Phone call and text inquiries are plotted as number of inquiries per week between March 1, 2019, and May 27, 2019, and March 1, 2020, and May 26, 2020. The vertical dashed line indicates the declaration of a health emergency by the Secretary of Health and Human Services, which occurred on January 31, 2020. The vertical dotted line indicates the initiation of school closures, which began on March 5, 2020. Calls initially increased, then decreased after January 31, 2020, and then increased again in May 2020 above 2019 levels. Text inquiries in 2020, while not directly comparable with 2019 data given their novelty as an added modality that year, more steadily increased after March 5, 2020, compared with phone calls.
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Ortiz R, Kishton R, Sinko L, et al. Assessing Child Abuse Hotline Inquiries in the Wake of COVID-19: Answering the Call. JAMA Pediatr. Published online May 03, 2021. doi:10.1001/jamapediatrics.2021.0525
Experts are concerned about increasing child distress and maltreatment alongside decreasing exposure to mandated child abuse reporters, such as teachers, during the COVID-19 pandemic.1 Hotlines may serve as alternate means to identify family violence and support at-risk children. This study assessed the volume of calls and texts to a national child abuse hotline during the pandemic compared with the prior year.
This cross-sectional study was conducted using restricted-access data from Childhelp, the only national hotline with a primary focus on child abuse and neglect. Childhelp has offered 24-hour multilingual counseling across all US states via phone call inquiries from youth and concerned adults since 1982 and via text message since 2019.2,3 Users anonymously provide optional demographic information, including their relationship to the youth (eg, themselves, parent, neighbor, or teacher). Users are then connected to a crisis counselor. Study data included the number of inquiries, modality (call or text), and demographic characteristics (inquirer’s age category, sex, and identifier type). The University of Pennsylvania Institutional Review Board deemed this study nonhuman subjects research.
Given the initiation of school closures on March 5, 2020, we examined differences in demographic information by modality between March 1, 2019, and May 27, 2019, and March 1, 2020, and May 26, 2020, using χ2 and Fischer exact tests. We then assessed inquiries for each full year beginning in January by modality. Analyses were performed using Stata/IC version 15.1 (StataCorp), with 2-tailed significance set at P < .05.
From March to May in 2019 and 2020 combined, Childhelp received 35 480 call and text inquiries, mostly from female individuals (74.63%) and adults 18 years and older (92.97%) (Table). Nearly 96% of callers were adults (18 years and older), while most texters were younger than 18 years. There was a 13.75% increase in the total number of inquiries in 2020 compared with 2019. Caller type differed between 2020 and 2019 as well, with a decrease in calls from school reporters (teachers, school personnel, and daycare personnel) and a smaller decrease from non–school-based mandated reporters (Child Protective Services [CPS] workers, counselors, foster care providers, health care workers, and authorities). There was an increase in calls from neighbors or landlords, relatives, and friends, and other caller types remained relatively stable (within 1%).
Calls increased after the declaration of a health emergency by the US Secretary of Health and Human Services on January 31, 2020, but then decreased after the initiation of school closures on March 5, 2020 (Figure). Additional analyses (not shown) revealed that a sustained decrease in school reporter calls was contrasted by a later increase in parent calls. Text inquiries increased after initial school closures. In May 2020, both calls and texts surged higher than 2019 levels.
In this national study, overall inquiries by phone call and text message to a child abuse hotline increased following school closures and quarantine orders associated with the COIVD-19 pandemic compared with overall inquiries in 2019. This may reflect a higher rate of child-related distress and maltreatment. After a dramatic decrease in calls during the immediate postclosure period, call volume rebounded by May 2020, and use of texts steadily increased. Decreased exposure to school-based mandated reporters may have contributed to the initial call decrease. Text messaging, a child- and teenager-friendly modality, expanded during the postclosure period, pointing to potential self-advocacy.
Limitations of this study include the inability to assess the nature or duration of user concerns, detailed demographic information, and generalizability to all children or CPS report volumes amid the pandemic. Nevertheless, our findings suggest that text-based access to hotlines or agencies may be an effective strategy while exposure to mandated reporters, particularly school personnel, remains limited. Our findings also suggest that hotline data, including both call and text inquiries, may provide a novel source of information to investigate the effect of COVID-19 on a vulnerable population otherwise challenging to study.
Accepted for Publication: March 2, 2021.
Published Online: May 3, 2021. doi:10.1001/jamapediatrics.2021.0525
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Ortiz R et al. JAMA Pediatrics.
Corresponding Author: Robin Ortiz, MD, University of Pennsylvania, 423 Guardian Dr, 1300 Blockley Hall, Philadelphia, PA 19104 (firstname.lastname@example.org).
Author Contributions: Dr Ortiz had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Ortiz, Kishton, Sinko, Fingerman.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Ortiz, Kishton, Sinko, Fingerman, Moreland.
Critical revision of the manuscript for important intellectual content: Ortiz, Kishton, Sinko, Fingerman, Wood, Venkataramani.
Statistical analysis: Ortiz, Moreland, Venkataramani.
Obtained funding: Ortiz, Sinko, Fingerman.
Administrative, technical, or material support: Ortiz, Kishton, Fingerman, Venkataramani.
Supervision: Ortiz, Fingerman, Wood, Venkataramani.
Conflict of Interest Disclosures: Dr Ortiz reports personal fees for consulting work with the Aurrera Health Group outside the submitted work. Ms Fingerman reports grants from the Leonard Davis Institute of Health Economics at the University of Pennsylvania for data acquisition from Childhelp. Dr Moreland reports a service agreement contract from Childhelp during the conduct of the study and grants from Childhelp outside the submitted work. Dr Venkataramani reports grants from the National Institutes of Health, the University of Wisconsin Center for Financial Security, and the US Social Security Administration outside the submitted work. No other disclosures were reported.
Funding/Support: The authors are supported by the University of Pennsylvania National Clinician Scholars Program, the Perelman School of Medicine at University of Pennsylvania, and the University of Pennsylvania School of Nursing. This work was supported in part by a grant from the Leonard Davis Institute of Health Economics at the University of Pennsylvania. The Childhelp National Child Abuse Hotline is funded in part by grants from In-N-Out Burger, Walmart Foundation: Community Grants, the IRONMAN Foundation, and the Administration on Children, Youth and Families at the Children’s Bureau, US Department of Health and Human Services.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank the Southwest Interdisciplinary Research Center, Arizona State University, Tempe, Arizona, specifically Wendy Wolfersteig, PhD, Marisol Juarez Diaz, JD, and Esther Gotlieb, MPH, for their data analysis support, and Jodi Hall, MPA, with Childhelp, Scottsdale, Arizona, for her support with budget management. These organizations received compensation through a grant from the Leonard Davis Institute, Philadelphia, Pennsylvania, that supported this project.
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