Berks County Medical Society Medical Record Fall 2021 - 22

Masked Maltreatment: A Study of Child Abuse
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INTERVIEWING EXPERTS IN THE FIELD
When speaking with the Lead District Nurse and the Director
of Student Support Services from Tulpehocken and Reading
School Districts, both individuals reported no significant change
in child abuse reports made at their school districts. This suggests
virtual class formatting did not lead to a loss of child abuse
reporting. It should also be noted that universal feeding, which
offers students breakfast and lunch meals, was provided on-site at
school buildings within the Reading School District throughout
the pandemic and may have increased child abuse reporting
opportunities. From an education standpoint, both experts stated
there was an adjustment period in delivering a virtual education to
their students at the beginning of the pandemic. In Tulpehocken,
the majority of students were assigned virtual assignments with
little real-time instruction while Reading students could pick up
printed assignments at the school or collect them while receiving
their daily meals. Fortunately, both school districts reported that
by the fall of 2020 every student was either attending school
in-person or possessed an electronic device and had Wi-Fi access.
While Tulpehocken students would return to in-person classes
in the fall of 2020, Reading students would continue to attend
classes remotely from home until mid-April and early May when
elementary and middle school students were invited back oncampus.
However, both informants shared that during 2020 and
2021 there was an increase in the number of home visits made to
students. While some visits were made to help set up resources for
families, the majority of home visits were made to inquire after
student truancy. It is interesting to note that 25 states consider
failure to educate a child a type of neglect, however, at this time
Pennsylvania does not.
Additionally, some experts shared how virtual learning
prompted students to perform schoolwork in other areas of the
state, country, and world. This is important as both a senior
Detective from the Berks County Detective Office and the
Assistant District Attorney stated that the report, investigation,
and prosecution of a case can often be impeded by jurisdictional
obstacles which delay justice for children and their families. The
Berks County Detective also expressed that during the pandemic
the office's monthly totals of reported abuse dropped to 100 cases
or less, a significant change for an office operating at roughly 2,000
cases or more per year. While the Berks County Detective Office
was closed for two weeks during the beginning of the pandemic,
detectives continued to investigate cases during that time.
The Director of the Children's Alliance Center (CAC),
which partners with the District Attorney's Office and local law
enforcement to serve primarily victims of sexual abuse, was also
interviewed. She stated that while the center did not see any drops
in clients, the CAC struggled to connect victims with mental health
resources due to an increase in demand by the public for such
services. The director also noted an increase in the severity of sexual
and physical cases seen by the center. However, this may have
occurred as hospitals were the main source of victim referrals to the
CAC during the pandemic.
The Chief of Pediatric Emergency Medicine at Tower Health
was interviewed and described an increase in mental health resource
utilization in ER treatment. This expert also perceived an increase
in neglect potentially due to parental/caregiver burnout, a concern
expressed by other experts. He additionally noted an increase in
drug-related child endangerment resulting from guardian substance
use, specifically Fentanyl, and accidental ingestion by children
around 1-4 years old. The Assistant District Attorney also noticed
an increase of drug-related endangerment cases, however she
specified the majority of children were 18 months old or younger.
Most importantly, from his experience, the Chief of Pediatric
Emergency Medicine perceived an increase in sexual abuse victims,
and thus anticipates sexual abuse will be the most prevalent form of
child abuse treated during the pandemic.
The final expert interviewed, who serves as both the Director
of Prevent Child Abuse PA and the Program Director at Suspected
Child Abuse & Neglect (SCAN), revealed differences in medical
mandated reporter training during the COVID-19 pandemic.
Medical mandated reporter trainings are typically offered as inperson
presentations, however during the pandemic, all trainings
were held virtually. Presentations were adapted to account
for COVID-19 virtual living conditions by integrating new
information on how to identify safety concerns during telehealth
visits. The expert also noted an increase in comments from
trainees regarding human trafficking which paralleled with a sharp
increase in human trafficking cases at several children advocacy
centers. Throughout the pandemic, school nurse turnout at
trainings increased due to easier summer access while hospital staff
attendance stayed roughly the same. However, the most prolific
finding was a suspension of EMS specific mandated reporter
trainings due to severe demands on Emergency Medical Service
resources from COVID-19.
SURVEY RESULTS
A total of 12 individuals partook in the virtual survey
disseminated with 90% of participants self-identified as medical
providers or healthcare workers. In contrast to several of the
interview findings, the survey found that physical and mental
abuse were perceived to have the highest incidence during the
pandemic (Figure 9). Indeed, the Assistant District Attorney
explicitly expressed there had been " no uptick " in criminal physical
abuse cases during the pandemic. When asked if the severity of
abuse has changed during the pandemic, over 80% of participants
said yes or were unsure, however the explanations as to how
COVID-19 affected the type and severity of abuse observed varied
(Figure 10). A consistent concern was children's lack of exposure
to community members and mandated reporters. While some felt
there was a decrease in reporting but " more frequent and more
severe incidences of all abuse, " others felt there was " less frequent
incidence overall " but increased severity. There were also diverse
answers as to which types of abuse experienced increased severity
and which age groups of children were affected.
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Berks County Medical Society Medical Record Fall 2021

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