Identifying child maltreatment during virtual medical appointments through the COVID-19 pandemic: A physician-based
Stephanie Lim-Reinders1, Michelle G K Ward1, Claudia Malic2
1Department of Paediatrics, University of Ottawa, Ottawa, Canada.
Insights
Pediatricians reported challenges identifying child maltreatment during virtual appointments, leading to missed or delayed cases. Virtual care presents barriers to timely detection, impacting child safety.
Area of Science:
- Pediatrics
- Child Health
- Telemedicine
Background:
- Child maltreatment reports declined during COVID-19 despite increased incidence.
- This decline raises concerns about missed cases and delayed interventions.
- Pediatricians' ability to identify maltreatment via virtual care is under scrutiny.
Purpose of the Study:
- To investigate how Canadian pediatricians identify child maltreatment during virtual medical appointments.
- To assess the challenges and barriers faced in virtual settings.
Main Methods:
- A survey was distributed to 2770 practicing general and subspecialty pediatricians in Canada.
- Data collection occurred between November 2021 and January 2022.
- 704 surveys were eligible for analysis.
Main Results:
- 11% of respondents reported at least one child maltreatment case after a virtual appointment.
- Case reporting correlated with years in practice, not virtual care volume or experience.
- Social stressors and disclosures were key triggers; virtual exams were not contributory.
- 24% required in-person visits before reporting; 32% felt cases were identified late or missed.
- Some reported clear harm resulted from delayed identification.
Conclusions:
- Pediatricians identified numerous barriers to detecting child maltreatment in virtual care settings.
- Virtual care may contribute to missed child maltreatment cases.
- Timely identification of child maltreatment is challenged by virtual care.
Background:
Throughout the COVID-19 pandemic there has been a documented decline in reports to child protective services, despite an increased incidence of child maltreatment. This is concerning for increasing missed cases. This study aims to examine if and how Canadian paediatricians are identifying maltreatment in virtual medical appointments.
Methods:
A survey was sent through the Canadian Paediatric Surveillance Program (CPSP) to 2770 practicing general and subspecialty paediatricians. Data was collected November 2021 to January 2022.
Results:
With a 34% (928/2770) response rate, 704 surveys were eligible for analysis. At least one case of child maltreatment was reported by 11% (78/700) of respondents following a virtual appointment. The number of cases reported was associated with years in medical practice (P = 0.026) but not with the volume (P = 0.735) or prior experience (P = 0.127) with virtual care, or perceived difficulty in identifying cases virtually (Cramer's V = 0.096). The most common factors triggering concern were the presence of social stressors, or a clear disclosure. The virtual physical exam was not contributory. Nearly one quarter (24%, 34/143) required a subsequent in-person appointment prior to reporting the case and 32% (207/648) reported concerns that a case had been identified late, or missed, following a virtual appointment. Some commented that clear harm resulted.
Conclusions:
Many barriers to detecting child maltreatment were identified by paediatricians who used virtual care. This survey reveals that virtual care may be an important factor in missed cases of child maltreatment and may present challenges to timely identification.
