Department of Research & Evaluation News

The rate of emergency department visits associated with child abuse or neglect at Kaiser Permanente Southern California hospitals doubled immediately after the March 2020 stay-at-home order. This increase in the rate of child maltreatment visits was highest among younger children, girls, and children who were Black or Hispanic. Over the following year and a half, the case rates slowly decreased to the pre-lockdown rates.

“Typically, teachers do most of the reporting of suspected child abuse, but during the pandemic lockdown, there was no in-person school, no after-school activities, and no school sports,” said the study’s lead author, Sonya Negriff, PhD, a developmental psychologist at the Kaiser Permanente Southern California Department of Research & Evaluation who specializes in child maltreatment. “This study shows us that in the future we need overlapping systems of care for children so if one is not available, such as schools, another one can be there to protect this vulnerable population. Everybody can be empowered to help protect children.”

The study was published in August 2022, in the journal Child Abuse & Neglect. This retrospective cohort study looked at electronic health records of children under 18 years old who visited Kaiser Permanente Southern California emergency departments from January 1, 2019, to September 30, 2021. Overall, the study included 407,228 pediatric emergency department visits, of which 918 were related to child maltreatment.

Although previous studies have documented an increase in the rates of child maltreatment seen in emergency departments nationally during the pandemic lockdown, this was one of the first to look at race, age, and gender as well.

Among the main findings were:

• There was a significant change in the percentage of child maltreatment visits immediately following the stay-at-home order, then small month-to-month decreases to near pre–stay-at-home order levels through the next 16 months.
• The rate of child maltreatment cases for children under 4 years old tripled.
• The increased rate of child maltreatment in the first month after the stay-at-home order was in place also was higher for female, Black, and Hispanic children.

This study looked at the rate of visits rather than the number of visits because the number of emergency department visits decreased during the stay-at-home order, as well as the number of child maltreatment visits. So, researchers looked at the proportion of visits to see if this stayed the same or changed after the stay-at-home order, which was a better reflection of the trend of child maltreatment visits across this time, Dr. Negriff explained.

The study’s senior author, Mercie DiGangi, DO, a pediatrician and regional lead of Kaiser Permanente’s Child Abuse Prevention Team, noted that the Southern California Permanente Medical Group is committed to the safety and health of every child.

“We have a robust regional team of physicians and social workers who work to improve identification of abuse in our members, improve our support resources, encourage utilization of our electronic health record for coordination of cases, and increase screening efforts to identify and assist families suffering from Adverse Childhood Experiences,” Dr. DiGangi said. “We recently received a large grant to improve our education of physicians and staff on child abuse of all types. With this funding, we built online training modules that have been shared intra-regionally and hired speakers on diversity, equity, and inclusion and its intersection with abuse reporting. We also improved our electronic health record tools to include helpful smart phrases, smart order sets, and pop-up warnings to help identify and recognize abuse.”

Both Dr. DiGangi and Dr. Negriff emphasized that public health mitigation measures such as lockdowns are critically important to reduce deaths during a pandemic.

Dr. Negriff added, “And what we learned from this study was that those lockdowns may affect different populations differently, and there are some children at increased risk. In addition to creating overlapping support systems to protect children from abuse, we need to ensure follow-up mental and physical health care is in place for these children.”

In addition to Dr. Negriff and Dr. DiGangi, other authors on the study include Adam Sharp, MD, MSc, and Brian Huang, PhD, formerly of the Department of Research & Evaluation.