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Shapiro MA, John SA, Muzwagi AB, Silverman AL, Soda T. Ethical Dilemmas and Countertransference in Legally Mandated Reporting of Fatal Child Neglect. Psychodyn Psychiatry 2024; 52:189-205. [PMID: 38829226 DOI: 10.1521/pdps.2024.52.2.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
In the fall of 2019, a much-publicized court case brought to national attention the issues of patient-doctor confidentiality when it comes to reporting the deaths of newborns in the United States. It is unclear whether the recent overturning of Roe v. Wade will lead to more cases like this. This article discusses issues of countertransference, as well as the ethical and legal implications were it to be a psychiatrist, in active treatment of such a patient, who would be required to make such a report. More specifically, as in the publicized court case, the patient could be a minor at the time, receiving treatment from a child psychiatrist. The implications of such a case include how countertransference affects the perception of fatal child neglect compared to intentional neonaticide; the ethical dilemma of generating a mandated report with the goal of child safety when such a report could lead to real legal consequences for a minor child; and considerations regarding continued treatment of a patient after such a report is made. It is likely that countertransference, shaped by attitudes toward mothers and idealized views on mothering, may play a large role in all these circumstances.
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Affiliation(s)
- Michael A Shapiro
- University of Florida College of Medicine Department of Psychiatry; Children's Hospital of the King's Daughters, Eastern Virginia Medical School
| | - Sheena A John
- University of Florida College of Medicine Department of Psychiatry
| | - Ashraf B Muzwagi
- University of Florida College of Medicine Department of Psychiatry
| | | | - Takahiro Soda
- University of Florida College of Medicine Department of Psychiatry
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2
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Dubinin A, Bialostozky M, Richardson A, Laub N. Presentation, Management, and Child Protective Service Reporting of Children Who Test Positive for Cannabis in an Emergency Room Setting. Pediatr Emerg Care 2024; 40:443-448. [PMID: 38471748 DOI: 10.1097/pec.0000000000003145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVES Rates of cannabis ingestion among young children are increasing. Small studies have evaluated symptomatology of these children. The literature lacks research regarding factors influencing medical management. Our goal was to 1) understand circumstances leading to exposure over time and 2) gain insight into factors that may influence emergency room management and Child Protective Services reporting over time. METHODS Retrospective cross-sectional study on children younger than 10 years with cannabis-positive urine drug screens in the emergency room setting. Single-factor analysis of variance and Fisher exact tests were used to assess for trends. Two-tailed t tests and Fisher exact tests were used to compare management of children presenting to the emergency room with chief complaint (CC) "ingestion" versus those without. RESULTS Of the 179 children, the mean age was 3.7 years and 48% were boys. We observed a significant increase over time in cannabis-positive children. The most common location of exposure was the primary residence (54%), with parents as the most frequent users (46%). In the emergency department, the most common CC was ingestion followed by altered mental status and fatigue. Children with an "ingestion" CC were managed with less testing than those with other CCs. They received fewer needle sticks (43% vs 91%), less imaging (5% vs 56% computed tomography heads), and fewer procedures (0% vs 8% lumbar punctures). Children with "ingestion" CC were less likely to be reported to Child Protective Services. CONCLUSIONS Pediatric cannabis exposures are increasing and have a wide array of clinical presentations that complicate emergency room management. Parental report of cannabis ingestion seems to impact and reduce potentially unnecessary testing.
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Negriff S. Incidence of child maltreatment diagnosis in electronic health records of a large integrated healthcare system: 2001-2018. J Child Health Care 2024; 28:221-234. [PMID: 35938633 DOI: 10.1177/13674935221116485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to identify the number of children (<18years old) with an International Classification of Disease (ICD) diagnosis code for child maltreatment each year from 2001-2018 and examine differences by age, gender, and race/ethnicity. Data were drawn from the electronic health records of children (birth to <18years old) who were members of a large integrated healthcare system in California. We calculated the incidence rate (1 per 1000 children) for each year from 2001-2018 separately by age groups, gender, and race/ethnicity. Adolescents (11-15years old) had the overall highest incidence of all ages groups. Females had nearly twice the rate of males for the past 5years. Lastly, for race/ethnicity Black children had the highest incidence and Asian children the lowest. The findings demonstrate that maltreatment diagnosis in medical settings may be underused. Understanding the trends of these ICD codes by demographic characteristics yields information that health care providers may use to both increase the identification and documentation of child maltreatment.
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Affiliation(s)
- Sonya Negriff
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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Shapiro JP, Pino EC, Goodridge A, Dholakia A, Nelson K, Hoch A, Kendi S, Boyle TP, Kistin CJ. Disparities in Child Welfare Referrals for Patients Seen in a Pediatric Emergency Department for Unintentional Ingestions. Acad Pediatr 2024; 24:686-691. [PMID: 38253175 DOI: 10.1016/j.acap.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To examine the characteristics of patients visiting the pediatric emergency department (PED) for unintentional ingestions and associations between patient race and ethnicity in referrals to Child Protective Services (CPS) for supervisory neglect. METHODS We conducted a cross-sectional analysis of children <12 years old who presented to the PED between October 2015 and December 2020 for an unintentional ingestion. Patients were identified by searching the electronic health record for diagnosis codes corresponding to unintentional ingestions. Patient demographics, ingestion type, disposition, and referrals to CPS were abstracted by manual chart review. Logistic regression models were used to evaluate associations between patient demographics and visit characteristics with referral to CPS. RESULTS We identified 129 PED encounters for unintentional ingestions that were included for analysis. Overall, 22 patients (17.1%) were referred to CPS for neglect. In the univariate analysis, both ingestion of an illicit drug and arrival to the PED by ambulance were associated with a higher odds of referral to CPS. In the multivariable model adjusted for parent language, ingestion type, and mode of arrival to the PED, Hispanic patients had higher odds of referral to CPS than White patients (adjusted odds ratio (aOR) = 17.2, 95% confidence intervals [1.8-162.3], P = .03). There was not a statistically significant association between Black race and referral to CPS. CONCLUSIONS Referrals to CPS from the PED after unintentional ingestions are common and disproportionally involve Hispanic patients. More research is needed to promote equitable child maltreatment reporting for children presenting to the PED following unintentional ingestions.
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Affiliation(s)
- Joseph P Shapiro
- Department of Pediatrics (JP Shapiro, A Hoch, S Kendi, and TP Boyle), Boston Medical Center & Boston University Chobanian & Avedisian School of Medicine, Boston, Mass.
| | - Elizabeth C Pino
- Department of Emergency Medicine (EC Pino), Boston Medical Center & Boston University Chobanian & Avedisian School of Medicine, Boston, Mass.
| | - Annie Goodridge
- Boston University Questrom School of Business (A Goodridge) & Boston University School of Public Health, Boston, Mass.
| | - Ayesha Dholakia
- Department of Pediatrics (A Dholakia), Boston Medical Center & Boston Children's Hospital, Boston, Mass.
| | - Kerrie Nelson
- Boston University School of Public Health (K Nelson), Crosstown Center 318, Boston, Mass.
| | - Ariel Hoch
- Department of Pediatrics (JP Shapiro, A Hoch, S Kendi, and TP Boyle), Boston Medical Center & Boston University Chobanian & Avedisian School of Medicine, Boston, Mass.
| | - Sadiqa Kendi
- Department of Pediatrics (JP Shapiro, A Hoch, S Kendi, and TP Boyle), Boston Medical Center & Boston University Chobanian & Avedisian School of Medicine, Boston, Mass.
| | - Tehnaz P Boyle
- Department of Pediatrics (JP Shapiro, A Hoch, S Kendi, and TP Boyle), Boston Medical Center & Boston University Chobanian & Avedisian School of Medicine, Boston, Mass.
| | - Caroline J Kistin
- Hassenfeld Child Health and Innovation Institute (CJ Kistin), Department of Health Services, Policy, and Practice Brown University School of Public Health, Providence, RI.
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Jude G, Slingsby B, Cassese JA, Schroeder C, Moore J, Barron C. Efficacy of Child Abuse Evaluations for Infants With Possible Subdural Hemorrhage Identified on Cranial Ultrasound Completed for Macrocephaly. Clin Pediatr (Phila) 2024; 63:506-511. [PMID: 37350029 DOI: 10.1177/00099228231182780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Abusive head trauma (AHT) is a significant cause of morbidity and mortality for infants. Determining when to pursue a complete physical abuse evaluation can be difficult, especially for nonspecific findings or when a child appears clinically well. This retrospective study of 7 cases sought to describe the presentation, evaluation, and diagnoses for infants with abnormal subdural collections identified on cranial ultrasound for macrocephaly, and to determine how frequently AHT is diagnosed. The results of this study showed that while each patient presented due to asymptomatic macrocephaly, the extent of the workup varied greatly. In addition, no infants had suspicious injuries for abuse during the initial evaluation or the year following. In summary, among the 7 patients seen for asymptomatic macrocephaly with possible subdural hemorrhage, there were very inconsistent child abuse workups. There needs to be a standardized clinical guideline for this specific patient population involving a child abuse pediatric evaluation.
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Affiliation(s)
- Gabrielle Jude
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Brett Slingsby
- Department of Pediatrics, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - John A Cassese
- Department of Pediatrics, The Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Diagnostic Imaging, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Jessica Moore
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Christine Barron
- Department of Pediatrics, The Warren Alpert Medical School, Brown University, Providence, RI, USA
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Barry MJ, Nicholson WK, Silverstein M, Chelmow D, Coker TR, Davis EM, Jaén CR, Krousel-Wood MT, Lee S, Li L, Rao G, Ruiz JM, Stevermer JJ, Tsevat J, Underwood SM, Wiehe S. Primary Care Interventions to Prevent Child Maltreatment: US Preventive Services Task Force Recommendation Statement. JAMA 2024; 331:951-958. [PMID: 38502069 DOI: 10.1001/jama.2024.1869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Importance Child maltreatment, which includes child abuse and neglect, can have profound effects on health, development, survival, and well-being throughout childhood and adulthood. The prevalence of child maltreatment in the US is uncertain and likely underestimated. In 2021, an estimated 600 000 children were identified by Child Protective Services as experiencing abuse or neglect and an estimated 1820 children died of abuse and neglect. Objective The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate benefits and harms of primary care-feasible or referable behavioral counseling interventions to prevent child maltreatment in children and adolescents younger than 18 years without signs or symptoms of maltreatment. Population Children and adolescents younger than 18 years who do not have signs or symptoms of or known exposure to maltreatment. Evidence Assessment The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of primary care interventions to prevent child maltreatment in children and adolescents younger than 18 years without signs or symptoms of or known exposure to maltreatment. Recommendation The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment. (I statement).
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Affiliation(s)
| | | | | | | | | | - Esa M Davis
- University of Maryland School of Medicine, Baltimore
| | | | | | - Sei Lee
- University of California, San Francisco
| | - Li Li
- University of Virginia, Charlottesville
| | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Joel Tsevat
- University of Texas Health Science Center, San Antonio
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Rebbe R, Malicki D, Siddiqi N, Huang JS, Putnam-Hornstein E, Laub N. Child Protection System Interactions for Children With Positive Urine Screens for Illicit Drugs. JAMA Netw Open 2024; 7:e243133. [PMID: 38512254 PMCID: PMC10958236 DOI: 10.1001/jamanetworkopen.2024.3133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/26/2024] [Indexed: 03/22/2024] Open
Abstract
Importance Young children are ingesting illicit drugs at increased rates, but it is unknown what the associated child protection system (CPS) responses are when a child tests positive. Objective To document the child protection system involvement and the characteristics of children who test positive for illicit substances. Design, Setting, and Participants This retrospective cross-sectional study linked medical discharge and child protection system administrative data. The setting was Rady Children's Hospital San Diego, a free-standing pediatric hospital in California. Participants included all emergency department and inpatient medical encounters involving children aged 12 years or younger with a positive urine drug test between 2016 and 2021. Statistical analysis was performed from February 2023 to January 2024. Exposure Drug type, including amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, fentanyl, opiates, and phencyclidine. Main Measures and Outcomes CPS responses associated with the medical encounter including reports, substantiations, case openings, and out-of-home placements. Results A total of 511 emergency department and inpatient medical encounters involving children had a positive drug test (262 [51.3%] were female; 309 [60.5%] were age 6 years or younger; fewer than 10 [<3.0%] were American Indian or Alaska Native; 252 [49.3%] were Hispanic [any race], 20 [3.9%] were non-Hispanic Asian, 56 [11.0%] were non-Hispanic Black, 143 [28.0%] were non-Hispanic White, 36 [7.0%] had other or unknown race and ethnicity; 233 [43.6%] had a CPS report prior to the medical encounter). Following the positive screen, 244 (47.7%) were reported to child protection, and 61 (11.9%) were placed out-of-home within 30 days. Mean (SD) quarterly counts of encounters with positive drug tests doubled after the COVID-19 pandemic onset (32.9 [9.8]) compared with prior to the pandemic onset (16.5 [4.7]); for encounters positive for cannabis, mean (SD) quarterly counts were 3 times as high after the pandemic onset than prior (16.6 [4.7] vs 5.7 [2.9]). Encounters for children under age 1 were significantly more likely to have associated child protection reports (relative risk [RR], 2.91 [95% CI, 2.21-3.83]) and child protection case openings (RR, 1.71 [95% CI, 1.07-2.72]) than encounters involving older children. Conclusions and Relevance In this cross-sectional study of emergency department and inpatient medical encounters, less than half of children with positive urine drug screens were reported to CPS; out-of-home placements were uncommon. With increased encounters for positive drug tests, it is unclear what services these children and families are receiving.
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Affiliation(s)
- Rebecca Rebbe
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill
| | - Denise Malicki
- University of California, San Diego
- Rady Children’s Hospital, San Diego, California
- Chadwick Center for Children and Families, San Diego, California
| | - Nadia Siddiqi
- Nova Southeastern University, Fort Lauderdale, Florida
| | - Jeannie S. Huang
- University of California, San Diego
- Rady Children’s Hospital, San Diego, California
| | | | - Natalie Laub
- University of California, San Diego
- Rady Children’s Hospital, San Diego, California
- Chadwick Center for Children and Families, San Diego, California
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Cerdeña J, Plaisime MV, Belcher HME, Wright JL. A PLAN for Race-Conscious Medicine in Pediatrics. Pediatrics 2024; 153:e2023061893. [PMID: 38425225 DOI: 10.1542/peds.2023-061893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 03/02/2024] Open
Affiliation(s)
- Jessica Cerdeña
- Department of Family Medicine, Middlesex Health, Middletown, Connecticut
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP)
- Department of Anthropology, University of Connecticut, Storrs, Connecticut
| | - Marie V Plaisime
- FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Penn Program on Race, Science & Society Center for Africana Studies (PRSS), University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harolyn M E Belcher
- Kennedy Krieger Institute, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph L Wright
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland
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Baghdadi S, Momtaz D, Torres-Izquierdo B, Pereira DE, Gonuguntla R, Mittal M, Hosseinzadeh P. The shifting trends in the epidemiology and risk factors of non-accidental fractures in children. CHILD ABUSE & NEGLECT 2024; 149:106692. [PMID: 38395018 DOI: 10.1016/j.chiabu.2024.106692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/11/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Fractures are a common presentation of non-accidental trauma (NAT) in the pediatric population. However, the presentation could be subtle, and a high degree of suspicion is needed not to miss NAT. OBJECTIVE To analyze a comprehensive database, providing insights into the epidemiology of fractures associated with NAT. PARTICIPANTS AND SETTING The TriNetX Research Network was utilized for this study, containing medical records from 55 healthcare organizations. TriNetX was queried for all visits in children under the age of 6 years from 2015 to 2022, resulting in a cohort of over 32 million. METHODS All accidental and non-accidental fractures were extracted and analyzed to determine the incidence, fracture location, and demographics of NAT. Statistical analysis was done on a combination of Python and Epipy. RESULTS Overall, 0.36 % of all pediatric patients had a diagnosis of NAT, and 4.93 % of fractures (34,038 out of 689,740 total fractures) were determined to be non-accidental. Skull and face fractures constituted 17.9 % of all NAT fractures, but rib/sternum fractures had an RR = 6.7 for NAT. Children with intellectual and developmental disability (IDD) or autism spectrum disorder (ASD) had a 9 times higher risk for non-accidental fractures. The number of non-accidental fractures significantly increased after 2019. CONCLUSIONS The study findings suggest that nearly 1 out of all 20 fractures in children under age 6 are caused by NAT, and that rib/sternum fractures are most predictive of an inflicted nature. The study also showed a significant increase in the incidence of NAT, during and after the pandemic.
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Affiliation(s)
- Soroush Baghdadi
- Division of Orthopaedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - David Momtaz
- UT Health San Antonio, Department of Orthopaedics, San Antonio, TX, USA
| | | | - Daniel E Pereira
- Washington University School of Medicine, Department of Orthopaedics, St. Louis, MO, USA
| | - Rishi Gonuguntla
- UT Health San Antonio, Department of Orthopaedics, San Antonio, TX, USA
| | | | - Pooya Hosseinzadeh
- Washington University School of Medicine, Department of Orthopaedics, St. Louis, MO, USA.
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10
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Negriff S, Sidell MA, DiGangi MJ. Adverse childhood experiences screening in healthcare settings: A focus on pediatric primary care. CHILD ABUSE & NEGLECT 2024:106709. [PMID: 38418328 DOI: 10.1016/j.chiabu.2024.106709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) screening in healthcare settings is emerging as one of the tangible responses to address the consistent evidence linking ACEs with health. Kaiser Permanente Southern California (KPSC) began ACEs screening in pediatric primary care in 2018 and has developed screening and referral processes based on continued feedback from stakeholders as well as data driven assessment. OBJECTIVE We give an overview of the state of ACEs screening in pediatric healthcare settings, challenges facing pediatric providers, and suggestions to address them. We then describe the development of our ACEs screening and referral process within KPSC as an example of how a large healthcare system has implemented and adapted ACEs screening from pilot testing, to phased expansion, to complete implementation. PARTICIPANTS AND SETTING Children aged 2-18 years old who were members of KPSC 2018-2023. RESULTS We present data on the tailored screening and referral workflows we have developed, rates of positive screens and referrals, and how the initiation of ACEs screening may affect the rates of visit to behavioral health as a treatment option. We also integrate qualitative data to demonstrate the perspective of parents, with the goal of understanding what might help or hinder receipt of behavioral health treatment after ACEs screening. CONCLUSIONS We close with future directions for ACEs screening in healthcare settings and considerations for pediatric healthcare providers who may want to begin ACEs screening or adapt their screening and referral processes.
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Affiliation(s)
- Sonya Negriff
- Kaiser Permanente Southern California, Department of Research & Evaluation, United States of America.
| | - Margo A Sidell
- Kaiser Permanente Southern California, Department of Research & Evaluation, United States of America
| | - Mercie J DiGangi
- Kaiser Permanente Southern California, Department of Pediatrics, United States of America
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11
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Slingsby B, Bachim A, Leslie LK, Moffatt ME. Child Health Needs and the Child Abuse Pediatrics Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678F. [PMID: 38300005 DOI: 10.1542/peds.2023-063678f] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Child abuse pediatrics (CAP) subspecialists evaluate, diagnose, and treat children when abuse or neglect is suspected. Despite the high rates of child maltreatment across the United States, CAP remains the smallest pediatric subspecialty. The CAP workforce faces numerous challenges, including few fellows entering the field, decreased financial compensation compared with other fields of medicine, and threats to workforce retention, including secondary trauma and harmful exposure in the media. A microsimulation model that estimates the future of the US CAP workforce over the next 20 years shows that, although the number of child abuse pediatricians in the field is expected to increase, the growth is smaller than that of every other pediatric subspecialty. In addition to the low overall CAP workforce in the United States, other workforce issues include the need to increase CAP subspecialists who are underrepresented in medicine and unequal geographic distribution across the country. To meet the medical needs of suspected victims of maltreatment, especially in CAP-underserved areas, many children are evaluated by providers who are not board-certified in CAP, such as general pediatricians, family medicine physicians, emergency medicine physicians, and advanced practice providers, whose CAP experience and training may vary. Current child abuse pediatricians should continue introducing the field to medical students and residents, especially those who identify as underrepresented in medicine or are from CAP-underserved areas, and offer mentorship, continuing education, and oversight to non-CAP physicians meeting this population's medical needs.
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Affiliation(s)
- Brett Slingsby
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Angela Bachim
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Laurel K Leslie
- American Board of Pediatrics, Chapel Hill, North Carolina
- Tufts University School of Medicine, Boston, Massachusetts
| | - Mary E Moffatt
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
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12
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Zamalin D, Hamlin I, Shults J, Katherine Henry M, Campbell KA, Anderst JD, Bachim AN, Berger RP, Frasier LD, Harper NS, Letson MM, Melville JD, Lindberg DM, Wood JN. Predictors of Making a Referral to Child Protective Services Prior to Expert Consultation. Acad Pediatr 2024; 24:78-86. [PMID: 37178908 PMCID: PMC10638459 DOI: 10.1016/j.acap.2023.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/24/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Suspicion for child abuse is influenced by implicit biases. Evaluation by a Child Abuse Pediatrician (CAP) may reduce avoidable child protective services (CPS) referrals. Our objective was to investigate the association of patient demographic, social and clinical characteristics with CPS referral before consultation by a CAP (preconsultation referral). METHODS Children<5years-old undergoing in-person CAP consultation for suspected physical abuse from February 2021 through April 2022 were identified in CAPNET, a multicenter child abuse research network. Marginal standardization implemented with logistic regression analysis examined hospital-level variation and identified demographic, social, and clinical factors associated with preconsultation referral adjusting for CAP's final assessment of abuse likelihood. RESULTS Among the 61% (1005/1657) of cases with preconsultation referral, the CAP consultant had low concern for abuse in 38% (384/1005). Preconsultation referrals ranged from 25% to 78% of cases across 10 hospitals (P < .001). In multivariable analyses, preconsultation referral was associated with public insurance, caregiver history of CPS involvement, history of intimate partner violence, higher CAP level of concern for abuse, hospital transfer, and near-fatality (all P < .05). The difference in preconsultation referral prevalence for children with public versus private insurance was significant for children with low CAP concern for abuse (52% vs 38%) but not those with higher concern for abuse (73% vs 73%), (P = .023 for interaction of insurance and abuse likelihood category). There were no differences in preconsultation referral based on race or ethnicity. CONCLUSIONS Biases based on socioeconomic status and social factors may impact decisions to refer to CPS before CAP consultation.
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Affiliation(s)
- Danielle Zamalin
- Department of Pediatrics (D Zamalin), Kravis Children's Hospital, Icahn School of Medicine, Mount Sinai Hospital, New York, NY.
| | - Irene Hamlin
- Perelman School of Medicine (I Hamlin), University of Pennsylvania, Philadelphia, Pa.
| | - Justine Shults
- Department of Biostatistics, Epidemiology (J Shults), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
| | - M Katherine Henry
- Division of General Pediatrics, Clinical Futures, and PolicyLab (M Katherine Henry), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
| | - Kristine A Campbell
- Department of Pediatrics (KA Campbell), University of Utah, Center for Safe and Healthy Families, Primary Children's Hospital, Salt Lake City, Utah.
| | - James D Anderst
- Children's Mercy Kansas City (JD Anderst), University of Missouri Kansas City School of Medicine.
| | - Angela N Bachim
- Division of Public Health Pediatrics, Department of Pediatrics (AN Bachim), Baylor College of Medicine, Texas Children's Hospital, Houston, Tex.
| | - Rachel P Berger
- Department of Pediatrics (RP Berger), UPMC Children's Hospital of Pittsburgh, Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pa.
| | - Lori D Frasier
- Department of Pediatrics (LD Frasier), Penn State Children's Hospital, Penn State Hershey College of Medicine, Hershey, Pa; Penn State Hershey Medical Center (LD Frasier), Center for the Protection of Children, Hershey, Pa.
| | - Nancy S Harper
- University of Minnesota School of Medicine (NS Harper), Center for Safe and Healthy Children, Minneapolis, Minn.
| | - Megan M Letson
- Nationwide Children's Hospital (MM Letson), The Ohio State University College of Medicine, Columbus, Ohio.
| | - John D Melville
- Division of Child Abuse Pediatrics (JD Melville), Medical University of South Carolina, Charleston, SC.
| | - Daniel M Lindberg
- Department of Emergency Medicine (DM Lindberg), The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colo.
| | - Joanne N Wood
- Division of General Pediatrics and PolicyLab (JN Wood), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
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Sump C, Sauley B, Patel S, Riddle S, Connolly E, Hite C, Maiorella R, Thomson JE, Beck AF. Disparities in the Diagnosis and Management of Infants Hospitalized With Inadequate Weight Gain. Hosp Pediatr 2024; 14:21-29. [PMID: 38087957 DOI: 10.1542/hpeds.2023-007188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2024]
Abstract
OBJECTIVES To evaluate the association between race and the named etiology for inadequate weight gain among hospitalized infants and assess the differences in management. METHODS This single-center retrospective cohort study of infants hospitalized for the workup and management of inadequate weight gain used infant race and neighborhood-level socioeconomic deprivation as exposures. The etiology of inadequate weight gain was categorized as nonorganic, subjective organic (ie, gastroesophageal reflux and cow's milk protein intolerance), or objective organic (eg, hypothyroidism). The management of inadequate weight gain was examined in secondary outcomes. RESULTS Among 380 infants, most were white and had a nonorganic etiology of inadequate weight gain. Black infants had 2.3 times higher unadjusted odds (95% credible interval [CI] 1.17-4.76) of a nonorganic etiology of inadequate weight gain compared with white infants. After adjustment, there was no association between race and etiology (adjusted odds ratio 0.8, 95% CI [0.44-2.08]); however, each 0.1 increase in neighborhood-level deprivation was associated with 80% increased adjusted odds of a nonorganic etiology of inadequate weight gain (95% CI [1.37-2.4]). Infants with a nonorganic etiology of inadequate weight gain were more likely to have social work and child protective service involvement and less likely to have nasogastric tube placement, gastroenterology consults, and speech therapy consults. CONCLUSIONS Infants from neighborhoods with greater socioeconomic deprivation were more likely to have nonorganic causes of inadequate weight gain, disproportionately affecting infants of Black race. A nonorganic etiology was associated with a higher likelihood of social interventions and a lower likelihood of medical interventions.
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Affiliation(s)
- Courtney Sump
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Beau Sauley
- Murray State University, Department of Economics, Murray, Kentucky
| | - Shivani Patel
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sarah Riddle
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emilia Connolly
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Partners In Health, Malawi, Abwenzi Pa Za Umoyo/Partners In Health, Neno, MW
| | - Corinne Hite
- Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - RosaMarie Maiorella
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joanna E Thomson
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew F Beck
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Medical Center, Cincinnati, Ohio
- General and Community Pediatrics, Cincinnati Children's Medical Center, Cincinnati, Ohio
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14
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Harding-Bremner M. Overcoming barriers to recognizing and reporting child abuse. JAAPA 2024; 37:22-27. [PMID: 38051825 DOI: 10.1097/01.jaa.0000995632.31241.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
ABSTRACT Infants and children under age 3 years have the highest risk of dying from child abuse and neglect. Clinicians treating children must recognize and report child abuse. Barriers to consistent recognition and reporting leave children in harm's way. Often, the signs of abuse in very young children are subtle, and clinicians may fail to recognize and report these signs. Clinicians also must understand the role of bias in the reporting of child abuse and ways to address abuse individually and as part of a larger system.
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Affiliation(s)
- Meredith Harding-Bremner
- Meredith Harding-Bremner works for AdventHealth Hendersonville (N.C.), providing medical services for children at Safelight Child Advocacy Center. The author has disclosed no potential conflicts of interest, financial or otherwise
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15
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Ruiz J. Buenos Días: A Letter to My Patient's Mother. J Clin Oncol 2023; 41:5324-5327. [PMID: 37816204 DOI: 10.1200/jco.23.01515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/27/2023] [Accepted: 08/11/2023] [Indexed: 10/12/2023] Open
Abstract
@JennyRuizMD shares a poignant story of peds oncology immigrant family, #SDOH, & similarities to her own family’s experience. #LatinasinMedicine
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Affiliation(s)
- Jenny Ruiz
- Division of Hematology-Oncology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
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16
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Jones MU, Banaag A, Nafea SS, Koehlmoos TP. Evaluation of Racial Disparities in Suspected Child Abuse among Insured Children with Head Injury. CHILD MALTREATMENT 2023; 28:713-722. [PMID: 36571822 DOI: 10.1177/10775595221148424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Previous studies demonstrate racial disparities in child abuse evaluations even after controlling for health insurance coverage. We conducted a cross-sectional study using the Military Health System Data Repository (MDR) of Military Health System (MHS) beneficiaries born between fiscal years 2016 and 2018 to evaluate racial disparities and other factors in the suspicion of child abuse. We observed beneficiaries for 2.5 years after birth and assessed the incidence of head injury using diagnostic codes. Among children with head injury codes, we performed a multivariable logistic regression analysis to measure the association between race and the concurrent use of the diagnostic code for suspected child abuse (SCA) or for the performance of a skeletal survey. There were 195,893 infants included and 45,269 (23.1%) underwent evaluations for head injury. Less than one percent (n = 424) concurrently had the diagnostic code for SCA or a skeletal survey performed within 2 weeks of the head injury evaluation. When controlling for other factors, race was not associated with SCA. Higher military rank was independently associated with decreased odds of SCA. Racial disparities in SCA may be mitigated in the MHS, and further evaluation is needed. Military rank could be a factor in SCA disparities and warrants further study.
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Affiliation(s)
- Milissa U Jones
- Department of Pediatrics, Uniformed Services University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Amanda Banaag
- Department of Pediatrics, Tripler Army Medical Center, Tripler Army Medical Center, HI, USA
| | - Shamim S Nafea
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA
| | - Tracey Perez Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA
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17
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Drake B, Jones D, Kim H, Gyourko J, Garcia A, Barth RP, Font SA, Putnam-Hornstein E, Duerr Berrick J, Greeson JKP, Cook V, Kohl PL, Jonson-Reid M. Racial/Ethnic Differences in Child Protective Services Reporting, Substantiation and Placement, With Comparison to Non-CPS Risks and Outcomes: 2005-2019. CHILD MALTREATMENT 2023; 28:683-699. [PMID: 36990447 DOI: 10.1177/10775595231167320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
We used National Child Abuse and Neglect Data System and Census data to examine Black-White and Hispanic-White disparities in reporting, substantiation, and out-of-home placement both descriptively from 2005-2019 and in multivariate models from 2007-2017. We also tracked contemporaneous social risk (e.g., child poverty) and child harm (e.g., infant mortality) disparities using non-child protective services (CPS) sources and compared them to CPS reporting rate disparities. Black-White CPS reporting disparities were lower than found in non-CPS risk and harm benchmarks. Consistent with the Hispanic paradox, Hispanic-White CPS reporting disparities were lower than risk disparities but similar to harm disparities. Descriptive and multivariate analyses of data from the past several years indicated that Black children were less likely to be substantiated or placed into out-of-home care following a report than White children. Hispanic children were slightly more likely to be substantiated or placed in out-of-home care than White children overall, but this difference disappeared in multivariate models. Available data provide no evidence that Black children were overreported relative to observed risks and harms reflected in non-CPS data. Reducing reporting rates among Black children will require addressing broader conditions associated with maltreatment.
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Affiliation(s)
- Brett Drake
- George Warren Brown School of Social Work, Washington University, St Louis, MO, USA
| | - Dylan Jones
- George Warren Brown School of Social Work, Washington University, St Louis, MO, USA
| | - Hyunil Kim
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - John Gyourko
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Antonio Garcia
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | - Richard P Barth
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Sarah A Font
- Department of Sociology and Criminology, Penn State University, University Park, PA, USA
| | - Emily Putnam-Hornstein
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jill Duerr Berrick
- School of Social Welfare, University of California at Berkeley, Berkeley, USA
| | - Johanna K P Greeson
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria Cook
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | - Patricia L Kohl
- George Warren Brown School of Social Work, Washington University, St Louis, MO, USA
| | - Melissa Jonson-Reid
- George Warren Brown School of Social Work, Washington University, St Louis, MO, USA
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18
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Briggs E, Hanson R, Klika JB, LeBlanc S, Maddux J, Merritt D, Palusci V, Panlilio CC, Roygardner D, Schelbe L, Stormer B, Valentino K, Vaughan-Eden V, Barboza G. Addressing Systemic Racism in the American Professional Society on the Abuse of Children Publications. CHILD MALTREATMENT 2023; 28:550-555. [PMID: 37554071 DOI: 10.1177/10775595231191394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
The United States continues to grapple with longstanding policies and systems that have adversely impacted historically marginalized communities who identify (and are racialized) as non-White. These stem from a legacy of structural and systemic racism, and the long-term consequences of sanctioned colonization. This legacy rests upon a field of scholarly research that is similarly fraught with white supremacy. As a field, we must examine the process of producing and publishing the body of evidence that has codified harmful policies and practices. Although racial and ethnic disparities have been discussed for decades in the child welfare and health systems, systemic racism has received comparatively little attention in academic research and journals. In this commentary, the authors detail concrete steps over the coming years that will advance diversity, equity, inclusion and justice through American Professional Society on the Abuse of Children's (APSACs) flagship journal, Child Maltreatment. The journal is committed to anti-racist publication processes, such that the journal pledges to develop procedures, processes, structures, and culture for scholarly research that promotes diversity, equity, inclusion, and justice in all forms.
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Affiliation(s)
- Ernestine Briggs
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rochelle Hanson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Jemour Maddux
- William Paterson University of New Jersey, Wayne, NJ, USA
| | - Darcey Merritt
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, USA
| | - Vincent Palusci
- Department of Pediatrics, Grossman School of Medicine, New York, NY, USA
| | - Carlomagno C Panlilio
- Department of Educational Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Debangshu Roygardner
- City University of New York- School of Professional Studies & New York Foundling's Vincent J. Fontana Center, New York, NY, USA
| | | | - Bri Stormer
- Illinois Action for Children, Chicago, IL, USA
| | - Kristin Valentino
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Viola Vaughan-Eden
- Ethelyn R. Strong School of Social Work, Norfolk State University, Norfolk, VA, USA
| | - Gia Barboza
- College of Public Health, The Ohio State University, Columbus, OH, USA
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19
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Palusci VJ, Barboza G, Hanson RF, Maguire-Jack KL, Valentino K, Donlin J. Our Commitment to Promoting Diversity, Equity, Inclusion, and Justice in Child Maltreatment. CHILD MALTREATMENT 2023; 28:543-549. [PMID: 37550085 DOI: 10.1177/10775595231193151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
In this commentary, the editorial team of Child Maltreatment extends and expands on APSAC's position on diversity, equity, inclusion, and justice, affirms our commitment and plans for addressing these issues in this publication, and highlights articles in this issue that continue the discussion about race and racism in the child welfare and child protection systems.
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Affiliation(s)
| | - Gia Barboza
- The Ohio State University, Columbus, OH, USA
| | - Rochelle F Hanson
- Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | | | - Kristin Valentino
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
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20
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Miller AP, Agrawal A. Genetic Contributions to Reported Childhood Maltreatment: What It Means and How It Could Mean More. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:587-589. [PMID: 37881533 PMCID: PMC10593938 DOI: 10.1016/j.bpsgos.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Alex P. Miller
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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21
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Duprey EB, Handley ED, Wyman PA, Ross AJ, Cerulli C, Oshri A. Child maltreatment and youth suicide risk: A developmental conceptual model and implications for suicide prevention. Dev Psychopathol 2023; 35:1732-1755. [PMID: 36097812 PMCID: PMC10008764 DOI: 10.1017/s0954579422000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Experiences of child abuse and neglect are risk factors for youth suicidal thoughts and behaviors. Accordingly, suicide risk may emerge as a developmental process that is heavily influenced by the rearing environment. We argue that a developmental, theoretical framework is needed to guide future research on child maltreatment and youth (i.e., adolescent and emerging adult) suicide, and to subsequently inform suicide prevention efforts. We propose a developmental model that integrates principles of developmental psychopathology and current theories of suicide to explain the association between child maltreatment and youth suicide risk. This model bears significant implications for future research on child maltreatment and youth suicide risk, and for suicide prevention efforts that target youth with child maltreatment experiences.
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Affiliation(s)
- Erinn B. Duprey
- Children’s Institute, University of Rochester, Rochester, NY, USA
- Mt. Hope Family Center, University of Rochester, Rochester, NY, USA
| | - Elizabeth D. Handley
- Mt. Hope Family Center, University of Rochester, Rochester, NY, USA
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | - Peter A. Wyman
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Andrew J. Ross
- Mt. Hope Family Center, University of Rochester, Rochester, NY, USA
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | - Catherine Cerulli
- Mt. Hope Family Center, University of Rochester, Rochester, NY, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- The Susan B. Anthony Center, University of Rochester, Rochester, NY, USA
| | - Assaf Oshri
- Department of Human Development and Family Science, University of Georgia, Athens, GA, USA
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22
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Imm P, Pac J. Child Maltreatment: A Comparison of Wisconsin Children Identified in Health Care and Child Protective Services (CPS) Records, 2018-2019. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:E181-E189. [PMID: 37097183 DOI: 10.1097/phh.0000000000001743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
CONTEXT Child Protective Services (CPS) reports and health records (hospital inpatient and emergency department visits) are the primary data sources to measure child maltreatment; yet, they are not linked at the state or national level. Linking provides novel insight into the demographic characteristics of the populations served by one or both agencies, thus informing opportunities for prevention and intervention. OBJECTIVE This study compares children identified as maltreated in health records (based on International Classification of Diseases, Tenth Revision, Clinical Modification [ ICD-10-CM ] codes indicating suspected or confirmed child maltreatment) and/or CPS reports. DESIGN Three mutually exclusive comparison groups were created: group 1- children with a nonfatal hospitalization and/or emergency department visit with a maltreatment ICD-10-CM code and an investigated CPS report; group 2- children with a maltreatment ICD-10-CM code in a health record without an investigated CPS report; and group 3- children with an investigated CPS report without a health record with a maltreatment ICD-10-CM code. Descriptive statistics and tests for statistically significant differences were conducted. SETTING AND PARTICIPANTS Wisconsin children with maltreatment ICD-10-CM code in health record and/or CPS-investigated report from 2018 to 2019. MAIN OUTCOME MEASURE Demographic and maltreatment type differences between groups. RESULTS Group 1 children were significantly younger than those in other groups ( P <. 001), and group 2 children were significantly more female (69.6%; P < .001). Black children were overrepresented in all groups and most disproportionate among group 1 (39.5%; P < .001). Maltreatment type also differed significantly across groups. CONCLUSIONS CPS staff and health providers encounter overlapping and nonoverlapping populations of children experiencing different types of maltreatment. Although interventions may be tailored toward the type of maltreatment and other relevant child characteristics, all populations could benefit from referrals and access to supportive social services. Agency contact provides an opportunity to intervene and support at-risk children and families.
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Affiliation(s)
- Pamela Imm
- Population Health Institute, University of Wisconsin-Madison and Wisconsin Division of Public Health, Madison, Wisconsin (Ms Imm) and Sandra Rosenbaum School of Social Work and Institute for Research on Poverty, University of Wisconsin-Madison, Madison, Wisconsin (Dr Pac)
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23
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Early Life Stress (ELS) Effects on Fetal and Adult Bone Development. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010102. [PMID: 36670652 PMCID: PMC9856960 DOI: 10.3390/children10010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023]
Abstract
Early life stress (ELS) refers to harmful environmental events (i.e., poor maternal health, metabolic restraint, childhood trauma) occurring during the prenatal and/or postnatal period, which may cause the 'epigenetic corruption' of cellular and molecular signaling of mental and physical development. While the impact of ELS in a wide range of human diseases has been confirmed, the ELS susceptibility to bone diseases has been poorly explored. In this review, to understand the potential mediating pathways of ELS in bone diseases, PRISMA criteria were used to analyze different stress protocols in mammal models and the effects elicited in dams and their progeny. Data collected, despite the methodological heterogeneity, show that ELS interferes with fetal bone formation, also revealing that the stress type and affected developmental phase may influence the variety and severity of bone anomalies. Interestingly, these findings highlight the maternal and fetal ability to buffer stress, establishing a new role for the placenta in minimizing ELS perturbations. The functional link between ELS and bone impairments will boost future investigations on maternal stress transmission to the fetus and, parallelly, help the assessment of catch-up mechanisms of skeleton adaptations from the cascading ELS effects.
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24
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Ethical Care for Patients with Self-Managed Abortion After Roe. Am J Nurs 2023; 123:38-44. [PMID: 36546386 DOI: 10.1097/01.naj.0000911524.68698.ea] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT The 2022 Supreme Court decision leaving the regulation of abortion to the states is sure to result in a complex regulatory environment for patients and nurses. In states where abortion is illegal, patients may self-manage abortions using medications they obtain through the mail or by other means. Nurses may care for these patients in multiple settings and may wonder about their own legal and ethical obligations. This article reviews patient privacy as it relates to self-managed abortion, ethical reporting requirements for nurses, and best practices for treating complications of self-managed abortion using a harm reduction framework, with a focus on protecting patients' rights. Recommendations for ethical patient care are also provided.
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25
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Greeley C. Advances in child abuse and neglect research and practice. CHILD ABUSE & NEGLECT 2022; 134:105875. [PMID: 36088662 DOI: 10.1016/j.chiabu.2022.105875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/05/2022] [Accepted: 09/04/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Christopher Greeley
- Division of Public Health Pediatrics, Baylor College of Medicine, Houston, TX, USA.
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26
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Jablonka O, Palusci VJ. Role of Psychologists in Child Abuse Pediatrics. Pediatr Clin North Am 2022; 69:879-893. [PMID: 36207099 DOI: 10.1016/j.pcl.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This article describes the extent of the problem and the medical evaluation of child maltreatment, focusing on the outpatient interdisciplinary assessment of suspected child physical and sexual abuse. Separate from their role as clinicians, the roles of the child psychologist before, during, and after the medical assessment are highlighted. The child psychologist is an important member of the interdisciplinary team who helps the team prepare for the evaluation (before), assists in screening and determining immediate psychological safety during the medical evaluation (during), and communicating the need for further treatment and follow-up (after).
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Affiliation(s)
- Olga Jablonka
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, 462 First Avenue, GC-65, New York, NY 10016, USA.
| | - Vincent J Palusci
- Department of Pediatrics, NYU Grossman School of Medicine, 462 First Avenue, GC-65, New York, NY 10016, USA
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27
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Trinidad S, Kotagal M. Social determinants of health as drivers of inequities in pediatric injury. Semin Pediatr Surg 2022; 31:151221. [PMID: 36347129 DOI: 10.1016/j.sempedsurg.2022.151221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A child's social determinants of health (SDH), including their neighborhood environment, insurance status, race and ethnicity, English language proficiency and geographic location, all significantly impact their risk of injury and outcomes after injury. Children from socioeconomically disadvantaged neighborhoods experience overall higher rates of injury and different types of injuries, including higher rates of motor vehicle-, firearm-, and violence-related injuries. Similarly, children with public insurance or no insurance, as a proxy for lower socioeconomic status, experience higher rates of injuries including firearm-related injuries and non-accidental trauma, with overall worse outcomes. Race and associated racism also impact a child's risk of injury and care received after injury. Black children, Hispanic children, and those from other minority groups disproportionately experience socioeconomic disadvantage with sequelae of injury risk as described above. Even after controlling for socioeconomic status, there are still notable disparities with further evidence of racial inequities and bias in pediatric trauma care after injury. Finally, where a child lives geographically also significantly impacts their risk of injury and available care after injury, with differences based on whether a child lives in a rural or urban area and the degree of state laws regarding injury prevention. There are clear inequities based on a child's SDH, most predominantly in a child's risk of injury and the types of injuries they experience. These injuries are preventable and the SDH provide potential upstream targets in injury prevention efforts.
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Affiliation(s)
- Stephen Trinidad
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children...s Hospital Medical Center, Cincinnati, Ohio.
| | - Meera Kotagal
- Assistant Professor, Division of General and Thoracic Surgery, Director, Trauma Services, Director, Pediatric Surgery Global Health Program, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States.
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28
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Rebbe R, Sattler KM, Mienko JA. The Association of Race, Ethnicity, and Poverty With Child Maltreatment Reporting. Pediatrics 2022; 150:188535. [PMID: 35843980 DOI: 10.1542/peds.2021-053346] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine the role of race/ethnicity and poverty in the likelihood of children younger than age 3 years hospitalized because of child abuse and neglect-related injuries being reported to child protective services (CPS) and being assigned a specific maltreatment diagnostic code. METHODS We used population-based linked administrative data comprising of birth, hospitalization, and CPS records. Children were identified for maltreatment-related hospitalizations using standardized diagnostic codes. Regression models were used to compute crude and adjusted race/ethnicity estimates regarding the likelihood of being reported to CPS and assigned a specific maltreatment diagnostic code during the maltreatment-related hospitalization. RESULTS Of the 3907 children hospitalized because of child maltreatment, those with public health insurance were more likely than those with private insurance (relative risk [RR]: 1.29; 95% confidence interval [CI], 1.16-1.42) and those with Asian/Pacific Islander mothers were less likely than those with White mothers to be reported to CPS (RR: 0.78; 95% CI, 0.65-0.93). No differences were found for children with Black, Hispanic, and Native American mothers compared with those with White mothers for CPS reporting. However, children with Native American mothers (RR: 1.45; 95% CI, 1.11-1.90) and public health insurance (RR: 2.00; 95% CI, 1.63-2.45) were more likely to have a specific maltreatment diagnostic code, the second strongest predictor of a CPS report. CONCLUSIONS Race/ethnicity and poverty were factors for CPS reports during a child maltreatment-related hospitalization. It is necessary to implement programs and policies that mitigate implicit bias to prevent inequities in which children receive protective intervention.
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Affiliation(s)
- Rebecca Rebbe
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Kierra Mp Sattler
- School of Human Development and Family Studies, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Joseph A Mienko
- Center for Social Sector Analytics and Technology, University of Washington School of Social Work, Seattle, Washington
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Renov V, Risser L, Berger R, Hurley T, Villaveces A, DeGue S, Katz A, Henderson C, Premo K, Talis J, Chang JC, Ragavan M. The impact of the COVID-19 pandemic on child protective services caseworkers and administrators. CHILD ABUSE & NEGLECT 2022; 130:105431. [PMID: 34953611 PMCID: PMC8665526 DOI: 10.1016/j.chiabu.2021.105431] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND The COVID-19 pandemic has impacted children and young people experiencing child abuse and neglect. Child Protective Services (CPS) has played an important role in supporting children and families during the COVID-19 pandemic. Few studies to-date have evaluated the impact of the pandemic on CPS caseworkers and administrators in the United States. OBJECTIVES We conducted interviews to explore CPS caseworkers' and administrators' experiences working and serving families during the pandemic. METHODS Participants were U.S.-based CPS caseworkers and administrators. We conducted semi-structured virtual interviews with participants and used an inductive thematic analysis approach. RESULTS We conducted 37 interviews. Participants discussed how the COVID-19 pandemic has changed the way they conduct investigations and provide services to families in the CPS system. Several services were adapted to occur virtually, providing challenges and unique opportunities. Participants also described the personal barriers they faced during the pandemic, including working remotely, experiencing burnout, and challenges obtaining personal protective equipment. Finally, participants shared creative solutions they engaged in to support children and families during the COVID-19 pandemic, including expanding collaborations with other community-based organizations. DISCUSSION This study suggests the important role that CPS has played during the pandemic and challenges individual CPS workers felt, in terms of both experiencing burnout and difficulty obtaining personalized protective equipment. Inclusion of the CPS system in emergency preparedness planning for future pandemics or natural disasters will ensure continuation of these vital services.
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Affiliation(s)
- Veronica Renov
- Pediatric Emergency Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, United States of America.
| | - Lauren Risser
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213, United States.
| | - Rachel Berger
- Division of Child Advocacy, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, United States of America.
| | - Tammy Hurley
- Child Welfare, Trauma, and Resilience Initiatives, American Academy of Pediatrics, 345 Park Blvd. Itasca, IL 60413, United States.
| | - Andrés Villaveces
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, S106-10, Atlanta, GA 30341, United States.
| | - Sarah DeGue
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, S106-10, Atlanta, GA 30341, United States.
| | - Abigail Katz
- Futures Without Violence, 101 Montgomery Street, San Francisco, CA, 94129, United States.
| | - Cynterria Henderson
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213, United States.
| | - Kelly Premo
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213, United States.
| | - Janine Talis
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213, United States.
| | - Judy C Chang
- Department of Obstetrics, Gynecology & Reproductive Sciences, and Internal Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, United States.
| | - Maya Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh, 3420 Fifth Avenue, Pittsburgh, PA 15213, United States.
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Pierce MC, Kaczor K, Olszewski AE. The Disproportionality of Poverty, Race, and Ethnicity With Child Maltreatment Reporting. Pediatrics 2022; 150:188532. [PMID: 35843993 DOI: 10.1542/peds.2022-056501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mary Clyde Pierce
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | - Kim Kaczor
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Aleksandra E Olszewski
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
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Debelle G, Efstathiou N, Khan R, Williamson A, Summan M, Taylor J. The Typology and Topography of Child Abuse and Neglect: The Experience of a Tertiary Children's Centre. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138213. [PMID: 35805871 PMCID: PMC9266617 DOI: 10.3390/ijerph19138213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022]
Abstract
Effective child protection systems and processes require reliable and accurate data. The aim of this study was to determine what data could be extracted from hospital records in a single site that reflected a child’s journey from admission with suspected abuse to the decisions regarding substantiation made by the multidisciplinary child protection team. A retrospective study of the case records of 452 children referred to a major UK children’s tertiary centre for suspected child maltreatment was undertaken. Child maltreatment was substantiated in 65% of referred cases, with the majority of referrals coming from children living in the most deprived neighbourhoods in the country. Domestic violence and abuse and the child’s previous involvement with statutory bodies were associated with case substantiation. Physical abuse predominated, with soft tissue injuries, including dog bites and burns, most frequent. Burns were related almost exclusively to supervisory neglect. There were also cases of medical neglect. Emotional abuse was associated with exposure to domestic violence and abuse and to self-harm. The strengths and limitations for single-centre data systems were explored, concluding with a recommendation to establish an agreed national and international minimum data set to protect children from maltreatment.
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Affiliation(s)
- Geoff Debelle
- Birmingham & Solihull NHS Clinical Commissioning Group, Birmingham B4 6AR, UK
- Correspondence: (G.D.); (J.T.); Tel.: +44-121-4148671 (J.T.)
| | - Nikolaos Efstathiou
- School of Nursing, University of Birmingham, Birmingham B15 2TT, UK; (N.E.); (R.K.)
| | - Rafiyah Khan
- School of Nursing, University of Birmingham, Birmingham B15 2TT, UK; (N.E.); (R.K.)
| | - Annette Williamson
- Birmingham Women and Children’s Hospital Foundation NHS Trust, Birmingham B15 2TG, UK; (A.W.); (M.S.)
| | - Manjit Summan
- Birmingham Women and Children’s Hospital Foundation NHS Trust, Birmingham B15 2TG, UK; (A.W.); (M.S.)
| | - Julie Taylor
- School of Nursing, University of Birmingham, Birmingham B15 2TT, UK; (N.E.); (R.K.)
- Birmingham Women and Children’s Hospital Foundation NHS Trust, Birmingham B15 2TG, UK; (A.W.); (M.S.)
- Correspondence: (G.D.); (J.T.); Tel.: +44-121-4148671 (J.T.)
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Stritzel H. State-level changes in health insurance coverage and parental substance use-associated foster care entry. Soc Sci Med 2022; 305:115042. [PMID: 35649299 PMCID: PMC10168186 DOI: 10.1016/j.socscimed.2022.115042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022]
Abstract
For many families whose children are placed in foster care, initial contact with the child welfare system occurs due to interactions with the healthcare system, particularly in the context of the opioid epidemic and increased attention to prenatal drug exposure. In the last decade, many previously uninsured families have gained Medicaid health coverage, which has implications for their access to healthcare services and visibility to mandatory reporters. Using administrative foster care case data from the Adoption and Foster Care Analysis and Reporting System Foster Care Files and health insurance data from the American Community Survey, this study analyzes the associations between state-level health insurance coverage and rates of foster care entry due to parental substance use between 2009 and 2019. State-level fixed effects models revealed that public, but not private, health insurance rates were positively associated with rates of foster care entry due to parental substance use. These results support the hypothesis that health insurance coverage may promote greater contact with mandatory reporters among low-income parents with substance use disorders. Furthermore, this study illustrates how healthcare policy may have unintended consequences for the child welfare system.
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Palusci VJ. Introduction: Special Collection of Medical and Health-Related Research. CHILD MALTREATMENT 2022; 27:151-155. [PMID: 35209728 DOI: 10.1177/10775595221079604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Alwash NM, Palusci VJ. Factors related to medical neglect recurrence and foster care and adoption services. CHILD ABUSE & NEGLECT 2022; 123:105378. [PMID: 34763185 DOI: 10.1016/j.chiabu.2021.105378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Medical neglect is defined as the failure of a caretaker to heed obvious signs of serious illness, to seek medical care in a timely fashion, or to follow instructions once medical advice is obtained. It is reportable as a form of child maltreatment. OBJECTIVES (1) identify factors associated with referrals after medical neglect to adoption and foster care services; (2) describe a cohort of children with first-time cases; and (3) assess whether there were factors associated with recurrence. PARTICIPANTS AND SETTING Data from the National Child Abuse and Neglect Data System for 36 U.S. states. METHODS A cohort of children was constructed with first confirmed reports of medical neglect in 2012 with matched confirmed reports during 2012-2017 to describe child, family, offender, and report factors associated with recurrence. These factors were then used in multivariate models, including logistic regression and Cox proportional hazard models, to assess their effects on recurrence and with referral to foster care and adoption services. RESULTS Complex family problems were associated with referral for foster care and adoption services, and 8.1% had recurrence within 5 years. Older children with medical problems, Black race, or who were reported by medical or legal personnel had increased risk for recurrence. Only referral to mental health care services was found to decrease this risk. CONCLUSIONS Medical neglect recurs within 5 years despite referrals to most services. Those trying to stop its recurrence should focus on mental health needs and families with children who are older, Black, or have complex medical problems.
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Affiliation(s)
- Norah M Alwash
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Vincent J Palusci
- New York University Grossman School of Medicine, New York, NY, United States of America.
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