Calculating the impact of COVID-19 pandemic on child abuse and neglect in the U.S.

BACKGROUND: COVID-19 has had a major impact on child abuse and neglect (CAN) in the U.S. leading to a change in the number of reported screened-in CAN investigations, missed prevention cases, and missed CAN cases. OBJECTIVES: To estimate the deficit number of CAN investigations and resultant estimated number of missed prevention and CAN cases due to the COVID-19 pandemic in the U.S. from March 2020 to December 2020. METHODS: Secondary data analyses of administrative child welfare data from January 2013 to December 2020 from New York City, Florida, New Jersey and Wisconsin were conducted. Spline regression modeling controlling for autocorrelation was utilized to explore any significant changes once the pandemic began in March 2020 in the number of screened-in CAN investigations. The seven-year monthly average of screen-in CAN investigations for March through December from 2013 to 2019 was calculated and compared to the numbers of CAN investigations for March 2020 to December 2020. The resultant number of missed prevention cases and CAN cases was estimated for the four jurisdictions and used to approximate the number of missed prevention cases and CAN cases in the U.S., as well as the projected estimation of national lifetime economic costs. RESULTS: Prior to the pandemic, there were insignificant monthly increases of 0.7 CAN investigations in NYC and 6.2 CAN investigations in Florida, a significant monthly increase 4.2 CAN investigations in New Jersey and an insignificant monthly decrease in 0.6 CAN investigations in Wisconsin. Once the pandemic began, there were significant monthly decreases (p < .001) in each of the four jurisdictions, including 1425.6 fewer CAN investigations in NYC, 3548.0 fewer CAN investigations in Florida, 963.0 fewer CAN investigations in New Jersey and 529.1 fewer CAN investigations in Wisconsin. There were an estimated 60,791 fewer CAN investigations in these four jurisdictions from March 2020 to December 2020 of which there were approximately 18,540 missed prevention and CAN cases suggesting up to $4.2 billion in lifetime economic costs. It was estimated that were 623,137 children not investigated for CAN in the U.S. during the same 10-month period. This suggests that there were an estimated 85,993 children were missed for prevention services and about 104,040 children were missed for CAN with a potential lifetime economic impact of up to $48.1 billion in the U.S. CONCLUSIONS: The COVID-19 pandemic has led to a precipitous drop in CAN investigations where almost 200,000 children are estimated to have been missed for prevention services and CAN in a 10-month period. There are opportunities for the child welfare jurisdictions to work with partner education, public health, social service and other providers to strategically approach this very grave issue in order to mitigate its impact on this very vulnerable population.

Who Is Caring for Health Care Workers' Families Amid COVID-19?

Amid the COVID-19 pandemic, women in medicine, including faculty, residents, medical students, and other health care workers (HCWs), are facing unparalleled challenges. The burdens of pandemic-associated increases in domestic and caregiving responsibilities, professional demands, health risks associated with contracting COVID-19, and the resulting psychosocial distress have exacerbated existing gender disparities at home, at work, and in academia. School and day care closures have created additional childcare needs, primarily for women, yet little support exists for parents and families. These increased childcare and domestic responsibilities have forced women HCWs, who make up the overwhelming majority of the workforce, to adapt their schedules and, in some cases, leave their jobs entirely. In this article, the authors detail how COVID-19 has exacerbated existing childcare accessibility and affordability issues as well as gender disparities. They argue that unless government and health care organization support for childcare increases, families, specifically women and children, will continue to suffer. Lack of access to affordable childcare can prevent HCWs from doing their jobs, including conducting and publishing academic scholarship. This poses incalculable risks to families, science, and society. COVID-19 should serve as a call to action to all sectors, including the government and health care organizations, to prioritize childcare provision and increase support for women HCWs, both now during the pandemic and going forward.

Progress Update in Pediatric Renal Tumors.

PURPOSE OF REVIEW: Pediatric renal tumors account for 7% of new cancer diagnoses in children. Here, we will review results from recently completed clinical trials informing the current standard of care and discuss targeted and immune therapies being explored for the treatment of high risk or relapsed/refractory pediatric renal malignancies. RECENT FINDINGS: Cooperative group trials have continued to make improvements in the care of children with pediatric tumors. In particular, trials that standardize treatment of rare cancers (e.g., bilateral Wilms tumor) have improved outcomes significantly. We have seen improvements in event free and overall survival in recently completed clinical trials for many pediatric renal tumors. Still, there are subsets of rarer cancers where outcomes remain poor and new therapeutic strategies are needed. Future trials aim to balance treatment toxicity with treatment efficacy for those with excellent outcomes while identifying novel therapeutics for those with poor outcomes.

How COVID-19 Is Placing Vulnerable Children at Risk and Why We Need a Different Approach to Child Welfare.

The onset of the COVID-19 pandemic brings new worries about the welfare of children, particularly those of families living in poverty and impacted other risk factors. These children will struggle more during the pandemic because of financial pressures and stress placed on parents, as well as their limited access to services and systems of support. In this commentary, we explain how current circumstances reinforce the need for systemic change within statutory child welfare systems and the benefits that would accrue by implementing a continuum of services that combine universal supports with early intervention strategies. We also focus on promising approaches consistent with goals for public health prevention and draw out ideas related workforce development and cross-sector collaboration.

Effect of COVID-19 lockdown on child protection medical assessments: a retrospective observational study in Birmingham, UK.

OBJECTIVES: To determine any change in referral patterns and outcomes in children (0-18) referred for child protection medical examination (CPME) during the COVID-19 pandemic compared with previous years. DESIGN: Retrospective observational study, analysing routinely collected clinical data from CPME reports in a rapid response to the pandemic lockdown. SETTING: Birmingham Community Healthcare NHS Trust, which provides all routine CPME for Birmingham, England, population 1.1 million including 288 000 children. PARTICIPANTS: Children aged under 18 years attending CPME during an 18-week period from late February to late June during the years 2018-2020. MAIN OUTCOME MEASURES: Numbers of referrals, source of disclosure and outcomes from CPME. RESULTS: There were 78 CPME referrals in 2018, 75 in 2019 and 47 in 2020, this was a 39.7% (95% CI 12.4% to 59.0%) reduction in referrals from 2018 to 2020, and a 37.3% (95% CI 8.6% to 57.4%) reduction from 2019 to 2020. There were fewer CPME referrals initiated by school staff in 2020, 12 (26%) compared with 36 (47%) and 38 (52%) in 2018 and 2019, respectively. In all years 75.9% of children were known to social care prior to CPME, and 94% of CPME concluded that there were significant safeguarding concerns. CONCLUSIONS: School closure due to COVID-19 may have harmed children as child abuse has remained hidden. There needs to be either mandatory attendance at schools in future or viable alternatives found. There may be a significant increase in safeguarding referrals when schools fully reopen as children disclose the abuse they have experienced at home.

Elementary School-Aged Children in Therapeutic Residential Care: Examining Latent Classes, Service Provision, and Outcomes.

BACKGROUND: Approximately one-third of children in residential care are elementary-school aged. Yet, little is known about the subset of younger children in residential care and the nature of these placements. OBJECTIVE: This study identified latent classes of younger children in residential care and compared the purposes for placement, treatment processes, and outcomes across classes. PARTICIPANTS AND SETTING: The sample included 216 children (ages 5-10) placed in therapeutic residential care. METHODS: A three-step latent class model was used to estimate conditional effects of class membership on impairment at discharge, length of stay, and discharge placement. A content analysis of a randomly selected sample of case records from each class was used to explore placement processes. RESULTS: There were three classes identified (class 1: child welfare/multi-problem families; class 2: mental-health/angry-oppositional; class 3: strong families/attachment). All classes experienced large improvements in functioning. Children in class 3 were in care longer (CI95% 1.72, 15.48) and experienced greater reductions in impairment (CI95% -11.17, -32.06) than class 2. Classes did not differ in rates of discharge to family-based care, however, more children in classes 1 (20.9%) and 3 (21.6%) discharged to group-based placements than class 2 (11.1%). The content analysis revealed similarities in reasons for placement and treatment processes across classes with some distinctions. Service goals were similar across classes and focused on emotional management, social skills, and developing trust. CONCLUSION: The results supported individualized approaches to facilitate discharge to stable, family-based care and reduced risks for re-entry and prolonged out-of-home care for younger children.

Differences and disparities over time: Black and White families investigated by Ontario's child welfare system.

BACKGROUND: Black-White disparities in child welfare involvement have been well-documented in the United States, but there is a significant knowledge gap in Ontario about how and when these disparities emerge. OBJECTIVE: This paper compares incidence data on Black and White families investigated by Ontario's child welfare system over a 20-year period. METHODS: Data from the first five cycles of the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) (1993-2013) were used to examine trends in child maltreatment investigations involving Black and White families. Incidence rates were calculated. T-tests were conducted to assess statistically significant differences between and within cycles. Population and decision-based enumeration approaches were also used to examine child welfare disparities. RESULTS: The incidence of investigations involving White families almost doubled between 1998 and 2003, but for Black families the incidence increased almost fourfold during the same period. These increases and the difference between Black and White families in 2003 were statistically significant. The results further indicate that Black families experience disparate representation in Ontario's child welfare system over time for most service dispositions. CONCLUSIONS: Several possible explanations are offered for the study's outcome, including changes in risk related to social safety net, the threshold for risk of harm, and bias and racist institutional policies and practices. This study invites policy-makers and child welfare authorities to rethink service delivery in addressing the disparate representation of Black families in the child welfare system.

Achieving Justice for Girls in the Juvenile Justice System.

Female involvement in the juvenile justice system has steadily increased in the United States over the past three decades. During this time, as male arrests have declined, female arrests have increased. Although many social workers have responded to these trends with a national call to identify and address the unique needs of these girls, we lack much high-quality research, including empirically supported interventions or programming to serve the needs of female youths involved in the justice system. This article provides a summary of the extant research that helps document the unique needs of these female youths and national policy efforts and practice considerations for social work practitioners. These needs and policy initiatives offer important opportunities for social workers to conduct research to improve the understanding of this population and also ways in which to provide services that address these youths' complex needs. The article concludes that these female youths-most of whom are not a danger to society-need services instead of involvement in the justice system.

Changing the Pediatric Paradigm: Focusing on Strengths.

Pediatricians need to adopt a strengths-based approach within their practices to better address their patients' health-related social needs. This approach becomes even more important as the pediatric population in the United States becomes increasingly diverse. Pediatricians must be cognizant of and address biases within their practices to maximize effectiveness of a strengths-based approach. With evidence mounting about their significance to health, a paradigm shift is needed to address health-related social needs by focusing on assets, not deficits. This shift will hopefully improve pediatric health outcomes which have languished in the United States, despite outspending other wealthy nations for decades.

Disparity in child welfare referrals from public schools: An example of Simpson's Paradox?

BACKGROUND: Black children continue to be found in child welfare outcome measures at rates nearly double those of White children in the United States. Researchers have turned from bias theory to risk theory, arguing that disparity disappears when considering only the subgroup of children in poverty. In this study, we consider whether this phenomenon is an example of Simpson's Paradox, where aggregate findings are confounded by a third factor. PARTICIPANTS: We created a dataset by matching child welfare data to schools in a metropolitan California county. METHODS: We consider measures of poverty and racial-ethnic student composition as possible confounders, utilizing compositional data analysis for the latter. Traditional linear and ridge regression models were used to calculate the unadjusted and adjusted effects of each independent variable. RESULTS: We find only partial evidence of Simpson's Paradox, in that Black to White disparity only disappears in the highest quartile of poverty. Holding poverty constant, only increasing student population non-White composition was significantly associated with reducing Black to White disparity ratios. CONCLUSION: In a small, exploratory study, we find that while poverty may serve as an equalizer, diversity racial/ethnic student body composition may serve as a neutralizer. We find that underlying causes of disparity are complex and caution against endorsement of single theories to explain the disproportionate representation of Black children in child welfare. We find utility in analyzing child welfare data with concepts and techniques common in other disciplines and highlight several weaknesses of current child welfare informatics which impact both program evaluation and research.

Analysis of psychiatric services provided to children and youth in 2010-2016 based on the National Health Fund data. / Analiza swiadczen psychiatrycznych udzielonych populacji rozwojowej w latach 2010­2016 na podstawie danych Narodowego Funduszu Zdrowia.

OBJECTIVES: In Poland, there is no systematic epidemiological research on mental disorders of children and adolescents in the general population, as well as a register dedicated to mental disorders. The aim of the presented study is to analyze psychiatric services reported to the National Health Fund that were provided to children and adolescents in the years 2010-2016. METHODS: The starting point of this study was report entitled Maps of health needs in mental disorders published by the Ministry of Health. The analysis concerns all mental health services provided to children and adolescents in the years 2010-2016. The analysis covers seven largest, in terms of the number of patients, groups of mental disorders according to ICD-10 in children and adolescents. RESULTS: In the years 2010-2016, both the number of psychiatric service users under the age of 18 years and the total number of healthcare services have increased in almost all of analyzed areas. Unusually high increase in the number of services provided in the ad hoc mode in A&E department was registered, with a very small share of services provided in home environment. In almost all analyzed groups of mental disorders, there was a greater number of boys, as well as residents of a town/city. Only in the group of neurotic disorders associated with stress and in the somatic form a slightly higher number of girls was noticed. CONCLUSIONS: In the years 2010-2016, an increase in the number of registered cases in the population of children and adolescents and the number of services in almost all of the analyzed areas was observed. High increase in services provided in the ad hoc mode in A&E department and a small share of services provided in the home environment indicates significant discrepancy between the needs and the availability of resources.

A Swedish national study: Immigrant-country of birth status and child welfare compulsory care among a sample of parents with risky substance use.

BACKGROUND: Sweden has a high percentage of foreign-born residents (18.5 %) and one of the highest overdose death rates in Europe. For immigrant parents with risky substance use (RSU), risk factors associated with immigration status (e.g., economic strain and psychological stress) potentially heightening the risk of involvement with the child welfare system (CWS). Using Swedish registry national data, this study explored the relationship between immigration-country of birth status, psychosocial risk factors, and child compulsory care for parents with RSU. METHODS: Study sample consisted of 5932 parents from 65 Swedish municipalities assessed for psychosocial problems (including alcohol and drug use) using the Addiction Severity Index (2007-2017). Stepwise multinomial logistic regression models examined the relationship between immigration-country of birth status (Swedish born, Nordic-born, and non-Nordic born), psychosocial problems, and compulsory care in the CWS. RESULTS: Compared to Swedish-born parents, parents not born in Sweden, Norway, Denmark or Finland (non-Nordic born parents) had a lower probability of children living in compulsory care (family homes or institutions). However, after accounting for psychosocial problems, immigration status was no longer significantly associated with children's living arrangements. CONCLUSIONS: Study findings indicate that parental immigrant status (even among parents dealing with RSU) in itself is not a risk factor for compulsory care in the CWS. Moreover, parental employment and health problems posed greater risk for children being in compulsory care. Receipt of targeted services for employment and health problems may help to maintain stable child living arrangements for immigrant parents dealing with RSU.

Socio-demographic predictors of well-being in United Kingdom adolescents, and the impact of well-being on a range of health-related outcomes.

The deleterious impact of low mental well-being, and higher levels psychological symptoms (collectively well-being), on concurrent and prospective health outcomes has elsewhere been demonstrated. Further, variables such as conurbation and deprivation have been found to be related to mental and physical heath. This study used data from a longitudinal study to examine which demographic predicted well-being scores, and how scores on these constructs were related to six health-related outcomes. Participants were adolescents (N = 4,956; Male = 2376[48%]), from 72 High Schools in Northern Ireland. Three waves of data were gathered on mental well-being, psychological symptoms, subjective life expectancy (living to age 35 and age 75 years), self-rated health, frequency of physical exercise, and lifetime use of cigarettes and cannabis. Results showed that both well-being scores were significantly associated with gender cross-sectionally, but demographic variables did not predict changes in well-being longitudinally. Both well-being measures were significantly associated with health outcomes cross-sectionally, with mental well-being (over time) predicting life subjective life expectancy, self-rated health, and addictive behaviors, while psychological symptoms (over time) predicted the former two, but not addictive behaviors. Overall, the relationship between mental well-being, psychological symptoms, and the health outcomes assessed, was small in terms of effect size.