A comparison of referral and treatment patterns at child development institutes during the Corona closures and pre-Corona periods

Hallel Katsir^1,2Michael Davidovitch²Michal Elboim- Gabyzon^1*

• ¹Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel
• ²Child Development, Medical Division, Maccabi Healthcare Services, Zichron-Yaakov, Israel

During the COVID-19 pandemic,there was a marked shift in the factors affecting health behaviors, suggesting a potential change in the rate of referrals to child development institutes during this period. To date, the rate of referrals to child development centers during the pandemic has not been thoroughly examined. To examined the difference in the annual and monthly referral and treatment patterns at child development institutes in the year 2020 (corona lockdown year) compared to the referrals in the year 2018–2019 (pre-corona period).Methods: This retrospective cohort study analyzed data from the medical records of applicants to nine Child Development Institutes operated by the second-largest health fund in Israel (Maccabi Health Services). Descriptive statistics (medians and IQR for continuous variables, frequencies and percentages for categorical variables) were calculated for the pre‐COVID period (2018–2019) versus the COVID‐closure year (2020. Inferential analyses used chi-square or Fisher’s exact tests for categorical outcomes and Mann–Whitney tests for continuous outcomes During the COVID-19 closure period in 2020, there was a slight decrease (2.77%) in the annual number of referrals compared to the average of the preceding years 2018-2019 (13,143 inquiries and 13,518 inquiries, respectively). This decrease occurred primarily during the first lockdown period (March–May, 2020). The percentage distribution of annual diagnoses across various healthcare professionals was consistent across all periods examined. Notably, a substantial increase in the percentage of remote treatments was observed during the closure period compared to the pre-COVID era. Differences emerged in the demographic and social characteristics of the applicants during the closure period, such as their socioeconomic status and age. COVID-19 closures altered referral patterns to child development centers in both volume and applicant characteristics. Caregiver concerns about infection risk reduced in-person visits; restrictions changed clinic accessibility and drove rapid telehealth adoption; and staffing reassignments modified referral protocols. As a result, initial referrals declined, remote treatments increased, and applicant profiles skewed younger with shifts in socioeconomic and insurance status. To maintain continuity during future disruptions, hybrid delivery models, robust telehealth infrastructure, and streamlined appointment processes are essential. These insights can also inform prevention programs, policy planning, and resource allocation during public health crises.