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Effect of COVID-19 lockdown on child protection medical assessments: a retrospective observational study in
Joanna Garstang1,2, Geoff Debelle2,3, Indu Anand1
1Birmingham Community Healthcare NHS Trust, Birmingham, UK.
Insights
Child protection medical examinations (CPME) saw a significant reduction in referrals during the COVID-19 pandemic. School closures may have hidden child abuse, necessitating future school attendance or alternatives to ensure child safety.
Area of Science:
- Pediatrics
- Public Health
- Child Protection
Background:
- The COVID-19 pandemic and associated lockdowns significantly altered societal structures, including education and child welfare services.
- Understanding the impact on child protection medical examinations (CPME) is crucial for assessing potential increases in hidden child abuse.
Purpose of the Study:
- To analyze changes in referral patterns and outcomes for children undergoing CPME during the COVID-19 pandemic compared to pre-pandemic years.
- To identify shifts in referral sources and the severity of safeguarding concerns.
Main Methods:
- A retrospective observational study was conducted using routinely collected clinical data from CPME reports.
- Data from an 18-week period during late February to late June across 2018, 2019, and 2020 were analyzed.
- The study focused on children aged 0-18 years referred for CPME in Birmingham, England.
Main Results:
- A significant decrease in CPME referrals was observed during the pandemic, with a 39.7% reduction from 2018 to 2020.
- Referrals initiated by school staff decreased notably in 2020 compared to previous years.
- Despite reduced referrals, 94% of CPME concluded significant safeguarding concerns, and 75.9% of children were already known to social care.
Conclusions:
- School closures during the COVID-19 pandemic may have led to an increase in hidden child abuse.
- Future safeguarding strategies should consider mandatory school attendance or alternative mechanisms to ensure child protection.
- A potential surge in safeguarding referrals is anticipated as schools fully reopen and children disclose abuse experienced during lockdowns.
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.
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