A Profile of Medical Neglect Investigations in Ontario

Background/Purpose: Medical neglect is defined as a form of maltreatment in which a caregiver fails to provide or allow the provision of timely healthcare services, to treat a child’s physical health issue, medical condition, injury, illness or impairment. While the proportion of substantiated maltreatment investigations involving medical neglect is relatively low (1.8% in Canada in 2008 and 2.2% in the United States in 2011), medical neglect has very serious short and long term consequences for children. Little is known how the system responds to children and families who are identified to the child welfare system for a medical neglect concern.

Methods: Using a mixed methods approach, qualitative and quantitative data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2013 were used to provide a profile of investigations involving medical neglect in Ontario in order to identify policy and practice implications. Investigations involving medical neglect for children age 0 to 15 were compared to other forms of maltreatment using descriptive and chi-square analyses. Qualitative analysis of case narratives followed the triangulation design validating quantitative data method to provide thematic support for the results of the quantitative analysis.  

Results: An estimated 1,774 medical neglect investigations were conducted in Canada in 2008, representing 2% of all maltreatment investigations. Of the 1,774 medical neglect investigations, only 34% were substantiated (an estimated 610 investigations. Medical neglect investigations were most often referred by school personnel (19%), followed by a relative (9%), community physician (9%) or community health nurse (9%).

Several significant differences emerged with regard to child, caregiver and household characteristics. Investigations focusing on medical neglect were significantly more likely to involve infants; involve a child who failed to meet developmental milestones, had a physical disability, or had Fetal Alcohol Syndrome. Medical neglect investigations were more likely to involve a caregiver who is a lone-parent; who has a mental health issue, few social supports, or a history of foster care/group home in childhood. Physical harm was more often noted for medical neglect investigations. The household’s primary source of income was more often social assistance/benefits and the worker was more likely to endorse that the family ran out of money for basic necessities in the past six months.

Qualitative analysis provided a rich description of six distinct forms of medical neglect leading to the initiation of a medical neglect investigation: neglect of dental needs, neglect of healthcare needs related to a specific medical condition, neglect of needs related to a developmental concern, neglect of mental health needs, failure to attend routine medical appointments and neglect of primary healthcare needs.

Conclusions and Implications: Our analysis provides further evidence that investigations focusing on medical neglect involve families with numerous child, caregiver and household-level needs requiring a coordinated service response. We suggest that categories of referral related to medical neglect could be used to guide the provision of services.