DiversityNursing Blog

According to Gallup, for the last 16 years, Americans' ratings of the honesty and ethical standards of 22 occupations found Nurses at the top of the list. Doctors and Pharmacists are also at the top of the list. 

The Gallup poll results showed more than eight in 10 (82%) Americans describe Nurses' ethics as "very high" or "high."

In an American Nurses Association (ANA) article, Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, President of the ANA said,  “Nurses provide much more than bedside care. We advocate for patients, deliver primary care, meet the complex needs of patients with chronic conditions, volunteer for disaster relief efforts, and are a trusted voice in boardrooms across the country." 

This poll reflects the trust the population has for Nurses. Patients rely on Nurses during their most vulnerable times and year after year Nurses show us that they do deserve that trust. 

Doctors manage the overall healthcare plan but, Nurses are the ones who implement it and in doing so they spend the most time with patients. 

Since Nurses spend the most time with patients, and they know the health care system’s limitations, they're in the best position to speak up about their patients’ needs and safety concerns and advocate for them. 

Audrey Wirth, MSN, RN-BC, CVRN-BC, Nursing instructor at Aurora University told travelnursing.com, “In the Nurse-to-patient relationship, there is a fundamental trust that occurs. Nurses must serve as advocates for both their patients and for better health care in general.”

 In 1999 Gallup began asking about Nurses, and the profession has topped the list every year except for 2001 after the 9/11 terrorist attacks, firefighters topped the list that year.

We know you put your patients first every day. We’re delighted that you are recognized for the important and vital work you do. Pat yourself on the back that you continue to make Nursing the most trusted profession! To learn more about what it takes to be a great Nurse check out the blog, Traits Every Great Nurse Has

You may want to consider a career as a Nurse Educator if you're interested in teaching or passionate about medical research and public policies.

Nurse Educators are faculty members in Nursing schools and teaching hospitals, they share their knowledge and skills to prepare future Nurses.

According to allnursingschools.com, you’ll be responsible for designing the curriculum of your students. You’ll set the structure and pace of your classroom and decide what textbooks and other materials your students will need. These curriculum decisions will need to meet accreditation requirements and be in line with the most up-to-date professional standards.

More people are becoming interested in joining the Nursing field. Faculty positions are not being filled because there aren't enough educators to meet the demand. 

The U.S. Department of Labor reports that 1 million new and replacement Nurses will be needed by 2020. But, according to the American Association of Colleges of Nursing, almost 65,000 qualified applicants were turned away from Nursing schools last year because Nursing schools don’t have enough Nurse Educators to educate all the students who want to become Nurses.

Becoming an educator broadens your employment opportunities.

Palliative care, end-of-life care, and hospice care share a common goal: to relieve suffering. But there are also important distinctions.

Both palliative care and hospice care provide comfort. But palliative care can begin at diagnosis, and at the same time as treatment. Hospice care begins after treatment of the disease is stopped and when it is clear that the person is not going to survive the illness.

Palliative services are typically provided by a team of interdisciplinary providers, including Physicians, Nurses, counselors, social workers, and chaplains. The team works together to assess and develop treatment plans with the patient and family that can provide the best possible quality of life.

According to the World Health Organization, palliative care:

• provides relief from pain and other distressing symptoms
• affirms life and regards dying as a normal process
• intends neither to hasten or postpone death
• integrates the psychological and spiritual aspects of patient care
• offers a support system to help patients live as actively as possible until death
• offers a support system to help the family cope during the patients illness and in their own bereavement
• uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated
• will enhance quality of life, and may also positively influence the course of illness
• is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

Jean Farley, DNP, RN, PNP-BC, assistant professor at Georgetown University School of Nursing & Health Studies said, “Think of palliative care as a value-added layer to typical care for an individual experiencing a serious or life-limiting illness,” like cerebral palsy or amyotrophic lateral sclerosis (ALS), “especially when that illness carries a heavy symptom burden that will persist over time.”

Ellen Goodman, co-founder of the Conversation Project is raising awareness about the importance of having conversations about end of life care and wishes.

“Patients who have end-of-life discussions are much more likely to be satisfied with their care, die at their place of choosing, and have markedly less distressed relatives,” said Thomas Smith, MD, the Director of Palliative Medicine and Professor of Oncology at Johns Hopkins. “In fact, looking at people who use hospice, the survival of their spouse is higher. It is really fascinating.”

In the last 15 years, the field of palliative care has experienced stunning growth. Over 1,700 hospitals with more than 50 beds have a palliative care team today. And, palliative care is spreading beyond the hospital into community settings where people with serious illnesses actually live.

Any information or experiences you’d like add, please share it below. Thank you.

With maternal mortality and morbidity rates that are worse than any other developing country in the world, America’s need for more diverse and culturally-conscious health care providers is urgent.

Many nursing institutions preach “diversity,” but schools like Frontier Nursing University (FNU) are achieving it through programming, initiatives and partnerships with like-minded organizations.

Each year, FNU hosts its Diversity Impact Student Conference. In its eighth year, the conference is hosted by students and faculty leaders in FNU’s PRIDE Program, which was established to promote recruitment and retention to increase diversity in Nurse-Midwifery and Nurse Practitioner education.

FNU has put the “impact” in Diversity Impact, especially in this year’s event. With a theme entitled “We Are One: Uniting Dreamers with Diverse Voices,” presenters at this year’s four-day conference spoke on mental health and cultural care, transcultural nursing and the current state of mortality rates in the African American community.

Each student who attended was given opportunity to not only listen to an impactful keynote, but also to participate in a culturally eye-opening field trip, cross-cultural communication exercise, and collaborative discussions to improve minority health among underrepresented and marginalized groups.

These powerful conversations ranged in topic from environmentally-sustainable healthcare to mental health in patient and police interactions, to vulnerable populations and sexual IQ risk reduction. Each year at Diversity Impact, attendees walk away with proactive solutions to create meaningful connections and provide better care within diverse communities.

In addition to its annual event, FNU partnered with the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) in a brand new initiative this year to produce a video about the need for a diverse nurse-midwifery workforce to improve health outcomes across the United States.

This five-minute video, filmed as part of AWHONN’s “Partners in Care" program, highlights how Frontier Nursing University students are providing significant contributions to address health disparities for women who are facing language, racial, geographical and other socioeconomic barriers. 

“The fact that African American women are 3 to 4 times more likely to die in and around childbirth than their white counterparts - that struck a chord with me,” said Ameenah Jackson, FNU nurse-midwifery student, in the video.

Jackson, along with hundreds of other FNU students, is the future of quality care for women who, before now, have not felt heard or valued by a health care provider.

A portion of the video is an interview with a new member of FNU’s Executive Leadership Team. Dr. Maria Valentin-Welch, DNP, MPH, CDP, CNM, FACNM, was brought on board in September 2017 as the inaugural Chief Diversity and Inclusion Officer (CDIO).

Valentin-Welch’s position is designed to guide FNU on matters of equity, diversity and inclusion. Together with the president, dean, chief operations officer, chief advancement officer, and executive vice president for finance and facilities, the CDIO will lead the development of a vision and strategy that champions the importance of a diverse and inclusive environment that values and supports all members of the University community.

With over 30 years of teaching experience, Dr. Valentin-Welch is working from the classroom outward in strategizing diversity initiatives for FNU.

“The strategies that I feel will have the most positive impact on Frontier are building these excellent student services, as well as diversity and inclusion training strategies and tactics to enhance our courses by threading diversity and inclusion issues along the way,” said Dr. Valentin-Welch. “We want to thread the subject matter even further throughout the curriculum. We will be stronger individually and as a whole because of the introductions of these plans.”

The AWHONN reporter concludes: “FNU is at the forefront of tackling the difficult and delicate issues related to equity of care through head-on conversations and diversity events for students.”

One such conversation was had in June 2018 between FNU President Dr. Susan Stone, DNSc, CNM, FACNM, FAAN, certified nurse-midwife, and President of the American College of Nurse-Midwives (ACNM) and Andrew Bennie, Product Director at Springer Publishing Group and guest host of the weekly “Nursecast” podcast series.

Dr. Stone and Bennie’s discussion tackled the question: “Why is Maternal Mortality Growing in the United States?” In the eighteen minute podcast, Dr. Stone pinpoints a lack of racially-concordant care as a culprit.

According to data, 700 women around the U.S. die of pregnancy complications per year, while 50,000 cases are near misses. Many of those cases are disproportionately correlated to race. 

Dr. Stone explains that patients are more receptive to care from a health provider who understands their culture and socioeconomic background. Currently, only 6% of midwives in the United States are women or men of color. FNU’s initiative is to diversify not only the field of midwifery, but the healthcare workforce as a whole.

“Today about 22% of FNU students are men and women of color – up from just 9% in 2010,” said Dr. Stone.

Each population in America’s melting pot, formed by race, socioeconomic status, sexual orientation, language, or a combination of other factors, will see better health outcomes with culturally-concordant healthcare providers and models. Institutions like Frontier Nursing University are equipping and encouraging their students to answer the call to make these underrepresented populations feel heard, valued and served.

About Frontier Nursing University:

The mission of FNU is to provide accessible nurse-midwifery and nurse practitioner education to prepare competent, entrepreneurial, ethical, and compassionate leaders in primary care to serve all individuals with an emphasis on women and families in diverse, rural, and underserved populations. FNU offers graduate Nurse-Midwifery and Nurse-Practitioner distance education programs that can be pursued full- or part-time with the student’s home community serving as the classroom. Degrees and options offered include Doctor of Nursing Practice (DNP), Master of Science in Nursing (MSN) or Post-Graduate Certificates. To learn more about FNU and the programs and degrees offered, please visit Frontier.edu.

NPR and ProPublica launched an investigation on America's rising maternal mortality rates. More American women are dying of pregnancy-related complications than any other developed country. 

The United States saw a 26.6% increase in maternal deaths from 2000 to 2014, according to a recent study published in Obstetrics & Gynecology.

Racial disparities make these trends even more distressing. According to the Centers for Disease Control and Prevention, African-American women are almost four times more likely to die of pregnancy complications. Maternal mortality is also more common for low-income women and women living in rural areas.

Only about 6 percent of the nation’s Ob–Gyns work in rural areas, according to the latest survey numbers from the American Congress of Obstetricians and Gynecologists (ACOG). Yet 15 percent of the country’s population, or 46 million people, live in rural America. As a result, fewer than half of rural women live within a 30-minute drive of the nearest hospital offering obstetric services. Only about 88 percent of women in rural towns live within a 60-minute drive, and in the most isolated areas that number is 79 percent.

The ProPublica investigation shows, America has not published official maternal mortality statistics in more than a decade. So we are forced to rely on incomplete estimates because the data needed to determine exactly how many women are dying, and from what causes, go uncollected.

Many states have created Maternal Mortality Review Committees (MMRCs). Maternal and public health experts analyze maternal deaths and propose ways to prevent similar deaths. The data from these MMRCs have revealed that more than half of maternal deaths are preventable. 

California created its MMRC in 2006 and reduced its maternal mortality rate by more than 55% to 4.5 per 100,000 live births, far lower than the national average. It was accomplished by using its data to design safety resources and tool kits aimed at the most common causes of maternal death in the state. For example, excessive bleeding and complications of high blood pressure, such as preeclampsia are common causes. Many states have not set up MMRCs due to lack of funding.

There are multiple reasons for a rising maternal mortality rate in the U.S. New mothers are older than they used to be, with more complex medical histories. Half of pregnancies in the U.S. are unplanned, so many women don't address chronic health issues beforehand. Greater prevalence of C-sections leads to more life-threatening complications. The fragmented health system makes it harder for new mothers, especially those without good insurance, to get the care they need. Confusion about how to recognize worrisome symptoms and treat obstetric emergencies makes caregivers more prone to error.

While most developed countries are making strides in preventing maternal-related deaths, the United States is falling behind. Addressing the causes of maternal mortality as well as contributing factors and underlying problems is a national concern. Health care professionals are the first line of defense for reversing this lethal trend.

Do you have any experiences or thoughts you’d like to share on this topic? Perhaps something you practice that would be helpful to other Nurses in a critical delivery situation?

RALEIGH – The North Carolina Nurses Association (NCNA) and its charitable arm, the North Carolina Foundation for Nursing (NCFN) are announcing an emergency campaign to provide support to nurses who have suffered loss or damages from Hurricane Florence. The NCFN - Nurse Recovery Fund seeks tax-deductible donations whose sole purpose is to help nurses get back on their feet sooner; NCNA and NCFN believe that helping nurses return to their normal lives will benefit the entire state.

“It is immensely harder to focus on patient care if you are reeling from your own losses, so we see this as a chance to support our fellow nurses and try to help them get back to normal,” said NCNA President Elaine Scherer, MAEd, BSN, RN. “Caring for each other is a vital part of being a nurse. We saw an opportunity to step up and have a positive impact on a terrible situation. Doing nothing was simply not an option.”

• People interested in donating can click here:
  https://portal.ncnurses.org/donate-now
• Nurses who need to apply for relief aid can click here:
  https://ncnurses.org/foundation/ncfn-nurse-recovery-fund/

All money collected by NCFN for this fund will be given directly to the people in need. NCNA is donating all of the staff time required to set up the campaign’s infrastructure and administer funds.

“We are so grateful to our colleagues at the Texas Nurses Association, who were already offering advice before the storm arrived last week,” said NCNA CEO & NCFN Executive Director Tina Gordon. “They launched a similar campaign in the aftermath of Hurricane Harvey, and the lessons they learned have been invaluable as we prepared to roll out the NCFN - Nurse Recovery Fund.”

Donations to this special fund will be distributed to actively-licensed Registered Nurses in North Carolina who have been impacted by Hurricane Florence. NCNA & NCFN will review applications from affected nurses and determine who receives assistance based on a sliding scale of needs. Funds will be collected for a limited time and distributed on a first-come-first-serve basis.

MEDIA CONTACT
Chris Cowperthwaite, APR
Manager of Communications & Outreach
(919) 821-4250 or chriscowperthwaite@ncnurses.org

ABOUT NCNA
As the leading professional organization for North Carolina’s registered nurses, we equip nurses at all stages to thrive in an ever-changing healthcare environment. NCNA helps keep North Carolina nurses on the cutting edge of nursing practice, policy, education, and more. Join us as we work to advance nursing and ensure high-quality healthcare for everyone. For more information, please visit www.ncnurses.org.

ABOUT NCFN
The North Carolina Foundation for Nursing is a nonprofit, 501(c)(3) corporation. Funding to support the Foundation and its activities comes from individual contributions, business donations, bequests, recognitions, and memorials.

The purpose and goals of the Foundation are to secure and administer funds directed toward:

1. education that assures that registered nurses are prepared to meet the current and changing health care needs of North Carolina citizens;
2. research that identifies the value of registered nurses in health care delivery; and,
3. activities that publicize the value of registered nurses in health care delivery.

Forensic Nurses provide healthcare to those incarcerated in the criminal justice system in a variety of settings such as jails, prisons, and juvenile detention centers. Many Correctional Nurses feel safer in this environment than working in traditional settings where security may be less vigilant.

The inmate patient population has many distinct characteristics to keep in mind when providing care. Although each patient is an individual, the population, as a whole, is likely to have these characteristics that should be taken into consideration when providing care.

• Inmates have a biological age older than their chronological ages. Many experts consider the incarcerated patient to be 10 years older than their chronologic age when it comes to the ravages of age and illness. So, many correctional settings consider elderly inmates to be 55 years and older.
• Less educated and less health-literate than the general population, inmates are more likely to have learning disabilities and have difficulty understanding basic health information.
• More infectious disease, especially HIV, Hepatitis C, sexually transmitted disease, and tuberculosis are found in this patient population.
• Inmates have higher rates of mental illness than the general public, especially depression, mania, and psychotic disorders. Mental illness can contribute to criminality. Borderline personality disorders that lead to poor impulse control, self-injury, and aggression are often present.
• This patient population also has higher rates of traumatic brain injury and post-traumatic stress disorder that can also lead to poor impulse control, erratic behavior, and inability to concentrate or understand health instruction.
• High levels of drug, alcohol, and tobacco use in this population increases the likelihood of withdrawal issues, liver toxicity, and respiratory conditions.
• Increased risk of suicide is found in this patient population as compared to the general population. This is a concern in any stage of the incarceration but especially of concern at entry into the jail and after sentencing when hopelessness, shame, and guilt are at their highest.

Although graduate Nurses have been successful in assimilating into the role of Correctional Forensic Nurse, the autonomous nature of the role and need for excellent assessment skills warrants experience in general Nursing practice before entry into the specialty. In particular, a background in emergency and/or mental health Nursing is helpful. Currently, certification is not required to enter a position as a Correctional Forensic Nurse, however, certification is available through the National Commission on Correctional Health Care (NCCHC) and the American Correctional Association (ACA).

Are you a Correctional Forensic Nurse? If so, what do you believe Nurses should know before considering this specialty? Please comment below!

An active shooter incident is something no nurse wishes to experience. Unfortunately, these situations can, and do, happen at healthcare organizations across the country.

These incidents are becoming more common, and although they are still rare compared with other shooting sites, incidents have increased in health care facilities. Agencies such as the Federal Bureau of Investigation, The Joint Commission, and the Emergency Nurses Association have emphasized that an action plan and training are essential for hospital preparedness.

Here are some resources to help us all be prepared for an active shooter incident.

• Many victims say, “I didn’t know what to do,” or “I was just waiting my turn to be shot.” The important lesson here is to tell people in an active shooter situation to do something. Time is a valuable commodity, and by doing something, one takes some time away from the shooter.
• 63% of active shooter incidents are in commerce or an education environment, but no place is off limits.
• Active shooter incidents typically evolve quickly and end (historically) within 10 to 15 minutes; 36% end before the police arrive.
• Be prepared:
  • Mental preparation – Chaos and panic will occur. As best as you are able, trust your instincts, breathe, and remain calm.
  • Sounding the fire alarm is NOT recommended. The potential negative consequences outweigh the benefit.
    • People are complacent with fire alarms.
    • People won’t think “active shooter.”
  • Role of police – Police officers are there to neutralize the threat, not treat injured.
• Three options (you may have to do all three):
  • Run – If you have an opportunity to escape, do so.
  • Hide – Don’t let anyone in.
  • Fight – Fight for your life with whatever you have. There is power in numbers and the shooter is typically not looking for a fight.

How to react when law enforcement arrives:

• Remain calm, and follow officers’ instructions
• Put down any items in your hands (i.e., bags, jackets)
• Immediately raise hands and spread fingers
• Keep hands visible at all times
• Avoid making quick movements toward officers such as holding on to them for safety
• Avoid pointing, screaming and/or yelling
• Do not stop to ask officers for help or direction when evacuating, just proceed in the direction from which officers are entering the premises

 
Information to provide to law enforcement or 911 operator:

• Location of the active shooter
• Number of shooters, if more than one
• Physical description of shooter/s
• Number and type of weapons held by the shooter/s
• Number of potential victims at the location

A survey by the Journal of Emergency Nursing shows that out of 202 Emergency Nurses and staff members who participated in active shooter training, 92% felt better prepared to respond if a shooting occurred at their facility.

Every healthcare facility is required to have an emergency action plan. Most of them conduct training exercises to prepare staff for emergency situations such as a fire emergency or bomb threats, but when it comes to dealing with an active shooter situation, most Nurses have no idea how to react because they aren't prepared for it. 

We hope this information is helpful and that you never have to use it. If you have anything you’d like to add, please share it here.

The Joint Commission defines a hand-off as a transfer and acceptance of patient care responsibility achieved through effective communication. It is a real-time process of passing patient-specific information from one caregiver to another, or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care.

Nurses typically take great pride and exert painstaking effort to meet patient needs and provide the best possible care. Unfortunately, too often, this diligence and attentiveness falters when the patient is handed off, or transitioned, to another health care provider for continuing care, treatment or services. A common problem regarding hand-offs is communication. Expectations can be out of balance between the sender of the information and the receiver. 

Please understand we know how incredibly busy you are every minute you are working. We appreciate transitioning patient information to the next caregiver is critical and that you do everything in your power to be clear and concise. These guidelines are meant to be helpful and reinforce what you most likely are already doing to keep communication transparent and smooth.

Abuse occurs in many areas of society and takes many forms. Some examples may involve the abuse of a child by a parent or caregiver; the abuse of a parent by an adult child; or the abuse of a spouse. In addition to the physical aspects, abuse can include emotional battering, financial exploitation and sexual assault. Many of these result in health problems for the victims. Your role in dealing with victims of abuse is multifaceted.

One of the most common and deadly forms of child abuse is not physical violence, but neglect. According to data from the National Child Abuse and Neglect Data System, neglect was a contributing factor in more than 71 percent of child maltreatment fatalities in 2011.

Possible signs of child maltreatment may include:

◗ Developmental delays
◗ Speech disorders
◗ Failure to thrive
◗ Poor hygiene
◗ Inappropriate seasonal clothing
◗ Lack of supervision
◗ Unattended medical needs
◗ Chronic truancy
◗ History of psychological disorders

When assessing a patient, you should be aware of the following physical signs of injuries related to domestic violence:

◗  Black eyes
◗  Bruises in various stages of healing, particularly on breasts or genitalia
◗  Symmetrical bruises on upper arms, wrist or neck
◗  “Bathing-suit pattern” marks that are covered by clothing
◗  Subdural hematomas
◗  Patches of missing hair
◗  Fractured mandibles
◗  Ruptured tympanic membranes
◗  Lacerations around the eyes and lips
◗  Rib fractures
◗  Unexplained venereal disease or genital infections
◗  Recurrent urinary tract infections
◗  Anal or genital bleeding or injury
◗  Marks consistent with the size of objects such as cigarettes or belts
◗  Signs of neglect, such as malnutrition, poor hygiene or skin ulcers
◗  Use of makeup or other methods to hide indicators
◗  Injuries not consistent with explanation of how they occurred

However, it is unlikely the patient will present with a physical injury. They will more likely present with issues such as:

• A stress-related illness
• Anxiety, panic attacks, stress and/or depression
• Drug abuse including tranquilizers and alcohol
• Chronic headaches, asthma, vague aches and pains
• Abdominal pain, chronic diarrhea
• Sexual dysfunction
• Joint pain, muscle pain
• Sleeping and eating disorders
• Suicide attempts, psychiatric illness
• Gynecological problems, miscarriages, chronic pelvic pain

The patient may also:

• Appear nervous, ashamed or evasive
• Describe their partner as controlling or prone to anger
• Seem uncomfortable or anxious in the presence of their partner
• Be accompanied by their partner who does most of the talking
• Give an unconvincing explanation of the injuries
• Be recently separated or divorced
• Be reluctant to follow advice

All Nursing schools include information about how to detect child and domestic abuse within the curriculum, but the practice of detection can be difficult. Most inpatient and outpatient facilities now require questions about personal safety and domestic violence screening questions as part of the intake process. In your role as the attending Nurse, it's important to ask these questions with intent and ensure the patient has enough time to answer. Do not rush the patient as they are most definitely scared. Some practitioners even wear buttons or badges that say, "It's okay to talk with me about domestic violence." Only ask questions about domestic violence when the patient's partner is out of the room.

The following questions may be helpful when assessing a patient for abuse, maltreatment, or neglect: 

• I noticed that you have a number of bruises. Can you tell me how they happened? Has anyone hurt you?
• You seem frightened. Has anyone ever hurt you?
• Have you been hit, slapped, kicked, pushed, shoved, or otherwise physically hurt by someone within the last year?
• Sometimes patients tell me that they've been hurt by someone at home or at work. Could this be happening to you?
• Are you afraid of anyone at home or work, or of anyone with whom you come in contact?
• Has anyone forced you to engage in sexual activities within the last year?
• Has anyone prevented you from seeing friends or other people whom you wish to see?
• Have you signed any papers that you didn't understand or didn't wish to sign?
• Has anyone forced you to sign papers against your will?

In a clinical setting, your most important role is to provide a safe environment for your patient; treat your patient's injuries; and observe, listen, and document the facts. Treatment focuses on the consequences of the abuse and preventing further injury. If the patient is in immediate danger, separate the patient from the perpetrator whenever possible.

Your next important job is to refer your patient to the appropriate authorities and/or agencies. Even if you aren't sure but suspect that your patient is a victim of abuse, report your suspicions. You won't be penalized and you may save your patient's life.

Additional resources are only a phone call away. These include hotlines such as:

* National Domestic Violence Hotline: 1-800-799-SAFE (7233); TTY: 1-800-787-3224

* ChildHelp USA National Child Abuse Hotline: 1-800-4-A-CHILD (422-4453); TDD: 1-800-2-A-CHILD (222-4453)

* National Youth Crisis Hotline: 1-800-442-HOPE (4673)