Effect of COVID-19 lockdown on child protection medical assessments: a retrospective observational study in Birmingham, UK

  1. Joanna Garstang
  2. Geoff Debelle
  3. Indu Anand
  4. Jane Armstrong
  5. Emily Botcher
  6. Helen Chaplin
  7. Nutmeg Hallett
  8. Clare Morgans
  9. Malcolm Price
  10. Ern Ern Henna Tan
  11. Emily Tudor
  12. Julie Taylor

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

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.

Article activity feed

  1. Version published to 10.1136/bmjopen-2020-042867
  2. ScreenIT

    SciScore for 10.1101/2020.08.09.20170977: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Setting and sample: All children aged 0-18 attending for CPME at Birmingham Community Healthcare Trust (BCHT), England.
    Community Healthcare
    suggested: None
    Statistical analysis: Anonymised data were entered into SPSS.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and weaknesses in relation to other studies, discussing important differences in results: Although the drop in CPME referrals has been noted elsewhere in the UK (12), the longer duration of our study enabled us to examine any effects of the partial re-opening of schools. Our detailed analysis of referral details and outcomes identified the change in referral patterns this year, which is a novel finding. As our CPME service covers a fixed population, we can be certain that changes in referral patterns are genuine, unlike tertiary paediatric centres whose referrals are determined by clinical need not home address (11). Meaning of the study: possible explanations and implications for clinicians and policymakers: Our findings further evidence the hidden harm to children from covid-19. The significant decrease in CPME referrals is likely largely a result of school closure and the partial re-opening of schools has not altered this trend. Attending school provides children and young people with access to a trusted adult and a safe space outside of the family home. Removing this provision increases the potential risk of abuse going unseen. Many schools have made strenuous efforts to maintain contact through remote methods, but these are not always private and it is not known who else may be in the room. Although UK government guidance was for vulnerable children, identified as those with an allocated social worker, to continue attending school, less than 10% did so (10). Ne...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.08.09.20170977v1 on medRxiv