Evaluating child maltreatment and family violence risk during the COVID-19 Pandemic: Using a telehealth home visiting program as a conduit to families

A global scoping review of adaptations in nurturing care interventions during the COVID-19 pandemic

Background

During the COVID-19 pandemic, children faced a disproportionate burden of malnutrition and poor health outcomes. Nurturing care interventions (NCIs) including actions toward good health, adequate nutrition, responsive care, opportunities for early learning, and security and safety are critical for promoting equity. Due to the need for evidence-based responses and preparedness, we analyzed adaptations in NCIs' implementation strategies during COVID-19 according to the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS).

Method

We conducted a global scoping review including peer-reviewed and non-peer-reviewed literature. The databases searched were PubMed, Embase, Scopus, BVS, Scielo, and Web of Science. This search was complemented by an extensive examination of relevant websites and an additional internet search via Google Scholar. We extracted and analyzed the data following the seven modules of the FRAME-IS.

Results

Out of 20 records, 27 NCI were identified across Africa (n = 3), Asia (n = 7), Europe (n = 3), North America (n = 11), Oceania (n = 1), and South America (n = 2). NCIs adapted their content (e.g., adding elements), evaluation (e.g., conducting needs assessment), training (e.g., using experts), and context (e.g., setting-shifting from in-person to remote, and population-expanding interventions' reach). Adaptation goals were to increase acceptability (n = 9, 32.1%), adoption (n = 5, 17.8%), appropriateness (n = 10, 35.7%), feasibility (n = 25, 89.3%), penetration (n = 15, 53.6%), sustainability (n = 23, 82.1%), and fidelity (n = 1, 3.7%). The rationale to adapt varied from sociopolitical (n = 6, 21.4%), organizational (n = 13, 46.4%), implementer (n = 11, 39.3%), practitioner (n = 15, 53.6%), and recipient (n = 11, 39.3%). A quarter were reactive planned adaptations and 75.0% were unplanned modifications. Decisions were led by program leaders (n = 21, 75.0%), funders (n = 9, 32.1%), partners (n = 3, 10.7%), researchers (n = 1, 3.6%), and practitioners (n = 3, 10.7%). Adaptations were widespread from unit (e.g., hospital) (n = 1, 3.6%), organization (n = 4, 14.3%), and community system (e.g., countrywide) (n = 14, 50.0%).

Conclusion

The results from our global scoping review show that it is possible for NCIs to continue and even improve their delivery despite the global crisis, suggesting that remote delivery is feasible and can work as an alternative when in lockdown. Strategic planning taking advantage of existing structures and partnerships may have allowed NCI adaptations to be sustainable as well as facilitated replication within the organization network system.

Child maltreatment during the COVID-19 pandemic: implications for child and adolescent mental health

As societies worldwide addressed the numerous challenges associated with the COVID-19 pandemic, a troubling concern emerged-the possible rise of child maltreatment, which is a pernicious risk factor for child and adolescent mental health difficulties. This narrative review aims to provide a comprehensive understanding of how the many changes and challenges associated with the pandemic influenced worldwide occurrences of child maltreatment and, subsequently, the mental health of children and adolescents. First, we present the well-established evidence regarding the impact of child maltreatment on the mental health of children and adolescents both before and during the COVID-19 pandemic. Next, we examine the existing literature on the prevalence of child maltreatment during the pandemic, explanations for conflicting findings, and key mechanisms influencing the prevalence of maltreatment. Using a heuristic model of child maltreatment and its downstream influence on child mental health, we discuss risk and protective factors for maltreatment as well as mechanisms by which maltreatment operates to influence child and adolescent mental health. Finally, based on the accumulated evidence, we provide important recommendations for advancing research on child maltreatment, emphasizing the necessity for routine monitoring of maltreatment exposure at a population level, and discussing the implications for the field of child protection. This comprehensive review aims to contribute to the understanding of the challenges arising from the intersection of the COVID-19 pandemic and child maltreatment, with the goal of informing effective interventions in the domain of child welfare.

Strategies and Adaptations to an Integrated Substance Use and Infant Mental Health Treatment Program During COVID-19

The COVID-19 pandemic resulted in increased parenting stress and substance use. At the same time that mental health and social service needs increased, access to services, including among those receiving treatment, decreased due to stay-at-home orders. Few programs were equipped or prepared to translate their interventions to a virtual format at the start of the pandemic. There is a critical need to identify effective adaptations to substance use and family-focused treatment during the COVID-19 pandemic. Effective program adaptations have continued relevance for the expansion of access to family-focused addiction services beyond the pandemic itself, particularly for rural or other hard to reach populations. Seventy-three semi-structured interviews were conducted with the five agencies participating in the implementation of the In-Home Recovery Program (IHRP), an in-home, substance use disorder (SUD) treatment program. Using a rapid analysis approach two coders analyzed interviews for recurring concepts and themes. Facilitators for adapting services included: (1) the introduction of virtual toxicology screens, (2) helping parents access technology, (3) assisting parents with non-identified children to decrease their stress, and (4) anticipating reoccurrences of substances during the pandemic. Barriers to adapting services included: (1) engaging young children in virtual treatment, (2) privacy, and (3) engaging in telehealth with parents experiencing domestic violence or reoccurrence of substances. Findings reveal virtual substance use treatment is possible. Facilitators to adaptation such as providing access to technology and virtual toxicology screens demonstrate the feasibility and acceptability of utilizing telehealth interventions for substance use. Barriers to adaptations were primarily related to the infant mental health component. Telehealth is likely not appropriate for children below the age of five. Individual sessions focusing on caregiving, rather than dyadic treatment may be more suitable to virtual formats.

Impact of the COVID-19 Pandemic On Violence Against Children: A Narrative Review

PURPOSE OF REVIEW

The goal of this paper was to explore the different ways the COVID-19 pandemic has affected violence against children (VAC).

RECENT FINDINGS

Recent research of peer-reviewed articles using operational or survey data revealed the pandemic's impact in terms of institutional responses, risk and mediating factors, changes in VAC dynamics, and a likely increase in child marriage. Findings include a decrease in institutional responses, activities, and prevention case openings; an increased incidence of interparental intimate partner violence (IPV) witnessing cases, hospital admissions for suspected Abusive Head Trauma (AHT), other pediatric injuries, and sexual violence; a change in family conflict dynamics; and an estimated increase in child marriages. It also revealed mediating factors between the relationship of the pandemic and VAC (such as parental stress and mental health symptoms), as well as risk factors observed by service providers, which include the risk of mental health symptoms of both parents and children. Post-pandemic VAC research can be improved by utilizing operational or survey data in a meaningful way to be able to derive sound intervention approaches to diminish the pandemic's impact on VAC and child marriage. We also propose for researchers to integrate child marriage into the definition of VAC.

The prevalences, changes, and related factors of child maltreatment during the COVID-19 pandemic: A systematic review

BACKGROUND

The impact of the COVID-19 pandemic has been extensive and drastic during the twenty-first century. The increasing phenomenon of child maltreatment during the pandemic is a significant public health concern.

OBJECTIVE

This study is the first systematic review to analyze and summarize the prevalence rates, risk factors, and protective factors related to child maltreatment during the COVID-19 pandemic.

METHODS

Four electronic databases (PubMed, Web of Science, Scopus, Embase) were systematically searched. Some potential studies were also identified from the reference lists of previously included articles. The quality of the included studies was assessed by the National Institutes of Health (NIH) Quality Assessment Tool and Critical Appraisal Skills Program (CASP) Quality Assessment Tool.

RESULTS

A total of 35 articles were included in the analysis, with 16 having prevalence information and 22 having factor information. Sixteen studies were conducted in the US, the other 17 studies were from 12 countries, and only two studies contained mixed countries. The prevalences of child maltreatment during the pandemic varied widely in different types and measurements. The pandemic rates of physical abuse, psychological abuse, neglect, and sexual abuse were 0.1 %-71.2 %, and 4.9 %-61.8 %, 7.3 %-40 % and 1.4 %-19.5 %, respectively. There was a decline in allegations of child maltreatment and an increase in severe cases of child maltreatment during the COVID-19 pandemic. Lockdown measures and their side effects were the main risk factors contributing to child maltreatment.

CONCLUSIONS

This review calls for targeted measures to prevent child maltreatment during the COVID-19 pandemic and current and future lockdowns and more future replication studies conducted in countries other than the US.

Factors associated with child abuse among children and adolescents in a Peruvian public hospital

The study's objective was to investigate the factors associated with child and adolescent abuse in the MAMIS program at Hipólito Unanue Hospital in the Tacna-Peru region during 2019-2021. The study used a quantitative, retrospective, cross-sectional, and correlational approach to analyze 174 cases of child abuse. The study found that the majority of child abuse cases involved children between the ages of 12-17 (57.4%), with a secondary level of education (51.15%), females (56.9%), and not consuming alcohol or drugs (88.5%). Prevalent household characteristics included single-parent families (48.28%), parents aged 30-59 (58.5%), divorced (37.3%), with secondary level of education (68.9%), independent occupation (64.9%), no history of parental violence (91.3%), no addiction or substance abuse issues (95.4%), and no psychiatric disorders (95.4%). The most common types of abuse were psychological (93.68%), followed by neglect or abandonment (38.51%), physical (37.93%), and sexual (27.0%). The study determined a significant relationship (95% confidence level) between socio-demographic characteristics, such as age, sex, and substance use, and specific types of child abuse.

Supporting Children Experiencing Family Violence During the COVID-19 Pandemic: IPV and CPS Provider Perspectives

OBJECTIVES

Children experiencing family violence (child abuse and neglect and exposure to intimate partner violence) are at a particularly elevated risk for compounding challenges during the COVID-19 pandemic. In this study, we interviewed intimate partner violence (IPV) advocates, child protective services (CPS) caseworkers, and IPV and CPS administrators on the needs of children experiencing family violence during the pandemic.

METHODS

We conducted semistructured interviews with IPV advocates, CPS caseworkers, and IPV and CPS administrators. Recruitment occurred through emails to national and state listservs, networks of the study team, and word of mouth. Interviews were completed through Zoom, took 45 to 60 minutes and were audio recorded. We used a mixed deductive-inductive content analysis approach.

RESULTS

Fifty-nine IPV advocates, 35 IPV administrators, 21 CPS workers and 16 CPS administrators participated in this study. Four themes emerged from this work. Participants discussed the role of social isolation, school closures, and distance learning on children experiencing family violence. They also noted child custody and visitation challenges, particularly in the context of abusive partners using custody to control IPV survivors and limitations to virtual visitation more broadly. Compounding challenges were described for children from marginalized communities due to structural-level inequities. Collaboration was discussed by participants from both IPV and CPS sectors.

CONCLUSION

This study is one of the first to describe the way the COVID-19 pandemic has impacted children experiencing family violence. Future studies should triangulate these results with children, families, and other child-serving providers.