The coronavirus disease 2019 (COVID-19) pandemic has changed the medical landscape, and the field of child abuse pediatrics has not been exempt from the reach of this disease. Previous widespread disease outbreaks and natural disasters have been associated with increased violence toward women and children, 1 and child abuse programs noted increased rates of abusive head trauma during the 2007-2009 recession. 2 The COVID-19 pandemic has led to increases in similar risk factors for child maltreatment, including employment instability, financial strain, reduced child care, and fewer available support structures. [3][4][5][6] Marginalized populations (eg, those in child protection systems, who already experience preexisting disparities) may be at particular risk because of widening inequalities with the pandemic. 7 Child abuse programs across North America have reported variable impacts of the COVID-19 pandemic, including changes to incoming referrals and modifications to clinical and educational activities. These impacts have yet to be described in the medical literature and are crucial to understand as child abuse clinicians and pediatric hospitalists adapt to the current context. In this commentary, we describe the impacts of the pandemic experienced by 1 interdisciplinary child abuse program practicing in a 300-bed tertiary care academic pediatric urban hospital in North America. This will include a discussion of necessary adjustments made by the program related to clinical practice, team functioning, clinician wellness, and medical education. CHANGES EXPERIENCED BY THE CHILD ABUSE PROGRAM Clinical PracticeThis interdisciplinary child abuse program is composed of pediatricians, nurse practitioners, social workers, and psychologists. The program provides 24-hour per day service, including inpatient, outpatient, and emergency department consultations. After closures in March 2020, the program documented a substantial reduction in incoming consultations (see Figs 1 and 2). A trend was also seen of fewer acute sexual assaults and more disclosures of historic sexual abuse. As communities reopened in May 2020, patient numbers gradually increased, and, anecdotally, there was a pattern of consultations for infants with positive workup for occult injuries who had bruising during the lockdown period that was not addressed. The pandemic highlighted the importance of early case planning, which involved planning discussions between clinicians and child protection workers and/or law enforcement before patient assessments. Although early case planning was already being used before the pandemic, it was expanded to include considerations of visitor restrictions and virtual assessment in select cases.

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BACKGROUND Fellows in child maltreatment paediatrics (CMP) are at risk of secondary traumatic stress (STS). Contributing factors include inexperience, younger age, lack of mastery, high caseloads, and longer working hours. Literature has previously focused on individual resilience; as understanding about STS evolves, it has been recognized that organizational resilience is important in supporting healthcare professionals. OBJECTIVES Our objective was to develop, implement, and evaluate an innovative program to increase resilience to STS among fellows in a child maltreatment training program. DESIGN/METHODS A trauma-informed counsellor with expertise in both secondary-traumatic stress and medical education was identified through the University Wellness Office. The counsellor was not a member of the CMP team and facilitated a targeted program that included monthly, small group session for all CMP fellows. Sessions involved low-intensity activities that encouraged self-reflection and focused attention. The counsellor facilitated discussions around difficult cases with active listening, immersion into the affective experience of others, and avoidance of judgment, blame, or criticism. Fellows were encouraged to speak about their own experiences, rather than commenting on the experiences of others. This created a safe environment in which to explore and process difficult material. Evidence-based strategies were offered at the end of each session. An important component of the program was an iterative process of feedback and reflection on the session structure and process. Written reflections were collected from fellows and staff, which were qualitatively analyzed by two reviewers to identify key themes. RESULTS Qualitative analysis of individual written reflections identified four major themes, including high satisfaction with program, strategies for prevention and management of STS, bonded fellowship peer group, and feelings of validation from one another. There was unanimous reporting of high levels of satisfaction with the program by both fellows and supervising staff. Fellows described excitedly anticipating sessions and experiencing renewed energy following group sessions. Supervising staff reported seeing fellows apply skills and strategies learned for prevention and management of STS. Between sessions, fellows reported improved STS symptoms and employing preventative self-care strategies. It was reported that the strategies learned assisted fellows in developing a reflection style that was intentional and individualized for their wellbeing. An unanticipated outcome that was unianimously reported by fellows and noted by staff was the fostering of a strongly bonded and supportive fellowship peer group, further increasing perceptions of wellbeing. Fellows reported feeling validation from one another during group sessions and utilizing approaches in real-time informal discussions with team members as difficult clinical cases arose. CONCLUSION This targeted program for fellows was developed as an innovative approach to addressing secondary traumatic stress among new learners in the challenging field of child maltreatment paediatrics. It has demonstrated acceptability among fellows and supervising staff with reported improvement in STS symptoms. Future steps will address the broader goal of optimizing organizational resilience among other members of the child maltreatment team.