We conducted a pilot study at the Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Forensic Examination Centre for Children and Adolescents (FOKUS Safeguarding team). This pilot study aimed to test research protocols, data collection instruments and sample recruitment strategies in preparation for a larger study. It is well known that pilot studies are of importance in the process of a wider research project aiming at identifying potential problem areas and proving the viability of a project idea. The study was approved by the ethics commission of the Medical University Vienna (EK 1365/2020).

We recruited a total of 35 carers during the pandemic period from June 2020 onwards; five participants were lost to follow-up. This study was completed successfully after two years of recruitment and finalized in September 2022.

A survey of the stress factors, as well as the risk and resilience factors, in Viennese families in the context of the effects of the COVID-19 pandemic in connection with the suspicion of child welfare endangerment was carried out in an anonymised manner. Legal guardians of children who were referred to the Forensic Examination Centre for Children and Adolescents (FOKUS Safeguarding team) were consented to participate in this study by completing an anonymised questionnaire (see Fig. 1Questionnaire 1) on psychosocial stress factors. The participating families (study group) were referred to the FOKUS Safeguarding team for suspected child physical abuse, sexual abuse and/or neglect. The usual route of referral involved the pediatric emergency unit of the outpatient clinic at the Department of Paediatrics and Adolescent Medicine. After explaining the study and obtaining consent, the questionnaire was filled in by the accompanying person with custody rights directly on site. The family was given the opportunity to have the guidance and help of the team at the Forensic Examination Centre for Children and Adolescents if questions were unclear to them.

Fig. 1

Questionaire 1 (English translation): Questionnaire on stress experience, risk and resilience factors of Viennese families in the context of the impact of the SARS-CoV‑2 pandemic 2020—a pilot study Version 3.0 from 25.05.2020

In addition, a control group of carers was also randomly enrolled by the FOKUS Safeguarding team as a convenience sample. The families and children who constituted the control group were attending the pediatric emergency unit of the outpatient clinic at the Department of Paediatrics and Adolescent Medicine for reasons other than suspected child maltreatment. In order to be eligible to be recruited into the control group, the corresponding child had to have no chronic co-morbidities. They completed the same questionnaires and the same processes were followed for both the study and the control group throughout.

The interviews were conducted by healthcare professionals, comprising Medical Doctors and Allied Health professionals including psychologists, who recruited the carers, explained the purpose of the study and obtained consent. The questionnaires were conducted as guided interviews.

A year later, a second questionnaire (see Fig. 2Questionnaire 2) was completed with the guidance of the same team of healthcare and allied health professionals. At that stage the interviews were conducted over the phone, after reaffirmation of consent. Identified stress factors were evaluated, and if new concerns were identified a second appointment was arranged in addition to the telephone follow-up. This was part of the agreement with families at recruitment. The new data was evaluated and support/guidance was provided if required.

Fig. 2

Questionaire 2 (English translation): Questionnaire on stress experience, risk and resilience factors of Viennese families in the context of the impact of the SARS-CoV‑2 pandemic 2020—a pilot study Version 3.0 from 25.05.2020

Fig. 1Questionnaire 1 and Fig. 2Questionnaire 2 were designed on individual 5‑stage scales, resulting in a maximum total score of 35 in relation to resilience factors. In the section regarding current employment a distinction was made between three levels, depending on whether both parents worked, one parent worked, or neither parent worked. Lastly, the living situation was captured by using the number of people and the number of square meters in the apartment/living accommodation, from which a ratio of people per square meter is devised.

Both questionnaires took approximately 10 min to complete, using a scale question and answer methodology. The questionnaires consisted of 12 questions with demographic data, and 14 interview questions for Fig. 1Questionnaire 1 and 7 interview questions for Fig. 2Questionnaire 2 respectively.

Inclusion criteria for the two groups were:

1.

An adult present at the time of the child protection referral who is either a birth parent or a legal guardian of the referred child (Child’s age 0–18 years)

2.

Main residence in the city of Vienna

3.

Well-founded suspicion of child protection concerns with a clear referral for potential child maltreatment (according to article 54 of the Medical Act)

4.

Understanding the nature of the study and signing the consent form

The examination of a migration background of the families as a possible factor was not included in this study. In its “EUROPEAN STATUS REPORT ON PREVENTING CHILD MALTREATMENT”, the WHO describes child endangerment as a social problem that exists in all countries [21].

Parents of children with chronic diseases were included in both the study population and the control group. Since chronically ill children have an increased risk of becoming victims, their inclusion is vital [22].

The statistical analysis of the data was performed using IBM SPSS Version 26 (IBM Ltd, Armoni, NY, USA) [23] and Prism OS Catalina Version 7.0 (GraphPad). Groups were compared by using Chi square and Mann Whitney U tests; a p-value of < 0.05 was considered statistically significant.