The Impact of Social Isolation and COVID-19 Pandemic Mitigation on Child Welfare and Domestic Violence
Danielle M. Moore, MPH
CornerHouse
March 25, 2020
Since the first COVID-19 case was confirmed in the United States in January 2020, the SARS-CoV-2 virus has spread rapidly throughout the country, prompting a national emergency proclamation, restricted international entry, state-by-state school and business closures, and strong federal recommendations for social distancing of all citizens. At this time, an unprecedented number of Americans are confined to their homes indefinitely. Some have been able to work remotely, while many others are finding themselves suddenly without jobs. Other families are facing hard choices between maintaining a paycheck, finding childcare, or taking care of their children at home. As social isolation continues in the coming weeks, there may be anxieties about food insecurity, household bills, meeting healthcare needs, and anxieties about the future. At the same time, they may find few social supports available as mitigation techniques and “shelter in place” advisories prolong to disrupt the community transmission of this novel virus. Under such circumstances, there is an escalated risk and concern for new or worsening child maltreatment and domestic violence within the isolated home environment.
The United States and much of the world has never entered into widespread containment on such a large scale. Accordingly, there is little empirical research describing the effects of quarantine on child maltreatment risk. Any data used to predict behavior and risk during this crisis can only be extrapolated from similar or less extreme scenarios and known risk indicators.
Psychological and Economic Impacts of Prior Outbreaks
Previous epidemic outbreaks have resulted in psychological stressors that are unlike other disaster events. Fear of infection, inadequate health communication, and access to support systems can cause extreme distress when compounded by social isolation due to containment measures. When assessed in prior infectious outbreaks, the quarantine process has shown to be strongly associated with fear, anxiety, anger, irritability, depression, and post-traumatic stress disorder (PTSD) in adults, with significantly higher levels of post-traumatic stress, anger, and avoidance behavior demonstrated in quarantine periods longer than 10 days (Brooks et. al, 2020). During the 2003 SARS outbreak in Toronto, approximately 15,000 people were voluntarily isolated. During that period, symptoms of depression were reported in 31.2 percent of 129 adults sampled. Those in quarantine who made less than 40,000 CAD per year (approximately 27,544 US dollars) trended toward increased risk for depression and PTSD symptoms (Hawryluck et. al, 2004). Years later, during a MERS outbreak in South Korea, individuals were quarantined for 2 weeks due to disease exposure. Of those isolated, a large percentage reporting feelings of persistent anger 4-6 months post-isolation (Jeong et. al, 2016). Among a cohort of 1394 survivors of the 2005-2006 SARS outbreak in Hong Kong, 47.8 percent experienced PTSD. Of those who experienced PTSD, 25.6 percent were still managing persistent symptoms 30 months after PTSD-directed therapy (Mak et. al, 2010). The participants who were surveyed emphasized a need for more financial supports, better access to food, and communication during isolation periods (Hawryluck et. al, 2004; Mak et. al, 2010).
In order to sufficiently decrease transmission of COVID-19, epidemiologists are projecting that mitigation methods will need to involve several periods of social distancing, isolation, and quarantine. Disease forecasters expect that until a vaccine is available, these periods could last many weeks with restrictions loosening only for temporary periods when cases decline. Still, as was the case with the 1918 influenza pandemic, experts are anticipating that outbreaks will roar back in the fall. Although there are several promising COVID-19 vaccines in development, none are expected to be safe enough for FDA approval for at least a year. This means several periods of social distancing and isolation will need to be implemented during that timeframe in order to adequately prevent recurrent disease transmission and rising fatalities nationwide (Anderson, Heesterbeek, Klinkenberg, & Hollingsworth, 2020). Absent the presence of routine professionals and mandated reporters who commonly report maltreatment, lengthy mitigation periods could lead to escalations in abuse, as the long corralling of one disease continues and fosters the advancement of another.
Social Isolation, Economic Insecurity, and Elevated Risks of Abuse
For many, home is not a safe place. Perpetrators who share communal spaces with survivors may attempt to use isolation to abuse, threaten, and control without fear of accountability. This exacerbates the potential for traumatization as survivors become trapped with their abuser. Those who are socially isolated are more prone to aggression and domestic violence when exposed to the additional cascading effects of depression, stress, and economic hardship. Parents who exhibit these behaviors have been shown to have smaller support networks, fewer contacts, and less community engagement (Gracia & Musitu, 2003; Coohey, 1996). On the other hand, caregivers who are connected to support systems report more perceived efficacy in the ability to internalize social norms and values -- a quality that is inversely associated with aggression and physical assault (Font & Maguire-Jack, 2016). Under normal circumstances with routine supports are in place, about two-thirds of child abuse cases are reported by professionals (i.e. teachers, law officers, social services, and medical staff) while the remaining reports are made by friends, neighbors, relatives, and anonymous reporters (Child Welfare, 2019). However, during indefinite confinement, survivors may not have guarantees that there will be supportive adults nearby for several weeks or more.
Economic insecurity presented by pandemic isolation periods is particularly concerning because it places pressure on caregivers that can intensify stress and establish known risk factors for neglect. A recent systematic review on the temporal impact of economic insecurity on child maltreatment showed disadvantages such as loss of income, housing loss, and food insecurity can have significant effects on child maltreatment risk (Conrad-Hiebner & Byram, 2018). Similarly, a 27-year prospective study of 2443 infants in Australia reported that economic hardship, parental unemployment, parental mental illness, substance use, and social instability were predictors of child neglect and abuse (Doidge, Higgins, Delfabbro, & Segal, 2017). Although the direction of experimental association between economic hardship under quarantine and child maltreatment is not yet available, based on ample evidence we can extrapolate that families impacted by the difficulties of job loss, loss of childcare, food access, and restricted community resources during prolonged isolation will put children at elevated risk.
These scenarios highlight the complex relationship between quarantine, social isolation, and their impact on the psychological and economic difficulties individuals, already at risk, may face under the stress of fractured social and community safety nets. Although, data shows children are statistically less vulnerable to the disease aspects of COVID-19, the overall effect of the pandemic is already impacting the economic, physical, and emotional well-being of both children and families throughout the world.
As Global Outbreaks Spread, News of Child Maltreatment Emerges
News is slowly emerging from outbreak zones across the world where reports of neglect, physical, and sexual abuse have skyrocketed (Wind, 2020). During one of the earliest COVID-19 quarantine periods in China’s Hubei province, domestic violence calls to police tripled when compared to the same period in the previous year (Allen-Ebrahimian, 2020). In another story, a police officer describes finding a woman and her two children wandering the streets after being physically abused, starved of food, and forcibly evicted from the house by the children’s father. The officer noted how easy it was for neglect and physical abuse to occur during lockdowns when restaurants are closed and transportation is shutdown. Wan Fei, founder of an anti-domestic violence nonprofit in China said that law enforcement has resisted responding to calls from survivors and detaining perpetrators due to erupting COVID-19 clusters in local prisons. At the same time, child and family advocacy representatives said officers were not restrained in their capacity to enforce the law during quarantine and were swiftly arresting people for not wearing masks in public and detaining them with consistency. As such, advocacy groups believed that responding to domestic violence and abuse reports was simply not a priority (Wanqing, 2020). Back home, Americans are already seeing calls double at crisis centers. Human services workers are hearing stories of perpetrators who are withholding medical and financial resources and using COVID-19 restrictions to exact control more over survivors. In response to an influx of calls, an organization in Oregon that provides emergency shelter to violence survivors, drained 20 percent of its budget for motel vouchers in less than a week (Crombie, 2020). As case managers across the country fear a rise in child neglect due to the stress of COVID-19, doctors from a children’s hospital in Texas are already shaken from the rise in child abuse fatalities. Within a week of the first business closures, six children under the age of four were treated for severe injuries – an amount they typically see over the course of an entire month. Four survived. Doctors told reporters they anticipated the increase in abuse cases due to what they witnessed during the 2008 recession. During that time, the hospital saw more deaths from head trauma due to abuse than from head trauma due to vehicle crashes (CBS, 2020)
The Looming Economic Impacts of COVID-19
On March 17, 2020, US Treasury Secretary Steven Mnuchin estimated a 20% unemployment rate if aggressive measures are not taken to reduce community spread of the virus. On the same day Gov. Tim Walz announced the first wave of business closures in Minnesota, and two days later applications for unemployment benefits were up to 50,000 (Crann & Burks, 2020). In a country long plagued by healthcare accessibility issues, poor workplace policies, and low wages, American workers were left in the rubble with few adequate protections to confront this crisis. Senate leaders and the Trump administration reached an agreement on a relief package in hopes of arresting the economic decline. Pending congressional approval, the $2 trillion-dollar stimulus would direct payments of $1200 to most adults and $500 per child and provide a robust federal unemployment insurance program that could be added onto statewide benefits. The legislation also includes $150 billion for state and local stimulus funds, loan forbearance for small businesses, and billions more to boost hospital resources among other provisions (Werner, DeBonis, Kane, & Stein, 2020). If approved, it will take some time to determine if the bill will be effective enough to protect against the extended impacts of economic decline as business shutdowns, pandemic social distancing, and isolation periods persist.
Community Response: Social Supports as Protective Factors
During this time of uncertainty, ensuring families have extra supports in place to meet basic and essential needs will function as the critical protective mechanism against the more extreme physical, emotional, and psychological risks of the pandemic. This will require advocacy groups to modify programming to respond to a fluctuation of social-ecological factors during the pandemic. This may require activity adjustments on the part of many organizations. According to a study of United States early childhood home visiting programs, less than half discussed external and additional community support resources during routine welfare visits (Lanier et. al, 2015). To keep children and families safe, multipronged approaches that facilitate access to basic economic and material resources, mental healthcare, and social supports will be paramount as families sequester at home. Child and family advocates should begin by implementing secure and confidential telecommunication tools that utilize text messaging so that survivors can safely connect during isolation. As a consequence of the rapid rates of SARS-CoV-2 transmission between people, conventional interventions in-person are not advised until rates of transmission decline. Fortunately, policy changes on the national and state level are responding to this challenging reality and emergency telehealth provisions for COVID-19 have loosened restrictions for those requiring mental healthcare during isolation (HHS, 2020). Since there is heightened awareness that many survivors lack safe places to call for help or may be isolated at home with abusers, advocacy organizations are utilizing private messaging services and creating alternative ways to report abuse (Safety Net, 2020). Emergency safety plans should also be established and reviewed with participants. For example, some advocates are empowering survivors to prepare a “go-bag” with a cell-phone and essential medications in case they need to seek urgent shelter or in case an abuser hides critical items like soap, disinfectant, and food (Safety Net, 2020). Case managers should develop plans tailored to case-specific risks and be prepared to act using evidenced-informed principles of psychological first aid as advised for pandemic response (Morganstein, et.al, 2020).
In addition, programs should incorporate assessments to monitor risk during regular online check-ins and choose reliable and practical measures that are brief enough for routine use. Assessments should address predictors of risk for child maltreatment and domestic violence such as economic disadvantage, extent of social support, quality of parent-child interactions, and new or worsening substance use and psychological disorders. Indicator scores and open-ended feedback that are collected during online services can help case managers determine the most extreme needs, assist in resource allocation, and inform the collaborative efforts with external organizations meant to tackle specific hardships such as housing, food, healthcare, childcare, and job insecurity.
While governments deliberate over the impact of stimulus packages and broader legislation, filling in the sudden gaps triggered by the shock of the COVID-19 pandemic will be critical for Children’s Advocacy Centers across the country. As families navigate these new and unprecedented circumstances, assessing risk, economic hardship, aiding resiliency, and ensuring safe environments at home should be considered the immediate priority of child welfare organizations focused on prevention.
Comments from CornerHouse’s Executive Director:
CornerHouse is a Children’s Advocacy Center located in Minneapolis that works with a multi-disciplinary team to respond to children impacted by the most serious cases of child abuse. We understand that this crisis is only amplifying their situation by causing further isolation, further confinement within abusive settings, further instability, and yet this situation is dramatically limiting families’ ability to access resources and support in order to best address these needs. CornerHouse and Children’s Advocacy Centers across the state and nation continue to modify services to increase accessibility through expanded outreach, tele-mental health, drop-in support groups, and direct family support.
Resources for Caregivers and Families:
CornerHouse’s Community Call line is open if you or someone you know is concerned about a child being abused and need resources or wants to connect with our programs you can find our Community Call number here. We will reply within 24 hours to answer your questions and connect you to resources.
United Way 2-1-1 is providing support via phone to help connect families to various community resources. Call 651-291-0211 or text their zip code to 898-211.
Minnesota Day One Crisis Hotline (for any domestic violence, sexual abuse, human
trafficking, etc. related concerns) 1-866-223-1111.Walk In Counseling Center offers free counseling sessions remotely
NAMI (National Alliance on Mental Illness) is holding free zoom support groups for individuals and caregivers
Call Sexual Violence Center’s 24-Hour Crisis Line: 612-871-5111 or 952-448-5425
References used in this article can be found here.