Hospital child social work interventions increased during the COVID-19 pandemic in 2020 and socioeconomic distress was the main cause.

More than 220 million learners were affected by 2020 school closures as a result of COVID‐19. , Children spent more time at home, where most child abuse occurs, and economic issues may have had a domino effect on children's mental and physical health. The aim of this study was to retrospectively assess whether the number and reasons for social work interventions due to family problems changed from 2019 to 2020.

We collected data on social work interventions in the paediatric emergency department and inpatient units for acutely ill children at our Italian hospital from 1 January 2019 to 31 December 2020. All the children were under 18 and were referred to social workers by their treating physicians. The data were collected from an anonymous database, and ethical approval was not needed.

The indications for social work interventions did not change during the study period, and there was no limit on the number of cases that could be referred or assessed. We grouped social work interventions together as follows: violence and abuse, suicide attempts, child behavioural misconduct, severe socioeconomic discomfort, maternal psychiatric disorders and other parental issues that limited the families’ ability to care for children, international humanitarian support and child abandonment. We also included issues related to COVID‐19, such as supporting the family during quarantine if they needed basic services or more suitable, non‐shared, accommodation. Severe socioeconomic discomfort was defined on a case‐by‐case basis and included the parents’ employment status, monthly income, type of housing and ability to provide food, basic clothes and school materials.

We compared the absolute and relative number of monthly admissions and the type of social service interventions in 2019 and 2020. The chi‐square test was used to evaluate the distributions between the months and events in the two years. The analyses were performed using SPSS version 25.0 (IBM Corp, New York, USA), and p values of <0.05 were statistically significant.

During 2019 and 2020, there were 14,672 and 7,973 acute visits and paediatric admissions to our hospital and the number of social work interventions was 98 (0.66%) and 119 (1.51%), respectively. The relative increase, calculated from the absolute frequencies of the interventions, was 21.5%, and it was a 126.3% rise when relative frequencies were used.

Table 1 also describes why the social work interventions were needed in 2019 and 2020. The most dramatic increase was found in severe socioeconomic discomfort, which increased from 28 interventions in 2019 to 52 in 2020. When this increase was analysed against the number of children seen, the percentage rose by 247%, from 0.19% to 0.66%. The largest increase was violence and abuse, which rose from eight interventions in 2019 to 11 interventions in 2020. These were 0.05% and 0.14% of the children seen, which was an increase of 180%. There were also particularly important increases in child abandonment (148.5%), suicide attempts (148.5%), maternal psychiatric disorders that limited parents’ ability to care for children (104.1%) and behavioural misconduct (59.7%). In contrast, interventions because parents were not suitable to care for their children and international humanitarian support decreased from 0.06% to 0.03% and 0.05% to none, respectively. The chi‐square test highlighted a significant difference between the distribution of absolute frequencies of causes in 2019 and 2020 (p=0.006).

TABLE 1

Reasons for social work interventions in 2019 and 2020, presented as number of interventions as a percentage of assessments and relative differences.

	2019 (n=14,672) Interventions (% of assessments)	2020 (n=7,973) Interventions (% of assessments)	Relative differences in % (actual numbers)	Relative differences in % (relative frequencies)
Child abandonment	6 (0.04)	8 (0.10)	33.33	148.5
International humanitarian support	7 (0.05)	0 (0.00)	−100.00	−100.0
Maternal psychiatric disorders	21 (0.14)	23 (0.29)	9.52	104.1
Severe socioeconomic discomfort	28 (0.19)	52 (0.66)	85.71	246.1
Child behavioural misconduct	14 (0.10)	12 (0.15)	−14,29	59.7
Unsuitable parents	9 (0.06)	2 (0.03)	−77.78	−58.6
COVID−19‐related issues	0 (0.00)	5 (0.06)	NA	NA
Suicide attempt	3 (0.02)	4 (0.05)	33.33	148,5
Violence/abuse	8 (0.05)	11 (0.14)	37.50	156.2
Missing	2 (0.01)	2 (0.03)	0.00	86.4
Total	98 (0.67)	119 (1.51)	21.43	126.3

Chi‐square test p value=0.006.

Abbreviation: NA, not applicable.

When we looked at the absolute frequencies of events requiring social work interventions by months (Table S1), there had been an increase in event frequencies every month in 2020, except February. Comparing the 2019 and 2020, distributions of social work interventions by months did not highlight any significant differences (chi‐square test, p=0.630).

Our study provides preliminary data of a relative increase in social work interventions during the COVID‐19 pandemic in 2020, compared with 2019. This was particularly noticeable during the second half of 2020, when mental health issues and economic distress may have increased. The most significant increase was the need for social and economic support. Although the absolute numbers of social interventions were almost the same in the two years, they increased as a percentage of emergency department visits and hospital admissions, because of COVID‐19 restrictions. These findings are of direct relevance to health and social workers and anyone caring for children.

One study from the USA did not show an increase in child abuse, but it was limited to the first six months of the pandemic when the general use of healthcare services was reduced and the general population was more resilient. The indirect consequences of the pandemic only started emerging some months after initial lockdowns.

The retrospective study design did not allow us to provide more details on the interventions and outcomes. However, our aim was to provide timely data on the potential impact of restrictive measures, highlighting the need to actively monitor this issue and provide guidance for clinicians and policymakers.

In conclusion, our study provides preliminary data that showed a relative increase in social work interventions due to physical abuse, mental health issues and, more importantly, socioeconomic distress due to restrictive pandemic measures. These findings should be taken into account when considering restrictive measures, such as school closures, and the potential consequences on child safety also need to be considered.

CONFLICT OF INTEREST

None.

Table S1

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