KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on WAMU 88.5. Welcome. The public health crisis caused by coronavirus is disruptive to everyone, but how will it affect our most vulnerable communities? Community advocates are working around the clock to brace for the long term impacts of quarantine on high risk populations. That includes people with an existing mental health condition, who now may find it much harder to manage their coping skills. It also includes survivors of domestic abuse, who are more likely to be reassaulted by their abusers under the pressure of home isolation. And children are particularly vulnerable to the feelings of fear and panic from the adults in their lives.

KOJO NNAMDIWhat are organizations in our region doing to address these populations and help them in their long term recovery when it's all over? Joining us now by phone is Meredith McKeen, Social Worker and Director of Multicultural Initiatives at Northern Virginia Family Service. Meredith McKeen, thank you for joining us.

MEREDITH MCKEENThank you for having me.

NNAMDIYour organization serves a vulnerable population and that during the best of times. What services do you provide and what challenges are you facing now?

MCKEENWell, at Northern Virginia Family Service are busy right now maintaining the services that we currently provide, which include mental health services for people who may not normally have access to services so infant and maternal mental health, mental health for immigrants, who have experience trauma, mental health for children who have been exposed to violence, and for individuals and families, who have experienced homelessness.

MCKEENSo we are currently using our expertise in that area to maintain contact and adapt our services to continue to serve the needs of the people we already serve while we're also figuring out how to address the emerging needs that we're seeing in our community and planning for long term services. And I think top of mind for us right now is making sure that everybody in our community has access to the resources that they need to stay safe and healthy.

MCKEENAnd in particular, in a time of anxiety and fear, feeling prepared is one of the best ways for people to reduce their anxiety and to feel ready to address challenges. And we at NVFS know that many people in our community cannot do even the basic preparedness, because they can't afford to stock up on food, for example, or do not have a safe place to sleep or do not have access to medical care if they're uninsured, undocumented or afraid to seek services. So we are working diligently to figure out how we can provide those services and those resources to the folks who are most in need.

NNAMDIHow are people who already suffer from anxiety dealing with this?

MCKEENSo I think if you're -- everybody is coping in many many different ways. And I think it's important first, also to say that it makes sense that people are feeling anxious and afraid. This is an uncertain time, but it is also important to know that when people can practice good self-care. And what we mean by that is adapting their coping skills. So if people are or have experienced anxiety, for example, they may need to find new ways to address those symptoms.

MCKEENSo their previous coping skills and ways of addressing it may need to change a little bit. If what they used to do, for example, was exercise or meet with people I think we're all sort of helping everybody figure out the best way to maintain healthy coping in completely new and changed circumstances.

NNAMDIWhat are the main obstacles your clients face when trying to access mental health services?

MCKEENSo in general even without the crisis we have -- we serve people, who experience barriers often because of language. If they do not speak English and service providers also don't, but also the majority of folks that we serve often are just afraid to seek services. So if they are undocumented or not familiar, for example, with the ways to navigate the variety of services those are some of the challenges that our folks face.

MCKEENWe also, again, in sort of pre-COVID-19 circumstances, we provide services in a variety of formats so that the access barriers are actually mitigated. So we will come to people's homes. We will partner with our schools. We provide services in locations that people are already familiar with and comfortable with so that we can overcome some of those challenges.

NNAMDIMeredith McKeen, many of the mental health services offered at the Northern Virginia Family Center are trauma centered. Do you think this crisis will potentially create additional traumas to work through?

MCKEENYes. I think, you know, there is definitely the potential for traumatic impacts. And I think it's important to remember in a crisis like this that the experience of trauma has tremendous impacts, but people absolutely can recover. With the right resources in place and support the impacts are significant and serious, but can be addressed. So I think what we are thinking about long term especially, but even in the short term is figuring out ways to address the losses that people will be experiencing or potentially have already experienced.

MCKEENI think all of us can relate to just the sort of loss of our normal and a loss of routine. As this crisis unfolds, we are anticipating economic loss, potential job loss and potential loss of loved ones. So there are multiple impacts and we know from our experience responding to other crisis and to other disasters and to doing trauma recovery work that what people will need is somebody to help them navigate that new normal. Help them access resources and also just somebody to listen. People will need to be heard. And have a place to ask questions, get information and get support.

NNAMDIJoining us now by phone is Natalia Otero, Co-Founder and Executive Director of DC SAFE. Natalia, thank you for joining us.

NATALIA MARLOW-OTEROThank you. Happy to be here.

NNAMDIThis situation we're living in right now is disruptive for everyone. But for survivors of domestic violence who still live with their abuser it can be dangerous. Why is it so high risk?

MARLOW-OTEROYeah, I think part of what goes on in a relationship that has violence is that it is centered within the power and control dynamic. And in isolation those things become more acute. In addition to that dynamic there are other factors that wouldn't normally happen. People are in close quarters for a lot longer time and that creates more conflict. There's also children present and that can exacerbate things. There might be other things that are happening like drug or alcohol use that would -- could also increase during this time. Not to mention the economic instability that might be present. And all of those things can kind of heighten or escalate violence.

NNAMDIWe have been seeing that police departments across China are reporting an increased incidents of domestic violence significantly so from say a year ago. What are some of the warning signs to look out for if you feel you may be in a dangerous situation at home?

MARLOW-OTEROWell, I think there's three different areas. We can look at it that way in terms of heightened risk. The first is what is happening in the home right now and what is happening with your partner. Has the abuse whether it's emotional, verbal or physical, has that increased in frequency? Has it increased in severity? Has the controlling behavior or jealousy increased? Obviously the isolation is there and that is also an issue.

MARLOW-OTEROYou can also look at it from the perspective of what is the behavior that you see in your partner and what is going on in the environment. So does your partner have access to or have weapons in the home? We know that in those cases there is an increase likelihood of violence and or homicide by about 15 times, so 15 times more likely for something to happen. Is there an increase in the drug or alcohol use if that is an issue in your relationship? Are there threats of suicide? Is your partner threatening to harm himself or are there threats to kill you or loved ones?

MARLOW-OTEROThere's also kind of a pattern of behavior over time. So you need to think about the history that you have lived with this person. Has there ever been a situation where this person has strangled you or hurt you while you were pregnant? Or have you ever had to have a stay away order against this person? Have they been chronically unemployed? Have you had to call the police before? All of those things are a part of what happens as the risk for serious injury or worse begin to escalate.

NNAMDINatalia, DC SAFE takes referral calls from emergency services. Are those services still running if someone needs to report domestic violence?

MARLOW-OTEROYes. We are currently being very proactive. We've increased our capacity on our response line that those are advocates that actually go out in the community. So right now we're still functioning. Our crisis shelter is still available. We are still sending community advocates out to meet with people, and we're accessible via the city victim hotline and through the police department.

NNAMDIHere now is Jeremy in Washington D.C. Jeremy, you're on the air. Go ahead, please.

JEREMYHi. Thank you for having this discussion. I actually have a big anxiety disorder and I get help with it a lot. And I have a lot of attack holds through in person meetings with therapists and a group that I go to just for that topic. And I've learned over the years to reach out with my friends that I trust or with my doctors. And I'm doing the best I can to hang on right now. But the isolation -- I used to seek out isolation on purpose when I would get depressed or anxious. And I've learned not to do that anymore.

JEREMYBut now it's different, because the isolation is thrust upon me. I don't have a choice in the matter. So I'm trying phone calls and I'm trying online meetings and stuff like that. But they're not the same. It doesn't feel like it's the same benefit. I miss the closeness in the interactions. And I was wondering if there's ways to maybe enhance some of that or like get something more out of online and phone messaging outside of just hearing other people's voices, because it's not the same.

NNAMDIAny suggestions, Meredith McKeen?

MCKEENThat's a wonderful question. And thank you for calling and sharing your experience. And I think it's an example of what a lot of people are trying to figure out is things that previously were helpful may not feel available at this time. I do know that I think sort of across the board in terms of the helping professions everyone is trying to figure out very quickly how to safely, carefully, ethically, confidentially adapt services.

MCKEENSo while they can't be in person, can there be a video function? A telehealth function? And I think you're right that it does not feel the same. But I encourage you to connect with the people that are providing those services and ask some of those questions, because they may not have necessarily thought of what some of the slightly different needs are. So it's potentially an opportunity, and really we need to collaborate and sort of work together to figure out the best way to make the services that are available be the most effective.

NNAMDIGot to take a short break. When we come back we'll continue this conversation. If you have called, stay on the line. We will get to your calls. I'm Kojo Nnamdi.

NNAMDIWe're talking about vulnerable populations during this time of the coronavirus pandemic and inviting your calls at 800-433-8850. We're talking with Meredith McKeen, Social Worker and Director of Multicultural Initiatives at Northern Virginia Family Center. And Natalia Otero, the Co-Founder and Executive Director of DC SAFE. I have a question for both of you. On Tuesday, the D.C. Council passed the COVID-19 Response Emergency Amendment Act of 2020. It extends unemployment benefits, protects tenant rights and offers other relief to residents. Will this help the clients you work with? First you, Natalia.

MARLOW-OTEROYeah. Absolutely. I think that there's going to be a lot to kind of deal with for survivors of domestic violence and the aftermath. And I think anything that we can do to soften that and provide additional support is a good thing.

NNAMDIHow about you, Meredith?

MCKEENYeah. So Northern Virginia Family Service is in Virginia. So we are the benefit of some of the changes in emergency orders that are happening in each of our jurisdictions and I think I am thankful and appreciative of the way that our communities are responding collectively. Our governments, our private non-profits, all of those things will be helpful.

MCKEENAt the same time there will still be people, who will be left out of the assistance. For example, it's just one example, but people who are in informal relationships with a landlord or people because of documentation or fears related to seeking services due to their immigration concerns will potentially have challenges that other folks won't in terms of accessing some of these benefits that are necessary and will become available, so organizations like NVFS are going to be needed to bridge that gap.

NNAMDIWe talked about what the D.C. Council did. Luke in Takoma, D.C. wants to talk about what happened in the Maryland General Assembly. Luke, you're on the air. Go ahead, please.

LUKEHey, Kojo.

NNAMDIGo right ahead, Luke.

LUKEI just wanted to talk about some of the stuff in Maryland that we're doing particularly around telehealth.

NNAMDIDo that. But please make it brief.

LUKEOkay. Well, we did cut off the session yesterday. The session the legislators were able to get through a lot of legislation around expanding telehealth services. So if you are looking for that keep an eye out if you live in Maryland. I just wanted to throw that out there.

NNAMDIThank you very much for sharing that with us, Luke. Joining us now by phone is Sheryl Chapman, the Executive Director of the National Center for Children and Families. Sheryl Chapman, thank you for joining us.

DR. SHERYL BRISSETT CHAPMANOh, thank you. Have a good afternoon.

NNAMDISame to you. You work primarily with vulnerable children and families in the region. What are you seeing within that population right now?

CHAPMANWell, I work the children families, who are in school who are poor and who are seeking mental health services on school campuses. But primarily the most vulnerable population we have are children in homeless facilities, short term families in shelters and children who are in the foster care system. We have half of the children in the District who are in care in Maryland. And so these are very very vulnerable populations, children struggling with separation from their birthparents, children who are with their parents struggling with the economic inequity that surrounds everything that their parents are struggling with.

CHAPMANWhat I'm seeing is the need for my staff and volunteers when they're available in this crisis to really support the parents being able to keep in mind that the most important gift they can give their children is modeling for them how to get through a tough time. This builds the child's confidence and builds their sense of assuredness and moving forward. I'm the child of Great Depression parents. You know, they're now 80-90 years old. And there was an imprint left from their struggle through that Great Depression. There will be an imprint left on these children from how their parents struggled through this.

CHAPMANWe see parents so focused on survival and their fear. It sometimes can become gripping. And although we continuously -- because that's what we do, our mission to provide them with community resources and supports and navigation so they can move out of poverty. Children can be reunited and given permanent families. We do see the need to help them focus on what their children are seeing. The anxiety, panic, fear gripping them translates to children who may even be too young to communicate. They may be playing happily in preschool, but they're absorbing it.

CHAPMANWe won't speak to adolescents who are absolutely focused developmentally on watching how adults gets their needs met appropriately is their whole agenda. So we're focused on helping the parents see their children, be able to model confidence and assuredness and be able to work through this, because we will work through this. So we want to model faithfulness and hopefulness versus just being gripped with fear for families, who are already -- for children who are already besieged with stressful circumstances.

NNAMDIWhat you're saying right now seems to be echoing a blog post that you decide -- that you were inspired to write about the impact that panic can have on all children. Is that your main concern in this situation?

CHAPMANYes because life will bring blows and it will come and it will go. We've been here in other ways. And this is maybe novel, but it's not really different in terms of the uncertainty that faces particularly children and families, who are already facing health disparities. I mean, our poor African American families who are dealing with deaths from flu and deaths from diabetes and deaths from hypertension. Infant mortality still comes up and down as an issue. So that's my concern that what will be the residual left, but also what is the opportunity left?

CHAPMANBecause the opportunity that's left is that your children see the character of a parent who can still sing with them, who can help them communicate that their favorite teacher they miss. They miss their friends. They miss the fact that they have no idea if they're going to graduate this year. That they're going to miss the senior ritual putting closure on high school. This is like a big deal and affects their sense of identity.

CHAPMANHow do I put closure on this and then move on to the next phase of my life? Is there a new phase of my life? Will I die too? Will you die? Do I need to take care of you as a parent? How do we take care of each other? Will I have to step up and be quiet while you cope? These are really important dynamic questions. And the way we handle it can really be both good or bad.

NNAMDIWe got an email from Jay who says, "In terms of vulnerable populations I'm wondering if your guests have received any direction as to the best ways to keep children safe who transition between two homes due to a court ordered 50-50 custody schedule. What should we do to keep our kids safe?" Natalia Otero, is that something you can respond to?

MARLOW-OTEROYes. Actually here in the District there is an online process through the court to submit modifications to civil protection orders like the one your viewer -- your caller is indicating. So this still is a process for modifying that due to this -- so that there could be a new arrangement made. So there is some assistance there.

NNAMDISheryl Chapman, what are some of the changes you have had to make in shelters and homes where large groups and families live for things like meals and visitation?

CHAPMANWell, we have to have individual meals now packaged so that we could deliver it to the room of the parent in the homeless facility and the children so they can get their food without having to come into a large group experience. We're doing that in our group homes also. We are suspending external visitation, but at the same time figuring out how we can have, like for example, freedom school done on our sites in small groups of three to five children rather than a big group, because they still need to have fun and parents still need a break while they're having fun. So that we can keep some semblance of normalcy.

CHAPMANWe're doing Facetime so children who are in foster care can talk to their worker, but also can talk to their parents. And we're investigating how we can make sure parents have the kind of telephones that will -- or cell phones that will allow them to communicate.

CHAPMANThis is where we get into the social equity thing, Kojo, because we're living -- we have poor parents living in communities where everyone has a $600 phone. And they don't have that smartphone. And they should have the smartphone so that they can continue the connections not just with their children, but with the system, because everyone is teleworking now. Parents need to be able to access this.

CHAPMANSo we're looking at how we can identify who in our midst needs to have the phone capacity so they can stay telephonically in connection. I heard that that's not perfect, but the Facetiming is a generational thing. And it can be done well where children can stay in touch with their parents on a daily, frequent multi-daily basis, and not feel abandoned.

NNAMDIHere is Diego in Washington D.C. Diego, you're on the air. Go ahead, please.

DIEGOHi, Kojo. I just wanted to share my experience losing access to my therapist because of the current situation. I receive my care through the VA. And through the VA I have access to a therapist that is outside of the VA hospital. She's a private therapist.

NNAMDIDiego?

DIEGOYes.

NNAMDIGo ahead. You missed a few words there. After you said you can see your therapist by way of the VA. Please continue.

DIEGOSure. So they have not been able to -- the VA has not been able to vet my provider and many providers outside of the hospital for telehealth access, because they are also operating at very minimal staff. So there is one person trying to vet every provider one by one. Apparently it's a bit of an involved process and in the meantime there's many veterans like myself who are not able to access a therapist until they figure out a better way. And I guess my only suggestion would be I know that they have listed a lot of requirements or red tape for Medicaid and Medicare patients to access telehealth. And I'm just not sure why that is not happening also at the VA.

NNAMDIDiego, keep listening, because the next caller I go to may have an answer for you. But thank you very much for you call and good luck to you. Here now is Liz Wolf in D.C. Liz Wolf, you're on the air. Go ahead, please.

LIZ WOLFHi, Kojo. Thank you for taking my call. I work at Mary's Center. We are a community health clinic here in D.C. And I am the Director of Clinical Services for our Behavioral Health Department. Mary's Center serves primarily D.C. residents with Medicaid and Medicare as well as people out in Maryland. We have a couple of clinics in Maryland as well. We serve a lot of Latino clients in D.C. and Spanish speaking immigrants here in D.C.

LIZ WOLFWe have a pretty large Behavioral Health Department with about 65 child and adult therapists as well as community support workers and psychiatrists. And we over the last week have had to mobilize our team to move all our services to virtual services, which has been a pretty big lift. Thankfully prior to this crisis we were already using telehealth. We used the Zoom platform for telehealth and we were already doing that. A lot of our providers are already familiar with that. And we already had the infrastructure built for that.

LIZ WOLFSo we've been able to transition almost all of our care to virtual care through tele-psychiatry and tele-behavioral health. And I have just been so amazed and grateful for the ways that my team has been able to transition to using telehealth for all of their clients. Everyone is working from home. All of staffers are working home. And our clients have really been able to engage with that platform for the most part. And as other callers have said, a lot of the regulations have been relaxed, which has really eased that transition for us.

NNAMDIThank you very much for sharing that with us. I hope you can be helpful to people like our last caller, Diego. We are almost out of time in this segment, Sheryl Chapman. But a lot of families are struggling with this new reality. School closed, parents working from home or being out of work all together, children's routines being disrupted. What is your advice to parents? How do they explain all this to kids without causing more fear and panic? We have less than a minute left, but go ahead, please.

CHAPMANOkay. Real quickly I think that parents should sit down and talk to their children. Play with their children. They can draw stuff if they're preschool. Talk to them about what they're hearing. Adults are connected to the media directly. What are they hearing? What are their concerns? And answer their questions or get help questions if you like.

CHAPMANBut I think most importantly is that the children should feel that they are still the center of their parents world. Even as the chaos of schooling them and their being home and the abnormality of that, they should feel that we're a family. And it matters what you feel and we're going to be okay, because we are going to be okay. They have to believe that. And they have to communicate that regularly. And it matters that they do.

NNAMDISheryl Chapman is the Executive Director of the National Center for Children and Families. Thank you for joining us.

CHAPMANThank you very much, Kojo. Appreciate your role in the community.

NNAMDIMeredith McKeen is a Social Worker and Director of Multicultural Initiatives at Northern Virginia Family Service. Meredith McKeen, thank you for joining us.

MCKEENThank you for having this topic.

NNAMDIAnd Natalia Otero is the Co-Founder and Executive Director of DC SAFE. Natalia, thank you for joining us.

MARLOW-OTEROThank you so much. Would it be too much to ask to give the hotline number?

NNAMDINo. Go ahead.

MARLOW-OTEROGreat. So we can be reached at the D.C. Victims Hotline. The number is 1-844-4HELPDC and if you want more information about us we are at www.dcsafe.org.

NNAMDIThank you very much for joining us. We're going to take a short break. When we come back we will be focusing on how persons with disabilities are dealing with the coronavirus pandemic and how people who need food are dealing with this. I'm Kojo Nnamdi.