Appendix

From In Good Hands by David Hechler

Interviews with Two Experts

In Good Hands by David HechlerEach of these women offered practical advice about how to keep children in day care safe. The second pointed out that her comments are just as germane to the care of a host of other vulnerable individuals with whom she has worked, including the elderly, people with disabilities, and patients in hospitals or rehab facilities. Neither of these experts was shown the manuscript of In Good Hands in order to ensure that their answers were independent and based entirely on their own knowledge and experience.

Each of these women offered practical advice about how to keep children in day care safe. The second pointed out that her comments are just as germane to the care of a host of other vulnerable individuals with whom she has worked, including the elderly, people with disabilities, and patients in hospitals or rehab facilities. Neither of these experts was shown the manuscript of In Good Hands in order to ensure that their answers were independent and based entirely on their own knowledge and experience.

Flora Colao was interviewed on October 10, 2015.

Flora ColaoColao, who was sixty-two at the time of this interview, is a therapist who works with children and adults on detecting, stopping and treating abuse and other trauma. She is also a consultant and teaches personal safety and crime avoidance. She earned a master’s in social work from Adelphi University in 1976, and went on to found two programs in New York City: a rape crisis center at St. Vincent Hospital and the Children’s Safety Project at Greenwich House. As a pioneer in working with child abuse victims, the only training available in the 1970s, she says, was workshops. When her daughter was born in 1976, Colao brought her to work for her first eighteen months. That decision not only solved her own child care problem at the time, it proved to be a canny career move. When St. Vincent colleagues saw all the toys in Colao’s office, “I was getting referrals because people assumed I worked with kids before I actually did.” She still spends about a week every month in New York, but she’s now based in San Francisco.

Q: Have you had experience dealing with safety in day care—both home-based day care and day care centers?

A: Yes. I’ve worked with children who were victimized in those settings. I’ve also had parents who were terrified of putting their kids in day care, or who were terrified that something happened because they saw a change in their child, and they didn’t know what it meant. So a lot of the calls I got from parents were, “I don’t know, should I be concerned?” I have a number of parents with child abuse histories who installed cameras in their homes. They had home-based care of their children, and they wanted to make sure that their kids were safe. And they had monitors that they could check to see what was going on.

Q: Did you find that having a monitor was useful?

A: For a lot of parents, it gave them a sense of security. For other parents, it created all kinds of anxiety. One woman discovered her babysitter—if the baby took a nap, she would leave. Sometimes a half an hour, and [the mother] didn’t know where she went. And that was very disturbing. And then it was, “How do I confront her on this? What do I do?” Another women discovered the babysitter was spitting on her floor. It was: “I don’t even know why this is happening, but it just grosses me out. She’s really doing a good job taking care of my child, but she’s spitting on the floor.”

Q: So they got information, and sometimes they didn’t know how to process it.

A: Yes.

Q: Did you ever advise parents that perhaps they ought to install some sort of monitoring device?

A: I had a mother whose kid had bruises. And she was like: “She said he fell.” And I said, “You can either fire her immediately, take a few days off, and find someone new. Or, how does your kid seem? What’s going on? Have you thought about some sort of monitor?” I always bring it up as a question, not as a suggestion, because I think that parents are already frightened. And for the family that can afford it, then it becomes: “I’m a bad mother if I don’t do it.”

Q: I have certainly read about home day cares where the providers have cameras and make available to the parents the ability to stream what’s happening with their children from their own computers at home or work. Have you had experience dealing with parents on this issue?

A: Oh yeah. And a lot of parents find it very reassuring. For a lot of parents that means: “I know my kid is safe.” It’s like being in the other room, and I can look in the window and see what’s going on. But I don’t have to let my kids see me to get upset that we’re separated. A lot of parents find that very reassuring.

Q: Do you think it’s a reliable indicator about how things are going there?

A: I think it can be. I mean look, if people are going to be deceptive, they’re going to be deceptive. But I do think it makes staff think differently. If you know people are watching, you behave differently. I think that’s the nature of humans.

Q: Have you offered parents advice on how to choose a child care facility or caregivers?

A: Absolutely. The first thing I tell them is they should check in with everyone they know whose judgments they trust. Find out where they sent their kids. What they liked, what they didn’t like. What was the quality of the care their kids got? How did their kids do? How are their kids now? Ask their kids—if they remember it—how do they remember it? Because the kid’s assessment is probably your best assessment. If the child is articulate enough to tell you, you’re going to get a much clearer understanding of what it was like. Kids will be very precise in their detail of what they like and don’t like. And they’ll tell you if there were mean teachers. They’ll tell you if it’s not fun. Because you want your kids to have fun. You want them to thrive. You want them to learn, if it’s a preschool setting. Mostly you want them to be in a loving environment that’s safe.

Q: At what age are children able to process what’s happening to them and therefore, whether it’s at the time or later, tell you what really happened?

A: I think the information is going to vary. By the time the kid is three or four, they can give you the emotional information. Why a kid particularly likes or dislikes someone varies. I can tell you my own experience with my grandson. We worked very hard to find him a good preschool. And we did. Highly recommended, highly regarded. He initially seemed to be thriving and liking it. Then he wasn’t. He wanted to stay home. Now his not liking it coincided with his baby sister being born. Was it jealousy? You go back and forth. You question yourself, you doubt yourself. It was a place that had all the qualities. You could drop in any time. There were windows you could look in. The caregivers seemed genuinely loving. But he was increasingly miserable. He was like, “They don’t like me. They say I’m bad.” And really, what we later discovered was he had a teacher who just had a hard time with active boys.

There was one point where I decided to pick him up early, and four boys were in the office at pick-up time. Four four-year-olds were sitting in the office, and I walked in and I was like, “What happened?” And one of the kids said, “Oh, he was bad, too.” And then I realized, “You know what? This is the wrong place.” We went from there to a pure play-based place. He didn’t learn a lot, and when he started school, he was completely unprepared. So he had to make up a lot, which he did. But he had a blast. He felt accepted. He felt loved. What’s your favorite thing about school? “Dirt mountain.” He would be outside playing in the dirt. Now he had four loving [parents and grandparents] around him all the time, but he was still in a situation that was not good for him.

Q: Now you described a situation where he had this new sister and all these other collateral issues. And you’ve got separation anxiety. So if a young child resists going to a new day care, is this a red flag? How can a parent tell what’s a real red flag, and what may be masquerading as a red flag but is not?

A: You have to look at it from the whole child point of view. This kid is clearly having a hard time with something. If parents haven’t dealt with their own history, then for them, it’s “Oh my God, she’s being abused.” I have a young mother I work with. She’s constantly convinced her kids are being abused. Because of her own history. It’s like the constant terrorized call. “He had a stomach ache when it was time to go to school.” And I was like, “Yup. Four-year-olds who don’t feel like going to school sometimes have a stomach ache. Let’s see. Let’s play detective a little bit. Let’s ask him what’s going on.” And it’s really walking her through how to talk to her child. What is it about school? “Do you know what you were supposed to do today?” And then it turned out that there was some anticipation about a project they were doing that he didn’t want to do. And that’s really what the stomach ache was. So you have to ground yourself as a parent, take several deep breaths, and be curious and not make assumptions. Because if you’re curious, the kid can eventually get to what it is.

My granddaughter switched classes in her preschool. She’s four. We went through this tremendous separation. “I don’t want you to go. I’d rather be with you.” And then I was like, “Well what is it? I’m trying to understand. You used to love school. And now you’re so unhappy.” Then it was just, “It’s a new classroom. You can’t do a project unless they ask you. And you have to pick a project, and I don’t know what to pick.” It was just: “This is overwhelming for me because the system is different.” Now, if I was a nervous parent or grandparent with my own history to project onto it, I would be like, “Oh my God, somebody in this class is being awful to her.” And I would start looking— because as humans we look for patterns—I would start looking for what’s different about this classroom. Oh, the other one has the door open and this one has the curtain on the door. You’d start looking for wrong things. You have to be open and curious, and try to figure it out from the kid’s point of view.

Q: How important is it for parents to learn to play detective when they’re dealing with day care?

A: I think it’s important when you’re dealing with anything. The truth is you have to be able to know what’s really going on, and the more curious you are, the clearer an understanding you’ll have. It has to be part of your thinking, and not necessarily always assuming something is sinister. I always ask the kids, “What was the best thing that happened today? What was the worst thing that happened today? Was there anything that made you angry? Was there anything that made you laugh?” In just those four questions you get a wealth of information. They’ll tell you what’s going on, because that’s how they remember. “I didn’t like it when Ella wouldn’t share with me. I really liked doing
that project. It really made me laugh when so-and-so said ‘fart’ to the teacher.”

Q: Of course what we’re assuming here is verbal skills that make it a lot easier for a parent to keep track of what’s going on. It’s got to be a lot more challenging with preverbal children. And a lot of them are these days, with two working parents being so common. So for parents who have preverbal children, what are some of the red flags they should be concerned about and try to explore?

A: It’s very tricky with infants. It’s very tricky with nonverbal toddlers. You have to know what’s normal for your kid. If it’s normal for your kid to initially cry at separation, I wouldn’t worry. But if you have a kid who normally cries for a minute but by the time you walk out the door they’ve stopped, who is now clinging onto you—I remember working with a father whose son was abused in a day care center. And he said, “I look back and I remember being angry that he was wrinkling my shirt, that he was clinging so hard that he was crumpling my shirt. And now I feel so guilty. I was worried about my shirt, and here was my beautiful boy going through this, and I didn’t realize it.” Part of it is getting to know what’s normal for your child in different situations. How does your child react to relatives they don’t know, friends of yours they don’t know versus people that they know but are not necessarily family? That’s a good gauge. Also, you want to look at eating patterns and sleeping patterns. Has that changed significantly? The problem is with different stages it changes. But if you’re seeing something that’s really different, that’s certainly something to look at and think about. How their play changes, if they stop playing. If you have a kid who’s normally happy and now is not so happy, you would be concerned about that.

Q: What are some of the positive characteristics parents should be looking for in the facility and the caregivers that will provide them with reassurance that this is the kind of environment that will be good?

A: Is it warm and loving and does it seem to be responsive to kids? Do they have age- appropriate toys? Do the other kids seem happy to be there, or is everybody crying or sleeping? I’m always concerned if they’re all sleeping. I’ve heard of situations where kids were drugged, because that made life easy for everybody. Does it seem physically safe? Does it seem baby-proofed and child-proofed? Does the caregiver seem to have an individual understanding of your child?

There’s one of the best home day cares right in my neighborhood. I see them in the park all the time. They’re limited to six children because the director puts her own kids in. And one of her things is she takes kids out every day, no matter what the weather. She tells parents, “I believe very strongly they need to be outside. No matter what age they are, they get at least a half-hour outside every day. We go across the street to the park.” I’ve seen her with kids in the rain, splashing in puddles. In the sun, playing in the sand box. I see her all the time. One of the things that’s really wonderful is that she genuinely adores all of her kids. But she’s also very clear on their individual personalities. So she’ll say, “This one’s a shy one, so back off; don’t rush her. He’s really active. I’ve got to watch him. He’s going to climb.” She knows all the kids very quickly. And so does her staff. She knows who has allergies. “Put extra sunscreen on her. That one will never keep a hat on her head.” You want to look for: Do they have an individual sense of who they work with?

Q: Suppose a parent does some research, checks some references, goes to meet with the caregivers at this facility that’s highly recommended, is able to observe and feels pretty good, and then she notices that there’s an outlet that’s uncovered. Is that a deal- breaker?

A: I think you bring it to their attention. “Hey, wow. I’m really liking everything, but I see that outlet’s uncovered.” Sometimes there’s a very simple explanation: “I totally forgot. I was plugging this in. Thank you for bringing it to my attention.” Then it’s sort of like, we all do it. We all make those quick errors. But I would also be more watchful. I would come back unannounced a couple of times to see what’s going on.

Q: What if the caregivers don’t like the disruption of having people come unannounced?

A: I would want to know the rationale for it. And I would want to let them know. The couple of moms I know who had their issues, one of them was just really upfront with the day care center. “I know you’re perfectly fine. I have heard only good things about you. I really have this terrible anxiety. If you tell me I can’t come, I can’t leave him here.” The woman was like, “Oh, I’m so sorry that happened to you. Yes, of course.” Once she heard that, she only needed to drop by once or twice and she was fine. The other thing you can do, and I have had parents do this, is say okay. And then say, “Oh, I have to pick him up early today.” And show up to pick him up early. I think there are ways to do it. “Oh, I’m sorry, I’m running late.” And show up late to see what it’s like when other kids are there.

Q: Do you think visiting unannounced or unexpected periodically is a really important part of playing detective?

A: Yeah, I think it is. It’s an important thing to be able to do, and it’s important to know. But I think the bulk of the information you get in regard to quality child care is from other families and particularly other kids. And you see kids who thrive and you see kids who don’t. I got a call recently from a grandmother, and she said her daughter is in a single-parent situation. Has to work. Works full-time. She’s got him in a day care. He’s sick all the time, but what she finds really distressing is he’s so aggressive. I heard this and I thought, “This may be this kid. But I wonder, is he somehow having to fight for attention? Is he not getting attention unless he’s fighting?” When you see that kind of behavior, what else is going on?

Q: How important is it for parents to talk to other parents?

A: I think it’s crucial. And not just one other parent, but several other parents. And finding out what their experience is, what works. For millennia, children were raised in communities. That’s not happening anymore.

Q: We’re talking about after they select the day care. When their kids are in day care, they don’t just assume everything is going okay. They need to keep talking to other parents. What is going to come from those conversations?

A: I’ll use my grandson’s example. He was miserable. He was one of four children with a time-out in the office at four years old. At his birthday party, my daughter casually said to one of the other parents, “I don’t know what I’m going to do. He just hates school.” It set off this groundswell. The other mother said, “So does mine.” We found out that all the boys hated school. This was not an individual child’s problem. This was a systemic problem. So talking to other parents: “How’s he doing? How’s she doing? Does she like school? She really hates the art class.” It’s all information that’s helpful.

Q: What about the relationship of parent to caregiver. Let’s assume we’re dealing with a mother who is the primary contact and a female caregiver. I’m aware of situations where there was a real closeness and a bond formed between the mother and the caregiver. And that seemed very important to the mother. Is that an important factor— positive or negative—in the day care equation?

A: Oh I think it can be a very important factor. Look, there’s positives and negatives in everything. But I think that if you feel close to the people taking care of your kids, you do feel like you can rely on them and you’re going to get the feedback you need when something’s up. The negative side is that it’s always hard for us to see flaws in people we care about.

Q: What about the way that relationship can affect a parent’s willingness not only to see problems, but to act on them?

A: Then you need sort of a sounding board. If it wasn’t somebody you knew, what would you do? Or if someone came to you, what would you do? I do that with kids sometimes. Would you want your best friend to go to this school? “No!” Okay, why? “Oh, she’d hate it.” That always gives you a clue of what’s going on.

Q: How difficult can it be for parents to decide they need to make a change in day care? What are the factors that can make it difficult?

A: It is very difficult. Because it is starting the process all over again, having had a negative experience and wanting to avoid that. So in some ways you’re having to reassess how you made your first decision and trying to figure out your next decision. And all the more reason you’ll need to rely on parents. And you’ll need to be able to articulate what went wrong the first time around, and what you’re really needing this time around. My grandson being the perfect example: We knew that the second place was not the ideal place for him, but we knew it was the right place as a stopgap.

Q: Have you counseled parents who were in the process of deciding to fire one day care and hire another one?

A: I have. And it’s hard. Sometimes it’s really clear why they’re leaving. Sometimes it’s just not the right fit. It’s not the right fit for my child’s temperament. And it becomes an issue of knowing your child and knowing what works for your child.

Q: Have you found sometimes that the parents have a hard time accepting the role of being the employer firing an employee, and feeling that they need to have justification that they can articulate in order to feel that they can do so?

A: Yeah. It’s funny you should say that. One mother was like, “My kid is miserable, but there’s no real reason.” And I was like, “That’s a reason. Your kid is miserable. For whatever reason, this is not a fit for your child.” The kid would say, “She’s boring.” And it was really that you just had someone who didn’t play with kids, and he really needed to be engaged. She was keeping the kid clean and fed and taking the kid to the park, but she wasn’t engaging and the kid was unhappy. That’s a reason. Being unhappy is a reason. Sorry, it isn’t about you. It’s the way your personalities are. But that was a reason. I think we all feel like we have to give—I had one mother who said, “Well I’m just telling her I’m moving.” Because she was going to move in a few months. She said, “I’ll just tell her I want to get the new person on board before the move, because I don’t want to hurt her feelings.”

Q: That’s a big deal, isn’t it? The hurt feelings issue.

A: Exactly.

Q: And was that okay?

A: Look, whatever it takes to get it done. Whatever your reason, it doesn’t matter. You want your kid in another setting because this one isn’t working.

Q: Is it okay to make things up?

A: Why not? I always tell people, “Lying is an important social skill that we rarely teach our children except by example.” Now obviously you want to be honest on the important things, but there are times that it just makes things easier to say this is what’s going on because it’s pragmatic. What I always try to do with people is, “Okay, what is it about owning this that’s so hard for you?” You usually have someone that’s spent their lives pleasing others, so they would rather lie because it’s too uncomfortable for them. I do try to get them to work on that. “Why is that so uncomfortable? Aren’t you entitled to all your feelings the same way your child is? It’s interesting to me that you’re saying your child’s feelings are important, and that’s why you want to make the change, but your feelings are not important enough. We should maybe work on that. But do whatever’s easiest to get this done.” That’s the other piece of it. Otherwise people, while they’re working on themselves, don’t get what needs to get done for their kids, and their kids have to be the priority.

Q: How can parents know what’s going on in their children’s day care? What you’ve told me so far is: They can talk to other parents. They can talk to their children, if their children are verbal. They can…

A: Observe when they’re there, observe other kids.

Q: Observe in the park, if it’s a facility that takes kids out, as the one you described. Some have camera capability—they can monitor remotely. Are there other ways that we haven’t talked about that parents can find out what’s going on in their children’s day care?

A: If you can find someone that’s already been through that program, you want to talk to them before you enroll your kid. I would also talk to the teachers. They let you know some of what’s going on. Both the positive and the negative. “What do you like about working there? How long have you been there? I have a colleague whose daughter is thinking of going into this [field]. Would this be a good place?” They’ll tell you. I had one teacher from a day care center say, “Well, we haven’t had a raise in four years.

Everybody’s getting frustrated. It’s not easy work.” That’s an interesting thing, because if you have unhappy employees, it makes it harder for them to be patient and loving with your kids.

Q: You’re thinking of larger set-ups where there are multiple employees.

A: It’s harder with home-based day care, when there’s a lot of infants. I’m a great fan of volunteer something if you can. I’ll do a story telling sometimes or a story reading. I’ve done crafts projects at different centers. Because I think it does give you a sense of what’s going on and how they interact.

Q: There’s one thing we haven’t talked about. What about the government? Does the government help to keep day care safe?

A: Well there are all kinds of regulations and accreditations. So you definitely want to have a place that’s accredited, that meets all the guidelines. And that does mean fingerprinting staff, that does mean doing background checks, all of that.

Q: In some places at some levels. Home day care does not necessarily require what you just described.

A: In California it does. Everybody has to be fingerprinted and go through a background check before they can set up a legal home day care. There are illegal ones all over the place, but to be a legal home day care you have to. It’s not hard to set it up. It’s time-consuming.

Q: Would you have confidence that a day care center that did all that was required would then qualify to be called safe?

A: Well I certainly think it’s safer. It’s much safer. And then you want to look at what it’s like in terms of child friendly—then all those other things need to be looked at.

Q: Based on your knowledge and experience, whatever state someone lives in, how much can you count on the government monitoring safety in day care in the United States in 2015?

A: It’s probably cursory. I think people get licensed. Once they’re licensed, not a lot is looked at. There aren’t repeated checks. But all new employees, at least in California, are supposed to go through the checks. It’s safer, but you still have your own work to do. Let’s put it that way.

Q: It sounds to me from our conversation so far that there aren’t a lot of bright lines that allow you to tell parents, “If you see this, do this.”

A: No there aren’t.

Q: There are a lot of gray areas. But are there any bright lines? Not even something that you set out in advance. But just looking back on your experience, have there been behaviors that have been described to you where you say, “If it were me, I’d be gone tomorrow”? Bright lines in child care.

A: I think the father, when he was saying his kid was clinging onto him. When you have a kid who’s pleading with you, “Please don’t leave me there.” That’s pretty right there. There’s something wrong. The bright line is really: Know your child and know what’s really out of character for your child. No matter what their age, you know it. And the more tuned in you are to your child, the clearer it’s going to be when something’s wrong.

Q: From the little research that’s been done in this area, it appears that home day cares, small home day cares, are the most dangerous for children. Does this correspond to your experience and your view?

A: Well, you know, I’ve had a few people who went to home day cares where something went really wrong. I think home day cares—I would have to check the research, but there are a lot more accidents in home day care. And I think the situations where there have been outright abuses, they happen everywhere because it’s dealing with a troubled person or troubled people. And that’s a different kind of situation. But accidents, the less monitoring and the less-—Sometimes it’s just lack of information. People don’t understand why something would be dangerous until a terrible accident happens. So it makes sense to me that home day cares may be more dangerous, but I suspect this might be more about accidents than abuses. But I don’t know.

Q: Two of the explanations I’ve heard from another expert who has studied this—and there’s a lot of speculation, because as I said, there isn’t a lot of research—but one is that when you have a single individual in a home, it’s common that they take care of more children than they’re supposed to. The legal number is often six, and that includes your own children under the age of twelve.

A: Right.

Q: And many of the women who are doing this have young children, but many take more than six in addition to their own. And the more children you have, the less supervision they’re getting.

A: Right.

Q: Second, in a day care center or a preschool like the kind you’ve been discussing, where you have three or four employees, there are not only parents watching, there are other employees watching…

A: Coworkers watching, right.

Q: When you have one person working alone, there’s less of that kind of scrutiny that you talked about earlier. And that may lead people to behave in ways that aren’t safe.

A: Yeah, I think that’s true.

Q: Now I want to go back and look at some of the things you’ve said, and maybe you can expand on them. What would make day care safer in this country? If you were the day care czar—if we had a day care czar, and you were she—and you could wave your wand and say, “By my decree, tomorrow all of these things will be true of every day care in the country,” what would you do?

A: First of all, you do need whoever is providing day care to have child development information and training. And that’s something that should be publicly available, or very low cost. Caregivers need the information, they need to understand what children are like at different stages of development, what their basic needs are, how you are enhancing their development by things that you do. That has to be part of it. It does need to be a situation where there are regulations that make sense and they’re uniform. Because at this point I don’t think they are. So there needs to be training, there needs to be education, there needs to be accreditation. There need to be safe environments.

Q: When you say caregivers need an education in child development, it’s possible that some people are thinking, “Well, they’ve been parents themselves and they’ve raised a kid up to age fifteen, and now they’re running a home day care. They obviously have their education in child development through the experience of raising a child.”

A: Right. And they have it for children of the temperament of the children they’ve raised. They don’t necessarily have it for the temperament of other children. And I’m not saying they have to go back and get a degree. But I think workshops on child development, workshops particularly on zero to three.

Q: So there’s a lot to learn beyond simply your own experience as a parent.

A: Exactly.

Q: Are there other things you’d like to see widely adopted in child care?

A: Work-based day care. That’s the other thing. Families do better in the places where there’s a day care center at the workplace, so parents can go and visit their kids on lunch hour and see that they’re doing okay. That’s something that’s really helpful.

Q: So if more companies made a larger commitment to making day care part of the benefit package—

A: Then you’d have happier employees, fewer absences. There would be so many things that would work well with that set-up. And in terms of technology, that’s all part of it. I think it’s reassuring to parents to check up on how their kid is doing. I know one mom: “Oh, I just keep the little screen on my computer at work. And then I just periodically say, ‘Oh, what’s he doing? Oh, he’s fine.’”

Q: There’s no reason why there couldn’t be that little window on every parent’s computer, if there were a commitment—if the government offered funding. Or maybe it should be the parents who decide—the equipment isn’t that expensive—“We’re willing to go in on this.” Or maybe the providers should charge a little more money and install the equipment themselves. Is this important?

A: I think it depends on—You know, some people see it as invasive. You kind of have to figure out what works for you and what does not.

Q: Any final thoughts?

A: When you visit a program or a place or someone’s home, look around and say, “Is this someplace where I would want to be?” My granddaughter’s day care center, you walk in and you see places to climb, places to flop down. There’s a fish tank. There’s art all over the walls. It looks like a fun place to hang out. So you also want to get that feeling: What does it feel like to be here?

Nora Baladerian was interviewed on October 11, 2015.

Nora BaladerianBaladerian, who was seventy at the time of this interview, is a psychologist who is best known for her work with children and adults with disabilities—especially those who have been victims of trauma or abuse. Based in Los Angeles, Baladerian earned her PhD in psychology at Sierra University in 1985. She currently directs the West Los Angeles Trauma and Crime Victim Center, and is a prolific author and frequent guest speaker at professional conferences. She also has experience working with the elderly. The focus of her work these days, she explains, is reducing the risk of abuse. And a big part of that is convincing the primary caregivers of individuals who are enrolled in programs that abuse can and does happen everywhere. To illustrate, she described a special school for children with disabilities where eight children with autism who were all under the age of ten were beaten daily and subjected to verbal and emotional abuse. Their parents noted the children’s bruises and their drastically altered behavior, and asked the teachers for explanations. “Here’s the interesting thing,” Baladerian says. Even though the parents did not believe the “stock answers” they were given about children “playing rough” and falling down, “there is a universal denial that the school staff could be the source of their children’s problems.”

Q: I don’t know if you’ve had enough experience with day care settings, such as the kind I’ve been looking at, but the parents you’ve worked with have a certain relationship with the teacher, a certain respect for the teacher’s role, and when they’re told by the teacher, “This is what’s going on,” they have a tendency to accept that. I’m wondering how that might correspond to the head of a day care, whether it’s a larger center or the kind I’m looking at, a home-based day care.

A: What I’m looking at is a loyalty to the teacher or the program director. They really, really trust this person.

Q: Why?

A: Ah. Well, I think one aspect with my kids—but I think it’s true of any kids—the individual who is the care provider has a reputation. And so they trust that. Oh, they’ve been here for a year or two years. And they have let’s say a day care license. And we know that when people are licensed they have met X criteria. And they would not want to lose their license, because this is their livelihood. And look at how wonderful they are, because they’re dealing with kids all day. And that’s a hard job. That’s a really hard job to deal with ten, twelve, eight kids or whatever. So there’s enormous trust without reflection. They’re not asking questions. They’re not insisting on dropping in. Which is part of my Ten Tips [on my website].

Q: And that’s the next thing I was going to ask. You mentioned that the school you were looking at didn’t allow unannounced visits. Some parents get around that by picking up a child early or late. Is that something that parents were able to do to allow them to get insight into what was going on?

A: They didn’t tend to do that because they didn’t suspect the school.

Q: What about peering through windows? Was that even a possibility at that facility?

A: It didn’t occur to anybody that I’ve talked to so far, which is a lot of people. You peek through a window if you suspect something. But they weren’t suspecting the school. They would talk to their partners—their husbands and wives: “What in the heck could be going on?” And they would even dance around it. “Well, do you think it could be at the school?” “No. It couldn’t be.”

Q: I’m wondering whether—not in this place, because you’ve already spelled out the limitations of the inquires—but there are plenty of examples of technology being used to help parents monitor all kinds of facilities. The nannycam, if you have an au pair. You’ve got home-based facilities where there’s a camera in a room that’s often used for the children’s care. Is any of that being used these days, in your experience, to give parents of these children an opportunity to see how things are going?

A: No. There’s been quite a bit of discussion about that. The petitions that have arisen asking for some kind of electronic monitoring have universally been denied because the recording would involve other children. This is a public school—or it may be a private school funded by the county. And so it would violate privacy rules. So no, you can’t do that. In Texas in August or September 2015, they finally got legislation passed that allows videos in special ed classrooms only. But that’s the only state where that’s happened. Now parents have put recording devices—audio recording devices—sewn them into their kids’ clothes. Interesting, huh?

Q: Surreptitiously.

A: Oh yes. Because they’re not allowed to record anything. So they sew it into their kids’ jackets and things like this. I love those. And then they have listened later. None of the parents that I’ve worked with directly have done that, but I do a weekly news feed. I read news articles on abuse and people with disabilities across the nation every week. So I kind of keep up with that.

Q: Wow.

A: Parents who have done the recording surreptitiously and then listened to it later have heard horrible goings-on, and usually that’s their [kid’s] last day at that school. And then the next day they may confront the school or they call the police or something. But those are the only parents that have gotten through that barrier, the invisible brain barrier that says, “It couldn’t be at the day program. It’s got to be something else.”

That’s why I wrote the Ten Tips. That was for a woman who was seventy and finally said, “I cannot adequately care anymore for my thirty-six-old child with autism. I just can’t do it.” And so very reluctantly she put her child into an independent living program with caregivers in his apartment—three staff—who would be caring for him. He started to have bruises when she visited him once a week. And she asked, “What’s going on with the bruises?” And the staff said, “Oh, you know, he falls a lot.” So after many weeks of that, she hid a nannycam in his room. And after a week she came home to watch it, and what she saw was her naked son on the floor of his bedroom being kicked and beaten by two of the male staff while the female staff watched from the doorway.

Q: Awful.

A: And that was pretty much daily. So then she knew what happened. And after two
weeks of this—he’s continuing to get beaten—she went back and confronted the staff, which is not the recommended thing to do. But nonetheless, that’s what she did. And their immediate action was to do what? Run to the bedroom and find the nannycam currently running and destroy the evidence.

Q: That’s right in your Ten Tips: why not to [confront abusive caregivers].

A: It’s ten tips to become aware that abuse exists period. And that there isn’t any one locale—school, or a day program, or a residence—that’s going to be safe. Just know that. It’s basically for [parents] to have a wakeup call. Abuse exists. It occurs anywhere you are not with your kids. If you see signs of anything that is weird, odd, off, let that be a wakeup call to you to heighten your awareness, and then to start doing something different. Dropping in, asking for supervisors, changing staff, putting in a nannycam. And when they feel sure that their child is being abused, remove the kid and call the authorities. And document what they’re doing. But the first thing that has to happen is awareness that abuse can and does happen in places where you’ve been promised it will never happen.

Q: Let me ask this. You’ve written that you are not a suspicious person. You expect that people will behave properly.

A: [Laughing] How dare you! How dare you!

Q: And you recognize that sometimes this doesn’t serve you so well. And you have to make adjustments. And you can try to train yourself to be more suspicious. But you choose not to try to change your personality, just adjust as you must. I said that not to try to contradict what you were just saying, but to ask you this. Do you recommend that parents, when their child is in a day care or a facility like the one you were describing, should their attitude be one of suspicion? Or what kind of attitude do you recommend they enter with?

A: Oh, um…I don’t know exactly how to characterize it. That’s a great question, and I feel like I’m caught with my pants down. On the other hand, this is a very specific kind of situation. If I have a kid that needs care, I’m in a different situation. Or if I have a parent [who needs care]. It could be anybody. But if I am responsible for another human being, and I have to deliver that human being to X location, I think it’s good to know a couple of things. One, anybody can be abused anywhere. You don’t have to have a disability. I was just working with a person who was a hospital patient sexually assaulted right after a procedure while she was in the twilight zone. She was definitely disabled in that moment, but she’s not a person who has a disability. But I would say, in answer to your question, because children are so vulnerable, that’s a reason to say, “I wonder what precautions I should be taking.” It’s knowing that my special person is more likely to be a victim of abuse than others. That would be an important piece of information to have. If I have that piece of information, then I might be more alert to changes that signal abuse.

Q: Changes in a child’s behavior, you mean.

A: I do trust people, and I have gotten into very bad situations because I do trust people. I just do. But in this, I’m talking about the importance of being alerted to possible danger. It would be a great help in not necessarily avoiding but maybe shortening the time when somebody is under an abusive situation. I mean if my kid came home with bruises all of a sudden one time, and I was told, “Oh, well, they were falling on the playground,” I might buy that. But I wouldn’t buy it every day if I were made aware that abuse happens, and it happens by responsible adults in responsible agencies. That’s the difference. The Ten Tips works just as well with seniors as it does with children or adults with disabilities.

Q: I’m glad you brought that up. And we’ll talk about seniors again before we’re finished. But I want to focus on the kind of balance you might try and strike between creating in the parent’s mind the possibility that something bad could happen and scaring the bejesus out of them when they’re already nervous—especially in the early stages of sending a very young child, an infant or a toddler, to day care, which is not even necessarily a choice.

A: To me, it’s sort of like saying, “Never cross the street.” There’s the possibility if you cross the street you’re going to get squooshed like a bug, right? It’s a kind of balance. I don’t know if you remember this: Trust and verify. It’s all trust and verify and monitoring for me. And so that’s why in my book on risk reduction, I promote the idea of getting to know the people that are going to be caring for your kid. But not only getting to know them, verify what you’ve learned. So, for example, if they come to see me as a therapist, and I see their child alone in a room behind two locked doors—the one to the office and the one from the main reception area—how do they know I’m not abusing their kids? They don’t. But a precaution might be to look me up and see if I’m really licensed. And a precaution might be to inquire about me to other people that they may know, or sit in the room with me. Or what I do is I invite them to do this. I leave my doors unlocked between the hallways and my office, and I invite parents to pop in for no reason from time to time, so that the kid gets the picture, “Oh, my parents could pop in anytime.” It’s a safety factor and a model.

Q: Is that really important for day cares, that they are open, accessible, available?

A: Oh yes. People should be invited to pop in anytime. And if they’re not, if they’re told, “No, you can only come at X hours” or “You have to have an appointment”— Actually, in several of the cases that I have been working on, they have been told, “You can come visit anytime you like, but you have to have an appointment.” Some parents figured that out when they were seeing these vast changes in their kids, and just decided to go without an appointment, and have seen—Let’s see, who was that? One had the aide who was kicking the child—and that’s when there were bruises—and another was where her kid was put in the cage all day. And when she would go for visits to the classroom before, she had to say what time. The office would call the teacher and say, “Sally is coming,” which gave them enough time to get the kid out of the cage. So she never knew.

Q: Is that a deal-breaker: You can’t visit unannounced without an appointment?

A: Yeah. Absolutely.

Q: That’s a red flag that says, “I’m not using this facility.”

A: Absolutely. And the same thing for a nursing home. I used to work with the elderly. That’s an absolute red flag.

Q: Are there others that you feel as strongly about?

A: Here’s another thing that I’m very unhappy about: background checks. The fact of the matter is you can do background checks initially, which is usually done. Often in day care, because they’re tight for getting staff in, they don’t complete the background check before employment begins. But even so, the background check depends upon how extensive you do it. You could do one that’s just for your county, or you could do one that’s just for your state, but it doesn’t address certain things. If he’s moved into the state from another place where he’s been in prison, for example, it’s not going to show up. I had a client who was sexually assaulted by her Medicaid-paid transportation provider. In the aftermath—after she reported it and it was being investigated—the law enforcement officer went to the transportation provider’s office and said, “You have hired this person. Did you do a background check?” “Sure did.” And the officer said, “Can I see it?” And the provider reached into his desk and pulled out an unopened envelope. So the officer said, “Let’s open it.” And they found that he was a convicted murderer on early release.

And that’s why my client and others were sexually assaulted by this guy, who actually left her in the forest to fend for herself, and she got up and ran after him and said, “You have to take me home. My mom’s going to be really mad that I’m late.” Which is very typical of people with developmental disabilities. However, this guy is out now. And he can go to any state not contiguous to Oregon and work without that being found out. He can work in elder care. That’s easy. He can work in day care. He can work in anything, and it’s not going to be found out unless they do a more extensive national data background.

Q: Is there a national database?

A: No.

Q: Is that something you advocate—that there should be some big national database for caregivers?

A: Of course. Absolutely. Can you imagine if in the day care programs you’re working with they have convicted murders out on release, having paid their debt to society? So that’s why I say, “Parents, do your own.”

Q: Now home-based day cares are a little different in that they’re really small. The provider is usually a parent, usually a woman who often has young kids of her own. Many times they’re not registered. They may charge less money. They may have good word-of-mouth in the community. And those who are registered—in South Carolina, to register a home day care, you just have to fill out a piece of paper and get three people to write recommendations for you and voila! That’s it. So there isn’t any real check.

A: But the parent can do their own check. They can do their own background check and they can Google them, for goodness sake. “Mary Jo Smith arrest.” “Mary Jo Smith abuse.” And you can do your own background check. You can pay for it yourself. I think it’s worth $15 or $30 [which some online services charge]. It’s your kid’s life. So if the state doesn’t do it, then fine, the parents should do it. If their kid needs a shot, they’re going to pay for it. If they need a child car seat, they’re going to buy it. So why not buy some knowledge about the person? And it’s not just the woman. Who else is in the house? That’s when we get into real trouble. It’s the boarder, it’s the uncle, it’s the grandpa that could be abusive, a drug addict, somebody who’s not doing too well so they’re staying at mom’s house, or grandma, or auntie, or whatever she is. They’re making a little money mowing the lawn, and might not have such a great background, and you wouldn’t necessarily want your kid with that person.

Q: And the other thing about the home-based day care situation is most states have a rule that says you can only care for six children, and that includes your own children under the age of 12. And I think it’s extremely common for that rule to be ignored—by both the caregiver and the parents, who obviously see different numbers than what they ought to know is the requirement.

A: In the home, if those people were asked, “You know, I’d really like to have a nannycam in here. Is that okay with you?” Would most say yes or would most say no?

Q: Good question. I don’t know.

A: I think it’s a test. I think if they say no, I might choose somebody else. Because why wouldn’t they be open to having the day care available remotely? Now we’re in an age of knowing. When my kid was young, my kid went to day care of course, and I never was alerted to any of these things. But I remember I did take her out of one after a week. And I can’t remember exactly what all the circumstances were, but I had a bad experience or a bad feeling. I didn’t see anything bad happening, but it just was not good. And I removed her. I was innocent in those days to this as a problem. And I actually got very good day care most of the—all of the time.

Q: The most vulnerable population is young, preverbal children—infants and toddlers —who can’t communicate in words, can’t come home and complain by speaking sentences…. You’re dealing with a population where the communication difficulties can be common for years, maybe a lifetime. And that has to create a real vulnerability. How do you and the parents deal with that?

A: I wrote a book called “A Risk Reduction Workbook for Parents and Service Providers: Practices to Reduce the Risk of Abuse, Including Sexual Violence, Against People with Intellectual and Developmental Disabilities.“ I couldn’t think of a longer title. It’s a complex rubric which I think you’ll be able to grasp pretty quickly. Before, during, and after. You like that?

Q: I get it.

A: Yeah. And the analogy is some natural disaster: floods, hurricanes, tornados, earthquakes, whatever. We don’t want it to happen, but it could. And a lot of people prepare—like if they know a hurricane is coming, they leave. They drive away. Or if it’s an earthquake, a lot of us in California have earthquake separation kits or disaster kits or whatever you call them. So we’re sort of ready in case that disaster happens. We should do the same with abuse. We should have our disaster preparedness kit, which includes informing the children that sometimes people do bad things to us. It’s just part of life, like crossing the street. You don’t want to get squooshed like a bug. You tell them about getting squooshed like a bug. Not to scare them. Just to say, “This could happen. We don’t want this to happen to you, so we take these measures.” And this is all the “before” [stage].

Now kids who don’t have language, you can’t do this. But for elders who may be aphasic and may not be able to speak anymore, for them they have icons that they can point to, or cards that are like icons that they can put in a sequence to indicate that someone has been hitting them or sexually abusing them or starving them or something. So you teach them. Because they’re taught all sorts of things, you know, “I need to go to the toilet.” Or “I want a sandwich.” Or “I want my iPad.” Their emergency is not having their iPad. They’re able to communicate that in one way or another. Lunging for the iPad. Or lunging for the fridge. Or trying to get water. So parents know how kids communicate whatever it is that they are able to communicate. And then you build on it. So in my book, for example, I have a communication workbook. I just took stuff off the Internet that shows a speech and language teacher, a neighbor, a bus driver, a custodian. So you want them to be able to communicate if something bad happens—which we don’t want, but it could. Who done it? So they can point to the custodian.

Then there’s the “during.” And during “during,” parents can’t do anything because they’re not there. But then “after” is essential. It’s absolutely essential. It’s when they can use that communication book and then reenact what happened at school.

Q: Are you talking about doing this routinely, or only when you know there’s been a problem?

A: When you know there’s something very wrong. When he comes home with bruises. They shouldn’t come home from school like that. That’s when you do your “after.”

Q: I’m of an age, not so different than yours, where I dealt with aging parents. So we find ourselves again playing parent, finding caregivers, doing the same kinds of things that my wife and I did many years ago with our two young boys. In your experience, is this process pretty similar?

A: I would say so. I would put in nannycams once parents are at home, and you have caregivers coming into the home. I would certainly put up nannycams, and I would do the background check, and all the things we’ve talked about. Pop in frequently. I would check weight, and health, and blood pressure, and the indicators for aging people. I would check the meds. Do the meds seem to be disappearing at the rate they should be? Or are the pills gone—being sold somewhere? Are they losing weight? Gaining weight? Sleeping all day? So it’s basically the same stuff. It’s trust but verify. And it’s monitoring, monitoring, monitoring. If I could put it in three words, it would be: “trust, verify, monitor.”

Q: Those are good ones.

A: If there were another one, it would be “awareness.” Be aware that abuse can happen to your loved one. They are vulnerable. So it’s assisted living. It’s an acute care hospital, where I’ve had several clients who were sexually abused. One was a woman with an intellectual disability and a broken arm who was sexually assaulted by the nurse’s aide. And she reported this to the charge nurse, and the charge nurse said, “Oh, my gosh. Don’t tell anybody. Don’t tell anybody else. We’ll take care of it.” And she reported it again to another nurse, and then all the nurses got mad at her. And then they
had the HR person finally come down, who told her, “Don’t tell anybody.” Nice, huh?

Q: Yeah.

A: So a few weeks later she told her mom, but by then all the evidence was gone. She was in there for a broken arm. It could be anywhere.

Q: We all have occasions when, if we are not permanently disabled, we are temporarily disabled. And I was thinking about sexual assaults on campus and how frequently alcohol is involved. It’s like you are disabling yourself.

A: Oh yeah. A self-induced temporary disability. There’s a lot of drunkenness around these parts. Yeah, we do that to ourselves, and it’s sort of acceptable. But I think that abuse at any level of any person who’s vulnerable at any time [is unacceptable]. Sometimes people say, “Oh, the MOST VULNERABLE PEOPLE ARE…blah blah blah.” I go to these conferences all the time, and it says, “Most Vulnerable Population” and then it names some teenagers or whatever. And I’m thinking, “What about the three- week infant that’s being sexually assaulted by the dad? That’s pretty vulnerable.” I don’t want to make comparisons, but how many thousands of infants at their six-week check- up have syphilis and gonorrhea? But you can’t really say, “I don’t like comparing, though my people are THE MOST whatever.”

Q: I think most people in this country don’t understand that, or want to understand that. They don’t want to even contemplate it.

A: Yeah. And they don’t want to contemplate abuse of children. And they don’t want to contemplate abuse of children and adults with disabilities. Even elder abuse has finally, over the last twenty years, gotten some play. And still we don’t have general knowledge of abuse of people with disabilities. And I don’t know how much is really accepted about abuse in day care. Do you?

Q: No.

A: Is it a high awareness or a low awareness?

Q: I think it’s a pretty low awareness because people, when they select a day care, they get really emotionally invested in believing a) they made the right choice; and b) this person loves my child as much as I do. My child is in as good hands as he or she would be with me. A lot of people have a need to believe that because they feel guilty, and because they really, really want to believe it. Flora Colao, who I interviewed yesterday, was talking about playing detective—you have to play detective sometimes. It seems to me you’re saying the same thing.

A: Yes. An investigator is investigating something. There’s a belief that something may be wrong or may go wrong. Whereas the others are not thinking that something may go wrong. They’re thinking, “Thank God I found someplace for my child to be safe!” And even though there’s these screaming signs that he’s not okay there, they don’t take the next step to say, “Maybe it’s the place he’s at all day.” I don’t know how to get through that, except keep saying, “It happens everywhere. It can happen to anyone.” I was doing a lecture on abuse and special ed. And [afterward] a couple of teachers came up to me and said, “You know, I’ve been a special ed teacher for forty years, and I’ve never had a kid abused that I’ve ever taught.” And I said, “Then you just didn’t know about them.” They said, “No one would abuse a special ed kid.” So I learned from that that this must be a pervasive belief: They’re so vulnerable, that no one would ever do that. And so special ed teachers hang on to [that belief] for dear life.

And then I get those kids.