Are we back to normal? Evaluating the impact of the COVID-19 pandemic on referrals to a child protection service in a tertiary care centre in Vienna, Austria.

BACKGROUND: Reports worldwide on suspected child maltreatment (CM) during and after the COVID-19 pandemic have been inconsistent. As no study has yet systematically examined whether structural disruptions to child protection systems have left measurable and lasting traces in referral patterns beyond the acute crisis phase, this study investigated the pandemic's impact on suspected CM referrals to the Forensic Examination Center for Children and Adolescents (FOKUS) in Vienna, Austria, and whether enduring shifts in CM presentation and referral dynamics have occurred. METHODS: Retrospective study using patient administrative data of suspected CM cases referred to FOKUS between 16 March 2019 and 15 March 2023, covering the periods before, during and after the pandemic. RESULTS: A total of 401 patients were referred to FOKUS during the study period. During the COVID-19 period, suspected physical abuse cases declined by 55.3% (p=0.029), while sexual abuse cases remained stable. Post-pandemic reports of suspected physical abuse returned to pre-pandemic levels, whereas suspected sexual abuse cases increased (p=0.013). Suspected sexual abuse cases showed a progressive increase in median age over time (p=0.025). Psychological support was more frequently required during the pandemic (63.5% vs 43.8% pre-pandemic, p=0.019), with elevated need continuing into the post-pandemic period (59.8%, p=0.018). CONCLUSION: The ongoing rise in suspected sexual abuse cases accompanied by different age victim profiles and increased need of psychological support following the pandemic indicates that a return to pre-pandemic norms is unlikely and the notion of 'back to normal' seems an oversimplification.