Assessing the role of collectivism and individualism on COVID-19 beliefs and behaviors in the Southeastern United States.

America's unique response to the global COVID-19 pandemic has been both criticized and applauded across political and social spectrums. Compared to other developed nations, U.S. incidence and mortality rates were exceptionally high, due in part to inconsistent policies across local, state, and federal agencies regarding preventive behaviors like mask wearing and social distancing. Furthermore, vaccine hesitancy and conspiracy theories around COVID-19 and vaccine safety have proliferated widely, making herd immunity that much more challenging. What factors of the U.S. culture have contributed to the significant impact of the pandemic? Why have we not responded better to the challenges of COVID-19? Or would many people in the U.S. claim that we have responded perfectly well? To explore these questions, we conducted a qualitative and quantitative study of Florida State University faculty, staff, and students. This study measured their perceptions of the pandemic, their behaviors tied to safety and community, and how these practices were tied to beliefs of individualism and collectivism. We found that collectivist orientations were associated with a greater likelihood of wearing masks consistently, severe interruptions of one's social life caused by the pandemic, greater concern for infecting others, and higher levels of trust in medical professionals for behavioral guidelines surrounding the pandemic. These associations largely persist even after adjusting for political affiliation, which we find is also a strong predictor of COVID-19 beliefs and behaviors.

Minimal COVID-19 quieting measured in the deep offshore waters of the U.S. Outer Continental Shelf.

Using a 2-year time series (2019-2020) of 1-min sound pressure level averages from seven sites, the extension of COVID-related quieting documented in coastal soundscapes to deep (approximately 200-900 m) waters off the southeastern United States was assessed. Sites ranged in distance to the continental shelf break and shipping lanes. Sound level decreases in 2020 were observed at sites closest to the shelf break and shipping lanes but were inconsistent with the timing of shipping changes related to a COVID-19 slowdown. These observations are consistent with increased numbers of vessel tracks in 2020 compared to 2019 at a majority of sites.

Pivoting Nursing Research and Scholarship During the COVID-19 Pandemic.

BACKGROUND: The global COVID-19 pandemic has brought numerous challenges for conducting the human subjects research needed to advance science and improve health. OBJECTIVES: The purpose of this article is to discuss how a college of nursing at a large public university in the southeast United States has responded to the challenges of conducting research during the novel COVID-19 pandemic. METHODS: Seven faculty researchers at the University of South Carolina College of Nursing share their experiences in overcoming the unique challenges of conducting research because of the COVID-19 pandemic. Strategies to overcome the challenges posed by COVID-19 are presented within the context of the research process, career implications, communication, and maintaining morale. RESULTS: Fears of COVID-19 and social distancing measures have hindered participant recruitment, enrollment, and involvement in ongoing studies. Increasing virtual technology use and enhancing safety precautions have assisted researchers to overcome barriers. Scholarly writing has increased for some faculty members whose studies have been stalled by the pandemic, yet others have seen a decline because of additional personal responsibilities. The careers of faculty members across all ranks have been uniquely affected by the pandemic. With most faculty working remotely, enhanced communication strategies at the university and college have supported the research enterprise. Morale has been adversely affected, but a variety of personal and collegial efforts have helped faculty cope and preserve a sense of normalcy during this devastating pandemic. DISCUSSION: Faculty and their ability to conduct the research needed to inform clinical and public health practice have been adversely affected by the COVID-19 pandemic. Despite the challenges of conducting research during this unprecedented crisis, faculty and institutions are taking novel steps to ensure the continuity of scientific progress for improving the health and well-being of patients and populations.

Vulnerability to COVID-19-related Harms Among Transgender Women With and Without HIV Infection in the Eastern and Southern U.S.

BACKGROUND: COVID-19 is a new pandemic, and its impact by HIV status is unknown. National reporting does not include gender identity; therefore, data are absent on the impact of COVID-19 on transgender people, including those with HIV. Baseline data from the American Cohort to Study HIV Acquisition Among Transgender Women in High Risk Areas (LITE) Study provide an opportunity to examine pre-COVID factors that may increase vulnerability to COVID-19-related harms among transgender women. SETTING: Atlanta, Baltimore, Boston, Miami, New York City, Washington, DC. METHODS: Baseline data from LITE were analyzed for demographic, psychosocial, and material factors that may affect vulnerability to COVID-related harms. RESULTS: The 1020 participants had high rates of poverty, unemployment, food insecurity, homelessness, and sex work. Transgender women with HIV (n = 273) were older, more likely to be Black, had lower educational attainment, and were more likely to experience material hardship. Mental and behavioral health symptoms were common and did not differ by HIV status. Barriers to health care included being mistreated, provider discomfort serving transgender women, and past negative experiences; as well as material hardships, such as cost and transportation. However, most reported access to material and social support-demonstrating resilience. CONCLUSIONS: Transgender women with HIV may be particularly vulnerable to pandemic harms. Mitigating this harm would benefit everyone, given the highly infectious nature of this coronavirus. Collecting gender identity in COVID-19 data is crucial to inform an effective public health response. Transgender-led organizations' response to this crisis serve as an important model for effective community-led interventions.

Southeastern United States Predictors of COVID-19 in Nursing Homes.

This study's aim was to determine nursing home (NH) and county-level predictors of COVID-19 outbreaks in nursing homes (NHs) in the southeastern region of the United States across three time periods. NH-level data compiled from census data and from NH compare and NH COVID-19 infection datasets provided by the Center for Medicare and Medicaid Services cover 2951 NHs located in 836 counties in nine states. A generalized linear mixed-effect model with a random effect was applied to significant factors identified in the final stepwise regression. County-level COVID-19 estimates and NHs with more certified beds were predictors of COVID-19 outbreaks in NHs across all time periods. Predictors of NH cases varied across the time periods with fewer community and NH variables predicting COVID-19 in NH during the late period. Future research should investigate predictors of COVID-19 in NH in other regions of the US from the early periods through March 2021.

Human Immunodeficiency Virus/Sexually Transmitted Infection Testing Preferences for Young Black Men Who Have Sex With Men in the Southeastern United States: Implications for a Post-COVID-19 Era.

BACKGROUND: Little is known regarding human immunodeficiency virus (HIV)/sexually transmitted infection (STI) testing preferences for location, staffing, and hours of operation among Young Black men who have sex with men (YBMSM) in the Southeastern United States, a population at high risk for HIV/STIs. We used a discrete choice experiment to explore these preferences. METHODS: Young Black men who have sex with men ages 16 to 35 years in Birmingham, AL and Jackson, MS completed online surveys evaluating their preferences (best/worst) for HIV/STI testing locations, staffing, hours, method of results notification, and cost. They also selected preferred combinations of these variables through choice tasks. Results were analyzed using joint best/worst and discrete choice experiment models. RESULTS: Between June 2018 and December 2019, participants in Alabama (n = 54) and Mississippi (n = 159) completed online surveys. Both groups preferred stationary testing locations over mobile testing vans, with the most significant difference favoring STI testing-only clinics in Mississippi and local health departments in Alabama (P < 0.001). Technician-performed tests or self-testing were significantly less preferred compared with clinician-performed testing for both groups (P < 0.0001 and P < 0.0001, respectively). Free testing and phone results notification (versus text) were preferred by both groups. The most desirable combination among all participants was weekday clinician-performed testing at the health department for $5. CONCLUSIONS: Young Black men who have sex with men in the Southeastern United States prefer traditional testing locations staffed by experienced personnel. Combination choices are influenced by services that are low or no cost. More research is needed to inform the best way(s) to provide affordable, high-quality HIV/STI testing services for YBMSM, particularly in the post-COVID-19 era when sexual health care delivery models are evolving toward home-based and remote health-focused strategies.

Factors influencing intent to receive COVID-19 vaccination among Black and White adults in the southeastern United States, October - December 2020.

Vaccination intent is foundational for effective COVID-19 vaccine campaigns. To understand factors and attitudes influencing COVID-19 vaccination intent in Black and White adults in the US south, we conducted a mixed-methods cross-sectional survey of 4512 adults enrolled in the Southern Community Cohort Study (SCCS), an ongoing study of racial and economic health disparities. Vaccination intent was measured as "If a vaccine to prevent COVID-19 became available to you, how likely are you to choose to get the COVID-19 vaccination?" with options of "very unlikely," "somewhat unlikely," "neither unlikely nor likely," "somewhat likely," and "very likely." Reasons for intent, socio-demographic factors, preventive behaviors, and other factors were collected. 46% of participants had uncertain or low intent. Lower intent was associated with female gender, younger age, Black race, more spiritual/religious, lower perceived COVID-19 susceptibility, living in a greater deprivation area, lower reading ability, and lack of confidence in childhood vaccine safety or COVID-19 vaccine effectiveness or safety (p < .05 for all). Most factors were present in all racial/gender groups. Contextual influences, vaccine/vaccination specific issues, and personal/group influences were identified as reasons for low intent. Reasons for higher intent included preventing serious illness, life returning to normal, and recommendation of trusted messengers. Hesitancy was complex, suggesting tailored interventions may be required to address low intent.

COVID-19 lockdowns drive decline in active fires in southeastern United States.

Fire is a common ecosystem process in forests and grasslands worldwide. Increasingly, ignitions are controlled by human activities either through suppression of wildfires or intentional ignition of prescribed fires. The southeastern United States leads the nation in prescribed fire, burning ca. 80% of the country's extent annually. The COVID-19 pandemic radically changed human behavior as workplaces implemented social-distancing guidelines and provided an opportunity to evaluate relationships between humans and fire as fire management plans were postponed or cancelled. Using active fire data from satellite-based observations, we found that in the southeastern United States, COVID-19 led to a 21% reduction in fire activity compared to the 2003 to 2019 average. The reduction was more pronounced for federally managed lands, up to 41% below average compared to the past 20 y (38% below average compared to the past decade). Declines in fire activity were partly affected by an unusually wet February before the COVID-19 shutdown began in mid-March 2020. Despite the wet spring, the predicted number of active fire detections was still lower than expected, confirming a COVID-19 signal on ignitions. In addition, prescribed fire management statistics reported by US federal agencies confirmed the satellite observations and showed that, following the wet February and before the mid-March COVID-19 shutdown, cumulative burned area was approaching record highs across the region. With fire return intervals in the southeastern United States as frequent as 1 to 2 y, COVID-19 fire impacts will contribute to an increasing backlog in necessary fire management activities, affecting biodiversity and future fire danger.

Pediatric emergency department visits due to child abuse and neglect following COVID-19 public health emergency declaration in the Southeastern United States.

BACKGROUND: The ongoing worldwide COVID-19 pandemic has heightened several risk factors  for child abuse and neglect (CAN). We study whether COVID-19 and the public health response to it affected CAN-related pediatric emergency department (ED) visits in the southeastern United States (US). METHODS: We performed a retrospective chart review on medical records of ED visits from a level I pediatric hospital system serving one of the largest metropolitan areas in the southeastern US from January through June 2018-2020. We used multivariate Poisson regression and linear regression to compare professionally identified CAN-related ED visits before and after a COVID-19 public health emergency declaration in 2020, relative to trends over the same period in 2018 and 2019. RESULTS: Although the number of both overall pediatric ED visits and CAN-related ED visits declined, the number of CAN-related ED visits due to neglect from inadequate adult supervision increased by 62 % (p < 0.01). The number of CAN visits per 1,000 pediatric ED visits also increased by 97 % (p < 0.01). Finally, the proportion of CAN-related ED visits due to neglect from inadequate supervision increased by 100 % (p < 0.01). CONCLUSIONS: Physicians should be aware that patients who present with injuries during a pandemic may be victims of neglect due to changes in social structures in their households. In particular, maltreatment presenting to the ED shifted toward treating injuries and abuse resulting from inadequate supervision. Policymakers should consider the impacts of stay-at-home orders on child well-being when determining appropriate public health responses in the midst of a pandemic. TRIAL REGISTRATION: Not applicable.

Agricultural Stakeholders' Perceptions of Occupational Health and Safety in the Southeastern U.S. Coastal States.

Agriculture remains a highly dangerous industry for occupational health and safety. This study sought to understand the perspective of agricultural professionals with respect to the current state of the industry, challenges, and opportunities relevant to occupational health and safety. Additional questions related to the COVID-19 pandemic emerged in the findings as well. Eleven industry professionals were interviewed, and the transcripts were qualitatively analyzed for emergent themes following a constant comparative method. Three themes emerged in our findings: a description of the current state of occupational health and safety in the agricultural industry, barriers to improving occupational health and safety, and enablers of occupational health and safety. Each theme contained subthemes. The description of the industry encompassed regulations, inherent danger, and attitudes and education. Barriers included education, health care access, logistics, discrimination and cultural competency, economic considerations, and the labor contracting system. Enablers included education, regulations, and health care and prevention. These findings are consistent with existing literature, revealing interconnected and overlapping challenges and opportunities. Further research is recommended with a broader sample of participants, especially farmworkers.

Assessing the impact of COVID-19 on mental health providers in the southeastern United States.

The COVID-19 pandemic has increased the need for mental health care despite novel barriers to services. Little is known about how the pandemic has affected mental health providers and their practice. In July 2020, we conducted a web-based survey of 500 licensed mental health providers to assess their employment and caseloads, logistics of care, quality of care, and patient-provider relationships and communication during the pandemic. Over 90% of providers reported changes to their employment (e.g., furloughs), with 64% no longer practicing. Providers who reported no longer practicing were older in age, racial minorities, served rural communities, worked in small clinics/provider networks, were social workers and marriage and family therapists, and relied on private insurance or out-of-pocket payment. Most practicing providers reported similar-to-increased caseloads (62%), new patients seeking services (67%), and appointment frequency (70%). Approximately 97% of providers used telemedicine, with 54% providing services mostly-to-exclusively via telemedicine. Most providers reported losing contact with patients deemed unstable (76%) or a danger to themselves/others (71%). Most providers reported maintained-to-improved quality of care (83%), patient-provider relationships (80%), and communication (80%). Results highlight concerns relating to mental health services during the pandemic, however practicing providers have demonstrated resilience to coordinate and provide high quality care.

Dormant tie reactivation as an affiliative coping response to stressors during the COVID-19 crisis.

This study takes an affiliative coping theory perspective to examine whether working adults reactivated dormant ties with individuals they had not contacted for at least 3 years to cope with stressors experienced due to the COVID-19 pandemic. Stressors originating in the workplace (job insecurity and remote work) and in the family (stressful familial social ties) were examined in a sample of 232 working adults in the southeastern United States. Individuals were more likely to reactivate their dormant ties when their job was insecure, and the magnitude of the reactivations was greater among individuals experiencing stressful social ties with family members than those not experiencing those stressors. We also found that there was a significant interaction between remote work and having a stressful tie within the household in dormant tie reactivation. Although previous theory has focused mostly on the benefits of frequent, active social relationships for coping, our results suggest that reactivating dormant ties might be a coping mechanism as well. Our study also suggests that workplace dormant tie research should broaden its focus beyond exchanged instrumental support to consider emotional support that might be transferred during reactivation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Learning During Crisis: The Impact of COVID-19 on Hospital-Acquired Pressure Injury Incidence.

ABSTRACT: The impact of COVID-19, on the health and safety of patients, staff, and healthcare organizations, has yet to be fully uncovered. Patient adverse events, such as hospital-acquired pressure injuries (HAPIs), have been problematic for decades. The introduction of a pandemic to an environment that is potentially at-risk for adverse events may result in unintended patient safety and quality concerns. We use the learning health system framework to motivate our understanding of the impact of the COVID-19 pandemic on the incidence of HAPIs within our health system. Using a retrospective, observational design, we used descriptive statistics to evaluate trends in HAPI from March to July 2020. Hospital-acquired pressure injury numbers have fluctuated from a steady increase from March-May 2020, hitting a peak high of 90 cases in the month of May. However, the trend in the total all stage HAPIs began to decline in June 2020, with a low of 51 in July, the lowest number since March 2020. Patients evaluated in this study did not have a longitudinal increase in HAPIs from March-July 2020 during the COVID-19 pandemic, despite similarities in illness severity between the two time points. Our experience has demonstrated the ability of our organizational leaders to learn quickly during crisis.

HPV vaccine promotion: Snapshot of two health departments during the COVID-19 pandemic.

The COVID-19 pandemic has impacted routine health care services including immunization delivery. The most common sexually transmitted infection in the United States is the human papillomavirus (HPV), and its sequelae may be prevented by vaccination. Sequelae that can develop if one's immune system is not able to clear the infection include warts, precancerous lesions, and cancer. The American College of Obstetricians & Gynecologists (ACOG) reports almost everyone who is sexually active will encounter the virus at some time during their life. Most of the estimated 79 million infections occur among people who are in their late teens or early 20s. Since 2006, there has been a vaccine available to prevent HPV infections in both males and females; however, administration of this vaccine has only been about half the rate of other vaccines and vaccine hesitancy may play a role. Public health nurses are vital in providing accurate and nonjudgmental vaccine education to their clients, especially unaccompanied minors seeking care in public health department clinics. This paper will explore the recommendations for providing this vaccine as well as a snapshot of current practice in two health departments in the Southeast region of the United States during the COVID-19 pandemic.

Coping and Mental Health in Early Adolescence during COVID-19.

The current longitudinal study examines changes in overall mental health symptomatology from before to after the COVID-19 outbreak in youth from the southeastern United States as well as the potential mitigating effects of self-efficacy, optimism, and coping. A sample of 105 parent-child dyads participated in the study (49% boys; 81% European American, 1% Alaska Native/American Indian, 9% Asian/Asian American; 4% Black/African American; 4% Latinx; and 4% other; 87% mothers; 25% high school graduate without college education; 30% degree from 4-year college; 45% graduate or professional school). Parents completed surveys when children were aged 6-9, 8-12, 9-13, and 12-16, with the last assessments occurring between May 13, 2020 and July 1, 2020 during the COVID-19 outbreak. Children also completed online surveys at ages 11-16 assessing self-efficacy, optimism, and coping. Multi-level modeling analyses showed a within-person increase in mental health symptoms from before to after the outbreak after controlling for changes associated with maturation. Symptom increases were mitigated in youth with greater self-efficacy and (to some extent) problem-focused engaged coping, and exacerbated in youth with greater emotion-focused engaged and disengaged coping. Implications of this work include the importance of reinforcing self-efficacy in youth during times of crisis, such as the pandemic, and the potential downsides of emotion-focused coping as an early response to the crisis for youth.

Nurse's Achilles Heel: Using Big Data to Determine Workload Factors That Impact Near Misses.

PURPOSE: To explore how big data can be used to identify the contribution or influence of six specific workload variables: patient count, medication count, task count call lights, patient sepsis score, and hours worked on the occurrence of a near miss (NM) by individual nurses. DESIGN: A correlational and cross-section research design was used to collect over 82,000 useable data points of historical workload data from the three unique systems on a medical-surgical unit in a midsized hospital in the southeast United States over a 60-day period. Data were collected prior to the start of the Covid-19 pandemic in the United States. METHODS: Combined data were analyzed using JMP Pro version 12. Mean responses from two groups were compared using a t-test and those from more than two groups using analysis of variance. Logistic regression was used to determine the significance of impact each workload variable had on individual nurses' ability to administer medications successfully as measured by occurrence of NMs. FINDINGS: The mean outcome of each of the six workload factors measured differed significantly (p < .0001) among nurses. The mean outcome for all workload factors except the hours worked was found to be significantly higher (p < .0001) for those who committed an NM compared to those who did not. At least one workload variable was observed to be significantly associated (p < .05) with the occurrence or nonoccurrence of NMs in 82.6% of the nurses in the study. CONCLUSIONS: For the majority of the nurses in our study, the occurrence of an NM was significantly impacted by at least one workload variable. Because the specific variables that impact performance are different for each individual nurse, decreasing only one variable, such as patient load, will not adequately address the risk for NMs. Other variables not studied here, such as education and experience, might be associated with the occurrence of NMs. CLINICAL RELEVANCE: In the majority of nurses, different workload variables increase their risk for an NM, suggesting that interventions addressing medication errors should be implemented based on the individual's risk profile.

Lessons learned from pharmacy learner and educator experiences during early stages of COVID-19 pandemic.

PURPOSE: To explore pharmacy learner (eg, resident, fellow) and educator (eg, residency program director, preceptor) experiences and lessons learned during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: In May 2020, attendees of the virtual Research in Education and Practice Symposium (REPS) were invited to participate in two 1-hour networking sessions. During these sessions, participants completed individual and group reflection exercises where they were asked questions about their experiences during the initial stages of the COVID-19 pandemic. Participants who volunteered submitted their responses through an electronic survey application. Anonymous responses were coded using thematic analysis to address the research questions. RESULTS: Sixty-eight and 38 participants, respectively, attended the 2 networking discussions. Participant-identified professional impacts of the COVID-19 crisis included unexpected learning experiences, greater adaptability, workflow and learning interruptions, and decreased productivity. Personal impacts included a greater focus on well-being, physical and social isolation, and changes in travel plans. Participants noted positive and negative emotions including acceptance, encouragement, anxiety, stress, and frustration. The main lessons learned focused on adaptability, gratitude, and empathy. Participants shared that they wished they would have known the anticipated duration of the pandemic, associated workflow changes, and reliance on technology prior to the start of the pandemic. In addition, they predicted that pharmacy practice will require changes to workflow flexibility, training expectations, the pharmacist's role, and organizational structure. CONCLUSION: The COVID-19 pandemic has positively and negatively impacted the professional and personal lives of pharmacy learners and educators, with the most notable impacts being in the areas of well-being and adaptability. Future research should explore the experiences of other workforce personnel and evaluate the long-term impact on pharmacy practice, patient outcomes, and workforce well-being and resiliency.

Insights From Rapid Deployment of a "Virtual Hospital" as Standard Care During the COVID-19 Pandemic.

BACKGROUND: Pandemics disrupt traditional health care operations by overwhelming system resource capacity but also create opportunities for care innovation. OBJECTIVE: To describe the development and rapid deployment of a virtual hospital program, Atrium Health hospital at home (AH-HaH), within a large health care system. DESIGN: Prospective case series. SETTING: Atrium Health, a large integrated health care organization in the southeastern United States. PATIENTS: 1477 patients diagnosed with coronavirus disease 2019 (COVID-19) from 23 March to 7 May 2020 who received care via AH-HaH. INTERVENTION: A virtual hospital model providing proactive home monitoring and hospital-level care through a virtual observation unit (VOU) and a virtual acute care unit (VACU) in the home setting for eligible patients with COVID-19. MEASUREMENTS: Patient demographic characteristics, comorbid conditions, treatments administered (intravenous fluids, antibiotics, supplemental oxygen, and respiratory medications), transfer to inpatient care, and hospital outcomes (length of stay, intensive care unit [ICU] admission, mechanical ventilation, and death) were collected from electronic health record data. RESULTS: 1477 patients received care in either the AH-HaH VOU or VACU or both settings, with a median length of stay of 11 days. Of these, 1293 (88%) patients received care in the VOU only, with 40 (3%) requiring inpatient hospitalization. Of these 40 patients, 16 (40%) spent time in the ICU, 7 (18%) required ventilator support, and 2 (5%) died during their hospital admission. In total, 184 (12%) patients were ever admitted to the VACU, during which 21 patients (11%) required intravenous fluids, 16 (9%) received antibiotics, 40 (22%) required respiratory inhaler or nebulizer treatments, 41 (22%) used supplemental oxygen, and 24 (13%) were admitted as an inpatient to a conventional hospital. Of these 24 patients, 10 (42%) required ICU admission, 1 (3%) required a ventilator, and none died during their hospital admission. LIMITATION: Generalizability is limited to patients with a working telephone and the ability to comply with the monitoring protocols. CONCLUSION: Virtual hospital programs have the potential to provide health systems with additional inpatient capacity during the COVID-19 pandemic and beyond. PRIMARY FUNDING SOURCE: Atrium Health.

The Perfect Storm: Hidden Risk of Child Maltreatment During the Covid-19 Pandemic.

The Covid-19 pandemic upended the country, with enormous economic and social shifts. Given the increased contact from families living in virtual confinement coupled with massive economic disarray, the Covid-19 pandemic may have created the ideal conditions to witness a rise in children's experience of abuse and neglect. Yet such a rise will be difficult to calculate given the drop in official mechanisms to track its incidence. The current investigation utilized two studies conducted early in the pandemic to evaluate maltreatment risk. In the first cross-sectional study, parents (n = 405) reported increased physical and verbal conflict and neglect which were associated with their perceived stress and loneliness. In the second study, parents (n = 106) enrolled in a longitudinal study reported increased parent-child conflict, which was associated with concurrent child abuse risk, with several links to employment loss, food insecurity, and loneliness; findings also demonstrated increases in abuse risk and psychological aggression relative to pre-pandemic levels. Findings are discussed in the context of a reactive welfare system rather than a pro-active public-health oriented approach to child maltreatment, connecting with families through multiple avenues. Innovative approaches will be needed to reach children faced with maltreatment to gauge its scope and impact in the pandemic's aftermath.