P3.G128: Child Protection Service Reports in Children with Complex Chronic Conditions

Background: Children with disabilities suffer higher rates of child maltreatment compared to healthy peers. Varying definitions of disability makes it difficult to determine which specific diagnoses place a child at increased risk of maltreatment. Children with complex chronic conditions (CCC) are a unique population and differ from broader groups of children referred to as “disabled” previously. This study aims to understand rates at which children with CCC are reported to child protective services (CPS), what factors increase the risk of CPS reports and what the outcomes of those CPS reports were.

Methods: Retrospective review of a linked database of Rady Children’s Hospital Network (RCHN) encounters between 2016-2021 with birth and CPS records for children under 10y with a CCC diagnosis. Descriptive statistics and regression modeling were performed.

Results: 47,896 children had a CCC diagnosis within RCHN. 55% were male, 52% had public insurance, and 64% were diagnosed with a CCC by age 4y. 43% identified as Hispanic, 36% as non-Hispanic White, and 5% non-Hispanic Black. The most common CCC types were cardiac, congenital/genetic defects, metabolic, and neurologic conditions. 10,104 children (21%) had at least one CPS report filed for maltreatment. Of the 10,104 children, 62% had more than one CPS report filed. The most common reason for first CPS report was general neglect at 44.5%. Regression analysis demonstrated increased risk for CPS reports in children with a neurologic condition (RR=1.38 [CI 1.31-1.45]), children on public insurance (RR 3.01 [CI 2.86-3.17]), and whose ethnicity was non-Hispanic Black (RR=1.58 [CI 1.47-1.70]) or non-Hispanic Native (RR 1.45 [CI 1.09-1.89]).

Of the 10,104 children with CCC diagnosis who had a CPS report filed, 1162 (11.5%) had at least one foster care placement. 141 (12.1%) of those children who had foster care placement had two or more foster care placements. 953 (82%) of the children with a foster care placement had their first placement prior to age 4.

Conclusion: 21% of children with CCC in the RCHN have been reported to CPS for child maltreatment. Increased risk of a CPS report includes children with public insurance or non-Hispanic Black and non-Hispanic Native race/ethnicity. These results highlight the vulnerability of this population and raise concerns regarding bias in reporting based on socioeconomic factors. A significant portion (11%) of children with a CCC diagnosis who have a CPS report filed have at least one foster care placement. Foster placement is more likely when children are of a younger age.