Family
Advocacy
Research
Digests

RESEARCH REVIEWCURRENT RESEARCH FOR FAMILY ADVOCACY PROGRAMS • VOL. 5, NO. 2 SPRING 2021
In this Issue

We present Research Review (RR), a publication of the Joining Forces Joining Families group. In
this RR, we present summaries of research on child maltreatment and intimate partner violence(IPV) in the context of the COVID-19 pandemic. A review of worldwide research on violence againstchildren summarizes prevalent methodological issues and descriptions of children’s experiences ofviolence. Other child maltreatment summaries describe possible family-related stressors associatedwith parental job loss, increased use of harsh child discipline, profiles of risks of caregivers, and casesof children seen in emergency departments for maltreatment including abusive head trauma. We alsopresent a summary of some of the effects of the isolation and loneliness in IPV victims during the
COVID-19 pandemic. Please share RR with your colleagues. Its distribution is unlimited.
CHILD MALTREATMENT

What Have We Learned from Studies of Violence Against Children
During the COVID-19 Pandemic, March-December 2020?
Understanding the results of research on violence againstchildren during the COVID-19 pandemic has been challenging because many studies have reported only interim findings. A review of 48 studies published worldwide between
March and December 2020 on the impact of violence againstchildren summarized three main findings related to themethods of the research and four on children’s experiences ofviolence (Cappa & Jijon, 2021). The identified methodological issues were:
1. studies have largely focused on physical andpsychological violence in the home with less attention toother forms of violence;
2. studies have relied primarily on administrative records,
less on surveys and big data;
3. differences in definitions and research designs have

CONTENTS
What Have We Learned from Studies of Violence Against
Children During the COVID-19 Pandemic, March-December
2020?……………………………………………………… 1
Positive Cognitive Reframing Can Help Abusive Parents Who
Have Lost their Job during the COVID-19 Pandemic……… 2
Four Risk Profiles of Households and Caregivers inChild Maltreatment Cases………………………………… 3
Parents Stressed by COVID-19 Used More Harsh

resulted in findings that are not directly generalizable tolarger populations.
The review of children’s experiences of violence during
COVID led to four findings:
1. a decrease in police reports and referrals to childprotective services
2. results were mixed on the number of calls to police(declined) and domestic violence helplines (increased);
3. child abuse injuries treated in hospitals (extreme cases)
increased, suggesting an increase in violence againstchildren in general; and4. surveys consistently reported an increase in family
violence, especially physical and emotional abuse, inthe home by parents and caregivers, higher rates ofContinued on page 6
Parenting and Felt Less Close to their Children……………
Calls to Child Abuse and Neglect Hotline (Childhelp.org)
Show Increased Concern During COVID-19………………
Emergency Department Visits for Child Maltreatment
Increased During Early COVID-19…………………………
Family Risk Factors for Abusive Head Trauma in YoungChildren During COVID-19 Lockdowns……………………
Isolation, Loneliness, and Intimate Partner Violence During
Lockdown…………………………………………………

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Positive Cognitive Reframing Can Help Abusive Parents Who
Have Lost their Job during the COVID-19 Pandemic
Job loss during the COVID-19 pandemic is a major
individual and family stressor with significant risks for childabuse and domestic violence (Lawson, Piel, & Simon, 2020).
In order to determine the association between job loss andchild maltreatment, a community sample of parents participated in an online survey of the impact of COVID-19 on
family interactions. The effects of job loss were measured using a family financial stability variable that included parental
report of job loss and how long the family would be able tocontinue to live at their current address and at their current
standard of living. The parents were compared to parents
who did not lose their job or did not work prior to or during
the pandemic. Child maltreatment was measured with fiveitems from the Parent-Child Conflict Tactics Scale, such as “Iswore or cursed at my child,” and the physical maltreatment
subscale consisting of 13 items related to corporal punishment (Straus, Hamby, Finkelhor, Moore, & Runyan, 1998).
Positive cognitive reframing (problem-solving andcoping strategies) was measured by the reframing subscaleof the Family Crisis Oriented Personal Evaluation Scales(F-COPES) (McCubbin, Olson, & Larsen, 1981). This 8-item
subscale includes items such as the extent to which the family believes they can handle their own problems and defining
the problem in such a way as to not get discouraged. Families in a committed romatic relationship with children 4-10
years old were recruited through Facebook.
Data were obtained from 342 parents. Parents who losttheir job were almost five times more likely to psychologically maltreat their children (OR=4.86) and were also moredepressed (OR=1.05) than parents who had not lost theirjob. Parents who had psychologically or physically maltreated their children before the pandemic were more likely toperpetuate this behavior during the pandemic (OR=111.94
and OR=20.10, respectively). Parents who physically abused
their children during the pandemic were also more likely
to be depressed (OR=1.04). There was a significant interaction between physical abuse and positive cognitive reframing among parents who lost their job. For this group, theprobability of physical abuse decreased as reframing coping
Continued on page 3

Parents who lost their job were more likely to psychologically and physically maltreat
their children and were more depressed than parents who had not lost their job.

JOINING FORCES
Joining Families

RESEARCH REVIEW
EditorRonald J. Whalen, PhD, LMSW
Research Assistant Professor
Department of Psychiatry, USU
e-mail to ronald.whalen.ctr@usuhs.edu(301) 319-8003

Editorial Consultants
Joshua C. Morganstein, MD
Captain, US Public Health Service
Assistant Director, CSTS
Associate Professor and Assistant Chair
Department of Psychiatry, USU

Joining Forces Joining Families—Research Review isa publication of the Family Violence and Trauma
Project, Center for the Study of Traumatic Stress,
Department of Psychiatry, Uniformed Services
University, Bethesda, Maryland 20814, and the
Army Deputy Chief of Staff, G-9, Family Advocacy
Program, Washington, DC

James E. McCarroll, PhD, MPH
Research Professor
Department of Psychiatry, USU

2 • RESEARCH REVIEW | Joining Forces/Joining Families

Assistants to the Editors
Alexandra Burris, BA
Britany Mullins-Husain, BA

Spring 2021

CHILD MALTREATMENT

Four Risk Profiles of Households and Caregivers inChild Maltreatment Cases
Policies mandated to slow the spread of COVID-19 suchas social distancing, restricted travel, and the closure ofschools and social support agencies may increase the stresson parents and children and result in increased child maltreatment (Campbell, 2020). Recent studies of family profilesof stressors can be helpful in understanding the possible
pathways to violence in at-risk families.
In order to improve assessments of family situations related to child maltreatment, a retrospective study of a sample
of 440 cases of children who entered the Child Protective
Service (CPS) in Singapore between March 2014-December
2015 examined eight familial and caregiver characteristics
with a family risk assessment tool used by the CPS (Chng,
Li, Chu, Ong, & Lim, 2018). The purpose of the study was to
identify the numbers and types of characteristics of families
whose children entered the CPS system based on their risk assessment. Half of the sample had experienced physical abuse(49%), followed by neglect (42%), sexual abuse (21%), andemotional abuse (20%).
The household and caregiver characteristics associatedwith the outcomes showed four patterns of familial characteristics: harsh parenting (27% of the sample), large household (27%), high criminality (12%), and a fourth group, low
disadvantage (34%), was low on all of the risk factors. Harshparenting was associated with a higher age of entry into the

CPS system. Harsh parenting had the highest percentage ofphysical abuse and emotional abuse (71% and 34%, respectively), and about 2.5 more times the likelihood of a recurrence of abuse compared to the low disadvantage group. The
low disadvantage group reported the highest percentage ofsexual abuse (28%) while the harsh parenting group reported
the lowest (12%).
This study provides risk information on families andgroups, not just individuals. Analysis of familial characteristics provides an additional method of risk assessment toscreen for and identify those at highest risk for child maltreatment. These results can be used to consider measures
to prevent and intervene in such families based on theirhousehold and caregiver risks.

References

Campbell, A. M. (2020). An increasing risk of family violence
during the Covid-19 pandemic: Strengthening community
collaborations to save lives. Forensic Science International:
Reports, 2. doi:10.1016/j.fsir.2020.100089
Chng, G. S., Li, D., Chu, C. M., Ong, T., & Lim, F. (2018).
Family profiles of maltreated children in Singapore: A
latent class analysis. Child Abuse & Neglect, 79, 465-475.
doi:10.1016/j.chiabu.2018.02.029

Four profiles of families of maltreated children were found in analyses of household and caregiverrisk factors: harsh parenting, high criminality, large household, and those with low disadvantage.
Positive Cognitive Reframing, from page 2

increased (OR=0.76). The authors suggested that positive
cognitive reframing was a buffer for the physical abuseassociated with job loss.
In addition to coping with job loss, positive cognitive reframing, reappraising and redefining stressors andattempting to make them more manageable, can also be
used to manage depression of parents and the psychological maltreatment of children. These coping strategies canbe applied to high-risk families, such as those previously
known to family advocacy and other child services. Theseskills are important prevention and intervention methods
during the COVID-19 pandemic and may also be usefulduring other prolonged family stressors, particularly thosethat involve job loss and among families with a history ofchild maltreatment.

http://www.CSTSonline.org

References

Lawson, M., Piel, M. H., & Simon, M. (2020). Child maltreatment during the COVID-19 pandemic: Consequences ofparental job loss on psychological and physical abuse towards children. Child Abuse & Neglect, 110(Pt 2), 104709.
doi:10.1016/j.chiabu.2020.104709
McCubbin, H. L., Olson, D., & Larsen, A. (1981). Family
Crisis Oriented Personal Evaluation Scales (F-COPES)In A. I. Thompson, H. L. McCubbin, & M. A. McCubbin(Eds.), Family Assessment: Resiliency, Coping and Adaptation Inventories for Research and Practice (pp. 455-507):
University of Wisconsin System.
Straus, M. A., Hamby, S. L., Finkelhor, D., Moore, D. W., &Runyan, D. K. (1998). Identification of child maltreatment
with the Parent-Child Conflict Tactics Scales: Development and psychometric data for a national sample ofAmerican parents. Child Abuse & Neglect, 22(4), 249-270.
RESEARCH REVIEW | Joining Forces/Joining Families • 3

CHILD MALTREATMENT

Parents Stressed by COVID-19 Used More Harsh Parenting
and Felt Less Close to their Children
Lockdowns during the COVID-19 pandemic may
increase parenting stress. This hypothesis was investigatedfrom April 22-May 5, 2020, in a survey of 258 parents in
Singapore through Facebook and community organizations
such as parenting-related support groups (Chung, Lanier, &Wong, 2020). The goal of this study was to understand if therestrictive measures taken in response to COVID-19 wereassociated with harsh parenting and parent-child closeness.
The study also attempted to determine if the outcomes (harshparenting and parent-child closeness) were mediated by parental stress. Respondents were mostly mothers (64%), 36-40
years old, had a university degree (80%), and employed fulltime (73%).
The impact of COVID-19 was measured by the Coronavirus Impacts Questionnaire, the CIQ (Conway, Woodard, &Zubrod, 2020). The CIQ consisted of two questions each on
financial impact (negative financial impact and lost job), access to resources such as food, and psychological impact (depression and negative impacts on health). Parental stress, themediating variable, was measured by the Parental Stress Scalewith 18 items such as “I am happy in my role as a parent” and“The major source of stress in my life is my child(ren)” (Berry& Jones, 1995). The parenting outcome measure consistedof harsh parenting behaviors and parent-child relationshipcloseness. Harsh parenting was measured by three questions: yelled/screamed at child more often, used harsh words
on children more often, and spanked or caned children more
often. Parent-child closeness was measured by three questions asking about behaviors in the past three weeks: howclose do you feel to your children, how often have you praisedor complimented your children, and how often have you andyour children shown love and affection to each other.
When compared to parents who felt less impacted by COVID-19, parents who were more impacted reported higher
parenting stress, used more harsh parenting, and felt lessclose to their children. Parenting stress was a significant mediator of harsh parenting and parent-child closeness. In otherwords, the impact of COVID-19 indirectly influenced theparenting outcomes (harsh parenting and the parent-childrelationship) through its effect on parenting stress. It wasalso noted that the younger age of parents was significantly
associated with parental stress.
Programs that reduce parenting stress may improvefamily well-being by decreasing harsh parenting andincreasing parent-child closeness. Examples are programs
that increase parents’ use of non-punitive discipline,
improve communication between parents and children,and help parents cope with increased stress. While theseinterventions may be more complex to implement whenfamilies are restricted in their movements, policy-makers andprogram administrators can develop interventions suited toparents’ needs and access, such as internet resources, manuals, videos on behavioral strategies, and leveraging expanded
access to telehealth (Chung et al., 2020).

References

Berry, J. O., & Jones, W. H. (1995). The Parental Stress Scale:initial psychometric evidence. Journal of Social and Personal Relationships, 12(3), 463-472.
Chung, G., Lanier, P., & Wong, P. Y. J. (2020). Mediating
effects of parental stress on harsh parenting and parentchild relationship during coronavirus (COVID-19)
pandemic in Singapore. Journal of Family Violence, 1-12.
doi:10.1007/s10896-020-00200-1
Conway, L. G., III, Woodard, S. R., & Zubrod, A. (2020).
Social Psychological Measurements of COVID-19:
Coronavirus Perceived Threat, Government Response,
Impacts, and Experiences Questionnaire. Preprint, 42.
doi:10.31234/osf.io/z2x9a

Parents who were more impacted by COVID-19 experienced moreparenting stress and, as a result, used more harsh parenting and felt
less close to their children.

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C HILD MALTREATMENT

Calls to the Child Abuse and Neglect Hotline (Childhelp.org)
Show Increased Concern During COVID-19
School closures, social distancing, and restrictions of
movement during the COVID-19 pandemic are of concern
because of possible associations with child maltreatment.
Evidence of this has been seen in reports of increased childpsychological abuse and non-medical neglect (Sharma et al.,2021) and in hospital emergency department visits (Swedo
et al., 2020b). Hotlines, such as Childhelp.org, can serve as asource of information on the prevalence of child abuse andneglect. Childhelp (childhelp.org/hotline at 800-422-4453),
provides 24-hour anonymous confidential multilingual counseling and crisis intervention, information, and referrals to
emergency, social service, and support resources.
The database of Childhelp (Childhelp.org/hotline) was
examined to answer the number of inquiries (phone calls
and text messages) during the COVID-19 pandemic (MarchMay 2020) compared with the same time in 2019 (Ortiz
et al., 2021). In 2020, calls and texts increased by 13.75%(n=18,881) compared with the same time in the year 2019
(n=16,599). Most calls in both time periods (96%) werefrom adults (18 years or older) while less than 5% were fromyouth. From March to May 2020, phone calls increased
from approximately 1,300 to over 1,600 per week, a 23%
increase. Texts made an even greater increase, from approximately 65 to more than 120, an 85% increase.
In 2020, there was a decrease in calls both from school
reporters (from 3.56 to 2.12%) and from non-school-based
mandated reporters (such as CPS workers, counselors, andhealthcare workers) from 6.91 to 6.28%. These decreases
were balanced by an increase in parent calls. There wasan increase in calls from neighbors or landlords (5.19 to
8.67%) and friends (5.08 to 6.36%).
This study was not able to assess the nature or duration ofcalls or more detailed demographics. The results of this study

suggest that during periods of restricted access to sentinels
and mandated reporters of child abuse and neglect, phone
and text hotlines can help concerned persons. These hotlines
can also provide a variety of additional information that canbe useful to policy-makers during a prolonged crisis suchas data on the nature and extent of community distress. The
increases in inquiries to Childhelp also suggests that when
traditional routes for help such as teachers and school counselors as well as other sources of support are cut off, people
will turn to other options. Of particular interest is the increase in texts, a medium favored by children and teenagers,which were received largely from youth, suggesting possible
self-advocacy.

References

Ortiz, R., KIshton, R., Sinko, L., Moreland, D., Wood, J., &Venkataramani, A. (2021). Assessing child abuse hotline
inquiries in the wake of COVID-19: Answering the call.
JAMA Pediatrics. doi:10.1001/jamapediatrics.2021.0525
Sharma, S., Wong, D., Schomberg, J., Knudsen-Robbins, C.,
Gibbs, D., Berkowitz, C., & Heyming, T. (2021). COVID-19: Differences in sentinel injury and child abuse
reporting during a pandemic. Child Abuse & Neglect,
104990. doi:10.1016/j.chiabu.2021.104990
Swedo, E., Idaikkadar, N., Leemis, R., Dias, T., Radhakrishnan, L., Stein, Z., … Holland, K. (2020). Trends in U.S.
emergency department visits related to suspected or confirmed child abuse and neglect among children and adolescents aged <18 years before and during the COVID-19
pandemic — United States, January 2019–September
2020. Morbidity and Mortality Weekly Report, 69(49).

Calls and text messages to a child maltreatment hotline increased in 2020
compared to 2019. Counseling and referrals can be available to persons
concerned about child abuse and neglect through childhelp.org/hotline.

http://www.CSTSonline.org

RESEARCH REVIEW | Joining Forces/Joining Families • 5

CHILD MALTREATMENT

Emergency Department Visits for Child Maltreatment
Increased During Early COVID-19
While the extent of child maltreatment during the COVID-19 pandemic can be estimated in a variety of ways, it islikely that the most severe incidents will be found in hospital emergency departments (ED). The National Syndromic
Surveillance Program of the CDC (https://www.cdc.gov/
nssp/index.html) counted the number of weekly ED visits
related to child abuse and neglect per 100,000 by age groupfrom January 2019 to September 2020 (Swedo et al., 2020a).
Compared to the same time period in 2019, the percentage
of ED visits increased significantly from 2.1% in 2019 to3.2% in 2020. Increases occurred in three age groups: 3.5%
to 5.3% for children 0-4, 0.7% to 1.3% for 5-11, and 1.6% to2.2% for 12-17 years old.
A review of cases from a single children’s hospital gave
a more specific picture of the nature of child maltreatments(Sharma, et al., 2021). Of the 296 of 776 child abuse reports(CAR) containing injuries in children under six months ofage that were admitted to an ED, emotional abuse increased
from 2.52% in years prior to the pandemic to 7.0%. Nonmedical neglect increased from 31.5% to 40.0% and medical
neglect increased from 3.06% to 4.19%. The referral rates forbone scans to assess for abuse-related fractures also increased
significantly during the pandemic, from 16.2% to 32.2%.
The percent of confirmed cases of abuse in patients undersix months increased from 5.5% to 9.6%. These data point

to significant concern for children’s health as the pandemic
continues to be associated with the possibility of mandatory
lockdown of communities.
The means to decrease child maltreatment during lockdowns are challenging. Increased awareness of ED providers for the various types of child maltreatment, including
emotional abuse and neglect in addition to physical abuse
can aid in detection and intervention. Infants under six
months of age are at high risk for physical abuse and deserve close attention by providers.

References

Sharma, S., Wong, D., Schomberg, J., Knudsen-Robbins, C.,
Gibbs, D., Berkowitz, C., & Heyming, T. (2021). COVID-19: Differences in sentinel injury and child abuse
reporting during a pandemic. Child Abuse & Neglect,
104990. doi:10.1016/j.chiabu.2021.104990
Swedo, E., Idaikkadar, N., Leemis, R., Dias, T., Radhakrishnan, L., Stein, Z., … Holland, K. (2020). Trends in U.S.
emergency department visits related to suspected or confirmed child abuse and neglect among children and adolescents aged <18 years before and during the COVID-19
pandemic - United States, January 2019-September 2020.
MMWR Morbidity and Mortality Weekly Report, 69(49),
1841-1847.

ED visits for child maltreatment increased nationally among all child age groups during
the early COVID-19 pandemic. As the possibility of continued social restrictions such as
lockdown continue, the rates of child maltreatment may also increase.
What Have We Learned, from page 1
community violence, and a higher risk of children
witnessing violence both inside and outside the home.

Reference

Cappa, C., & Jijon, I. (2021). COVID-19 and violenceagainst children: A review of early studies. Child Abuse &Neglect. doi:10.1016/j.chiabu.2021.105053

A review of research on violence against children during the COVID-19 pandemic reported methodologicalissues and interim research results. Methods of research have focused on physical and psychologicalviolence based largely on administrative records. Results have found increases as well as decreases in family
violence reports. However, data suggest increased severity of child physical abuse.

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CHILD MALTREATMENT

Family Risk Factors for Abusive Head Trauma in
Young Children During COVID-19 Lockdowns
Pediatric abusive head trauma (AHT) is an injury to achild younger than five years of age due to violent shaking
and/or abrupt impact and is a leading cause of death anddisability in children under two years old (Hung, 2020). A
study of children between the ages of 0.5 and 13 months
evaluated for AHT at a children’s hospital in the UK between
23 March-23 April 2020, a period of national isolation due to
COVID-19, found a marked increase of suspected AHT. Tenchildren with multiple physical findings were examined compared to a mean of 0.67 cases in the corresponding period
in the prior year, an increase of 1,493% (Sidpra, Abomeli,
Hameed, Baker, & Mankad, 2020).
In a study of patients between the ages of 0-17 years oldfrom 2010-2016 who were admitted to a level 1 trauma center in the U.S., 240 (including 42 fatalities) were diagnosed
with AHT. Family risk factors for AHT were intimate partner
violence (odds ratio=2.3, p=.02), substance abuse (OR=5.7,
p<.001), an unknown number of adults living in the household (4.1, p<.001), and prior police involvement (OR=5.9,
p<.001) (Sayrs et al., 2020).
Family history can be an aid to preventing AHT injuries.
Significant parental vulnerabilities for child maltreatment
include socioeconomic deprivation, criminal histories,
mental health disorders, and financial concerns. Risk factors
are likely to be exacerbated by lockdown measures in whichchildren are increasingly exposed to their parents and there islimited reporting due to decreased interaction with reporting

bodies such as teachers and health care personnel. This increase was termed a silent epidemic in contrast to the public
epidemic of COVID-19 (Sidpra et al., 2021).
Risk factors of family structure and history may suggest
an elevated risk of AHT and other forms of physical abuse to
greater degree than what is known from prior CPS or otherfamily advocacy involvement. These family-level factors
associated with AHT could be used in prevention programs
by family advocacy programs, medical providers, and law
enforcement to develop targeted interventions for those at
highest risk.

References

Hung, K.-L. (2020). Pediatric abusive head trauma. Biomedical Journal, 43(3), 240-250.
Sayrs, L. W., Ortiz, J. B., Notrica, D. M., Kirsch, L., Kelly, C.,
Stottlemyre, R., … Rowe, R. K. (2020). Intimate partner violence, clinical indications, and other family risk
factors associated with pediatric abusive head trauma.
Journal of Interpersonal Violence, 886260520967151.
doi:10.1177/0886260520967151
Sidpra, J., Abomeli, D., Hameed, B., Baker, J., & Mankad,
K. (2020). Rise in the incidence of abusive head trauma
during the COVID-19 pandemic. Archives of Disease inChildhood. doi:10.1136/archdischild-2020-319872

Knowledge of family history can aid in preventing AHT injuries. Among these family risk
factors are IPV, substance abuse, an unknown number of persons living in the household,mental health disorders, financial concerns, and prior police involvement.

http://www.CSTSonline.org

RESEARCH REVIEW | Joining Forces/Joining Families • 7

IN T I MATE PARTNER VIOLENCE

Isolation, Loneliness, and Intimate Partner Violence
During Lockdown
When isolation is required for any reason, such as during
the COVID-19 pandemic, an important additional stressor
is loneliness. When lockdown is mandated and extensive, its
effects may be exacerbated and result in increased vulnerability of IPV victims to abuse, negative health effects, and reduced opportunities for help-seeking (Goodman & Epstein,2020). Within relationships, isolation can also be used toenhance coercive control, one of the many tactics employedby perpetrators of intimate partner violence (IPV). Isolation also increases the likelihood of risky behaviors such as
self-medicating, smoking, alcohol consumption, and overeating (Leigh-Hunt et al., 2017). Recent reports cite evidence ofincreased calls to family violence hotlines in the US (Holland
et al., 2021), UK, Brazil, and Cyprus as well as increased domestic homicides in Spain (Bradbury-Jones & Isham, 2020).
Methods suggested to help victims of IPV under lockdown are to enable support services to remain open, increasing the capacity of helplines, and running targeted campaigns
against family violence. However, for victims experiencing
coercive control, seeking help in discrete ways is difficult(Bradbury-Jones & Isham, 2020).
There has been extensive research on loneliness (LeighHunt et al., 2017), but the aftermath of isolation and loneliness in the context of IPV has yet to be studied, particularly
with aspects of isolation being externally mandated in
response to COVID-19. Additional challenges following
the lifting of lockdowns will be to mitigate the previously
encountered stresses of isolation and loneliness that IPV victims have faced. Health and social service providers will needto consider ways to address victims who have had complex

and lengthy exposure to prolonged isolation and possible
abuse. For example, for IPV victims previously known to careproviders, periodic phone calls, emails, or texts could be sent
to inquire for victims’ safety and well-being followed by consultation. However, in these alternatives, knowledge of victim
safety is paramount and providers must conduct inquiries
discretely and in accordance with victim wishes and status.

References

Bradbury-Jones, C., & Isham, L. (2020). The pandemic
paradox: The consequences of COVID-19 on domestic
violence. Journal of Clinical Nursing, 29(13-14), 20472049. doi:10.1111/jocn.15296
Goodman, L. A., & Epstein, D. (2020). Loneliness and the
COVID-19 pandemic: Implications for intimate partner violence survivors. Journal of Family Violence, 1-8.
doi:10.1007/s10896-020-00215-8
Holland, K. M., Jones, C., Vivolo-Kantor, A. M., Idaikkadar,N., Zwald, M., Hoots, B., … Houry, D. (2021). Trends
in US emergency department visits for mental health,overdose, and violence outcomes before and during the
COVID-19 pandemic. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2020.4402
Leigh-Hunt, N., Bagguley, D., Bash, K., Turner, V., Turnbull, S., Valtorta, N., & Caan, W. (2017). An overview ofsystematic reviews on the public health consequences ofsocial isolation and loneliness. Public Health, 152, 157-171.
doi:10.1016/j.puhe.2017.07.035

In addition to IPV, among the stressors of prolonged isolation are loneliness and the increased
likelihood of risky behaviors such as self-medicating, smoking, alcohol consumption, and overeating.

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Spring 2021