In an era of heightened mental-health awareness, authorities and youth advocates in South Dakota say it is key not to lose sight of signs of child abuse, and experts say some crisis signals cross paths.

April is recognized in the U.S. as National Child Abuse Prevention Month.

Wendy Kloeppner, state's attorney for Lake County, said educators help by serving as "mandatory reporters" when they see bruises or other unexplained marks. During the pandemic, schools also have expressed more mental-health needs for students, citing changes in behavior.

Kloeppner pointed out all can be symptoms of abuse.

"Children who have mood changes or behavior disruptions, that would be something that we would look for," Kloeppner explained. "We would maybe want to inquire with the child about what is happening at home."

Kloeppner, also a board member with the Center for the Prevention of Child Maltreatment, said law enforcement looks for some of the same signs in cases tied to trauma.

The Center is encouraging South Dakotans to spread awareness this month by signing up to be a "Blue Ambassador." Enrollees can receive content to share within community and social media networks.

At the onset of the pandemic, the American Academy of Pediatrics urged parents to practice self-care, and not let COVID stress manifest into child abuse, including verbal attacks.

Kloeppner noted situations involving actions like excessive screaming are something law enforcement can follow up on.

"If a report comes to my office, for example, that a child is continuously emotionally abused, that could turn into what we call an abuse and neglect case, where we asked the Department of Social Services to step in and monitor the family," Kloeppner outlined.

And like other cases involving suspected abuse, social services can determine if a child should be removed from the home. Kloeppner hopes this month's awareness creates more places for kids to feel safe and talk with adults if they're experiencing trauma. Beyond schools, she said it can include after-school activities, such as sports.

Ohio community groups seeking ways to increase support for sexual assault survivors living with disabilities. A January 23rd training session hosted by the Ohio Alliance to End Sexual Violence will focus on how law enforcement, hospitals, and other institutions can provide equitable services.

Natasha Larson, director of training and member engagement with the Alliance explained it is common for perpetrators to be closely linked to their victims, and can often include family members or staff at a caregiving facility. She said people with disabilities are at higher risk for assault because their abuser can interfere with attempts to report it.

"They may tamper with things," Larson said, "like withholding any assistive technology that they have - mobility aids, communication devices - things that allow them to perform daily tasks."

A 2012 nationwide survey, the first of it's kind published by the Spectrum Institute, found more than one-third of respondents were victims of repeated sexual abuse. More information on the training is online at 'oaesv.org.'

Nicole Kass Colvin, manager of coordinated community responses with the Alliance, added society often views those with disabilities as asexual, and points out that people born with disabilities are less likely to be taught the proper names of body parts, or the definitions of sexual assault and consent.

"This leads to a lack of comprehensive sex education and consent education, which increases risk," she said.

Kass Colvin said Ohioans can help protect their loved ones with disabilities by advocating for increased accessibility in their communities and workplaces.

"When we are able to know ahead of time how to access or activate a trauma-informed qualified interpreter, or services that have accessible spaces, then we're better able to respond to those situations," she said.

Children with disabilities are nearly three times more likely to experience sexual violence, according to the World Health Organization.

A new statewide initiative aims to help connect domestic-violence survivors with medical providers, with a focus on treating traumatic brain injury.

Rachel Ramirez, founder the Ohio Domestic Violence Network's Center on Partner-Inflicted Brain Injury, said survivors often experience severe violence aimed directly at the head, neck and face. But there's been a longstanding gap in accessing the right medical services when individuals come into shelters.

She said $5.12 million dollars in funding will be used to pay for medical services.

"To pay for health care that people are not able to get reimbursed through other means, through Medicaid or insurance. We want to investigate the possibilities of working with occupational therapy to help with brain-injury rehabilitation," Ramirez said.

The three-year project in collaboration with the Ohio Association of Community Health Centers will cover four to six areas of the state. According to data from the Ohio Domestic Violence Network, the state suffered 112 domestic violence-related fatalities between June 2021 and June 2022. More than twenty of those killed were children.

Ramirez said advocates are also working on developing a statewide virtual and call-in center known as the Care Health Connection.

"That will be a place where domestic-violence programs and survivors can also talk to an advocate when they have health-related needs to help them get better connected to either telehealth services, behavioral-health services or other health services in their community," she said.

Emily Kulow, director of mobile advocacy and meaningful access at the Ohio Domestic Violence Network, said the goal is to eliminate barriers that prevent survivors from seeking help, and then providing a holistic approach once a connection has been made.

"So checking in with the survivor about what's going on with their housing, what's going on with their health care. When was the last time they were even seen by a doctor," she said.

According to the National Center for Health Research, women who experience domestic abuse are more likely to suffer from diabetes, asthma, lower back pain, headaches and other chronic conditions.

A bill headed to President Joe Biden's desk addresses a long-standing problem for domestic violence survivors, ending their ties to their abusers' cellphone plans.

A North Dakota coalition predicts the changes will be helpful. The Safe Connections Act recently cleared its final Congressional hurdle. It removes financial penalties for survivors who are trying to separate their phone lines and their dependents' lines from an abuser.

Dana Mees, administrative director of the North Dakota Council on Abused Women's Services, said unresolved phone plans can be a major obstacle for someone from trying to move on from an abusive situation.

"They do give abusers access to call logs, text messages, voice mails, or family tracking features that can be used to monitor, stalk and harass survivors," Mees explained.

She added survivors are forced to pay a lot of money in termination fees, often making it difficult to transition to a safer environment. The bill had bipartisan support, but other advocates say they would have preferred policymakers not include a provision requiring the survivor to provide documentation they were abused, arguing it added to their trauma.

A separate aspect of the bill calls on the Federal Communications Commission to create rules requiring cellphone providers to expunge any calls or texts to hotlines, such as those operated by crisis centers. Mees noted it is another important tool.

"If they're calling a crisis line, and that shows up in their call log, that can tip an abuser off that they're thinking of leaving," Mees pointed out. "It can put them in a more dangerous situation."

As for financial barriers, the bill expands eligibility for the FCC's Lifeline Program, which provides monthly cellphone plan subsidies.

Collectively, Mees believes the actions should help survivors move forward with their lives without having to change a number or get another phone. President Biden is expected to sign the measure.