Episode 324: Recast: Rebecca Moles: Preventing Abuse and Neglect With AAC

This week, we present a Recast of Chris’s interview with Dr. Rebecca Moles! Recast episodes are previous episodes from the early days of TWT that Chris and Rachel want to highlight! In this Recast, Dr. Moles shares the importance of communication and AAC in preventing child abuse, the categorization of abuse types, the need for educators to equip children with the language necessary for self-advocacy, and more!

Before the interview, Chris, Rachel, and former host Lucas Stuber share some of their experiences with abuse and neglect, and highlight some of the strategies they have used to give children access to the language they need to report abuse and neglect.

Key Ideas this Episode:

🔑 There are several ways to identify signs of physical abuse, including the presence of bruises in unusual places on a child's body or bruises that resemble objects. Dr. Moles also discusses how the age and mobility of the child can help distinguish between normal childhood bruises and bruises that might indicate abuse.

🔑 Dr. Moles explains the concept of mandated reporting, which requires professionals working with children (such as teachers, medical providers, and coaches) to report any suspicions of child abuse or neglect to state agencies. She stresses that mandated reporters do not need to be certain of the abuse, they only to have a reasonable concern.

🔑 It is important that children be able to communicate effectively about abuse, especially children with complex communication needs who use AAC devices. Rebecca emphasizes the need for AAC users to have access to words for all body parts, feelings, and basic actions to support the accurate reporting of abuse and neglect.

Links:

Crimes Against Persons with Disabilities Report: bit.ly/abusestatistics2014

Transcript of the Episode

Please Note: This transcript was generated using speech recognition & AI tools; it may contain some grammatical and/or spelling errors.

00:00:08 Lucas Stuber
Welcome back once again to Talking with Tech. My name is Luke Stuber. Joined today by Rachel Madel. How are you?

00:00:14 Rachel Madel
I'm doing well. How are you doing, Lucas?

00:00:16 Lucas Stuber
I am a fantastic, even more so because I'm also joined by Chris Bugaj. How are you?

00:00:21 Chris Bugaj
I'm great. I'm still at work, so if the bell goes off or there's some sort of, you know, announcement, I apologize to everybody listening.

00:00:29 Lucas Stuber
I think I think we all know how that goes. A lot of folks listening. So today we're going to discuss a little bit of a tough topic. And so I want to sort of preface this by saying that if anyone would prefer not to hear a conversation, then it goes into various forms of abuse and the forms that can take in our community. You're welcome to to skip to a different episode, but we feel like it's a very important topic and one that people really don't talk about enough. And we'd, I guess, like to start a conversation here.

00:00:59 Chris Bugaj
Yeah, Lucas, I want to say that I want to reiterate what you just said about that. This might be, I think maybe the most important episode we've ever done on the podcast. So stick around if you can, because even though it might be a difficult conversation to hear and listen to, it's also super important. The interview that we have today is with Doctor Rebecca Moles, who is a MD who works specializes in child abuse and neglect. And so it's a very important topic, one that I've been wanting to talk about for a while, because one of the things I find that I out in the schools and I wonder what you find with Rachel and Lucas, what you find as well is that there's often really good care, you know, like there's a lot of good care for people with complex communication needs, But sometimes the teaching is lacking, especially when it comes to language. You know, that's one of the reasons we do this podcast is to help all those people learn more about how to teach the language. And, and sometimes the conversations that I've had over the years with certain teachers, they're not really understanding that if you don't, if a student leaves you and they don't have a way to protect themselves, you are setting them up for potential abuse and potential neglect. Language is a way to protect yourself, right? And there are some statistics that kind of back that up. One of the things that that I came across when we were researching, actually even before this podcast article, I was looking at how. Can I start? Convince people that they it's not just about taking care of the kids, it's about educating them when they leave. And I found this, this, this statistics from the Bureau of Justice to it's called the Bureau of Justice Statistics and the title of the report is Crime Against Persons with Disabilities, and it is from 2009 to 2014. They look at this, the statistics from 2009 to 2014 and the URL for that, if people wanted to check it out, is bit dot LY slash abuse statistics 2014. And it basically it says there's lots of different statistics there. But what it basically says is that the rate of violent crime against people with disabilities is 2.5 times higher than those with without disabilities, right? It's more than twice as likely to happen to a person with a disability. And that's just disabilities in general, let alone people who have complex communication needs don't have an ability to prevent the abuse by reporting it. I don't know that that was an alarming statistic to me when I saw it. Everyone, everyone needs to know the statistic and understand the imperative nature behind what we're doing. Because it's not just about like, well, I don't know. It's not about just learning core words. Like there's a whole purpose behind it. It's about protecting yourself and be able to say what you want to say because there's a there's a desperate need there.

00:03:49 Rachel Madel
Exactly. And that that self advocacy piece is so important. And I think that while discussions like this are sometimes challenging to talk about and hard for people to swallow, I think that we need to remember at the end of the day that This is why we support using core words and really being able to teach kids how to say whatever it is that they want to say. And I think that it's a, it's actually a topic that's really sensitive to me. I have a family right now actually going through a case of ongoing abuse in the schools through their aid. And it's just heartbreaking to think about these children are nonverbal and using a device and just starting to emerge in their communication and have a lot of noun based vocabulary, pretty solid. But aren't, you know, combining words and are, you know, still emerging with their ability to use core words. And it's just they have no way of communicating what's happening. And so for this family in particular, they're just there were a lot of things in retrospect that we're seeing now and it's all kind of the pieces are coming together. But you know, if it weren't for some people at the school, some insiders at the school telling the parents, listen, you need to watch the videotape on the bus rides home, they would have no idea what's going on. And it's just, it's, it's, it's really sad. And it, it makes me even more motivated to continue teaching them and continuing to support their ability to express their feelings and understand what the word hurt means and understand where their people folder is. So it's just, yeah, it's a really, it's a really tough topic.

00:05:36 Lucas Stuber
Yeah, I know I'm, I'm like uncharacteristically quiet over here because I'm, I'm sort of just unhappy about it, right? And, but, but the, I don't know, I guess the point of, of us talking about this is not to make folks unhappy about their right, but but rather to raise awareness around this very important issue. And, and, and in doing that, we do need to talk about some of the specific issues, right. So the, the personal, I think if you, if you work in the schools, if you work in this field for long enough, you will, you will have those occasions when you've made the CPS calls and whatever else. I think for me, I made three when I was in the school and they were never easy. The toughest situation I've faced is actually with a with a family friend who has a son who's non verbal, uses AAC, who was abused for years by a caregiver, was only discovered because of a video recorder that was placed in the home because she's started to suspect things. And the worst part of the story for me was that the District Attorney actually declined taking this to court because he was unable to testify the the user of AAC, which just blows my mind. And it ended up sort of being vindicated in a way, because in a separate civil case, they were successful, right? So he was dead wrong about what that meant. But I, I mean, this there, there is an argument to be made that the, the people that we serve are the most marginalized population in our society, right? And it it sort of strikes home the burden that we have, I guess, in terms of in terms of giving them support that they need.

00:07:02 Chris Bugaj
Yeah, You know, I actually say this sometimes during presentations I do, is that all of these important movements that our time is, is, is getting new experience and being a part of, you know, the Me Too movement, the Black Lives Matters movement. Those people have voices. They can have a movement, right? But the people that we're serving, yes, there are a population that have come out the back end. They have voices, but there's not enough of them, right? And so we all have to be advocates for them as well. You know something you said, Lucas, they kind of stuck with me just just there a moment ago was that you've had to call CPSA number of times based on your experience in the schools and hear me currently working in schools, I cannot imagine anyone doing anything to a student. No one that I work with, no one that I in the. Past that I've ever worked with have I could I think that that they would do something and of course I could be wrong, right? But, but I can't imagine it. But I could imagine that when they leave those people's care that they don't, we don't know where they go. You know what I mean? And all, all the work that and all the time and all the care that we're putting into them right now. If we're not teaching them language, we are setting them up for potentially an abusive situation down the line. And something that comes to mind here, some people may have seen this video. There's sort of in the AAC world, this is sort of famous video by GAIL van Taitenov. And you know which one I'm referencing.

00:08:27 Lucas Stuber
I do. Or she, Yeah. Go ahead, though, yeah.

00:08:30 Chris Bugaj
So there's this user that luckily GAIL van Taitenov, one of the famous AAC speech language pathologist who work with AAC, she was working with this gentleman and taught him core vocabulary words. And when he was an adult, he was not being fed at his at his group home. And so she recorded this video of him using core vocabulary to report the the neglect to her, which then she could go and make the the official report. But he could not have done that other if she had not taught him in the past how to use the core vocabulary words that he needed to be able to put it all together. To say I am not being fat, I am hungry. This person.

00:09:12 Lucas Stuber
Because you don't see that preprogrammed phrase very often in devices, do you?

00:09:16 Chris Bugaj
No, you don't, right? And you can't get very far with I want Goldfish Crackers and recording your, you know, your abuse and neglect. So it's one of those powerful reasons why core vocabulary is so important. And I think that's why it gets shared in certain presentations. Why GAIL has shared it is that this is the power of core vocabulary. I think I might even get the title of the video. The power of core vocabulary is that it it enables people to be able to protect themselves.

00:09:43 Lucas Stuber
Right. Well, and and even just to look at more minimal examples of that, I mean, that's for the moment when the, you know, an adolescent is lost in Safeway and can't find their parents or those sorts of things. I mean, there's all these times when generative language ability will enable you to say things that you couldn't otherwise. I mean, I mean, this just happens to be the case. You can point to and say this is the most obvious, right? Because this is you. You're not going to have that, Like I say, like a phrase that's in the device that already says these things. And God help you, you never want to have have to have that, right? But we need to be teaching users the full portfolio of everything that they need in order to advocate for themselves in all contexts, right?

00:10:19 Rachel Madel
This actually reminds me of an experience that I had very early on in my career. I was working doing early intervention and in Philadelphia and I was working in a lot of homes with three and four year olds and the parents weren't sending their kids to school. And I was kind of naive just coming out of school and was like, why wouldn't they send their kids to school? This makes no sense. And I was working in inner city Philly and some not so nice neighborhoods. And one day when I was trying to encourage a family to send their daughter to school, the mom just like got very defensive with me and angry that I was even, you know, insinuating that I would recommend school. And she said to me, and I'll never forget this. She said, why on earth would I send my daughter to school when she has no words to tell me if somebody hurt her or not? And so it, it just, you know, for me, I grew up in a small farm town where school was a safe place. And, you know, I never would have thought anything different. But for this, this family and this woman, she, you know, she didn't want to send her child who was not verbal on a bus and to a school where, you know, she couldn't express herself and she didn't say if someone, you know, had hurt her. And after that, it really opened my eyes to the rest of the families that I was working with. Oh, OK, this makes more sense. You know, I, I didn't step into their shoes. I didn't think, you know, what would it be like to have a child who was not able to communicate, you know, especially in areas that might not be what, you know, we consider safe. So that was a really eye opening experience. And, and I really think it changed the way I thought about, you know, kids with complex communication needs and children who are non verbal. And it definitely made me more considerate when I was encouraging school for these families because it's hard. I think there's a lot of fear that parents have and rightly so. There's a lot of things that can go on and there's a lot of people who would be worried about something happening and are worried. So it it definitely has shaped my my practice for sure.

00:12:28 Lucas Stuber
Well, and you know, like, like Chris said too, I mean, none of us wants to think this of educators and, and you know, this, the CPS that I, I mentioned earlier, those were all related to things we found out that were happening outside of school, right? So I, I would argue for the most part, school is a very safe place to be. But I completely understand the concern. And they just say, it also goes to show you how this is true across all contexts, right? I remember reading A blog a few years ago that was written by an adult with CPAC user who had added a profanity page for the subway because they would sort of get heckled sometimes and they wanted to be able to sort of, I'd say F you if you need to, I guess, you know, and I, I have to admit that if that was said to me out of a speech generating device and I was a stranger, I'd kind of be like, whoa, we're going to give you some space. OK, That's probably pretty effective. So I'm not saying that that should be the go to in our core word vocabulary necessarily. But I mean, you know, especially as we're planning for the whole scope of someone's lifetime, right? This is part of a much bigger conversation about providing language appropriate to everything, to sexuality, to, you know, to violence. I mean, anything that needs to be discussed, right? Because sometimes we have to talk about those things and they should be able to too.

00:13:40 Rachel Madel
I have a question for you guys that just popped into my brain. What are ways that we can prepare our students with the language that they would need in a situation of abuse, which I know is kind of a loaded question and I know that it's not something that like 01 day. We're just going to talk about, you know, the word abuse and what that means, but what are just your initial thoughts on ways that we can start thinking through that lens? Because I think it's important, you know, we kind of sometimes get tunnel vision when we're working on goals and supporting core words and all these things. What are some things that we can start early on incorporating to help support self advocacy for for these kids?

00:14:20 Chris Bugaj
Well, OK, then what immediately comes to mind is that I just had a conversation about the word sick with a teacher. And she's like, yeah, he won't even tell me when they're when they're sick. And it's like, well, that's because the kid doesn't know what this word sick means. So when they're. So if the kid is sick, you know they're sick, but they don't know what that word is. So you have to just tell them you look sick, you are sick sick, because now they'll know you're pairing it together. And so that same thing, you would use that same analogy for hurt, you know, when the kid falls or gets bumped or there's a bruise, you could say hurt and bring out a, you know, because kids fall and they get hurt. You know, Doctor Moles is going to say that she's like, you know, kids get bruises all the time. Doesn't mean they're being abused, you know, right. And so the the same ideas, but they the kids we work with, they might not know what that word means. So we have to teach. Them that word.

00:15:11 Lucas Stuber
Yep, that actually that Harkins back well to something that Rachel said. I know recently about how so, and I'm, I'm paraphrasing here, but the, the, the bad moments are, are moments to teach about communication opportunities, right, just as much as the the good ones, right? So we talk about these creating these wonderful environments and, and using that to teach communication, but we also shouldn't ignore that moment when the kid trips and falls or has a tantrum or whatever it might be, because all of that is, is just as motivating for communication. Another piece that comes to mind for me is, you know, we, we, we talk, I don't know how much, but a little bit on, on the show, I know about developmental versus chronological age, right? And, and how sometimes we're teaching students to where they are developmentally versus where they are chronologically. Well, the world doesn't care, right? The world is going to see a 16 year old girl as a 16 year old girl. And, you know, it's I think important also to to then look at what's happening in the general education environment in terms of, for example, sexual education and these things and try to align with that to some extent in terms of introducing some of this vocabulary. And I know that's uncomfortable and I didn't know that's a conversation that has to happen with parents very often. But you know, any of the, the major apps that are out there will have actually pages and iconography related to stuff like that. It just typically isn't enabled to, you know, by default.

00:16:28 Chris Bugaj
That was one of the questions, Doctor Moles, I don't think it made it into the interview because we talked a little bit beforehand and she said, you know, what words do you talk about? Do you talk about the all the body parts? And it's like, yeah, that's something we should be teaching. It's something teachers teach quite a bit is arm and head and leg. But do you teach about the other body parts, you know, the sexual body parts? And it's like, you know, we I said every school has FLE, you know, and so there's no reason you wouldn't also teach 50 school. If the parents have opted the student into learning about FLE, then these students will be learning that as well. You know, and you would be teaching those words for the what is.

00:17:04 Lucas Stuber
FLE.

00:17:05 Chris Bugaj
Family life education.

00:17:06 Lucas Stuber
So, yeah, I hadn't heard that one before. I think, I think every district seems to call it or every, every state calls it something a little bit different. But but right, I mean, that's a typical part of the curriculum. And you know, what's funny is this actually has, this has come up in other contexts in the last few days, interestingly enough, in, in planning for a variety of things. And I, I remember my own experience in that with Wade elementary school, maybe your middle school, which was pretty much a room full of boys giggling every time a word was said that we thought was funny. And I don't remember much of the content as a result of that. But I mean, it's something that we, we do and we recognize the importance of, and we should have the same conversations with parents around it in terms of opting out, right? And things that can be done at home. I mean, obviously these are, as Rachel pointed out, very sensitive things, but it's just, it's just a disservice not to be openly speaking about these things for the population we serve, right? Because why would we be treating this topic any differently? This is a hard one guys.

00:17:57 Chris Bugaj
This conversation is really difficult to have and I'm glad you stuck with us. And I want to tell you the interview that you're about to hear with Doctor Moles is really refreshing. She gives a lot of good strategies to bust some myths down about that I that I had about like CPS, like with the, the repercussions you're calling CPS. She really talks about, not to spoil it, but she really talks about how that whole service is about supporting the families and making things better, not about stripping the kids away from their families. You know, it's about, it's really not punitive at all, even though you might be thinking that in your head. It's all much more supportive than most people think. The interview you're about to hear is really worth your time. It's not all doom and gloom and about more abuse statistics. It's all about what to do in those situations about educating people.

00:18:41 Lucas Stuber
And those strategies are a hugely important part of our job. So I hope everyone listens as we go now to Chris's interview with Doctor Rebecca Moles.

00:18:58 Chris Bugaj
Welcome back to Talking with Tech. I'm Chris Bugaj, and I'm here with Doctor Moles. Am I saying that right, Doctor Moles? Am I pronouncing your last name correctly? You are, yes. So Doctor Moles, I wanted to have you on for a long time on the podcast because I think we're going to talk about kind of a serious topic today, which is all about neglect and abuse. So let's start off with who you are and what do you do?

00:19:19 Rebecca Moles
So I am Rebecca Moles. I am a pediatrician, so a Doctor Who specializes in the care of children, but I have specialized training in a subspecialty realm of Pediatrics, which is child abuse Pediatrics. So I specialize in see children where there are concerns about physical abuse of them or sexual abuse or neglect. I currently work at Connecticut Children's Medical Center, which is in Hartford, CT as part of a team of other physicians, nurse practitioners, and social work, and I see children in an inpatient setting, so admitted to the hospital or an outpatient setting and work closely with Child Protective Services. Often called DCF Department of Children and Families, depending on your state and law enforcement to make sure that children get medical evaluations when there's concerns about abuse.

00:20:10 Chris Bugaj
So is that when you say you're, you're working with a team, Does the entire team work with that population of students or is it you? Is it all medicine?

00:20:18 Rebecca Moles
So the I have a very specific team that is specifically a suspected child abuse and neglect team. So there's a handful of us that work together, but we we interact with all different realms of other medical providers in the hospital, out in the community as well as we interact every day with often law enforcement or Child Protective Services.

00:20:42 Chris Bugaj
Thank you for coming on the podcast and talking about all this because one of the reasons we wanted to have you on in the 1st place was this idea that why do people need to communicate? You know, this podcast is all about augmentative communication. And one of the strong reasons we, we feel, at least I feel so strongly and I know the other host of the podcast do feel so strongly about helping kids learn language that don't have language is so that they can protect themselves in some way. They need to know about their bodies. They need to know about what their, you know, the people who are providing care, what they're supposed to be doing. You know, and I, there are some, some videos out there where of adults who have been using communication devices and they've had to report abuse and they can only report the abuse because someone has taught them how to advocate for themselves and to put the words together that they need to know. And so I often point to those videos and say, OK, that's what we're shooting for. We need to be able to have our students generate language for this particular reason. So maybe one way to have this conversation is to first start off with a definition, just so we're all on the same page, because maybe that's kind of a confusing thing. How do you define abuse and how do you define neglect?

00:21:54 Rebecca Moles
So it's one of those questions that when I sat down to think about an answer to this, it was really hard to know how to answer that because it's it's one of those questions that have the answer. Like I'll know it when I see it. Like I'll know what abuse is when I see it, or I'll I'll know what neglect is. It is. There are some definitions, one that comes from the federal Child Abuse Prevention and Treatment Act, defined as an act or a failure to act by a caregiver or a parent, which results in death, serious physical, emotional harm, sexual abuse or exploitation of a child. So that's really chewy. And that's a federal definition, but every state defines it differently. So there's defining, they define serious physical or emotional harm differently. Generally for physical abuse, it's thought to be hitting or striking a child or you know, doing something to the child's skin or to the child's body that needs pain or marks on the skin or some type of injury to the organs. And then different categories, sexual abuse, which is genital touching, could be showing a child images of genitals or some type of sexual activity, taking pictures of children's genitals or taking pictures of them in a sexual manner or making them do sex acts with each other or with adults. And then even broader than that is neglect. Generally, we separate that into categories, meaning like medical neglect, where a child isn't getting the care that they need because the caregiver is not following up with something that they need. And that can include mental health care, educational neglect, not going to school, supervisional neglect, the child's not supervised. So it's getting into situations where they're unsafe. And then of course, basing neglect, which is like not having food, clothing, shelter. So there, that's a long answer to your question, but it's difficult to summarize.

00:23:46 Chris Bugaj
Yeah. Well, I mean, I think something that struck me when you were kind of giving the the definition and explaining that was that part of the definition is the failure to act. So if you are thinking that there's some sort of abuse or neglect happening, then it's your obligation as a care provider to report it in some way, is my thinking of that right?

00:24:08 Rebecca Moles
Yes and no. So in the definition that I was talking about, which is the federal definition of an act or a failure to act by a character, that means harm to a child by hitting them or hurting them. So that's, you know, acting on them. But you can also call cause harm to a child by failing to act, so meaning failing to protect them or failing to provide them with what they need for success. So that's part of that definition. But I think you're getting at the the a separate but related issue, which is because that's defined, there's also national and state laws about mandated reporting, which is when you are any person who has a professional role with children are generally defined as mandated reporters. So that would be all medical providers, speech, language pathologists, teachers, coaches like church, you know, leaders, people who have a role with children are mandated by law to report to a state agency when there's a when they have a concern that a child may be being physically abused, sexually abused or neglected. So they don't have to be sure that they're being abused, they just have to have some type of concern.

00:25:21 Chris Bugaj
OK, So what's your question? Yeah, totally. And that totally clarifies it because I was totally thinking of it differently. But yes, that makes perfect sense. So me working in a school would be obligated to report if I am suspect something. And so when I start to wonder like, OK, what signs might someone like me look for if, you know, I was starting to suspect something or what should I be looking for? I mean, I don't even know how to get that suspicion. Do you know what I mean? So right, what would I be looking for?

00:25:50 Rebecca Moles
Sure. Well, I think I want it before I think about what to look for, meaning actions that the child is doing or bruises on their body, something you would look for. I think I want to get back to what you said before about communication because a lot of what causes people to be concerned about someone, a child being abused or neglected is because of what the child says. So it's, you know, whether they're using words or some other type of way of communicating. So I evaluate a child with bruises, for instance. There's millions of different ways and a child can get a bruise. But if a child says to me, my dad hit me and points to a bruise, then that narrows it, narrows it considerably. What could cause that bruise? Whereas the same type of bruise could be caused by running into the coffee table or some other kind of accident. So what the child says about what happens is so important and so much so that there's a whole science about how to gather information from children so that they're not being led by police officers or investigators to say what happened here, did your daddy hit you? You know, those types of questions. So I think the ideal of how of making sure that children have the ability to communicate in whatever way they can is so important for this type of concern.

00:27:10 Chris Bugaj
Yeah, so absolutely, that's exactly what this podcast is all about. How and somebody, how, how can we get the language out of somebody if they don't have the language? And so often what we're talking about in this podcast is communication devices. And so the students would need to have the words and maybe would you say maybe practiced in some regard or at least know the words in some for for what to say. I don't know. What do you?

00:27:34 Rebecca Moles
Think sure. So I mean, I think that it would be important for children to have to make sure they have words for all of their body parts, including their genital body parts. You know where they words for peeing, for pooping and whatever the family is, is the most comfortable describing the body parts and how they're used as well as words for feelings. Because children, even children who don't have any communication issues, you know who are just depending on their regular developmental level, they don't often start off by saying a full report of what happened to them. They usually when they're talking to an adult, they will give a little bit of information. They might say something like, I don't like going to daddy's house and they're counting on the person that they're communicating with to say why and they're testing the waters to see what their response is going to be. So that they don't. If they don't, if they don't have the adequate language to even start that conversation and be able to to access the communication back from the person that they're trying to communicate with and they won't proceed with the conversation. They usually disclose a little bit and then test the water and then give more and more depending on the receptiveness of the adult that they're talking, talking.

00:28:53 Chris Bugaj
To that makes total sense. So it makes it maybe even more imperative that that we teach those words when I say those words, we talk a lot about in this podcast called core vocabulary words, which are a set of 300 to 350 most frequently used words. You used them in that phrase like I don't like to go, maybe not Daddy's house. I mean, house is not necessarily core vocabulary, but there.

00:29:19 Rebecca Moles
With.

00:29:20 Chris Bugaj
Him you know those would be other words that that would all be core vocabulary. And so if we're not teaching those then how can the student learn them right Something else that you so so this is one reason to teach them as I guess we're getting there is that this might help them defend themselves later or report what's happening and say, you know, to get them out of a situation that they shouldn't be in right. The other thing that that struck me while you were talking is that so often what you said about the feeling words is that is something that teachers often start with is there or they want to say, and I feel sick or I feel mad or I feel hungry, right? And and so we often get comment like, yeah, the kids just not using this device. They're just not. And we put it in place and they're just, you know, we pointed to them And when they're they're obviously not feeling well, they're holding their belly and they're not showing us that they're sick. And we said, well, that's because they don't know what the word sick means. So you have to teach them. You have to have the device in front and go. When you know the kid is sick, you have to say you are sick.

00:30:22 Rebecca Moles
Yes.

00:30:23 Chris Bugaj
Sick. You know, when I'm sick and not feeling well, I come over to the kid and I say I'm the device. I am sick, you know, so that they had this exposure to the word sick along with the other words like mad and sad and frustrated and scared, you know, and on the other words that have to do with you and happy you. Know. Right. OK. So I think we've hope we focused on that. We have to teach these words. It's a, it's a, it's imperative that we do. So let's say I. I, you know, I'm working with a child and I am seeing some sort of, I don't know, bruises or they are they do know some of these words and they're starting to say some of these things. They're on their device. They're saying I don't like it. Maybe they they're looking afraid whenever a certain parents picking them up. I don't know. Is that a sign to be looking for? You tell me what should be looking for.

00:31:11 Rebecca Moles
Well, I mean, I think that I like to kind of separate it into a couple different categories. I mean, I've talked already about physical abuse, sexual abuse and neglect, and I feel like it makes sense to keep it in those categories because it's just easier to wrap your head around each one separately. So physical abuse being injury to the body, that and the most common type of child abuse is brewing. Although the most common type of normal childhood injury is bruising from just life. So often the difficulty is trying to figure out what bruising is normal from childhood and what bruising is unusual and should be, should prompt you to be worried. Some of that has to do with the age of the child, because kids who are under six months of age, who don't yet move on their own, who don't, who aren't crawling or pulling up to a stand and and falling down shouldn't have bruises from just normal activity because their normal activity is like nothing, you know, like they don't do much, they don't do enough to bruise themselves. So I think that that would be something that if you are working with a child that young, I recognize they're not using assistive technology, but they may be speech language pathologists who are working with those young children who are seeing that that that their patient or their student has has a bruise and is that young. That should prompt a concern just by itself. After children start to move around on their own, then we really start to look at where they bruised. Because you know from life and from being a dad and from dealing with children that most kids have bruises mostly on their shins or on Bony parts of their body and mostly on the front because most of us are going forward most of the time. So when you go forward, you bump into self, right? And certainly as kids are learning to walk and learning to run, a huge part of that is standing up and falling down. Standing up and falling down. So there's a predictable spots where we expect kids to have bruises like on their shins, on their forehead because they smack their head into things. So when we see bruises that are in places that aren't those places. So over squishy spots like over your neck or on your trunk, like the torso on the butt is an unusual place because it's squishy and it's usually covered with a diaper depending on how old you are, right? So those parts are less common, so we start being more worried about the location. Some of those locations may be less likely for your listeners to heat to just see normal and normal interact. But certainly we worry about injuries like inside the mouth is not a common place other than someone cutting, biting themselves by accident when you bite your own cheek. But injuries to the tongue or in the mouth, when children are young, we worry about someone forcing something in their mouth and hurting them there. But then also we see patterned injuries. So by that I mean injuries that look like an object, so like a belt mark or like a slap mark that don't just look like the standard round BLOB bruise that you get when you hit your shin, you know, into something. So I think that the it's the idea of how young, you know, how young is the child? Are they old enough to bruise on their own from their own activity? And then it's where are they? Are they bruised? And then what type of bruise? What type of pattern is it?

00:34:31 Chris Bugaj
Sure. I would say something else there is that I think many people that might listen to this podcast know students that have an obviously complex communication needs, but that often also associates with complex other needs. Meaning they might be in a wheelchair, so there's ambulatory or might not be moving at all. So you might have an 18 year old that is just moving his head or something like that. And so that that I think is goes along with what you're saying, is that you're still looking for those injuries and those sorts of parts because how would someone get those injuries, you know, and if they're repeated? Yeah.

00:35:08 Rebecca Moles
Right. And let me just say that simply having a bruise on your back or on an uncommon place does not necessarily mean 100% that you were abused. It's just something that's much less less common or that we would expect that either the child would have a good history about why it happened because it would be memorable. You know, it's not like each screws on your kids shin that they can't remember where they got it. You know, it's, it'd be a memorable event that happened or that a caregiver who's caring for them would know what happened because it was an event for them too, because they were caring for them and something happened and the child got injured. So it I agree with what you're saying. Of course, thinking about a lot of the children who may have communication needs, have other needs, may not be as developmentally mobile as other children their same age. And that could make me approach bruising in them more like they were six months old and then they're 16 years old if they are chronic bedridden or chronic wheelchair background and don't have a lot of activity on their own.

00:36:05 Chris Bugaj
Yeah, that's a great way to put it. So let me ask you, OK, so now I do suspect like maybe I have some sort of thought and I'm thinking, OK, maybe I'm not sure maybe what, what are my responsibilities? What are my next steps? What do you what do you think I should do or people should do?

00:36:22 Rebecca Moles
Right. So all states have some type of a statute that has mandated reporting and that was statues are all similarly written to say that you have to have some reasonable suspicion. So any of the things we just talked about would be a reasonable suspicion. It's kind of purposely vague to cast a wide net to make sure that they're getting they want to have many, many more reports than that they actually decide or abuse because they're not missing anything. So I think that depending on what your, what your practice structure is, certainly yourself, you may report it directly to Child Protective Services. So in most states, there's some type of a hotline, there's a form you fill out and you report it directly there. If you're working in a hospital or a school environment, a lot of times there's a team you would talk to, you know, meaning you talk to your supervisor or there's like a social worker that does the reporting. So there's a, there's a team structure that you would go through just more for your own professional courtesy to talk to the rest of the team and make sure that everybody agrees with your concern. But that's, but that is the first step. And, and generally then that's the only step that needs to happen from the report is to report it to the state agency that's responsible for getting those reports in your state.

00:37:41 Chris Bugaj
So let me ask you with your experience here, I would imagine that this can be a difficult thing to decide to do because one, you might have a relationship with the, I mean, in, in my case, working in the schools, you have a relationship with the parents and you'd be thinking they're going to think that I'm thinking they're abusing their kid when they're not Yes. Tell me if this is just wrong, like if someone with my own children, if they were reported us to Child Protective Services and I, I would be grateful, I think, right. Is that a way to think of it, or am I just casting again, too wide of an answer to right?

00:38:15 Rebecca Moles
No. Well, I think that it, it depends on how you frame it to the family, right. And, and there may be times where you are, and it's, it's so hard to talk about this in generalities because every case is different. But there certainly could be times where you are with a child and the child is communicating to you that they're afraid to go home, that their parent is hurting them or then they have injuries that you're seeing or not, you know, and they're, but they're able to communicate with you that they're, they're worried that that is an urgent situation, you know, meaning you're not just going to send that child home and then go talk to your supervisor and ask if you should call someone because the child's telling you right there, don't make me go home. I'm scared. Most of the cases are not that. Most of them are when you have this niggling like, Oh, I don't really like that. Why is it looking like that? Like you're not sure And then you talk to to a colleague and get that confirmation that they also agree with your worry. But generally, to get back to talking to the family about it, generally what I suggest is being as upfront with the family as you can be and meaning to say, I'm I'm concerned because your child is telling me something that makes me worry that they're not safe. Or I'm concerned because your child has an you know, I'm seeing injuries in their mouths that don't make sense to me or whatever. The fill in the blank is why you're concerned and getting to be a partner with you in that concern that they should also be concerned about the issue, whatever it is, it has you concerned and you want to partner with them because you want to say to them, did you see this injury? What, what do you think about this? You know, like, because you may be talking to the person who hurt them, but you may be talking to the person who didn't, you know, and so that you're trying to get their take on it as well. And then ultimately you can certainly fall back on the, you know, I am required by law to report this to, to Child Protective Services, whatever it's called in your state or our hospital is mandated or the school is mandated to report this, whatever. So that you're you're trying to depersonalize. It and say I'm not filing against you parent ABC I'm filing on behalf of your child because I'm worried about him or I'm worried about her. I can't say that it won't that your relationship will not be strained by that with that parent. But I agree with you that ultimately they should be happy and many parent not happy. That's been strong maybe, but they're but be grateful, as you said, that people are looking out for their child because a lot of parents of children who have communication concerns live in fear of their child going to school or going out of their care where they don't know what's happened to them and their kid can't tell them when they get home what happened. So a lot of them are worried and are grateful that someone else's is recognizing that their child may be vulnerable to being injured or hurt and not being able to say what's happening to them, or may be vulnerable to being injured because there may be difficult to care for because they can't communicate their needs. So the child may be frustrating to caregivers because they can't communicate their needs. And so the caregiver gets frustrated and maybe the child is more likely to be injured or disciplined in a way that's not appropriate.

00:41:31 Chris Bugaj
I think that's such an excellent point. So something I talked about a little bit is called the least St. least dangerous assumption, right? And so I think that in this case this might apply where we would say, OK, I'm not sure if I should report it or not. Well, I'm going to ask myself this question. What's the least dangerous assumption for the student? And if the chances are it'd be better to report it than not reported and be wrong, then if I made the other assumption and said yeah, it's probably not happening and it was happening, then I'm really one, I'm in trouble and two of the kids, the kid possibly continues to be at risk and so what's least dangerous is to do the reporting right.

00:42:11 Rebecca Moles
Yes, because I mean, I think that sending a child home to an unsafe situation is the worst that we could do for them. So putting a family through a invest an investigation that ultimately ends up being not substantiated as being abuse. While I agree that that's terrible and not anything that anybody would want to go through that to me is the lesser of two evils than than not exploring something I came on behalf. And I would say especially these children that have have communication challenges and are maybe don't have the language to say it, don't have the receptive adults to hear it. You know, they may be somewhat isolated. You know, whether they're in their own head, isolated because they can't communicate out or because they're just don't come in contact with that many people to communicate with, you know, who could argue on their behalf?

00:43:01 Chris Bugaj
All right, so let me take the next step, which would be all right, I have reported it. Either I've gone to my team and my team, the, the person that does that on my team has reported to CPS, to Child Protective Services. Or maybe I'm a private speech therapist and I'm noticing something and I don't have, I have a team, but I do it. I go right to the Child Protective Services. What can I expect to happen next, both for the family and the child and for me? You know, like as.

00:43:26 Rebecca Moles
Sure, so for you is easier to start with. For you, you should expect that most likely you would hear back from someone from Child Protective Services because when you initially call in or fill a form, you're getting information and then it gets routed up through their chains, through their supervisors and often someone calls you back to get more information. So I always recommend that professionals don't file anonymously. So you can ask to be anonymous to the family so that they are not going and saying Mr. Boogay reported you to Child Protective Services, but you want to be not anonymous to Child Protective Services so they can call you back, you know, to get information, to gather more information from you about what your concerns were. Then most of the time your role would be done, you know, like they want to get some more initial information from you. In most states, you, if you're the reporter, you'll get some type of a letter, usually a form letter that just says that they've accepted or what kind of a little basic information about the outcome of the investigation with not a lot of nitty gritty, you know, so you won't get like their whole, you know, case report of what happened, but you would get something. But then for the child and the family, generally what happens is that they that Child Protective Services would reach out to that family. And how urgently they do that depends on the urgency of the concern, but they sometimes will come right to school and talk to the child or meet with the child or the the teachers, etcetera. At school, they have to meet with the parents. They often have to evaluate other children in the home, you know, the other children that might be unsafe and they're gathering a bunch of information from them. Sometimes they need to come for a medical evaluation, like with someone like me. Sometimes the children go for a specialized interview to gathering nation from them by specialized interviewers that the children are not getting interviewed by the school guidance counselor and then police and then child protect services so that they kind of streamline that effect. Then they're depending on what the indications are most. The goal is not for children to be removed from their home. You know, Child Protective Services is trying to strengthen the family and keep the children there, help them be safe. They might ask the person who's harming the child to to leave the home, or they might say you need more parenting supports and put some supports or things in place to try to help the family stay intact. It was a long answer to your question. Is that what you're hoping?

00:46:06 Chris Bugaj
For that was great. That was totally great. That's totally what I want to know because I need to know. First of all, I'm not suspecting this of anybody. I'm just having this conversation to go, well, it's just suspecting somebody at one of his schools like that.

00:46:18 Rebecca Moles
Right, exactly right.

00:46:20 Chris Bugaj
But I want to know from my own edification what to expect. And then I want to, of course, share that with everyone, every listener, so that they would know what to expect. That's really helpful. One of the things we have talked about in the past, Doctor Moles, is the idea that if, if I've given a lot of instruction and education to a parent about how to help them communicate with their child and teach their child language, could that, and they don't, they'd said, you know what, I'm not going to use this communication device. I'm fine. I think I know everything my kid says by just nodding and blinking and, and, and, and maybe making some sort of vocalization, like a sound sort of thing. And I think and, and as a professional, as a speech language pathologist, we're thinking we have a, we could teach a lot more, a lot more. It could that possibly fall under the, the, the idea of or the definition of neglect. You know, we've talked about in the past and you gave me some good advice on this, so.

00:47:19 Rebecca Moles
Yes. I mean, the short answer to that question is yes for me. It's easy for me to frame that in the same idea as getting appropriate medical care for your child. So the concept of neglect is kind of squishy and it's hard to define and it's defined differently in every state. But generally a report to Child Protective Services is warranted when there is a concern that that that the child is suffering some type of harm because the caregivers not following up with what's with what's recommended. So it could be, you know, your child needs chemotherapy and you're not following up with that or they have asthma and you don't give them their medication, so they keep getting admitted to the hospital with their asthma. So I think that the concept of we could teach your child to communicate, but you're not doing it. Do you know what I mean is is so profound because we you don't have to be a speech language pathologist to recognize how important communication is and how devastating that would be of a child to not have it. And by reporting it, it does not necessarily mean again, that they're going to remove the child from the home. They would not and they're not going to criminally prosecute, you know, the a parent for having done that. Because a lot of times there's barriers that the child and family are facing that sometimes if you're working on it in a multidisciplinary team in a hospital situation or something, you would work on getting the family resources to get the devices or get a Medicare to get to the, to get to the appointment. Like if they just can't physically get there because they're not a car, like those types of things. And a lot of what what Child Protective Services do would do with a case like that is to try to see how can we get, how can we get this to happen And try to assess what are the, is it that the parent has unmet mental health needs themselves and they can't, they just can't get the child what they need. It's not that they're actively trying to withhold it from them, you know, and then there may be parents who have issues that with their own cognitive abilities and aren't even able to grasp that their child could grow from this. Like they're just not even. They just aren't even able to understand what they're not doing with their child.

00:49:40 Chris Bugaj
I think that's.

00:49:41 Rebecca Moles
A big way? Go ahead.

00:49:42 Chris Bugaj
And I think that's a big take away from this conversation is that I think, you know, maybe because it's a media or whatever, but I think a lot of people's impression of Child Protective Services had a picture. You have this image of people coming and grabbing them from a house and removing them. Now they're in a cop car and they're crying if they want their mom back. Do you know what I mean? Right. What you're describing is more that Child Protective Services is more about helping the family get what they need and get everyone in the family what they need. And that might be, you said, helping them provide other services to, in this case, you know, helping the kid learn language. Maybe you're helping the parents help the child learn language. Yes. Well, like Mythbusters on this show, right?

00:50:23 Rebecca Moles
Right, exactly. Yes, that could be our next installment, right, right. I mean, that is a common mystery. There's misperception that people think that they report to Child Protective Services means that my patients going to foster care or my students going to foster care, and there's like 450 steps that would have to happen. And there's only a very small percentage of children who end up in the foster care system. And it's only when they meet very specific criteria. Like, the goal is always to keep them with their families and again, to help their parents or their caregivers be better being caregivers.

00:51:01 Chris Bugaj
So let me ask you the sort of a blanket question we ask everybody that comes on the show is if there's sort of one thing you'd want people to know, every caregiver, every speech, language, pathologist, just in general, what's one thing you'd like people to know about abuse and neglect?

00:51:15 Rebecca Moles
So I think that the one thing that I want everybody to know is that this is so common. Physical abuse is common, Sexual abuse is common and it can happen in all different types of families, families of all different skin colors, all different education levels, all different language, you know, all different ethnicities, all different socioeconomic size. We know in the medical literature that certainly it's abuse is not suspected as much in the white middle class family or the intact family. And it's suspected more in in families where there's a lot of social stressors. And it may happen more on those families, but we don't actually know because we don't suspect it and report it in the other families. So I think that helping people recognize that this happens and not being afraid to talk about it and not being afraid to give our children the words to be able to communicate about what's happening to their bodies would be the one to take away. I'd like people to have.

00:52:19 Chris Bugaj
Awesome. All right. And the last question I want to ask you is, you know what we talk a lot about, Like what do you on this podcast? We often ask like. What are you? Questing about what are you learning about what is driving you right now? You know, what's your next thing that you're thinking? I want to learn more about this. What's been on your mind lately in this room?

00:52:36 Rebecca Moles
Sure. So I think a hot topic for me and also and actually expect that trauma has on the developing brain. So meaning there's much more science out there about how when you experience trauma as an infant, as a young child, how that affects how your brain develops and how that affects all of the future learning that you do. And I think that it's just a new frontier. And we're just starting to recognize that children who have been classified as having ADHD, for instance, so attention deficit disorder may be all just having reactive trauma behaviors that they that they had suffered some type of trauma or they are continuing to suffer some type of trauma and they are experiencing behaviors that are related to that, that it's actually not ADHD, it's a reaction to the trauma they're experiencing. So this is a whole new frontier and whole new thought process kind of turning the the Pediatrics world on its head a bit about thinking about how to even address that.

00:53:40 Chris Bugaj
Yes. How would you assess it and and figure out that's what caused what's happening now the the future behaviors? Yeah. I mean, that is fascinating. I can see why that's that's interesting to you, you know.

00:53:51 Rebecca Moles
Sure.

00:53:52 Chris Bugaj
Well, thank you so much for being on this podcast. We really appreciate it. Like I said, I think this is going to be one of the most necessary podcasts that people listen to. So I appreciate your time and I appreciate for, for, for me and from everyone else for you, for you doing what you do because.

00:54:06 Rebecca Moles
Thank you.

00:54:07 Chris Bugaj
It's a necessary thing out there and there's just thank you for doing it.

00:54:11 Rebecca Moles
Thank you. Thanks for having me on the show. I'm glad to get the education out there to more and more people.

00:54:25 Lucas Stuber
Well, thank you so much for Doctor Moles for meeting with Chris. That was a fantastic interview and wonderfully times.

00:54:30 Chris Bugaj
Yeah, the ending of that interview, she really hits the point that this is more common than you think. It's it's really intentional on our part that we put this right in the middle of AAC Awareness month because This is why we do what we do right, is to give people words and give people language so that so that they can stay out of these situations, report them when they have.

00:54:51 Lucas Stuber
Please do track US down on Facebook. You can look for for talking with tech. We have a group and a page. The group is is fantastic. It's a a good little place to have a conversation.

00:54:59 Chris Bugaj
Tied to the. Podcast Scroll down, hit the subscribe button. That's right, the subscribe button is right next to How to Write a Review, so you can't miss it right down.

00:55:06 Lucas Stuber
There we go, you just do both at once. Well, again, this is Lucas Stuber along with Rachel Madel and and Chris Bugaj. We really appreciate you you sticking around through this conversation and we can't wait to talk to you all next week.