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With kids stuck at home, ER doctors see more severe cases of child abuse

Angela Haslett, a forensic interviewer, at SafeSpot, a children's advocacy center in Fairfax, Va., on Monday. (Jahi Chikwendiu/The Washington Post)

Angela Haslett used to spend her days asking children about the people who hurt them.

The calls came from police or child protective services, sometimes 10 to 15 a week, most of them about sexual abuse. The children would sit across from her in a soundproof room at SafeSpot Children’s Advocacy Center in Fairfax, Va., as the forensic interviewer asked in a soft voice: “Has somebody done something to your body that they shouldn’t have?”

Lately, it’s gone quiet. Since the coronavirus pandemic forced schools to close and families to stay home, the calls have slowed to two to five a week, with more of them involving children with injuries so visible — a broken arm, a beat-up face — an adult had to seek medical help.

“What keeps me up at night,” Haslett said, “is the children that we’re not seeing.”

Across the country, from California to Iowa to Massachusetts, child abuse reports have plummeted since the virus arrived. In the nation’s capital, hotline reports of abuse and neglect between mid-March and mid-April were 62 percent lower than in the same period last year, according to the D.C. Child and Family Services Agency. Reports to child protective services in Maryland have fallen just as far, and in Virginia, referrals from school staffers have dipped by 94 percent.

The cases surfacing often involve children so severely injured they end up in the emergency room and intensive care unit. In some hospitals, they are dying at an unusually high rate.

Pediatricians across the country are sounding the alarm: The stress of unemployment and financial insecurity has strained relationships between children and those who care for them. The closures of schools and day cares have forced children closer to adults who may not be safe.

In a world without school, doctors and advocates say, no one is there to watch, to speak up, until it’s too late.

Trapped inside

The American system of catching child abuse relies on kids venturing outside their homes.

Year after year, most referrals to child protective services come from professionals — police officers, lawyers, doctors, anyone who comes into contact with a child as part of their job. But no group reports more than educators, who were responsible for 21 percent of the 4.3 million referrals made in 2018, according to federal data.

After 17 years in the classroom, one fifth-grade teacher in Northern Virginia said she’s learned exactly what to watch for: Students falling asleep inexplicably or stealing peers’ food at snack time. Prolonged absences from school paired with reasons that make little sense — out for a week, she was told once, because the student slid and fell. Promised doctor’s notes that never arrived.

She’s trying to stay in touch with her fifth-graders, holding video class and office hours, phoning and emailing. But the teacher, who spoke on the condition of anonymity to protect her students’ privacy, knows it’s not enough.

She worries about students she says are showing troubling signs — withdrawing, refusing to show themselves on video lessons. She worries especially about a student she has twice reported as a possible victim of abuse this year. Recently, she wrote that student a letter.

“Remember that no matter how crazy the world seems, you are not alone,” the teacher wrote. “Send me an email if you want or need to.”

She has not received a reply.

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The teacher is not hopeful someone else will intervene. She knows that while professionals like her do the most reporting, families do much less: Roughly 16 percent of the abuse reports made in 2018 came from family and other people close to the victims.

That’s because family are usually the abusers. In 2018, nearly 80 percent of perpetrators were parents of the victim. That year, the U.S. Department of Health and Human Services estimated 1,770 children died of abuse and neglect.

With the country locked down, the only people seeing children are the very people most likely to abuse them, said Jeanine Harper, executive director of Greater Richmond SCAN (Stop Child Abuse Now).

“You’ve got stressed adults and vulnerable children and very few exits,” Harper said. “And you don’t have eyes on them.”

Two women who survived domestic violence talk about the peril facing those who are trapped at home with their abusers during the coronavirus pandemic. (Video: The Washington Post)

The few reports getting through to hotlines often come from victims themselves, if they are old enough to call or text. In March, for the first time ever, half of the visitors to the National Sexual Assault Hotline were minors. Among those who called with concerns related to the pandemic, 79 percent said they were living with their perpetrator.

Unlike some child protective services and law enforcement, which often rely on mandatory reporters, the Childhelp National Child Abuse Hotline has seen an uptick in calls: 31 percent more calls and messages this March than in the same month last year, said Michelle Fingerman, the hotline’s director. Many of these messages came through the hotline’s online chat option, Fingerman said, from teenagers who didn‘t have access to a phone, whose phones were taken away as punishment, or who feared being overheard.

One non-binary teenager called the hotline terrified their parents were going to kick them out. The parents had assaulted and threatened violence before, the 17-year-old said, according to a hotline supervisor who described several calls to The Washington Post. Before, when things would get heated, the teenager would leave the home to cool off. With the stay-at-home order in place, that was no longer an option.

Another caller reported that her relative was a health-care employee in New York City, working longer shifts than usual. With schools and child-care centers closed, the relative left her two young sons with a boyfriend “who didn’t have a lot of patience and tolerance with the kids,” Fingerman said. When she came home from work one day, her 5-year-old had a black eye.

‘The final act’

It was mid-March, still the early stages of the pandemic, when doctors at Cook Children’s began noticing the spike. That week, six children had been admitted to the Fort Worth hospital with signs of severe physical abuse.

Two of the children died the same day. The hospital would typically see four to six deaths a year from child abuse.

Jamye Coffman, medical director for the hospital’s Center for Prevention of Child Abuse and Neglect, wasn’t entirely surprised by the numbers; during the 2008 recession, the hospital had seen the leading cause of death in children change from car crashes to abusive head trauma. But the severity of these new cases troubled her.

In the weeks that followed, three more children were admitted to the hospital for serious physical abuse — and a 3-year-old boy died on Easter morning after suffering head trauma. He was living with family friends at the time. His death was ruled a homicide.

“I don’t want to see any more coming across my desk,” Coffman said. “It is so unusual, and the children that have died have been horribly battered."

A similar pattern has emerged in hospitals across the country. Leigh Vinocur, a spokeswoman for the American College of Emergency Physicians, said doctors nationwide have reported treating more serious injuries in a week than they are used to seeing in a month.

In Fairfax County, one girl arrived in the emergency department this month with an arm so badly broken she required surgery. With the children and adults stuck at home, the father had grown frustrated with the noise levels, said William E. Hauda, medical director of the Inova Ewing Forensic Assessment and Consultation Team.

The father, who was later arrested, tossed the girl sideways, causing her to fall down a stairwell, Hauda said.

“That’s one that I can speak to,” Hauda said, “because we haven’t seen very many.”

In a hospital in Jacksonville, Fla., more than double the usual number of children were hospitalized for child abuse in the past month — all with fractures and nearly all with head trauma. One child died.

At Children’s National Hospital in the District, the overall number of children referred with child abuse concerns has dropped. But the cases coming in are more severe than usual: From March 15 through April 20 of last year, about 50 percent of the children had injuries serious enough to be hospitalized. This year, 86 percent did. During the same period last year, about 34 percent of children had head trauma, fractures, or injuries in multiple areas of the body. This year, that number jumped to 71 percent. Last year, 3 percent of the children referred for child abuse died. This year, 10 percent died.

“People are waiting until these children have stopped breathing or something extremely serious before they’re coming into the emergency departments,” Vinocur said. “When there’s more reporting, we can pick up injuries that are more minor. Now we’re relying on parents who have injured their child to bring them in.”

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The cases don’t always involve intentional abuse, she said. Many injuries are the result of neglect, including accidents involving firearms, medications or toxic household cleaning items.

“I don’t know if it’s the stress, problems inherent in social welfare systems, I don’t know right now,” said Coffman, the doctor in Fort Worth. “That’s the part that’s so frustrating. I keep trying to review these cases to find the common thread.”

One unusual pattern did stand out to Coffman. Most of the hospital’s deaths from child abuse in the past few years had involved infants. But the three recent fatalities were all preschool-age children.

“It is harder to kill older children. It takes more force,” Coffman said. “What have these children been living in prior to this? What have they had to endure before the final act that brought them to our hospital?”

Searching for signs

Worried educators, psychologists and social workers are turning to online tools — calls, texts, videoconferences — to reach the families they serve.

The effort is complicated because some of the most vulnerable households lack computers or Internet access. Even if they can get students on the phone, some conversations feel impossible: How do you ask a child about abuse when their abuser may be standing right behind them or listening in the next room?

Sixth-grade teacher Lee Duhé is among those searching for a way.

Duhé, a longtime teacher in Northern Virginia’s Fairfax County Public Schools, one of the largest systems in the nation, recently added a special feature to her online classes. As students click through her powerpoints, a pop-up prompt asks them to register how they’re feeling on a sliding scale: from red (awful) to orange to yellow to blue (perfect).

“That answer is sent directly to me; their parents and caregivers can’t see it,” Duhé said. “We understand they’re in the house, maybe with someone who … Well, we don’t want to get them into further trouble.”

In Danville Public Schools, educators are taking advantage of the few glimpses of children they still get. The school system is delivering meals by bus to its nearly 6,000 students in rural Southern Virginia, where 1 in 4 families live below the poverty line. On those trips, said director for student support services Robin Owens, nutrition staffers make sure to “engage with families” as much as they can and try to catch sight of children.

The school system also sent child abuse prevention resources to principals and school counselors, Owens said, including a 12-step pamphlet Danville staff members were asked to distribute to parents. The pamphlet lists a dozen alternatives to lashing out at children acting inappropriately: Splash cold water on your face. Hug a pillow.

“Close your eyes,” one reads, “and imagine you’re hearing what your child is about to hear.”

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For teachers who do manage to identify at-risk children, and manage to reach them, the questions only multiply — especially when it comes to the youngest students.

Ann Abell is a clinical coordinator of a preschool program in Richmond, serving children who have experienced trauma. She has been testing out virtual play therapy as a way to get preschoolers to open up.

Seated before a laptop in her house, with toys splayed on a table and more in a box at her feet, Abell offers options to the child watching on the other end of the Zoom call. Magna-Tiles, or maybe Play-Doh? Bubble blowing? How about a Superman figurine?

“Is Superman angry?” she will ask. “Did someone do something to upset him?”

It was awkward at first, but the children are getting used to the camera, Abell said. That’s a relief, she said, because she fears she may have to keep doing this for a while.

Though some states are moving to reopen their economies, social distancing measures may keep many students confined to their homes throughout summer. Schools are under pressure to reopen in the fall, but they may only accept children in rotational shifts, meaning students will still be stuck at home for long stretches of unobserved time.

Children’s advocacy centers, aware of these possibilities, say they are anticipating a deluge of new cases of abuse in the fall. Some advocates worry they will not be prepared.

Advocates in the District and Virginia are petitioning schools to hire more psychologists, social workers and counselors to help traumatized children readjust and recover once they return to school. State and local budgets are being starved by the virus, which may leave some school districts and other crucial watchdogs facing cuts.

Many children’s advocacy centers, which provide support for families and children as abuse cases move through the justice system, were forced to cancel some of their biggest fundraising events of the year in April, which is child abuse awareness month. The National Children’s Alliance estimates the total funding loss to the child advocacy field will amount to about $87.7 million. The group’s executive director, Teresa Huizar, said she worries the economic fallout from the pandemic will force some advocacy centers to close their doors “at a time when abused children will need them the most.”

Haslett, the forensic interviewer in Fairfax, continues to meet with children in person, as carefully as she can. She knows she cannot control when or how schools will reopen, or which abused children will go unnoticed until then.

But on a recent morning, the last time she would interview a child for almost two weeks, she could control the tone of her voice and the look in her eyes as she led the way to the room with the comfortable chairs.

She faced the child across from her and asked her first question.

Coronavirus: What you need to know

The latest: The CDC has loosened many of its recommendations for battling the coronavirus, a strategic shift that puts more of the onus on individuals, rather than on schools, businesses and other institutions, to limit viral spread.

Variants: BA.5 is the most recent omicron subvariant, and it’s quickly become the dominant strain in the U.S. Here’s what to know about it, and why vaccines may only offer limited protection.

Vaccines: Vaccines: The Centers for Disease Control and Prevention recommends that everyone age 12 and older get an updated coronavirus booster shot designed to target both the original virus and the omicron variant circulating now. You’re eligible for the shot if it has been at least two months since your initial vaccine or your last booster. An initial vaccine series for children under 5, meanwhile, became available this summer. Here’s what to know about how vaccine efficacy could be affected by your prior infections and booster history.

Guidance: CDC guidelines have been confusing — if you get covid, here’s how to tell when you’re no longer contagious. We’ve also created a guide to help you decide when to keep wearing face coverings.

Where do things stand? See the latest coronavirus numbers in the U.S. and across the world. The omicron variant is behind much of the recent spread.

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