Studies have shown that the isolation and tension brought on by COVID-19 is fueling an increase in cases of abuse and neglect, and without in-person visits those cases are harder to identify. Shifting those visits to telehealth can present challenges in spotting problems, but it also opens the door to newer and even better ways to address the issue.
“The pandemic seemed like a perfect storm,” says Stephanie Deutsch, MD, MS, a pediatrician with a subspecialty in child abuse and neglect at Nemours/Alfred I. duPont Hospital for Children in Wilmington, DE. The combination of forced isolation, a struggling economy, the threat of infection and a lack of access to in-person healthcare, she says, not only increases instances of abuse and neglect, but means only the most serious cases show up in the ED, well past the time that someone could have intervened and prevented the suffering.
Deutsch, who recently co-authored a paper in Pediatrics Consultant on the challenges of identifying and preventing child abuse during the pandemic, says providers need to adjust to connected health, and in doing so they may see more success.
“There are some creative and innovative ways to support kids and identify safety concerns through telehealth,” she says.
It’s not an easy task, and for good reason. Providers are specially trained to identify signs of abuse or neglect, and in the past those signs could only be detected through an in-person exam and interview. Clues, both noticeable and extrapolated, are best gathered in person.
On a telemedicine platform, however, those clues have to be gathered differently, with the realization that an audio-video connection and wireless devices present images and data differently, and people react differently when talking virtually instead of face-to-face. There’s also the question of what’s going on beyond the boundaries of the video screen, and who else is in on the conversation.
Deutsch says telehealth has always been a part of the process, particularly in linking ERs, clinics and doctor’s offices to trained specialists in other locations who can conduct interviews and provide guidance to care providers on the scene. But those specialist consults often came after, or in conjunction with, an in-person visit. With the pandemic reducing those visits, doctors and nurses – including primary care providers – are faced with identifying those signs via video.
“We’re doing so much more based on a telehealth visit alone,” she says.
By the same token, Deutsch says, a virtual visit can give a care provider more to work with in spotting signs of abuse or neglect. Instead of being in an office or hospital room, the patient is at home, giving the provider an idea of what that home looks like, and what environment he or she may be living in. In addition, in instances where the care provider can be assured that the patient is alone, an online conversation can sometimes be more candid than an in-person conversation, as some patients are more comfortable with that format.
Telehealth platforms also give the care provider an opportunity to access resources more quickly to help and patient and the family. This might include pulling in counselors or specialists, or linking with social services to address issues like parenting techniques, financial management, child care, school services and health and wellness.
“Those concrete tools and resources need to be at the healthcare provider’s fingertips,” Deutsch says.
The key factor to using telehealth, she says, is training. Providers need to know how to use the technology properly to spot clues and gather information, and they need to know what they can and can’t do in a video visit. They also need to be aware of the resources they can pull into a telehealth platform to aid not only in identifying, but in treating.