Experiences of a Child Abuse Program in the Time of COVID-19

Abstract

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.

Supporting survivors of child sexual abuse during the COVID-19 pandemic: An ecosystems approach to mobilizing trauma-informed telemental healthcare.

“…While our outpatient clinic referrals for medical evaluation of physical and sexual abuse dropped substantially during the acute pandemic period (Cho et al, 2021), the demand for mental health support surged following a brief dip. This was due, in part, to community-based agencies lacking capacity to deliver teletherapy, resulting in a redirection of referrals to our program.…”

Medical Knowledge Acquisition during a Pandemic: Pediatric Subspecialty in-Training Examination and Board Certification Exam Passing Rate

“… 20 , 21 , 22 Increased CAP consultations during this time of stress may have led to increased case logs and clinical experience, boosting SITE. 23 …”

The impact of the resumption of in-person school attendance on COVID-affected child abuse and neglect trends in Florida

“…Even with an increase in CAN reports from medical professionals, COVID has had an impact on the ability of some physicians to identify CAN. Hospitals and other health settings have seen decreases in patient volumes ( Cho et al, 2021 ; Edigin et al, 2020 ), less in-person consultation, and more social distancing measures ( Cho et al, 2021 ; Edigin et al, 2020 ). At some medical training universities, medical students and interns had to take part in remote learning from home leading to a reduction in an adequate range of training on child abuse cases ( Cho et al, 2021 ).…”

“…Hospitals and other health settings have seen decreases in patient volumes ( Cho et al, 2021 ; Edigin et al, 2020 ), less in-person consultation, and more social distancing measures ( Cho et al, 2021 ; Edigin et al, 2020 ). At some medical training universities, medical students and interns had to take part in remote learning from home leading to a reduction in an adequate range of training on child abuse cases ( Cho et al, 2021 ). This then reduces in-person physical examinations which is an essential skill that can only be mastered with years of practice ( Edigin et al, 2020 ) that may lead to failing to identify sentinel injuries (such as minor injuries indicative of CAN) by not only medical students, but also less experienced physicians which could lead to a child being left in an abusive or neglectful environment ( Whelan et al, 2021 ).…”