Poverty is associated with an increased likelihood that a young child hospitalized for maltreatment would be reported to Child Protective Services, or CPS, according to study results published in Pediatrics.
“This suggests that children and families of a lower socioeconomic status may be more closely scrutinized for child maltreatment in hospital settings than those with more means,” Rebecca Rebbe, PhD, MSW, EdM, assistant professor at the University of North Carolina at Chapel Hill School of Social Work, and colleagues wrote.
Rebbe and colleagues used public health insurance as a proxy for poverty status in the study.
“We know that child maltreatment can have significant impacts on those who experience it, and we know that not all children who experience maltreatment are reported to CPS agencies,” Rebbe told Healio.
“A previous study identified that among those children who had inpatient hospitalizations for child maltreatment-related reasons, some children were not reported to CPS,” Rebbe said. “Given that race and poverty had been identified in previous studies as a factor in how children were evaluated for child maltreatment in medical settings, we sought to investigate if race, ethnicity, and poverty were factors in our cohort of children.”
Rebbe and colleagues used a dataset comprising all children born in Washington State from 1999 through 2013, with details on birth, hospitalization and CPS records, which allowed the researchers to follow children longitudinally across their interactions within different systems.
“We started with all children born in the state and identified children who experienced a child maltreatment-hospitalization before the age 3,” Rebbe said. “We then calculated the rates of children experiencing a maltreatment-related hospitalization before age 3 by the number of children born in the state by maternal race/ethnicity. We then ran regression models to test the likelihood that a child who experienced a maltreatment-related hospitalization was reported to CPS and was associated with a specific maltreatment diagnosis code.”
From the 3,907 children in Washington who were hospitalized due to child maltreatment, those with public health insurance were more likely to be reported to CPS than those with private insurance, and those with Asian/Pacific Islander mothers were less likely to be reported than those with white mothers — both outcomes consistent with previous research.
The researchers found no differences for children with Black, Hispanic and Native American mothers compared with those with white mothers for CPS reporting.
Further, children of Native American mothers were more likely to “have a specific maltreatment diagnostic code, the second strongest predictor of a CPS report.”
Rebbe added that although she would not consider the findings “surprising,” the results do highlight the complexity of child maltreatment and responses to it.
“Medical professionals have an important role in recognizing and reporting child maltreatment, yet the decision to report or not report a child to CPS is a complex one,” Rebbe said. “Race and poverty status should not affect these crucial decision points.”
The article was accompanied by a commentary from Mary Clyde Pierce, MDKim Kaczor, MS; and Aleksandra E. Olszewski, MD, MA, all from the Lurie Children’s Hospital of Chicago.
“We must also recognize that underresourced and distressed families may have needs and stressors that contribute to a child’s increased risk of negative outcomes, including maltreatment. The effects of compounded bias, oppression, injustice, and resource scarcity for certain communities are, unfortunately, enduring problems,” they wrote.
“A public health approach is required to address these injustices at the community level, along with simultaneous work toward behavior change at the individual level to mitigate impacts of bias, and policy change at the institutional level to reduce the harms of unjust systems. Strategies for opening our eyes to our own biases, while not turning a blind eye to the risk to children that poverty brings, are critical to achieve equitable care for all.”
Pierce MC, et al. Pediatrics. 2022;doi:10.1542/peds.2022-056501.
Rebbe R, et al. Pediatrics. 2021;doi:10.1542/peds.2021-053346.