Lindsey Bullinger on Evaluating Risk of Child Maltreatment During the COVID-19 Pandemic

Dave Chancellor [00:00:02] Thanks for joining us for the Poverty Research and Policy podcast from the Institute for Research on Poverty at the University of Wisconsin–Madison. I’m Dave Chancellor. When the pandemic hit, many people who study child maltreatment, abuse and neglect were worried that some children might be at greater risk due to more time at home and a host of other factors that the pandemic could possibly exacerbate. But at the same time, many children had much less access to other adults who might be able to notice if something was wrong. So for this episode, I spoke with Dr Lindsey Bullinger of Georgia Tech’s School of Public Policy about how she and her colleagues went about trying to measure rates of maltreatment early in the pandemic when many families need to stay at home.

Dave Chancellor [00:00:46] Dr Lindsey Bullinger, thanks for joining us for the Poverty Research and Policy podcast. You know, you have recently published a number of coauthored papers looking at child neglect and child maltreatment in the context of the pandemic. And you know, we’ve all been living in this for a couple of years now. But when it comes to child neglect, child maltreatment, what changed in March 2020?

Lindsey Bullinger [00:01:09] Lots, lots changed in March of 2020, so I sort of like to say. Well, COVID happened and in particular, the first wave of the pandemic in March of 2020 was was calamitous. So most people in the United States were under instructions to stay at home to reduce the spread of COVID-19. And these public health orders led to the sudden and truly unprecedented increase in the amount of time that people were spending literally inside their homes. And for parents, perhaps the bigger challenge was that schools and daycares also closed, and so they were simultaneously providing childcare and children’s educational instruction while maybe working in person or having to work from home, or maybe losing their job and losing, at least for the foreseeable future. Financial stability and other sources of of usual parenting support, such as, you know, visiting family or visiting friends, turning to houses of worship and using public services were also mostly out of the question. And so this left parents to effectively fend for themselves while facing this enormous amount of increased stress and social isolation in the context of child neglect and maltreatment. This meant that there were fewer eyes on children, so to speak. And so either in the context of schools and other community resources or in the context of parents having to work while also taking care of their kids. So although home is a potentially safe place to be for COVID avoidance it, it may be unsafe for a variety of other reasons. On the other hand, though, it’s possible that the parents and children were able to spend more time together in an increased quality of time spent together, which could potentially reduce child neglect and maltreatment.

Dave Chancellor [00:03:01] So I want to step back from the pandemic just for a second, because I think we should probably put some definitions around what is child neglect, child maltreatment. How do we think about it when it’s reported? How does that work? And maybe some of the other factors that are perhaps correlated in families’ lives with child neglect, maltreatment. What can you tell me there?

Lindsey Bullinger [00:03:23] Yeah, that’s a good point. So, so child maltreatment includes physical abuse, sexual abuse, emotional abuse and neglect and neglect is sort of a catchall, and it could be supervisory neglect as in not enough or inappropriate supervision of a child. Or it could be material. So things like the inadequate provision of food or clothing or shelter or medical care or improper hygiene and child no treatment can be observed by researchers in a variety of ways. And one of the more typical ways that researchers measure maltreatment is through maltreatment reports. And usually, these reports are to child protective services agencies, and they come from people who are usually mandated by law to report suspected abuse or neglect. So these are people like teachers, medical professionals, social workers, police officers and similarly, people will sometimes call 9-1-1 to report child abuse. This is a more common route for neighbors, family, friends or anonymous reporters. Another way to measure maltreatment and this is a bit more common in the medical community of maltreatment researchers is using things like injuries or abuse that’s observed in hospitals or other medical facilities, and addressing the factors that are associated with maltreatment is kind of tricky, since it varies so much by maltreatment type. So, for example, younger children are more likely to be neglected than older children, but older children are more likely to be victims of sexual abuse. Children with family exposure to substance use disorders are at a greater risk for maltreatment. Parenting, stress and social isolation can also perpetuate maltreatment. And finally, financial hardship is tightly linked with maltreatment and in particular, neglect, and so is community violence, housing insecurity and unemployment.

Dave Chancellor [00:05:18] I know back in early 2020, pediatrician groups kind of raised this alarm that they were really concerned that there might be potential increases in child maltreatment, child neglect as a result of sort of the conditions that were going to be seen early in the pandemic. But reports actually went down. So what happened? How do you make sense that?

Lindsey Bullinger [00:05:39] Yes, this was a universal phenomenon. So we saw this in my home state of Georgia. We saw this in Indiana, in Florida, Colorado, New York City and many other places, even internationally. And the evidence is now quite clear that this was largely due to fewer education personnel making reports to CPS agencies. But it wasn’t only teachers and daycare employees. So in Georgia, for example, all reporter types were reporting less. Law enforcement. Social workers, medical staff, everyone. Not a single reporter type increased in the weeks following the state’s stay at home order. But the drop in CPS reports was perhaps expected since something similar happens during school breaks like winter and and summer break. And an unknowing reader might say, Hey, this pandemic has been great for kids, but anyone who has interacted with children might not believe that. And so just as an example, early in the pandemic, on one of the papers that has been published on COVID and maltreatment, we surveyed providers of a child maltreatment prevention program to see if they thought the families that they served were at a greater risk of maltreatment, and eighty nine percent of them actually said yes. And so this is why it was and continues to be important for researchers to be creative in measuring child maltreatment in the context of the pandemic.

Dave Chancellor [00:07:05] OK, so we should talk about that because you and your coauthors have taken sort of a number of approaches to measure maltreatment that may have been happening. You also have done work to link it up to the likelihood of people staying at home to kind of give us a sense of like how these things are interacting. Can you tell me about that?

Lindsey Bullinger [00:07:22] Yes, that’s correct. So this was a really fun project to work on in an interesting way. It’s not necessarily fun to do child maltreatment research, but to be creative in the research is is a really fun part of the job. And so one thing we did was peer cell phone tracking data with CPS reports at the community level here. We’re not tracking any individual person’s phone or anything, but we did this to see if there was a relationship between these prolonged periods of time spent inside the home and child maltreatment reporting. And we found that each 15 minutes that was spent at home was associated with an increase in referrals of material neglect. So the lack of provision of things like food, shelter, clothing, medical care, et cetera, by about three and a half percent and the supervisory neglect was associated with about a one percent increase. So importantly, we saw that that relationship between the time people spend at home and maltreatment reports was completely meaningless before the pandemic. But once stay at home orders went into effect and people started staying at home for very lengthy periods of time. It was predictive of of maltreatment reporting. Now, unfortunately, the data we have don’t allow us to see who was doing the reporting because that would be really interesting to know. I want to note, though, that children do not and sometimes cannot report their own maltreatment and maltreatment requires a third party involvement. And so with fewer opportunities for third party observers, maybe child maltreatment reports to CPS agencies are the wrong way to measure child maltreatment in the context of the pandemic. And so my colleagues and I thought, all right, if if reports from mandatory reporting are down and kids are in their homes more often, maybe we’re seeing more calls to 9-1-1 for abuse, for example, which which might be coming from neighbors, for example. But at least in Chicago, when we looked at this, 9-1-1 calls for child abuse didn’t show any significant change. So next we thought, OK, if maltreatment is still occurring, maybe we only observe the worst cases like those that show up to the emergency department. So in another paper, we use medical records from Atlanta’s largest children’s hospital system, which is staffed with child abuse pediatricians and social workers. And so importantly, kids basically just stopped coming to emergency departments altogether, even for child abuse related reasons. There is one exception to this, however. So kids coming to the aid for injuries and abuse due to supervisory neglect actually increase. And what exactly does this mean? This is things like unwitnessed injuries or ingesting poisonous materials that may have not been secured or near drownings or falls or gunshot wounds from guns maybe that weren’t safely stored. So, so that’s kind of an interesting juxtaposition to the enormous decrease that we’re seeing both in CPS reports and in ED visits. Importantly, however, we did not see worse cases of abuse as measured by, for example, visits that ended up in the pediatric intensive care unit, which is sort of what we expected to find. And then the last thing that we did was we measured maltreatment using social media data that we saw that we scraped from the web. So we did this because so many people were turning to social media to seek community during the early stages of the pandemic. And so we found that trends in social media posts suggestive of emotional abuse increased, but not for other types of of abuse or neglect. And so each of these measures is important because they tell us something different about abuse and neglect during this pandemic, but also during times of crisis more generally.

Dave Chancellor [00:11:25] So I want to go back to your studies that looked at cell phone data because I think in the one in Indiana that you looked at, right, you sort of saw a reversal of previous trends in terms of where it was happening. Is that is that right?

Lindsey Bullinger [00:11:41] That’s right. So we interpret the findings from that paper on Indiana data to mean that substantiated child maltreatment cases, so those that that have been confirmed using evidence by caseworkers, those that occurred in areas that stayed home more during the early stages of the pandemic increased relative to areas that stayed home less. During during the COVID-19 response, however, an alternative interpretation is that substantiated maltreatment in areas that stayed home less declined, more so than those in areas that stayed home, more so. But one thing that we do in that paper is we find that children residing in each of those types of places are subject to similar kinds of surveillance and reporting tendencies. So just, for example, they’re as likely to be reported by teachers as they are to be reported by other types of reporters.

Dave Chancellor [00:12:40] So as you were doing this research, was there anything that maybe caught you by surprise or just wasn’t what you were expecting to see?

Lindsey Bullinger [00:12:47] I mean, my personal opinion on all of these papers, I really like the emergency department paper, and I think it’s because, you know, so many people were saying early on in the pandemic that, oh OK, CPS reports are down, but more children are dying as a result of abuse or neglect, or that the cases are worse. And this is what we were seeing in media reports, and I heard this anecdotally, but we just don’t see it in the data, which I think is really interesting because maybe that is supportive of of this, this idea that, OK, maybe children aren’t as at-risk, maybe as what we thought they were going to be, which is good news for humanity and good news for kids, of course. But I’m not sure, you know, there was a commentary. I believe in JAMA. I think a few weeks ago that very boldly stated something like child abuse did not increase during the pandemic, and I don’t think that’s fair to say because I think all of these nuances are super important for making a claim like that. And so just for example, like, I don’t know, social media data say people are more at risk for emotional abuse. Yeah. Maybe it’s not that we’re seeing the really intense physical abuse that we expected to see or more sexual abuse because, you know, kids are and adolescents in particular are in their homes with their perpetrators. Like, maybe we’re not seeing that, but just because the data aren’t showing that, that’s why it’s really important to triangulate all of these different data sources. Because just because CPS reports are down, that doesn’t mean that it’s not happening. Maybe it’s just not being reported in the same way that it was being reported before. So I think that’s a really important lesson just overall for this line of research to understand how was child maltreatment changing, if at all, during the pandemic, especially in the early stages?

Lindsey Bullinger [00:14:53] A couple of episodes back in this podcast, we post the conversation between author Andrea Elliott and Dr. Darcy Merritt about a family’s interactions with the Child Protective Service System. And I think I think you heard that one. And I think it’s fair to characterize one of the points that Elliott and Merritt made was that many of the things we see classified as neglect or perhaps functions of poverty, where parents are in the really difficult position of having to make tradeoffs between work and material provision and supervision of their kids. And it seems like this pandemic really pushed a lot of more advantaged families into situations where they were having to make some of those same decisions about tradeoffs. How do you think about that?

Lindsey Bullinger [00:15:33] Yeah. So I first want to say that was a fabulous conversation between these two phenomenal researchers and writers and what a truly powerful piece of journalism Andrea Elliott’s book is. And Dr. Merritt’s work is so important in this context, too. So I think that is certainly one interpretation of the findings of some of our work. Higher income families can, you know, they can generally pay for things that may prevent a child maltreatment report. But what happens if those things are no longer available, like child care in the context of the pandemic? The abrupt changes and the uncertainty that parents experienced put significant strains on parents available resources and put them into a sort of imbalance. And an alternative point, though, is that possibly we are just seeing fewer of these poverty driven reports in the CPS data. Maybe we’re not actually missing maltreatment, so to speak, but rather just not observing parents of, as Andrea Elliott describes in her book, These unkempt children being reported for maltreatment, and some research suggests that maybe that’s not such a bad thing.

Dave Chancellor [00:16:46] You know, we’re at the point in the pandemic where we hopefully know a lot more than we did two years ago. As someone that has been looking at this at this data and trying to study this for the last couple of years, what sort of lessons do you think that we that we have now that we didn’t two years ago? If you were going to talk to a policymaker or how do we think about these things when it comes to sort of making the decisions around a large event like this pandemic and the way they affect families and potentially childhood abuse and neglect?

Lindsey Bullinger [00:17:18] Yeah. So so to be clear, social distancing was a necessary public health approach to curtail the spread of COVID-19. I’m not an epidemiologist, but that’s what the epidemiologists told us. But these sort of stay at home orders and really blunt tools, policy tools can create new problems that affect broad populations. In particular, parents and children. And these are things that policymakers and decision makers need to keep in mind when crafting policies and interventions. Unfortunately, two years later, access to child care and formal schooling are still unattainable or unpredictable or uncertain for many families. And this is particularly problematic for working parents who are forced to balance the competing demands of work and child care, which, just as an example, could increase the risk for neglect. My some of my colleagues and I like to say that, you know, parents need both time and money to raise kids. And if we can’t give parents time either to work or for child rearing, then perhaps we need to give them the money to to get the resources to do so.

Dave Chancellor [00:18:33] I’m so grateful for having you share all this work with us and taking the time to talk to me today. So thanks so much for being here.

Lindsey Bullinger [00:18:39] It’s my pleasure. Thanks for having me.

Dave Chancellor [00:18:42] Many thanks to Professor Bullinger for taking the time to talk with us. You can find more of our work at lindseybullinger.com. This podcast was supported in part by funding from the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. But its contents don’t necessarily represent the opinions or policies of that office, any other agency of the federal government or the Institute for Research on Poverty. Music for the episode is by Poi Dog Pondering. Thanks for listening.