The emergence of the COVID-19 global health pandemic and its associated adversities have had cascading and compounding effects on vulnerable children and families impacted by abuse and trauma. Mandated public health physical distancing measures necessitated an abrupt transition from traditional in-person mental healthcare to virtual mental healthcare. While ushering in new and unexpected opportunities, this shift presented significant challenges and unique implications for trauma-focused

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... ic interventions. In this article, we (a) propose an ecological systems framework through which we can better understand the multilevel effects of child sexual abuse in the context of a pandemic; (b) describe our administrative and clinical processes for rapidly mobilizing a trauma-informed model of telemental healthcare for sexually abused children and families in a pediatric hospital setting; and (c) share our clinical observations and experiences delivering therapy via virtual platforms during the early stage of the pandemic through an ecosystems lens. Key learnings inform tailored teletherapy approaches that can be applied in present and future viral outbreaks and sustained in the postpandemic era. Public Significance Statement The COVID-19 pandemic, physical distancing measures, and related challenges uniquely impact children and families with prior exposure to abuse and trauma. Ensuring mental health support during stay-at-home orders and social isolation is critical and requires special considerations. This article explores the intersection of the traumatic effects of child sexual abuse with the stressful conditions of the pandemic, presents one pediatric hospital's approach to implementing a trauma-informed model of telemental healthcare, and highlights clinical insights and applications of virtual therapy with abuse survivors and their families.