The impact of stay-at-home orders on the rate of emergency department child maltreatment diagnoses

Effects of COVID-19-targeted non-pharmaceutical interventions on pediatric hospital admissions in North Italian hospitals, 2017 to 2022: a quasi-experimental study interrupted time-series analysis

Background

The use of Non-Pharmaceutical Interventions (NPIs), such as lockdowns, social distancing and school closures, against the COVID-19 epidemic is debated, particularly for the possible negative effects on vulnerable populations, including children and adolescents. This study therefore aimed to quantify the impact of NPIs on the trend of pediatric hospitalizations during 2 years of pandemic compared to the previous 3 years, also considering two pandemic phases according to the type of adopted NPIs.

Methods

This is a multicenter, quasi-experimental before-after study conducted in 12 hospitals of the Emilia-Romagna Region, Northern Italy, with NPI implementation as the intervention event. The 3 years preceding the beginning of NPI implementation (in March 2020) constituted the pre-pandemic phase. The subsequent 2 years were further subdivided into a school closure phase (up to September 2020) and a subsequent mitigation measures phase with less stringent restrictions. School closure was chosen as delimitation as it particularly concerns young people. Interrupted Time Series (ITS) regression analysis was applied to calculate Hospitalization Rate Ratios (HRR) on the diagnostic categories exhibiting the greatest variation. ITS allows the estimation of changes attributable to an intervention, both in terms of immediate (level change) and sustained (slope change) effects, while accounting for pre-intervention secular trends.

Results

Overall, in the 60 months of the study there were 84,368 cases. Compared to the pre-pandemic years, statistically significant 35 and 19% decreases in hospitalizations were observed during school closure and in the following mitigation measures phase, respectively. The greatest reduction was recorded for "Respiratory Diseases," whereas the "Mental Disorders" category exhibited a significant increase during mitigation measures. ITS analysis confirms a high reduction of level change during school closure for Respiratory Diseases (HRR 0.19, 95%CI 0.08-0.47) and a similar but smaller significant reduction when mitigation measures were enacted. Level change for Mental Disorders significantly decreased during school closure (HRR 0.50, 95%CI 0.30-0.82) but increased during mitigation measures by 28% (HRR 1.28, 95%CI 0.98-1.69).

Conclusion

Our findings provide information on the impact of COVID-19 NPIs which may inform public health policies in future health crises, plan effective control and preventative interventions and target resources where needed.

The Impact of COVID-19 on Infant Maltreatment Emergency Department and Inpatient Medical Encounters

OBJECTIVE

To assess the counts of infant maltreatment-related medical encounters at a large medical system during a 21-month span of the COVID-19 pandemic.

METHODS

Retrospective data for this study came from all inpatient and emergency department medical encounters for infants from January 1, 2016, through November 30, 2021, at a single children's hospital system in California. Distributions of medical encounters were tabulated and plotted over time. Interrupted time series models were used to evaluate changes in child maltreatment medical encounters.

RESULTS

Medical encounters for infants with child maltreatment diagnoses increased following the onset of COVID-19. Monthly counts of encounters with indicated maltreatment trended upward following the start of the pandemic. Interrupted time series models showed that the count of maltreatment encounters increased 64% with the onset of COVID-19.

CONCLUSIONS

We found an increase in infant maltreatment medical encounters during a 21-month period following the onset of COVID-19. These findings suggest that the pandemic may have adversely affected the safety of infants and ongoing work is needed to understand better the pandemic impacts on child maltreatment.

The global impact of COVID-19 on child protection professionals: A scoping review and thematic analysis

BACKGROUND

The COVID-19 pandemic triggered new risks for child maltreatment (CM) and exacerbated existing challenges for families and children, elevating the importance of child protection professionals (CPPs) while also adding barriers to their work. During the pandemic, many CPPs experienced increased workloads, a disrupted work environment, and personal pandemic-related hardships. However, the scope of how COVID-19 impacted CPPs globally, as well as their adopted coping strategies, have not been well explored.

OBJECTIVE

This study addresses these gaps in the research by conducting an international scoping review to explore and analyze these topics.

METHOD

The scoping review was performed in six languages: English, Hebrew, Arabic, French, Spanish, and Portuguese, across 16 databases. Sixteen manuscripts were included in the final thematic analysis of this review.

RESULTS

Two main themes were identified: 1) the impact of COVID-19 on CPPs, and 2) the coping and adaptation strategies employed by CPPs during COVID-19. This review revealed and emphasized the importance of CPPs' resilience during COVID-19, underpinned by the theoretical framework of the social ecology of resilience.

CONCLUSIONS

This study highlights the responsibility of social ecologies and organizational structures to create readiness for a rapid response in times of crisis as well as valuable evidence to inform how CPPs, children, and families may be better supported in the event of a future crisis.

Hospitalization for child maltreatment and other types of injury during the COVID-19 pandemic

BACKGROUND

The possibility that child maltreatment was misclassified as unintentional injury during the COVID-19 pandemic has not been evaluated.

OBJECTIVE

We assessed if child maltreatment hospitalizations changed during the pandemic, and if the change was accompanied by an increase in unintentional injuries.

PARTICIPANTS AND SETTING

This study included children aged 0-4 years who were admitted for maltreatment or unintentional injuries between April 2006 and March 2021 in hospitals of Quebec, Canada.

METHODS

We used interrupted time series regression to estimate the effect of the pandemic on hospitalization rates for maltreatment, compared with unintentional transport accidents, falls, and mechanical force injuries. We assessed if the change in maltreatment hospitalization was accompanied by an increase in specific types of unintentional injury.

RESULTS

Hospitalizations for child maltreatment decreased from 16.3 per 100,000 (95 % CI 9.1-23.4) the year before the pandemic to 13.2 per 100,000 (95 % CI 6.7-19.7) during the first lockdown. Hospitalizations for most types of unintentional injury also decreased, but injuries due to falls involving another person increased from 9.0 to 16.5 per 100,000. Hospitalization rates for maltreatment and unintentional injury remained low during the second lockdown, but mechanical force injuries involving another person increased from 3.8 to 8.1 per 100,000.

CONCLUSIONS

Hospitalizations for child maltreatment may have been misclassified as unintentional injuries involving another person during the pandemic. Children admitted for these types of unintentional injuries may benefit from closer assessment to rule out maltreatment.

How the COVID-19 pandemic hit crime in Barcelona: Analysis of variation in crime trends

Objectives

To compare the observed and forecasted crime trends in Barcelona, using crime statistics from January 2018 to March 2021.

Methods

We trained (seasonal) auto-regressive integrated moving average modelling (95% confidence intervals) using daily recorded crimes from January 2018 to February 2020. These models were then used to forecast crime data from March 2020 to March 2021 across four periods (lockdown, summer, fall and winter). Crime data were organized into two categories: property (burglary, theft) and violent crimes (robbery, assault, domestic violence and sexual offenses [rape, assault or abuse]).

Results

Overall, crime levels for property and violent crimes during lockdown declined sharply from the forecasted levels. Theft, burglary, assault, robbery and sexual offenses exhibited general decreases throughout the study period, with the same sharp declines during the lockdown, progressive recovery in the summer, and steady or slight reductions from fall to March 2021. Only domestic violence differed, reaching the forecasted levels for all periods and surpassing the forecast for summer 2020.

Conclusions

Our findings show how the pandemic has affected mid-term crime trends. They help to place the measures applied in the last year into context and to determine the most suitable policies to reduce crime during societal change.

Child welfare workers satisfaction and wellbeing during the COVID-19 pandemic: Perspectives of agency staff in Ohio

BACKGROUND

The COVID-19 pandemic has impacted the lives of children and families, created additional stressors, and increased risks for maltreatment. The pandemic has changed the way child welfare agencies operate, requiring changes to policies and practice. Minimal research has considered the effects of the COVID-19 pandemic on child welfare workers wellbeing and job satisfaction.

OBJECTIVE

This mixed-methods research study seeks to understand CPS staff satisfaction, variables impacting satisfaction, and challenges that increased since the pandemic began for child welfare workers in Ohio.

PARTICIPANTS AND SETTING

A sample of staff members (n = 267) from 50 CPS agencies across Ohio participated in the study.

METHODS

This mixed-methods study used logistic regression, chi square analyses, and thematic analysis to analyze the data from a survey sent to child welfare agencies in Ohio.

RESULTS

Caring for minor children, primary role at work, and years in child welfare were significantly associated with job satisfaction. Those working in foster care/placement, adoption/permanency, family support/visitation, kinship were 7.57 times more likely than those doing intake/investigation work to be satisfied with their job (p = .007). Thematic analysis of staff issues that increased during the pandemic resulted in six themes: Stress and Anxiety, Feeling Overwhelmed, Burnout, All, Motivation, and Isolation and Disconnection.

CONCLUSIONS

The COVID-19 pandemic has created additional stressors for child welfare staff. Practice implications are discussed to help increase job satisfaction, staff wellbeing, and mitigate turnover.