Child Welfare System Involvement Among Children With Medical Complexity

Abstract

Children with medical complexity may be at elevated risk of experiencing child maltreatment and child welfare system involvement, though empirical data are limited. This study examined the extent of child welfare system involvement among children with medical complexity and investigated associated health and social factors. A retrospective chart review of children with medical complexity (N = 208) followed at a pediatric hospital-based complex care program in Canada was conducted. Descriptive statistics and odds ratios using logistic regression were computed. Results showed that nearly one-quarter (23.6%) had documented contact with the child welfare system, most commonly for neglect; of those, more than one-third (38.8%) were placed in care. Caregiver reported history of mental health problems (aOR = 3.19, 95%CI = 1.55–6.56), chronic medical conditions (aOR = 2.86, 95%CI = 1.09–7.47), and interpersonal violence or trauma (aOR = 17.58, 95%CI = 5.43–56.98) were associated with increased likelihood of child welfare system involvement, while caregiver married/common-law relationship status (aOR = 0.35, 95%CI = 0.16–0.74) and higher number of medical technology supports (aOR = 0.75, 95%CI = 0.57–0.99) were associated with decreased likelihood. Implications for intervention and prevention of maltreatment in children with high healthcare needs are discussed.

Do children evaluated for maltreatment have higher subsequent emergency department and inpatient care utilization compared to a general pediatric sample?

“…It should be noted that very few studies have assessed ACSCs for children who have possibly experienced maltreatment, and this issue needs to be investigated further in other samples (e.g., children involved in child protective services). Relative to the general pediatric population, children with suspected maltreatment have more chronic illnesses and higher medical complexity (Azzopardi et al, 2021), and therefore may have certain reasons to make health care use decisions. To identify potentially modifiable factors and develop appropriate interventions, more in-depth studies are needed on parent perspectives about the reasons that drive their use of ambulatory care for children at risk of maltreatment.…”

Introduction: Special Collection of Medical and Health-Related Research

“…Children with special medical needs and medical fragility are often involved in the child protection and child welfare systems (Palusci, 2017b). Azzopardi et al (2022) found that nearly one-quarter (23.6%) of children with medical complexity had documented contact with the child welfare system, most commonly for neglect; of those, more than one-third (38.8%) were removed by CPS. Caregivers reported a history of mental health problems, chronic medical conditions, and interpersonal violence or trauma, but caregiver married/ common-law relationship status and a higher number of medical technology supports were associated with decreased likelihood of child welfare system involvement.…”