Reports and Removals of Child Maltreatment-Related Hospitalizations: A Population-Based Study

Background & Purpose:

In 2017, the majority (65.7%) of reports to child protective services (CPS) screened in for investigation were made by professionals for an estimated total of over 1.5 million (US HHS, 2019). Indeed, CPS in the U.S. relies on mandated reporters to refer concerns of child maltreatment to them. But surveys of mandated reporters, including pediatricians, have indicated that they continue to be reluctant to report suspected maltreatment to CPS. Despite this, there is little data regarding which children mandated reporters decide to report. Therefore, the aim of this study was to identify which children hospitalized for child maltreatment-related reasons were reported to CPS and which were removed by CPS.

Methods:

We used a population-based dataset of linked birth records, hospital discharges, and child protective services (CPS) administrative data for all children born in a U.S. state from 1999 through 2013 (N = 1,271,416). We identified maltreatment-related hospitalizations for children under age three using standardized diagnostic codes. Records for children with maltreatment-related hospitalizations were examined to identify if a CPS report was made during the hospitalization and if the child was removed from their parents. We tested for differences in responses using multinomial regression for the three mutually-exclusive outcomes of interest: 1) a hospital admission-related removal, 2) an intake made during the period of time the child was hospitalized (and no hospitalization-related removal), and 3) no CPS report or removal related to the hospitalization. Covariates included the type of maltreatment code used, the maltreatment subtype, and sociodemographic information from the birth record.

Results:

We identified 3,907 children under age three hospitalized for a maltreatment-related reason. About two-thirds (66.4%) of children identified as hospitalized for maltreatment-related reasons were not reported to CPS, while 20.5% were reported to CPS without a related removal, and 13.1% were removed. Differences were observed in the distribution of response category by the presence of a specific maltreatment code, where 84.7% of children with a specific code were reported to CPS in comparison to only 24.9% of those without a specific code. For the multinomial regression, the odds of being reported to CPS (without removal) were 3.9 times higher for children with diagnoses related to abuse, 2.9 times higher for sexual maltreatment, and 3.5 times higher for poly-maltreatment compared to children with neglect related diagnoses. Children with abuse (OR: 7.1; 95% CI: 5.0, 10.1) and poly-maltreatment (OR: 4.8; CI: 3.2, 7.2) hospitalizations had increased odds of being removed by CPS than children hospitalized for neglect.

Conclusions:

This study provides new knowledge ascertaining which maltreatment-related hospitalized children are reported to CPS by health professionals and, of those children, which are removed immediately by CPS, including two important findings. First, responses were dependent on the subtype of maltreatment and type of diagnostic code. Explicitly, physical abuse and codes specifically related to maltreatment had higher rates of CPS reports and removals. Second, about two-third of children who experienced a maltreatment-related hospitalization were not reported to CPS, despite mandated reporting laws. Practice and policy implications will be discussed.