not be able to identify who the perpetrator is.

So, no matter what the classification may be, we are, by state statute.

Half to classify that case within 30 days. So a lot of these timelines that you look at that we have to abide by.

Could be either through state statute, or through the Council of Accreditation, which is the organization that we get our accreditation from.

So, again, these investigative cases, these are our most severe cases. Uh, these are the cases that we work in conjunction most of the time with the police department.

Uh, if a case is considered severe, it has to go to the Child Protection Investigative Team, or what we call CPIT.

Prior to it being closed, and for those who don't know what CPIT is, the next slide, we'll go through that.

So, child protection investigative team, this is something that's mandated through state statute.

So, and this has been around for quite some time, I believe, since the 80s.

Uh, and to tell you anything, when I worked in Indiana, we did not have.

A child protective investigative team. We did not have… I didn't… I never worked with a detective, I never worked with any police department.

Uh, when I work these types of cases. So when I came here as a police officer and ended up working these cases as a detective, it was really beneficial.

To have this tool, to have this child protection investigative team, because there's a lot of… There's a lot of benefits to it.

Uh… So, first of all, the department, when we get a case of severe abuse.

We have to convene the CPIT team. Which means we all have to get together and talk about the case and figure out what's our strategy, what's our plan for going out and investigate this case.

In a collaborative manner. And then once we get done investigating it, we come back together, and we discuss how we want to classify this case, we discuss what the progress of the case is, and we also discuss whether this case needs to be prosecuted or not.

So, as you can see on that last bullet point. The people that are involved in the CPIT team is Department of Children's Services, there's law enforcement, District Attorney's Office, Juvenile court.

Child Advocacy Center, mental health representative, a medical representative. So, these are all the folks to get together, and we discuss.

How we're doing on this case, what other evidence do we need to collect, what other information do we need to have, in order to come to an agreement of what the classification should be.

And or if there's going to be any prosecution going forward.

But that's so important for so many different reasons. One, we don't have people running in different.

Different directions, repeating the same type of work. And I think what's the most important, and one of the reasons that the Child Protection Investigative Team even came about in the first place, is because our victims.

We're having to get interviewed multiple times about the exact same thing.

You know, DCS may go out and interview the child, the law enforcement goes out and interview the child, then the case is going to get prosecuted, and the district attorney goes out and interviews the child.

Uh, possibly there's going to be some type of interview at the Child Advocacy Center. So.

What the child protection investigative team does is limit the amount of times the child has to disclose the abuse because of the trauma that's associated with that.

And also, there's the issue of, like, if you talk to a kid multiple times.

Their story could change a little bit because of their age and maybe the length of time since the abuse happened.

So, right now, what we do is we… make a referral to the Child Advocacy Center, and we try to get a forensic interview in which we could all go and observe it from an observation room.

And so that child only has to be interviewed one time to reduce the amount of trauma and have one statement on file.

So that's… in a sense, we could talk an hour just on the CPIT team and all the different, uh, all the different mechanisms and levers that goes along with that.

In all the roles and responsibilities of each member of that team, but our time is a little bit limited. So, next slide.

So, assessment cases. This is the type of referral we might get.

These are less severe types of cases. We're going to evaluate the child and the family's needs and risk.

Uh, when abuse and neglect allegations are less severe. And what the main thing on this is we want to put services in place, we want to investigate it.

But we want to make sure, what does this family need?

What can we do to assist the family? Uh, types of cases we get are educational neglect, uh, environmental neglect.

Dirty houses, uh, maybe they're just missing… maybe there's just some resources they need, maybe there's some therapy that's needed in this house.

Uh, these cases, again, just like before, have to be classified within 30 days, but the case must be completed and closed within 90 days.

So a lot of people are thinking, your investigative cases, those are more severe, and you only have 60 days to close these.

These aren't nearly as severe. Uh, why do you have more time to close those? Why do you have 90 days to close those, as opposed to the investigative cases? And the answer is because we want to spend time with these cases.

Because we want to do more evaluation of what services are needed for this family.

How do we get those services included in the family? Because what we're trying to do is keep these at-risk families from having to come into custody.

Um, we're trying to make sure that if it's homemaker services, if it's therapy services.

Whatever needs this family get, and there might be services just like they need bedding, they need food, they need different types of things that they just don't have access to. What can we do to solidify that family?

And make sure that we limit the risk of them having to come into custody in the future.

Um, again, these aren't considered severe cases, and these cases would not have to go in front of the Child Protection Investigative Team.

Next slide, please. So, other types of referrals.

Uh, the majority of referrals we get, we would slide under the other types of referrals category.

This could be resource linkage. Special Investigations Unit cases.

Duplicate cases, investigative orders, and out-of-state. Courtesy request. Now, let me explain a little bit about what those mean.

A resource linkage case. Could be… it doesn't rise to the level of an assessment case, it doesn't rise to the level of an investigative case.

It might just be someone calling in to say, hey, this family needs bedding.

Hey, this family is going through a hard time right now, they need therapy.

This family just needs some food. So, we would send that to our resource linkage unit.

Uh, in each region of the state has different, uh. Case managers who work in the Resource Linkage Unit.

That they may make contact with that family and get them the needs that they have to have.

If it's bedding, or whatever, whatever they need. We try to get it for them, right? And we also have a program throughout the state called the Care Portal, which we can make referrals in our faith-based organizations.

Can get us resources for the families that are in need, too. But it's a fantastic… a lot of people don't realize that we have a resource linkage.

That they think the only time they should call in is if there's abuse or neglect. But if there's just things the family need, and again, if it doesn't rise to the level.

Of a CPS investigation or severe abuse, or even an assessment case, we can still get that family what they need through this resource linkage.

Uh, the second bullet point was a special investigation. Unit cases. We call it SIU, and basically what they work.

Is they're going to work any cases involving abuse, neglect allegations within a foster home?

Abuse allegations involved with some type of institution, such as a school.

A church, the Boy Scouts. It could be involving DCS employees.

They would go out and they would work those types of investigations.

We get duplicate referrals, we might get 5 referrals about the exact same incident.

So those would be considered others, and those would get screened out, basically.

Investigative orders, uh, those are when people come to court. And file a petition, and the judge may read the petition, decide.

I'm gonna make an order for DCS to get this to… and to investigate this, and I'm going to give DCS.

X amount of days, typically about a month. To get this investigation over and come back to court and let me know what they find.

And they will call those in through the… through the hotline as well.

And so, we'll get investigative orders issued through juvenile court. Then out-of-state courtesy requests could be… you know, Alabama has a family that they had a case on, and they realized the family moved to Tennessee.

And they're sending us a referral to say, can you all go out and check on this family, because we have a case on them.

Or, hey, there's someone involved in our case. And they have moved to Tennessee, or they live in Tennessee. Can you all go out and please do a courtesy interview with them?

And respond back with what your findings are. So those are the different types of referrals we may get that's outside of the investigative or the assessment cases.

And… go on to the next slide. So, to give you an idea of how many referrals we get a year.

Over 151,000 referrals we get a year. Now, of those. The investigative or those severe cases that we worked in conjunction with law enforcement and the district attorney's office through the Child Protection Investigative Team.

That's about 16,127. Referrals each year.

Um, and assessment cases, just shy of 43,000 in 2025. Now, there's other referrals, which seems like a lot.

Uh, about 92,489 referrals that we're getting. And again, that could be duplicates.

Out-of-state referrals, um, things that are screened out, resource linkage, SIU.

Um, so that's… that's the amount of referrals we get, and that's a lot of information in a short amount of time.

Um, but the main thing I want people to take away from this is, one.

When you have any suspicions of any abuse or any neglect.

And you're going, well, should I call? Shouldn't I call, call?

Call us, call law enforcement, but call. You're protected under the law, you can do it anonymously.

And if it's just that you think a family needs some help.

Call. We're not here to be punitive, we're here to try to find out what are the needs of our kids and our community.

How can we get them the help that they need? How can we make them safe?

That's the number one priority. Again, our mission is to act in the best interest of Tennessee's youth, children, and youth.

And that's what we want to do, and our vision is children… children first.

Uh, so we just want to work in the best interest of the kids. We want to make sure kids are safe. We want to try to unify families and make sure families are stronger.

Uh, we think it's always best when kids can stay with their families when it's safe.

Um, you know, really, we work through an idea of prevention to permanency.

We want to make sure that, you know, we're preventing kids from having to come into custody.

That's what our investigations… what we're trying to… that's what we're trying to find out, if there's any abuse or neglect, and what can we do.

And what's most important is finding out what families need before we get to that point.

What are the community-based resources out there? What are referrals that we can make out to the community?

To make sure that we're giving families what they need, so they don't get to the level where they need to come into custody.

And once if, unfortunately, they have to come into custody, what can we do to give that child permanency?

And permanency could be a lot of different things. It could be… It could be reunification with their family, it could be adoption.

It could be independent living, uh, it can be a variety of things, but our job is, if they come into custody, we give them that sense of permanency, we give them that light at the end of the tunnel.

So, that's all I have. I appreciate it, and open to any questions.

Thank y'all for the opportunity.

That was awesome, thank you. Um.

I'm gonna real quick… share and just go over some… brain injury information. I feel like that was such a nice, um.

With all three of the speakers. Um.

Covering everything from what… what do we… looking out for to how to prevent it.

To how to report, what does that process look like? Um, I'm getting no response.

From my share button. Then, let's see, let's make sure that…

I'm listed as a… I was a co-host, so there should be no issue.

I stopped sharing mine, so we should be good there.

All right. Okay, maybe that'll help.

I'm gonna click Make host.

I blame it on the weather. It messed up everything.

Yeah.

Okay. Let's see if that worked. Did it fix it?

Yeah. Wow. No. Nothing… it is not responding at all.

If you… if you want to send it to me by email real quick, maybe I can pull it up.

Um… So, let me…

Or maybe Paula, either one of us?

Is it in the S drive?

I… not the one that was from today, this morning updated.

Um. Let me… Go ahead, what were you gonna say?

Do you want us to… do you want us to say or do anything for a minute while you focus on being able to send that?

Let me… let me see… Let me just… let me just, um, continue. So, I wanted to just share some, um, brain injury information.

So, right before the speakers talked, I talked about 30-60% of perpetrators of domestic violence.

Also, abusing children, and I talked about abusive head trauma. As, um, a leading cause of death from physical abuse under 5.

Um, what I didn't talk about, though, was that. Um, we, uh, I am the… a co-leader of a national group.

That puts together a guide on brain injury in the child welfare system, and working with the child welfare.

Uh, to become brain injury informed, to screen. Um, and so I just want to talk a little bit about brain injury and child welfare.

Um, we need to consider that the child. Or the parent, or both may have had a brain injury.

In the past, and so all. We recommend that all children, all parents that are going through.

Any part of the child welfare system be screened for a prior history.

Of brain injury, because parents with brain injury. May have cognitive changes that make parenting difficult. They can't maybe follow rules, they can't remember appointments that you're asking them.

To attend, and it might look like they don't care when that has nothing to do with it. They might have lower frustration tolerance, be quicker to anger.

Have increased impulsivity, poorer judgment. Um, children with brain injury might find it harder to conform.

And adapt to new placements that they might be put in.

They're also at increased risk of mental health issues. An academic struggles.

Um, social challenges, substance use. And involvement with the justice system, and David mentioned the juvenile justice system.

So up to 67% of children, of youth within the juvenile justice system.

Have a prior history of brain injury. Um, so again, really important to be looking at what's happening with these.

Parents and these children, these teens. And be getting them the, um, the education that they need.

Getting staff the education they need about brain injury, and getting, um… Um.

Supports in there as well, in the form of accommodations. Um, and… Uh, then also referrals out into the community.

Um, so it's a… brain injury is just a much bigger problem than most realize, and we… there is a… Brain Injury and Child Welfare Best Practice Guide.

That, um, is a part of. The, um, PowerPoint that we can make sure gets.

Out to you all. Um, and then I did want to… I can copy this and put it in the chat.

There is a survey that we normally share with everybody for.

A certificate. For, uh, being here.

I want to share that in the last few minutes we have here in the chat. Pause here to see the Certificate Survey link: https://form.jotform.com/222828486483064