Documentation of Child Maltreatment in Electronic Health Records

Karatekin, Canan; Almy, Brandon; Mason, Susan M.; Borowsky, Iris Wagman; Barnes, Andrew J.

doi:10.1177/0009922817743571

Cited by 23 publications

(30 citation statements)

References 51 publications

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“…The limited documentation of codes in the medical record explicitly indicating maltreatment (n = 265) is consistent with results from prior studies in the literature. 24,25 Similar to those studies, we also found that including ICD-9-CM codes suggestive of maltreatment in this analysis increased detection of visits involving potential maltreatment by more than 12-fold. Susceptibility to maltreatment decreases with age, 4 placing younger children at the greatest risk for abuse and neglect.…”

Section: Discussionsupporting

confidence: 87%

Identification of Child Maltreatment-Related Emergency Department Visits in Connecticut, 2011 to 2014

Hunter

Bernstein

2019

Clin Pediatr (Phila)

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Child maltreatment identified by medical professionals is poorly represented in records of child protection. International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes may better represent the burden of maltreatment treated in clinical settings. Using emergency department (ED) discharge data from 2011 to 2014, we enumerated presentations of maltreatment treated in Connecticut EDs for children under 10 years. Of 790 080 discharges, child maltreatment was explicitly documented in 265 (0.03%) unique ED visits, consistent with prior studies. Sexual maltreatment was most prevalent. A total of 3634 visits included an ICD-9-CM code suggestive of maltreatment. Children with these codes were significantly younger, more likely to be of white race, and use private insurance. Use of ICD codes in child maltreatment surveillance may elucidate characteristics of maltreatment not captured by child welfare data. Combining ICD codes for explicit and suggestive maltreatment will aid in understanding the extent of this problem.

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Section: Discussionsupporting

confidence: 87%

Identification of Child Maltreatment-Related Emergency Department Visits in Connecticut, 2011 to 2014

Hunter

Bernstein

2019

Clin Pediatr (Phila)

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“…Few pediatric clinicians ask about ACEs or document childhood adversity in the medical record. 44 Notably, ACEs surveys do not typically include housing status, so even if ACEs surveillance became a routine part of pediatric or community healthcare, housing experiences and/or needs might not be considered without additional screening. While some clinical systems have piloted methods to screen for social determinants of health, including housing and ACEs, efforts are widely variable and lack consistent protocols across the field.…”

Section: Discussionmentioning

confidence: 99%

Health and Adverse Childhood Experiences Among Homeless Youth

Barnes

Gower

Sajady

et al. 2020

Preprint

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Background and Objectives Homelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. This study investigated the relationship between ACEs, housing, and child health, and whether: 1) ACEs and health vary by housing context; 2) ACEs and homelessness confer independent health risks; and 3) ACEs interact with housing with regard to adolescent health.Methods Using data from 119,254 8th-11th graders, we tested independent and joint effects of ACEs and past-year housing status (housed, family homelessness, unaccompanied homelessness) on overall health and chronic health conditions, controlling for sociodemographic covariates.Results The prevalence of ACEs varied by housing status, with 34.1% of housed youth experiencing ≥1 ACE vs. 56.3% of family-homeless and 85.5% of unaccompanied-homeless youth. Health status varied similarly. Homelessness and ACEs were independently associated with low overall health and chronic health conditions, after adjusting for covariates. Compared to housed youth, both family-homeless youth and unaccompanied-homeless youth had increased odds of low overall health and chronic physical and/or mental health conditions. All ACE x housing-status interactions were significant (all p<0.001), such that ACE-related health risks were moderated by housing status.Conclusions ACEs and housing status independently predict health status during adolescence beyond other sociodemographic risks. Being homeless unaccompanied is also riskier than being homeless with family, and every additional ACE increases this risk. Clinicians and health systems should advocate for policies that include stable housing as a protective factor.

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“…Few pediatric clinicians ask about ACEs or document childhood adversity in the medical record. 41 Notably, ACEs surveys do not typically include housing status, so even if ACEs surveillance became a routine part of pediatric or community healthcare, housing experiences and/or needs might not be considered without additional screening. While some clinical systems have piloted methods to screen for social determinants of health, including housing and ACEs, efforts are widely variable and lack consistent protocols across the field.…”

Section: Discussionmentioning

confidence: 99%

Health and Adverse Childhood Experiences Among Homeless Youth

Barnes

Gower

Sajady

et al. 2020

Preprint

View full text Add to dashboard Cite

Background and Objectives Homelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. This study investigated the relationship between ACEs, housing, and child health, and whether: 1) ACEs and health vary by housing context; 2) ACEs and homelessness confer independent health risks; and 3) ACEs interact with housing with regard to adolescent health. Methods Using data from 119,254 8th-11th graders, we tested independent and joint effects of ACEs and past-year housing status (housed, family homelessness, unaccompanied homelessness) on overall health and chronic health conditions, controlling for sociodemographic covariates. Results The prevalence of ACEs varied by housing status, with 34.1% of housed youth experiencing ≥1 ACE vs. 56.3% of family-homeless and 85.5% of unaccompanied-homeless youth. Health status varied similarly. Homelessness and ACEs were independently associated with low overall health and chronic health conditions, after adjusting for covariates. Compared to housed youth, both family-homeless youth and unaccompanied-homeless youth had increased odds of low overall health and chronic physical and/or mental health conditions. All ACE x housing-status interactions were significant (all p<0.001), such that ACE-related health risks were moderated by housing status. Conclusions ACEs and housing status independently predict health status during adolescence beyond other sociodemographic risks. Being homeless unaccompanied is also riskier than being homeless with family, and every additional ACE increases this risk. Clinicians and health systems should advocate for policies that include stable housing as a protective factor.

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Documentation of Child Maltreatment in Electronic Health Records

Cited by 23 publications

References 51 publications

Identification of Child Maltreatment-Related Emergency Department Visits in Connecticut, 2011 to 2014

Identification of Child Maltreatment-Related Emergency Department Visits in Connecticut, 2011 to 2014

Health and Adverse Childhood Experiences Among Homeless Youth

Health and Adverse Childhood Experiences Among Homeless Youth

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