The impact of COVID-19 on child maltreatment-related medical encounters and system responses using linked administrative data

Project Summary/Abstract:
With schools and daycare facilities closed and unemployment rates soaring due to the COVID-
19 pandemic, experts worry not only that the incidence of child maltreatment has increased but
that that new or recurrent cases of maltreatment have gone undetected because two-thirds of
reports to child protective services (CPS) are made by professionals. Linked administrative data
(i.e., records collected for the provision of services, including health and child protection) can
overcome the challenges of relying solely on CPS reports by joining the CPS database with
medical records. Medical records have been identified as a useful data source for measuring
child maltreatment. The objective of this application is to determine if and how the COVID-19
pandemic has impacted the incidence of child maltreatment-related medical encounters and the
system responses to diagnosed cases of maltreatment. The rationale is maltreatment has
significant identified impacts on children and if maltreatment has increased during this time, it
will be important to allocate resources to address this detrimental form of trauma. The proposed
study will take advantage of a natural experiment to focus on two specific aims: 1) Compare the
incidence rates of child maltreatment-related medical encounters, before and during COVID-19;
and 2) Determine the social and legal interventions/system responses to diagnosed medical
encounters of child maltreatment before and during the pandemic. For the first aim, an
interrupted time series will be used to identify the frequency of diagnosed maltreatment in
primary care, emergency department, and hospitalization medical encounters. For the second
aim, interrupted time series and logistic regression will be used to determine the percentage and
likelihood of diagnosed maltreatment-related medical encounters being reported to CPS. The
proposed research is innovative because it uses data from multiple sources and includes
several types of medical encounters. The proposed research is significant because
maltreatment is highly consequential but difficult to measure. Results will identify with robust
empirical evidence if the pandemic COVID-19 has increased the incidence and severity of child
maltreatment-related medical encounters and changed the social and legal interventions in
response to such medical encounters. Ultimately, such knowledge has the potential to identify
how community-level events impact child maltreatment, informing public policy, resource
allocation, professional training, and future research.